The case concerns the alleged failure by the resisting administration to fulfill obligations arising from the contract and employment relationship, as well as the violation of safety regulations leading to the workplace accident reported by an Airforce Sergeant. Following the accident, the soldier complains of developing barotraumatic hearing loss with tinnitus and reactive post-traumatic stress disorder to the traumatic event. The case provides an opportunity to analyze the relevance of forensic medical assessment and its integration with psychodiagnostic examination for the correct nosographic classification aimed at evaluating and quantifying biological damage.

A case is described in which appendicitis presented in a 73-year-old woman the day after a colonoscopy. Possible mechanisms for appendicitis aggravated by colonoscopy include barotrauma, irritation by residual glutaraldehyde type solution used for cleaning the endoscope, fecalith, and/or appendicolith being pushed into the orifice of the appendix by insufflation during the colonoscopy. This rare complication is likely most often unavoidable due to the pressure required to properly visualize the colon (which typically ranges from 9 to 57 mmHg) and the manipulation required to visualize and cannulate the ileocecal valve. Physicians should consider possibility of acute appendicitis after colonoscopy when evaluating abdominal pain after a recent colonoscopy.

A compressed air nozzle has the potential to result in lethal injuries when handled inappropriately. Owing to the rarity of colorectal perforations due to barotrauma, no clear pathway to managing them has been established. We report an incident of a 33-year-old male patient who presented with tension pneumoperitoneum due to rectosigmoid perforations after being subjected to transanal compressed air insult. An emergency laparoscopic exploration with primary repair of the rectal perforation and Hartmann procedure were performed resulting in a smooth postoperative course. We hereby conclude that laparoscopy is a safe and effective approach associated with faster recovery and fewer adverse events.

Scuba diving has become a common and popular activity, and adverse events can occur following this activity. Among those events, intracranial hemorrhage is very rare, and only intracerebral hemorrhage and subarachnoid hemorrhage are reported. However, the occurrence of chronic subdural hematoma (CSDH), possibly as an adverse event following scuba diving, has not been described. A 49-year-old man with no significant medical history visited our hospital complaining of memory disturbance and aphasia. He had experienced a minor head trauma five months before and had gone scuba diving six times between the traumatic episode and the visit to our hospital. A brain computed tomography scan revealed a left CSDH. The patient underwent burr-hole surgery to remove the CSDH, and his symptoms resolved. We report the first case of CSDH possibly related to scuba diving. No recurrence of CSDH was observed at 28 months postoperatively.

BACKGROUND: Middle-ear adenoma is a rare benign endocrine tumor with slow progression, and can, in very rare cases, lead to recurrent peripheral facial palsy.
METHODS: A young man experienced three episodes of right peripheral facial palsy of incremental intensity, suggestive of barotrauma. CT and MRI found a tissue mass in the tympanic cavity, and biopsy diagnosed middle-ear adenoma. Electroneuromyography found 50% impairment of facial function. Closed right tympanoplasty with complete tumor resection enabled complete recovery of facial function within 1 month.
CONCLUSIONS: Middle-ear adenoma is diagnosed on histology, as imaging on MRI can be non-specific, mimicking chronic otitis. Facial involvement is rare and is due to edematous compression of the vasa nervorum. Treatment is surgical, and follow-up should be prolonged. Palsy assessment on electroneuromyography indicates the urgency of treatment.

Tracheobronchial diverticulum (TBD) is an asymptomatic, benign cystic lesion outside the lumen of the trachea and bronchus. This is the first report case of a SCUBA (self contained underwater breathing apparatus) diver diagnosed with TBD, which is a potential risk to diving. No literature or guideline is available so far on the diving fitness for patients with congenital or acquired TBD condition. A healthy 26-year-old male professional diver has records of SCUBA diving up to a depth of 40 meters sea water. He did not have any diving-related injuries or symptoms during his career and had no history of smoking, drinking, or other special illnesses except for a COVID-19 infection. A tracheal diverticulum was found accidentally by computed tomography (CT), but its communication with the trachea was not clear initially. Therefore, high-resolution CT and electronic bronchoscopy were done to clarify the situation of the diverticulum and identify the diving risk. High-resolution CT showed a possible opening in the diverticulum, but this was not seen under electronic bronchoscopy. Although a potential opening was shown in high-resolution CT, the lack of visual bronchoscopic evidence made it likely to be a dead cavity. As there is a higher theoretical risk of barotrauma during decompression, leading to pneumomediastinum, hemorrhage, or arterial gas embolism, the current clinical consensus is that air-containing tissue should be regarded as a relative contraindication for diving. Overall, it is recommended that the diver should dive carefully and avoid ascending too rapidly.

As COVID-19 emerged in the world, there was a high prevalence of intubation and intensive care admissions. Many cases of barotrauma were reported in those patients. This condition is caused by alveoli rupture, which causes the air to enter the surrounding extra-alveolar spaces. It mainly happens in intubated patients. Here, we report 14 cases of barotrauma in COVID-19 patients, which appeared either spontaneously or after receiving non-invasive ventilation, some of the patients presented initially with mild-moderate forms of the disease in terms of severity. Developing barotrauma causes a management challenge in COVID-19 patients, where the patients might require invasive mechanical ventilation afterwards, which is a difficult situation. Lung protective measures should be used to reduce the risk of barotrauma in all patients as it is associated with increased mortality.

The infraorbital nerve is responsible for the sensory innervation of the lower eyelid, the lateral nose, the cheek, the upper lip, and the maxillary teeth. It passes along the infraorbital canal, which runs superior to the maxillary sinus. Dehiscence of the infraorbital canal and its ectopic course in the maxillary sinus is a rare variation. A nerve with these variations may be affected by pathologies in the maxillary sinus and this may constitute a rare cause of facial pain. In this report, we present the clinical symptoms of a 29-year-old male patient who had an infraorbital nerve with an ectopic course and dehiscence in light of the literature.

BACKGROUND: The risk of barotrauma associated with different types of ventilatory support is unclear in COVID-19 patients. The primary aim of this study was to evaluate the effect of the different respiratory support strategies on barotrauma occurrence; we also sought to determine the frequency of barotrauma and the clinical characteristics of the patients who experienced this complication.
METHODS: This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death.
RESULTS: We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-10.03, p<0.001).
CONCLUSIONS: C-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality.
BACKGROUND: this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021).

UNASSIGNED: Compressed air is used to apply paint, wash vehicles or machines, and remove water droplets after washing the precision instrument. Barotrauma due to high-pressure compressed air is extremely rare.
METHODS: We report a case of transverse colon perforation caused by a compressed air gun in a 20-year-old male. He used a compressed air machine to dust after work, and a coworker inserted compressed air transanally as a joke. Although he returned home once, he consulted a former hospital with worsening abdominal pain. Radiography and computed tomography (CT) revealed a massive amount of free air. The patient was admitted to our hospital. The patient underwent emergency surgery. Transverse colon perforation with extensive serosal tears and massive air bubbles inside the omental bursa were observed. Double-barrel colostomy using transverse colon perforation point for decompression and diverting the stoma at the ileum end was performed with serosal tear repair and abdominal cleaning drainage. Four months after the surgery, the patient underwent colostomy and diverting stoma closure.
UNASSIGNED: The management of colon injury due to compressed air has two aspects: tension pneumoperitoneum and colon injury. The initial management of tension pneumoperitoneum is converted to open pneumoperitoneum and early emergency operation for colon injury is recommended as soon as full-thickness perforation is diagnosed.
CONCLUSIONS: Transanal high-pressure compressed air can cause lethal situations, and we encountered a similar case that required surgical intervention.