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PubMed2005

Decompression sickness during simulated extravehicular activity: ambulation vs. non-ambulation.

BACKGROUND: Extravehicular activity (EVA) is required from the International Space Station on a regular basis. Because of the weightless environment during EVA, physical activity is performed using mostly upper-body movements since the lower body is anchored for stability. The adynamic model (restricted lower-body activity; non-ambulation) was designed to simulate this environment during earthbound studies of decompression sickness (DCS) risk. DCS symptoms during ambulatory (walking) and non-ambulatory high altitude exposure activity were compared. The objective was to determine if symptom incidences during ambulatory and non-ambulatory exposures are comparable and provide analogous estimates of risk under otherwise identical conditions. METHODS: A retrospective analysis was accomplished on DCS symptoms from 2010 ambulatory and 330 non-ambulatory exposures. RESULTS: There was no significant difference between the overall incidence of DCS or joint-pain DCS in the ambulatory (49% and 40%) vs. the non-ambulatory exposures (53% and 36%; p > 0.1). DCS involving joint pain only in the lower body was higher during ambulatory exposures (28%) than non-ambulatory exposures (18%; p < 0.01). Non-ambulatory exposures terminated more frequently with non-joint-pain DCS (17%) or upper-body-only joint pain (18%) as compared with ambulatory exposures, 9% and 11% (p < 0.01), respectively. DISCUSSION: These findings show that lower-body, weight-bearing activity shifts the incidence of joint-pain DCS from the upper body to the lower body without altering the total incidence of DCS or joint-pain DCS. CONCLUSIONS: Use of data from previous and future subject exposures involving ambulatory activity while decompressed appears to be a valid analogue of non-ambulatory activity in determining DCS risk during simulated EVA studies.

Decompression Sickness↗
PubMedDate not supplied

Diving behaviour and decompression sickness among Galapagos underwater harvesters.

Diving conditions, dive profiles, vascular bubbles, and symptoms of decompression sickness (DCS) in a group of Galapagos commercial divers are described. They harvest sea cucumbers from small boats with surface supplied air (hookah). Dive profiles for 12 divers were recorded using dive loggers, and bubble formation was measured in the pulmonary artery. DCS symptoms were assessed by interview. A total of 380 immersions were recorded over a nine day period. The divers did on average 6.3 immersions per day, in a yo-yo pattern. Mean overall depth was 34.5 FSW. Maximum recorded depth was 107 FSW. Average bottom time per day per diver was 175 minutes. 82 % of all ascents exceeded the recommended maximum ascent rate of 30 FSW/ min. High bubble grades were observed on six occasions, but the test was unreliable. Muscle and joint pain was reported on five occasions, in three different divers. Symptoms were typically managed by analgesics, in-water recompression or not at all. The divers were extremely reluctant to seek professional help for DCS symptoms, mostly due to the high costs of treatment. We conclude that the fishermen dive beyond standard no-decompression limits, and that DCS symptoms are common.

Adolescent↗
PubMed2005

Headache and altitude decompression sickness: joint pain or neurological pain?

INTRODUCTION: Exposure to reduced ambient pressure may result in decompression sickness (DCS). Headache is among the DCS symptoms encountered and is usually regarded as neurological DCS, which is traditionally classified as serious DCS. Since cranial sutures may be considered joints, it is possible that some headaches are actually joint pain and when associated with decompression sickness need not be neurological DCS. METHODS: Records were individually recovered from the Davis Hyperbaric Laboratory at Brooks City-Base, TX. Information was extracted using a detailed survey instrument. Possible joint pain headache cases were identified using three criteria: headache localized at a suture, normal neurologic exam, and resolution within 30 min of hyperbaric oxygen treatment. RESULTS: A total of 729 records documenting treatment for DCS were scrutinized. Of these, 70 cases of altitude DCS with headache were examined. Analysis, using the three criteria, showed 23% (16 cases) of altitude headache DCS symptoms could potentially be re-classified as joint pain. CONCLUSION: Generally, headache DCS is considered neurological DCS. However, since cranial sutures are joints, both histologically and functionally, and since DCS most commonly affects joints, headache DCS may, at times, be joint pain DCS. Indeed, retrospective data analysis suggests that this possibility exists. Such a reclassification from neurological to joint pain DCS would lessen the aeromedical impact of a DCS headache.

Adult↗
PubMed2005

Neuropraxia of the palmar cutaneous branch of the ulnar nerve during carpal tunnel decompression.

Carpal tunnel syndrome is one of the most commonly encountered conditions in the hand clinic and carpal tunnel decompression is the most frequently performed procedure in hand surgery. It is an effective procedure for patients with carpal tunnel syndrome. However, there is a high risk of complications that can be avoided with an understanding of wrist anatomy, appropriate planning and execution. We highlight one such complication, a case of neuropraxia of the palmar cutaneous branch of the ulnar nerve that followed carpal tunnel decompression.

Carpal Tunnel Syndrome↗
PubMedDate not supplied

[Leukocyte-modulating and antioxidant activity of blood serum and bronchoalveolar lavage fluid in the course of the decompression period of long crush syndrome].

We studied leukocyte-modulating activity (LMA) and antioxidant activity (AOA) of blood serum and bronchoalveolar lavage fluid (BAL) in the course of a postcompression period of crush syndrome (CS) in rats. CS was modelled by compression of the left back leg of the animal with metal vice (compression area 5 cm2, duration 4 hours). In CS decompression, LMA of both the serum and BAL was high. On decompression day 1 there was a compensatory growth of serum and BAL AOA, its fall on day 3 and 7 and recovery by day 21. Calculation of the coefficient of LMA to AOA shows imbalance between pro- and antioxidant systems with development of oxidant stress. Thus, prevalence of blood and lung LMA over AOA on intermediate stages of CS may cause stimulation of destruction in hepatic and pulmonary tissues with development of inflammatory reaction.

Animals↗
PubMed2006

[Microvascular decompression for refractory neurogenic hypertension: case report].

It is noted that the increased central sympathetic nerve activity caused by neurovascular compression at the rostral ventrolateral medulla (RVLM) is closely related to the genesis of neurogenic hypertension. The authors present the case of a 49-year-old female with refractory neurogenic hypertension to be uncontrolled even with all kinds of oral antihypertensive medications. After approval by the Ethical Committee in a hospital, she had received an intravenous introduction of calcium antagonist and beta-blocker at home for three years. The subsequent examination detail showed increased sympathetic nerve activity and compression of the left vertebral artery (VA) at the left RVLM on magnetic resonance imaging, and therefore microvascular decompression (MVD) underwent through a left lateral suboccipital approach. The left VA was seen indenting the left RVLM. To ensure the complete decompression, the distal part of VA was moved away from RVLM to fix to the dura of the petrous bone with a glue. Her blood pressure became normalized afterwards without drugs and remained normotensive for 23 months after MVD. In order to decide the surgical indication for pure neurogenic hypertension due to neurovascular compression, a strict differential diagnosis is necessary.

Decompression, Surgical↗
PubMedDate not supplied

Probability of decompression sickness in no-stop air diving and subsaturation diving.

Probabilistic models allow estimation of the probability (Pdcs) that decompression sickness (DCS) will occur in any particular dive. Our objective is to provide Pdcs estimates for no-stop diving instructions used by the U.S. Navy and various other navies. To do so, we develop statistics-based (probabilistic) and intuition-based (deterministic) models using dive-outcome data from the U.S. Navy Decompression Database. We give special attention to subsaturation dives (defined as no-stop dives shallower than 40 fswg with bottom times between 4 hr and one day), for which experimental dives are scarce. According to our models, probability of DCS is 2% or less for current U.S. Navy no-stop air dive schedules and near 1% for the navies of Great Britain, Canada, and France; also the current U.S. Navy prescriptions for subsaturation dives seem to be appropriate. Our probabilistic models fail for deep dives; they do not avoid observed DCS cases in the calibration dataset and provide longer no-stop times than allowed by tables used operationally; we advocate prescriptions by our deterministic model for deep no-stop dives.

Algorithms↗
PubMed2006

Dehydration effects on the risk of severe decompression sickness in a swine model.

BACKGROUND: Several physiological factors have been suspected of affecting the risk of decompression sickness (DCS), but few have been thoroughly studied during controlled conditions. Dehydration is a potential factor that could increase the risk of DCS. It has been suggested that hydration may enhance inert gas removal or increase surface tension of the blood. HYPOTHESIS: Dehydration increases DCS risk. METHODS: Littermate pairs of male Yorkshire swine (n=57, mean +/- 1 SD 20.6 +/- 1.7 kg) were randomized into two groups. The hydrated group received no medication and was allowed ad lib access to water during a simulated saturation dive. The dehydrated group received intravenous 2 mg x kg(-1) Lasix (a diuretic medication) without access to water throughout the dive. Animals were then compressed on air to 110 ft of seawater (fsw, 4.33 ATA) for 22 h and brought directly to the surface at a rate of 30 fsw x min(-1) (0.91 ATA x min(-1)). Outcomes of death and non-fatal central nervous system (CNS) or cardiopulmonary DCS were recorded. RESULTS: In the hydrated group (n=31): DCS=10, cardiopulmonary DCS=9, CNS DCS=2, Death=4. In the dehydrated group (n=26): DCS=19, cardiopulmonary DCS=19, CNS DCS=6, Death=9. Dehydration significantly increased the overall risk of severe DCS and death. Specifically, it increased the risk of cardiopulmonary DCS, and showed a trend toward increased CNS DCS. In addition, dehydrated subjects manifested cardiopulmonary DCS sooner and showed a trend toward more rapid death (p < 0.1). CONCLUSION: Hydration status at the time of decompression significantly influences the incidence and time to onset of DCS in this model.

Analysis of Variance↗
PubMed2005

[The study on the value of the decompression to the optic nerve channel for the optic atrophy patients].

OBJECTIVE: To evaluate the effective treatment method for the optic nerve atrophy. METHOD: Sixteen patients were diagnosed as optic nerve atrophy by examining the sight, eye base and VEP. There were no occupied lesion in the eye, nose sinus and the intracranial through the CT examination. The visual ability were become worse before the operation. This group of the patients were underwent the eye-nose-ethmoid -sphenoid approach to undergo the decompress of the optic nerve channel. During the operation, the ethmoid was removed and the sphenoid sinus was opened. When the optic nerve channel was found, more than half of it was removed. Then the whole nerve channel was opened. The sheath and the tendon of the optic nerve were opened in longitude direction. The antibiotic, hormone vessel dilation drugs were given. The changes of the visual ability, eye base and VEP between preoperation and postoperation were compared. RESULT: The visual ability and the VEP of 16 cases of the of the patients were improved. A week after the operation and three months latter examination of the eye base showed that ten of the patients got improved and six of them no change. There were no serious postoperative complication. CONCLUSION: The decompression of the optic nerve channel is the ideal method to deal with optic nerve atrophy.

Adult↗
PubMed2006

Timing of decompression and fixation after spinal cord injury--when is surgery optimal?

Spinal cord injury affects a large number of young individuals with a significant cost to affected persons, families and societies both in terms of economic and non-economic costs. To date, our interventions have been limited to prevention, good initial resuscitation, modest pharmacotherapy and nursing care. This review examines the role of surgery in spinal cord injury. The pathophysiology of spinal cord injury is reviewed. The compelling animal data for early decompression is discussed as well as evidence for improved neurological outcome with early decompression in humans. Finally, the impact of early surgery on non-neurological outcome and overall complication rates is examined with the concept of "damage control" discussed with relevance to spinal cord injury. It appears that favourable outcomes are achieved with early surgery, with reduced morbidity/mortality, but definitive data is still pending.

Animals↗
PubMed2005

[Cubital tunnel syndrome: results of simple decompression].

32 cases of cubital tunnel syndrome were treated by simple decompression of the ulnar nerve. Physical examination showed that ulnar nerve function - motor and sensory improved after surgery treatment. Simple decompression is a reliable and effective surgical option.

Adult↗
PubMed1991

Predictability of adequacy of spinal root decompression using evoked potentials.

Dermatomal evoked potentials are being used to obtain accurate information concerning the viability of specific nerve root pathways and the quality and extent of nerve root decompression. Twelve patients with quantifiable weakness were selected and tested before, during, and after surgery. Nine patients showed dramatic intraoperative electrical improvement, including decreased latencies and/or increased amplitudes; all had postoperative relief of pain and motor return. Three patients showed variable intraoperative electrical responses with complete pain relief but no motor improvement. No patients had false-negative findings. Intraoperative monitoring of dermatomal evoked potentials appears to be of value in predicting the quality of spinal decompression. Similar monitoring of somatosensory evoked potentials alone cannot provide the specificity for individual root levels that is available by monitoring individual dermatomes.

Adult↗
PubMed2006

[Decompressive craniectomy for ischemic stroke].

We analysed retrospectively 15 consecutive patients with cerebral infarction undergoing decompressive craniectomy. Ninety-three percent of patients survived, and 53% of them were partially dependent (Barthel Index > 0). We defined the partially dependent patients as good outcome group, and totally dependent as poor outcome group. In good outcome group, compared with poor outcome group, there are more frequent left hemispheric lesion (50%: 0%, p = 0.029), and pre-operative JCS < or = II-30 (62.5%: 14.3%, p = 0.057). Although many patients were severely disabled, 79% of the patients and their family answered that having operation was correct choice. All the patients in good outcome group acquired the ability of oral feeding and communication skill. 87.5% of the patient in good outcome group was satisfied with the outcome. Based on these results, we emphasized that comprehensive evaluations, including satisfaction scale and QOL assessment necessary to decide the indication of decompressive craniectomy for ischemic stroke.

Activities of Daily Living↗
PubMed2006

Vascular distribution of an ultrasound contrast agent used to simulate decompression bubbles.

OBJECTIVE: The objectives of this preliminary work were to evaluate the distribution of an ultrasound contrast agent (UCA) (microbubbles) in different arterial regions (brain, kidney, lower limbs) using the Doppler spectrum brightness analysis and to discuss the results in the context of decompression physiology. METHOD: There were four patients who instrumented with two pulsed Doppler sensors in order to monitor in real-time the spectrum of the middle cerebral femoral arteries. Renal arteries were investigated using an echo-Doppler probe handled by a sonographer. Measurements of the systolic mean, diastolic frequencies, qualitative, and quantitative analysis of the spectrum brightness intensity were performed before and after intravenous injection of a UCA. RESULTS: All of the systolic mean and diastolic arterial frequencies remained constant during the experiment. Some seconds after the first injection, the cerebral spectrum was heterogeneously enhanced with strong flashes over the entire spectrum. The renal and femoral spectrums were homogeneously reinforced. The spectrum brightness patterns did not change during the first 10 min. DISCUSSION: This work shows that the distribution of the UCA microbubbles within the vessel sections changed according to the distance from the heart, as suggested by the spectrum recorded at different sites. By mixing the blood, the heart could re-aggregate the UCA particles, even when they returned from the distal vascular regions where they were homogeneously distributed. The circulating microbubbles and their distribution within the arteries should be considered in decompression procedures with repetitive dives.

Adult↗
PubMed2006

Interspinous process decompression (IPD) system (X-STOP) for the treatment of lumbar spinal stenosis.

With increased life expectancy and an aging population, many patients suffering from progressive lumbar spinal stenosis with symptomatic neurogenic intermittent claudication (NIC) have been limited to a choice between nonsurgical therapies or a more traumatic decompressive surgical procedure, with or without lumbar fusion. The interspinous process decompression (IPD) system, the X-STOP implant, was developed to provide a minimally invasive alternative therapeutic treatment of lumbar spinal stenosis. The X-STOP IPD system, surgical indications, operative techniques, and the potential complications and their avoidance are described and discussed herein.

Decompression, Surgical↗
PubMed2006

[Chronic pancreatitis: resective and decompressive procedures].

PURPOSE: Definition of resective and decompressive operations in chronic pancreatitis. MATERIALS AND METHODS: A retrospective analyses of surgical management of 51 chronic pancreatitis patients is carried out. 24 patients underwent longitudinal pancreaticojejunostomy (PA), 27--pancreatic head ( PH) resective procedures: Beger--5, modified Frey (PH intraparenchimatose resection-- IR, supposing removal of fibrous masses from the ventral and greater part of the dorsal PH)--22. According to the character of the PH lesion the patients were divided in 3 groups: head dominant (13), total (11) and cystic pancreatitis (20). RESULTS: One early postoperative death developed after reoperation for adhesive intestinal ileus in patient with PA. No mortality was noted after IR. Remote results in terms of 4.8+/-0,7 years were studied in 32 (71%) patients underwent PA and IR. IR lead to good and satisfactory results. After PA poor results came to 5 (29.5%). CONCLUSIONS: Combination of PH IR and PA is indicated in head dominant and total chronic pancreatitis patients. In cases of pseudocysts and dilation of the main pancreatic duct (>6-7 cm) decompressive variant of procedure cysto-pancreato-jejunostomy is preferable.

Adult↗
PubMed1991

Oxyhemoglobin saturation following rapid decompression to 18,288 m preceded by diluted oxygen breathing.

This investigation studied oxyhemoglobin saturation (SaO2) and cardiovascular indices after rapid decompression (RD). Before RD, fractional inspired O2 concentration (FIO2) simulated the range of product gas from molecular sieve O2 generating systems (MSOGS). Four subjects breathed 1.0-0.80 FIO2 at 6,858 m. After decompression to 18,288 m, the subject received 1.0 FIO2 at a positive pressure of 70 mm Hg for 3 min. There were no incidents of severe hypoxia. The mean SaO2 was 98.0% before RD. After RD, SaO2 was maintained at the pre-RD level for 8 s, decreased rapidly over the next 10 s, and over the rest of the 1st min decreased more gradually to reach approximately 82%. Varying FIO2 before RD had no effect on the alteration in SaO2, heart rate, stroke index, and blood pressure after RD. The MSOGS O2 product range offers adequate protection against hypoxia during RD to 18,288 m.

Adult↗
PubMed1991

[The biorhythmological aspects of morbidity from decompression sickness].

The article analyses diurnal and seasonal rhythms of decompression disease (DD) in a group of deep-water divers during 17 years. The diurnal dynamics of DD morbidity has a straight 12 hours rhythm with acrophases between 4-8 a.m. and 4-8 p.m. The morbidity is higher at the first half of a day--from midnight till midday. Its diurnal rhythm is conditioned by circadian and ultradian rhythms of cardiorespiratory system. The seasonal DD morbidity has its maxima in September-October, February-March and May, i.e. in months of man's adaptation for changes in climate conditions. In these critical periods it is recommended to realize prolonged decompression, increasing its oxygen part, and redouble control over the health of divers.

Adult↗

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