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Druelle A, Blatteau JE, Daubresse Duchadeuil L, Morin J, Roffi R, Dufresne PL, Lehot H, Castagna O. Case report: Reassessing guidelines for safe resumption of diving after spinal decompression sickness: insights from a challenging case. Front Med (Lausanne) 2024; 11:1347465. [PMID: 38784237 PMCID: PMC11111850 DOI: 10.3389/fmed.2024.1347465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Background Recreational divers who have experienced Spinal Decompression Sickness (DCS) often aspire to return to their diving activities. Traditionally, it is recommended to observe a waiting period of several months before contemplating a return to unrestricted diving, particularly when clinical symptoms are absent, spinal cord Magnetic Resonance Imaging shows no anomalies, and the evaluation for Patent Foramen Ovale (PFO) returns negative results. Methods This article presents a compelling case study involving a 51-year-old recreational scuba diver who encountered two episodes of spinal decompression illness within a two-year timeframe. Notably, the search for a PFO produced negative results. The primary objective of this article is to underscore the critical importance of a meticulously planned approach to resuming diving after DCS incidents, emphasizing the potential for recurrence and the essential preventive measures. Conclusion We delve into the intricate decision-making process for returning to diving, emphasizing the significance of clinical evaluations, PFO assessments, spinal cord Magnetic Resonance Imaging, and the absence of clinical symptoms. By recognizing the risk of recurrence and the need for proactive prevention measures, we provide recommendations for both medical professionals and divers, with the ultimate goal of enhancing safety and informed decision-making within the diving community.
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Affiliation(s)
- Arnaud Druelle
- Ste Anne Military Hospital (HIA Ste Anne), Service de médecine hyperbare et d’expertise plongée (SMHEP), Toulon, France
| | - Jean-Eric Blatteau
- Ste Anne Military Hospital (HIA Ste Anne), Service de médecine hyperbare et d’expertise plongée (SMHEP), Toulon, France
| | - Lucile Daubresse Duchadeuil
- Ste Anne Military Hospital (HIA Ste Anne), Service de médecine hyperbare et d’expertise plongée (SMHEP), Toulon, France
| | - Jean Morin
- Ste Anne Military Hospital (HIA Ste Anne), Service de médecine hyperbare et d’expertise plongée (SMHEP), Toulon, France
| | - Romain Roffi
- Ste Anne Military Hospital (HIA Ste Anne), Service de médecine hyperbare et d’expertise plongée (SMHEP), Toulon, France
| | | | - Henri Lehot
- Ste Anne Military Hospital (HIA Ste Anne), Service de médecine hyperbare et d’expertise plongée (SMHEP), Toulon, France
| | - Olivier Castagna
- Ste Anne Military Hospital (HIA Ste Anne), Service de médecine hyperbare et d’expertise plongée (SMHEP), Toulon, France
- Underwater Research Team-ERRSO, Military Biomedical Research Institute-IRBA, Toulon, France
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2
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Kohshi K, Morimatsu Y, Nishikiori H, Kondo T, Tamaki H, Ishitake T. [The Japanese Law Regulating Underwater and Caisson Work: Current Issues and Future Developments]. J UOEH 2022; 44:359-372. [PMID: 36464310 DOI: 10.7888/juoeh.44.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The Japan "Ordinance on Safety and Health of Work under High Pressure", which is the law regulating health conditions for workers under high pressure environments, was amended in 2014. The revised regulations have highlighted other difficulties and new problems, but they have not yet written an appropriate amendment based on the aspect of occupational and environmental health. Health management for occupational divers and caisson workers in accordance with the new regulations has not determined the best approach to reducing related disorders and will cause other legal problems. This paper presents some issues in the new regulations for hyperbaric workers, which directly or indirectly involve occupational health physicians. Health checkups and work limitations should be done in consideration of the occupational characteristics of the undersea and hyperbaric environment. Regular examinations using specific studies are useful to diagnose the early stages of chronic conditions for workers, and are also useful for determining the hiring suitability for hyperbaric workers. Work limitations should be decided by the conditions that induce serious accidents or disorders that result from exposure to hyperbaric environments, and depend on the obstacles for work due to sequelae of decompression sickness. The new regulations need to be properly revised, based on scientific evidence, to include health management for workers in undersea and hyperbaric environments.
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Affiliation(s)
- Kiyotaka Kohshi
- Division of Neurosurgery, Nishinihon Hospital, Higashi-ku, Kumamoto 861-8034, Japan
- Department of Environmental Medicine, Kurume University School of Medicine, Asahi-machi, Kurume 830-0011, Japan
| | - Yoshitaka Morimatsu
- Department of Environmental Medicine, Kurume University School of Medicine, Asahi-machi, Kurume 830-0011, Japan
| | - Hideharu Nishikiori
- Department of Environmental Medicine, Kurume University School of Medicine, Asahi-machi, Kurume 830-0011, Japan
- Diving Engineering Department, Chugoku Diving Company Limited, Iwakuni 740-0032, Japan
| | - Toshihiro Kondo
- Corporate Planning Department, 2nd team, Oriental Shiraishi Corporation, Koto-ku, Tokyo 135-0061, Japan
| | - Hideki Tamaki
- Department of Environmental Medicine, Kurume University School of Medicine, Asahi-machi, Kurume 830-0011, Japan
- Division of Surgery and General Medicine, Tamaki Hospital, Hagi 758-0071, Japan
| | - Tatsuya Ishitake
- Department of Environmental Medicine, Kurume University School of Medicine, Asahi-machi, Kurume 830-0011, Japan
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3
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Abstract
Metabolic and toxic causes of myelopathy form a heterogeneous group of disorders. In this review, we discuss the causes of metabolic and toxic myelopathies with respect to clinical presentation, pathophysiology, diagnostic testing, treatment, and prognosis. This review is organized by temporal course (hyperacute, acute, subacute, and chronic) and etiology (e.g., nutritional deficiency, toxic exposure). Broadly, the myelopathies associated with dietary toxins (neurolathyrism, konzo) and decompression sickness present suddenly (hyperacute). The myelopathies associated with heroin use and electrical injury present over hours to days (acutely). Most nutritional deficiencies (cobalamin, folate, copper) and toxic substances (nitrous oxide, zinc, organophosphates, clioquinol) cause a myelopathy of subacute onset. Vitamin E deficiency and hepatic myelopathy cause a chronic myelopathy. Radiation- and intrathecal chemotherapy-induced myelopathy can cause a transient and/or a progressive syndrome. For many metabolic and toxic causes of myelopathy, clinical deficits may stabilize or improve with rapid identification and treatment. Familiarity with these disorders is therefore essential.
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Affiliation(s)
- Michaël C C Slama
- Department of Neurology, St. Elizabeth's Medical Center, Boston, Massachusetts
| | - Aaron L Berkowitz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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4
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Razdan PS, Buteau D, Pollock NW. A case of Löfgren's syndrome confused with decompression sickness. Diving Hyperb Med 2019; 49:306-310. [PMID: 31828751 DOI: 10.28920/dhm49.4.306-310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/14/2019] [Indexed: 11/05/2022]
Abstract
A broad differential diagnosis is important to provide appropriate care. This may be challenging for conditions like decompression sickness (DCS) which can be easily confused with other conditions. In suspected DCS, treatment may be an important part of the diagnosis. An improvement in symptoms after hyperbaric oxygen treatment (HBOT) is consistent with a DCS event. However, HBOT may also impact symptoms in other conditions, including Löfgren's syndrome (LS). LS, a poorly understood, clinically distinct phenotype of sarcoidosis, is a complex, multi-system granulomatous inflammatory condition. Like DCS, LS symptoms are heterogeneous and idiosyncratic. We report on a patient initially diagnosed with DCS who presented new symptoms suggestive of LS after HBOT.
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Affiliation(s)
- Payal S Razdan
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,CISSS Chaudière-Appalaches (CHAU-Hôtel-Dieu de Lévis), Hyperbaric Medicine Unit, Lévis, Québec, Canada.,Corresponding author: Rm 4807, Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, QC, Canada, G6V 3Z1,
| | - Dominique Buteau
- Family Medicine and Emergency Medicine Department, Faculty of Medicine, Université Laval, Québec, Canada.,CISSS Chaudière-Appalaches (CHAU-Hôtel-Dieu de Lévis), Hyperbaric Medicine Unit, Emergency Department, Lévis, Quebec, Canada
| | - Neal W Pollock
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.,CISSS Chaudière-Appalaches (CHAU-Hôtel-Dieu de Lévis), Hyperbaric Medicine Unit, Lévis, Québec, Canada
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5
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Saadi A, Ferenczi EA, Reda H. Spinal Decompression Sickness in an Experienced Scuba Diver: A Case Report and Review of Literature. Neurohospitalist 2019; 9:235-238. [PMID: 31534615 DOI: 10.1177/1941874419828895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Decompression sickness from diving is a rare but potentially reversible cause of spinal injury. Early treatment with hyperbaric oxygen is associated with a better neurologic outcome, making prompt recognition and management clinically important. We describe a case of a 65-year-old diver who presented with thoracic back pain and bilateral leg weakness after a 70 feet of sea water (fsw) (21 meters of sea water [msw]) dive, with no acute abnormality on spinal magnetic resonance imaging (MRI). He made a partial recovery after extended hyperbaric oxygen therapy. We discuss the epidemiology and pathophysiology of central nervous system injury in decompression sickness, as well as acute management and prognostic factors for recovery, including the role of adjunctive therapies and the implications of negative MRI. Ultimately, clinicians should make the diagnosis of spinal cord decompression sickness based primarily on clinical evaluation, not on MRI findings.
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Affiliation(s)
- Altaf Saadi
- Partners Neurology Residency Program, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA, USA
| | - Emily A Ferenczi
- Partners Neurology Residency Program, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA, USA
| | - Haatem Reda
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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6
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Zhang R, Yu Y, Manaenko A, Bi H, Zhang N, Zhang L, Zhang T, Ye Z, Sun X. Effect of helium preconditioning on neurological decompression sickness in rats. J Appl Physiol (1985) 2019; 126:934-940. [PMID: 30653414 DOI: 10.1152/japplphysiol.00275.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Decompression sickness (DCS) occurs because of an excessively rapid and extensive reduction of the ambient pressure. Bubble-induced spinal cord ischemia is generally considered as a part of neurological DCS pathogenesis. Because helium preconditioning (HPC) recently demonstrated beneficial properties against ischemic damage, we hypothesized that HPC may decrease the neurological deficits of DCS in rats. Seventy-five male Sprague-Dawley rats were divided into a non-HPC group ( n = 25) and a HPC group ( n = 25) and 25 naive animals that were euthanized for histological examination ( n = 5) or anesthetized for baseline somatosensory evoked potential (SSEP) recordings ( n = 20). To induce DCS, rats were compressed with air to a pressure of 709 kPa for 60 min and decompressed at a rate of 203 kPa/min. HPC was administered as three episodes of 79% helium-21% oxygen mixture inhalation for 5 min interspersed with 5 min of air breathing. We found that HPC resulted in significantly decreased DCS incidence and delay of DCS onset. HPC also improved animal performance on the grip test after decompression and significantly ameliorated decompression-induced decrease of platelet number. Furthermore, the incidence of abnormal SSEP waves and histological spinal lesions was significantly reduced by HPC. We conclude that HPC can decrease the occurrence of DCS and ameliorate decompression-induced neurological deficits. NEW & NOTEWORTHY Helium preconditioning ameliorates decompression-induced neurological deficits in rats. Helium breathing before air dives may prevent neurological deficit and attenuate symptoms after decompression.
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Affiliation(s)
- Rongjia Zhang
- Department of Naval Aeromedicine, Faculty of Naval Medicine, Second Military Medical University , Shanghai , People's Republic of China
| | - Yongchao Yu
- Department of Cardiac Surgery, Changhai Hospital, Second Military Medical University , Shanghai , People's Republic of China
| | - Anatol Manaenko
- Department of Neurology, University of Erlangen-Nuremberg , Erlangen , Germany
| | - Hongda Bi
- Department of Plastic Surgery, Changhai Hospital, Second Military Medical University , Shanghai , People's Republic of China
| | - Ning Zhang
- Department of Naval Aeromedicine, Faculty of Naval Medicine, Second Military Medical University , Shanghai , People's Republic of China
| | - Ling Zhang
- Department of Medical Genetics, Second Military Medical University , Shanghai , People's Republic of China
| | - Ting Zhang
- Department of Naval Aeromedicine, Faculty of Naval Medicine, Second Military Medical University , Shanghai , People's Republic of China
| | - Zhouheng Ye
- Department of Naval Aeromedicine, Faculty of Naval Medicine, Second Military Medical University , Shanghai , People's Republic of China
| | - Xuejun Sun
- Department of Naval Aeromedicine, Faculty of Naval Medicine, Second Military Medical University , Shanghai , People's Republic of China
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7
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Seyithanoğlu MH, Abdallah A, Dündar TT, Kitiş S, Aralaşmak A, Gündağ Papaker M, Sasani H. Investigation of Brain Impairment Using Diffusion-Weighted and Diffusion Tensor Magnetic Resonance Imaging in Experienced Healthy Divers. Med Sci Monit 2018; 24:8279-8289. [PMID: 30447152 PMCID: PMC6252049 DOI: 10.12659/msm.911475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to understand the changes of decompression illness in healthy divers by comparing diffusion-weighted (DWI) and diffusion tensor MRI findings among healthy professional divers and healthy non-divers with no history of diving. Material/Methods A total of 26 people were recruited in this prospective study: 11 experienced divers with no history of neurological decompression disease (cohort) and 15 healthy non-divers (control). In all study subjects, we evaluated apparent diffusion coefficient (ADC) and type of diffusion tensor metric fractional anisotropy (FA) values of different brain locations (e.g., frontal and parieto-occipital white matter, hippocampus, globus pallidus, putamen, internal capsule, thalamus, cerebral peduncle, pons, cerebellum, and corpus callosum). Results ADC values of hippocampus were high in divers but low in the control group; FA values of globus pallidus and putamen were lower in divers compared to the control group. DWI depicted possible changes due to hypoxia in different regions of the brain. Statistically significant differences in ADC values were found in hypoxia, particularly in the hippocampus (p=0.0002), while FA values in the globus pallidus and putamen were statistically significant (p=0.015 and p=0.031, respectively). We detected forgetfulness in 6 divers and deterioration in fine-motor skills in 2 divers (p=0.002 and p=0.17, respectively). All of them were examined using neuro-psychometric tests. Conclusions Repeated hyperbaric exposure increases the risk of white matter damage in experienced healthy divers without neurological decompression illness. The hippocampus, globus pallidus, and putamen are the brain areas responsible for memory, learning, navigation, and fine-motor skills and are sensitive to repeated hyperbaric exposure.
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Affiliation(s)
| | - Anas Abdallah
- Department of Neurosurgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Tolga Turan Dündar
- Department of Neurosurgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Serkan Kitiş
- Department of Neurosurgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Ayşe Aralaşmak
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Hadi Sasani
- Department of Radiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
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8
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Abstract
Decompression sickness and arterial gas embolism, collectively known as decompression illness (DCI), are rare but serious afflictions that can result from compressed gas diving exposures. Risk is primarily determined by the pressure-time profile but is influenced by several factors. DCI can present idiosyncratically but with a wide range of neurologic symptoms. Examination is critical for assessment in the absence of diagnostic indicators. Many conditions must be considered in the differential diagnosis. High-fraction oxygen breathing provides first aid but definitive treatment of DCI is hyperbaric oxygen.
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9
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Gempp E. Commentary: Correlation between Patent Foramen Ovale, Cerebral “Lesions” and Neuropsychometric Testing in Experienced Sports Divers: Does Diving Damage the Brain? Front Psychol 2016; 7:1254. [PMID: 27604662 PMCID: PMC4995207 DOI: 10.3389/fpsyg.2016.01254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/08/2016] [Indexed: 11/24/2022] Open
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10
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Balestra C, Germonpré P. Correlation between Patent Foramen Ovale, Cerebral "Lesions" and Neuropsychometric Testing in Experienced Sports Divers: Does Diving Damage the Brain? Front Psychol 2016; 7:696. [PMID: 27242609 PMCID: PMC4863080 DOI: 10.3389/fpsyg.2016.00696] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 04/26/2016] [Indexed: 11/13/2022] Open
Abstract
SCUBA diving exposes divers to decompression sickness (DCS). There has been considerable debate whether divers with a Patent Foramen Ovale of the heart have a higher risk of DCS because of the possible right-to-left shunt of venous decompression bubbles into the arterial circulation. Symptomatic neurological DCS has been shown to cause permanent damage to brain and spinal cord tissue; it has been suggested that divers with PFO may be at higher risk of developing subclinical brain lesions because of repeated asymptomatic embolization of decompression-induced nitrogen bubbles. These studies however suffer from several methodological flaws, including self-selection bias. We recruited 200 volunteer divers from a recreational diving population who had never suffered from DCS; we then randomly selected 50 of those for further investigation. The selected divers underwent brain Magnetic Resonance Imaging to detect asymptomatic brain lesions, contrast trans-oesophageal echocardiography for PFO, and extensive neuro-psychometric testing. Neuro-psychometry results were compared with a control group of normal subjects and a separate control group for subjects exposed to neurotoxic solvents. Forty two divers underwent all the tests and are included in this report. Grade 2 Patent Foramen Ovale was found in 16 (38%) of the divers; brain Unidentified Bright Objects (UBO's) were found in 5 (11.9%). There was no association between PFO and the presence of UBO's (P = 0.693) or their size (p = 0.5) in divers. Neuropsychometric testing in divers was significantly worse from controls in two tests, Digit Span Backwards (DSB; p < 0.05) and Symbol-Digit-Substitution (SDS; p < 0.01). Compared to subjects exposed to neurotoxic solvents, divers scored similar on DSB and SDS tests, but significantly better on the Simple Reaction Time (REA) and Hand-Eye Coordination (EYE) tests. There was no correlation between PFO, number of UBO's and any of the neuro-psychometric tests. We conclude that for uneventful recreational diving, PFO does not appear to influence the presence of UBO's. Diving by itself seems to cause some decrease of short-term memory and higher cognitive function, including visual-motor skills; this resembles some of the effects of nitrogen narcosis and we suggest that this may be a prolonged effect of diving.
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Affiliation(s)
- Costantino Balestra
- DAN Europe Research DivisionBrussels, Belgium; Faculté des Sciences de la Motricité, Université Libre de BruxellesBrussels, Belgium; Motor Sciences and Physiotherapy, Environmental and Occupational (Integrative) Physiology, Haute Ecole Paul Henri SpaakBrussels, Belgium
| | - Peter Germonpré
- DAN Europe Research DivisionBrussels, Belgium; Center for Hyperbaric Oxygen Therapy, Military Hospital Queen AstridBrussels, Belgium
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Vallée N, Lambrechts K, De Maistre S, Royal P, Mazella J, Borsotto M, Heurteaux C, Abraini J, Risso JJ, Blatteau JE. Fluoxetine Protection in Decompression Sickness in Mice is Enhanced by Blocking TREK-1 Potassium Channel with the "spadin" Antidepressant. Front Physiol 2016; 7:42. [PMID: 26909044 PMCID: PMC4755105 DOI: 10.3389/fphys.2016.00042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/29/2016] [Indexed: 01/17/2023] Open
Abstract
In mice, disseminated coagulation, inflammation, and ischemia induce neurological damage that can lead to death. These symptoms result from circulating bubbles generated by a pathogenic decompression. Acute fluoxetine treatment or the presence of the TREK-1 potassium channel increases the survival rate when mice are subjected to an experimental dive/decompression protocol. This is a paradox because fluoxetine is a blocker of TREK-1 channels. First, we studied the effects of an acute dose of fluoxetine (50 mg/kg) in wild-type (WT) and TREK-1 deficient mice (knockout homozygous KO and heterozygous HET). Then, we combined the same fluoxetine treatment with a 5-day treatment protocol with spadin, in order to specifically block TREK-1 activity (KO-like mice). KO and KO-like mice were regarded as antidepressed models. In total, 167 mice (45 WTcont 46 WTflux 30 HETflux and 46 KOflux) constituting the flux-pool and 113 supplementary mice (27 KO-like 24 WTflux2 24 KO-likeflux 21 WTcont2 17 WTno dive) constituting the spad-pool were included in this study. Only 7% of KO-TREK-1 treated with fluoxetine (KOflux) and 4% of mice treated with both spadin and fluoxetine (KO-likeflux) died from decompression sickness (DCS) symptoms. These values are much lower than those of WT control (62%) or KO-like mice (41%). After the decompression protocol, mice showed significant consumption of their circulating platelets and leukocytes. Spadin antidepressed mice were more likely to exhibit DCS. Nevertheless, mice which had both blocked TREK-1 channels and fluoxetine treatment were better protected against DCS. We conclude that the protective effect of such an acute dose of fluoxetine is enhanced when TREK-1 is inhibited. We confirmed that antidepressed models may have worse DCS outcomes, but concomitant fluoxetine treatment not only decreased DCS severity but increased the survival rate.
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Affiliation(s)
- Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle Toulon, France
| | - Kate Lambrechts
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique OpérationnelleToulon, France; UFR STAPS, Laboratoire Motricité Humaine Education Sport Santé, Université du Sud Toulon VarLa Garde, France
| | - Sébastien De Maistre
- Hôpital d'Instruction des Armées, Service de Médecine Hyperbare et Expertise Plongée Toulon, France
| | - Perrine Royal
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle Toulon, France
| | - Jean Mazella
- Centre National de la Recherche Scientifique and Université de Nice Sophia Antipolis, Institut de Pharmacologie Moléculaire et Cellulaire, UMR 7275 Valbonne, France
| | - Marc Borsotto
- Centre National de la Recherche Scientifique and Université de Nice Sophia Antipolis, Institut de Pharmacologie Moléculaire et Cellulaire, UMR 7275 Valbonne, France
| | - Catherine Heurteaux
- Centre National de la Recherche Scientifique and Université de Nice Sophia Antipolis, Institut de Pharmacologie Moléculaire et Cellulaire, UMR 7275 Valbonne, France
| | - Jacques Abraini
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique OpérationnelleToulon, France; Département d'Anesthésiologie, Université LavalQuébec, QC, Canada; Faculté de Médecine, Université de Caen NormandieCaen, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle Toulon, France
| | - Jean-Eric Blatteau
- Institut de Recherche Biomédicale des Armées, Equipe Résidante de Recherche Subaquatique Opérationnelle Toulon, France
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12
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Blatteau JE, de Maistre S, Lambrechts K, Abraini J, Risso JJ, Vallée N. Fluoxetine stimulates anti-inflammatory IL-10 cytokine production and attenuates sensory deficits in a rat model of decompression sickness. J Appl Physiol (1985) 2015; 119:1393-9. [PMID: 26494447 DOI: 10.1152/japplphysiol.00602.2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/15/2015] [Indexed: 11/22/2022] Open
Abstract
Despite "gold standard" hyperbaric oxygen treatment, 30% of patients suffering from neurological decompression sickness still exhibit incomplete recovery, including sensory impairments. Fluoxetine, a well-known antidepressant, is recognized as having anti-inflammatory effects in the setting of cerebral ischemia. In this study, we focused on the assessment of sensory neurological deficits and measurement of circulating cytokines after decompression in rats treated or not with fluoxetine. Seventy-eight rats were divided into a clinical (n = 38) and a cytokine (n = 40) group. In both groups, the rats were treated with fluoxetine (30 mg/kg po, 6 h beforehand) or with a saccharine solution. All of the rats were exposed to 90 m seawater for 45 min before staged decompression. In the clinical group, paw withdrawal force after mechanical stimulation and paw withdrawal latency after thermal stimulation were evaluated before and 1 and 48 h after surfacing. At 48 h, a dynamic weight-bearing device was used to assess postural stability, depending on the time spent on three or four paws. For cytokine analysis, blood samples were collected from the vena cava 1 h after surfacing. Paw withdrawal force and latency were increased after surfacing in the controls, but not in the fluoxetine group. Dynamic weight-bearing assessment highlighted a better stability on three paws for the fluoxetine group. IL-10 levels were significantly decreased after decompression in the controls, but maintained at baseline level with fluoxetine. This study suggests that fluoxetine has a beneficial effect on sensory neurological recovery. We hypothesize that the observed effect is mediated through maintained anti-inflammatory cytokine IL-10 production.
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Affiliation(s)
- Jean-Eric Blatteau
- Institut de Recherche Biomédicale des Armées, Équipe de Recherche Subaquatique Opérationnelle, Toulon, France;
| | - Sébastien de Maistre
- Institut de Recherche Biomédicale des Armées, Équipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Kate Lambrechts
- Institut de Recherche Biomédicale des Armées, Équipe de Recherche Subaquatique Opérationnelle, Toulon, France; Laboratoire Motricité Humaine, Éducation, Sport, Santé (LAMHESS), Université de Toulon UFR STAPS, La Garde, France
| | - Jacques Abraini
- Département d'Anesthésiologie, Université Laval, Québec, Canada; and Normandie-Université, Université de Caen-Basse Normandie, Caen, France
| | - Jean-Jacques Risso
- Institut de Recherche Biomédicale des Armées, Équipe de Recherche Subaquatique Opérationnelle, Toulon, France
| | - Nicolas Vallée
- Institut de Recherche Biomédicale des Armées, Équipe de Recherche Subaquatique Opérationnelle, Toulon, France
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13
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Clopidogrel reduces the inflammatory response of lung in a rat model of decompression sickness. Respir Physiol Neurobiol 2015; 211:9-16. [DOI: 10.1016/j.resp.2015.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 02/08/2023]
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14
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Jüttner B, Wölfel C, Liedtke H, Meyne K, Werr H, Bräuer T, Kemmerer M, Schmeißer G, Piepho T, Müller O, Schöppenthau H. [Diagnosis and treatment of diving accidents. New German guidelines for diving accidents 2014-2017]. Anaesthesist 2015; 64:463-8. [PMID: 26025255 DOI: 10.1007/s00101-015-0033-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In 2015 the German Society for Diving and Hyperbaric Medicine (GTÜM) and the Swiss Underwater and Hyperbaric Medical Society (SUHMS) published the updated guidelines on diving accidents 2014-2017. These multidisciplinary guidelines were developed within a structured consensus process by members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), the Sports Divers Association (VDST), the Naval Medical Institute (SchiffMedInst), the Social Accident Insurance Institution for the Building Trade (BG BAU), the Association of Hyperbaric Treatment Centers (VDD) and the Society of Occupational and Environmental Medicine (DGAUM). This consensus-based guidelines project (development grade S2k) with a representative group of developers was conducted by the Association of Scientific Medical Societies in Germany. It provides information and instructions according to up to date evidence to all divers and other lay persons for first aid recommendations to physician first responders and emergency physicians as well as paramedics and all physicians at therapeutic hyperbaric chambers for the diagnostics and treatment of diving accidents. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose and the following key action statements: on-site 100% oxygen first aid treatment, still patient positioning and fluid administration are recommended. Hyperbaric oxygen (HBO) recompression remains unchanged the established treatment in severe cases with no therapeutic alternatives. The basic treatment scheme recommended for diving accidents is hyperbaric oxygenation at 280 kPa. For quality management purposes there is a need in the future for a nationwide register of hyperbaric therapy.
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Affiliation(s)
- B Jüttner
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland,
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Kamtchum Tatuene J, Pignel R, Pollak P, Lovblad KO, Kleinschmidt A, Vargas MI. Neuroimaging of diving-related decompression illness: current knowledge and perspectives. AJNR Am J Neuroradiol 2014; 35:2039-44. [PMID: 24924550 DOI: 10.3174/ajnr.a4005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diving-related decompression illness is classified into 2 main categories: arterial gas embolism and decompression sickness. The latter is further divided into types 1 and 2, depending on the clinical presentation. MR imaging is currently the most accurate neuroimaging technique available for the detection of brain and spinal cord lesions in neurologic type 2 decompression sickness. Rapid bubble formation in tissues and the bloodstream during ascent is the basic pathophysiologic mechanism in decompression illness. These bubbles can damage the central nervous system through different mechanisms, namely arterial occlusion, venous obstruction, or in situ toxicity. Neuroimaging studies of decompression sickness have reported findings associated with each of these mechanisms: some typical results are summarized and illustrated in this article. We also review the limitations of previous work and make practical methodologic suggestions for future neuroimaging studies.
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Affiliation(s)
- J Kamtchum Tatuene
- From the Neurology Division (J.K.T., P.P., A.K.), Department of Clinical Neurosciences
| | - R Pignel
- Hyperbaric Medicine Centre (R.P.), Department of Emergency Medicine
| | - P Pollak
- From the Neurology Division (J.K.T., P.P., A.K.), Department of Clinical Neurosciences
| | - K O Lovblad
- Neuroradiology Division (K.O.L., M.I.V.), Department of Imaging and Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland
| | - A Kleinschmidt
- From the Neurology Division (J.K.T., P.P., A.K.), Department of Clinical Neurosciences
| | - M I Vargas
- Neuroradiology Division (K.O.L., M.I.V.), Department of Imaging and Medical Information Sciences, Geneva University Hospitals, Geneva, Switzerland.
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Abstract
Diving exposes a person to the combined effects of increased ambient pressure and immersion. The reduction in pressure when surfacing can precipitate decompression sickness (DCS), caused by bubble formation within tissues due to inert gas supersaturation. Arterial gas embolism (AGE) can also occur due to pulmonary barotrauma as a result of breath holding during ascent or gas trapping due to disease, causing lung hyperexpansion, rupture and direct entry of alveolar gas into the blood. Bubble disease due to either DCS or AGE is collectively known as decompression illness. Tissue and intravascular bubbles can induce a cascade of events resulting in CNS injury. Manifestations of decompression illness can vary in severity, from mild (paresthesias, joint pains, fatigue) to severe (vertigo, hearing loss, paraplegia, quadriplegia). Particularly as these conditions are uncommon, early recognition is essential to provide appropriate management, consisting of first aid oxygen, targeted fluid resuscitation and hyperbaric oxygen, which is the definitive treatment. Less common neurologic conditions that do not require hyperbaric oxygen include rupture of a labyrinthine window due to inadequate equalization of middle ear pressure during descent, which can precipitate vertigo and hearing loss. Sinus and middle ear overpressurization during ascent can compress the trigeminal and facial nerves respectively, causing temporary facial hypesthesia and lower motor neuron facial weakness. Some conditions preclude safe diving, such as seizure disorders, since a convulsion underwater is likely to be fatal. Preventive measures to reduce neurologic complications of diving include exclusion of individuals with specific medical conditions and safe diving procedures, particularly related to descent and ascent.
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Affiliation(s)
- E Wayne Massey
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.
| | - Richard E Moon
- Departments of Anesthesiology and Medicine, Duke University Medical Center, Durham, NC, USA
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Lee YI, Ye BJ. Underwater and hyperbaric medicine as a branch of occupational and environmental medicine. Ann Occup Environ Med 2013; 25:39. [PMID: 24472678 PMCID: PMC3923352 DOI: 10.1186/2052-4374-25-39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/11/2013] [Indexed: 11/29/2022] Open
Abstract
Exposure to the underwater environment for occupational or recreational purposes is increasing. As estimated, there are around 7 million divers active worldwide and 300,000 more divers in Korea. The underwater and hyperbaric environment presents a number of risks to the diver. Injuries from these hazards include barotrauma, decompression sickness, toxic effects of hyperbaric gases, drowning, hypothermia, and dangerous marine animals. For these reasons, primary care physicians should understand diving related injuries and assessment of fitness to dive. However, most Korean physicians are unfamiliar with underwater and hyperbaric medicine (UHM) in spite of scientific and practical values. From occupational and environmental medicine (OEM) specialist’s perspective, we believe that UHM should be a branch of OEM because OEM is an area of medicine that deals with injuries caused by physical and biological hazards, clinical toxicology, occupational diseases, and assessment of fitness to work. To extend our knowledge about UHM, this article will review and update on UHM including barotrauma, decompression illness, toxicity of diving gases and fitness for diving.
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Affiliation(s)
| | - Byeong Jin Ye
- Department of Occupational & Environmental Medicine, College of Medicine, Kosin University, 34-1 Amnam-dong, Seo-gu, Busan 602-702, South Korea.
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Relation between cervical and thoracic spinal canal stenosis and the development of spinal cord decompression sickness in recreational scuba divers. Spinal Cord 2013; 52:236-40. [PMID: 24126850 DOI: 10.1038/sc.2013.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/09/2013] [Accepted: 09/16/2013] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES The intent of this study was to investigate the relationships between vertebral degenerative changes resulting in spinal canal stenosis, spinal cord lesions and the development of spinal cord decompression sickness (DCS) in scuba divers. SETTING Referral hyperbaric facility, Toulon, France. METHODS We examined 33 injured divers less than 50 years old by cervical and thoracic MRI and compared them with 34 matched control divers. The number of intervertebral disk abnormalities and the degree of canal compression were analyzed on T2-weighted sagittal images using a validated grading system developed recently. The presence and the distribution of hyperintense cord lesions in relation with the accident and the recovery status at 6 months were also assessed. RESULTS Canal spinal narrowing was more common in injured divers than in controls (79% vs. 50%, OR=3.7 [95% CI, 1.3-10.8], P=0.021). We found a significant linear association between the extent of canal stenosis, multisegmental findings and the development of spinal cord decompression sickness. MRI intramedullary lesions were significantly more frequent in divers with incomplete recovery (OR=16 [95% CI, 2.6-99], P=0.0014), but statistical analysis failed to demonstrate a significant relationship between canal compression, signal cord abnormalities and a negative clinical outcome. CONCLUSIONS These results suggest that divers with cervical and thoracic spinal canal stenosis, mainly due to disk degeneration, are at increased risk for the occurrence of spinal cord decompression sickness.
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Abstract
BACKGROUND Decompression illness (DCI) is a major concern in pressure-related activities. Due to its specific prerequisite conditions, DCI is rare in comparison with other illnesses and most physicians are inexperienced in treatment. In a fishery area in northern China, during the past decade, tens of thousands of divers engaged in seafood harvesting and thousands suffered from DCI. We established a hyperbaric facility there and treated the majority of the cases. METHODS AND RESULTS A total of 5,278 DCI cases were admitted in our facility from February 2000 through December 2010 and treated using our recompression schedules. Cutaneous abnormalities, joint and muscular pain and neurological manifestations were three most common symptoms. The initial symptom occurred within 6 h after surfacing in 98.9% of cases, with an overall median latency of 62 min. The shorter the latent time, the more serious the symptoms would be (P<0.0001). Nine cases died before recompression and 5,269 were treated using four recompression schedules, with an overall effectiveness rate of 99.3%. The full recovery rate decreased with the increase of the delay from the onset of symptoms to the treatment (P<0.0001). CONCLUSIONS DCI presents specific occurrence rules. Recompression should be administered as soon as possible and should never be abandoned irrespective of the delay. The recompression schedules used were effective and flexible for variety conditions of DCI.
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The emulsified perfluorocarbon Oxycyte improves spinal cord injury in a swine model of decompression sickness. Spinal Cord 2012; 51:188-92. [DOI: 10.1038/sc.2012.135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Blatteau JE, Barre S, Pascual A, Castagna O, Abraini JH, Risso JJ, Vallee N. Protective effects of fluoxetine on decompression sickness in mice. PLoS One 2012; 7:e49069. [PMID: 23145072 PMCID: PMC3493517 DOI: 10.1371/journal.pone.0049069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 10/02/2012] [Indexed: 12/14/2022] Open
Abstract
Massive bubble formation after diving can lead to decompression sickness (DCS) that can result in central nervous system disorders or even death. Bubbles alter the vascular endothelium and activate blood cells and inflammatory pathways, leading to a systemic pathophysiological process that promotes ischemic damage. Fluoxetine, a well-known antidepressant, is recognized as having anti-inflammatory properties at the systemic level, as well as in the setting of cerebral ischemia. We report a beneficial clinical effect associated with fluoxetine in experimental DCS. 91 mice were subjected to a simulated dive at 90 msw for 45 min before rapid decompression. The experimental group received 50 mg/kg of fluoxetine 18 hours before hyperbaric exposure (n = 46) while controls were not treated (n = 45). Clinical assessment took place over a period of 30 min after surfacing. At the end, blood samples were collected for blood cells counts and cytokine IL-6 detection. There were significantly fewer manifestations of DCS in the fluoxetine group than in the controls (43.5% versus 75.5%, respectively; p = 0.004). Survivors showed a better and significant neurological recovery with fluoxetine. Platelets and red cells were significantly decreased after decompression in controls but not in the treated mice. Fluoxetine reduced circulating IL-6, a relevant marker of systemic inflammation in DCS. We concluded that fluoxetine decreased the incidence of DCS and improved motor recovery, by limiting inflammation processes.
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Affiliation(s)
- Jean-Eric Blatteau
- Equipe Résidante de Recherche Subaquatique Opérationnelle. Institut de Recherche Biomédicale des Armées - Toulon, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France.
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Hennedige T, Chow W, Ng YY, Chung-Tsing GC, Lim TCC, Kei PL. MRI in spinal cord decompression sickness. J Med Imaging Radiat Oncol 2012; 56:282-8. [PMID: 22697324 DOI: 10.1111/j.1754-9485.2012.02386.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Spinal cord decompression sickness (DCS) is a rare condition that can lead to spinal cord infarction. Despite the low incidence of diving-related DCS, we have managed to collect the data and MRI findings of seven patients who have been diagnosed with and treated for DCS in our local hyperbaric facility. This study describes the clinical presentation, MRI spinal cord findings, treatment administered and outcome of these patients. METHODS The patient medical records, from 1997 to 2007, were retrospectively reviewed. All patients with a final diagnosis of DCS and who underwent examination were included. The images were independently reviewed by two radiologists who recorded the location and number of lesions within the spinal cord. The Frankel grading was used to assess the initial and clinical outcome response. RESULTS Patchy-increased T2W changes affecting several levels at the same time were found. Contrary to the popular notion that venous infarction is the leading cause of DCS, most of our patients also demonstrated affliction of grey matter, which is typically seen in an arterial pattern of infarction. Initial involvement of multiple (>6) spinal cord levels was associated with a poor outcome. Patients who continued to have multiple neurological sequelae with less than 50% resolution of symptoms despite recompression treatment were also those who had onset of symptoms within 30 min of resurfacing. CONCLUSIONS DCS is probably a combination of both arterial and venous infarction. Short latency to the onset of neurological symptoms and multilevel cord involvement may be associated with a poorer outcome.
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Affiliation(s)
- Tiffany Hennedige
- Department of Diagnostic Radiology, Singapore General Hospital, National Neuroscience Institute, Singapore.
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Vallee N, Meckler C, Risso JJ, Blatteau JE. Neuroprotective role of the TREK-1 channel in decompression sickness. J Appl Physiol (1985) 2012; 112:1191-6. [DOI: 10.1152/japplphysiol.01100.2011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nitrogen supersaturation and bubble formation can occur in the vascular system after diving, leading to death and nervous disorders from decompression sickness (DCS). Bubbles alter the vascular endothelium, activate platelets, and lead to focal ischemia with neurological damage mediated by the mechanosensitive TREK-1 neuronal potassium ion channel that sets pre- and postsynaptic resting membrane potentials. We report a neuroprotective effect associated with TREK-1. C57Bl6 mice were subjected to decompression from a simulated 90 msw dive. Of 143 mice that were wild type (WT) for TREK-1, 51.7% showed no DCS, 27.3% failed a grip test, and 21.0% died. Of 88 TREK-1 knockouts (KO), 26.1% showed no DCS, 42.0% failed a grip test, and 31.8% died. Mice that did not express TREK-1 had lower DCS resistance and were more likely to develop neurological symptoms. We conclude that the TREK-1 potassium channel was neuroprotective for DCS.
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Affiliation(s)
- Nicolas Vallee
- Equipe Résidante de Recherche Subaquatique Opérationnelle, Institut de Recherche Biomédicale des Armées-Toulon, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
| | - Cédric Meckler
- Equipe Résidante de Recherche Subaquatique Opérationnelle, Institut de Recherche Biomédicale des Armées-Toulon, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
| | - Jean-Jacques Risso
- Equipe Résidante de Recherche Subaquatique Opérationnelle, Institut de Recherche Biomédicale des Armées-Toulon, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
| | - Jean-Eric Blatteau
- Equipe Résidante de Recherche Subaquatique Opérationnelle, Institut de Recherche Biomédicale des Armées-Toulon, Département Environnement Opérationnel, Unité Environnements Extrêmes, Toulon, France
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Blatteau JE, Gempp E, Simon O, Coulange M, Delafosse B, Souday V, Cochard G, Arvieux J, Henckes A, Lafere P, Germonpre P, Lapoussiere JM, Hugon M, Constantin P, Barthelemy A. Prognostic factors of spinal cord decompression sickness in recreational diving: retrospective and multicentric analysis of 279 cases. Neurocrit Care 2012; 15:120-7. [PMID: 20734244 DOI: 10.1007/s12028-010-9370-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study aims to determine the potential risk factors associated with the development of severe diving-related spinal cord decompression sickness (DCS). METHODS Two hundred and seventy nine injured recreational divers (42 ± 12 years; 53 women) presenting symptoms of spinal cord DCS were retrospectively included from seven hyperbaric centers in France and Belgium. Diving information, symptom latency after surfacing, time interval between symptom onset and hyperbaric treatment were studied. The initial severity of spinal cord DCS was rated with the Boussuges severity score, and the presence of sequelae was evaluated at 1 month. Initial recompression treatment at 2.8 ATA with 100% oxygen breathing or deeper recompression up to 4 or 6 ATA with nitrogen or helium-oxygen breathing mixture were also recorded. RESULTS Twenty six percent of DCS had incomplete resolution after 1 month. Multivariate analysis revealed several independent factors associated with a bad recovery: age ≥ 42 [OR 1.04 (1-1.07)], depth ≥ 39 m [OR 1.04 (1-1.07)], bladder dysfunction [OR 3.8 (1.3-11.15)], persistence or worsening of clinical symptoms before recompression [OR 2.07 (1.23-3.48)], and a Boussuges severity score >7 [OR 1.16 (1.03-1.31)]. However, the time to recompression and the choice of initial hyperbaric procedure did not significantly influence recovery after statistical adjustment. CONCLUSIONS Clinical symptoms of spinal cord DCS and their initial course before admission to the hyperbaric center should be considered as major prognostic factors in recovery. A new severity score is proposed to optimize the initial clinical evaluation for spinal cord DCS.
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Affiliation(s)
- Jean-Eric Blatteau
- Institut de Recherche Biomédicale des Armées, Antenne Toulon, UMR - MD2, P2COE Université de la Méditerranée, BP 20548, 83041, Toulon Cedex 9, France.
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Grønning M, Aarli JA. Neurological effects of deep diving. J Neurol Sci 2011; 304:17-21. [PMID: 21377169 DOI: 10.1016/j.jns.2011.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 01/19/2011] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
Abstract
Deep diving is defined as diving to depths more than 50 m of seawater (msw), and is mainly used for occupational and military purposes. A deep dive is characterized by the compression phase, the bottom time and the decompression phase. Neurological and neurophysiologic effects are demonstrated in divers during the compression phase and the bottom time. Immediate and transient neurological effects after deep dives have been shown in some divers. However, the results from the epidemiological studies regarding long term neurological effects from deep diving are conflicting and still not conclusive. Prospective clinical studies with sufficient power and sensitivity are needed to solve this very important issue.
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Affiliation(s)
- Marit Grønning
- National Centre for Hyperbaric and Diving Medicine, Department of Occupational Medicine, Haukeland University Hospital, N-5021 Bergen, Norway.
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Abstract
Decompression illness is caused by intravascular or extravascular bubbles that are formed as a result of reduction in environmental pressure (decompression). The term covers both arterial gas embolism, in which alveolar gas or venous gas emboli (via cardiac shunts or via pulmonary vessels) are introduced into the arterial circulation, and decompression sickness, which is caused by in-situ bubble formation from dissolved inert gas. Both syndromes can occur in divers, compressed air workers, aviators, and astronauts, but arterial gas embolism also arises from iatrogenic causes unrelated to decompression. Risk of decompression illness is affected by immersion, exercise, and heat or cold. Manifestations range from itching and minor pain to neurological symptoms, cardiac collapse, and death. First-aid treatment is 100% oxygen and definitive treatment is recompression to increased pressure, breathing 100% oxygen. Adjunctive treatment, including fluid administration and prophylaxis against venous thromboembolism in paralysed patients, is also recommended. Treatment is, in most cases, effective although residual deficits can remain in serious cases, even after several recompressions.
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Affiliation(s)
- Richard D Vann
- Department of Anesthesiology and Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC 27710, USA.
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Prise en charge des accidents de décompression médullaire en plongée sous-marine : actualités en 2010. Presse Med 2010; 39:778-85. [DOI: 10.1016/j.lpm.2010.02.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 01/25/2010] [Accepted: 02/08/2010] [Indexed: 11/19/2022] Open
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Risk factors and treatment outcome in scuba divers with spinal cord decompression sickness. J Crit Care 2009; 25:236-42. [PMID: 19682840 DOI: 10.1016/j.jcrc.2009.05.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 05/05/2009] [Accepted: 05/12/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE This study was designed to determine the recompression strategy and the potential risk factors associated with the development of severe diving-related spinal cord decompression sickness (DCS). MATERIAL AND METHODS Sixty-three injured recreational divers (52 men and 11 women; 46 +/- 12 years) presenting with symptoms of spinal involvement were retrospectively included. Diving information, symptom latency after dive completion, and time interval between symptom onset and hyperbaric treatment were studied. The severity of spinal cord DCS was rated numerically for both the acute event and 1-month later. Initial recompression treatment at 2.8 atmosphere absolute (ATA) with 100% oxygen breathing or deeper recompression at 4 atmosphere absolute with nitrogen-oxygen or helium-oxygen breathing mixture was also noted. RESULTS Twenty-one divers (33%) had incomplete resolution after 1 month. The clinical severity at presentation was the only independent predictor of poor outcome (odd ratio, 2.68; P < .033). Time to treatment did not influence the recovery with a similar median delay (3 hours) between the divers with or without long-term sequelae. Choice of recompression procedure was not also a determinant factor for treatment outcome. CONCLUSION The initial clinical course before treatment is a major prognostic factor of spinal cord DCS. Delay to recompression less than 3 hours and use of deep treatment tables did not improve outcome in DCS divers.
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