Decompression sickness "divers' disease"

A 55-year-old male diver begins complaining of back pain and urinary retention 1 h after a dive. What is the MOST likely diagnosis?

• (A)Barotrauma to the bladder
• (B)Lumbar strain
• (C)Neurotoxin from a marine envenomation
• (D)Nitrogen narcosis
• (E)Decompression sickness

The answer is E.

Barotrauma is the most common affliction of divers and usually affects the ears, sinuses, lungs, and, rarely, the gastrointestinal tract. The bladder is not involved.

Decompression sickness (DCS),also known as divers' disease, the bends or caisson disease, is caused by formation of gas bubbles in tissues after ascent from a dive and results in vascular occlusion, usually in the venous circulation. DCS may have cutaneous manifestations including rash and pruritus. It classically causes joint and back pain and may be associated with neurologic symptoms secondary to spinal cord involvement.

Patients with neurologic or other severe forms of DCS should be referred for hyperbaric oxygen therapy. Nitrogen narcosis is due to the anesthetic effects of breathing nitrogen at high partial pressures and causes divers to become altered on deep dives.

MCQ on Case of Medical Industries

A 42 year old man who has industrial exposure to benzene, complains of fatigue, abdominal fullness and night sweats. Finally, because his wife insists, he sees his doctor. On physical examination, he is found to have a low grade fever and dramatic splenomegaly. His doctor comments that he has never seen such splenomegaly. Laboratory tests are done, including a CBC with differential. His white blood count is 150,000/cu mm. His blood smear shows mature granulocytes, a few immature granulocytes and basophilia. No Auer rods are visualized. He is positive for Philadelphia chromosome. Which of the following is most likely?

a) acute lymphoblastic leukemia
b) acute myelogenous leukemia
c) chronic lymphoblastic leukemia
d) chronic myelogenous leukemia
e) hairy cell leukemia

The correct answer is D

Explanation
This patient is the average age for the onset of CML. Exposure to benzene is a known risk factor. Fatigue, night sweats, low grade fever and abdominal fullness secondary to splenomegaly are all symptoms that can be associated with CML The splenomegaly in CML can be marked. The laboratory findings in chronic myelogenous leukemia will show an elevated granulocytic counts, as in this scenario. Basophilia can also be seen with CML. The Philadelphia chromosome, a translocation between chromosome 22 and 9, is positive in the vast majority (90-95%) of patients with chronic myelogenous leukemia.In acute lymphoblastic leukemia (choice a) there would be numerous blast cells in the peripheral smear. ALL tends to occur in children with an average age of 4 (however, it can occur in adults).In acute myelogenous leukemia (choice b) there would be numerous blast cells in the peripheral smear. AML tends to strike adults. The presence of Auer rods indicates AML.In chronic lymphocytic leukemia (choice c) there would be a lymphocytosis with mature looking cells. CLL occurs in older people.Hairy cell leukemia (choice e) has distinctive cells present in the peripheral blood smear, called 'hairy cells'

Caplan Syndrome (Coal worker's)

Posteroanterior radiograph shows a multitude of fairly well-circumscribed nodules and masses ranging in diameter from 1 to 5 cm, scattered randomly throughout both lungs with no notable anatomic predilection. No cavitation is apparent, and there is no evidence of calcification.

This patient, a 56-year-old man, had been a coal miner for many years and in recent years had developed arthralgia, which proved to be due to rheumatoid arthritis. As a means of establishing the nature of the pulmonary nodules, a percutaneous needle aspiration was performed on the large mass situated in the lower portion of the left lung (arrowheads): Several milliliters of inky black fluid were aspirated.

Coal workers pneumoconiosis - stage II

This chest x-ray shows stage II coal worker's pneumoconiosis (CWP). There are diffuse, small light areas on both sides of the lungs. Other diseases that may explain these x-ray findings include simple silicosis, disseminated tuberculosis, metastatic lung cancer, and other diffuse, infiltrative pulmonary diseases.

Mesothelioma Diagnosis

Mesothelioma Diagnosis

Asbestos

Asbestos is a tough, heat-resistant mineral that was added to the building materials of many older homes. It can pose health hazards to workers and homeowners who renovate or demolish those homes. This animation shows how asbestos fibres could damage lung tissue and lead to lung disease.

Surgical Options on Pleural Mesothelioma Treatment

Learn about mesothelioma treatment options via surgery from the International Symposium on Malignant Mesothelioma 2008. Presentation by Dr. Robert Kratzke.

Peritoneal Mesothelioma

View this mesothelioma resource as presented at the International Symposium on Malignant Mesothelioma 2008, hosted by the Mesothelioma Applied Research Foundation. Presentation by Dr. James F. Pingpank, Head of the Surgical Metabolism Section of the Surgery Branch of the NCI, in Bethesda Maryland.

Some Occupational Lung Diseases and Their Causes

* Asbestosis, caused by exposure to asbestos particles. Often found among people who worked in shipyards, asbestos mines, and factories that refined or used asbestos to manufacture products.
* Black lung (Coalworker's pneumoconiosis) which affects coal workers
* Chronic Beryllium disease (CBD), which affects workers in a variety of metallurgical occupations
* Byssinosis (brown lung disease), often occurs in cotton and textile workers when bacteria released from cotton or other materials is inhaled and grows with the lungs. This is often associated with poor ventilation systems.
* Hypersensitivity pneumonitis, this can affect people who work in office buildings whose air-conditioning systems are contaminated by certain fungi and bacteria.
* Occupational asthma, can affect people who work with a variety of materials. This includes animals (dander), carbamates (urethanes), dyes, epoxy resins and enzymes used in detergent, leather goods, latex, and automotive paints
* Silicosis often developed by people who worked with clay, sand and stone dust including miners, stone cutters and sandblasters.

job hazards in Lung Cancer

As we know cigarettes are the most important cause of lung cancer,But chemicals and other on-the-job hazards "play a remarkable role" in lung cancer risk.

5% of lung cancers in men are job-related. Men in the known to be risky occupations were 74% more likely to have been diagnosed with lung cancer.

The strongest associations were seen for ceramic and pottery jobs and brick manufacturing, as well as for those working in manufacturing of non-iron metals.

A Chest X-Ray shows a right upper lobe (RUL) mass due to lung cancer.

Asbestosis: a problem of industerial exposure

Pathophysiology, clinical data and radiology

Asbestosis

Asbestos

We have include this picture of asbestos fibers becuase inhaling these fibers is the cause of asbestosis and Mesothelioma.




Asbestosis is a lung disease that is caused by breathing asbestos fibers. It results in lung disorders, as pleural fibrosis.