Bone Lesions in Compressed Air Workers

Abstract

1. A radiographic investigation of a group of 241 men who had worked in compressed air at pressures up to 35 pounds per square inch gauge on the construction of tunnels under the River Clyde showed that forty-seven men (19 per cent) had one or more lesions of aseptic necrosis of bone. 2. The radiological lesions have been classified as juxta-articular, which may lead to pain and limitation of movement, and head, neck and shaft lesions, which are usually symptomless. In 10 per cent of the men the lesions were juxta-articular and therefore potentially disabling. The treatment ofjuxta-articular lesions is described and reviewed. 3. The environmental factors associated with the occurrence of aseptic necrosis of bone, the radiological and histological appearances, and the pathogenesis of the lesions are discussed. Bone lesions were found to be related directly to the number of times a man had been decompressed, to the height of pressure at which he had worked and to attacks of bends for which treatment was given. 4. When the histological and radiographic appearances of aseptic necrosis of bone in compressed air workers are compared it is clear that a radiograph may not always reveal the full extent of the lesion, and some lesions may not show up at all. The cause of the necrosis is obscure because experimental and direct evidence of bone infarction by gas bubbles is lacking. 5. The currently accepted decompression procedures and treatment of bends used in civil engineering practice, do not prevent the occurrence of aseptic necrosis of bone in compressed air workers. 6. It is suggested that periodic radiological examination of the bones of compressed air workers should be carried out and the results correlated with other information about the men and the contracts on which they have worked in order to elucidate the causative factors in aseptic necrosis of bone. A central registry has been set up by the Medical Research Council in the University of Newcastle upon Tyne to fulfil this function.

The relationship between pregnancy and femoral head necrosis

“…trauma (Catto, 1965), Caisson disease (McCallum and Walder, 1966), and steroid therapy (Heinemann and Freiberger, 1960). It is by no means clear why only a proportion of patients with these predisposing conditions actually develop this pathology.…”

Vital issues in computing decompression schedules from fundamentals

“…However, no correlation could be found between the type of symptom and the theoretical tissue "caught", although a shift in the predominant location of the same symptom with exposure time has been described by Behnke (1951). While this has generally been assumed to be a manifestation of decompression sickness (Griffiths, 1969;McCallum and Walder, 1966), it has been attributed to the compression (Hills, 1970b), recent measurements of intramedullary pressure tending to confirm this opinion (Harrelson and Hills, 1970). This can be explained, in part at least, by occupational differences since bends can be preferentially induced in those limbs selectively exercised at pressure (Cook, 1951}. There does appear to be a fairly clear division of symptoms into two categories which have been well defined by Griffiths (1969).…”

“…They should, therefore, produce different symptoms of decompression sickness. A different symptom arising from hyperbaric exposure is aseptic (avascular) necrosis of bone (McCallum and Walder, 1966}. An analysis of 131 Naval dives showed a 70% occurrence of painful symptoms in the upper extremities, particularly the shoulder, compared with a predominance of bends in the lower extremities of caisson workers and in men returned to the surface from "saturation" dives.…”

Avascular necrosis of bone following allogeneic stem cell transplantation: MR screening and therapeutic options

“…[2][3][4][5][6][7][8][9] Treatment with corticosteroids is another risk factor in the pathogenesis of osteonecrosis as first mentioned in 1950. 10 Therefore, avascular necrosis is a well-described complication after renal and cardiac transplantation, especially in patients receiving high-dose steroids for graft rejection.…”