Monday, January 30, 2006

Inhaled Insulin Approved by FDA (from Medscape)

Inhaled Insulin Approved by FDA

Daniel J. DeNoon
Medscape

Jan. 27, 2006 — The first inhaled insulin (Exubera) was approved today by the US Food and Drug Administration (FDA) for the treatment of adult patients with type 1 and type 2 diabetes. An inhaled powder form of recombinant human insulin (rDNA), the drug and delivery system is the first new insulin formulation introduced since the discovery of insulin in the 1920s, according to the FDA.

The FDA approval requires the manufacturer to distribute medication guides along with Exubera. The guide contains FDA-approved information written especially for patients.

Exubera is not to be used by smokers or people who have quit smoking within the previous 6 months, according to the FDA. It is also not recommended for people with asthma, bronchitis, or emphysema. However, people with colds or or other upper respiratory infection should still be able to take the drug, although it may cause coughing.

The FDA recommends pulmonary function testing prior to starting inhaled insulin and then every 6 to 12 months thereafter.

The treatment has been in development for 10 years in a joint effort by Pfizer, Sanofi-Aventis, and Nektar Therapeutics. Earlier this month Pfizer bought Sanofi-Aventis' rights to Exubera.

"Until today, patients with diabetes who need insulin to manage their disease had only one way to treat their condition," Steven Galson, MD, director of the FDA's Center for Drug Evaluation and Research, says in a news release. "It is our hope that the availability of inhaled insulin will offer patients more options to better control their blood sugars."

The device that administers the insulin is not as small as an asthma inhaler. Folded up, it is the size of a standard flashlight. A retractable inhaler tube comes out from the body of the device; when extended it reaches from the chest to the mouth. A blister pack of insulin then must be inserted before the device is triggered. Patients and doctors will get extensive training on how to use Exubera.

Inhaled insulin is not the only alternative form in development. Others include insulin mouth sprays, insulin patches, and even oral forms of insulin. And other companies — notably a collaboration between Eli Lilly & Co. and Alkermes Inc. — are racing to develop their own versions of insulin inhalers.

Concern Over Lung Safety

The FDA approval of Exubera follows a 7-2 vote recommending approval by a panel of expert advisors. The advisory panel — in a 5-4 vote — also called for new studies of Exubera's long-term safety in people with underlying lung disease.

The FDA's approval requires the manufacturer to perform long-term studies to confirm Exubera's safety.

The drug is approved for treatment of both type 1 and type 2 diabetes. However, clinical trials found that fewer than 30% of people with type 1 diabetes were able to reduce their blood sugar to recommended levels after 6 months of treatment with the inhaled insulin.

Pfizer and Sanofi-Aventis did not seek FDA approval for Exubera in children and teenagers. Early trials in children were stopped due to concerns about Exubera's effects on children's breathing. The companies plan to restart pediatric studies after consultation with the FDA.

The European Union yesterday approved Exubera for treatment of type 1 and type 2 diabetes in adults.

More about diabetes and diving on our web site at http://www.scuba-doc.com/endmet.html#Diabetes_and_Diving

The 4th Karolinska Post Graduate Course in Clinical Hyperbaric Oxygen Therapy will be April 26-28, 2006.

The 4th Karolinska Post Graduate Course in Clinical Hyperbaric Oxygen Therapy will be April 26-28, 2006.

We will have the opening of our great new rectangular ICU chamber and we will have an educational and important academic meeting where it is possible to meet the faculty and get involved in future clinical multicenter trials, etc..

For more information on this course, please visit our website: www.stocon.se/karolinskaHBO

Sunday, January 29, 2006

More Free Full Text Articles about decompression

Using animal data to improve prediction of human decompression risk following air-saturation dives.
http://snipurl.com/m1kn

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Arterial gas embolism and decompression sickness.
http://snipurl.com/m1kt

More about AGE and DCS at these sites:
http://scuba-doc.com/ageprbs.html
http://www.scuba-doc.com/decosknss.htm

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Hyperbaric oxygen may reduce gas bubbles in decompressed prawns by eliminating gas nuclei.
http://snipurl.com/m1kr

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Ascent rate, age, maximal oxygen uptake, adiposity, and circulating venous bubbles after diving.
http://snipurl.com/m1km

More about obesity at this site: http://scuba-doc.com/obesity.html

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Modulation of decompression sickness risk in pigs with caffeine during H(2) biochemical decompression.
http://snipurl.com/m1kk

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Heat stress attenuates air bubble-induced acute lung injury: a novel mechanism of diving acclimatization.
http://snipurl.com/m1kj

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British Thoracic Society guidelines on respiratory aspects of fitness for diving.
http://snipurl.com/m1ki

More about pulmonary problems at http://www.scuba-doc.com/pulprbs.html

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Contemporary management of patent foramen ovale.
http://snipurl.com/m1kg

More about PFO at http://scuba-doc.com/pfo.htm

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NOS inhibition increases bubble formation and reduces survival in sedentary but not exercised rats.
http://snipurl.com/m1kf

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Biophysical basis for inner ear decompression sickness.
http://snipurl.com/m1kd

More about this at http://scuba-doc.com/inearprobs.htm

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Evaluation of decompression safety in an occupational diving group using self reported diving exposure and health status.
http://snipurl.com/m1kc

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[Acute myelopathy in a diver caused by decompression sickness. A case description and a survey of the literature]
http://snipurl.com/m1kb

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Decompression sickness and recreational scuba divers.
http://snipurl.com/m1k9

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Should computed chest tomography be recommended in the medical certification of professional divers? A report of three cases with pulmonary air cysts.
http://snipurl.com/m1k6

More about this at http://scuba-doc.com/risksPBT.html

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Simulated high altitude diving experiment for the underwater construction operation.
http://snipurl.com/m1k4

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[Somatosensory evoked potentials in decompression sickness]
http://snipurl.com/m1k2

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High-altitude decompression illness: case report and discussion.
http://snipurl.com/m1jz

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Exercise and nitric oxide prevent bubble formation: a novel approach to the prevention of decompression sickness?
http://snipurl.com/m1jx

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Indications for the closure of patent foramen ovale.
http://snipurl.com/m1ju

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Aerobic exercise before diving reduces venous gas bubble formation in humans.
http://snipurl.com/m1jt

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A 32-year-old man with acute bilateral leg weakness following recreational diving.
http://snipurl.com/m1jr

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Exercise and decompression sickness: a matter of intensity and timing.
http://snipurl.com/m1jp

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Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale.
http://snipurl.com/m1jm

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Aseptic bone necrosis in an amateur scuba diver.
http://snipurl.com/m1j4

More about this at http://scuba-doc.com/chrbone.htm

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Cardiac decompression sickness.
http://snipurl.com/m1j7

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Cardiac decompression sickness after hypobaric chamber training: case report of a coronary gas embolism.
http://snipurl.com/m1j9

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The powerful microbubble: from bench to bedside, from intravascular indicator to therapeutic delivery system, and beyond.
http://snipurl.com/m1jb

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Friday, January 27, 2006

Some Links of Interest

Conservation International Frontlines: Ravaging the Reefs
http://snipurl.com/m00b

Divers? Lifesaver Closed
http://snipurl.com/luyl

NASA Space Station On-Orbit Status 25 January 2006
http://snipurl.com/lz2t

Peninsula Wound Center Adds Largest Hyperbaric Oxygen Chamber on Delmarva
http://snipurl.com/m006


Bahamas Recompression Chamber Announcement by Paul Kotik on DeeperBlue.net
http://www.deeperblue.net/newsfull.php/1233

Wednesday, January 25, 2006

UHMS CALL FOR ABSTRACTS DEADLINE IS FAST APPROACHING

Here is a note from Lisa Wasdin, UHMS

UHMS CALL FOR ABSTRACTS DEADLINE IS FAST APPROACHING -- USE THE UNDERLINED "2006 CALL FOR ABSTRACTS" LINK BELOW TO SUBMIT YOUR ABSTRACT.

2006 CALL FOR ABSTRACTS: Deadline for Submission: FEBRUARY 28, 2006

EXTENSION: If you need to request a submittal extension, a fee of $75.00 will apply. Extension deadline is March 31, 2006.

IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT ME.

Sincerely,

Lisa
UHMS

Tuesday, January 24, 2006

New Book, Dangerous Marine Animals, Recognition, first aid and prevention

We have received a note form one of our long-standing newsletter subscribers, John Serton, who has written a book about dangerous marine animals - titled "Gevaarlijke Zeedieren. Herkenning, eerste hulp en preventie". [Dangerous Marine Animals, Recognition, first aid and prevention]

Here is his note and a pdf flyer concerning his new book written in conjunction with a biologist. The book is in Dutch.

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Hello Ernest,

Together with a biologist I have written a new Dutch language book on dangerous marine animals called "Gevaarlijke Zeedieren. Herkenning, eerste hulp en preventie".

It is a prizewinning (Scienceprize of the Dutch National Dive league NOB/CMAS) book with a medical-biological aproach on the subject. With how to recognize the animal, first aid and prevention. It has over 200 references of scientific articles and books of experts like Fenner, Burnett, Williamson etc.

We write about sponges, jellyfish, sea-urchins, stingrays, sharks, stonefish and several other fishspecies to seasnakes, seacrocodile and mammals.
It has become the standardwork for the Dutch Navy.

It has over 300 great and interesting pictures of seacreatures and wounds inflicted by them. 200 full color pages and a luxury hard-cover. See flyer at http://scuba-doc.com/GZFlyer.pdf

To order:
- www.cosmiczebra.com
- books@cosmiczebra.com
- +31-(0)40-2116363

We also do lectures on this topic.

Regards,

John Serton
Author Gevaarlijke Zeedieren

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For more information about this subject, go to our web pages at http://www.scuba-doc.com/hzrdmrnlf.html
http://www.scuba-doc.com/qkrsp.htm

Sunday, January 22, 2006

Free Full Text Articles in the Diving Medical Literature

Have you ever been interested in a subject, really needing more information and finding that all you can get is an abstract. Sure, the full article might be available through a library for significant money or through the Journal if you are a subscriber. Who, for goodness sake, has the need to subscribe to numerous journals or the cash to pay for articles in order to research a subject.

Well, here is my contribution to the problem that many of us face when trying to keep up with medicine. Listed below, in no particular order, are some free full text articles that you might find interesting and might just want to bookmark.

Free Full Text Article
Aerobic exercise before diving reduces venous gas bubble formation in
humans -- Dujic et al. 555 (3): 637 -- The Journal of Physiology Online
http://snipurl.com/ltq1

Free Full Text Article
J Appl Physiol 93: 1349-1356, 2002.
Ascent rate, age, maximal oxygen uptake, adiposity, and circulating venous bubbles after diving
http://snipurl.com/ltq3

See also on our web site:
Exercise and DCS
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Full text article
British Thoracic Society guidelines on respiratory aspects of fitness
for diving -- 58 (1): 3 -- Thorax
http://snipurl.com/ltqw

See also on our web site:
Pulmonary Problems Associated with Diving
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Free Full text
Cardiovascular problems in divers -- WILMSHURST 80 (6): 537 -- Heart
http://snipurl.com/ltrc

See also on our web site:
Heart Problems and Diving
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Free full text article
Exercise-induced intrapulmonary arteriovenous shunting in healthy humans
-- Eldridge et al. 97 (3): 797 -- Journal of Applied Physiology
http://snipurl.com/ltq5

See also article in NEJM about shunting.
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Free Full text article
Bleomycin and scuba diving
http://snipurl.com/ltqo

See more about bleomycin and diving on our website.
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Free Full text article
Hemoptysis Provoked by Voluntary Diaphragmatic Contractions in
Breath-Hold Divers -- Kiyan et al. 120 (6): 2098 -- Chest
http://snipurl.com/ltqz

More about this on our web site here.
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Free Full text article
Neurologic Complications of Scuba Diving - June 1, 2001 - American
Family Physician
http://snipurl.com/ltr3

See more on our web site here.
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Free full text article
Recreational scuba diving, patent foramen ovale and their associated risks
http://snipurl.com/ltq2

More about PFO on our web site.
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Free Full text Article
Should computed chest tomography be recommended in the medical
certification of professional divers? A report of three cases with
pulmonary air cysts -- Toklu et al. 60 (8): 606 -- Occupational and
Environmental Medicine
http://snipurl.com/ltqs

More about Chest CT scans and pulmonary barotrauma on our web site.
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Free Full text article
Computed tomography of the chest in diving-related pulmonary barotrauma
-- Reuter et al. 70 (833): 440 -- The British Journal of Radiology
http://snipurl.com/ltsl

More here.
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Free Full text article
Diving and the risk of barotrauma -- Russi 53 (Supplement 2): 20 -- Thorax
http://thorax.bmjjournals.com/cgi/reprint/53/suppl_2/S20

More about the risk of barotrauma on our web site.
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Free Full text article
Pulmonary barotrauma and related events in divers -- Raymond 107 (6):
1648 -- Chest
http://www.chestjournal.org/cgi/reprint/107/6/1648

More about pulmonary barotrauma on our web site.
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Free Full text article
Pulmonary barotrauma in divers: can prospective pulmonary function
testing identify those at risk? -- Bove 112 (3): 576 -- Chest
http://www.chestjournal.org/cgi/reprint/112/3/576

More about pulmonary function testing and pulmonary barotrauma.
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Free Full text article
Risk Factors for Pulmonary Barotrauma in Divers
http://www.chestjournal.org/cgi/reprint/112/3/654

More about the risk of barotrauma on our web site.
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Friday, January 20, 2006

The Medical Examination and Assessment of Divers (MA1)

Here is the HSE guideline for medical examination and evaluation of divers in the UK.
This is in pdf format and can be seen in it's entirety at http://www.hse.gov.uk/diving/ma1.pdf.

It is interesting to note that disabled divers are not to be refused diving privileges without due consideration and examination (p. 7)

The Medical Examination and Assessment of Divers (MA1)

The Medical Examination and Assessment of Divers (MA1)

Contents:
INTRODUCTION ....
The role of the medical examiner
The Diving at Work Regulations 1997
Initial medical examination
Annual medical examination
RETURN TO WORK AFTER ANY SERIOUS INJURY OR ILLNESS
INCLUDING DECOMPRESSION ILLNESS
Recommended times away from diving
Certificate of medical fitness to dive
Certification of fitness with restrictions
Second opinions and additional advice
Appeal
Medical Records
GENERAL MEDICAL CONSIDERATIONS
Gender
Age
HIV Infection and impaired immunity
Communicable diseases
Medication
Smoking
The Disabled Diver
A. PSYCHIATRIC ILLNESS
Alcohol, drug or substance misuse
B. RADIOGRAPHY
C. RESPIRATORY SYSTEM
D. ASTHMA
E. OBESITY
F. CARDIOVASCULAR SYSTEM
Ischaemic Heart disease
Dysrhythmias
Pacemaker
Patent foramen ovale
Valvular Heart Disease
Blood pressure
ECG
Peripheral Cir
G. EXERCISE TESTING
H. CENTRAL NERVOUS SYSTEM
I. MUSCULOSKELETAL SYSTEM
J. ENT
K. VISION
L. DENTAL
M. ENDOCRINE SYSTEM
Thyroid disease.
Diabetes
N. GENITO-URINARY SYSTEM
O. GASTRO-INTESTINAL SYSTEM
P. SKIN
Q. HAEMATOLOGY
ANNEX A - MEDICAL QUESTIONNAIRE-TO BE COMPLETED BY THE
CANDIDATE DIVER AND GP TO CONFIRM MEDICAL HISTORY
(NO EXAMINATION IS REQUIRED)
ANNEX B - MA2 ANNUAL RESULTS LOG
ANNEX C - DIVER FACT SHEET
1. Pre-employment matters
2. Existing diver health issues
3. Certificate of Medical Fitness to Dive (MA2)
4. Appeals
ANNEX D - CARDIAC SCREENING TOOL
ANNEX E

Thursday, January 19, 2006

Hyperbaric Study of Brain Injury, LDS Hospital

There is an article in the Salt Lake Tribune about a study at the LDS Hospital to determine whether hyperbaric oxygen therapy is effective in treating a range of brain injuries including those from stroke, hypoxia resulting from carbon monoxide poisoning, cardiac arrest and trauma. They request patients suffering from "brain injury' contact them.

LDS Hospital researchers are exploring whether a treatment used for wounds and carbon monoxide poisoning has any clinical value for those suffering traumatic brain injuries.

Patients who undergo the therapy are administered 100 percent oxygen in an enclosed chamber at pressure two to three times greater than normal sea level pressure. (Hyperbaric oxygen)

LDS Hospital is offering hyperbaric oxygen to people with brain injury who meet other qualifications. For instance, patients must be an adult and the injury at least one year old. Currently, there are about 10 people at various stages of the study, but the researchers want to enroll at least 30 more.

Anyone interested in this study can call the LDS Hospital Hyperbaric Medicine Center for more information at 801-408- 3623 .

Things Your Instructor Didn't Tell You! (Scuba diving Humor)

From time to time we get humor that is particularly good or apropos to scuba diving. Here is a set of 'funnies' or truisms sent me by Bill Henss.



Things Your Instructor Didn't Tell You!



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* Don't take up diving to get a suntan.
* People who look good with a mask on are usually ugly without one.
* Inverse Law of Patches: A diver's ability is inversely proportional to
the number of patches they wear
* Diving unprotected with a stranger is like having unprotected sex with
a stranger.
* Never clear a snorkel on a Mexican Federale'
* Anyone who says they have never been afraid while diving hasn't been
diving or is a bad liar.
* Never use a sun intensifier lotion within 30 miles of the Equator.
* People say the funniest things when you shut their air off.
* Never have sex underwater above a coral reef.
* Dry Suits and Beers do not mix
* How to avoid shark attacks:
1. Never Leave Kansas
2. Roll in manure before diving. Sharks hate anything breaded
3. Always dive with a buddy. On sharks approach, point to buddy
4. Dive with a briefcase. Shark may mistake you for an attorney and
leave you alone out of professional courtesy
* Buddies are never where you need them to be.
* You WILL run out of film before the Whale Shark Swims By
* 60 minute camcorder batteries aren't
* One should never make a night dive on a coral reef after taking:
1. Acid
2. Marijuana
3. Black Russians
4. Prosaic
5. Sleeping Pills
* You can spot divers by:
1. Funny Tan Lines
2. Big Watch
3. Says "Huh" alot
4. Bad shocks and springs in car
5. Scars from trigger fish bites
6. Expertise on anti-histamines
* You can spot old time divers by:
1. Funny Tan Lines
2. Big Expensive Watch
3. Old Jeep with bad shocks
4. Log Book has volume number on cover
5. Deaf in at least one ear
6. Has multiple scars.
7. Has cylinders older than you are
8. Talks about making their first wet suit
9. Dive gear is faded
10. Limps from Dysbaric Osteonecrosis
* You can spot newbie divers by:
1. Sunburned
2. Timex Watch
3. Nice car
4. Fills in all the blanks in their logbook
5. No diving related scars
6. Says "Wow, did you see that" alot
7. Equipment looks nice
8. Perfect hearing

Good Things to say to Students or Things Instructors Say

* Welcome to the foodchain folks, you are no longer on the top!
* So what's your point?
* Ah, we did cover this in class didn't we?
* What part of this did you understand?
* No, descending butt first is not acceptable
* You couldn't make it to class because your what died?
* I'm sorry, but no matter what the store owner said I'm not going to
carry all your gear around for you
* Yes Sir, a bad attitude does come with the job
* I see, you just forgot to mention the epilepsy
* Yes, I know you were scared, but don't ever bite me again!
* What do you mean you always bleed like that?
* You don't want to do the buddy breathing because you have what!
* No, this isn't all I do for a living
* Yes, this is what I do for a living...why?
* No Sir, I really can't explain all the biochemical reactions in the
body to hyperbaric stress..BTW, what did you say you did for a living?
* Don't worry about this dive UNLESS..______ ! (fill in from below)
1. You hear the theme music from JAWS
2. You see someones foot hanging out of a fish's mouth
3. All the fish on the reef disappear
4. You see the boat pass you going down while you're on the anchor
line.
* You know your too deep when I start looking good
* You know you need to lose weight when remore' and pilot fish start
hanging around you.
* You know you need to lose a lot of weight when you can't complete a
beach dive because the "Save The Whale Foundation" folks keep pushing
you back in the water.

Things Dive Masters Say

* I don't care who the hell you are Mr. Cousteau. Everyone does a pool
checkout!
* To a nice looking lady carrying her handbag onboard:
o Can I help you with that mam?
* To a guy carrying a set of twin 120's onboard
o Looks heavy dude!
* You should've been here last week, the visibility was great
* You didn't see the whale shark?
* This is just my day job. I want to be an instructor and make the big
bucks

Things Store Owners Say

* REFUNDS!..We Don't Give No Stinking REFUNDS!!!!
* Ok, it's 2 AM, you drive till we get there
* As their instructor, they trust you..so sell like hell!
* Look, I'm, letting you take the boat trips for free, what else do you
want?
* I can't pay you anymore, you know I don't make money on classes
* I can't pay you anymore, you know I don't make money on trips
* I can't pay you anymore, you know I don't make money on equipment
sales
* Sorry about the problem with that check
* Well, I couldn't find the student certification forms you signed, so I
signed them off myself. BTW, did I mention that I had enough
certifications now to get my Master Instructor!
* Let's see, that will be $3,289...ooops! I forgot the mask clear, that
will be $3,292.45!
* If I gave you 10% off, I couldn't stay in business!
* It's the instructor's fault
* Sure, anyone can learn to dive, now what was that problem you had?
* Ok, so your out of the hospital, when can you take another class?
* You want a compass...hmmm, you must mean a directional monitor

Things Divers and Customers Say

* Yeah, like I was in the SEALS, but I can't find my card
* You got any of that scuba stuff here? (toothpick in mouth manditory)
* Can I be certified by tonight, I'm leaving for Cancun tomorrow
* My friend Chuck took me diving once. Can I get a discount?
* I never had this problem before
* Can I hold your hand during the dive?
* Are you married?
* What do you mean I made a 36 on the test?
* I hate your guts
* Thank you very much!

The Great Lies of Scuba Diving

* Sure, anyone can learn to dive!
* Diving is perfectly safe!
* Nah, you don't have to be a good swimmer to dive
* You can learn to dive in just three days!

Useful Hand Signals Not Found in Diving Manuals

* Point finger at SPG. Means: How much air do you have? Raise middle
finger if partner has more air than you!
* Point at mask. Draw line across chest followed by drawing line from
sternum to stomach. Means: Look at the babe over their who's top has
fallen off. Variation #1 Draw line from hip bone to hip bone. Means:
Look at the stud muffin/babe over there who's trunks/bottoms have
fallen down.
* Point in a direction, followed by making squeezing motions with both
hands. Means: Lets follow the gal/guy in the thong!
* Make a motion with hand simulating the use of a yo-yo preceeded with a
pointing motion. Means: Look at the Yo-Yo!
* Point at divers fins. then make circle with right hand while thrusting
left index finger into hole made by right hand followed by pointing at
the bottom. Means Hey you jerk, stop kicking up the F'ing bottom!
* Point at yourself, point at partner. Then make circle with right hand
while thrusting left index finger into hole made by right hand. Means:
Hey, ever done it underwater?
* Thrust finger of either hand against mask of another diver until their
head bounces off cylinder valve. Means: Please pay attrention!
* Point at regulator, then point at crotch or rear end. Means Bite me!

UK Chamber Under Threat of Closure

See News release at http://snipurl.com/lp6e

See also related web site on Diving Medicine Online at http://scuba-doc.com/divuk.htm .

Scapa Flow chamber under threat

Dr John A.S. Ross, consultant for NHS Grampian and a senior lecturer in hyperbaric medicine at The University of Aberdeen, contacted DIVE Magazine to express concern that Orkney Health Board could withdraw financial support for the doctors who staff the chamber. Apparently, a cost-cutting exercise in Orkney has lead to fears that Scapa Flow’s recompression service may be compromised. The chamber in Stromness is seen as an important safety facility for the 4,000 divers who visit Scapa each year.

‘If local medical support is withdrawn, there is a chance that people who get symptoms after diving – and who don’t really have decompression sickness – will have to fly to Aberdeen for assessment,’ Dr Ross said. ‘As it is, anyone with symptoms can be seen at Stromness and evaluated there.

‘I’m concerned that if divers are faced with a flight to the chamber in Aberdeen, they may not come forward for immediate assessment and those who actually have decompression sickness may miss out on the important early treatment.’

A spokesman for Orkney’s NHS service said it had to address a £300,000 deficit, and that ‘efficiencies’ in the hyperbaric service were one of many possible routes being investigated. ‘This is a review of clinical needs,’ said the authority’s medical director, Dr Rosaleen Beattie. ‘We must have appropriate services for diving medicine, and we will definitely have to continue to provide an appropriate service.

‘There are issues that need to be ironed out… There is a recognisable risk, and if we have 4,000 visiting divers, plus locals and commercial divers, then we should expect at least 40 accidents each year and we need appropriate services.’

The issue was due to be discussed at an NHS Orkney meeting in January.

Tuesday, January 17, 2006

Hyperbaric Oxygen Treatment, Google Alert

Google Alert for: hyperbaric oxygen treatment

Hospital purchases hyperbaric chamber
Daily Herald - Provo,UT,USA
... A person getting hyperbaric oxygen treatment sits in the chamber wearing a plastic hood with pure oxygen piped into it, Prothero said. ...

More about Hyperbaric Chamber locations


Doctors question benefit of hyperbaric oxygen therapy for autistic ...
NorthJersey.com - Hackensack,NJ,USA
... "If there is a treatment for autism, the approach would ... "There is little or no evidence that hyperbaric oxygen is helpful for established brain injury.". ...

See discussion in Ten Foot Stop at http://scuba-doc.com/nl040104.pdf



American Diabetes Association(R) Brings National Hyperbaric Rehab ...
Business Wire (press release) - San Francisco,CA,USA
... a daily basis. Hyperbaric oxygen treatment is considered the best treatment for many nonhealing diabetic wounds. It has been instrumental ...

See also http://www.scuba-doc.com/endmet.html


Six ill in Norton
Attleboro Sun Chronicle - Attleboro,MA,USA
... Hospital in Providence, which has a hyperbaric oxygen chamber to treat victims of carbon monoxide poisoning. A sixth person later sought treatment at Sturdy ...

See also
http://www.scuba-doc.com/carbonmon.html

UHMS Mid-West Chapter, 2006 Hyperbaric Medicine Update

Save the Date!!

FRIDAY OCTOBER 13TH & SATURDAY OCTOBER 14TH

K.S.U. CONFERENCE CENTER

STARK COUNTY CAMPUS

Canton, Ohio

Sponsored by:

Mid-West Chapter of UHMS & Mercy Medical Center

Canton, Ohio

Saturday, January 14, 2006

Undercurrent Subscriber Online Update

Reprinted with permission

Undercurrent -- Consumer Reporting for The Serious Scuba Diver since 1975
www.undercurrent.org

January 12, 2006

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Dive News

Recompression Chambers Reject DAN America Insurance: The SSS Recompression chamber network, operator of hyperbaric chambers in a dozen popular dive destinations, has announced that some facilities will no longer accept the Divers Alert Network (DAN) America insurance for payments at some chambers: Nassau, Bahamas; Cabo San Lucas, Merida and Cancun, Mexico. SSS has other chambers, which they say may also stop accepting DAN insurance payments: Cozumel and Playa Del Carmen, Mexico; Ambergris Cay, Belize; the Galapagos Islands, and five in Thailand. In a prepared statement, SSS declared it could "no longer tolerate unpaid services, and since the only insurer in the world who has refused to settle our bills is DAN America, some SSS chambers have no other choice but to ask DAN America patients to pay for services when rendered and file the claims themselves with DAN America." SSS owner Mauricio Moreno told Undercurrent that their chambers are still "duty bound to render services despite a patients' ability to pay." SSS has filed a lawsuit against DAN over the matter.

DAN issued a statement saying: "The dispute involves what constitutes reasonable and customary charges for hyperbaric chamber treatment. Even though some insurers may have signed exclusive arrangements with [SSS] in exchange for lower rates, DAN believes exclusive arrangements are not in the diver's best interest, when the diver needs help at the nearest available chamber to avoid medically unacceptable delays." DAN CEO Dan Orr told Undercurrent that discussions are ongoing and he hopes to work out a solution "that's right for DAN members as well as the industry."

Meanwhile, make sure your credit card limit is high enough to cover emergency medical expenses, no matter what insurance you carry. The full story will be in the February issue of Undercurrent.

Norine Rouse Dies: Norine Rouse, who for nearly three decades guided dives from her Palm Beach Florida Norine Rouse Scuba Club, has died at the age of 80. In 1966, Rouse moved to Freeport, Bahamas with $125 she had won on a television game show and became one of the world's first women diving instructors. Later, she was one of a handful of people licensed by the state of Florida to swim with sea turtles and would steadfastly record and photograph their behavior for scientists. From the 1970s to the 1990s, she tracked the annual return of two loggerhead turtles to the same local reefs. When Robert the turtle returned each Christmas, Rouse would don her trademark yellow wet suit and take kitchen scrubbies out to clean him. (Palm Beach Post)

Somewhat Serious About Underwater photography? Time magazine selected the SeaLife DC500 digital underwater camera as one of the "Most Amazing Inventions of 2005." They said, "The camera eliminates the traditional bulk of underwater cameras, measuring a mere 3.5 in. by 5.5 in. and weighing just under 17 oz. But there's no sacrificing image quality. The SeaLife 500 captures ultra sharp, high-resolution pictures and overcomes underwater photography challenges including poor light, waterborne particles and quick-moving subjects. The camera is waterproof down to 200 ft. and has six modes for land." It's a 5-megapixel camera with a 3x optical zoom lens. Price is $550, strobes are additional. www.sealife-cameras.com

Disallowing a diver to dive: We occasionally get a complaint from a diver who has been told by the captain or crew member that he will not be allowed to dive, and we'd like to gather more incidents. Have you ever been at a resort or live-aboard when the captain disallowed a diver -- or you -- to dive for any reason, e..g. a health issue, breaking rules, alcohol consumption, bad conditions, insufficient experience for a particular dive, anything. How was the issue handled? In your mind was the action proper, i.e., were there safety issues involved? What effect did the discipline have on the other divers, and crew? If you are a professional in the industry, have you ever kept a diver out of the water? Include specifics (where and when the incident happened, name of responsible captain or crew member). Please email your response to clickundercurrent@comcast.net.

Fish, Critter, Coral ID Books: You'll find the best in fish ID books at www.undercurrent.org, everything from Paul Humann's series on the Caribbean and Galapagos, to the hard-to find books specializing in the South Pacific, Indonesia and other exotic waters. All profits from any purchase through www.undercurrent.org go to preserve coral reefs.

Coming up in the February Issue: Sky Dancer, Galapagos, Where the big fish are, Ashore on the Islands, Holbox Whale Sharks, Bonaire Wild Side, Providencia/San Andres _ not as good the second time, Divebag Security Screeners; watch your gear. Undercurrent, Now a nonprofit organization. ... and much more.

In future issues, look for first hand reviews of diving with white sharks south of San Diego, the undiscovered Corn Islands off Nicaragua, Deep Ships on Midway Island, a unique site in the Sea of Cortez, an Aussie live-aboard ... and much much more.

Note: Our travel writers never announce their purpose, are unknown to the destination, and receive no complimentary services or compensation from the dive operators or resort.

Ben Davison, editor/publisher
editor@undercurrent.org

Thursday, January 12, 2006

Interesting Stuff: SSS vs. DAN

Recompression Chamber Network To Stop Accepting DAN Insurance 1/10/2006
Important information for dive travelers relating to Chamber coverage and protection. Article from DiveNewsWire

--------------------------------------------------------------------------------

Divers Alert Network Responds to SSS Statement 1/10/2006
DAN issues a statement relating to issues of DAN chamber treatment coverage around the world. Article from DiveNewsWire

----------------------------------------------------------------------------------

TO: SSS Recompression Chamber Network Affiliates & General Public

FROM: Quantum Processing Services Co, Ltd.

SSS USA Corporate Office.

REF: DIVER ALERT NETWORK DIVE INSURANCE

We would like to inform all that the facilities as listed below will continue to accept Divers Alert Network (DAN) America Insurance. Our facilities are open and ready to treat any dive medical illness. These facilities are under new ownership; however, we are still dedicated to provide the best service possible. For any inquiries, please contact insuranceqt@sssnetwork.com.



Buceo Medico Mexicano

COZUMEL

Cozumel, Q. Roo, Mexico

Ph: 52.987.872.1430

Fax: 52.987.872.1848



PLAYA DEL CARMEN

Playa Del Carmen

Q. Roo, Mexico

Ph: 52.984.873.1365

Fax: 52.984.873.1755



Protesub, S.A.

GALAPAGOS

Galapagos, Ecuador

Ph/Fax: 593.52.526.911



Subaquatic Services of Belize, Ltd.

Ambergris Caye, Belize

Ph: 501.226.2851

Fax: 501-226.2852



Hyperbaric Services of Thailand, Ltd.

PHUKET

Phuket, Thailand

Ph: 66.76.342.518

Fax: 66.76.345.051



KOH SAMUI

Koh Samui, Thailand

Ph: 66.77.427.427

Fax: 66.77.427.377



KRABI

Krabi, Thailand

Ph: 66.75.695.275



KOH TAO

Koh, Tao, Thailand

Ph/Fax: 66.77.456.572



KHAO LAK

Khaolak, Thailand

Ph: 66.76.423.812

Fax: 66.76.423.813

Tuesday, January 10, 2006

Note from Don Chandler, Executive Director, UHMS

To all--

Several months ago we posted several "calls" out for some important matters in our society. There was a call for abstracts, a call for officer nominations, and a call for award nominations, and an opportunity to apply, or submit nominations, for the position of Executive Director. Either you haven't accessed our website to see them or did see them and then forgot they were there (maybe we posted them too early?). For whatever reason, the calls have been largely ignored. We have received only seven abstracts here at the corporate office so far, there have been ZERO nominations for officers, we received only one nomination for an award and it came in without the supporting paragraph telling us why the person is nominated, and we have received only three résumé's from people who want to be considered for the position of Executive Director. In view of this, I am appealing to you to:

1. Send an abstract to us for presentation at our annual meeting in Orlando. Deadline is February 28, 2006. Click on link: http://www.uhms.org/Meetings/ABSTRACTS_Eform.asp

2. Regular members: Please nominate other Regular members for the offices of President-Elect, Vice President, Secretary, and three Members-at-Large. Deadline is February 20, 2006. Click on link: http://www.uhms.org/OFFICER%20NOMINATION.asp

3. Both Regular and Associate members: Please nominate other members for our several annual awards. Deadline is May 1, 2006. Click on link: http://www.uhms.org/Meetings/AWARDS.asp

4. If any of you know of someone you would like to see as our Executive Director, please send that person's name and contact information to me at donchandler@uhms.org or to the Chair of our Search Committee, Dr. Bret Stolp at stolp002@mc.duke.edu and either Dr. Stolp or I will personally contact him/her to see if he/she is interested in submitting a resume to our committee. According to our Constitution the Executive Director must be a member of the UHMS. If a candidate is not a member of the society, we will give him/her an opportunity to join and then reapply. The deadline for resumes is June 1, 2006.

I hope to hear from many of you in response to these important matters.

Don

*******************************************************************

Position Description
***Executive Director***
Undersea and Hyperbaric Medical Society

The Executive Director shall be responsible for the day-to-day operation and direction of the administrative offices of the Society. He/She shall inform and advise the Board of Directors on all matters of planning, policy and finances affecting the Society. The Society’s newsletter Pressure shall be the responsibility of the Executive Director, who shall function as the Executive Editor of the newsletter. He/She will be responsible for the signing of all legally binding documents for the Society and perform other duties as requested by the Board of Directors. The Executive Director shall be responsible for the proper maintenance and improvement in the Society’s office spaces. He/She shall also serve as the Society’s fiscal officer and, as such, shall be empowered to sign all checks written against the Society’s funds/bank accounts and for overseeing the Society’s annual budget.

The Executive Director shall be responsible for seeking funding to support the Society’s literature service, workshops, and symposia. He/She will serve as a liaison with the Armed Services and other federal agencies and, when necessary, interact with congressional committees; of particular importance in staying current with activity of national importance, such as the Centers for Medicare and Medicaid Services (CMS) reimbursement issues for hyperbaric oxygen treatments. The Executive Director shall, as much as possible, develop a strong liaison with other national and international societies and associations. The Executive Director shall work closely with the Workshop Committee chairperson to inform him/her about areas requiring review and to then seek funding to support any approved workshops.

The Executive Director shall be responsible for all official correspondence, electronic information management, and telephone information related to Society activities and questions related to diving and hyperbaric medicine. He/She shall oversee and be responsible for the Board of Directors and annual meeting arrangements, as carried out by the Society Meeting Planner/Coordinator; in the absence of a Meeting Planner/Coordinator, the Executive Director shall assume this responsibility.

The Executive Director shall require that an annual audit be carried out in a timely fashion by a reliable accounting firm or an individual accountant with CPA status. He/she shall arrange for periodic budget committee meetings in concert with the Chairperson of the Budget Committee and shall assist in the preparation of the annual budget committee report as needed.

The Executive Director shall be responsible for keeping the President informed about any national issues in the fields of hyperbaric and diving medicine requiring his/her attention. He shall also keep the President informed about new sources of Society revenue or unusual debts.

The Executive Director shall advise and assist the staff person responsible for Society membership. He/she shall be responsible for soliciting corporate members and the soliciting of funds for the Society’s Research Foundation. He /She also shall assist the Editor of the Society peer-reviewed professional journal, Undersea and Hyperbaric Medicine, to ensure the journal articles are properly reviewed and is published on time. The Executive Director is responsible for maintaining both the Awards Committee and the Membership Committee files in the Society office. He/She is a permanent member of these two committees and works to assist the chairpersons.

The performance of the Executive Director shall be evaluated every two years, on the anniversary of his/her appointment. A team made up of the President and the Immediate Past President shall perform this review. This responsibility cannot be delegated to other UHMS office holders. The results of the performance review will be given, in writing, to the Executive Director prior to being reported to the Board of Directors in regular session. In the event the evaluators determine unsatisfactory performance on the part of the Executive Director, he/she will be given one year to improve his/her performance to be recommended for out-placement; said recommendation to be made to the Board of Directors in executive session which shall be made up of only the elected members of the Board of Directors.

Resume diving, Type II diabetic scuba instructor?

Here is a question presented to us about an older diabetic scuba instructor resuming diving.

Dear Sir,

I used to be a PADI scuba Instructor in 1978 in Papua New Guinea. I have not been diving since then. Recently my son has bought me a scuba diving course and would like me to do the course with him. I am 68 years old and I guess reasonably fir, but I have type 2 diabetes. What are the risks involved for a person of my age with non insulin diabetes? Your advise would be very much appreciated.

Answer from scubadoc.

One would suppose that your answer lies in the degree of control of your diabetes that you manage. You don't mention several things that are important: the HgbA1c level, the medications that you take and whether or not you have any degree of coronary artery disease.

If your HgbA1c is within normal limits and you are personally OK with your medication and diet regimen - then there would be little in the way of risk as concerns your blood sugar levels dropping during a dive. Most diabetics who dive carry along some glucose replacement in case of hypoglycemic need at depth.

Other factors that are of concern would be your level of physical fitness and whether or not you have any degree of target organ damage such as renal, eye, brain or heart disease secondary to the diabetes. Peripheral neuropathy would preclude you diving as it would mask decompression sickness.

This might be good in that it might cause you to start an exercise program and get medical evaluation that you have been putting off. Get a good physical exam including an exercise stress test before you do anything.

Before taking the course ask yourself if, as an instructor, you would give someone other than yourself lessons. If the answer is yes, after the above considerations - then by all means go diving. Also, see our web page about diabetes and diving.

Hope this is helpful!

Ernie Campbell, MD
Scubadoc's Diving Medicine online
http://scuba-doc.com

More about diabetes and diving here:

1. Diabetes
The information on this web page can be found at http://www.scuba-doc.com/endmet.html . Return to our Home Page Go to our Site Map
http://www.scuba-doc.com/dbts.htm

2. Endocrine problems
Discussions of Diabetes and Diving (Changing outlook) Hyperthyroidism ... PAGE PDF Index Diabetes and Diving The Thyroid and ... Obesity and Diving Diabetes and Diving Guidelines for
http://www.scuba-doc.com/endmet.html

3. Questions and Answers
Questions and Answers frequently encountered HOME Here Scuba Clinic Forum || Weblog of Site Updates || Tenfootstop Weblog || DiveMed Email || FAQ || Contact Us Scubadoc's Diving Medicine
http://www.scuba-doc.com/Q&A.html

4. Endocrine problems
DOWNLOAD THIS PAGE Index Diabetes and Diving The Thyroid and Diving ... problems settings. The Diabetes and Diving Committee of the ... of the American Diabetes Association notes that there
http://www.scuba-doc.com/endmet.pdf

Sunday, January 08, 2006

Comparison of three monoplace hyperbaric chamber intravenous infusion pumps. UHM 2005: VOL 32, ISSUE #6

Have you ever wondered about pressure and gravity functions of intravenous and other drainage tools in patients in a hyperbaric chamber? Well, here ia an article comparing the changes that take place with various infusion pumps during pressurization in a chamber.

Comparison of three monoplace hyperbaric chamber intravenous infusion pumps. L.K. Weaver, D. Ray, D. Haberstock

Abstract:

We compared the infusion accuracy of the Baxter Flo-Gard 6201,IVAC  530 and Abbott Lifecare 3HB pumps with saline and enteral formula at chamber pressures from 86.1 kPa (0.85 atm abs)to 304 kPa (3.0 atm abs).

The Baxter pump infused ±10% saline at all tested pressures and rates (1-1,999 ml/hr).At 1 ml/hour,the IVAC infused 18%more saline than expected (86.1 kPa).

The Abbott infused -15%and -23%than expected at 202.6 kPa (999 ml/hr)and 304 kPa (800 ml/hr),respectively.A 10-minute chamber compression and decompression (86.1-304-86.1 kPa) resulted in lower-than-expected measured volumes during compression (64-112%)and higher-than-expected measured volumes during decompression (62-114%)at rates of 1,5,and 10 ml/hr for all pumps.

Enteral infusions (100 ml/hour)resulted in -20%to +12%fluid volume discrepancies.In conclusion,the Baxter pump had the best overall performance.Changes observed during compression and decompression may be clinically important.

Saturday, January 07, 2006

HBO2 for treatment of necrotizing fasciitis. UHM 2005: VOL 32, ISSUE #6

Adjuvant Hyperbaric oxygen therapy (HBO2)for treatment of necrotizing fasciitis reduces mortality and amputation rate. S.J. Eescobar, J.B. Slade,Jr., T.K. Hunt, P. Cianci

Abstract:
Objective: A retrospective analysis of 42 patients with necrotizing soft tissue infections treated with adjunctive HBO2 to ascertain efficacy and safety. Overall mortality was 11.9% and morbidity 5%.

Summary Background Data: Necrotizing soft tissue infections have historically high rates of mortality and morbidity, including amputation. Common misconceptions that prevent widespread use of adjunctive HBO2 for this diagnosis include delays to surgery, increased morbidity, and significant complications.

Methods: Forty-two consecutive patients (average age 56.1) with necrotizing fasciitis presenting to a major referral center were treated with adjunctive HBO2 as part of an aggressive program of surgery, antibiotics and critical care. Involved areas included the lower abdomen (15 patients), thigh and perineum (9 patients), flank (4 patients), lower leg (3 patients) and arm,shoulder,and axilla (2 patients). Co-morbidities included diabetes mellitus, chronic renal failure, intravenous drug abuse, peripheral vascular disease and malignancy.

Results: Mortality was 11.9%(5 patients). Both amputations (a finger and a penis), occurred prior to transport to our facility. The average number of surgical debridements was 2.8 per patient; 1.25 performed prior to the start of HBO. The infectious process was controlled after an average of 7 HBO2 treatments were administered to ensure successful wound closure. Complications consisted of only mild ear barotrauma in 3 patients (7%) and confinement anxiety in 17 (41%) but did not prevent treatment.

Conclusion: Compared to national reports of outcomes with “standard ”regimens for necrotizing fasciitis, our experience with HBO2, adjunctive to comprehensive and aggressive management, demonstrates reduced mortality (34% v.11.9%), and morbidity (amputations 50% v.0%). The treatments were safe and no delays to surgery or interference with standard therapy could be attributed to HBO.

Related links on Scubadoc's Diving Medicine Online

Hyperbaric Oxygen Treatment, Abstract and Full Text of JAMA Article
necrotizing fasciitis, since anaerobic bacteria play a role in ... Although
necrotizing fasciitis is an accepted indication for HBO, the benefit HBO ...
www.scuba-doc.com/hbotrtmnt.html

Links to HBO Therapy
... MANAGEMENT OF DECOMPRESSION SICKNESS http://www.aerospacemed.org/11mgmt_dcs.htm.
Necrotizing fasciitis http://www.emedicine.com/EMERG/topic332.htm. ...
scuba-doc.com/hbolnks.htm

Recent HBO References
Necrotizing fasciitis of the eyelids and orbit. Arch Ophthalmol. 1998
Nov;116(11):1548-9. . (kein Abstract verfuegbar) (No abstract) ...
www.scuba-doc.com/HBOref.html

[PDF] Ten Foot Stop, October 1, 2001
... Mathieu D. Related Articles [Hyperbaric oxygen for the treatment of necrotizing
fasciitis]. Ann Dermatol Venereol. 2001 Mar;128(3 Pt 2):411-8. Review. French. ...
www.scuba-doc.com/archoct0101.pdf

Functions derived from diffusion-based decompression theory. UHM 2005: VOL 32, ISSUE #6

Relationship between two different functions derived from diffusion-based decompression theory.
H. Ashida, T. Ikeda, P. Tikuisis, R.Y..Nishi

Abstract:
Hempleman's diffusion-based decompression theory yields two different functions;one is expressed by a simple root function and the other by a complex series function. Although both functions predict the same rate of gas uptake for relatively short exposure times, no clear mathematical explanation has been published that describes the relationship between the two functions.We clarified that
(1)the root function is the solution of the one-dimensional diffusion equation for a semi-infinite slab,
(2)the series function is an applicable solution for a finite slab thickness,
(3)the parameter values of the root function can be used to determine the parameter values of the series function,and
(4)the predictions of gas kinetics from both functions agree until an adequate amount of diffusing inert gas reaches the boundary at the opposite end of the finite slab. The last point allows the use of the simpler root function for predicting short no-stop decompression limits. Experience dictates that the inert gas accumulation for a 22 min at 100 feet of seawater (fsw)dive is considered safe for no-stop decompression.

Although the constraint,Depth X the square root of bottom time = 100 X the square root of 22 has been applied as an index to determine either the safe depth or bottom time (given the other)for no-stop decompression,it should not be applied more broadly to dives requiring decompression stops.

The relative safety of forward and reverse diving profiles. UHM 2005: VOL 32, ISSUE #6

The relative safety of forward and reverse diving profiles. S. McInnes, C. Edmonds, M. Bennett

Abstract:

A recent workshop found that with no-decompression dives, “reversed dive profiles ”(RDP) did not increase the risk of decompression sickness (DCS). Thus in multi-level dives, the deeper part of a dive may be performed later in the dive, and repetitive dives may progress from shallow to deep. This contradicts the conventionally recommended forward dive pro file (FDP) when the deeper dive, or deeper part of the dive,is performed first. The RDP Workshop recommendations were made despite the absence of adequate data.

We performed two groups of experiments to test this hypothesis. We exposed two matched groups of 11 guinea pigs each to forward and reverse multi-level diving profiles to determine any substantial difference between FDPs and RDPs. There was no evidence of DCS in any of the FDP animals, while six (55%) of the RDP animals exhibited symptoms of severe DCS and died. This difference was statistically significant (P =0.01).

We then compressed two groups each of 11 guinea pigs to repetitive dives to determine any substantial difference in the risk of DCS when two equivalent sets of three dives were conducted from the deepest to most shallow on the one hand (FDP), and from the shallowest to the deepest on the other (RDP). Over two such series of dives (the second extended in time and depth to increase DCS risk), there was a significantly higher incidence of severe DCS in those animals in the RDP group. Seven of 21 exposures (33%) in the RDP group resulted in severe DCS versus none in the FDP group (P =0.01).

Our findings suggest that multi-level and repetitive dives performed in the established FDP manner are less hazardous than those performed in the reverse pro- file mode, at least for the exposures we chose. We believe the recommendations of the workshop should be re-examined.

Workshop Links

Scientific Diving Safety Manual: Appendix 13
Reverse dive profiles are being performed in recreational, scientific, ... No convincing evidence was presented that reverse dive profiles within the ...
www.sfos.uaf.edu/dive/manual/appendix13.html

[PDF] UCSB Diving Manual
Reverse dive profiles are being performed in recreational, scientific, commercial, ... The prohibition of reverse dive profiles by recreational training ...
www.ehs.ucsb.edu/units/diving/dsp/forms/manual/l.pdf

Smithsonian Scientific Diving Program Diving Safety Research
Proceedings of Reverse Dive Profiles Workshop. Smithsonian Institution ... Reverse dive profiles are being performed in recreational, scientific, ...
www.si.edu/dive/ds_research.htm

DCS Risk, direct ascent from N2-O2 saturation dives, UHM 2005: VOL 32, ISSUE #6

Direct ascent from air and N2-O2 saturation dives in humans: DCS risk and evidence of a threshold.
H. D. Van Liew, E.T. Flynn

Abstract:
To estimate the risk of decompression sickness (DCS)for direct ascents from depth to the sea surface for personnel who are saturated with hyperbaric nitrogen, we analyzed 586 experimental air or nitrogen-based saturation dives. No DCS occurred on shallow saturation dives between 12.0 and 20.5 feet of seawater,gauge (fswg) but incidence of DCS rose abruptly when depth was deeper than 20.5 fswg, reaching 27% at 30 fswg. This is evidence of a threshold for clinical DCS.

A model based on a Hill function that provides for a threshold predicts the observations better than a model having no threshold provision; the no-threshold model overestimates risk shallower than 20.5 fswg and underestimates risk between 20.5 and 30 fswg. For situations such as submarine rescues,we recommend our threshold model when the exposure pressure is 33 fswg or less. We also discuss deeper dives where there are no human data; extrapolations can be quite different for models that provide for a threshold than for models that do not.

Menstrual cycle dependent right-to-left shunting: A single-blinded transcranial Doppler sonography study. UHM 2005: VOL 32, ISSUE #6

Menstrual cycle dependent right-to-left shunting: A single-blinded transcranial Doppler sonography study. S.Klien, M. Spiege, K. Engelhard, C. Schmidaue, H. Ulme, M.Dieper, T. Mutzbaue, E. Schmutzhard

Abstract:

Background and purpose:
Menstruation has been described as risk factor for neurological decompression sickness in divers.In considering this for paradoxical gas embolism, we hypothesized that there may be a link between cycle-dependent hormonal changes and the manifestation of a right-to-left shunt (RLS).

Methods:
40 women with a regular cycle of 28 days underwent transcranial Doppler sonography examinations (TCD) on day 1 and on day 15 of the menstrual cycle. Cerebral high intensity transient signs (HITS) proved a RLS.

Results:
We found a 25% RLS incidence consistent with the literature. In 7 of 10 shunt positive women it was detected mainly or exclusively on day 15. This difference in PFO detection rate is statistically significant (p=0.031),indicating more RLS during the peri-ovulatory period.

Conclusions:
Our results do not support menstruation as a risk factor for neurological decompression sickness. The peri-ovulatory estrogen peak, which leads to systemic vasodilation, may explain our data.Factors that increase the risk for developing a RLS and thereby paradoxical embolism should be avoided, perhaps including diving during the peri-ovulatory period of the menstrual cycle. Furthermore, contrast PFO testing in fertile females may be most sensitive if conducted mid-cycle.

Related links on Scubadoc's Diving Medicine Online
Patent Foramen Ovale
PFO (Patent foramen ovale) is a persistent opening in the wall of the heart which
... Echocardiography is the tool of choice in making the diagnosis of PFO. ...
scuba-doc.com/pfo.htm

[PDF] Patent Foramen Ovale
File Format: PDF/Adobe Acrobat -
PFO (Patent foramen ovale) is a persistent opening in the wall of the heart which
did ... and some experts feel that a large atrial septal defect (PFO) is a ...
www.scuba-doc.com/pfo.pdf

References for PFO
HOME > Heart > Patent Foramen Ovale > PFO References, ... Search this site powered by
FreeFind. Medline References for PFO. Moon RE, Camporesi EM, Kisslo JA. ...
scuba-doc.com/refpfo.htm

Chronic Neurological Adverse Effects of Diving
Patency of the foramen ovale (PFO) may be a cause of unexplained decompression
... transesophageal contrast echocardiography for the presence of PFO. ...
www.scuba-doc.com/chrneur.htm

Gender Differences in Divers
The underlying mechanism for the correlation between menstrual cycle and ... There was no differences between mean duration of menstrual cycle and menses in ...
www.scuba-doc.com/womdiff.htm

Risks of Women In Diving
ST LEGER DOWSE M, BRYSON P, GUNBYP, FIFE W: Scuba diving and the Menstrual cycle: retrospective data from a follow on prospective study of diving women UHMS ...
www.scuba-doc.com/rskwomdiv.htm

[PDF] Divemed/Ten Foot Stop Newsletter, 12/31/03
... http://snipurl.com/3kx9 RESEARCH shows possible link between menstrual cycle and bends in ... Divernet, UK ... 1 Decompression ...
scuba-doc.com/nl123103.pdf

[PDF] Microsoft PowerPoint - 3E3847B2-72CB-08175E.ppt
Women, Menstrual. Cycles, and. Cycles, and. Decompr. essi. on Sickness. Decompr. essi. on Sickness. Martin M. Quigley, MD. Naval O ...
www.scuba-doc.com/womensesdcs.pdf

[PDF] Divemed/Ten Foot Stop Newsletter, 12/15/03
... Page 4. Divemed/Ten Foot Stop Newsletter, 12/15/03 Research shows possible link between menstrual cycle and bends in women divers http://snipurl.com/3fck ...
scuba-doc.com/nl121503.pdf - Supplemental Result - Similar pages

[PDF] Divemed/TFS Newsletter, March 31, 2002
... 7: Rowe WJ. Optimal time in the menstrual cycle for spacewalks. Aviat Space Environ Med. 2001 Aug;72(8):770-1. No abstract available. ...
www.scuba-doc.com/mar3102.pdf

[PDF] Divemed/Ten Foot Stop Newsletter, 11/30/03
... Decompression sickness in women: a possible relationship with the menstrual cycle. Lee V, St Leger Dowse M, Edge C, Gunby A, Bryson P. http://snurl.com/378i ...
scuba-doc.com/nl113003.pdf

EEG & MRI in Neurological DCS, Abstract from UHM 2005: VOL 32, ISSUE #6

Electroencephalography and magnetic resonance imaging in neurological decompression sickness.

M. Gronning, J. Risberg,, H. Skeidsvoll, G. Moen, L.Aanderud, K. Troland, E. Sundal , E. Thorsen

Abstract:
The purpose of this study was to evaluate the use of electroencephalography (EEG)and magnetic resonance imaging (MRI)in the clinical evaluation of acute decompression sickness(DCS)in the central nervous system (CNS). Twenty-one patients treated because of acute DCS in the CNS during 1999-2001 were included,15 patients with clinical cerebral DCS and five with clinical spinal cord DCS. Seven patients had abnormalities in their EEG, five with a cerebral DCS and two with spinal cord DCS.

MRI showed high intensity lesions in the spinal cord in four patients with clinical spinal cord DCS and in one with clinical cerebral DCS. Cerebral lesions were not identi fied by MRI in any patient. In conclusion,EEG showed unspecific abnormalities in only one third of the cases. Conventional MRI with a 1.5 T scanner may be of help in the diagnosis of DCS in the spinal cord, but not in the brain. EEG and MRI have low sensitivity in the diagnosis of acute DCS in the CNS. Recompression treatment of DCS should still be guided by clinical neurological examination and assessment of symptoms.

Related links in Scubadoc's Diving Medicine Online

Long-term Effects of Sport Diving
Osteonecrosis, neurological disturbances, systemic and genetic problems, ...
Spinal cord DCS (cervical tract).
www.scuba-doc.com/LTE.htm

Chronic Neurological Adverse Effects of Diving
Thirty-seven divers who suffered from neurological DCS were compared with matched
control divers who never had DCS. All divers were investigated with ...
www.scuba-doc.com/chrneur.htm

Dockwalk Magazine publishes article from Scubadoc's Diving Medicine Online

Dockwalk Magazine, a prestigious publication for captains and crew of cruisers and large vessels located in Fort Lauderdale, Florida has published our article about "Ideal Body Weight for Diving", on page 12 0f their November 2005 issue.

The article was originally in our Ten Foot Stop Newsletter on 06/15/04 at http://scuba-doc.com/nl061504.pdf . The article is reproduced below.

"Edmonds, in the book, Diving and Subaquatic Medicine, states that weight
should be less than 20 % above the average ideal weight for age, height and
build. Obesity is undesirable because it increases the risk of decompression
illness, there being an increase in nitrogen absorption of 4.5 times in fat. Sport
diving is more lenient than commercial in this regard in that the bottom times
can be reduced according to the percentage that the candidate's weight
exceeds that expected for height and build.

Body mass index (BMI) is a method for determining the percentage of fat. It
is determined by weight in Kg divided by height in meters squared.
In some areas of the world where medical fitness is more stringently regulated
than the US, a high BMI (body mass index) would deter one from diving.
Complicating conditions of adiposity include diabetes mellitus, dyslipidemia or
hypertension and their associations with coronary artery disease. The BMI is
important to divers due to the fact that people with high BMI are more prone
to coronary artery disease and an untoward coronary event while diving. A BMI
above 30 kg/m2 is thought to be excessively risky for diving. Of course,
measured %BF can sometimes show that the diver is quite large and muscular
and this needs to be taken into consideration.

Related links:
Obesity and DCS
Describes the increased risks of diving with obesity. ... Home > Endocrine and
Metabolic Problems >

[PDF] Ten Foot Stop Newsletter, 06/15/04


[PDF] BRITISH SUB AQUA CLUB
File Format: PDF/Adobe Acrobat


[PDF] DiveMed/TFS Newsletter, Dec. 31. 2002

Friday, January 06, 2006

Of Interest to all Hyperbaricists, letter from UHMS

Here is a letter from Don Chandler, Executive Director, UHMS. I believe that even if you are not a member of the UHMS - that you will find this material important and helpful.

"Here are some items that I believe you will find interesting.

Blue Cross/Blue Shield is (again) reclassifying what medical conditions they will approve for HBOT. Sometime in the early fall we learned that BC/BS of Idaho had reclassified some medical conditions from the traditionally accepted indications for adjunctive hyperbaric oxygen treatment from the "approved " to the "investigational" category. This concerned us greatly and we discussed a plan for a strategy to approach Idaho BC/BS during our last Board of Directors (BOD) meeting. Following the BOD meeting, Tom Workman showed the announcement to Dr. Dick Smerz, who was doing a hyperbaric facility survey for him. Dick said that he was familiar with the language from Idaho BC/BS because he had recently been informed of a similar action by BC/BS of Hawaii. This raised a "danger flag" in everyone's mind. Since that time, we have learned that one of the Blues in Pennsylvania has also taken a similar action. As reported by Dr. Bob Warriner the conditions reclassified by BC/BS of Idaho, Hawaii, and Pennsylvania into the "investigational" category are:

Carbon monoxide poisoning
Necrotizing soft tissue infections
Acute peripheral arterial insufficiency
Chronic refractory osteomyelitis an acute osteomyelitis refractory to standard medical management
Cerebral edema
Refractory mycoses (mucormycosis, actinomycisis, canidiobolus coronato)
Radiation necrosis (osteoradionecrosis and soft tissue radiation necrosis)

Your society has not been silent nor have we been taking the position of just an interested bystander with this issue. Our President, Dr. Lin Weaver had just recently formed a new committee to deal with such issues. The new committee is called Authorization, Utilization, Quality, and Reimbursement Committee (AUQR). AUQR is chaired by Dr. Ron Bangasser with members consisting of Tom Workman, Dr. Bob Warriner, and Dr. Jeff Niezgoda. Dr. Weaver acted quickly to activate this committee and also sought the assistance of Dr. Ben Slade, Dr. Laurie Gesell (Chair, HBOT Committee) and Dr. John Feldmeier. As I write this they are working hard to develop a position that will be presented to BC/BS at the national level. Even this week, some of the committee will be meeting with BC/BS in Hawaii to see what they can learn.

This is a classic example of how your society works for you, our members...and the several thousand who work in the field of Hyperbaric Medicine but are not members of the UHMS. We are working with the ACHM and HOTA as we plan the strategy to reverse this very disturbing BC/BS action. Please be assured that we have some of the best in the world working this issue. Give them a couple of weeks to get their strategy together and BC/BS will think they have a hornet loose in their bonnet. I will keep you informed as progress is made.

More on Malpractice Insurance.
Dr. Bob Goad reports that Doctors Company has been his malpractice insurer since 1993 and he considers them superb and with highly competitive rates.
Berry Baker forwarded an email he got from an insurer friend of his who said: "I have a market for HBOT physicians. Physicians Insurance Company (PIC) and their reinsurers have agreed to accept HBOT physicians in Florida and Texas. PIC only writes on an admitted basis (protects policyholders if company becomes insolvent). PIC had very good rates, but they only take about 70% of the physicians that apply...Rates are based on Physician's Specialty if they are practicing HBOT only part time. If they are HBOT full time, a rate for General Practice/non-surgical will be used." This comes from Chris Baxter in Pensacola FL (800) 641-8865.
Dr. Ron Bangasser heard from his Paralegal in California. She stated that NorCal covers Wound Care and HBO as Family Practice with Surgery Assisting. Ron reports that he has had that coverage for years and that Wound Care and HBO did not change or add anything to that coverage.
Dr. Bonnie Bock informed me that she was with Doctors Company, but then changed to CAP MT a year ago due to cost and service. She reports that both companies are HBO friendly and she is classed as an internist, with no added fees.
Dr. Tom Bozzuto wrote that he was in an Emergency Medicine group Florida and they were covered by Mag Mutual. For those who did HBO/Wound Care under their ER coverage, there was no additional premium.
Dr. Richard Sadler reported that he is a practicing thoracic and vascular surgeon and he does HBO one morning each week using three monoplace chambers. His malpractice policy covers him for all of this activity in a "wraparound" policy. He uses MMIC.
More on CO Poisoning Following the Hurricanes.
Robin Shafer RRT/CHT who is the Safety Supervisor at the Christus St. Elizabeth Hyperbaric and Wound Care Center in Beaumont, Texas sent me some information well worth passing on to you. Much of Robin's report follows:
"We had two male patients that were sleeping in a mobile home with a generator at the far end of the trailer. The first night with this arrangement they were okay. On the second night, they think that the wind shifted. One of the men woke up and felt strange. When he tried to stand, his legs felt rubbery and out of control. He could not awaken his friend, so called 911. On arrival the friend was still unconscious, but woke up (somewhat) just prior to his first HBO treatment. We treated these two guys in our two monoplace chambers, as we had not yet had a chance to check out the multiplace chamber after the storm. They both and several treatment here and were released to return to other areas, so we're not sure of the total number of treatments they had.
Then we had two more guys who were in a hotel in Jasper , TX. They were from Mississippi and were doing seismographic work in the area. The hotel had lost power (as had every other place in the area). The hotel staff placed a generator right outside the mens room. The older gentleman said he know that was dangerous , so he moved it away before going to bed. Later that evening someone (probably hotel staff) moved it back. When the other workers tried to get them up to go to work in the morning they were unable to get a response from them. They finally got the staff to open the door and both were unconscious. On arrival to our facility probably about 3 hours had passed. The younger victim had c/o nausea and vomiting, but the older one was unconscious and posturing. By he end of the first treatment the older one was responding slightly to his name. They had BID treatments for several days and were finally released to go back to Mississippi for follow-up. Although the older patient (they were 19 and 47) had several other events related to his CO exposure (MI and renal infarct), he seemed to be recovered completely mentally.
One other event was a family of 5, also staying in a mobile home, who presented with headaches and nausea. This was a man and kids ranging from 2-9. They all recovered well (perhaps more warning about the use of generators near mobile homes should be given). The highest CO level recorded in our patients was 13, but they had all been on O2 for varying periods of time on arrival All the patients after the first two were treated in our multiplace chamber (12 patient unit made by Gulf Coast Hyperbarics)."
Julio Garcia, Center Director of the Center for Wound Care and Hyperbaric Medicine at the Springhill Medical Center in Mobile, AL sent me a copy of an article that ran in the Mobile (AL) Register. The following excerpts from the article written by Penelope Mc Clenny are worth reading:
"Renee Funk, an epidemiologist with he Atlanta-based CDC, and Deidre Crocker, and epidemiological intelligence officer with the agency, spent two weeks in Mobile ...interviewing several of the more than 20 patients who were treated at Springhill Medical Center for carbon monoxide poisoning following the Aug. 29 storm.
In the days after Katrina, the hyperbaric medicine department at Springhill became packed with carbon monoxide victims, said Julio Garcia, a registered nurse and director of the department. The hospital uses its hyperbaric chamber to treat those poisoned from carbon monoxide with pressurized oxygen.
While some of the ill people had operated generators inside their homes, Funk and Crocker discovered that other victims thought they had placed generators in safe areas.
So many poisonings had occurred, even though people knew not to keep them indoors. 'That's one of concerns,' Funk said. 'Most people had them in carports or porches.'
Garcia, who worked with the CDC scientists and local health department officials during their review of the situation, said he was surprised by some of the information that they uncovered.
'What we found to be the biggest contributing (factor) is that it is not well-defined what is a well-ventilated area,' Garcia said. 'It is not as simple as you think, Really...they thought they were doing the right think.'
In a number of cases, people put generators in covered areas close to their homes to protect them from rain, or placed them in nearby outdoor areas to guard against theft, Garcia said.
A generator that's too close to a house..especially near an open window or vent...poses dangers because of the high concentrations of gas that it emits.
'They actually produce more carbon monoxide that a car,' Funk said. Funk and Crocker said they will use the information they gathered in Mobile to encourage more public awareness campaigns about generator safety. For instance out of all the Mobile-area victims they interviewed, few said they used carbon monoxide detectors while their generators were operating. Those that did have dectors had dead batteries, Funk said. Funk and Crocker are planning on working with the Consumer Product Safety Commission to ensure that instructions on generators clearly explain where to keep them in proximity to a home. The epidemiologists also plan to talk to retailers, urging them to group generator-related supplies together in their stores.
'If they see the CO detector and the extra long extension cord, they are more likely to pick them all up at once," Funk said.
The Mobile County Health Department is considering holding news conferences on generator safety at the start of next year's hurricane season, according to Melissa Tucker, the department epidemiologist who worked with the CDC scientists.
"I don't know what it's going to take to make people understand that people can get hurt or killed from carbon monoxide poisoning,'Tucker said"

We wonder, too, Melissa, we wonder too...but certainly more of what the CDC and the Mobile County Health Department says they will do certainly will help. Thanks for doing what you do to save lives!

That's all for now, folks. The best to you!

Don"

News Release from Dick Clark, Baromedical Reearch Foundation

NEWS RELEASE
December 28, 2005

The Baromedical Research Foundation announces the formation of a Data Safety and Monitoring Board.

One provision of acceptance of some U.S. federally funded human research is that a Data Safety and Monitoring Board be in place. The purpose of the DSMB is to oversee the safety of participants and the validity and integrity of resulting data. The Foundation is not currently the recipient of federal funds, although grant applications have been filed. However, the Foundation places high priority on scientific integrity and the safety of patients enrolled into its clinical trials. Accordingly, a DSMB has been convened. It is multidisciplinary in scope, involving experts from clinical practice, hyperbaric safety, biostatistics and bioethics.

To learn more about the Foundation’s human hyperbaric trials currently underway and planned, and the role and composition of the DSMB please visit www.baromedicalresearch.org