Gastric rupture in a diver due to rapid ascent

A 37-year-old, experienced female diver developed gastric rupture due to rapid ascent from a depth of 37 meters. The incident was preceded by a heavy meal, intake of soda beverages, swallowing of air and water under water, and panic. Sharp abdominal pain was present immediately after surfacing and afterwards. Full abdominal distension developed within two hours after the ascent. No other diving-related pathology was found. Surgery was performed around three hours after the accident and revealed pneumoperitoneum, gastric rupture, gastric content in the abdomen cavity, and signs of acute peritonitis. On surgery, a 4-cm rupture of the lesser curvature was found and sutured. The patient was discharged eight days after the event.     

Effects of voluntary fluid intake deprivation on mental and psychomotor performance

Aim

To assess if there is deterioration in mental and psychomotor performance during 24-hour voluntary fluid intake deprivation.

Methods

A battery of computer generated psychological tests (Complex Reactionmeter Drenovac) was applied to 10 subjects to test light signal position discrimination, short-term memory, simple visual orientation, simple arithmetic, and complex motor coordination. We measured total test solving time, minimum (best) single task solving time, total ballast time, and total number of errors. Mood self-estimate scales of depression, working energy, anxiety, and self-confidence were used to determine the emotional status of subjects. During the first day of the experiment, subjects had free access to drinks. After a 48-hour interval, subjects voluntarily abstained from fluid intake for 24 hours. During that period, the testing was performed 7 times a day, at 3-hour intervals, except during the night. Z-transformation of the results enabled the comparison of 50 dependent measurements on the same subjects.

Results

During dehydration, there was significant deterioration in total test solving time, minimum single task solving time, and total ballast time. No significant deterioration was found by mood self-estimate scales, except on the scale of energy at 23:00 hours.

Conclusion

Voluntary 24-hour fluid intake deprivation led to deterioration in objective parameters of psychological processing, but not in subjective parameters. The results suggest that the duration of fluid intake deprivation can be a useful indicator of mental and psychomotor deterioration level.There are many life situations when unfavorable circumstances influence the hydration regime. The problem of dehydration in humans has been extensively studied and the physiology of this phenomenon is generally well understood (1-6). The neurophysiological mechanisms affecting mental and psychomotor performance in dehydration are extremely complex and include structural and functional changes of neuronal and glial cells (7-10).Mental and psychomotor processing deterioration and the dynamics of its onset during dehydration are of great practical importance but are still not completely understood. Deteriorated mental and psychomotor processing could endanger performance of tasks that require high precision, are performed under forced regime and rhythm, permit no mistakes, or involve sophisticated, expensive, or dangerous equipment. Deteriorated psychological processing was described in experiments in which dehydration was either heat stress induced (11-14) or induced by a combination of heat, stress, and exercise (15-17). Both stressors were necessarily multifactorial and could not represent a valid experimental frame for studying dehydration. In rare experiments in which dehydration was a consequence of voluntary fluid intake deprivation, only deterioration in subjective parameters was found (18-20).Testing mental and psychomotor performance in possibly dehydrated subjects in a real-life situation and under complex circumstances would be most impractical. In such situations, it would be practical to measure a simple parameter indicating deterioration level of mental and psychomotor abilities, at the same time predicting the level of expected performance efficiency.The objective of this study was to measure the deterioration in mental and psychomotor performance and dynamics of its onset during voluntary 24-hour fluid intake deprivation by objective and subjective parameters of psychological processing under laboratory conditions.     

Clinical analysis of propofol deep sedation for 1,104 patients undergoing gastrointestinal endoscopic procedures： A three year prospective study

AIM: To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy. METHODS: In this prospective study, conducted over a period of three years, 1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus (0.5-1.5 mg/kg). Arterial blood pressure (BP) was monitored at 3 min intervals and heart rate and oxygen saturation (SpO2) were recorded continuously by pulse oximetry. Analyzed data acquisition was carried out before, during, and after the procedure. RESULTS: A statistically significant reduction in mean arterial pressure was demonstrated (P<0.001) when compared to pre-intervention values, but severe hypotension, defined as a systolic blood pressure below 60mmHg, was noted in only 5 patients (0.5%). Oxygen saturation decreased from 96.5% to 94.4 % (P<0.001). A critical decrease in oxygen saturation (<90%) was documented in 27 patients (2.4%). CONCLUSION: Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant hemodynamic side effects if carefully titrated. All the patients (and especially ASA III group) require monitoring and care of an anes- thesiologist.     

Endoscopic ultrasound elastography strain histograms in the evaluation of patients with pancreatic masses

AIM: To investigate the accuracy of the strain histogram endoscopic ultrasound(EUS)-based method for the diagnostic differentiation of patients with pancreatic masses. METHODS: In a prospective single center study, 149 patients were analyzed, 105 with pancreatic masses and 44 controls. Elastography images were recorded using commercially available ultrasound equipment in combination with EUS linear probes. Strain histograms(SHs) were calculated by machine integrated software in regions of interest and mean values of the strain histograms were expressed as Mode 1(over the mass) and Mode 2(over an adjacent part of pancreatic tissue, representing the reference area). The ratio between Mode 2 and Mode 1 was calculated later, representing a new variable, the strain histogram ratio. After the final diagnosis was established, two groups of patients were formed: a pancreatic cancer group with positive cytology achieved by fine needle aspiration puncture or histology after surgery(58 patients), and a massforming pancreatitis group with negative cytology and follow-up after 3 and 6 mo(47 patients). All statistical analyses were conducted in SPSS 14.0(SPSS Inc., Chicago, IL, United States).RESULTS: Results were obtained with software for strain histograms with reversed hue scale(0 represents the hardest tissue structure and 255 the softest). Based on the receiver operating characteristics(ROC) curve coordinates, the cut-off point for Mode 1 was set at the value of 86. Values under the cut-off point indicated the presence of pancreatic malignancy. Mode 1 reached 100% sensitivity and 45% specificity with overall accuracy of 66%(95%CI: 61%-66%) in detection of pancreatic malignant tumors among the patients with pancreatic masses. The positive and negative predictive values were 54% and 100%, respectively. The cut-off for the new calculated variable, the SH ratio, was set at the value 1.153 based on the ROC curve coordinates. Values equal or above the cut-off value were indicative of pancreatic malignancy. The SH ratio reached 98% sensitivity, 50% specificity and an overall accuracy of 69%(95%CI: 63%-70%). The positive and negative predictive values were 92% and 100%, respectively.CONCLUSION: SH showed high sensitivity in pancreatic malignant tumor detection but disappointingly low specificity. Slight improvements in specificity and accuracy were achieved using the SH ratio.     

Scuba diver with a knife in his chest: homicide or suicide?

A scuba diver was found dead at the bottom of an undersea cave at 54.1 m water depth, with a knife protruding from his chest. Autopsy confirmed death due to both drowning and a penetrating knife wound. The incident was first considered a homicide and two suspects were arrested. Careful forensic analysis of the profile of the diver's last dive stored in the dive computer, dimensions of the undersea cave, as well as other forensic findings, showed that the case was a suicide, which the diver most probably committed while running out of air, in an attempt to avoid the agony of drowning. To the best of our knowledge, this is the first report on a suicide during diving.     

Dietary Intake and Status of Vitamin B12 in Slovenian Population

Vitamin B12 deficiency poses a health concern, especially in vulnerable populations. Dietary vitamin B12 intake was obtained by two 24 h dietary recalls and food propensity questionnaires in a representative Slovenian cross-sectional food consumption survey, SI.Menu (n = 1248 subjects; 10–74 years). For a subgroup of 280 participants, data on serum vitamin B12 were available through the Nutrihealth study. The estimated usual population-weighted mean daily vitamin B12 intakes were 6.2 µg (adults), 5.4 µg (adolescents), and 5.0 µg (elderly). Lower intakes were observed in females. Inadequate daily vitamin B12 intake (<4 µg) was detected in 37.3% of adolescents, 31.7% of adults, and 58.3% elderlies. The significant predictors for inadequate daily vitamin B12 intake were physical activity score in all age groups, sex in adolescents and adults, financial status and smoking in elderly, and employment in adults. Meat (products), followed by milk (products), made the highest vitamin B12 contribution in all age groups. In adolescents, another important vitamin B12 contributor was cereals. The mean population-weighted serum vitamin B12 levels were 322.1 pmol/L (adults) and 287.3 pmol/L (elderly). Low serum vitamin B12 concentration (<148 nmol/L) and high serum homocysteine (>15 µmol/L) were used as criteria for vitamin B12 deficiency. The highest deficiency prevalence was found in elderlies (7.0%), particularly in males (7.9%). Factors associated with high serum homocysteine were also investigated. In conclusion, although vitamin B12 status was generally not critical, additional attention should be focused particularly to the elderly.     

Self-expandable metal stent for dysphagia caused by mediastinal masses in patients with lung cancer

Background and study aims

We intended to evaluate the role of self-expandable metal stents (SEMS) for palliation of malignant dysphagia in patients with lung cancer.

Helicopter transport of patients from Croatian Adriatic Islands and coastal area in the period from 1996 to 2002

For most of the Croatian Adriatic islands and coastal area, helicopter is the fastest, and for some remote areas the only effective way of patient transport. In Croatia, most of the aeromedical transports are performed by helicopters of 95th Air Force Base. During the post-war period, the number of civilian patients transported with those helicopters increased from 56 in 1996 to 311 in 2002, this trend continuing in 2003. The majority of these transports were performed in the third trimester of the year, the largest number of patients were transported from the Island of Hvar, and the most common medical indication for aeromedical trasport was trauma. The lack of competent medical escort may have unfavourable impact on patient health and flight safety. The increasing trend in requesting aeromedical transport would obviously justify the foundation of a specialized commercial service to provide both safe transport and competent medical escort.