Dysbaric osteonecrosis in divers and caisson workers. An animal model.

Dysbaric osteonecrosis was induced successfully in adult sheep after 12 to 13, 24-hour exposures to compressed air (2.6-2.9 atmospheres absolute) during a 2-month period. All exposed sheep had decompression sickness and extensive bone and marrow necrosis in their long bones. Radiographic analysis of these progressive lesions showed mottled to distinct medullary opacities and endosteal thickening characteristic of dysbaric osteonecrosis. Six months after the last hyperbaric exposure, neovascularization of once ischemic fatty marrow was centripetal from the diaphyseal cortex. Proliferating endosteal new bone, fatty marrow calcification, and appositional new bone formation were widespread. Juxtaarticular osteonecrosis involved marrow fibrosis and loss of osteocytes in subchondral cortical bone. Tidemark reduplication in juxtaarticular bone and cartilage thinning suggested possible early osteoarthritis induction by recurrent episodes of transient ischemia after multiple hyperbaric exposures. Dysbaric osteonecrosis appears to involve a bone compartment syndrome of elevated intramedullary pressure initiated by decompression induced N2 bubble formation in the fatty marrow of the long bones. An animal model that can be used to investigate the pathogenesis, diagnosis, and treatment of dysbaric osteonecrosis is discussed.

Static lung load and posture effects on pulmonary mechanics and comfort in underwater exercise.

Static lung load (SLL), or transrespiratory pressure gradient, imposed by underwater breathing apparatus can affect breathing comfort and mechanics, especially during exertion. We examined the effects of body position and SLL on two factors known to affect or limit exertion: a) tidal flow-volume limitation, i.e., the percentage of the tidal volume that meets the boundary of the maximum expiratory flow-volume curve; and b) breathing discomfort. Eight healthy male scuba divers (28 +/- 4 yr) performed cycle ergometry to exhaustion during immersion in each of four combinations of body position and SLL: upright, prone, +10 cmH2O, -10 cmH2O. SLL was referenced to the sternal notch. Tidal flow-volume limitation was significantly greater with the negative SLL (P less than 0.05). In the prone position, higher expiratory flows were achieved (P less than 0.01) and flow limitation was not significantly increased. Respiratory discomfort was quantified with a psychophysical rating scale and increased significantly as exercise intensity increased (P less than 0.01). No effect of posture or SLL on discomfort was found. We conclude that, although respiratory comfort is unaffected, positive static lung loading and the prone body position minimize adverse changes in respiratory mechanics during exercise in immersion.

Behavioral effects of increased CO2 load in divers.

The behavioral effects of elevated PACO2 were examined to clarify risks due to CO2 retention in diving. In two separate laboratory studies, experienced divers breathed 6% CO2 mixtures under normobaric conditions. Normoxic study: Subjects (n = 8) first breathed air (control); then 6% CO2, 21% O2, balance N2 (exposure); and then air again (postexposure). Hyperoxic study: Subjects (n = 10) first breathed 100% O2; then 6% CO2 in O2; and then O2 again. Subjects performed a test battery in each condition. In the control and postexposure conditions, tests consisted of simple and choice reaction time, postural sway, tremor, and hand steadiness. In the exposure conditions, only the simple and choice reaction time tests were performed. No significant performance decrements during CO2 exposure were found in either study. However, regression analyses indicated that changes in postural sway, tremor, and decision-making time after normoxic CO2 exposure were proportional to decrements in individual end-tidal PCO2 levels following CO2 exposure. We conclude that divers may be at risk for performance impairment immediately after a period of CO2 retention.

Experimental respiratory decompression sickness in sheep.

Respiratory decompression sickness (RDCS, "the chokes") is a potentially lethal consequence of ambient pressure reduction. Lack of a clearly suitable animal model has impeded understanding of this condition. RDCS, unaccompanied by central nervous system signs, occurred in 17 of 18 unanesthetized sheep exposed to compressed air at 230 kPa (2.27 ATA) for 22 h, returned to normal pressure for approximately 40 min, and taken to simulated altitude (0.75 ATA, 570 Torr). Respiratory signs, including tachypnea, sporadic apnea, and labored breathing, were accompanied by precordial Doppler ultrasound evidence of marked venous bubble loading. Pulmonary arterial pressures exceeded 30 Torr in five catheterized sheep that died or became moribund. Hypoxemia (arterial Po2 less than 40 Torr), neutropenia, and thrombocytopenia were observed. Peribronchovascular edema was the most prominent necropsy finding. Chest radiography indicated interstitial edema in most affected sheep. High body weight and catheterization predisposed the sheep to severe RDCS. It appears that this protocol reliably provides a useful animal model for studies of RDCS and obstructive pulmonary hypertension, that the precipitating event is massive pulmonary embolization by bubbles, and that venous bubbles, detected by Doppler ultrasound, can signal impending RDCS.

An in vivo technique for the measurement of bone blood flow in animals.

A new technique to measure the in vivo clearance of 41Ar from the bone mineral matrix is demonstrated following fast neutron production of 41Ar in bone via the 44Ca(n, alpha) reaction at 14.1 MeV. At the end of irradiation, the 41Ar activity is assayed with a Ge(Li) detector where sequential gamma-ray spectra are taken. Following full-energy peak integration, background and dead time correction, the activity of 41Ar as a function of time is determined. Results indicated that the Ar washout from bone in rats using this technique was approximately 16 ml (100 ml min)-1 and in agreement with other measurement techniques. For sheep the bone perfusion in the tibia was approximately 1.9 +/- 0.2 ml (100 ml min)-1.

Hydrogen washout in bone cortex and periosteum.

Residence time distributions of hydrogen in bone of anesthetized dogs and rabbits were used to estimate local blood perfusion rates and to characterize the important transport processes taking place. The hydrogen was administered by inhalation, and the concentrations in the bone were measured by embedded platinum microelectrodes. Mean residence times varied significantly both with position and time, and it was found preferable to calculate residence time from moments of the residence time distribution rather than the downslope method. Moreover, the downslope on a semilogarithmic scale continued to decrease with the increase in observation time. For the tissue investigated, simple compartmental models are inadequate even for the small regions characterized by the electrodes. This means that a large number of Haldanian compartments are needed even to characterize local washout behavior. The significance of this finding for the selection of decompression schedules is briefly discussed.

Lack of harmful effects from simulated dives in pregnant sheep.

The purpose of the study was to determine if a near-maximum exposure to air at increased atmospheric pressure causes gross fetal malformations, decreased birth weight, or death when administered to pregnant sheep during peak development of the embryo. Twenty-eight timed-pregnant sheep were alternately assigned to a series of 25- or 30-minute exposures at either 4.6 atmospheres absolute or surface pressure between days 12 and 40 of gestation. About day 130 of pregnancy, 11 experimental and eight control fetuses were recovered, weighed, measured, fixed, and examined for defects. No major structural malformations were present. One minor variation, an undescended testis, occurred in a treated fetus. The results indicate that a series of short, marginally tolerated "dives" by pregnant sheep during peak development does not affect fetal health or survival.

Responses of fetal sheep to simulated no-decompression dives.

The effect of simulated standard no-decompression dives to 60 and 100 ft of seawater was tested in 12 near term sheep carrying 16 fetuses. In the immediate postdive period there were no significant changes in fetal blood pressure or fetal placental or renal blood flow, but the maternal blood pressure was elevated and the maternal placental blood flow was depressed. Six surgically prepared fetuses were dived to 100 ft. Five died within 20 min of ascent and the sixth suffered severe cardiac arrhythmia and hypotension. At autopsy all fetuses were observed to have massive bubbling in the arterial system and heart. Five fetuses were dived to 100 ft without surgery. Two were alive 3 h later and no bubbles were present at autopsy, and three were born alive at term. With the 60-ft dives, three fetuses were subjected to surgery and all suffered massive bubbling. Two fetuses were dived to 60 ft without surgery; one was alive after 3 h and the other was born alive at term. We conclude that surgery and monitoring result in the formation of postdive gas bubbles that would not otherwise appear.

Inert gas transport in the microcirculation: risk of isobaric supersaturation.

This paper is concerned with the theretical background and implications of isobaric supersaturation and bubble formation in the microcirculation following an abrupt shift from one inspired inert gas to another. The use of more than one inert gas, simultaneously or sequentially, has become common in diving and presents risks as well as potential benefits. A review of microcirculatory model useds, theoretical approaches to decompression, and order of magnitude calculations indicates that present empiricisms are inadequate for predicting such supersaturation phenomena. This is true whether based on the familiar assumption of perfusion-limited behavior or its diffusion-limited counterpart. The "chromatographic" model used here, which considers both perfusion and axial diffusion in tissue cylinders, shows that these combined effects can produce unexpectedly high local supersaturation. The implications include new possibilities for the experimental evaluation of gas transport models as well as practical risks of inert gas shifts in diving and certain diagnostic procedures.

Nitrogen elimination in man during decompression.

The effect of ambient pressure on inert gas elimination during decompression was investigated using human subjects breathing air in a dry hyperbaric chamber. This was done by measuring nitrogen recovery during three different decompression schedules following identical simulated dives. Five subjects were used, each with normal pulmonary function. In each case the simulated dives consisted of exposure for 40 min to air at 4 ATA corresponding to a depth of about 100 fsw and 28 degrees C. Following these exposures each subject was decompressed in different experiments to 50 fsw (2.515 ATA) and to 10 fsw (1.303 ATA) while breathing a mixture of 80:20 helium-oxygen. In addition, two of these subjects were denitrogenated isobarically, at 100 fsw, breathing 80:20 helium-oxygen. Significant differences in nitrogen-elimination rate were observed, with nitrogen removed most effectively at 50 fsw and least at 100 fsw. To explained these unexpected results it is tentatively suggested asymptomatic bubble formation occurred at both 10 and 50 fsw.

Apparatus for intracellular electrophysiological measurements at 200 ATA.

An apparatus has been constructed and tested at pressures to 200 ATA which meets the basic requirements for intracellular microelectrode work. Standard microelectrodes, unaffected by pressure in this range, were used with lobster axon and frog sartorius fibers and action potentials have been recorded at pressure up to 151 ATA. The chamber itself has a simple roll-in door and a modular design that recommends it as a highly convenient multipurpose vessel for work at moderately high pressures.