Influence of common bile duct stones and juxta-papillary duodenal diverticula on endoscopic retrograde cholangiopancreatography and related coping strategies / 临床肝胆病杂志

Juxta-papillary duodenal diverticula (JPD) may easily cause biliary and pancreatic diseases. JPD changes papillary position and shape and increases the difficulties in endoscopic retrograde cholangiopancreatography (ERCP) intubation and stone removal, and it may also cause a series of complications. With reference to related articles in China and foreign countries, this article briefly describes the typing and development of JPD and its association with biliary and pancreatic diseases, analyzes the influence of common bile duct stones and JPD on ERCP, and summarizes related coping strategies, in order to provide suggestions and bases for clinical diagnosis and treatment.

Influence of common bile duct stones and juxta-papillary duodenal diverticula on endoscopic retrograde cholangiopancreatography and related coping strategies / 临床肝胆病杂志

Juxta-papillary duodenal diverticula (JPD) may easily cause biliary and pancreatic diseases. JPD changes papillary position and shape and increases the difficulties in endoscopic retrograde cholangiopancreatography (ERCP) intubation and stone removal, and it may also cause a series of complications. With reference to related articles in China and foreign countries, this article briefly describes the typing and development of JPD and its association with biliary and pancreatic diseases, analyzes the influence of common bile duct stones and JPD on ERCP, and summarizes related coping strategies, in order to provide suggestions and bases for clinical diagnosis and treatment.

Bone Mineral Density and Osteoporotic Vertebral Fractures in Traditional, Unassisted, Free-Diving Women (Haenyeos)

BACKGROUND: Water pressure and muscle contraction may influence bone mineral density (BMD) in a positive way. However, divers experience weightlessness, which has a negative effect on BMD. The present study investigated BMD difference in normal controls and woman free-divers with vertebral fracture and with no fracture. METHODS: Between January 2010 and December 2014, traditional woman divers (known as Haenyeo in Korean), and non-diving women were investigated. The study population was divided into osteoporotic vertebral fracture and non-fracture groups. The BMD of the lumbar spine and femoral neck was measured. The radiological parameters for global spinal sagittal balance were measured. RESULTS: Thirty free-diving women and thirty-three non-diving women were enrolled in this study. The mean age of the divers was 72.1 ± 4.7 years and that of the controls was 72.7 ± 4.0 years (P = 0.61). There was no statistical difference in BMD between the divers and controls. In divers, cervical lordosis and pelvic tilt were significantly increased in the fracture subgroup compared to the non-fracture subgroup (P = 0.028 and P = 0.008, respectively). Sagittal vertical axis was statistically significantly correlated with cervical lordosis (Spearman's rho R = 0.41, P = 0.03), and pelvic tilt (Spearman's rho R = 0.46, P = 0.01) in divers. CONCLUSION: BMD did not differ significantly between divers and controls during their postmenopausal period. When osteoporotic spinal fractures develop, compensation mechanisms, such as increased cervical lordosis and pelvic tilt, was more evident in traditional woman divers. This may be due to the superior back muscle strength and spinal mobility of this group of women.

A Case of Dysbaric Osteonecrosis in Commercial Diver

Chronic complication of diving and working in compressed air is dysbaric osteonecrosis. Dysbaric osteonecrosis could be diagnosed by simple bone x-ray, in the case of exposure history to dysbaric atmosphere. The case is 44 years old man who worked as a shell fish diver for 20 years. He was exposed dysbaric atmosphere during diving. He had bone necrosis in both femur head, both distal femur and proximal tibia. He had multiple attacks of decompression sickness. Other causes of bone necrosis are ruled out. We conclude that diver's bone necrosis is dysbaric osteonecrosis.

Diving patterns and diving related disease of diving fishermen in Korea / 예방의학회지

Diving related disease including decompression sickness is an important occupational health problem and diving fishermen remain a fairly hazardous occupation in Korea. To prevent diving related disease, we investigate diving patterns, incidence of diving related diseases, and contributing factors of 433 diving fishermen of three coast interviewing and mailing questionnaire in 1996. Mean age of divers was 39.7 years, ranged from 24 to 58 years, 92.8% of these were male, and 58.4% of divers were high school graduates. Mean duration of work as a diver was 12.9 years, ranged from 2 to 40 years. It was found that 70.4% of divers were using hookah system, 22.2% of helmet, and only 2.5% SCUBA. About half of them have learned diving skills from other divers. The peak season of diving was from April to June and mean working days were 20.3 days per month during the peak season. On the average, the divers dived 5-6 times, ranged from 1 to 10 times a day with 51.1 minutes of diving time, ranged from 20 to 120 minutes, at 30 m or 40 m in depth, and 35.5 minute of interval on surface. Most divers ascended slowly making decompression stop, yet the decompression profile used was not based on any scientific knowledge except for their own experiences. It appeared that each diving system had slightly different diving patterns. There were 282(65.0%) divers that suffered from DCS in 1995 and 31.2% of divers were given recompression therapy at a medical facility since they worked as diving fishermen. Skin and musculoskeletal complaints were common symptoms of DCS and 39% of divers experienced a voiding difficulty. In univariate analysis, females have an increased frequency of DCS(93% vs 66% for males). Old age, long duration of work, helmet diving, diving time, diving depth, repetitive diving, and blow up were all contributing factors to DCS. It was found that most diving patterns exceed no decompression limit and did not use the standard decompression table. This suggests that most of divers are at high risk of developing diving related disease with prolonged dives and lengthy repetitive diving in deep depth. Considering the diving patterns and economic aspect of professional diving, the incidence of DCS among diving fishermen in Korea will not decrease in the near future. These findings suggest that periodic health surveillance for divers, and education of health and safety are important for reducing the risk of diving related disease in the population of diving fishermen.

A Clinical Analysis of the Diver's Osteonecrosis / 대한정형외과학회잡지

Diver's bone lesion was described for the first time by Grutzmacher in 1941. Ten cases of osteonecrosis of the femoral head in divers were analysed on the basis of clinical and pathologic feature. The pathologic feature of the osteonecrosis in divers was not reported in Korea previously. The cases were observed from March, 1985 to June, 1988. The authors treated the cases with total hip replacement and obtained good results. The results were as follows:1. The average ate age at the time of operation was 41.5 years. 2. The average follow-up was 20.4 months. 3. The specimens were confirmed as osteonecrosis mieroscopically. 4. By Meyer's modification of Marcus and Enneking classification the average stage was 3.7. 5. Divers bone lesion was increased with the length of diving experiences:diving depth, diving time, age and with bends. 6. The pathologic feature of osteonecrosis in divers differ from that of idiopathic avascular or aseptic osteonecrosis and could be differentiated easily. 7. After total hip replacement, according to Harris hip rading score system, all results were good.

Bony Lesion of Divers in Korea / 대한정형외과학회잡지

Bornstein and plate (1911) and Bassoe (1913), followed by many European and American, described the radiographic appearance of avascular necrosis of the bone in compressed air worker. Divers bone lesions was described for the first time by Grutzmacher in 1941. There is not any report of information on the caisson disease and divers bone lesions in this country. Inview of these considerations, during the period from March to June 1981, 124 traditional civilian divers and 132 Naval divers, were observed in eight Korean coastal cities (In-cheon, Sam-chun-po, Sin-hae, Pu-san, Ul-san, Ku-ryung-po, joo-moon-jin and Sok-cho). For each divers, a record was made of his medical history, diving experiences and frequencies of bends attacks. The clinical examination included blood pressure, body weight, a chest radiograph and routine checks of the shoulders, hips and knees, but an X-ray examination extended to the spines, ankles, elbows when symptoms existed. The results were as follow: l. Out of 256 divers, 113 (44.2%) had bone lesions, seventy-five traditional divers (60.5%) had bone lesions out of 125 divers, but naval divers, only thirty eight (28.8%) of 132 had such lesions. 2. Divers bone lesion incidence is increased with diving experience especially over 10 years. 3. The most frequent bone lesions occured in the upper end of the humerus, the upper end of the femur, the lower end of the femur and proximal tibia. 4. The most frequent divers bone lesions in X-ray was dense areas (Bl). 5. There was a high incidence (93.1%) in man with a history of the bends and significantly relate between the sites of the bends and those of the lesions. 6. Divers bone lesions incidence was increased with the length of diving experiences, diving depth, diving time, ages and with bends experiences.