Emmanuel Gempp - Academia.edu (original) (raw)
Papers by Emmanuel Gempp
Vascular gas bubbles are considered the principal element in decompression sickness (DCS) develop... more Vascular gas bubbles are considered the principal element in decompression sickness (DCS) development. Traditionally these bubbles were called VGE (venous gas emboli), however scientific knowledge indicates that similar bubbles may also be present in the arterial circulation, therefore we propose to use “VGE” for “Vascular Gas Emboli”, and we will do so throughout the text. Reduction of VGE production represents an interesting endpoint to decrease decompression stress and DCS risk. Here we will discuss state of the art pre-dive techniques and approaches, commonly known as preconditioning, used to reduce post-dive VGE load and decompression stress. Evidence based approaches clearly show that some types of preconditioning are more potent in VGE reduction, some indecompression stress reduction and there are some with a positive impact on both. Nevertheless, further research is required to investigate the mechanisms underlying these positive effects.
![Research paper thumbnail of [Early detection of asymptomatic dysbaric osteonecrosis of the shoulder after type 1 decompression sickness: a case report]](https://attachments.academia-assets.com/39647802/thumbnails/1.jpg)
](La Revue de Médecine Interne
¹Groupe de plongeurs-démineurs de la méditerranée, BP 733, 83800 Toulon armées. ²Centre d'experti... more ¹Groupe de plongeurs-démineurs de la méditerranée, BP 733, 83800 Toulon armées. ²Centre d'expertise du personnel plongeur, hôpital d'instruction des armées Clermonttonnerre, BP 41, 29240 Brest armées. Auteur correspondant : gempp Téléphone : 04 94 02 81 23 Fax : 04 94 02 67 90 gempp@voila.fr Revue de médecine interne 2005 2 RESUME bénéficier précocement d'une exploration par IRM pour dépister des lésions de remaniements ostéo-médullaires susceptibles de s'aggraver ultérieurement en plongée et d'évoluer secondairement vers une ostéonécrose. Mots clés : Ostéonécrose dysbarique, infarctus osseux, plongée, accident de décompression, IRM.
We report the case of a 64-year-old healthy male diver who presented an unusual diving- related p... more We report the case of a 64-year-old healthy male diver who presented an unusual diving- related pulmonary edema induced by a painless myocardial infarction with normal coronary arteriography. We review the related literature and discuss the pathophysiologic mechanisms that would contribute to provoke this myocardial injury during diving.
Applied Physiology Nutrition and Metabolism
Exercise at depth and during decompression is a commonly accepted factor that affects the risk of... more Exercise at depth and during decompression is a commonly accepted factor that affects the risk of decompression sickness in divers and aviators, but data documenting these effects are limited and conflicting. The mechanisms may be complex and influenced by several factors, such as the type and nature of exercise, the temporal course of the exercise in relation to the decompression procedure, and the diving profile. This paper reviews previous studies in this field of research, and discusses current concepts in diving activities.
La Presse Médicale
The outcome of spinal cord decompression sickness after scuba diving is unpredictable during the ... more The outcome of spinal cord decompression sickness after scuba diving is unpredictable during the 24 first hours with a high risk of incomplete recovery. The treatment is defined on first aid normobaric oxygen when neurological symptoms occur, rehydration and prompt recompression in hyperbaric chamber. The presence of initial motor impairment, the aggravation of symptoms during the transfer to the hyperbaric facility and the emergence of sphincter dysfunction are predictive of poor prognosis whatever the treatment undertaken.
Aviation Space and Environmental Medicine
The N-terminal pro brain natriuretic peptide (N-BNP) is a promising cardiac natriuretic peptide u... more The N-terminal pro brain natriuretic peptide (N-BNP) is a promising cardiac natriuretic peptide used as a clinical hormonal marker in cardiac dysfunction. The main stimulus for N-BNP synthesis and secretion is cardiac wall stress, which is recognized as a common denominator of many cardiac diseases. Diving is associated with environmental factors leading to variations in thoracic blood volume and hemodynamic changes. The purpose of the present study was to examine the changes in the concentration of N-BNP in healthy men during and after scuba diving. There were 10 healthy military divers (mean age 33 yr) who performed a dive in the sea for 1 h at 10 m depth. Venous blood samples were taken at timed intervals to allow evaluation of plasma levels of N-BNP at different steps, namely at To (before immersion), at T30 min (during the dive, after a short surfacing), at T60 min (right after surfacing), at T300 min (post-dive), and finally at T24 h. Peptide blood concentrations were determin...
Aviation Space and Environmental Medicine
A single bout of aerobic exercise 24 h before a dive significantly reduces the formation of circu... more A single bout of aerobic exercise 24 h before a dive significantly reduces the formation of circulating venous gas emboli (VGE) on decompression. The purpose of this investigation was to determine the effect of aerobic exercise 2 h before a dive. There were 16 trained military divers who were compressed to 30 msw (400 kPa) for 30 min breathing air in a dry hyperbaric chamber at rest, then decompressed at a rate of 10 m x min(-1) with a 9-min stop at 3 msw. Each diver performed two dives 3 d apart, one with and one without exercise that consisted of running for 45 min at 60-80% of maximum heart rate (estimated as 220 - age). VGE were graded according to the Spencer scale using a pulsed Doppler detector on the precordium at 30 min (T30) and 60 min (T60) after surfacing. Mean bubble grades at T60 were 1.25 for control dives and 0.44 for dives preceded by exercise, the difference being highly significant. None of the divers showed an increase in venous bubble grade after exercise. Like ...
Aviation Space and Environmental Medicine
We report a case of transient neurological disorder compatible with cerebral decompression illnes... more We report a case of transient neurological disorder compatible with cerebral decompression illness in a breath-hold diver. A large right-to-left shunt was later detected with contrast transcranial Doppler ultrasound. While the mechanism of brain damage is unclear, this observation highlights the need for breath-hold divers to avoid excessive nitrogen loading and to refrain from forceful Valsalva maneuvers that may contribute to the opening of a patent foramen ovale and lead to paradoxical cerebral embolism. Because decompression illness is a possibility, anyone who experiences unusual symptoms after breath-hold diving should seek immediate medical attention.
Spinal Cord
Study design:Retrospective case-control studyObjectives:The intent of this study was to investiga... more Study design:Retrospective case-control studyObjectives: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...
Arbeitsphysiologie
Preventive measures to reduce the risk of decompression sickness can involve several procedures s... more Preventive measures to reduce the risk of decompression sickness can involve several procedures such as oxygen breathing during in-water decompression. Theoretical predictions also suggest that brief periods of recompression during the course of decompression could be a method for controlling bubble formation. The aim of this study was to get clearer information about the effects of different experimental ascent profiles (EAPs) on bubble reduction, using pure oxygen or recompression during decompression for nitrox diving. Four EAPs were evaluated using bubble monitoring in a group of six military divers using Nitrox 40% O(2) breathing with a rebreather. For EAP 1 and 2, 100% O(2) was used for the end stage of decompression, with a 30% reduction of decompression time in EAP 1 and 50% in EAP 2, compared to the French navy standard schedule. For EAP 3 and 4, nitrox 40% O(2) was maintained throughout the decompression stage. EAP 3 is based on an air standard decompression schedule, wher...
The American journal of cardiology
Immersion pulmonary edema in scuba divers is a rare disorder that tends to recur and can be poten... more Immersion pulmonary edema in scuba divers is a rare disorder that tends to recur and can be potentially fatal, even in the absence of underlying cardiac disease. Anecdotal cases of reversible myocardial dysfunction have been described in this setting, but little is known of its pathogenesis. The purpose of the present study was to determine the clinical outcomes and the determinants associated with this condition. The data from 54 consecutive divers admitted for acute immersion pulmonary edema during a 5.5-year period were retrospectively studied. A diagnosis of myocardial dysfunction was established by the presence of elevated cardiac troponin T levels, coupled with electrocardiographic changes and/or wall motion abnormalities on the echocardiogram. The demographic, clinical, biologic, and diving characteristics were tested as potential predictors of this disorder. All the patients had complete resolution of symptoms within 72 hours, but 3 required intensive ventilation or hemodyna...
The Journal of sports medicine and physical fitness
Individual or environmental factors that predispose to the recurrence of neurological decompressi... more Individual or environmental factors that predispose to the recurrence of neurological decompression sickness (DCS) in scuba divers are not known and preventives measures designed to mitigate the risk of a subsequent episode remain empirical. The aim of this controlled study was to examine some potential risk factors predictive of recurrent DCS event that may lead to practical recommendations for divers who wish to continue diving after an initial episode. Age, gender, diving experience, presence of a large right-to-left shunt (RLS) and diving practice following post-DCS resumption were evaluated as potential predictors of a further DCS in recreational divers admitted in our hyperbaric facility over a period of 12 years. Twenty-four recurrent cases and 50 divers treated for a single DCS episode which continued diving were recruited after review of medical forms and follow-up interview by telephone. After controlling for potential confounding variables between groups, multivariate ana...
Journal of the South Pacific Underwater Medicine Society
Neuron-specific enolase (NSE) and S100B protein are brain-origin proteins commonly described to a... more Neuron-specific enolase (NSE) and S100B protein are brain-origin proteins commonly described to assess the presence and severity of neurological injury. To date, there are limited data examining the influence of scuba diving on these biomarkers, particularly when symptoms of decompression sickness (DCS) occur. The purpose of this controlled study was to determine whether these serum neurochemical markers could be used as 1) indicators of neurological DCS and 2) predictors of incomplete recovery. Fifty-nine divers with neurological DCS and 37 asymptomatic divers admitted for inadequate decompression, serving as controls, were consecutively enrolled between 2010 and 2012. Blood samples were collected at initial presentation up to 6 hours after dive completion (controls) or onset of symptoms (DCS divers). Biomarkers were quantified in nonhaemolysed samples only. Clinical outcome was assessed at 6 months post-injury. The two groups did not differ regarding the variables examined, except...
Neuropsychiatrie de l'Enfance et de l'Adolescence, 2010
Various therapies take place in autism treatment. Cerebral hypoperfusion, neuro-inflammation and ... more Various therapies take place in autism treatment. Cerebral hypoperfusion, neuro-inflammation and oxidative stress findings in autistic children have led clinicians to experiment hyperbaric oxygen therapy. To date, except two single case descriptions, only available results are about five case series, three of whom very briefly described, and two randomized comparative studies. Improvement in cerebral perfusion is found in one study
La Revue de Médecine Interne, 2005
ABSTRACT
Aviation, space, and environmental medicine, 2014
Prior reports have shown that decompression sickness (DCS) in scuba divers is accompanied by vasc... more Prior reports have shown that decompression sickness (DCS) in scuba divers is accompanied by vascular endothelium damage attributed to gas emboli formation, resulting in capillary leak with hemoconcentration. The significance of serum albumin as a biomarker of vascular permeability in this condition has been insufficiently investigated. We studied whether there was a relationship between low serum albumin values on admission and the occurrence of neurological DCS. Demographic, diving, and laboratory data of 52 randomly selected DCS divers were compared with those of 52 asymptomatic divers referred for inadequate decompression. The diagnostic performance of serum albumin in predicting neurological DCS was assessed. Both groups did not differ from the variables examined. Serum albumin was significantly lower in injured divers than in controls (38.7 ± 3 g · L(-1) vs. 41 ± 2.9 g · L(-1)). At a cut-off value of 35.2 g · L(-1), we found a specificity of 98% (95% CI 90-100) and a sensitivi...
Diving and hyperbaric medicine, 2013
Haemoptysis and pulmonary oedema following deep breath-hold diving have been described in recent ... more Haemoptysis and pulmonary oedema following deep breath-hold diving have been described in recent years. We describe the case of a 33-year-old healthy military diver who presented symptoms suggestive of pulmonary oedema after two breathhold dives, the first lasting 0.5-1 min and the second 1-2 min, to 6 metres' depth in the sea. The diagnosis was promptly confirmed with chest computed tomography showing bilateral interstitial infiltrates in the upper regions of the lungs. To our knowledge, this is the first report to document pulmonary oedema in this setting of shallow breath-hold diving with atypical radiological presentation. A definite mechanism for this specific distribution of lung injury remains unclear.
Diving and hyperbaric medicine, 2012
Decompression sickness often manifests as central nervous system impairment. We report a 49-year-... more Decompression sickness often manifests as central nervous system impairment. We report a 49-year-old woman who developed an unusual case of spinal cord decompression sickness presenting as complete Brown-Sequard syndrome. Initial MRI revealed increased signal intensity in the left side of the cervical cord at the level of C2-C3. A second MRI at 10 days post-injury showed signal abnormalities corresponding to an infarction in the posterior spinal artery territory. After two weeks of intensive treatment with various HBOT regimens, the clinical outcome was still poor, but at six months after the injury her neurological condition was greatly improved, with only slight impairment of proprioception on the left when walking remaining.
Diving and hyperbaric medicine, 2009
Dysbaric osteonecrosis (DON) is a complication that usually occurs in professional divers or comp... more Dysbaric osteonecrosis (DON) is a complication that usually occurs in professional divers or compressedair workers. Its correlation with a previous musculoskeletal decompression injury (i.e., 'limb bend') remains a controversial subject. There is little information about the prevalence of DON and its relationship to decompression sickness (DCS) in recreational divers. We undertook an observational, retrospective study of recreational divers treated for musculoskeletal DCS between 2004 and 2008 in three hyperbaric centres in the south of France using magnetic resonance imaging (MRI) following hyperbaric treatment. Twenty-five (11.5%) musculoskeletal DCS cases were identified amongst 288 diving accidents treated during this period. Average age was 38 years with a mean body mass index of 26 kg/square m. Joint pains were located in the shoulder area in 21 divers, mainly in experienced male divers after performing repetitive long, deep dives with adequate decompression using dive...
Presse médicale (Paris, France : 1983)
The outcome of spinal cord decompression sickness after scuba diving is unpredictable during the ... more The outcome of spinal cord decompression sickness after scuba diving is unpredictable during the 24 first hours with a high risk of incomplete recovery. The treatment is defined on first aid normobaric oxygen when neurological symptoms occur, rehydration and prompt recompression in hyperbaric chamber. The presence of initial motor impairment, the aggravation of symptoms during the transfer to the hyperbaric facility and the emergence of sphincter dysfunction are predictive of poor prognosis whatever the treatment undertaken.
Vascular gas bubbles are considered the principal element in decompression sickness (DCS) develop... more Vascular gas bubbles are considered the principal element in decompression sickness (DCS) development. Traditionally these bubbles were called VGE (venous gas emboli), however scientific knowledge indicates that similar bubbles may also be present in the arterial circulation, therefore we propose to use “VGE” for “Vascular Gas Emboli”, and we will do so throughout the text. Reduction of VGE production represents an interesting endpoint to decrease decompression stress and DCS risk. Here we will discuss state of the art pre-dive techniques and approaches, commonly known as preconditioning, used to reduce post-dive VGE load and decompression stress. Evidence based approaches clearly show that some types of preconditioning are more potent in VGE reduction, some indecompression stress reduction and there are some with a positive impact on both. Nevertheless, further research is required to investigate the mechanisms underlying these positive effects.
La Revue de Médecine Interne
¹Groupe de plongeurs-démineurs de la méditerranée, BP 733, 83800 Toulon armées. ²Centre d'experti... more ¹Groupe de plongeurs-démineurs de la méditerranée, BP 733, 83800 Toulon armées. ²Centre d'expertise du personnel plongeur, hôpital d'instruction des armées Clermonttonnerre, BP 41, 29240 Brest armées. Auteur correspondant : gempp Téléphone : 04 94 02 81 23 Fax : 04 94 02 67 90 gempp@voila.fr Revue de médecine interne 2005 2 RESUME bénéficier précocement d'une exploration par IRM pour dépister des lésions de remaniements ostéo-médullaires susceptibles de s'aggraver ultérieurement en plongée et d'évoluer secondairement vers une ostéonécrose. Mots clés : Ostéonécrose dysbarique, infarctus osseux, plongée, accident de décompression, IRM.
We report the case of a 64-year-old healthy male diver who presented an unusual diving- related p... more We report the case of a 64-year-old healthy male diver who presented an unusual diving- related pulmonary edema induced by a painless myocardial infarction with normal coronary arteriography. We review the related literature and discuss the pathophysiologic mechanisms that would contribute to provoke this myocardial injury during diving.
Applied Physiology Nutrition and Metabolism
Exercise at depth and during decompression is a commonly accepted factor that affects the risk of... more Exercise at depth and during decompression is a commonly accepted factor that affects the risk of decompression sickness in divers and aviators, but data documenting these effects are limited and conflicting. The mechanisms may be complex and influenced by several factors, such as the type and nature of exercise, the temporal course of the exercise in relation to the decompression procedure, and the diving profile. This paper reviews previous studies in this field of research, and discusses current concepts in diving activities.
La Presse Médicale
The outcome of spinal cord decompression sickness after scuba diving is unpredictable during the ... more The outcome of spinal cord decompression sickness after scuba diving is unpredictable during the 24 first hours with a high risk of incomplete recovery. The treatment is defined on first aid normobaric oxygen when neurological symptoms occur, rehydration and prompt recompression in hyperbaric chamber. The presence of initial motor impairment, the aggravation of symptoms during the transfer to the hyperbaric facility and the emergence of sphincter dysfunction are predictive of poor prognosis whatever the treatment undertaken.
Aviation Space and Environmental Medicine
The N-terminal pro brain natriuretic peptide (N-BNP) is a promising cardiac natriuretic peptide u... more The N-terminal pro brain natriuretic peptide (N-BNP) is a promising cardiac natriuretic peptide used as a clinical hormonal marker in cardiac dysfunction. The main stimulus for N-BNP synthesis and secretion is cardiac wall stress, which is recognized as a common denominator of many cardiac diseases. Diving is associated with environmental factors leading to variations in thoracic blood volume and hemodynamic changes. The purpose of the present study was to examine the changes in the concentration of N-BNP in healthy men during and after scuba diving. There were 10 healthy military divers (mean age 33 yr) who performed a dive in the sea for 1 h at 10 m depth. Venous blood samples were taken at timed intervals to allow evaluation of plasma levels of N-BNP at different steps, namely at To (before immersion), at T30 min (during the dive, after a short surfacing), at T60 min (right after surfacing), at T300 min (post-dive), and finally at T24 h. Peptide blood concentrations were determin...
Aviation Space and Environmental Medicine
A single bout of aerobic exercise 24 h before a dive significantly reduces the formation of circu... more A single bout of aerobic exercise 24 h before a dive significantly reduces the formation of circulating venous gas emboli (VGE) on decompression. The purpose of this investigation was to determine the effect of aerobic exercise 2 h before a dive. There were 16 trained military divers who were compressed to 30 msw (400 kPa) for 30 min breathing air in a dry hyperbaric chamber at rest, then decompressed at a rate of 10 m x min(-1) with a 9-min stop at 3 msw. Each diver performed two dives 3 d apart, one with and one without exercise that consisted of running for 45 min at 60-80% of maximum heart rate (estimated as 220 - age). VGE were graded according to the Spencer scale using a pulsed Doppler detector on the precordium at 30 min (T30) and 60 min (T60) after surfacing. Mean bubble grades at T60 were 1.25 for control dives and 0.44 for dives preceded by exercise, the difference being highly significant. None of the divers showed an increase in venous bubble grade after exercise. Like ...
Aviation Space and Environmental Medicine
We report a case of transient neurological disorder compatible with cerebral decompression illnes... more We report a case of transient neurological disorder compatible with cerebral decompression illness in a breath-hold diver. A large right-to-left shunt was later detected with contrast transcranial Doppler ultrasound. While the mechanism of brain damage is unclear, this observation highlights the need for breath-hold divers to avoid excessive nitrogen loading and to refrain from forceful Valsalva maneuvers that may contribute to the opening of a patent foramen ovale and lead to paradoxical cerebral embolism. Because decompression illness is a possibility, anyone who experiences unusual symptoms after breath-hold diving should seek immediate medical attention.
Spinal Cord
Study design:Retrospective case-control studyObjectives:The intent of this study was to investiga... more Study design:Retrospective case-control studyObjectives: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...
Arbeitsphysiologie
Preventive measures to reduce the risk of decompression sickness can involve several procedures s... more Preventive measures to reduce the risk of decompression sickness can involve several procedures such as oxygen breathing during in-water decompression. Theoretical predictions also suggest that brief periods of recompression during the course of decompression could be a method for controlling bubble formation. The aim of this study was to get clearer information about the effects of different experimental ascent profiles (EAPs) on bubble reduction, using pure oxygen or recompression during decompression for nitrox diving. Four EAPs were evaluated using bubble monitoring in a group of six military divers using Nitrox 40% O(2) breathing with a rebreather. For EAP 1 and 2, 100% O(2) was used for the end stage of decompression, with a 30% reduction of decompression time in EAP 1 and 50% in EAP 2, compared to the French navy standard schedule. For EAP 3 and 4, nitrox 40% O(2) was maintained throughout the decompression stage. EAP 3 is based on an air standard decompression schedule, wher...
The American journal of cardiology
Immersion pulmonary edema in scuba divers is a rare disorder that tends to recur and can be poten... more Immersion pulmonary edema in scuba divers is a rare disorder that tends to recur and can be potentially fatal, even in the absence of underlying cardiac disease. Anecdotal cases of reversible myocardial dysfunction have been described in this setting, but little is known of its pathogenesis. The purpose of the present study was to determine the clinical outcomes and the determinants associated with this condition. The data from 54 consecutive divers admitted for acute immersion pulmonary edema during a 5.5-year period were retrospectively studied. A diagnosis of myocardial dysfunction was established by the presence of elevated cardiac troponin T levels, coupled with electrocardiographic changes and/or wall motion abnormalities on the echocardiogram. The demographic, clinical, biologic, and diving characteristics were tested as potential predictors of this disorder. All the patients had complete resolution of symptoms within 72 hours, but 3 required intensive ventilation or hemodyna...
The Journal of sports medicine and physical fitness
Individual or environmental factors that predispose to the recurrence of neurological decompressi... more Individual or environmental factors that predispose to the recurrence of neurological decompression sickness (DCS) in scuba divers are not known and preventives measures designed to mitigate the risk of a subsequent episode remain empirical. The aim of this controlled study was to examine some potential risk factors predictive of recurrent DCS event that may lead to practical recommendations for divers who wish to continue diving after an initial episode. Age, gender, diving experience, presence of a large right-to-left shunt (RLS) and diving practice following post-DCS resumption were evaluated as potential predictors of a further DCS in recreational divers admitted in our hyperbaric facility over a period of 12 years. Twenty-four recurrent cases and 50 divers treated for a single DCS episode which continued diving were recruited after review of medical forms and follow-up interview by telephone. After controlling for potential confounding variables between groups, multivariate ana...
Journal of the South Pacific Underwater Medicine Society
Neuron-specific enolase (NSE) and S100B protein are brain-origin proteins commonly described to a... more Neuron-specific enolase (NSE) and S100B protein are brain-origin proteins commonly described to assess the presence and severity of neurological injury. To date, there are limited data examining the influence of scuba diving on these biomarkers, particularly when symptoms of decompression sickness (DCS) occur. The purpose of this controlled study was to determine whether these serum neurochemical markers could be used as 1) indicators of neurological DCS and 2) predictors of incomplete recovery. Fifty-nine divers with neurological DCS and 37 asymptomatic divers admitted for inadequate decompression, serving as controls, were consecutively enrolled between 2010 and 2012. Blood samples were collected at initial presentation up to 6 hours after dive completion (controls) or onset of symptoms (DCS divers). Biomarkers were quantified in nonhaemolysed samples only. Clinical outcome was assessed at 6 months post-injury. The two groups did not differ regarding the variables examined, except...
Neuropsychiatrie de l'Enfance et de l'Adolescence, 2010
Various therapies take place in autism treatment. Cerebral hypoperfusion, neuro-inflammation and ... more Various therapies take place in autism treatment. Cerebral hypoperfusion, neuro-inflammation and oxidative stress findings in autistic children have led clinicians to experiment hyperbaric oxygen therapy. To date, except two single case descriptions, only available results are about five case series, three of whom very briefly described, and two randomized comparative studies. Improvement in cerebral perfusion is found in one study
La Revue de Médecine Interne, 2005
ABSTRACT
Aviation, space, and environmental medicine, 2014
Prior reports have shown that decompression sickness (DCS) in scuba divers is accompanied by vasc... more Prior reports have shown that decompression sickness (DCS) in scuba divers is accompanied by vascular endothelium damage attributed to gas emboli formation, resulting in capillary leak with hemoconcentration. The significance of serum albumin as a biomarker of vascular permeability in this condition has been insufficiently investigated. We studied whether there was a relationship between low serum albumin values on admission and the occurrence of neurological DCS. Demographic, diving, and laboratory data of 52 randomly selected DCS divers were compared with those of 52 asymptomatic divers referred for inadequate decompression. The diagnostic performance of serum albumin in predicting neurological DCS was assessed. Both groups did not differ from the variables examined. Serum albumin was significantly lower in injured divers than in controls (38.7 ± 3 g · L(-1) vs. 41 ± 2.9 g · L(-1)). At a cut-off value of 35.2 g · L(-1), we found a specificity of 98% (95% CI 90-100) and a sensitivi...
Diving and hyperbaric medicine, 2013
Haemoptysis and pulmonary oedema following deep breath-hold diving have been described in recent ... more Haemoptysis and pulmonary oedema following deep breath-hold diving have been described in recent years. We describe the case of a 33-year-old healthy military diver who presented symptoms suggestive of pulmonary oedema after two breathhold dives, the first lasting 0.5-1 min and the second 1-2 min, to 6 metres' depth in the sea. The diagnosis was promptly confirmed with chest computed tomography showing bilateral interstitial infiltrates in the upper regions of the lungs. To our knowledge, this is the first report to document pulmonary oedema in this setting of shallow breath-hold diving with atypical radiological presentation. A definite mechanism for this specific distribution of lung injury remains unclear.
Diving and hyperbaric medicine, 2012
Decompression sickness often manifests as central nervous system impairment. We report a 49-year-... more Decompression sickness often manifests as central nervous system impairment. We report a 49-year-old woman who developed an unusual case of spinal cord decompression sickness presenting as complete Brown-Sequard syndrome. Initial MRI revealed increased signal intensity in the left side of the cervical cord at the level of C2-C3. A second MRI at 10 days post-injury showed signal abnormalities corresponding to an infarction in the posterior spinal artery territory. After two weeks of intensive treatment with various HBOT regimens, the clinical outcome was still poor, but at six months after the injury her neurological condition was greatly improved, with only slight impairment of proprioception on the left when walking remaining.
Diving and hyperbaric medicine, 2009
Dysbaric osteonecrosis (DON) is a complication that usually occurs in professional divers or comp... more Dysbaric osteonecrosis (DON) is a complication that usually occurs in professional divers or compressedair workers. Its correlation with a previous musculoskeletal decompression injury (i.e., 'limb bend') remains a controversial subject. There is little information about the prevalence of DON and its relationship to decompression sickness (DCS) in recreational divers. We undertook an observational, retrospective study of recreational divers treated for musculoskeletal DCS between 2004 and 2008 in three hyperbaric centres in the south of France using magnetic resonance imaging (MRI) following hyperbaric treatment. Twenty-five (11.5%) musculoskeletal DCS cases were identified amongst 288 diving accidents treated during this period. Average age was 38 years with a mean body mass index of 26 kg/square m. Joint pains were located in the shoulder area in 21 divers, mainly in experienced male divers after performing repetitive long, deep dives with adequate decompression using dive...
Presse médicale (Paris, France : 1983)
The outcome of spinal cord decompression sickness after scuba diving is unpredictable during the ... more The outcome of spinal cord decompression sickness after scuba diving is unpredictable during the 24 first hours with a high risk of incomplete recovery. The treatment is defined on first aid normobaric oxygen when neurological symptoms occur, rehydration and prompt recompression in hyperbaric chamber. The presence of initial motor impairment, the aggravation of symptoms during the transfer to the hyperbaric facility and the emergence of sphincter dysfunction are predictive of poor prognosis whatever the treatment undertaken.