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Asia Pac J Public Health 2019 Apr 15:1010539519839816. Epub 2019 Apr 15.

5 Mahidol University, Bangkok, Thailand.

This study aimed to clarify the prevalence of hearing loss and its risk factors among Thai naval divers. The participants were 263 military divers in the Royal Thai Navy, aged 22 to 55 years. The participants were asked to fill in a questionnaire and to undergo the examinations on hearing acuity and physical measurement. Read More

Proc Biol Sci 2019 Jan;286(1895):20182533

16 Marine Ecology & Telemetry Research , 2468 Camp McKenzie Tr NW, Seabeck, WA 98380 , USA.

Mass stranding events (MSEs) of beaked whales (BWs) were extremely rare prior to the 1960s but increased markedly after the development of naval mid-frequency active sonar (MFAS). The temporal and spatial associations between atypical BW MSEs and naval exercises were first observed in the Canary Islands, Spain, in the mid-1980s. Further research on BWs stranded in association with naval exercises demonstrated pathological findings consistent with decompression sickness (DCS). Read More

Arh Hig Rada Toksikol 2018 Dec;69(4):350-353

Polyclinic Salus, Pula, Croatia.

We report a unique and well-documented case of a type II decompression sickness (DCS) with a latency interval of 70 hours. It may raise divers' awareness and help medical practitioners to keep suspect divers under close observation longer than before and identify and treat DCS accordingly. Read More

Interv Cardiol 2019 Feb;14(1):34-41

Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust Cambridge, UK.

Patent foramen ovale (PFO) is a common abnormality affecting between 20% and 34% of the adult population. For most people it is a benign finding; however, in some the PFO can open widely, enabling a paradoxical embolus to transit from the venous to arterial circulation, which is associated with stroke and systemic embolisation. Percutaneous closure of PFO in patients with cryptogenic stroke has been undertaken for a number of years, and a number of purpose-specific septal occluders have been marketed. Read More

Diving Hyperb Med 2019 Mar;49(1):64

Corresponding author: Associate Professor, Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand,

Gas micronuclei are gas-filled voids in liquids from which bubbles can form at low gas supersaturation. If water is depleted of gas micronuclei, high gas supersaturation is required for bubble formation. This high gas supersaturation is required in part to overcome the Laplace pressure at the point of transition from dissolved gas to a bubble of perhaps nanometer-scale radius. Read More

Diving Hyperb Med 2019 Mar;49(1):61-63

Department of Hyperbaric Medicine, Sainte-Marguerite Hospital, APHM, Marseille, France.

Introduction: Portal venous gas from a diving injury is an infrequent finding and only a few cases are described. We report a case of severe decompression sickness (DCS) associated with a massive amount of gas in the portal and mesenteric veins.

Case Report: A 49-year-old man suffered from DCS after two deep dives on the same day. Read More

Diving Hyperb Med 2019 Mar;49(1):57-60

Orkney Hyperbaric Unit, Stromness, Orkney, Scotland.

Lion's mane jellyfish stings are usually characterised by local inflammation, especially weals. Systemic symptoms are not widely described although there is a well known fictional description of a fatal reaction to envenoming. We describe five divers presenting with suspected decompression sickness, where the probable diagnosis was jellyfish envenoming. Read More

Ann Glob Health 2018 Aug 31;84(3):442-449. Epub 2018 Aug 31.

Center for International Health at the Institute for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336 Munich, DE.

Background: Diving within artisanal fishing is a profession carried out by many men in coastal communities of southern Chile. These shellfish divers use surface supplied air for breathing. Among potential health threats are occupational accidents, decompression sickness and barotrauma. Read More

Laryngoscope 2019 Feb 27. Epub 2019 Feb 27.

National Hearing Implant and Research Centre, Beaumont Hospital, Dublin, Ireland.

Objectives/hypothesis: Complications during or after cochlear implantation are relatively rare. They occur more frequently in patients who partake in activities that can potentially lead to local trauma. No formal recommendations exist for participation in self-contained underwater breathing apparatus (SCUBA) activities. Read More

MedEdPORTAL 2018 Dec 21;14:10788. Epub 2018 Dec 21.

Clinical Instructor of Medicine, Department of Emergency Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center.

Introduction: Arterial gas embolism (AGE) is a rare but severe complication of scuba diving. While AGE is most commonly encountered in coastal areas with high volumes of recreational divers, at-risk populations exist throughout the United States, making basic knowledge of the disease important for all emergency medicine (EM) physicians.

Methods: We used a hypothetical simulation case to train EM residents on diagnosis and management of AGE. Read More

Laryngoscope 2019 Feb 18. Epub 2019 Feb 18.

Department of Surgery, Division of Otolaryngology, University of Connecticut Health, Farmington, Connecticut, U.S.A.

Objectives: Introduce pertinent self-contained underwater breathing apparatus (SCUBA) physiology and corresponding terminology. Appreciate the scope of diving and related otolaryngological injury. Illustrate pathophysiologic mechanisms for diving injuries. Read More

Laryngoscope 2019 Feb 18. Epub 2019 Feb 18.

Department of Surgery, Division of Otolaryngology, University of Connecticut Health, Farmington, Connecticut, U.S.A.

Objectives: Challenge current practices and misconceptions in treating recreational SCUBA (Self-contained underwater breathing apparatus) divers. Differentiate patients who are fit to dive and those with relative and absolute contraindications. Redefine the standard of care for fitness to dive parameters based on the most up-to-date evidence. Read More

J Appl Physiol (1985) 2019 Apr 14;126(4):1006-1014. Epub 2019 Feb 14.

Department of Emergency Medicine, University of Maryland School of Medicine , Baltimore, Maryland.

Hyperbaric oxygen (HBO) became a mainstay for treating decompression sickness (DCS) because bubbles are associated with the disorder. Inflammatory processes including production of circulating microparticles (MPs) have now been shown to occur with DCS, leading to questions regarding pathophysiology and the role for HBO. We investigated effects of HBO on mice exposed to 790 kPa air pressure for 2 h, which triggers elevations of MPs ladened with interleukin (IL)-1β that cause diffuse vascular injuries. Read More

J Occup Health 2019 Jan;61(1):143-153

Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Republic of Korea.

Objectives: We aimed to report the characteristics of diving practice and the incidence of decompression sickness (DCS) among South Korean fishery divers.

Methods: We sent out questionnaires to 215 registered boat owners, and 196 of the fishery divers responded. The questionnaire was comprised of demographical characteristics, diving-related characteristics, and experiences with DCS. Read More

J Appl Physiol (1985) 2019 Apr 17;126(4):934-940. Epub 2019 Jan 17.

Department of Naval Aeromedicine, Faculty of Naval Medicine, Second Military Medical University , Shanghai , People's Republic of China.

Decompression sickness (DCS) occurs because of an excessively rapid and extensive reduction of the ambient pressure. Bubble-induced spinal cord ischemia is generally considered as a part of neurological DCS pathogenesis. Because helium preconditioning (HPC) recently demonstrated beneficial properties against ischemic damage, we hypothesized that HPC may decrease the neurological deficits of DCS in rats. Read More

J Radiol Case Rep 2018 Oct 31;12(10):17-23. Epub 2018 Oct 31.

Department of Radiology, Hahnemann University Hospital, Philadelphia, PA, USA.

This case report depicts the radiologic findings of a 51-year-old male presenting with Decompression Sickness. Decompression Sickness is diagnosed clinically, therefore radiologic imaging of this disease entity is limited. Our patient's history includes a scuba dive to depth of 110 feet with a descending time of 24 minutes and an ascending time of 8 minutes. Read More

Front Physiol 2018 29;9:1695. Epub 2018 Nov 29.

Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France.

Circulating mitochondrial DNA (mtDNA) is receiving increasing attention as a danger-associated molecular pattern in conditions such as autoimmunity or trauma. In the context of decompression sickness (DCS), the course of which is sometimes erratic, we hypothesize that mtDNA plays a not insignificant role particularly in neurological type accidents. This study is based on the comparison of circulating mtDNA levels in humans presenting with various types of diving accidents, and punctured upon their admission at the hyperbaric facility. Read More

Diving Hyperb Med 2018 Dec;48(4):262-263

Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Shizuoka Prefecture, Japan.

Commercial or occupational breath-hold (BH) harvest divers along the coast and islands of Japan are collectively called Ama divers. Repetitive BH diving by Ama divers may place them at risk of developing neurological decompression sickness (DCS). We report a 74-year-old Ama diver who demonstrated right hemiparesis during an ascent after free diving at a depth of 5 metres' sea water. Read More

Diving Hyperb Med 2018 Dec;48(4):259-261

Department of Pulmonary Medicine, Kameda Medical Centre, Kamogawa, Chiba, Japan.

Immersion pulmonary oedema (IPE) is particularly associated with an excessive reaction to exercise and/or cold stress. IPE usually resolves without recompression therapy within a day or two. Herein we report a diver diagnosed with IPE, in whom symptoms persisted for five days. Read More

Diving Hyperb Med 2018 Dec;48(4):252-258

Washington DC, USA.

Introduction: Whilst the US Navy has been very systematic about validating Navy dive computer algorithms, there has been little documented or published evidence of rigorous testing of the algorithms in commercial off-the-shelf dive computers. This paper reports the evaluation of four algorithms used in these - Bühlmann ZHL-16C; VPM-B; Suunto-RGBM; EMC-20H - by comparison with US Navy experimental dives with known decompression sickness outcomes.

Methods: Three specific tests were developed to test the algorithms' ability to mitigate decompression sickness: Total decompression time; no stop times and first stop depth. Read More

Diving Hyperb Med 2018 Dec;48(4):235-240

Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.

Introduction: Vibration from a helicopter during aeromedical retrieval of divers may increase venous gas emboli (VGE) production, evolution or distribution, potentially worsening the patient's condition.

Aim: To review the literature surrounding the helicopter transport of injured divers and establish if vibration contributes to increased VGE.

Method: A systematic literature search of key databases was conducted to identify articles investigating vibration and bubbles during helicopter retrieval of divers. Read More

Diving Hyperb Med 2018 Dec;48(4):218-223

Department of Anaesthesiology, Faculty of Medicine and Health Sciences, University of Auckland.

Introduction: Health and safety within the recreational diving industry are poorly described. We aimed to obtain the true prevalence of decompression illness (DCI) and other diving and non-diving injuries, including occupational injuries, in a large recreational diving charter operation.

Methods: A New Zealand recreational diving operator keeps detailed records of diving activity and event/incident reports. Read More

Diving Hyperb Med 2018 Dec;48(4):209-217

Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.

Introduction: High concentration normobaric oxygen (O₂) is a priority in treating divers with suspected decompression illness. The effect of different O₂ mask configurations on tissue oxygenation when breathing with a demand valve was evaluated.

Methods: Sixteen divers had tissue oxygen partial pressure (PtcO₂) measured at six limb sites. Read More

Aerosp Med Hum Perform 2018 12;89(12):1085-1088

Decompression sickness is a condition that results from an abrupt change from a higher to a lower pressure. It is described most commonly in divers; however, it can occur in aviation incidents, which this case report will discuss. Following an acute cabin depressurization incident, 36 patients presented to a small outpatient clinic with multiple symptoms, including fatigue, headache, nausea, vomiting, and dizziness. Read More

J Intensive Care 2018 22;6:77. Epub 2018 Nov 22.

Underwater and Hyperbaric Medicine Department, Istanbul Faculty of Medicine, Istanbul, Turkey.

We have read the case report about a decompression sickness that was unresponsive to hyperbaric oxygen treatment in your journal. Presented case is intriguing; however, we think there are some contradictive issues in the discussion of the case. In this letter, we aim to comment on these issues that may raise further question. Read More

Biom J 2019 01 25;61(1):203-215. Epub 2018 Nov 25.

Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Mixed case interval-censored data arise when the event of interest is known only to occur within an interval induced by a sequence of random examination times. Such data are commonly encountered in disease research with longitudinal follow-up. Furthermore, the medical treatment has progressed over the last decade with an increasing proportion of patients being cured for many types of diseases. Read More

Int J Sports Med 2019 Jan 20;40(1):31-37. Epub 2018 Nov 20.

German Sport University, Institute of Physiology and Anatomy, Cologne, Germany.

Circulating venous bubbles after dives are associated with symptoms of decompression sickness in adults. Up to now it is not known to what extent children and adolescents are subjected to a bubble formation during their shallow dives and if there are possible indications for that. The aim of this pilot study is to investigate whether bubbles and/or symptoms occur after standardised repeated dives performed by young divers. Read More

Med Sci Monit 2018 Nov 17;24:8279-8289. Epub 2018 Nov 17.

Department of Radiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey.

BACKGROUND The aim of this study was to understand the changes of decompression illness in healthy divers by comparing diffusion-weighted (DWI) and diffusion tensor MRI findings among healthy professional divers and healthy non-divers with no history of diving. MATERIAL AND METHODS A total of 26 people were recruited in this prospective study: 11 experienced divers with no history of neurological decompression disease (cohort) and 15 healthy non-divers (control). In all study subjects, we evaluated apparent diffusion coefficient (ADC) and type of diffusion tensor metric fractional anisotropy (FA) values of different brain locations (e. Read More

Eur J Public Health 2018 Nov 14. Epub 2018 Nov 14.

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Background: The aims were to study the differences in work-disability in patients with low back pain (LBP) in relation to (i) treatment provided (non-surgical or lumber spine surgery (decompression or fusion), and (ii) two time points, i.e. before and after the social insurance regulation changes in the in 2008. Read More

Cureus 2018 Sep 13;10(9):e3295. Epub 2018 Sep 13.

Department of Internal Medicine, East Tennessee State University, Quillen College of Medicine, Johnson City, USA.

Cardiac arrest due to air embolism is an infrequent complication. Air embolism can be associated with procedures like endoscopic retrograde cholangiopancreatography, endoscopic variceal ligation, operative hysteroscopy, laparoscopic surgery, pacemaker placement, cardiac ablation, fiberoptic bronchoscopy, and decompression sickness. In rare cases, air embolus can be a catastrophic complication of computed tomography (CT) guided lung biopsy, which can lead to cardiac arrest. Read More

Rev Pneumol Clin 2018 Dec 12;74(6):416-426. Epub 2018 Nov 12.

Université de Lille, 59000 Lille, France. Electronic address:

Introduction: Scuba diving has long been contraindicated for asthmatics. Recommendations are evolving towards authorisation under certain conditions. Our objective was to review the literature on the risks associated with scuba diving among asthmatics and about recommendations on this subject. Read More

J R Army Med Corps 2018 Nov 14. Epub 2018 Nov 14.

RAF Centre of Aviation Medicine, Royal Air Force, Henlow, UK.

Undersea Hyperb Med 2018 Sep-Oct;45:531-539

International Hospital, Cozumel, Quintana Roo, Calle 5 Sur 21B, Centro, 77600 San Miguel de Cozumel, Quintana Roo, Mexico.

Diving fisheries are an important source of income and protein for many coastal communities around the world. However, these fisheries are also the cause of both fatal and non-fatal injuries. The aim of this study is to estimate the costs of decompression sickness (DCS) in the diving small-scale fisheries that target benthic resources in the Yucatan, Mexico. Read More

Undersea Hyperb Med 2018 Sep-Oct;45:511-520

Duke Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, North Carolina U.S.

This report summarizes some of the most relevant studies during the 2017-2018 academic year of scientific literature for diving medicine. The article selection is the result of a PubMed search for "diving," as well as a manual review of the journals Undersea and Hyperbaric Medicine and Diving and Hyperbaric Medicine. Four articles were published reporting on new advances in decompression modeling. Read More

Neurology 2018 Oct;91(18):847-848

From the Neuroimaging Department (C.G., S.R.) and the Infectious Diseases Department (T.M.), North Lisbon Hospital Center; and Underwater and Hyperbaric Medicine Center (A.T.), Portuguese Navy, Portugal.

Aerosp Med Hum Perform 2018 Nov;89(11):941-951

A review of decompression sickness (DCS) cases associated with the NASA altitude physiological training (APT) program at the Johnson Space Center (JSC) motivated us to place our findings into the larger context of DCS prevalence from other APT centers. We reviewed JSC records from 1999 to 2016 and 14 publications from 1968 to 2004 about DCS prevalence in other APT programs. We performed a meta-analysis of 15 APT profiles (488 cases / 385,116 exposures). Read More

J Exp Biol 2018 Dec 4;221(Pt 23). Epub 2018 Dec 4.

Fundación Oceanografic de la Comunidad Valenciana, Gran Vía Marques del Turia 19, 46005 Valencia, Spain.

To provide new insight into the pathophysiological mechanisms underlying gas emboli (GE) in bycaught loggerhead sea turtles (), we investigated the vasoactive characteristics of the pulmonary and systemic arteries, and the lung parenchyma (LP). Tissues were opportunistically excised from recently dead animals for studies of vasoactive responses to four different neurotransmitters: acetylcholine (ACh; parasympathetic), serotonin (5HT), adrenaline (Adr; sympathetic) and histamine. The significant amount of smooth muscle in the LP contracted in response to ACh, Adr and histamine. Read More

Rev Med Interne 2019 Jan 17;40(1):38-42. Epub 2018 Oct 17.

Service de médecine hyperbare et expertise plongée (SMHEP), hôpital d'instruction des armées (HIA) Sainte-Anne, BP 600, 83800 Toulon cedex 9, France.

Background: Capillary leak syndrome is a rare type of decompression sickness (DCS) that may be responsible for hypovolemic shock with edema.

Clinical Case: A 21-year-old amateur diver suffered from an inner ear DCS following air diving to 96msw. He presented subsequent deterioration with hypovolemia and facial edema secondary to capillary leak syndrome. Read More

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2018 Jun;36(6):454-456

Yangpu Hospital, Tongji University, Shanhai 200090, China.

To investigate the value of MRI in the early diagnosis of diagnosis of dysbaric osteonecrosis. Labor hygiene investigation and occupation health were examined on 52 high pressure operating personnel, were selected for the examination of both shoulders, hips and knees with X-ray and CT scan. The cystic sign in dysbaric osteonecrosis as an important imaging feature, which perform in the MRI examination for T1W I sequence showed low or slightly low signal and T2W I sequence showed high signal, and X-ray and CT have a lower detection rate than MRI. Read More

Undersea Hyperb Med 2018 Jul-Aug;45(4):445-451

UNEXMAR, Universidad Marista de Mérida, Mérida, Yucatán.

Introduction: Decompression sickness is endemic to small-scale fishermen-divers from coastal communities in southeast Mexico; overweight and obesity are also highly prevalent in the region. Existing literature suggests it is possible that fat tissue could play a role in decompression sickness pathophysiology. Our aim in this study is to describe the association between the number and severity of DCS events treated at the hyperbaric program and fishermen-diver body mass index. Read More

Undersea Hyperb Med 2018 Jul-Aug;45(4):427-436

University of Texas Medical Branch, Galveston, Texas.

Astronauts training for extravehicular activity (EVA) operations can spend many hours submerged underwater in a pressurized suit, called an extravehicular mobility unit (EMU), exposed to pressures exceeding 2 atmospheres absolute (ATA). To minimize the risk of decompression sickness (DCS) a 46% nitrox mixture is used. This limits the nitrogen partial pressure, decreasing the risk of DCS. Read More

Diving Hyperb Med 2018 Sep;48(3):197

Corresponding author: The Israel Naval Medical Institute, Israel Defence Forces Medical Corps, Haifa, Israel; Eliachar Research Laboratory, Western Galilee Medical Centre, Nahariya, Israel, 12 Klil-Hakhoresh, Rakefet, D.N. Misgav 2017500, Israel,

In a study of the effect of a fatty diet on decompression bubbles, based on the responses to a questionnaire regarding daily food consumption, the approximate fat intake for each diver was calculated, taking into account the maximum recommended intake for a person doing his type of work. Following hyperbaric exposure, divers were divided into two groups: 'bubblers' (a minimum of the second level on the Kisman-Masurel scale) and 'non-bubblers'. Bubblers had higher fat consumption than non-bubblers (146 ± 39% versus 92 ± 18%). Read More

Diving Hyperb Med 2018 Sep;48(3):186-193

Corresponding author: Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, Hawaii, USA,

Objective: To systematically search the literature for studies evaluating the typical presentation and testing that is performed for divers with inner ear symptoms and then to create a tool for clinicians when evaluating a diver with inner ear symptoms.

Methods: Nine databases, including PubMed/MEDLINE were systematically searched through 31 January 2018. The PRISMA statement was followed. Read More

Diving Hyperb Med 2018 Sep;48(3):132-140

French Navy Diving School, Toulon, France.

Introduction: Ultrasonic detection of venous gas emboli (VGE) in the precordial (PRE) region is commonly used in evaluation of decompression stress. While subclavian (SC) VGE detection can also be used to augment and improve the evaluation, no study has rigorously compared VGE grades from both sites as decompression stress indicators.

Methods: This retrospective study examined 1,016 man-dives breathing air extracted from the Defence Research and Development Canada dataset. Read More

Diving Hyperb Med 2018 Sep;48(3):130-131

Diving Medical Centre, Royal Netherlands Navy, PO Box 10.000, 1780 CA Den Helder, The Netherlands,

Since decompression sickness (DCS) in humans was first described, mankind has embarked on an odyssey to prevent it. The demonstration that decompression releases bubbles, which mainly contain inert gas (nitrogen, helium), into the circulation and that the slower the decompression rate the lesser the incidence of DCS, resulted in 1908 in the publication of the first, reasonably safe diving tables. Besides the development of proper diving tables, the selection of divers is also of importance. Read More

Neth Heart J 2018 Nov;26(11):535-539

Department of Cardiology, University Medical Center, Utrecht, The Netherlands.

Objective: To study the effect of percutaneous patent foramen ovale (PFO) closure in divers with a history of decompression sickness (DCS).

Study Design: (1) Retrospective study of patient records and (2) telephonic follow-up. Patients with unexplained decompression sickness, who were referred to a cardiologist with a focus on diving medicine between 2000 and 2017, were included in the study RESULTS: A total of 62 divers with DCS were included. Read More

Respir Physiol Neurobiol 2019 01 30;259:119-121. Epub 2018 Aug 30.

The Israel Naval Medical Institute, Haifa, Israel; Eliachar Research Laboratory, Western Galilee Medical Centre, Nahariya, Israel. Electronic address:

Decompression bubbles can develop only from pre-existing gas micronuclei. These are the nanobubbles which appear on active hydrophobic spots (AHS) found on the luminal aspect of all blood vessels. Following decompression, with the propagation of blood along the arterial tree, diffusion parameters cause increased transfer of nitrogen from the tissue into the artery, and more so if perfusion is low. Read More

Br J Dermatol 2018 Jul;179(1):e1

Emek Medical Center, Department of Dermatology, Afula, Israel.