RESUMEN
BACKGROUND: Symptoms of neurological decompression incidents (DCS/AGE) can be severe or mild. It is unknown if these differences of symptom presentation represent different clinical entities or if they represent just the spectrum of DCS/AGE. METHODS: 267 cases with DCS/AGE were compared retrospectively and classified into two subgroups, the Type A-DCS/AGE for cases with a severe and often stroke-like symptomatology and the Type B-DCS/AGE for those with milder and sometimes even doubtful neurological symptoms. The main outcome measures were the number of hyperbaric treatments (HTs) needed and the clinical outcome. RESULTS: 42 patients with DCS/AGE were classified as Type A- and 225 patients met the criteria for a Type B-DCS/AGE. Patients with Type A-lesions were more severely affected, needed more hyperbaric treatments and had a less favorable outcome than patients with the Type B-variant. CONCLUSIONS: The Type A- and the Type B-DCS/AGE are likely to be different entities with better clinical outcome in the Type B-variant and possibly significant differences in the underlying pathophysiologies of both variants. Future studies with a particular focus on the up to now inadequately investigated Type B-DCS/AGE are necessary to elucidate such differences in the pathophysiology.
Asunto(s)
Enfermedad de Descompresión/clasificación , Buceo/efectos adversos , Embolia Aérea/clasificación , Síndrome Neurológico de Alta Presión/diagnóstico , Adulto , Enfermedad de Descompresión/diagnóstico , Enfermedad de Descompresión/terapia , Diagnóstico Diferencial , Embolia Aérea/diagnóstico , Embolia Aérea/terapia , Femenino , Síndrome Neurológico de Alta Presión/terapia , Humanos , Oxigenoterapia Hiperbárica/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
BACKGROUND: Hyperbaric oxygen can cause central nervous system (CNS) toxicity with seizures. We tested the hypothesis that CNS toxicity could be predictable by cerebral blood flow velocity (CBFV) monitoring. METHOD: We monitored 369 mandatory oxygen tolerance tests (30 min, 280 kPa O(2)) by video-documentation and since May 2005 by additional CBFV registration (n = 61). RESULTS: The onset of early manifestations of CNS toxicity was documented in 11 of 369 tests within 22 +/- 3 min. These included twitches and/or agitation, 6 of 11 and tonic-clonic seizures in 5 of 11 cases. In both cases with CBFV monitoring, an increase in CBFV preceded symptom onset, once followed by seizure, once without seizure after timely oxygen reduction. CONCLUSIONS: During exposure to 280 kPa oxygen at rest a constant delay of approximately 20 min precedes the onset of central nervous oxygen toxicity. An increase in CBFV may indicate the impending seizure.
Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Encéfalo/irrigación sanguínea , Encéfalo/efectos de los fármacos , Enfermedades del Sistema Nervioso Central/diagnóstico , Circulación Cerebrovascular/fisiología , Hiperoxia/fisiopatología , Adulto , Enfermedades del Sistema Nervioso Central/etiología , Electrocardiografía , Humanos , Oxigenoterapia Hiperbárica , Convulsiones/diagnóstico , Convulsiones/etiologíaRESUMEN
BACKGROUND: During May and June 1996, an outbreak of rubella occurred offshore aboard a ship of the German Navy. The outbreak spread among 330 crew members over a period of 9 weeks, ending 2 days after the ship's return. This is the first detailed epidemiological investigation of a rubella outbreak on a ship, describing temporal progression, clinical manifestations, immunization status and seroprevalence of the population exposed. PATIENTS AND METHODS: Outbreak investigation using a questionnaire, health records and rubella serology (hemagglutination inhibition (HI) test and EIA). RESULTS: Of the 330 crew members 298 (90%) participated in the investigation. The outbreak was continuous without a peak and ended abruptly after the ship's return. It resulted in 20 cases, 11 of which were clinically symptomatic. A total of 35 (12%) crew members were susceptible to rubella prior to the outbreak, resulting in an attack rate of 57%. The highest risk for infection was linked to accommodation aboard the ratings deck (chi(2)-test, p = 0.004) with most favorable conditions of transmission. Only 9% of the participating crew were able to provide complete proof of their immunization status. The positive predictive value of a past history of rubella for the presence of antibodies against rubella was 59%. CONCLUSION: The transmission of rubella that we describe aboard a ship was facilitated by the unusually close proximity of the crew and their insufficient immunity. Documentation of immunization was inadequate in this population.