This article describes the theory of the formation of the vacuum phenomenon (VP), the detection of the VP, the different medical causes, the different locations of the presentation of the VP, and the differential diagnoses. In the human body, the cavitation effect is recognized on radiological studies; it is called the VP. The mechanism responsible for the formation of the VP is as follows: if an enclosed tissue space is allowed to expand as a rebound phenomenon after an external impact, the volume within the enclosed space will increase. In the setting of expanding volume, the pressure within the space will decrease. The solubility of the gas in the enclosed space will decrease as the pressure of the space decreases. Decreased solubility allows a gas to leave a solution. Clinically, the pathologies associated with the VP have been reported to mainly include the normal joint motion, degeneration of the intervertebral discs or joints, and trauma. The frequent use of CT for trauma patients and the high spatial resolution of CT images might produce the greatest number of chances to detect the VP in trauma patients. The VP is observed at locations that experience a traumatic impact; thus, an analysis of the VP may be useful for elucidating the mechanism of an injury. When the VP is located in the abdomen, it is important to include perforation of the digestive tract in the differential diagnosis. The presence of the VP in trauma patients does not itself influence the final outcome.

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This is the first study to identify and prioritize hospital operations necessary for the efficient continuation of medical treatment during suspension of the water supply by applying a BIA. Understanding the priority of operations and the minimum daily water requirement for each operation is important for a hospital in the event of an unexpected adverse situation, such as a major disaster.

Context:There have been few reports investigating the effects of air transportation on patients with decompression illness (DCI).Aims:To investigate the influence of air transportation on patients with DCI transported via physician-staffed emergency helicopters (HEMS: Emergency medical system of physician-staffed emergency helicopters).Settings and Design:A retrospective medical chart review in a single hospital.Materials and Methods:A medical chart review was retrospectively performed in all patients with DCI transported via HEMS between July 2009 and June 2013. The exclusion criteria included cardiopulmonary arrest on surfacing. Statistical analysis used: The paired Student's t-test.Results:A total of 28 patients were treated as subjects. Male and middle-aged subjects were predominant. The number of patients who suddenly surfaced was 15/28. All patients underwent oxygen therapy during flight, and all but one patient received the administration of lactate Ringer fluid. The subjective symptoms of eight of 28 subjects improved after the flight. The range of all flights under 300 m above sea level. There were no significant differences between the values obtained before and after the flight for Glasgow coma scale, blood pressure, and heart rate. Concerning the SpO2, statistically significant improvements were noted after the flight (96.2 ± 0.9% versus 97.3 ± 0.7%). There were no relationships between an improvement in subjective symptoms and the SpO2.Conclusion:Improvements in the subjective symptoms and/or SpO2 of patients with DCI may be observed when the patient is transported via HEMS under flights less than 300 m in height with the administration of oxygen and fluids.

A 39-year-old female recreational diver, who developed cardiopulmonary arrest after diving, was transferred to our department 5 hours after the arrest by a helicopter emergency medical service. The diver performed two repetitive dives to a depth of 27 metres; 50 minutes bottom time for each dive. She had omitted the usual surface interval (resting near the surface) between the dives; the dive profile was otherwise unremarkable. On examination, she was in deep coma with dilative non-reactive pupil, hypotension supported by continous infusion of catecholamine, apnea sup-porting by mechanical ventilation and a widespread marbling rash (cutis marmorata) on her body and extremities (Picture). Whole body computed tomography revealed marked diffuse brain swelling and bilateral severe lung edema without sign of gas. She was diagnosed as clinical brain death due to Type II Decompression Sickness and died on the same day.Cutis marmorata is a distinct cutaneous manifestation of decompression sickness. It is easily recognized by its typical mottled, marbling violaceous appearance. It may start as an intense multifocal itching, followed by a generalized hyperaemia which in turn progresses to irregular dark violet or purple patches. The cutis marmorata is thought to be caused by vascular congestion triggered by vascular inflammation secondary to the development of intravascular gas bubbles. Cutis marmorata is usually transient and does not require any means of treatment. However, it is a warning sign of a more severe manifestation of decompression sickness so that careful follow-up is required.