Static stabilometry and repeated testing in a normal population.

BACKGROUND: The purpose of the present study was to see if there is a learning effect of repeated static stabilometric testing, using a protocol suitable for testing postural control in narrow spaces, like hypo- and hyperbaric chambers. HYPOTHESIS: Static stabilometry testing under normobaric conditions is objective and reproducible. With repeated testing, a learning effect may be observed. METHODS: Four groups of healthy individuals were tested ten times under the same four acoustically and visually standardized and normobaric normoxic test conditions on a static balance platform. First, the subjects were asked to stand on a bare platform with the eyes open, thereafter with the eyes closed. This was repeated with a foam rubber mat placed on top of the balance platform. The time interval between the first and the last test sequence was 11 (10-13) days for the test subjects in group I (n = 22), 17 d for group II (n = 13), 31(28-36) days for group III (n = 15) and 115 (49-193) days for group IV (n = 10). RESULTS: Static stabilometry tests in a normal population are objective and reproducible. With repeated tests, a learning effect was observed. The learning effect was largest when standing on a foam rubber mat with eyes closed and when the time intervals between the tests were shortest. There was no difference in sway pattern or learning ability between tall and short test subjects, between subjects with heavy and light body weight or between the sexes.

[Back pain--when both patients and physicians are in deep waters]. / Ryggsmerter--når så vel pasient som lege går i vannet.

BACKGROUND: Intraosseous pneumatocysts are rare and represent a benign condition. Such cysts can be an incidental finding described as a lytic process on plain X-rays. Computed tomography (CT) will confirm the diagnosis. Bone cysts filled with air are most frequently described in the iliac bone and in the sacrum, very rarely in the vertebrae or other bones. MATERIAL AND METHODS: This paper describes a patient that over a four to five-years period experienced relapses of rather strong lower back and hip pain of short duration during shallow water diving and ascent, and also during air travel. RESULTS: Plain X-rays of the lower spine and left hip (prescribed because of an earlier hip trauma) demonstrated a lytic process in the left iliac bone. CT of the pelvis confirmed the diagnosis of an intraosseous pneumatocyst in the left iliac bone. A mini-invasive procedure with CT-guided puncture under local anaesthesia and destruction of the cyst relieved the patient's symptoms. INTERPRETATION: The physician should consider rear causes of lower back pain in otherwise healthy patients. As demonstrated here, the causal treatment can sometimes be quite simple.

[Hyperbaric oxygen therapy. Now an established treatment in Norway]. / Hyperbar oksygenbehandling. Nå et etablert tilbud i Norge.

Hyperbaric oxygen therapy can be a life-saving form of treatment for certain acute medical conditions, e.g. cerebral gas embolism, clostridial infections, and smoke/carbon monoxide inhalation. It has long been used for treating decompression illness in divers. As from 1994 our hospital has been delegated the national responsibility for hyperbaric medicine in Norway. This paper describes the physiological basis, indications, and contraindications for hyperbaric oxygen treatment, and summarises hyperbaric oxygen treatment in Bergen over the last two years.

A histopathologic and immunocytochemical study of the spinal cord in amateur and professional divers.

To clarify the influence of diving activity on the central nervous system, we studied 10 amateur and 10 professional deceased divers with emphasis on the presence of subacute or chronic pathologic changes in the spinal cord. Of the 10 professional divers (median age 38 yr; range 29-52; median experience in excess of 13 yr), 7 were experienced saturation divers. Five had dived to a maximum depth of 150 meters of seawater, the 2 others to 300 and 500 msw, respectively. Five of the professional divers had experienced decompression sickness. The experience of the amateur divers (median age 29 yr; range 17-51) varied from a few dives to many years of recreational diving. The spinal cords were formalin-fixated and routinely processed for neuropathologic examination, which included light microscopy after immunostaining for glial fibrillary acidic protein and monocyte-macrophage-microglial markers. The microscopic examination did not reveal previous spinal cord damage. Thus, diving activity, saturation diving to extreme depths included, does not in itself seem to lead to necrosis, degeneration, or scar formation in the human spinal cord.

[Neurological decompression sickness]. / Neurologisk trykkfallsyke.

We have examined 34 divers, mean age 30 years, after treatment for neurological decompression sickness. The initial symptoms often indicated mild sensory or motor involvement. After recompression treatment five of 19 divers with primary affection of the brain had slight hemiparesis or dysphasia. Nine of 14 divers with primary affection of the spinal cord showed signs of spinal cord dysfunction following treatment. Only 16 divers were recompressed within six hours after start of the neurological symptoms. It is concluded that neurological decompression sickness is a serious disorder with a high rate of residual findings. The condition should be treated with prompt recompression, administration of oxygen, and intravenous fluid.

Cerebral air embolism after transthoracic aspiration with a 0.6 mm (23 gauge) needle.

A 54 yr old man experienced weakness in his legs, ataxia and subsequent urinary retention after a percutaneous fine-needle aspiration of a tumor in the right lower lobe. Clinical neurological examination and electroencephalography revealed signs of a brain stem lesion, probably due to an air embolism to the basilar artery. The symptoms and signs gradually disappeared prior to, as well as after, hyperbaric oxygen treatment. We believe this to be the first case of air embolism after transthoracic puncture with a 23 gauge needle to be reported in medical literature.

Effect of hyperbaric oxygen treatment on immunological parameters in multiple sclerosis.

Hyperbaric oxygen (HBO) treatment has been reported to cause amelioration of clinical symptoms in patients with multiple sclerosis (MS). We have treated 10 MS patients with hyperbaric oxygen (100% O2 at 2 atmospheres absolute for 90 min daily for a total of 20 exposures), and performed immunological studies on peripheral blood and cerebrospinal fluid (CSF). After treatment there was a significant increase in total and helper T lymphocyte counts in peripheral blood, as well as an increase in both E, Fc gamma and C3b receptor-bearing lymphocytes. The responses to the mitogens PHA, con A and PWM were unchanged. Granulocytes showed an increased proportion of Fc gamma receptor and C3b receptor positive cells after treatment. The O2 consumption of granulocytes also increased, but phagocytosis, as measured by chemiluminescence, was unchanged. Serum IgA levels were slightly increased, while IgG and IgM concentrations remained unchanged after treatment. Cerebrospinal fluid cell counts, protein and IgG concentrations, as well as IgG indexes remained unchanged.

An explosive decompression accident.

Four divers in a compression chamber system were suddenly decompressed from 9 atm to 1 atm. One of the divers was about to close the door between the chamber system and the trunk when the accident happened. He was shot out through the door and severely mutilated. The three others died on the spot. The autopsy results are described. The most conspicuous finding was large amounts of fat in the large arteries and veins and in the cardiac chambers, as well as intravascular fat in the organs, especially the liver. This fat can hardly have been embolic, but must have "dropped out" of the blood in situ. It is suggested that the boiling of the blood denatured the lipoprotein complexes, rendering the lipids insoluble.

Facial baroparesis: a review.

If impaired eustachian tube function causes an overpressure to remain in the middle ear after ascent in diving or aviation in a subject with a defect in the wall of the facial canal, an ischemic neurapraxia of the seventh cranial nerve may occur. This type of facial palsy is designated facial baroparesis, baroparesis facialis, or alternobaric facial palsy. If the middle ear pressure is asymmetric the subject may also have alternobaric vertigo. A causative relationship between middle ear overpressure and facial palsy is supported by the palsy's rapid onset following a reduction in ambient pressure and by its quick disappearance after either an increase in ambient pressure or release of the middle ear overpressure. Transient compression-induced ischemic neurapraxia of the facial nerve is also demonstrated in animal experiments. A similar palsy, ischemic neurapraxia of the fifth cranial nerve due to compression in the maxillary sinus, has been reported in divers. Although it is under-reported, facial baroparesis occurs infrequently, with 23 subjects mentioned in the available literature. Nevertheless, it is important to be aware of its existence, because misdiagnosis as type II DCS or air embolism results in unnecessarily long recompression treatments and pointless delay of resumption of diving. In the worst case, a misdiagnosis might cause a diving license to be revoked.

Facial baroparesis: a report of five cases.

Six episodes of facial baroparesis in 5 divers are reported. Three of the divers experienced left-sided paresis and 2 right-sided. In 2 of the subjects (3 episodes) the paresis disappeared spontaneously when the relative middle ear overpressure cleared, and in the remaining 3 subjects the paresis disappeared on recompression to less than 2 m. No residual effects were found, but the subject who experienced 2 episodes stopped diving. Available evidence favors the theory of ischemic compression neurapraxia.

Central nervous dysfunctions after near-miss accidents in diving.

The possible differences in specific central nervous system functions in 2 groups of divers were studied: Divers with a history of diving accidents (accident group, N = 9) and accident-free divers (non-accident group, N = 15). Both groups were characterized with a mean I.Q. level (WAIS) within the normal range. Of the nine accident group divers, 8 showed abnormalities on neuropsychological tests implicating lesions on higher CNS levels. In addition, five of the accident group divers had a syndrome of subcortical/limbic dysfunctions--specific memory deficits, low autonomic reactivity, sustained attention problems, and emotional lability. The data confirmed previous findings that a severe diving accident may lead to cerebral dysfunctions. However, in contrast to the previous studies, our study indicated that divers with average intellectual levels can develop specific CNS dysfunctions after a near miss diving accident. Therefore, we conclude that a combined effect of emboli with multifocal lesions and/or a more specific effect on limbic structures represent the pathophysiology of a severe near-miss diving accident.

Hyperbaric oxygen treatment in gas-producing infections.

Thirty patients with gas-producing infections were treated with surgery, antibiotics and hyperbaric oxygen during 1964-1977. Fourteen patients were infected with C. perfringens or C. septicum, 8 patients with B. fragilis or B. melaninogenicus, in 7 patients only aerobic bacteria were found, and in one patient no bacteria could be demonstrated. Thirteen patients had infections due to wounds, lacerations and/or compound fractures. Nine patients had gas-producing infection after surgery. Eight patients had abscesses and gas-producing infection. Of the 14 patients with clostridial infections, 2 patients died, and 6 underwent amputation. Four of the 8 patients with Bacteroides infection died, no amputation having been performed. Of the 7 patients in whom only aerobic bacteria were demonstrated, 3 patients died.