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Whilst underwater, the body is submitted to significant variations of the surrounding pressure according to the depth. These conditions modify the hemodynamic and the ventilatory mechanics considerably. Some repercussions, like pulmonary barotrauma, are related to simple physical phenomena. Others, like decompression sickness, are due to more com- plex processes. Breath-hold diving disrupts haematosis and can be complicated by alveolar haemorrhage and loss of consciousness. Acute pulmonary oedema during scuba-diving, breath-hold diving and swimming has been reported more recently. In case of pulmonary disorders scuba-diving is contraindicated most of the time. It is therefore highly recommended to seek medical advice to prevent problems.

Introduction: When facing cochleovestibular symptoms such as hearing loss, dizziness or unsteadiness, or a tinnitus evolving in the aftermath of a cranial trauma or overpressure in the form of inner ear barotrauma after diving or a from blast, a perilymphatic fistula must be considered., Materials and Methods: We present a homogenous prospective series of 16 cases of perilymphatic fistulae occurring after head trauma or overpressure between 2003 and 2011. Patients suspected of suffering from a perilymphatic fistula and presenting with the following criteria were included: the occurrence after a variable delay of cochleovestibular symptoms (vertigo, tinnitus, and hearing loss) in the aftermath of a head trauma or overpressure. All patients received medical treatment with intravenous corticosteroids. Failure of the initial treatment and in the presence of clinical data suggesting a perilymphatic fistula, an exploration of the middle ear was performed., Results: 13 patients (81.2% underwent surgical exploration with early and stable subtotal recovery of hearing in 90%, a rapid disappearance of vertigo in 89.9%, a loss of tinnitus in 45% and in 27% improvement., Conclusion: The diagnosis must be supported by various diagnostic tests. If evidence in favor of a perilymphatic fistula is credible, surgery has always achieved an excellent functional outcome.

We report the case of a 84-year-old patient who came to the emergency department for vomiting and epigastralgia which had occurred during an air flight. These symptoms were related to the intraabdominal perforation of a massive hiatal hernia on barotrauma due to high altitude.

Portal vein thrombosis complicating a trauma is rare. We report a case of portal vein thrombosis associated with esophageal rupture after a blast injury due to the explosion of a pressurized nitrogen bottle. Portal vein thrombosis was discovered during oesophageal reconstruction, 70 days after the initial injury. A favorable outcome was observed.

Gastric perforation secondary to barotrauma is rare. The case of a diver suffering from gastric rupture due to a decompression accident is presented here. This rupture was a linear one, localized on the lesser curvature and responsible for a large pneumoperitoneum. Rupture occurs with an excluded stomach, a condition implying cardio-pyloric occlusion. The expansion of intra-gastric air, further worsened by accelerated surfacing provokes excessive gastric dilatation leading to partial or complete rupture (by virtue of the Boyle-Mariotte law: Pressure x Volume = constant). The lesion is always on the lesser curvature. However, it is often difficult to locate, even when peroperative gastroscopy is performed.

Mechanical ventilation may have adverse effects on the lung. The appearance of extra-alveolar air, either as a pneumothorax or as subcutaneous emphysema along with other manifestations, is a complication of barotrauma which has been known for a long time. Recent experimental studies have clearly shown that mechanical ventilation can also lead to alterations in the blood gas barrier. Mechanical ventilation with high inflation pressure and elevated tidal volumes induces pulmonary oedema; the genesis of which results principally from anomalies of alveolar capillary permeability. These anomalies are made as a result of pulmonary distension and not as a result of elevated pressures in the airways, thus justifying the term "volume traumatism". The existence of previous acute pulmonary injury considerably worsens the deleterious pulmonary effect of mechanical ventilation. Although the direct clinical implications of these experimental studies are difficult to confirm, these latter have nevertheless lead to profound changes in ventilatory strategy during the course of acute pulmonary disease such as the adult respiratory distress syndrome.

The presence of air in the interstitial pulmonary tissues is shown as interstitial emphysema and is often the first sign of barotrauma. It results from hyper-pressure in the airways occurring for the greater part of the time on some underlying pulmonary pathology. This extra alveolar air may diffuse into the interstitium and collect under the visceral pleura, appearing on radiographs as air cysts from 3 to 10 centimeters in diameter. We described 7 cases of air cysts occurring in adults on mechanical ventilation. The lesions seem to us to represent a radiological entity and evidence of barotrauma due to mechanical ventilation and possessing its own potential outcome, namely rupture leading to pneumothorax, infection, persistence, or disappearance. The early occurrence in its history of a particular disease should be noted, enabling one to minimise the factors contributing to the barotrauma.

The symptoms and signs of perilymphatic fistulae (PLF) are very varied and frequently misleading. The operative demonstration of a perilymph leak is not always obvious and the therapeutic results are sometimes disappointing. The study of 26 cases demonstrates certain concepts concerning the diagnostic and therapeutic difficulties. Any atypical cochleovestibular symptoms, particularly occurring in a traumatic context, should suggest the possibility of PLF. Exploratory surgery must be performed according to a rigorous protocol in order to demonstrate the fistula. Search for a fenestra ovalis sign due to pressure on the membrane of the fenestra rotunda may help to reveal a lesion of the annular ligament. Simple filling of the breach is not always effective, especially at the level of the stapes. Stapedectomy frequently constitutes the best solution for fistulae of the fenestra ovalis.

Aseptic necrosis of the femoral head is a well-defined entity. The underlying diseases originate from very different types of pathological conditions. Alcoholism, cortisone therapy, gout or hyperuricemia, sickle cell anaemia and others all lead, through various pathways, to the impairment of the medullary blood flow. In many instances, a compartment syndrome can be demonstrated in the femoral head. Death of the osteocytes follows bone marrow necrosis. Revascularisation originates in the periphery of the necrotic segment. Vascular buds and fibroblasts invade the medullary space. New bone is laid over the necrotic trabeculae. Mechanical failure results from changes in the bony framework at three different levels. The subchondral boneplate may be weakened by the process of revascularisation, the necrotic trabeculae may fail because of diminished stiffness and strength, and overloading has been demonstrated at the junction between dead and living bone. Elevation of the intramedullary pressure is the first objective sign of impending or established bone necrosis. Scintigraphy with Technetium 99 m - Sulphur colloid can now show the early stages of marrow necrosis. Roentgenographic changes only appear in a later phase of the disease. Aseptic necrosis must be considered as involving both hips, unless proven otherwise. Attention given to the "silent hip" may allow salvage and prevent the occurrence of osteo-arthritic changes leaving merely unilateral disease. As long as the geometrical shape of the femoral head is maintained operation may well prove useful. The aim at this stage is to prevent collapse. It is impossible to know in the early stages whether mechanical failure will occur, but there is general agreement that the femoral head will eventually undergo deformation. A spherical epiphysis is therefore considered a success. All the conservative methods aim to decompress the medullary cavity. Core biopsy, curettage, bone grafting and intertrochanteric osteotomy all have their advocates. After fracture of the subchondral bone plate has occurred, there is evidence that grafts are unable to restore the strength of the necrotic area. Intertrochanteric osteotomy brings under the main load-bearing zone a vital part of the femoral head. Varus osteotomy can be successful if necrosis has spared sufficient of the lateral portion of the head. Rotation osteotomies, as proposed by Sugioka, are more radical and difficult operations. The published results are promising. Revascularisation of the weight-bearing area by pedicle grafts has been attempted, alone or in addition to osteotomy.(ABSTRACT TRUNCATED AT 400 WORDS)