ABSTRACT
Recreational diving developed in the late 1940s when self-contained underwater breathing apparatus (SCUBA) first became available for civilian use. At the same time the development of the commercial airliner, in particular the jet airliner, made possible the concept of international travel for pleasure as opposed to business. Over the past 50 years the number of international tourists has increased by over 2500% from a mere 25 million in 1950 to over 700 million in 2002 (Treadwell TL. Trends in travel. In: Zuckerman JN, editor. Principles and practice of travel medicine, 2001; p. 2-6). The popularity of recreational diving has also increased over the same period from an activity experienced by a small number of individuals in the early 1950s to an activity today enjoyed by many millions. The combination of increased international travel and the means by which to enter and explore the underwater world has led to diving becoming increasingly popular as a tourist activity.
Subject(s)
Diving , Medicine , Specialization , Adolescent , Aged , Child , Child, Preschool , Decompression Sickness/prevention & control , Diving/adverse effects , Diving/physiology , Female , Humans , Male , Pregnancy , Recreation , TravelABSTRACT
Lyme disease is just one of the many tick borne diseases to be encountered within the United States that can affect humans. To the visitor who confines their time to major conurbations the risk of contracting Lyme disease is minimal. However, anyone planning a hiking trip during tick season must take precautions to prevent being bitten and possibly infected. For those of us who live within an endemic area the shower after a days gardening is not just to remove sweat and dirt but also an opportunity to check for, and if necessary remove, any ticks that may have chosen a human host. Fortunately, the liberal use of insecticide around our house combined with one of our cat's single pawed attempt to eliminate the local white-footed mouse population appears to have been effective in reducing the tick count.
Subject(s)
Lyme Disease/transmission , Humans , Lyme Disease/diagnosis , Lyme Disease/epidemiology , Lyme Disease/therapy , Naval Medicine , United States/epidemiologyABSTRACT
On 12 August 2000 a Russian Oscar class submarine, the KURSK, sank in the Barents Sea. This article describes the medical support provided by the Royal Navy in response to this tragic accident.
Subject(s)
Rescue Work/methods , Submarine Medicine , Decompression/methods , Humans , Russia , United KingdomABSTRACT
BACKGROUND: After recompression therapy, some cases of neurological decompression illness (DCI) have a significant residual deficit. Boussuges et al. report a scoring system to predict sequelae using weighted historical and clinical indices at presentation which we applied to the British Hyperbaric Association (BHA) database of UK diving accidents, held at the Institute of Naval Medicine (INM). METHODS: A database search identified 234 cases of neurological DCI from the 2 yr, 1995-6. Of these, 217 case records contained sufficient data to apply the scoring system. Outcome was classified as severe sequelae (i.e., causing a functionally important deficit) or as mild/no sequelae. RESULTS: The median score in UK cases with severe sequelae was 13 (95% C.I. 11.5 to 14.5) and in cases with mild/no sequelae, 6 (95% C.I. 5.5 to 6.5). Significantly more cases with scores > 7 had severe sequelae than cases with scores < or = 7 (chi2, p < 0.0001). The sensitivity of a score > 7 (for severe sequelae) was 94% and the specificity was 65%. The positive predictive value of a score > 7 (for severe sequelae) was 18% and the negative predictive value of a score < or = 7 was 99%. CONCLUSIONS: When applied to the INM/BHA database a score of > 7 by this scoring system has a higher sensitivity and lower specificity for severe sequelae than reported by Boussuges et al. It has a higher predictive accuracy for successful outcome of treatment (99% vs. 89%) but a much lower predictive value for severe sequelae (18% vs. 86%). Convergence between this and other published scoring systems may allow derivation of a generic scoring system that could then be evaluated prospectively in multiple centers.
Subject(s)
Decompression Sickness/complications , Decompression Sickness/therapy , Hemiplegia/etiology , Hyperbaric Oxygenation , Paraplegia/etiology , Paresthesia/etiology , Severity of Illness Index , Urination Disorders/etiology , Humans , Naval Medicine , Paralysis , Prognosis , Reproducibility of Results , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Treatment OutcomeABSTRACT
Between 1975 and 1997, a total of 115,090 ascents, from depths of between 9 and 28 m, have been made by trainees at the submarine escape training tank HMS Dolphin. During this 22-yr period, 53 incidents have occurred in which, after an ascent, the trainee required hospital or recompression therapy or both. Scrutiny of the incident records revealed unequivocal evidence of pulmonary barotrauma in six incidents with an additional four in which, despite a negligible gas burden, a confident diagnosis of acute neurologic decompression illness with short latency could be made. No causative mechanism other than arterial gas embolism following pulmonary barotrauma can be implicated in these four cases despite the absence of clinical or radiographic evidence of lung injury. In all 10 cases the forced vital capacity (FVC) of the trainees was less than the predicted value for their age and height, revealing a statistically significant (P< 0.01) association between values of FVC below predicted and pulmonary barotrauma. The median FEV1 for the 10 cases was also significantly (P < 0.05) less than the predicted value after allowing for age and height. No such association was found for the FEV1:FVC ratio. FVC would thus seem to be the measure of lung function most closely associated with increased risk of pulmonary barotrauma. Possible reasons for this finding are discussed. It is concluded that although the association between low FVC and pulmonary barotrauma is statistically significant, it is insufficiently specific for low FVC to serve as an exclusion criterion for submarine escape training.
Subject(s)
Barotrauma/diagnosis , Decompression Sickness/diagnosis , Lung Diseases/diagnosis , Submarine Medicine , Barotrauma/etiology , Barotrauma/physiopathology , Cysts/complications , Cysts/physiopathology , Decompression Sickness/complications , Decompression Sickness/physiopathology , Diagnosis, Differential , Embolism, Air/complications , Forced Expiratory Volume , Humans , Lung Diseases/etiology , Lung Diseases/physiopathology , Male , Military Personnel , Spirometry , Vital CapacitySubject(s)
Diving/injuries , Mediastinal Emphysema/etiology , Obstetric Labor Complications , Sneezing , Adult , Female , Humans , Male , PregnancyABSTRACT
An adult male diver developed limb pains and peripheral neurologic signs following a series of dives. He was treated for acute neurologic decompression illness (DCI) and responded well, but subsequently he deteriorated and developed features of a progressive multisystem disease. Investigation confirmed a clinical diagnosis of polyarteritis nodosa complicated by a mononeuritis multiplex. Vasculitis is uncommon and its masquerade as neurologic DCI may be unique. However, this case empha-sizes the importance of careful clinical assessment and illustrates the potentially wide differential diagnosis of DCI.
Subject(s)
Decompression Sickness/diagnosis , Hyperbaric Oxygenation , Vasculitis/diagnosis , Adult , Decompression Sickness/therapy , Diagnosis, Differential , Humans , Male , Prognosis , Vasculitis/complications , Vasculitis/therapyABSTRACT
We present the case of a helicopter pilot who suffered an arterial gas embolism following instruction in the use of the Short Term Air Supply System (STASS) at a depth of 1 m of water. This is believed to be the shallowest depth from which a case of arterial gas embolism associated with the use of compressed air breathing apparatus has been reported.
