title: Vascular hyperpermeability in pulmonary decompression illness: 'the chokes'.
abstract: Decompression illness (DCI) develops during or after diving. Pulmonary decompression illness ('Chokes') is rarely seen because the affected individual usually dies in the water. We encountered a rare and interesting case. A 60-year-old man complained of leg pain after diving. Despite rapid transfer to a nearby hospital, advanced respiratory failure and shock had set in. He was then transferred to our hospital for hyperbaric oxygen therapy (HBOT). On account of his poor general condition, we initially treated him in the intensive care unit without HBOT, where he showed extreme hyperpermeability and a high level of serum procalcitonin (PCT; 20.24 ng/mL). Despite large-volume fluid therapy, severe intravascular dehydration and shock status remained. We assume that the injured endothelial cells induced vascular hyperpermeability and increased levels of inflammatory cytokines leading to the high serum PCT level. PCT might be a useful stress marker of endothelial damage and severity in DCI, including Chokes.
authors.affiliation: Department of Emergency Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan. kondokondou2000@yahoo.co.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kondo
authors.forename: Shinya
authors.initials: S
authors.lastname: Shiohira
authors.forename: Kota
authors.initials: K
authors.lastname: Kamizato
authors.forename: Koji
authors.initials: K
authors.lastname: Teruya
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Fuchigami
authors.forename: Manabu
authors.initials: M
authors.lastname: Kakinohana
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kukita
mesh_terms: D002116:Calcitonin / Q000097:blood; D003665:Decompression Sickness / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D012120:Respiration Disorders / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D002116:Calcitonin