Dysbaric disorders: aseptic bone necrosis in tunnel workers and divers

Osteonecrosis

Younger patients are affected more often by osteonecrosis than by osteoarthritis, and osteonecrosis has significantly greater long-term morbidity.

Corticosteroids are the most common cause of nontraumatic osteonecrosis.

The femoral head is the most common site of osteonecrosis.

In rare instances, osteonecrosis of the jaw has been associated with bisphosphonate exposure. This phenomenon is more common with repeated intravenous infusions of bisphosphonates.

Case reports of osteonecrosis of the jaw in association with other medications, such as denosumab, have been reported.

The final common pathway in the pathogenesis of osteonecrosis is disruption of blood supply to a segment of bone.

Abnormalities in lipid metabolism, bone homeostasis, regulation of apoptosis, coagulopathies, innate immunity, and oxidative stress may play a role in the pathogenesis of osteonecrosis.

Epigenetics may alter the predisposition to develop osteonecrosis.

MRI is currently the optimal test for early diagnosis and identification of the extent of osteonecrosis.

Nonsurgical treatment of osteonecrosis does not change the natural history of the disease.

Although surgical treatment of femoral head osteonecrosis has many variations, most symptomatic patients eventually require total hip arthroplasty.

Knowledge of risk factors and early detection are crucial to the successful management of osteonecrosis.

Because of the lack of successful treatment options, new modes of management focus on the prevention of osteonecrosis.

Pregnancy outcome in partners of male professional divers in Norway

BACKGROUND

Diving is associated with both acute and long-term effects in several organ systems. Reduced semen quality after extreme diving and a reduced proportion of males in the offspring of divers have previously been reported.

AIMS

To study pregnancy outcomes in partners of professional male divers.

METHODS

The cohort of divers registered with the Norwegian Inshore Diving Registry was linked to the Medical Birth Registry of Norway (MBRN).

RESULTS

In total, 6186 male divers had 10395 children registered in the MBRN during the study period. Of these, 52% were boys, compared to 51% in the general population. The partners of a subgroup of divers who were most likely to be occupationally exposed at the time of conception reported that early miscarriage was more frequent (27%) than in the general population (21%; relative risk 1.21, 95% confidence interval 1.05-1.39). Otherwise, there was a lower risk of adverse pregnancy outcomes such as preterm birth, stillbirth, low birthweight, small for gestational age and low Apgar score compared to the general population. Birthweight above 4000g was more frequent.

CONCLUSIONS

We observed no reduced sex ratio in the offspring of occupational divers. Except for an increase in self-reported early miscarriage in the partners of exposed divers, we observed no excess risk of any of the adverse perinatal pregnancy outcomes studied.

Osteonecrosis

Osteonecrosis affects younger patients more often than osteoarthritis and has significantly greater long-term morbidity.

Corticosteroids constitute the most common cause of nontraumatic osteonecrosis.

The femoral head is the most common site of osteonecrosis.

Bisphosphonate use is associated with osteonecrosis of the jaw.

The final common pathway in the pathogenesis of osteonecrosis is disruption of blood supply to a segment of bone.

Abnormalities in lipid metabolism, bone homeostasis, regulation of apoptosis, coagulopathies, and oxidative stress may play a role in the pathogenesis of osteonecrosis.

Magnetic resonance imaging is currently the optimal test for early diagnosis and identification of the extent of osteonecrosis.

Nonsurgical treatment of osteonecrosis does not change the natural history of the disease.

Although there are many variations on surgical treatment of femoral head osteonecrosis, most patients eventually require total hip arthroplasty.

Knowledge of risk factors and early detection are crucial to the successful management of osteonecrosis.

Due to the lack of successful treatment options, new modes focus on prevention of osteonecrosis.

MRI screening of dysbaric osteonecrosis in hyperbaric-chamber inside attendants

Inside attendants are medical staff who accompany patients during hyperbaric oxygen treatments. Dysbaric osteonecrosis (DON) is a well-known consequence of hyperbaric exposure. The aim of this study was to evaluate DON in inside attendants using magnetic resonance imaging (MRI). The bilateral shoulder, hip and knee joints of 12 inside attendants (four men, eight women; mean age 29 years; age range 22 - 36 years) were investigated. The mean +/- SD duration of employment as an inside attendant was 3.8 +/- 3.0 years (range 1 - 9 years) and the mean +/- SD number of hyperbaric exposures was 198 +/- 267 (median 96; range 30 - 950). None of the inside attendants had a history of decompression sickness. The MRIs of the attendants did not reveal bone lesions consistent with DON. This study failed to find an increased risk for DON in inside attendants. Additional multicentre epidemiological studies are warranted to investigate the occupational safety of inside attendants.

Reduced health-related quality of life in former North Sea divers is associated with decompression sickness

BACKGROUND

Diving is associated with long-term effects on several organ systems.

AIM

The objective was to investigate the impact of decompression sickness (DCS) and diving exposure on health-related quality of life (HRQL) in former Norwegian North Sea divers.

METHODS

HRQL was recorded by a questionnaire in the cohort of 375 Norwegian North Sea divers registered before 1990. Demographic data, relevant health data and data on diving education, history of DCS and SF-36 were recorded in 230 divers.

RESULTS

All SF-36 sub-scores were significantly reduced compared with Norwegian norms. Reduced scores were seen for all scales among divers who reported previous DCS compared to those without DCS. A decreasing trend in scores was seen when comparing no DCS, skin or joint DCS and neurological DCS. There was a decreasing trend in scores related to number of days in saturation and maximal depth. Stratification on DCS showed that the impact of saturation diving was present only in divers with DCS.

CONCLUSIONS

HRQL was reduced in this study sample of divers. Having had DCS during the diving career contributed significantly to the reduction in all SF-36 scales, and apparently neurological DCS has the most pronounced impact. Cumulative diving exposure including days in saturation and maximal depth contributed to a reduced HRQL.

Chronic subdural haematoma, an unusual injury from playing basketball

Although the literature records instances of acute epidural haematoma and acute subdural haematoma related to playing basketball, there has not been a report of chronic subdural haematoma as a basketball injury. With the burgeoning interest in this sport in the United Kingdom and Europe, the possibility of this particular neurotrauma increases. Such an injury, along with the diagnosis and management of this often insidious lesion, is documented in this case report.

Dysbaric osteonecrosis of the shoulder in a sport scuba diver

The previously unreported occurrence of dysbaric osteonecrosis in an amateur sport scuba diver who had no other identified cause of avascular bone necrosis is described.