October 1999 newsletter

Hyperbaric chamber-related decompression illness in a patient with asymptomatic pulmonary sarcoidosis.

The authors (from Kiel, Germany) describe the development of right hemiparesis, ataxia, vertigo and paraesthesiae in a 46 year old male doctor undergoing a dry chamber dive to 50m. He was recompressed and developed full resolution of his symptoms. Subsequent investigation included MRI of brain which showed a cerebellar lesion 8 hours post injury. This completely r3esolved 5 days later. However a chest X-ray showed bilateral opacities and CT of chest confirmed bilateral pleuroparenchymal changes which at biopsy were consistent with sarcoidosis. Serum ACE was elevated. Pulmonary function testing was abnormal with reduced FVC and FEV1. The authors suggest that this case illustrates the need for routine chest X-rays (although this had not been performed as part of the subject's commercial diving workup). A chest X-ray had been performed 4 years previously and was normal. Perhaps a non-invasive, non-hazardous alternative would be pulmonary function testing. Routine irradiation of healthy subjects has now been abandoned for sport diving in most countries.

Tetzlaff K, Reuter M, Kampen J, Lott C. Aviat Space Environ 1999;70(6):594-7

Barontalgia: a review, and the influence of simulated diving on microleakage and on the retention of full cast crowns.

This study looks at the causes of dental pain during diving. They suggest that pain during descent is usually referred from barosinusitis whereas pain during ascent is usually caused by pressure differential in teeth affected by dental work. They also compared the strength of different bonding compounds for crowns and found that those using zinc phosphate were weaker than glass ionemer cement. This weakness increases with repetitive pressure cycles. Resin cements are recommended.

Lyons KM, Rodda JC, Hood JAA. Military Medicine 1999;164(3):221-27