Barotrauma was observed in breath-hold divers who increased their lung volumes by GI. The long-term effects of this barotrauma are uncertain and longitudinal studies are required to assess cumulative lung damage.

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Glossopharyngeal insufflation is used by competitive breath-hold divers to increase lung gas content above baseline total lung capacity (TLC) in order improve performance. Whilst glossopharyngeal insufflation is known to induce hypotension and tachycardia, little is known about the effects on the pulmonary circulation and structural integrity of the thorax.Six male breath-hold divers were studied. Exhaled lung volumes were measured before and after glossopharyngeal insufflation. On two study days, subjects were studied in the supine position at baseline TLC and after maximal glossopharyngeal insufflation above TLC. Tc 99 m labelled macro-aggregated albumin was injected and a computed tomography (CT) scan of the thorax was performed during breath-hold. Single photon emission CT images determined flow and regional deposition. Registered CT images determined change in the volume of the thorax.CT and perfusion comparisons were possible in four subjects. Lung perfusion was markedly diminished in areas of expanded lung. 69% of the increase in expired lung volume was via thoracic expansion with a caudal displacement of the diaphragm. One subject who was not proficient at glossopharyngeal insufflation had no change in CT appearance or lung perfusion.We have demonstrated areas of hyperexpanded, under perfused lung created by glossopharyngeal insufflation above TLC.KEYWORDS: Breath-hold diving, glossopharyngeal insufflation, hyperinflation, perfusion imaging, pulmonary perfusion B reath-hold diving, or freediving, is a highly organised, increasingly popular extreme sport. Many competitive breathhold divers perform glossopharyngeal breathing both as a training exercise and just prior to a dive or submersed breath-hold. Glossopharyngeal breathing, a pump-like action involving the glossopharyngeal structures and larynx that forces air into the airways [1], was originally developed as a therapeutic technique for neuromuscular patients to help expand tidal volume and cough effectiveness [2,3]. The increase in expired lung volume above baseline total lung capacity (TLC) using glossopharyngeal breathing is achieved by a combination of an increase in the Euclidian size of the lung and gas compression [4,5]. Participants refer to this technique as lung packing; however this is described in the literature as glossopharyngeal insufflation (GI) [1,5,6].In theory, GI above TLC has the potential to assist breath-hold diving performance by increasing available oxygen stores and providing a volume buffer against the compressive effects of hyperbaria. Improvements in both static apnoea duration and breath-hold diving performance have been shown [7]. The potential for adverse cardiocirculatory effects is also clear. The extremely high transpulmonary pressures achieved, of up to 80 cmH 2 O [5], are associated with tachycardia, hypotension and biventricular systolic dysfunction [8]. In keeping with these observations, adverse neurological symptoms (e.g. presyncopal episodes and light-headedness) have been associated with this manoe...

Ankle sprains are a common injury and may occur in as many as 75% of sporting participants. More complex injuries involving a rotational component may lead to injury of the interosseous membrane, its supporting ligaments, or the tibial plafond, compromising the integrity of the ankle mortice. Four such cases that show the scintigraphic manifestation of the injury are presented. In addition to the standard planar views of the ankles, special magnified anterior views were obtained with the feet in internal rotation of 25 degrees to 35 degrees. These special views facilitated the diagnoses.

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