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Biomedical subjects

K Tetzlaff

Publications and source records attributed to K Tetzlaff.

At least 37 records · Page 2Linked to original sources
PubMed2000

Does diving damage the brain? MR control study of divers' central nervous system.

PURPOSE: To evaluate the prevalence of cerebral white matter changes on MR imaging in healthy elderly compressed air divers with a long diving history in comparison with control subjects who have never dived. MATERIAL AND METHODS: The investigation employed 59 experienced elderly divers and 48 control subjects matched for age, body mass index, alcohol and smoking history. MR studies included a fluid attenuated inversion recovery sequence and T1- and T2-weighted pre- and postcontrast images in axial orientation of the whole brain to localize white matter changes. RESULTS: MR images did not show any morphologic abnormalities in the brains of divers. Both groups - divers and controls - did not differ significantly with respect to white matter changes of the brain. CONCLUSION: No increased prevalence of cerebral white matter changes in compressed air divers compared with a healthy worker sample of similar age were found. Thus, extensive compressed air diving may not necessarily be related to radiological changes on MR.

Adult↗
PubMed2000

Underwater application of nasal decongestants: method for special operations.

A simple method of emergency underwater application of a nasal decongestant in divers to prevent diving-related accidents or even fatalities attributable to sequelae of middle-ear and sinus barotrauma of ascent was evaluated. Eleven military divers had to inject 1 mL of 0.02% methylene blue into a central venous catheter after having inserted the tip between their upper lip and the mask at 1 m depth in a pool. After injection, the head had to be reclined. Blue liquid flowing from a diver's nostril and a "bitter" taste sensation reported immediately after surfacing indicated successful application. All divers were observed to have had blue liquid flowing from the nostril of application, and one diver could not describe the taste. This method of underwater application of nasal decongestants may be useful for emergency prevention in divers, especially during covert operations. Underwater availability of the system in a special kit carried by divers would be required.

Adult↗
PubMed2000

Exposure to soda-lime dust in closed and semi-closed diving apparatus.

BACKGROUND: Chronic exposure to hyperbaric hyperoxia and venous gas microembolism have been shown to contribute to the long term health effects of diving, especially diver's lung function. Factors related to special diving equipment may add to these effects. This study was conducted to evaluate possible additional hazards for respiratory function of divers employing closed and semi-closed diving apparatus. METHODS: We analyzed soda-lime dust found in the air-intake loop of a closed-circuit oxygen rebreathing diving apparatus which had passed through the filter screen of the diving apparatus's soda-lime cartridge. The geometrical characteristics were evaluated by scanning electron microscopy. The amount of dust that passed through the screen during a normal dive profile was measured by an artificial airflow through a filter membrane. After dives by subjects using these devices, the pH-value of water condensate in the air-intake hose was measured. RESULTS: There was a relevant amount of residual soda-lime dust found in the air-intake loop. The dust particles showed diameters down to 1 micron and a rounded structure. The total amount of dust averaged 9.6 mg.m-3 of breathing mixture. During diving, the mean pH-value of condensate in the hose is estimated at 8.87 (+/- 0.12). CONCLUSION: There is a relevant exposure to soda-lime dust in divers using closed-circuit rebreathing apparatus. This occupational exposure may contribute to chronic airway inflammation and subsequent development of small airway disease in divers.

Calcium Compounds↗
PubMed1999

Respiratory pattern after wet and dry chamber dives to 0.6 MPa ambient pressure in healthy males.

The purpose of this study was to evaluate respiratory effects of wet and dry hyperbaric chamber dives to 0.6 MPa ambient pressure in healthy males. There were 19 and 22 subjects who participated in two series of dives with a bottom time of 15 min and decompression times of 28 and 17 min, respectively. Airways conductance, residual volume, forced vital capacity, forced expiratory volume in 1 sec, mid expiratory flow at 25, 50 and 75% of FVC, and diffusion capacity for CO were measured before the dives, after 3 h, and after 24 h. Multivariate analysis of covariance revealed no statistically significant effects of time or the interaction between time and dry or wet environment on the measured lung function parameters. These findings suggest first that even deep air dives may not necessarily affect pulmonary function, and second, that factors related to the particular wet environment do not seem to contribute to lung function changes after dives.

Adult↗
PubMed1999

Blood lactate changes in men during graded workloads at normal atmospheric pressure (100 kPa) and under simulated caisson conditions (400 kPa).

OBJECTIVES: A hyperbaric environment may influence lactate metabolism due to hyperoxia affecting biochemical pathways. The purpose of our study was to determine the blood lactate levels occurring at high workloads in a sample of professional divers under simulated caisson conditions. The ambient air pressure was equivalent to a diving depth of 30 m of seawater (400 kPa). METHODS: A total of 23 healthy male subjects performed graded bicycle exercise in a dry hyperbaric chamber up to a maximum of 3.5 W kg(-1) body weight at normal (100 kPa) and elevated ambient air pressure (400 kPa). The blood lactate level and the heart rate were measured. RESULTS: In comparison with control conditions, the heart rate and the peripheral blood lactate level were significantly lower at depth for all workloads. CONCLUSIONS: The differences between the normobaric and hyperbaric lactate values may be explained by an overall improvement in lactate metabolism at elevated ambient pressure, especially in the working muscles and the organs responsible for the lactate reduction, i.e., the liver. The reduced heart rate may be an effect of the improved tissue oxygen supply at depth.

Adult↗
PubMed1999

Magnetic resonance signal abnormalities and neuropsychological deficits in elderly compressed-air divers.

We investigated the association between MR signal abnormalities of the central nervous system, neuropsychologic performance and exposure indices in 20 experienced elderly compressed-air divers who had no history of neurological decompression illness (DCI). Results of MRI of the brain and psychometric testing were compared with 20 matched healthy commercial employees who never dived: 60% of the divers and 45% of the controls had hyperintense MR abnormalities. Among divers, both the number and the size of abnormalities correlated with hours diving in the deep air-diving range of 40-60 m (p < 0.05). Divers' mental flexibility and visual tracking performance were decreased in comparison with controls (p < 0.05 and p < 0.01). Divers thus are at risk of detrimental long-term effects of compressed-air diving on the central nervous system even in the absence of a history of neurological DCI.

Barotrauma↗
PubMed1999

Perception of dyspnea during histamine- and methacholine-induced bronchoconstriction.

BACKGROUND: Perception of dyspnea is poorly related to bronchoconstriction and may be influenced by distinct psychophysiologic stimuli. OBJECTIVE: This study compared the perceived psychophysiologic changes during histamine- and methacholine-induced bronchoconstriction using verbal as well as nonverbal assessment techniques. METHODS: Perception of dyspnea was studied during induced bronchoconstriction in 40 atopic subjects randomly ascribed to either histamine (n = 20) or methacholine (n = 20) bronchial challenge. A 100% increase in specific airway resistance (sR(aw)) indicated airway hyperresponsiveness (AHR). Dyspnea was verbally assessed by the Borg Scale (BS) and the Asthma Symptom Checklist (ASL). A hand dynamometer (HD) served for nonverbal assessment. Both challenge groups did not differ significantly with respect to age, anthropometric data, smoking and lung function before challenge. RESULTS: AHR did not differ between groups but groups differed significantly with respect to the number of symptoms and to symptom intensity reported after challenge. Subjects who underwent the histamine challenge scored significantly higher on both measures derived from the ASL. BS ratings and HD scores correlated significantly but were not significantly related to the degree of AHR. Accurate and poor perceivers could be discriminated by analysis of the relationship between BS and sR(aw). CONCLUSIONS: These findings suggest that perception of induced dyspnea differs between histamine and methacholine when assessed by a symptom report.

Adult↗
PubMed1999

Functional and high-resolution computed tomographic studies of divers' lungs.

OBJECTIVES: Several cross-sectional studies have described a decrease in the expiratory flow rates of divers. The objective of this study was to determine whether the combined application of high-resolution computed tomography (HRCT) and lung function testing supports the reported development of small airway obstruction in divers. METHODS: Thirty-two navy divers, 27 commercial divers, and 48 referents matched for age and smoking history underwent pulmonary function testing and HRCT of the lungs supplemented by a limited number of expiratory scans. The commercial divers were older and dived longer than the navy divers. Multivariate regression analysis was used to assess the relevant correlations of age, height, pack-years of cigarette smoking, and indices of diving exposure with lung function parameters. RESULTS: The inspiratory vital capacity and forced vital capacity (FVC) were greater, while the FEV% [(100 x FEV10)FVC] and maximum expiratory flow (MEF) at 25% (MEF25) of the FVC were lower for the navy divers than for the referents. The lung volumes and expiratory airflow pattern did not differ between the commercial divers and the corresponding referents. The forced expiratory volume in 1 second (FEV10), FEV%, MEF75, and MEF25 correlated negatively with the years of diving experience. This association was independent of age, height, and pack-years of cigarette smoking. For the majority of the divers and referents the expiratory HRCT revealed minor lobular air trapping without any difference between the groups. The HRCT did not show relevant morphologic abnormalities of small or large airways. CONCLUSIONS: The data confirm that diving may affect pulmonary function. However, there is no radiologic evidence for the development of small airway disease in these 2 subgroups of divers.

Adult↗
PubMed1999

Hyperbaric chamber-related decompression illness in a patient with asymptomatic pulmonary sarcoidosis.

An asymptomatic 46-yr-old male sustained an acute neurologic insult, appearing during the decompression phase of a 50-m dry hyperbaric chamber dive. The right hemisyndrome was most probably related to diving, since symptoms responded rapidly to the early commenced recompression therapy. Further diagnostics revealed a previously unknown pulmonary sarcoidosis with bilateral pulmonary opacities and pleural adhesions that might have predisposed to arterial gas embolism secondary to pulmonary barotrauma. This case may illustrate a potential risk of decompression illness even during dry chamber dives in patients suffering from asymptomatic pleuro-parenchymal pulmonary disease. The value of chest X-ray in the medical assessment of fitness to dive is therefore emphasized.

Biopsy↗
PubMed1999

[Prospective lung function determination using an electronic miniature spirometer for detection of acute obstructive respiratory changes in diving students during occupational diving training].

BACKGROUND: Changes in lung function have been shown in experienced divers. The purpose of this study was to measure the pulmonary function of diving trainees who were not exposed to a hyperbaric environment before. METHODS: We measured the lung function in a sample of fifteen randomized selected young healthy non-smoking diving trainees parallel to fourteen open water dives. Five subjects used common compressed air diving apparatuses (breathing gas: 21% O2/78% N2) and ten subjects used closed circuit diving apparatuses (breathing gas compositions depended to the diving depths; 24 m: 60% O2/40% N2, 42 m: 40% O2/60% N2, 54 m: 32.5% O2/67.5% N2). The values (FVC, FEV1, PEF, MEF 25, MEF 50, MEF 75) were obtained by an electronic miniature-spirometer directly before descent, upon surfacing, and after one hour and four hours. RESULTS: The lung function values of the subjects who used compressed air showed no relevant impairment of lung function after the diving exposures. Significant (p < 0.05) post dive lung function reductions (FVC, FEV1, PEF, MEF 25, MEF 50, MEF 75), were evident in subjects using closed circuit diving apparatuses, after deep dives and shallow water dives. CONCLUSIONS: The decreased lung function of the used diving apparatuses. The impaired lung functions in subjects using closed circuit diving apparatuses may be induced by a subclinical lung edema generated by pressure differences between breathing gas and thorax tissues as well as the influences of soda-lime dust. Compared to compressed air diving the significantly increased oxygen partial pressures (p < 0.001) in closed circuit diving apparatuses may be an additional reason for the reversible airway obstructions.

Adult↗
PubMed1999

Modified closed circuit underwater breathing apparatus LAR VII and laryngeal mask airway as adjuncts for dive buddy artificial ventilation.

This study evaluated the feasibility of using the modified semi-closed circuit underwater rebreathing system (URS) LAR VII in connection with a laryngeal mask airway (LMA) as an expedient ventilatory adjunct in an operational setting. Fourteen combat swimmers, unfamiliar with this equipment, underwent cardiopulmonary resuscitation (CPR) mannequin training using these devices. Eighteen subjects, using a standard AMBU bag for ventilation, served as controls. Thirteen test persons were able to ventilate with the modified URS. Tidal volumes were significantly lower with the LAR VII/LMA than with the AMBU bag (medians, 350 vs. 800 mL). No significant difference was found in total time required for 10 CPR cycles (medians, 78 vs. 68.5 seconds). The median delay between recognition of cardiac arrest and first chest compression, however, was markedly increased with the LAR VII/LMA than with the AMBU bag (medians, 76.5 vs. 14.5 seconds). After proper training, divers might use a modified URS such as the LAR VII for CPR in connection with a LMA. Lower tidal volumes might prevent gastric inflation. Chest compression should be continued during LMA insertion.

Cardiopulmonary Resuscitation↗
PubMed1998

Respiratory responses to exercise in divers at 0.4 MPa ambient air pressure.

OBJECT: This study was carried out to evaluate changes in the breathing pattern of divers during exercise at an elevated ambient air pressure equivalent to a depth of 30 m of seawater. METHODS: A total of 22 healthy male subjects performed graded bicycle exercise in a dry hyperbaric chamber up to a maximum of 3.5 W kg(-1) body weight at normal (0.1 MPa) and at elevated ambient air pressure (0.4 MPa). The exercise ventilation (VE), tidal volume (VT), breathing frequency (BF), oxygen uptake (VO2), carbon dioxide elimination (VCO2), and heart rate (HR) were measured. Perceived dyspnea was assessed by Borg scale ratings. RESULTS: Comparison of respiratory indices between conditions (0.1 versus 0.4 MPa) revealed a significant reduction in VE, VT, BF, and HR during exercise at 0.4 MPa. VO2 and VCO2 did not differ significantly between conditions. Likewise, no significant difference between conditions emerged in perceived dyspnea. CONCLUSION: Ventilation is significantly impaired during heavy bicycle exercise at 0.4 MPa. This is obviously not apparent with regard to subjective perception of dyspnea.

Adult↗
PubMed1998

Atopy, airway reactivity and compressed air diving in males.

A decline in expiratory flow rates in divers has recently been attributed to chronic exposure to hyberbaric air. Airway hyperresponsiveness (AHR) to stimuli due to a hyperbaric environment may play a certain role in this context. The aim of this study was to determine the prevalence of AHR in compressed air divers and to assess the value of bronchial challenges for prediction of fitness to dive. A cross-sectional sample of 59 healthy male volunteers--28 divers and 31 diving candidates (controls)--who had been found fit to dive in a diving medical examination underwent additional allergy screening (skin prick and serum IgE) and a histamine bronchial challenge. Pre- and postchallenge body plethysmography was completed to assess AHR. AHR to histamine was significantly increased among divers and positively related to diving experience whereas divers and controls did not differ significantly with respect to age, anthropometric data, current smoking habits, skin prick reaction, and elevated serum IgE. Our results indicate an increased prevalence of AHR to nonspecific inhalation stimuli in experienced divers. Bronchial challenge tests may be helpful to detect asthmatics in the medical assessment of fitness to dive and for follow-up examinations during a diver's career.

Adult↗
PubMed1998

Expiratory flow limitation in compressed air divers and oxygen divers.

Divers are exposed to dense gases under hyperbaric and hyperoxic conditions and, therefore, may be at risk of developing respiratory disease. Long-term effects on respiratory function have been found in commercial divers who perform deep dives. This study was conducted to detect possible lung function changes in scuba divers who dive in shallow water using compressed air or oxygen as a breathing gas. A cross-sectional sample of 180 healthy male divers (152 air divers and 28 oxygen divers) and 34 healthy male controls underwent a diving medical examination including body plethysmography, diffusion capacity measurement and a cold-air isocapnic hyperventilation test (CAIH). Air divers and oxygen divers had a lower mid-expiratory flow at 25% of vital capacity (MEF25) than controls (p<0.01 and p<0.05, respectively). Oxygen divers also had a decreased mid-expiratory flow at 50% of vital capacity (MEF50) (p<0.05). Divers' groups and controls did not differ with respect to age, smoking or medical history. The prevalence of airway hyperresponsiveness to CAIH was 1.4% (n=3 divers). MEF25 and MEF50 were inversely related to years of diving (p<0.01 and p<0.001, respectively). The pattern of lung function changes obtained in scuba divers is consistent with small airways dysfunction and the association between diving exposure and lung function changes may indicate long-term effects on respiratory function.

Adult↗
PubMed1998

Pulmonary Wegener's granulomatosis: correlation between high-resolution CT findings and clinical scoring of disease activity.

STUDY OBJECTIVE: To evaluate the usefulness of high-resolution CT (HRCT) for monitoring pulmonary disease activity in Wegener's granulomatosis (WG). DESIGN: Prospective study of CT and clinical data. SETTING: Main referral hospital for rheumatic diseases and department of diagnostic radiology of collaborating university hospital. PATIENTS: Seventy-three patients with WG underwent 98 staging examinations using HRCT. The status of pulmonary disease activity at the time of examination was scored according to clinical, bronchoscopic, BAL, and radiographic findings as follows: activity (n=25, group 1), past activity (n=45, group 2) and lack of any pulmonary disease (n=28, group 3). HRCT findings were correlated with the clinical scoring of pulmonary disease activity. RESULTS: Of 98 staging examinations 78 (79.6%) revealed abnormal CT scans showing the following main abnormalities: (a) nodules or masses (group 1: 16 [60.4%], group 2: 9 [20%]); (b) parenchymal bands (group 1: 12 [48%], group 2: 27 [60%], group 3: 6 [21.5%]); (c) septal thickening (group 1: 8 [32%], group 2: 6 [13.3%]); (d) parenchymal opacification (group 1: 7 [28%], group 2: 4 [8.9%]); and (e) pleural irregularity (group 1: 14 [56%], group 2: 22 [49%], group 3: 9 [32%]). Nodules/masses and areas of parenchymal opacification were significantly associated with florid disease activity of the lungs. Parenchymal bands and septal thickening were observed in both groups with pulmonary involvement, but statistical analysis revealed no significant difference. Pleural irregularities were nonspecific. CONCLUSION: HRCT may be a useful adjunct to clinical scoring of pulmonary disease activity in patients with WG and suspected lung involvement.

Adult↗
PubMed1998

Memory deficits at 0.6 MPa ambient air pressure.

We investigated the effects of an elevated ambient air pressure of 0.6 MPa on verbal memory performance. Twenty-four experienced divers were compressed in a dry hyperbaric chamber to pressures equivalent to 0.5 meters of seawater (msw) (n = 12) and 50 msw (n = 12). Verbal memory was assessed by free recall and recognition of visually presented word lists. The testing procedure specified learning and testing at surface, learning at surface and testing at depth, learning and testing at depth, and learning at depth and testing at surface. Non-specific stress was assessed by measurement of salivary cortisol, heart rate, and subjective stress before, during, and after the dives. The 50-msw dive group showed a significant decrease of free recall performance when the material was learned at depth (P < 0.01). However, only postdive recall of material learned at depth remained significantly impaired (P < 0.05), whereas recognition performance was normal. For both groups no significant effects of depth on the investigated stress indices were obtained. These results are taken as evidence that inert gas narcosis may interfere with encoding and/or retrieval of verbal information, although the possibility that other stressors in the hyperbaric environment contributed to these deficits cannot be eliminated entirely.

Adult↗