Scuba diving is possible and safe for patients with haemophilia.

For a long time, physical activities have been contraindicated in haemophiliacs or were restricted to few activities. Sports are nowadays advocated for haemophiliacs. Although various lists of physical activities have been proposed, scuba diving is never mentioned. Thus, with a group of haemophilic volunteers, a study was launched on whether, with strict medical follow-up, scuba diving could be allowed for patients with haemophilia. All the participants followed a training program including theory and assessment. In 6 years, a total of 517 dives were performed by 20 patients with congenital bleeding disorders. Nine were under prophylaxis for haemophilia, and nine received on-demand treatment. Two patients had type I von Willebrand's disease. Among the 20 patients, 12 made 12-153 dives, whereas six made eight dives each. No incident was noted during or after the dives. Thus, scuba diving can be authorized for PWH, if they have none of the specific medical contraindications for diving and if they have received medical training allowing them to manage their disease themselves.

[Study of myocardial metabolism of NADH by laser fluorimetry during cardiac catheterization]. / Exploration du métabolisme myocardique par fluorimétrie laser du NADH au cours du cathétérisme cardiaque.

Laser fluorimetry of reduced nicotinamide-adenine-dinucleotide (NADH) p6 a new technique used for in situ and real-time study of myocardial metabolism. We have evaluated its applicability to clinical situations in 5 patients undergoing haemodynamic exploration. An optic fibre was inserted in a catheter the end of which was positioned in the postero-diaphragmatic part of the left ventricle. The optic fibre was connected to a Cilas-Alcatel fluorimeter. Variations in fluorescence were studied during variations in left ventricular end-diastolic pressure (LVEDP) and during coronary arteriography. An increase in LVEDP resulted in a slight increase in NADH, but when the LVEDP was reduced by a nitroglycerin infusion, NADH fell significantly below baseline values in patients with coronary disease. This effect was most probably due to redistribution of the coronary blood flow from healthy territories to ischaemic territories. In patients without significant coronary stenosis, NADH was not modified by an injection of 10 ml of contrast medium into the right coronary artery. In contrast, in patients with severe stenosis NADH fluorescence significantly increased during the injection, reflecting the ischaemia or myocardial anoxia induced by the contrast medium. NADH laser fluorimetry therefore seems to be promising as a means of exploring myocardial metabolism during cardiac catheterization.