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PubMed2002

Modulation of decompression sickness risk in pigs with caffeine during H(2) biochemical decompression.

In H(2) biochemical decompression, H(2)-metabolizing intestinal microbes remove gas stored in tissues of animals breathing hyperbaric H(2), thereby reducing decompression sickness (DCS) risk. We hypothesized that increasing intestinal perfusion in pigs would increase the activity of intestinal Methanobrevibacter smithii, lowering DCS incidence further. Pigs (Sus scrofa, 17-23 kg, n = 20) that ingested caffeine (5 mg/kg) increased O(2) consumption rate in 1 atm air by ~20% for at least 3 h. Pigs were given caffeine alone or caffeine plus injections of M. smithii. Animals were compressed to 24 atm (20.5-23.1 atm H(2), 0.3-0.5 atm O(2)) for 3 h, then decompressed and observed for signs of DCS. In previous studies, DCS incidence in animals without caffeine treatment was significantly (P < 0.05) lower with M. smithii injections (7/16) than in controls (9/10). However, contrary to our hypothesis, DCS incidence was marginally higher (P = 0.057) in animals that received caffeine and M. smithii (9/10) than in animals that received caffeine but no M. smithii (4/10). More information on gas kinetics is needed before extending H(2) biochemical decompression to humans.

Animals↗
PubMed1999

Degenerative lumbar spinal stenosis. Long-term results after undercutting decompression compared with decompressive laminectomy alone or with instrumented fusion.

The aim of the study was to evaluate the long-term outcome of various surgical procedures for lumbar spinal stenosis. Operations were performed on 117 consecutive patients for lumbar spinal stenosis between 1987 and 1992. Pre- and intraoperative data were recorded in a standardized manner. Three treatment groups were distinguished: group I consisting of 39 patients submitted to undercutting decompression; group II, 51 patients, submitted to laminectomy and foraminal decompression alone; and group III, 27 patients, who underwent foraminal decompression and laminectomy with instrumented fusion. Eight years (5-10 years) after surgery a questionnaire was mailed to the patients containing the outcome scales according to Greenough and Fraser [6] and Turner et al. [22] together with questions about residual pain, necessity of treatment and satisfaction with the operative outcome. A total of 72 questionnaires (61.6%) gave enough information for analysis. After a mean follow-up of 8 years, walking capacity had increased significantly in all groups (P < 0.001). Compared to preoperative values, pain had decreased significantly in all groups (P < 0.01). In group I 36% had good-to-excellent outcomes, and 30.8% and 23.8% in groups II and III (P > 0.05). Forty percent of group I patients were unsatisfied with the result, compared to 38.4% and 33.3% in the other groups (P > 0.05). Overall, 25 of 72 patients (34.7%) had severe constant back and/or leg pain requiring daily administration of analgesics. We conclude that the long-term outcome of decompressive surgery of the lumbar spinal canal, without and with instrumented fusion, is less favourable than was previously reported.

Aged↗
PubMed2003

Probabilistic modelling for estimating gas kinetics and decompression sickness risk in pigs during H2 biochemical decompression.

We modelled the kinetics of H2 flux during gas uptake and elimination in conscious pigs exposed to hyperbaric H2. The model used a physiological description of gas flux fitted to the observed decompression sickness (DCS) incidence in two groups of pigs: untreated controls, and animals that had received intestinal injections of H2-metabolizing microbes that biochemically eliminated some of the H2 stored in the pigs' tissues. To analyse H2 flux during gas uptake, animals were compressed in a dry chamber to 24 atm (ca 88% H2, 9% He, 2% O2, 1% N2) for 30-1440 min and decompressed at 0.9 atm min(-1) (n = 70). To analyse H2 flux during gas elimination, animals were compressed to 24 atm for 3 h and decompressed at 0.45-1.8 atm min(-1) (n = 58). Animals were closely monitored for 1 h post-decompression for signs of DCS. Probabilistic modelling was used to estimate that the exponential time constant during H2 uptake (tau(in)) and H2 elimination (tau(out)) were 79 +/- 25 min and 0.76 +/- 0.14 min, respectively. Thus, the gas kinetics affecting DCS risk appeared to be substantially faster for elimination than uptake, which is contrary to customary assumptions of gas uptake and elimination kinetic symmetry. We discuss the possible reasons for this asymmetry, and why absolute values of H2 kinetics cannot be obtained with this approach.

Animals↗
PubMed2000

Delayed onset pulmonary barotrauma or decompression sickness? A case report of decompression-related disorder.

A-24-yr-old male professional diver began to complain of substernal pain 3 h after a controlled ascent from a dive of less than 40 ft of sea water (fsw). The diving master who supervised his dive and the physicians who examined him on presentation suspected pulmonary barotrauma rather than decompression sickness (DCS) because he had only descended to a depth of 32 fsw. Hyperbaric oxygen therapy (HBO) by U.S. Navy treatment Table VI was implemented because of his progressively worsening pain. HBO was apparently effective and a relapse was not seen. The author cannot label his condition based on the conventional classification categories, such as decompression sickness (DCS), barotrauma or even decompression illness. This case report is offered as a topic for consideration in the controversy over decompression-related disorders.

Adult↗
PubMed2001

Effect of ambient temperature on the risk of decompression sickness in surface decompression divers.

BACKGROUND: Several studies have noted an apparent increase in decompression sickness (DCS) risk with surface decompression diving in warm water or with hot water suits (Van Der Aue 1951, Shields 1986, Leffler 1997), but did not perform statistical tests to control for the pressure-time profile. METHODS: The 1986 data, including 73 DCS cases out of 14,891 dives, were analyzed by Mantel-Haenszel analysis to control for depth and bottom time. Dive profiles from the 1951 U.S. Navy report, including 147 DCS cases from 1507 dives, were analyzed with logistic regression analysis to control for depth, bottom time, and aspects of the decompression profile. RESULTS: In the 1986 data, hot water suits, as compared with passive thermal protection, were associated with an odds ratio (OR) of 1.81 (95% confidence interval, CI = 0.96 to 3.42) for DCS. In the 1951 data, each 10 degree C increase in water temperature yielded an OR for DCS of 1.96 (95% CI = 1.33 to 2.90). The interaction of temperature and bottom time suggested that the effect was more pronounced in shorter dives. Among DCS cases, the OR for type 2 symptoms with hot water suits was not significant in the 1986 data (p = 0.18). In the 1951 data, the probability of type 2 symptoms among DCS cases was better explained by the dive profile than by the temperature. Thermal effects on gas physics, metabolism, hemostasis, and nociception were reviewed. CONCLUSION: Surface decompression divers who are warm at depth face an increased risk of DCS. Vasodilatation in warm divers may result in more rapid on-gassing of tissues with short time constants. A full evaluation of DCS risk should consider physiological and physical effects of ambient temperature.

Decompression Sickness↗
PubMed1989

Sensory recovery in the plantar aspect of the foot after surgical decompression of posterior tibial nerve. Possible role of steroids along with decompression.

In leprosy, involvement of the posterior tibial nerve leads to sensory loss in the plantar aspect of the foot. As a result plantar ulcers are common and lead to deformity and disability. Restoration of plantar sensation can prevent ulcer formation. Posterior tibial decompression was done for the recovery of sensation in the plantar aspect of the foot. Seventy-two patients under went decompression on 84 feet, 25 received steroids pre- and post-operatively. The recovery of sensation was better if surgery was done before 6 months of onset of anaesthesia. Decompression along with steroids gave better results than decompression alone in patients with active neuritis especially in BT cases whereas in BB, BL and LL cases there was no significant improvement of sensation. The results are discussed.

Adolescent↗
PubMed1995

Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful. The Ischemic Optic Neuropathy Decompression Trial Research Group.

OBJECTIVE: To assess the safety and efficacy of optic nerve decompression surgery compared with careful follow-up alone in patients with nonarteritic anterior ischemic optic neuropathy (NAION). DESIGN: The Ischemic Optic Neuropathy Decompression Trial (IONDT) is a randomized, single-masked, multicenter trial. SETTING: Twenty-five US clinical centers. PARTICIPANTS: The IONDT ceased recruitment on October 20, 1994, on the recommendation of its Data and Safety Monitoring Committee. The preliminary results presented herein are based on data as of September 8, 1994, from 244 patients with NAION and visual acuity of 20/64 or worse. One hundred twenty-five patients had been randomized to careful follow-up, and 119 had been randomized to surgery, with 91 and 95, respectively, having completed 6 months of follow-up. INTERVENTION: Patients in the surgery group received optic nerve decompression surgery and follow-up ophthalmologic examinations; those in the careful follow-up group received ophthalmologic examinations at the same times as the surgery group. MAIN OUTCOME MEASURES: Gain or loss of three or more lines of visual acuity on the New York Lighthouse chart at 6 months after randomization, as measured by a technician masked to treatment assignment. RESULTS: Patients assigned to surgery did no better when compared with patients assigned to careful follow-up regarding improved visual acuity of three or more lines at 6 months: 32.6% of the surgery group improved compared with 42.7% of the careful follow-up group. The odds ratio (OR) for three or more lines better, adjusted for baseline visual acuity and diabetes, was 0.74 (95% confidence interval [CI], 0.39 to 1.38). Patients receiving surgery had a significantly greater risk of losing three or more lines of vision at 6 months: 23.9% in the surgery group worsened compared with 12.4% in the careful follow-up group. The 6-month adjusted OR for three or more lines worse was 1.96 (95% CI, 0.87 to 4.41). No difference in treatment effect was observed between patients with progressive NAION and all others. CONCLUSION: Results from the IONDT indicate that optic nerve decompression surgery for NAION is not effective, may be harmful, and should be abandoned. The spontaneous improvement rate is better than previously reported.

Aged↗
PubMed1996

Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone.

One hundred twenty-four patients with degenerative lumbar stenosis underwent decompression with fusion (32 patients) and without fusion (92 patients) during a 30-month period between 1986 and 1988. Patient-reported satisfaction at a mean follow-up period of 5.8 years (range 4.6-6.8 years) revealed a 79% good or fair outcome and a 21% poor outcome (26 patients). Seven patients (6%) developed lumbar instability, three patients (2%) developed new stenosis at an adjacent unoperated level, and three patients (2%) developed a new disc herniation between 2 and 5 years after surgery. Progressive postoperative spondylolisthesis occurred in 31% of patients with normal preoperative alignment (mean 7.8 mm, range 2-20 mm) and in 73% of patients with preoperative subluxation (mean 5.1 mm, range 2-13 mm) in whom fusion was not attained. Radiological progression did not correlate well with patient-reported outcome. The major conclusions from this study are the following: 1) the majority of patients respond well to this surgery, but complication (22%) and late deterioration (10%) rates are not insignificant; 2) radiological instability is common after decompression for degenerative lumbar spinal stenosis, but this correlates poorly with clinical outcome; 3) there are no definitive clinical or radiological factors that preoperatively predict patients at risk for a poor outcome; 4) post-operative radiological instability is more likely to occur when the following criteria are present: preoperative spondy-degenerated L-4 or a markedly degenerated L-3 disc; and when a radical and extensive decompression greater than one level is planned; and 5) the group at greatest risk for a poor outcome consists of those patients with normal preoperative alignment who do not suffer slippage following surgery.

Adult↗
PubMedDate not supplied

[Comparative study of decompression-induced formation of gas bubbles using ultrasonic equipment and the development of altitude-decompression disorders].

442 altitude experiments on 40 volunteers were performed. Gas bubbles in venous blood were detected using an ultrasonic Doppler system functioning in a continuous mode at a frequency of 5 MHz. The threshold of bubble formation was identified in 31 test subjects and that of emergency of altitude-decompression disorders, in 28 test subjects. Individual resistance to decompression-induced bubbles was revealed. It was shown that the thresholds may vary with time, in the head-down position and in the head-down position combined with exercises. A correlation was established between the rate of intravascular bubble formation and the frequency of altitude-decompression disorders.

Adult↗
PubMed1991

Does microsurgical vascular decompression for trigeminal neuralgia work through a neo-compressive mechanism? Anatomical-surgical evidence for a decompressive effect.

The positive effect of Microsurgical Vascular Decompression (MVD) on idiopathic trigeminal neuralgia still remains controversial between a decompressive mechanism and a "neo-compressive" one. This paper is a summary of a comparative study of the results on pain obtained with two technical modifications of the MVD procedure. The first consisted of interposition of a foreign material between the nerve and the transposed artery after dissection of the trigeminal nerve, whilst in the second the offending vessel(s) was dislodged without using any material touching the nerve. The two series of 60 patients in each were similar concerning the clinical features. Evaluation of results on neuralgia - with one year follow-up-in both series, shows that the technique used in the second group was not followed by a higher rate of recurrence than the technique used in the first group. On the contrary; 4.5% in the 2nd group compared to 10% in the first. This indicates that MVD would not act as a result of "neo-compression" of the nerve, but rather through a real decompressive mechanism.

Arteries↗
PubMed1988

Medical decompression of toxic megacolon by "rolling". A new technique of decompression with favorable long-term follow-up.

We treated 19 consecutive patients with toxic megacolon complicating inflammatory bowel disease with the usual intensive medical regimen, but also added a new technique, namely, the frequent rolling of the patient to the prone position in order to redistribute colonic gas and thereby promote decompression. In all 19 patients (100%) the colon was decompressed within 1-13 days (mean 4.9 days). Two patients (10.5%) died. In long-term follow-up (mean 6.5 years), only 4 of the 17 survivors (21%) ultimately required colectomy; the remaining 13 (68%) were either completely well or only minimally symptomatic and did not require steroids. Most reports on the management of toxic megacolon stress the need for early surgical intervention, but our success in decompression with the addition of the "rolling technique" suggests an improvement in the nonoperative management of toxic megacolon.

Adult↗
PubMed1997

[Evaluation of the risk of decompression disease during hypobaric decompression from the standpoint of the probability theory].

Author's probabilistic theory of decompression sickness (DS) asserts that DS risk for human subjects during a single-stage reduction of pressure will be rated by distribution of estimated nucleation efficiency in the "worst" body tissues and its critical value as a function of initial nitrogen pressure, end-pressure, and bubble growth dynamics. The method was tested in the analysis of literature on the DS risk during altitude exposures with preliminary denitrogenation of varying length. Results of the analysis suggest that washing out half of nitrogen from the "worst" tissues will take minimum 480 minutes instead of 360 minutes. Calculated parameters of nucleation in tissues were used to plot DS risk due to hypobaric decompression against the final pressure. Influence of physical activity on nucleation parameters and DS risk curves is discussed.

Decompression↗
PubMed2000

[Viral infection, the mask of decompression sickness and decompression sickness diagnosed as viral infection].

Two cases of diving persons: a soldier from the military centre of divers training and a student amateur diver, have been presented in the study. On the basis of similar symptoms--among others: muscular pain, discomfort, subfebrile body temperature, extremely different, incorrect diagnoses were given and improper treatment was introduced. In the case of the soldier suffering from a viral infection decompression sickness was diagnosed only because he served in a divers unit. Whereas, in the second case a physician did not take into consideration all available history data and diagnosed influenza despite evident symptoms of decompression sickness. In the discussion the factors which should have guided the physician in both cases to proper diagnosis and proper therapeutic management have been indicated.

Adult↗
PubMed1996

[New surgical technique of anterior decompression for cervical disc disease: vertebral column autograft with the intervertebral disc after anterior cervical decompression].

The authors describe the surgical technique of vertebral column autograft with the intervertebral disc after anterior decompression for cervical disc disease. This series consisted of 41 patients with cervical disc disease suffering from cervical spondylotic radiculomyelopathy. There were 27 men and 14 women, ranging in age from 27 to 72 years (mean age 49 years). 33 patients were operated on at one level and 8 patients at two levels. The average postoperative follow-up period was one year 10 months and ranged from 6 months to 3 years 3 months. The patients were generally allowed out of bed wearing a soft collar within 1 day postoperatively. The collar was used for 2 months after surgery. The postoperative course of all patients was uneventful and neurological symptoms improved. Postoperative X-ray films showed some movement in the operated disc level in all patients. The authors think that this surgical procedure may be suitable for preserving mobility of the spine.

Adult↗
PubMed1998

[Decompression of the ulnar wrist joint compartment by decompression osteotomy of the head of the ulna].

Both post-traumatic shortening of the radius and positive ulnar variance can lead to a compression syndrome in the ulnar compartment of the wrist. The indication for a decompression osteotomy of the ulnar head after a distal radius fracture is limited to only those cases in which there is a slight shortening without a deviation of the axis of the distal radius. In order to enlarge the space between the ulnar head and proximal row of the carpal bones, a 2 to 3 mm slice is taken from the ulnar head by means of two oblique, parallel osteotomies and fragment retention with two screws. 47 patients were re-examined after an average period of 3 1/2 (1 to 8) years. In 23 cases the results were very good and in 17 cases good. In five cases the results were poor. In two cases, the bone did not heal and the Kapandji-Sauvé procedure was performed.

Adult↗