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PubMed2002

[Interventional occlusion of foramen ovale and atrial septal defects after paradoxical embolism incidents].

Two hundred and fifty-one patients with a persistent foramen ovale (PFO), mean age 43.3 +/- 12.4 years, underwent catheter closure between 6/1995 and 6/2001. One hundred and forty-one had an ischemic stroke, 99 a transient ischemic attack (TIA) or prolonged reversible ischemic neurologic deficit, 5 peripheral arterial embolism, 4 suffered from decompression sickness after diving and 2 had transient global amnesia. Fifty-nine of them had multiple events in spite of antiplatelet or anticoagulant therapy. The patients received five different devices: 13 Rashkind Occluders, 20 Amplatzer septal Occluders, 109 Amplatzer PFO-Occluders, 73 CardioSEAL and 36 STAR-Flex devices. Time of fluoroscopy was 8.3 +/- 4.5 min. In three patients a device embolized and had to be removed from the groin vessels. We saw five inguinal or retroperitoneal venous hematomas with the need for operation in one patient. One early and one late perforation of the left atrium caused by a guide wire and a left-atrial disc, respectively, also needed surgery. Fourteen patients had documented late arrhythmias. Six patients with atrial fibrillation needed drugs or cardioversion while the other patients with runs of supraventricular tachycardia, atrial flutter and multiple extrasystoles needed no therapy. On transesophageal echocardiography (TEE) 6 months after implantation we found four significant residual leaks. These patients had the defect closed with a second device. In addition a secundum atrial septal defect (ASD) was closed in 17 patients (mean age 38 +/- 10.5 years) with Amplatzer septal Occluders (12) and CardioSEAL devices (5). These patients had experienced eight strokes and nine TIAs, 3 of them had had multiple events. Two of these patients had a significant residual defect and one had atrial flutter following the procedure. Two hundred and two PFO-patients and 12 ASD patients were followed for 6-62 (24.6 +/- 14.2) months; 2 died due to a traffic accident and a myocardial infarction, respectively. Four patients had another neurologic event following PFO-closure. We now overlook 210 patients with 348.6 symptom-free patient years and have a 1-year recurrence rate of neurologic events of 1.9%. Catheter closure of the PFO and atrial septal defect is a simple, effective and quick method which ensures a high closure rate, avoids life-long anticoagulation and has a low recurrence rate of neurologic events.

Adolescent↗
PubMed1997

Effects of a single saturation dive on lung function and exercise performance.

We studied the effects of an experimental saturation dive to 360 and 450 m in a simulation chamber on spirometric lung function, diffusing capacity, pulmonary compliance, and exercise performance in eight professional divers (age 22-40 years). To assess intraindividual variability, all parameters were measured on 2 days before and on 2 consecutive days immediately after the dive. For the group as a whole there was a significant increase in vital capacity and alveolar volume, and a decrease in Krogh factor and specific compliance (P < 0.01). These changes were reduced on the 2nd day after the dive. All subjects showed lowered exercise performance after the dive. Arterial pressure of oxygen and ventilation during exercise increased (P < 0.01), whereas arterial pressure of carbon dioxide, oxygen uptake, and anaerobic threshold decreased (P < 0.01). Exercise parameters showed only a slight trend towards pre-dive values on the 2nd day after a dive. The individual analysis revealed that after the dive two subjects showed a marked decrease in diffusing capacity and a more than average decrease in Krogh factor (TLCO/VA). One of them had signs of mild decompression sickness and the other, signs of pre-existing obstructive airways disease. Our data are compatible with the hypothesis that the effects of a single deep saturation dive on pulmonary function and exercise performance are the results of counteracting mechanisms. We suggest that lung volumes increase due to the enhanced work of breathing during a deep saturation dive and that these changes could mask an impairment in gas exchange. Furthermore, a saturation dive can induce an apparent deterioration of pulmonary function.

Adult↗
PubMed2003

Gastric barotrauma in a scuba diver: report of a case.

Stomach rupture can occur as a consequence of the expansion of compressed air during rapid ascent after diving. We present the case of a middle-aged woman who suffered a gastric tear from surfacing too quickly after diving, and discuss the diagnosis and management of such patients by reviewing previously reported similar events. Gastric barotrauma should be suspected in divers who complain of abdominal pain, even in the absence of frank signs of peritoneal irritation. Although pneumoperitoneum is always present in these patients, it can also occur as a consequence of pulmonary barotrauma, making gastroscopy or radiological contrast studies, or both, essential for a definitive diagnosis. Surgical repair represents the treatment of choice for an active full-thickness tear and, if associated with arterial gas embolism or decompression sickness, should ideally be performed in a center where a category I (intensive care-capable) hyperbaric unit is available.

Barotrauma↗
PubMed2004

Sports-related headache.

Sports-related or sports-associated headaches are common. They can be benign as in primary exertional headache or may signal serious pathology as in headache associated with traumatic subdural hematoma. Specific sports activities are associated with unique headache conditions such as decompression sickness headache or high-altitude headache, which mountain climbers experience along with other symptoms of chronic mountain sickness. The management of sports-related headaches requires an adequate understanding of its underlying etiology with subsequent cause-directed treatment plan.

Female↗
PubMed2004

Headache and facial pain in scuba divers.

Headache occasionally occurs during or after scuba diving. Although its significance often is benign, headache may signal a serious neurological disorder in some circumstances. In addition to the usual causes of headache, the diagnostic evaluation should consider otic and paranasal sinus barotrauma, arterial gas embolism, decompression sickness, carbon dioxide retention, carbon monoxide toxicity, hyperbaric-triggered migraine, cervical and temporomandibular joint strain, supraorbital neuralgia, carotid artery dissection, and exertional and cold stimulus headache syndromes. Focal neurologic symptoms, even in the migraineur, should not be ignored, but rather treated with 100% oxygen acutely and referred without delay to a facility with a hyperbaric chamber.

Barotrauma↗
PubMed1991

Electroencephalography, evoked potentials and MRI brain scans in saturation divers. An epidemiological study.

One hundred and fifty-six air and saturation divers, mean age 33.6 (range 21-49) years, were examined. The control group consisted of 100 offshore workers and policemen with the health requirements to have a diving certificate, mean age 34.0 (range 22-48) years. The examination protocol included electroencephalography (EEG), visual evoked potentials (VEPs), brain-stem auditory evoked potentials (BAEPs) and magnetic resonance imaging (MRI) of the brain and brain-stem. Abnormal EEGs, with focal slow waves mostly in the temporal regions and sharp potentials, were found in 18% of the divers and in 5% of the controls (P = 0.003). Abnormal EEGs correlated significantly with the exposure to saturation diving (P = 0.0006) and the prevalence of decompression sickness (P = 0.0102). Alcohol consumption was negatively correlated with abnormal EEGs (P = 0.0006). Mean I-III BAEP latency was increased (P = 0.047) in the diver group. P100 VEP latency decreased with age (21-49 years). High signal intensity changes obtained by MRI were found in 33% of the divers and in 43% of the controls (P = 0.14). It is concluded that the nervous system of saturation divers is influenced by their occupation and that EEG is a useful method in the health examination of divers.

Adult↗
PubMed1991

EVA medical problems.

The experience gained in the USSR allows the following conclusions: physiological responses to EVA do not depend on flight duration in qualitative and quantitative terms. Physiological responses to EVA are mainly determined by following 3 factors: physiological activities; space suit environmental parameters; physiological stress. This paper reviews problems, associated with altitude decompression sickness; thermal regulation of the body, visual function and physiological psychological stress as well as individual EVA experience in physiological responses.

Aerospace Medicine↗
PubMed1987

Perfluorocarbons as oxygen-transport fluids.

1. An overview of the proposed biological applications of perfluorocarbons and their emulsions as oxygen-transport fluids is presented. 2. Aspects of the properties, preparation, composition and physiological assessment of perfluorocarbon emulsions are discussed. 3. The experimental basis for some of the potential therapeutic uses of PFCs in liquid ventilation, treatment of decompression sickness, organ perfusion, oxygenation of ischaemic and malignant tissues, and as contrast media for NMR imaging is described. 4. The extent to which emulsified perfluorocarbons may have value as substitutes for red blood cells is discussed in detail. Data from both animal and human studies with such emulsions is reviewed. Brief consideration is also given to the possible use of native and modified haemoglobin in blood replacement together with recent work on the preparation of so-called "synthetic red cells".

Animals↗
PubMed1994

Adjunctive hyperbaric oxygen therapy in the treatment of thermal burns: a review.

Hyperbaric oxygen therapy provided in specially designed pressure chambers is currently the treatment of choice for decompression sickness, arterial gas embolism, and serious carbon monoxide poisoning. It is an important adjunct in the treatment of gas gangrene, chronic osteomyelitis, radiation injury, and indolent wounds. The potential benefit in the treatment of thermal burns is not well appreciated. Hyperbaric oxygen therapy may significantly reduce morbidity, mortality, and cost of care. The application of this technology based on the demonstrated beneficial effects on the pathophysiology of the burn wound merits consideration in selected patients.

Animals↗
PubMed2006

The effect of hypobaric hypoxia on multichannel EEG signal complexity.

OBJECTIVE: The objective of this study was the development and evaluation of nonlinear electroencephalography parameters which assess hypoxia-induced EEG alterations, and describe the temporal characteristics of different hypoxic levels' residual effect upon the brain electrical activity. METHODS: Multichannel EEG, pO2, pCO2, ECG, and respiration measurements were recorded from 10 subjects exposed to three experimental conditions (100% oxygen, hypoxia, recovery) at three-levels of reduced barometric pressure. The mean spectral power of EEG under each session and altitude were estimated for the standard bands. Approximate Entropy (ApEn) of EEG segments was calculated, and the ApEn's time-courses were smoothed by a moving average filter. On the smoothed diagrams, parameters were defined. RESULTS: A significant increase in total power and power of theta and alpha bands was observed during hypoxia. Visual interpretation of ApEn time-courses revealed a characteristic pattern (decreasing during hypoxia and recovering after oxygen re-administration). The introduced qEEG parameters S1 and K1 distinguished successfully the three hypoxic conditions. CONCLUSIONS: The introduced parameters based on ApEn time-courses are assessing reliably and effectively the different hypoxic levels. ApEn decrease may be explained by neurons' functional isolation due to hypoxia since decreased complexity corresponds to greater autonomy of components, although this interpretation should be further supported by electrocorticographic animal studies. SIGNIFICANCE: The introduced qEEG parameters seem to be appropriate for assessing the hypoxia-related neurophysiological state of patients in the hyperbaric chambers in the treatment of decompression sickness, carbon dioxide poisoning, and mountaineering.

Adult↗
PubMed1997

Gynecomastia following spinal cord disorder.

Gynecomastia, an excessive development of the mammary glands in men, is a known phenomenon among patients with spinal cord disorder, yet in the last 50 years it has not been fully described in relation to spinal cord disorder. Over a period of 2 years, six patients with spinal cord disorder (4 secondary to a traumatic injury, 1 to decompression sickness, and 1 to transverse myelitis) manifested gynecomastia. The onset of gynecomastia occurred between 1 to 6 months after injury. These patients are presented along with a review of the possible causes for gynecomastia and a suggested workup routine. A clinical examination for the presence of gynecomastia should be performed for every patient with spinal cord disorder and a thorough endocrinological workup should follow to rule out malignancy and reassure the anxious patient undergoing a disruption of his body image.

Adolescent↗
PubMed1960

The kinetics of distribution of the fat-soluble inert gas cyclopropane in the body.

A kinetic analysis is made of the experimentally measured time course of respiratory uptake of the highly fat-soluble, inert gas cyclopropane by normal human subjects. The analysis is based on the well-known perfusion-limited model in which a number of body compartments are arranged in parallel with the lungs via the circulating blood. Three distinct body compartments are derived from the data. These are tentatively identified as: (a) adipose tissue (b) fat-poor tissue of low perfusion such as resting muscle, skin, and connective tissue (c) fat-poor tissue of high perfusion such as brain, heart, gut, liver, and kidney. Blood flow rates to the several compartments are also derived from the data. The rates to compartments (a) and (b) are each approximately 10 per cent of the estimated total cardiac output. The derived perfusion (blood flow rate/compartment weight) of the three compartments are in the range, respectively, (a) 2 to 4, (b) 1 to 2.5, (c) 25 to 75 ml/min/100 gm. Uncertainties arising from the experimental data and from simplifications of the model (neglect of lung fill-up phase of uptake and gross diffusion of cyclopropane from one tissue into another) are discussed. The present type of uptake experiment is significant for the problems of total body fat determination, of gross body composition in relation to weight change, of gross shunting of blood flow from one compartment to another, of anesthesia by fat-soluble substances, and of decompression sickness.

Adipose Tissue↗
PubMed2002

ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists.

The physiologic and morphologic changes of pregnancy may interfere with the ability to engage safely in some forms of physical activity. A woman's overall health, including obstetric and medical risks, should be evaluated before prescribing an exercise program. Generally, participation in a wide range of recreational activities appears to be safe during pregnancy; however, each sport should be reviewed individually for its potential risk, and activities with a high risk of abdominal trauma should be avoided during pregnancy. Scuba diving also should be avoided throughout pregnancy because the fetus is at an increased risk for decompression sickness during this activity. In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women.

Exercise↗
PubMed1997

Hyperbaric oxygen in the treatment of acute ischemic stroke: an unsettled issue.

Therapy for acute ischemic stroke can be approached in two basic ways: first, by an attempt to restore or improve blood flow in an occluded vascular territory and, second, via therapy directed at the cellular and metabolic targets. As local anoxia and energy failure are the initiating cellular stage in ischemia, the inhalation of oxygen at increased atmospheric pressures might be effective. Treatment of acute focal cerebral ischemia with hyperbaric oxygen (HBO) has been reported in animals and humans. In general, the results of research in animals have suggested a promising role for the use of HBO. More than 400 cases of human ischemic stroke treated with HBO have been reported. In about half of the cases, improvement in status has been claimed on clinical or electroencephalographic grounds. In fact, the effectiveness of HBO in most disease processes other than carbon monoxide poisoning and decompression sickness is a subject of major ongoing debate. This short review will attempt: (1) to recall some early experiments involving HBO in the treatment of acute ischemia: (2) to point out some conflicting results regarding the role of HBO on cellular and metabolic disorders; and (3) to determine the possibility of a future role for HBO therapy in acute ischemic stroke.

Acute Disease↗
PubMed2002

ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period.

The physiologic and morphologic changes of pregnancy may interfere with the ability to engage safely in some forms of physical activity. A woman's overall health, including obstetric and medical risks, should be evaluated before prescribing an exercise program. Generally, participation in a wide range of recreational activities appears to be safe during pregnancy; however, each sport should be reviewed individually for its potential risk, and activities with a high risk of abdominal trauma should be avoided during pregnancy. Scuba diving also should be avoided throughout pregnancy because the fetus is at an increased risk for decompression sickness during this activity. In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women.

Exercise↗
PubMed2000

A mathematical model of diffusion-limited gas bubble dynamics in tissue with varying diffusion region thickness.

The three-region model of gas bubble dynamics consists of a bubble and a well-stirred tissue region with an intervening unperfused diffusion region previously assumed to have constant thickness and uniform gas diffusivity. As a result, the diffusion region gas content remains unchanged as its volume increases with bubble growth, causing dissolved gas in the region to violate Henry's law. Earlier work also neglected the relationship between the varying diffusion region volume and the fixed total tissue volume. The present work corrects these theoretical inconsistencies by postulating a difference in gas diffusivity between an infinitesimally thin layer at the bubble surface and the remainder of the diffusion region, thus allowing both thickness and gas content of the diffusion region to vary during bubble evolution. The corrected model can yield bubble lifetimes considerably longer than those yielded by earlier three-region models, and meets a need for theoretically consistent but relatively simple bubble dynamics models for use in studies of decompression sickness (DCS) in human subjects.

Air Pressure↗
PubMed1995

Central nervous system lesions and cervical disc herniations in amateur divers.

Permanent neuropsychological changes such as memory disturbances and depression have been found in professional divers, even in those who have never had decompression sickness. The changes are probably the result of intravascular gas bubbles insufficient to cause acute symptoms. We examined amateur divers with long histories of self-contained underwater breathing apparatus diving by magnetic resonance imaging and compared them with normal controls. Hyperintense lesions of the subcortical cerebral white matter and degenerative changes of the cervical disks were significantly more common in the divers. 27 of 52 divers had a total of 86 focal hyperintensities versus 10 of 50 controls with 14 focal hyperintensities (p < 0.01). 32 divers had at least one degenerated intravertebral disc versus 9 controls (p < 0.0001). These results suggest that amateur divers are at risk of accumulating lesions in the central nervous system and in cartilage.

Adult↗
PubMed1995

Internal carotid artery dissection associated with scuba diving.

A 52-year-old man presented to the emergency department with dysphasia and a headache after scuba diving. He was treated initially for decompression sickness. Subsequent workup revealed bilateral internal carotid artery dissection. The risk factors, presenting symptoms, diagnosis, and treatment of internal carotid artery dissection are reviewed. The importance of considering unusual causes of neurologic deficits after scuba diving is emphasized.

Aortic Dissection↗