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Benjamin S Carson - One of the best experts on this subject based on the ideXlab platform.
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cervicomedullary Decompression for foramen magnum stenosis in achondroplasia
2006Co-Authors: Carlos A Bagley, Jonathan Pindrik, Markus Bookland, Joaquin Camaraquintana, Benjamin S CarsonAbstract:OBJECT: Achondroplasia is the most common hereditary form of dwarfism, and is characterized by short stature, macrocephaly, and a myriad of skeletal abnormalities. In the pediatric population, stenosis and compression at the level of the cervicomedullary junction commonly occurs. The goal in this study was to assess the outcomes in children with achondroplasia who underwent cervicomedullary Decompression. METHODS: Forty-three pediatric patients with heterozygous achondroplasia and foramen magnum stenosis underwent 45 cervicomedullary Decompressions at the authors' institution over an 11-year period. After surgical Decompression, complete resolution or partial improvement in the preoperative symptoms was observed in all patients. There were no deaths in the treated patients. The surgical morbidity rate was low and usually consisted of a cerebrospinal fluid (CSF) leak in patients in whom the dura mater had been opened (either intentionally or accidentally). This problem was successfully managed in all cases with local measures (wound oversewing) or CSF diversion. CONCLUSIONS: In this review the authors demonstrate that Decompression of the cervicomedullary junction in the setting of achondroplasia may be accomplished safely with significant clinical benefit and minimal morbidity.
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cervicomedullary Decompression for foramen magnum stenosis in achondroplasia
2006Co-Authors: Carlos A Bagley, Jonathan Pindrik, Markus Bookland, Joaquin Camaraquintana, Benjamin S CarsonAbstract:Object Achondroplasia is the most common hereditary form of dwarfism, and is characterized by short stature, macrocephaly, and a myriad of skeletal abnormalities. In the pediatric population, stenosis and compression at the level of the cervicomedullary junction commonly occurs. The goal in this study was to assess the outcomes in children with achondroplasia who underwent cervicomedullary Decompression. Methods Forty-three pediatric patients with heterozygous achondroplasia and foramen magnum stenosis underwent 45 cervicomedullary Decompressions at the authors’ institution over an 11-year period. After surgical Decompression, complete resolution or partial improvement in the preoperative symptoms was observed in all patients. There were no deaths in the treated patients. The surgical morbidity rate was low and usually consisted of a cerebrospinal fluid (CSF) leak in patients in whom the dura mater had been opened (either intentionally or accidentally). This problem was successfully managed in all cases w...
Carlos R Gordon - One of the best experts on this subject based on the ideXlab platform.
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inner ear Decompression sickness and inner ear barotrauma in recreational divers a long term follow up
2003Co-Authors: Avi Shupak, Carlos R Gordon, Amnon Gil, Zohar Nachum, Shira Miller, Dror TalAbstract:Objectives/Hypothesis The objectives were to report the authors' experience with the long-term follow-up of patients with diving-related inner ear Decompression sickness and inner ear barotrauma and to discuss residual cochlear and vestibular damage in relation to the question of fitness to dive. Study Design Retrospective consecutive case series. Methods Eleven recreational divers with inner ear Decompression sickness and nine with inner ear barotrauma (IEB) were followed. A complete otoneurological physical examination and laboratory evaluation were carried out. The latter included audiometry, electronystagmography, a rotatory chair test using the sinusoidal harmonic acceleration protocol, and computerized dynamic posturography. Results Residual cochleovestibular deficits were found in 10 (91%) of the patients with inner ear Decompression sickness and 3 (33%) of those with IEB (P < .02, Fisher's Exact test; odds ratio, 20). A significantly shorter follow-up period was required for the inner ear barotrauma group (P < .05, simple t test) because three patients (33%) recovered completely within 1 month of the diving accident. Eight patients had residual vestibular deficits on follow-up, but only one (12.5%) was symptomatic. However, five (56%) of the nine patients who had a cochlear insult, as documented by follow-up audiometry, complained of significant hearing loss and tinnitus. Conclusion Inner ear Decompression sickness carries a high risk for residual inner ear damage despite hyperbaric oxygen recompression therapy. A favorable prognosis might be anticipated for inner ear barotrauma. The finding that most patients with residual vestibular deficits were asymptomatic at the time of follow-up emphasizes the need for a complete vestibular evaluation, including specific bedside testing and laboratory examinations, before a return to diving activity may be considered.
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inner ear Decompression sickness in sport compressed air diving
2001Co-Authors: Zohar Nachum, Avi Shupak, Orna Spitzer, Zohara Sharoni, Ilana Doweck, Carlos R GordonAbstract:Objective We report our experience over the past 12 years with recreational diving-related inner ear Decompression sickness (IEDCS). Study Design Retrospective, consecutive case series. Methods Twenty-four divers, representing 29 cases of IEDCS, are presented with regard to evaluation, treatment, and follow-up. Results These 29 cases represent 26% of the severe Decompression sickness (DCS) cases treated in that period. The patient group includes 22 divers who had a single event of IEDCS, one diver who had two events, and one with five repeated episodes. The cause of injury in 23 cases (79%) was violation of the Decompression schedule. The mean time from surfacing to appearance of symptoms was 47 ± 65 minutes. In 83%, symptoms appeared within 1 hour of ascent, in 97% within 2 hours, and in only one diver after 5.5 hours. Ten divers (34%) had pure vestibular involvement, 4 (14%) had cochlear insult alone, and 15 (52%) had combined vestibulo-cochlear injury. Except for one patient who had central as well as peripheral vestibulo-cochlear DCS, all the remaining patients had end organ involvement only, as demonstrated by physical examination and laboratory test results. Fifteen (52%) had isolated IEDCS, whereas 14 had additional symptoms of DCS. Twenty-six cases were treated by hyperbaric oxygenation with supplementary daily hyperbaric sessions. Of the 25 cases with vestibular injury and the 19 with cochlear damage, only 7 (28%) and 6 (32%), respectively, made a full recovery, whereas the others remained with residual damage. Of the 17 treated within 6 hours of symptom appearance, 9 (53%) were cured, compared with one of the 9 treated later (P <.05). Conclusions IEDCS related to compressed-air recreational diving is more common than previously thought, and might occur even when no Decompression schedule violation took place. Prompt diagnosis leading to the early commencement of hyperbaric oxygen recompression therapy is the key to complete recovery of cochlear and vestibular function.
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spinal cord Decompression sickness in sport diving
1993Co-Authors: Judith Aharonperetz, Yohai Adir, Carlos R Gordon, Shahar Kol, Nachum Gal, Y MelamedAbstract:• Objective. —To summarize 16 years' experience in the diagnosis and treatment of spinal cord Decompression sickness in Israel. Design. —The survey data were collected firsthand by physicians trained in underwater diving medicine. Setting. —The Israeli Naval Medical Institute, Israel's national hyperbaric referral center. Patients. —Sixty-eight sport divers diagnosed as having spinal cord Decompression sickness. Interventions. —Hydration and 100% oxygen breathing until the patient reached the hyperbaric chamber. All patients received recompression therapy on US Navy treatment tables using oxygen, except for six who were treated by Comex Treatment Table CX-30, which uses helium in addition to oxygen. Main Outcome Measures. —Neurological examination after the completion of recompression therapy. Results. —Forty-one percent of the dives were performed within the Decompression limits of the US Navy standard Decompression tables. Risk factors were fatigue, circumstances suggesting dehydration, and extreme physical effort. The most common presenting symptoms were paresthesias, weakness of the legs, lower back pain, or abdominal pain. Full recovery was achieved in 79% of the patients. Spinal symptoms appeared immediately on surfacing in six of the eight patients who continued to have multiple neurological sequelae. Conclusions. —United States Navy air Decompression tables appear not to be completely safe for sport divers. Even mild spinal symptoms identified on surfacing should be treated vigorously. High-pressure oxygen-helium therapy seems to be a promising alternative in cases of severe spinal cord Decompression sickness.
Jeaneric Blatteau - One of the best experts on this subject based on the ideXlab platform.
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hyperbaric medicine and emergency medicine an example of Decompression sickness in diving
2018Co-Authors: Claire Chantre, Jeaneric Blatteau, J Morin, Henri Le Hot, Hugues LefortAbstract:One of the reasons for the emergency use of a hyperbaric chamber concerns a diving-related accident. Decompression sickness is potentially serious; it requires urgent treatment and hyperbaric recompression. It is caused by the formation of nitrogen bubbles in the organism which appear during the diver's ascent and throughout his or her Decompression.
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prevention and treatment of Decompression sickness using training and in water recompression among fisherman divers in vietnam
2016Co-Authors: Jeaneric Blatteau, Jeanmichel Pontier, Peter Buzzacott, Kate Lambrechts, Van Mui Nguyen, Philippe Cavenel, Jean RuffezAbstract:Introduction Many fisherman divers in Vietnam suffer from Decompression sickness (DCS) causing joint pain, severe neurological deficit or even death. The objective of this pilot study was to evaluate the effectiveness of a training programme to prevent DCS and also treat DCS using the method of in-water recompression (IWR). Methods 63 divers were interviewed and trained over a period of 3 years from 2009. Fifty one per cent of all trained divers were reinterviewed in 2011–2012 to collect mortality and morbidity data as well as information on changes in diving practices. Results Since 2009, most fisherman divers have changed their practices by reducing bottom time or depth. Mortality was reduced and the incidence of severe neurological DCS decreased by 75%. Twenty four cases of DCS were treated by IWR. Ten cases of joint pain were treated with IWR using air, affording immediate relief in all cases. Out of 10 cases of neurological DCS, 4/4 recovered completely after IWR with oxygen whereas only 2/6 subjects recovered immediately after IWR with air. In addition, 3/4 further cases of DCS treated with IWR using oxygen immediately recovered. Conclusions Our results suggest that IWR is effective for severe neurological DCS in remote fishing communities, especially with oxygen.
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risk factors and clinical outcome in military divers with neurological Decompression sickness influence of time to recompression
2011Co-Authors: Jeaneric Blatteau, Emmanuel Gempp, P Constantin, Pierre LougeAbstract:Background This study was designed to examine the influence of short delay to recompression and other risk factors associated with the development of severe neurological Decompression sickness (DCS) in military divers. Methods Fifty-nine divers with DCS treated in less than 6 hours from onset of symptoms to hyperbaric recompression were included retrospectively. Diving parameters, symptom latency and recompression delay were analysed. Clinical symptoms were evaluated for both the acute event and one month later. Results Median delay to hyperbaric treatment was 35 min (2-350 min). Resolution was incomplete after one month in 25.4 % of divers with DCS. Multivariate analysis demonstrated that severe symptoms, classified as sensory and motor deficits or the presence of bladder dysfunction, were predictors of poor recovery with adjusted odds ratios (OR) of 4.1 (1.12 to 14.92) and 9.99 (1.5 to 66.34) respectively. There was a relationship between a longer delay to treatment and incomplete recovery, but the increased risk appeared negligible with an adjusted OR of 1.01 (1-1.02). Conclusion Our results suggest that neurological severity upon occurrence is the main independent risk factor associated with a poor outcome in military divers with DCS. Clinical recovery was not dramatically improved in this series when recompression treatment was performed promptly.
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risk factors and treatment outcome in scuba divers with spinal cord Decompression sickness
2010Co-Authors: Emmanuel Gempp, Jeaneric BlatteauAbstract: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 b .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. © 2009 Published by Elsevier Inc.
Carlos A Bagley - One of the best experts on this subject based on the ideXlab platform.
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cervicomedullary Decompression for foramen magnum stenosis in achondroplasia
2006Co-Authors: Carlos A Bagley, Jonathan Pindrik, Markus Bookland, Joaquin Camaraquintana, Benjamin S CarsonAbstract:OBJECT: Achondroplasia is the most common hereditary form of dwarfism, and is characterized by short stature, macrocephaly, and a myriad of skeletal abnormalities. In the pediatric population, stenosis and compression at the level of the cervicomedullary junction commonly occurs. The goal in this study was to assess the outcomes in children with achondroplasia who underwent cervicomedullary Decompression. METHODS: Forty-three pediatric patients with heterozygous achondroplasia and foramen magnum stenosis underwent 45 cervicomedullary Decompressions at the authors' institution over an 11-year period. After surgical Decompression, complete resolution or partial improvement in the preoperative symptoms was observed in all patients. There were no deaths in the treated patients. The surgical morbidity rate was low and usually consisted of a cerebrospinal fluid (CSF) leak in patients in whom the dura mater had been opened (either intentionally or accidentally). This problem was successfully managed in all cases with local measures (wound oversewing) or CSF diversion. CONCLUSIONS: In this review the authors demonstrate that Decompression of the cervicomedullary junction in the setting of achondroplasia may be accomplished safely with significant clinical benefit and minimal morbidity.
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cervicomedullary Decompression for foramen magnum stenosis in achondroplasia
2006Co-Authors: Carlos A Bagley, Jonathan Pindrik, Markus Bookland, Joaquin Camaraquintana, Benjamin S CarsonAbstract:Object Achondroplasia is the most common hereditary form of dwarfism, and is characterized by short stature, macrocephaly, and a myriad of skeletal abnormalities. In the pediatric population, stenosis and compression at the level of the cervicomedullary junction commonly occurs. The goal in this study was to assess the outcomes in children with achondroplasia who underwent cervicomedullary Decompression. Methods Forty-three pediatric patients with heterozygous achondroplasia and foramen magnum stenosis underwent 45 cervicomedullary Decompressions at the authors’ institution over an 11-year period. After surgical Decompression, complete resolution or partial improvement in the preoperative symptoms was observed in all patients. There were no deaths in the treated patients. The surgical morbidity rate was low and usually consisted of a cerebrospinal fluid (CSF) leak in patients in whom the dura mater had been opened (either intentionally or accidentally). This problem was successfully managed in all cases w...
Y Melamed - One of the best experts on this subject based on the ideXlab platform.
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spinal cord Decompression sickness in sport diving
1993Co-Authors: Judith Aharonperetz, Yohai Adir, Carlos R Gordon, Shahar Kol, Nachum Gal, Y MelamedAbstract:• Objective. —To summarize 16 years' experience in the diagnosis and treatment of spinal cord Decompression sickness in Israel. Design. —The survey data were collected firsthand by physicians trained in underwater diving medicine. Setting. —The Israeli Naval Medical Institute, Israel's national hyperbaric referral center. Patients. —Sixty-eight sport divers diagnosed as having spinal cord Decompression sickness. Interventions. —Hydration and 100% oxygen breathing until the patient reached the hyperbaric chamber. All patients received recompression therapy on US Navy treatment tables using oxygen, except for six who were treated by Comex Treatment Table CX-30, which uses helium in addition to oxygen. Main Outcome Measures. —Neurological examination after the completion of recompression therapy. Results. —Forty-one percent of the dives were performed within the Decompression limits of the US Navy standard Decompression tables. Risk factors were fatigue, circumstances suggesting dehydration, and extreme physical effort. The most common presenting symptoms were paresthesias, weakness of the legs, lower back pain, or abdominal pain. Full recovery was achieved in 79% of the patients. Spinal symptoms appeared immediately on surfacing in six of the eight patients who continued to have multiple neurological sequelae. Conclusions. —United States Navy air Decompression tables appear not to be completely safe for sport divers. Even mild spinal symptoms identified on surfacing should be treated vigorously. High-pressure oxygen-helium therapy seems to be a promising alternative in cases of severe spinal cord Decompression sickness.
