Peter Wilmshurst

RELATION BETWEEN INTERATRIAL SHUNTS AND DECOMPRESSION SICKNESS IN DIVERS

The prevalence of right-to-left interatrial shunts was determined by contrast echocardiography in a blind comparison of 61 divers who had had decompression sickness, divided into four predetermined clinical subgroups, and a control group of 63 who had not. The prevalence of shunt was 15/63 in the controls and did not differ significantly in 24 divers with onset of neurological symptoms more than 30 minutes after surfacing (4/24) or 6 with joint pain only (1/6). In divers who had neurological symptoms within 30 minutes of surfacing the prevalence of shunt was 19/29, significantly higher. Rashes soon after surfacing were related to shunts but late rashes were not.

COLD-INDUCED PULMONARY OEDEMA IN SCUBA DIVERS AND SWIMMERS AND SUBSEQUENT DEVELOPMENT OF HYPERTENSION

The effect of cold and/or a raised partial pressure of oxygen was examined in eleven people with no demonstrable cardiac abnormality but who had pulmonary oedema when scuba diving or surface swimming, and in ten normal divers. These stimuli induced pathological vasoconstriction in the pulmonary oedema group, nine of whom also showed signs of cardiac decompensation when so stimulated. The pulmonary oedema patients have been followed-up for an average of 8 years. Seven have become hypertensive. Except for the onset of lone atrial fibrillation in one normotensive female diver and development of Raynauds phenomenon in a normotensive man, there have been no cardiovascular events and no deaths.

Growth Hormone Therapy in Adults with Growth Hormone Deficiency

From the Department of Endocrinology and Chrmicul Pathology, United Mrrlicd cintl Derircil School. of Guys and St Thomas Hospitcrls, Sr Thomas Hospital, 2the Departmcvit of Neuro/ogv, St 77ionitr. Hospital. 3the Department oJ Cardiology, St Thomas Hospital, London, cmd the Rudioisoto[w. Diiision Medical Restarch Cottncil CIinicaf Research Centre, Northwick Park Hospird, Hcirroir-, Micttllrsct , U K