Publications by authors named "Mathieu Coulange"

28 Publications

  • Page 1 of 1

Middle-ear barotrauma after hyperbaric oxygen therapy: a five-year retrospective analysis on 2,610 patients.

Undersea Hyperb Med 2020 Second Quarter;47(2):217-228

Hyperbaric Medicine Centre, Pôle RUSH, Sainte-Marguerite Hospital, Marseille, France.

Introduction: Hyperbaric oxygen (HBO2) therapy is the use of oxygen or gas mixtures at a pressure above atmospheric pressure for therapeutic purposes. This treatment is used in numerous pathological processes. Its main side effect is middle ear barotrauma (MEB), which represents a great concern for iatrogenic HBO2 therapy. The aim of this work is to describe this adverse event in order to highlight clinical elements that can contribute to its prevention and management.

Methods: We conducted a five-year retrospective study from January 2013 to December 2017, where 2,610 patients were selected, in the Hyperbaric Medicine Centre, Sainte- Marguerite Hospital of Marseille, France.

Results: 262 patients experienced MEB after HBO2, representing a prevalence of 10.04% and incidence of 0.587%. Their average age was 55 ± 19 years. Women were more affected than men. We have not highlighted a seasonality to this condition. Risk factors were: age older than 55 years, female gender, ear, nose and throat history (cancer, radiotherapy, infections or allergies, malformations or benign tumors), general history (smoking, obstructive breathing disorders, thyroid disorders and obesity), HBO2-approved indications of sudden deafness and delayed wound healing, and altered tympanic mobility on initial examination. Although the benign stages of Haines-Harris classification were the most encountered in our study, MEB was responsible for premature discontinuation of HBO2.

Conclusion: MEB is a common condition responsible for many premature discontinuations of HBO2. Its origin is multifactorial, associating non-modifiable and modifiable factors. Better management of this affection will further contribute to making HBO2 a low-risk treatment.
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January 2021

Drowning Classification: A Reappraisal of Clinical Presentation and Prognosis for Severe Cases.

Chest 2020 08 14;158(2):596-602. Epub 2020 Feb 14.

Emergency Department, Timone University Hospital, Aix-Marseille University, Marseille, France.

Background: Drowning is still a major cause of accidental death worldwide. In 1997, Szpilman proposed a classification of drowning that has become the reference. As considerable efforts have been made to improve prevention and care, it seemed appropriate to reassess the prognosis and clinical presentation of drowning patients more than 20 years after this first publication. The aim of this study is to provide a reappraisal of patients who need advanced health care and a precise description of their respective neurologic, respiratory, and hemodynamic profiles.

Methods: This retrospective study was conducted over four consecutive summer periods between 2014 and 2017 in ICUs located in France, French Polynesia, and the French Antilles. Patients were classified according to the drowning classification system proposed by Szpilman.

Results: During the study period, 312 drowning patients were admitted with severe clinical presentation (grades 2-6). All patients benefited from rapid extraction from the water (< 10 min for all) and specialized care (emergency medical services), starting from the prehospital period. Although the global hospital mortality was similar to that previously reported (18.5%), great differences existed among the severity grades. Respective grade mortalities were low for grades 2 through 5 (grade 2, 0%; grade 3, 3%; grade 4, 0%; grade 5, 2%), and the mortality for grade 6 remained similar to that previously reported (54%). These results confirmed that the occurrence of cardiac arrest after drowning is still bad prognosis. Conversely, for other grades, this study strengthens the importance of specialized intervention to interrupt the drowning process.

Conclusions: On the basis of these results, drowning-related cardiac arrest is still the prognosis cornerstone. For other victims, the prognosis was better than previously expected, which strengthens the importance of specialized intervention to interrupt the drowning process.
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http://dx.doi.org/10.1016/j.chest.2020.01.035DOI Listing
August 2020

Physiological stress markers during breath-hold diving and SCUBA diving.

Physiol Rep 2019 03;7(6):e14033

C2VN, INSERM, INRA, Aix-Marseille Université (AMU), Marseille, France.

This study investigated the sources of physiological stress in diving by comparing SCUBA dives (stressors: hydrostatic pressure, cold, and hyperoxia), apneic dives (hydrostatic pressure, cold, physical activity, hypoxia), and dry static apnea (hypoxia only). We hypothesized that despite the hypoxia induces by a long static apnea, it would be less stressful than SCUBA dive or apneic dives since the latter combined high pressure, physical activity, and cold exposure. Blood samples were collected from 12SCUBA and 12 apnea divers before and after dives. On a different occasion, samples were collected from the apneic group before and after a maximal static dry apnea. We measured changes in levels of the stress hormones cortisol and copeptin in each situation. To identify localized effects of the stress, we measured levels of the cardiac injury markers troponin (cTnI) and brain natriuretic peptide (BNP), the muscular stress markers myoglobin and lactate), and the hypoxemia marker ischemia-modified albumin (IMA). Copeptin, cortisol, and IMA levels increased for the apneic dive and the static dry apnea, whereas they decreased for the SCUBA dive. Troponin, BNP, and myoglobin levels increased for the apneic dive, but were unchanged for the SCUBA dive and the static dry apnea. We conclude that hypoxia induced by apnea is the dominant trigger for the release of stress hormones and cardiac injury markers, whereas cold or and hyperbaric exposures play a minor role. These results indicate that subjects should be screened carefully for pre-existing cardiac diseases before undertaking significant apneic maneuvers.
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http://dx.doi.org/10.14814/phy2.14033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434169PMC
March 2019

Massive portal venous gas embolism after scuba diving.

Diving Hyperb Med 2019 Mar;49(1):61-63

Department of Hyperbaric Medicine, Sainte-Marguerite Hospital, APHM, Marseille, France.

Introduction: Portal venous gas from a diving injury is an infrequent finding and only a few cases are described. We report a case of severe decompression sickness (DCS) associated with a massive amount of gas in the portal and mesenteric veins.

Case Report: A 49-year-old man suffered from DCS after two deep dives on the same day. He presented with cutaneous, neurological and pulmonary symptoms associated with hypoxaemia. He had no abdominal pain. A computed tomography (CT) scan showed large quantities of hepatic and portal venous gas and excluded other explanations for its presence. All symptoms disappeared with hyperbaric oxygen therapy and there were no further complications.

Discussion And Conclusion: The role of portal venous gas in DCS is not obvious. Isolated portal venous gas seems to cause no obvious harm. Medical imaging should be considered for differential diagnosis and to prevent some complications, especially in divers presenting with abdominal pain.
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http://dx.doi.org/10.28920/dhm49.1.61-63DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526053PMC
March 2019

Troponins in scuba divers with immersion pulmonary edema.

Biosci Rep 2018 10 28;38(5). Epub 2018 Sep 28.

Diving and Hyperbaric Center, Geneva University Hospital, Centre for Cardiovascular Disease and Nutrition, Bvd J Moulin, Marseille 13005, France.

Immersion pulmonary edema (IPE) is a serious complication of water immersion during scuba diving. Myocardial ischemia can occur during IPE that worsens outcome. Because myocardial injury impacts the therapeutic management, we aim to evaluate the profile of cardiac markers (creatine phosphokinase (CPK), brain natriuretic peptide (BNP), highly sensitive troponin T (TnT-hs) and ultrasensitive troponin I (TnI-us) of divers with IPE. Twelve male scuba divers admitted for suspected IPE were included. The collection of blood samples was performed at hospital entrance (T0) and 6 h later (T0 + 6 h). Diagnosis was confirmed by echocardiography or computed-tomography scan. Mean ± S.D. BNP (pg/ml) was 348 ± 324 at T0 and 223 ± 177 at T0 + 6 h (<0.01), while mean CPK (international units (IUs)), and mean TnT-hs (pg/ml) increased in the same times 238 ± 200 compared with 545 ± 39, (=0.008) and 128 ± 42 compared with 269 ± 210, (=0.01), respectively; no significant change was observed concerning TnI-us (pg/ml): 110 ± 34 compared with 330 ± 77, =0.12. At T0 + 6 h, three patients had high TnI-us, while six patients had high TnT-hs. Mean CPK was correlated with TnT-hs but not with TnI-us. Coronary angiographies were normal. The increase in TnT during IPE may be secondary to the release of troponin from non-cardiac origin. The measurement of TnI in place of TnT permits in some cases to avoid additional examinations, especially unnecessary invasive investigations.
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http://dx.doi.org/10.1042/BSR20181024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165839PMC
October 2018

Drowning in fresh or salt water: respective influence on respiratory function in a matched cohort study.

Eur J Emerg Med 2019 Oct;26(5):340-344

Emergency Department, Timone University Hospital.

Introduction: For the most severe drowned patients, hypoxemia represents one of the major symptoms. As the influence of the type of water (fresh or salt water) on respiratory function is still unclear, the primary endpoint of this multicenter study was to compare hypoxemia according to the type of water.

Methods: Medical records of adult patients who experienced a drowning event and were consequently admitted to 10 ICU for acute respiratory failure were analyzed retrospectively using data collected over three consecutive summer periods. From an initial cohort of acute respiratory failure drowned patients, patients were matched by age, sex, Glasgow Coma Scale, and occurrence of cardiac arrest (yes or no).

Results: Among an initial cohort of 242 patients, 38 pairs were matched correctly. At the initial assessment, carried out upon ICU admission, hypoxemia was found to be deeper in the fresh water group (PaO2/FiO2: 141 ± 76 vs. 220 ± 122, P < 0.05). However, there was no significant difference in tissue oxygenation (assessed by blood lactate level) between groups. In terms of biology results, sodium levels were higher in the salt water group in the initial assessment (144 ± 6.8 vs. 140 ±5.2 mmol/l, P = 0.004), but no difference was observed later. No difference was recorded in the outcome or length of stay in ICU between groups.

Conclusion: Drowning in fresh water was associated with deeper hypoxemia in the initial assessment. Despite this initial difference, latter respiratory and biological parameters or outcome were similar in both groups.
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http://dx.doi.org/10.1097/MEJ.0000000000000564DOI Listing
October 2019

Recreational Diving Practice for Stress Management: An Exploratory Trial.

Front Psychol 2017 18;8:2193. Epub 2017 Dec 18.

Ecole du Val de Grâce, Paris, France.

Within the components of Scuba diving there are similarities with meditation and mindfulness techniques by training divers to be in a state of open monitoring associated with slow and ample breathing. Perceived stress is known to be diminished during meditation practice. This study evaluates the benefits of scuba diving on perceived stress and mindful functioning. A recreational diving group (RDG; = 37) was compared with a multisport control group (MCG; = 30) on perceived stress, mood, well-being and mindfulness by answering auto-questionnaires before and after a 1-week long UCPA course. For the diving group, stability of the effects was evaluated 1 month later using similar auto-questionnaires. Perceived stress did not decrease after the course for the MCG [ The divers showed a significant reduction on the perceived stress score ( < 0.05) with a sustainable effect ( = 0.01)]. An improvement in mood scale was observed in both groups. This was associated to an increase in mindfulness abilities. The practice of a recreational sport improves the mood of subjects reporting the thymic benefits of a physical activity performed during a vacation period. The health benefits of recreational diving appear to be greater than the practice of other sports in reducing stress and improving well-being.
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http://dx.doi.org/10.3389/fpsyg.2017.02193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741699PMC
December 2017

Preparation and medical follow-up for a single-handed transatlantic rowing race.

Int Marit Health 2017 ;68(1):7-11

Emergency Department, Pasteur 2 University Hospital, Nice, France.

Background: A single-handed transatlantic rowing race was organised between Senegal and French Guyana (2600 nautical miles). During the race, rowers adjust their lifestyle to maintain an optimal level of performance. Nutrition, circadian rhythm disturbance, psychological state, pain and other medical problems impact on physical abilities and increase the occurrence of accidents. We surveyed the prevalence of medical complications during this race and the preparation that we could suggest for this kind of activity.

Materials And Methods: This is a descriptive, retrospective case series study. Follow-up consisted of sending out a questionnaire and performing individual interviews.

Results: A total of 23 participants including 1 woman and 22 men; mean age of 46.5 years (range: 35-59) entered the race. The race lasted for 39 to 52 days with participants rowing between 10 and 12 h/day. Nine participants dropped out. Energy intake was 4500 to 6000 kcal/day and fluid intake was 4 to 5.5 L/day. Mean weight loss was 13.3 kg. The resting period was 6 ± 1 h/24 h divided into 1.5 to 2 h periods essentially during darkness. A total of 92% of the racers required medical care for dermatological problems; other conditions requiring medical care were: tendinitis in 10 cases, diarrhoea in 4, moderate to severe seasickness in 4, hallucinations in 3, panic attacks in 2, burns in 2, and disembarkation syndrome ("land sickness") lasting from 45 min to 6 h in 13.

Conclusions: Physiological and psychological impact of this type of event is still unclear. The most common medical problems are dermatological, rheumatological complications and minor trauma. Medical and psychological preparation should be offered to candidates for these competitions.
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http://dx.doi.org/10.5603/IMH.2017.0002DOI Listing
September 2017

Anti-infective therapy without antimicrobials: Apparent successful treatment of multidrug resistant osteomyelitis with hyperbaric oxygen therapy.

IDCases 2016 28;6:60-64. Epub 2016 Sep 28.

Service Des Maladies Infectieuses, Centre Hospitalo-Universitaire de la Conception, 147 boulevard Baille, 13005 Marseille, France; Centre Interrégional de Référence des Infections Ostéo-articulaires Méditerranée Sud, 147 boulevard Baille, 13005 Marseille, France; Aix-Marseille Université, URMITE, CNRS UMR 6236, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053032PMC
http://dx.doi.org/10.1016/j.idcr.2016.09.008DOI Listing
September 2016

Pathophysiological and diagnostic implications of cardiac biomarkers and antidiuretic hormone release in distinguishing immersion pulmonary edema from decompression sickness.

Medicine (Baltimore) 2016 Jun;95(26):e4060

aDepartment of Hyperbaric Medicine, Sainte-Anne Hospital, Toulon bDepartment of Hyperbaric Medicine, Sainte-Marguerite Hospital, Marseille cUMR MD2, Aix-Marseille University and Institute of Biological Research of the Army dLaboratory of Biochemistry, Timone University Hospital, Marseille eSchool of Biological Sciences, University of Reading, United Kingdom fInstitut des Sciences Biologiques, CNRS, France.

Immersion pulmonary edema (IPE) is a misdiagnosed environmental illness caused by water immersion, cold, and exertion. IPE occurs typically during SCUBA diving, snorkeling, and swimming. IPE is sometimes associated with myocardial injury and/or loss of consciousness in water, which may be fatal. IPE is thought to involve hemodynamic and cardiovascular disturbances, but its pathophysiology remains largely unclear, which makes IPE prevention difficult. This observational study aimed to document IPE pathogenesis and improve diagnostic reliability, including distinguishing in some conditions IPE from decompression sickness (DCS), another diving-related disorder.Thirty-one patients (19 IPE, 12 DCS) treated at the Hyperbaric Medicine Department (Ste-Anne hospital, Toulon, France; July 2013-June 2014) were recruited into the study. Ten healthy divers were recruited as controls. We tested: (i) copeptin, a surrogate marker for antidiuretic hormone and a stress marker; (ii) ischemia-modified albumin, an ischemia/hypoxia marker; (iii) brain-natriuretic peptide (BNP), a marker of heart failure, and (iv) ultrasensitive-cardiac troponin-I (cTnI), a marker of myocardial ischemia.We found that copeptin and cardiac biomarkers were higher in IPE versus DCS and controls: (i) copeptin: 68% of IPE patients had a high level versus 25% of DCS patients (P < 0.05) (mean ± standard-deviation: IPE: 53 ± 61 pmol/L; DCS: 15 ± 17; controls: 6 ± 3; IPE versus DCS or controls: P < 0.05); (ii) ischemia-modified albumin: 68% of IPE patients had a high level versus 16% of DCS patients (P < 0.05) (IPE: 123 ± 25 arbitrary-units; DCS: 84 ± 25; controls: 94 ± 7; IPE versus DCS or controls: P < 0.05); (iii) BNP: 53% of IPE patients had a high level, DCS patients having normal values (P < 0.05) (IPE: 383 ± 394 ng/L; DCS: 37 ± 28; controls: 19 ± 15; IPE versus DCS or controls: P < 0.01); (iv) cTnI: 63% of IPE patients had a high level, DCS patients having normal values (P < 0.05) (IPE: 0.66 ± 1.50 μg/L; DCS: 0.0061 ± 0.0040; controls: 0.0090 ± 0.01; IPE versus DCS or controls: P < 0.01). The combined "BNP-cTnI" levels provided most discrimination: all IPE patients, but none of the DCS patients, had elevated levels of either/both of these markers.We propose that antidiuretic hormone acts together with a myocardial ischemic process to promote IPE. Thus, monitoring of antidiuretic hormone and cardiac biomarkers can help to make a quick and reliable diagnosis of IPE.
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http://dx.doi.org/10.1097/MD.0000000000004060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937958PMC
June 2016

Saccharomyces cerevisiae osteomyelitis in an immunocompetent baker.

IDCases 2016 19;5:1-3. Epub 2016 May 19.

Centre de Référence des Infections Ostéo-Articulaires (CRIOA) Interrégional Sud-Méditerranée, Hôpital de la Conception, 147, boulevard Baille, Marseille, France; Service des Maladies Infectieuses, Hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France; Aix-Marseille Université, URMITE, UM 63, CNRS 7278-IRD 198, INSERM 1095, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille, France.

Invasive infection caused by Saccharomyces cerevisiae is rare. We report the first case of osteomyelitis caused by S. cerevisiae (baker's yeast) in a post-traumatic patient. The clinical outcome was favorable after surgical debridement, prolonged antifungal treatment and hyperbaric oxygen therapy.
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http://dx.doi.org/10.1016/j.idcr.2016.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909721PMC
June 2016

Ischaemia-modified albumin during experimental apnoea.

Can J Physiol Pharmacol 2015 Jun 6;93(6):421-6. Epub 2015 Feb 6.

UMR MD2, Aix Marseille Université and Institut de Recherche Biomédicale des Armées, Faculty de Medicine Nord, boulevard Pierre Dramard 13015 Marseille, France., Université de Toulon et du Var, avenue de l'Université, B.P. 20132-83957 La Garde Cedex, France.

Ischaemia-modified albumin (IMA) is a marker of the release of reactive oxygen species (ROS) during hypoxaemia. In elite divers, breath-hold induces ROS production. Our aim was to evaluate the kinetics of IMA serum levels during apnea. Twenty breath-hold divers were instructed to perform a submaximal static breath-hold. Twenty non-diver subjects served as controls. Blood samples were collected at rest, every minute, at the end of breath-hold, and 10 min after recovery. The IMA level increased after 1 min of breath-hold (p < 0.003) and remained high until recovery. Divers were separated into 2 groups: subjects who held their breath for less than 4 min (G-4) and those who held it for more than 4 min (G+4). After 3 min of apnoea, the increase of IMA was higher in the G-4 group than in the G+4 group (p < 0.008). However, at the end of apnoea, the IMA level did not differ between groups. If IMA level was globally correlated with the apnoea duration, it is interesting to note that the higher IMA level was not found in the best divers. Similarly, if arterial blood oxygen saturation (SpO2) was globally inversely correlated with apnoea duration, the lowest SpO2 at the end of breath-hold was not found in the divers that performed the best apnoea. We concluded that these divers save their oxygen. The IMA level provides a useful measure of resistance to hypoxaemia.
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http://dx.doi.org/10.1139/cjpp-2014-0538DOI Listing
June 2015

Glossopharyngeal insufflation and breath-hold diving: the more, the worse?

Wilderness Environ Med 2014 Dec 14;25(4):466-71. Epub 2014 Oct 14.

UMR-MD2, French Armed Biomedical Research Institute, IRBA, Brétigny sur Orge, and Aix-Marseille University, Marseille, France (Drs Boussuges, Bessereau, Coulange, and Rossi); Internal Medicine Department, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France (Dr Rossi).

Objective: The glossopharyngeal insufflation maneuver (lung packing) is largely performed by competitive breath-hold divers to improve their performance, despite observational evidence of fainting and loss of consciousness in the first seconds of apnea.

Methods: We describe here the time course of hemodynamic changes, induced by breath-holding with and without lung packing, in 2 world-class apnea competitors.

Results: When compared with apnea performed after a deep breath (100% vital capacity), lung packing leads to a decrease in cardiac output, blood pressure, and cerebral blood flow during the first seconds after the beginning of apnea. The major hemodynamic disorders were observed in diver 1, who exhibited the greater increase in pulmonary volume after lung packing (+22% for diver 1 vs +10% for diver 2). After the initial drop in both cardiac output and blood pressure, the time course of hemodynamic alterations became quite similar between the two apneas.

Conclusions: Some recommendations, such as limiting the number of maneuvers and performing lung packing in the supine position, should be expressed to avoid injuries secondary to the use of glossopharyngeal insufflation.
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http://dx.doi.org/10.1016/j.wem.2014.04.010DOI Listing
December 2014

Postmortem CT appearance of gas collections in fatal diving accidents.

AJR Am J Roentgenol 2014 Sep;203(3):468-75

1 Laboratoire d'Imagerie Interventionnelle Expérimentale, Aix-Marseille Université, 27 Blvd Jean Moulin, 13385 Marseille cedex 5, France.

OBJECTIVE. The purpose of our study was to define the postmortem CT semiology of gas collections linked to putrefaction, postmortem "off-gassing," and decompression illness after fatal diving accidents and to establish postmortem CT diagnostic criteria to distinguish the different causes of death in diving. SUBJECTS AND METHODS. A 4-year prospective study was conducted including cases of death during diving. A hyperbaric physician analyzed the circumstances of death and the dive profile, and an autopsy was performed. Subjects were divided into three groups according to the analysis from their dive profile: decompression illness, death after decompression dive without decompression illness, and death after nondecompression dive without decompression illness. Full-body postmortem CT was performed before autopsy. RESULTS. The presence of intraarterial gas associated with death by decompression illness had a negative predictive value (NPV) of 100%, but the positive predictive value (PPV) was only 54% because of postmortem off-gassing. The PPV reached 70% when considering pneumatization of the supraaortic trunks. Pneumothorax, subcutaneous emphysema, and intraarterial gas, all of which are classic criteria for decompression illness diagnosis, are not specific for decompression illness. CONCLUSION. This study is the first to show that pneumothorax, subcutaneous emphysema, and intraarterial gas, all of which are classic criteria for decompression illness diagnosis, are not specific for decompression illness. Complete pneumatization of supraaortic trunks is the best postmortem CT criteria to detect a fatal decompression illness when CT is performed within 24 hours after death.
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http://dx.doi.org/10.2214/AJR.13.12063DOI Listing
September 2014

Purinergic profile of fainting divers is different from patients with vasovagal syncope.

Int J Cardiol 2014 Jul 24;174(3):741-3. Epub 2014 Apr 24.

UMR MD2, AMU, Faculty of Medicine, Marseille, France; IRBA, France; Laboratory of Biochemistry, Timone University Hospital, AP-HM, France. Electronic address:

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http://dx.doi.org/10.1016/j.ijcard.2014.04.090DOI Listing
July 2014

Pelvic radiation disease management by hyperbaric oxygen therapy: prospective study of 44 patients.

Gastroenterol Res Pract 2014 27;2014:108073. Epub 2014 Jan 27.

Aix-Marseille University, UMR 911, Campus Santé Timone, 13005 Marseille, France ; Hyperbaric Medicine, Sainte Marguerite Hospital, Aix-Marseille University, UMR MD2, 13385 Marseille, France.

Pelvic radiation disease (PRD) occurs in 2-11% of patients undergoing pelvic radiation for urologic and gynecologic malignancies. Hyperbaric oxygen therapy (HBOT) has previously been described as a noninvasive therapeutic option for the treatment of PRD. the purpose of study was to analyze prospectively the results of HBOT in 44 consecutive patients with PRD who were resistant to conventional oral or topical treatments. Material and Methods. The median age of the cohort was 65.7 years (39-85). Twenty-seven percent of patients required blood transfusion (n = 12). The median of delay between radiotherapy and HBOT was 26 months (3-175). We evaluated the results of HBOT, using SOMA-LENT Scale. Results. SOMA-LENT score was decreased in 59% of patient. The median of SOMA-LENT score before HBOT was significantly higher, being equal to 14 (0-36), than after HBOT with the SOMA-LENT score of 12 (0-38) (P = 0.003). Tenesmus (P = 0.02), bleeding (P = 0.0001), and ulceration (P = 0.001) significantly decreased after HBOT. Regarding patients with colostomy, 33% (n = 4) benefited from colostomies closure. HBOT was generally well tolerated. Only one patient stopped precociously due to transient myopia. Conclusion. This study is in favor of the interest of HBOT in pelvic radiation disease treatment (PRD).
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http://dx.doi.org/10.1155/2014/108073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922018PMC
March 2014

Evaluation of transport ventilators at mild simulated altitude: a bench study in a hypobaric chamber.

Respir Care 2014 Aug;59(8):1233-41

Background: Previous studies on ventilators used for air transport showed significant effects of altitude, in particular with regard to accuracy of the tidal volume (VT) and breathing frequency. The aim of the study was to evaluate transport ventilators under hypobaric conditions.

Methods: We conducted a bench study of 6 transport ventilators in a Comex hypobaric chamber to simulate mild altitude (1,500 m [4,920 feet] and 2,500 m [8,200 feet]). The ventilators were connected to a test lung to evaluate their accuracy: (1) to deliver a set VT under normal resistance and compliance conditions at F(IO2) = 0.6 and 1, (2) to establish a set PEEP (0, 5, 10, and 15 cm H2O), and (3) to establish a set inspiratory pressure in pressure controlled mode, (4) at a F(IO2) setting, and (5) and at a frequency setting.

Results: Four ventilators kept an average relative error in VT of < 10% without effect of altitude. The Medumat ventilator was affected by the altitude only at F(IO2) = 1. The Osiris 3 ventilator had > 40% error even at 1,500 m. We found no change in frequency as a function of altitude for any ventilators studied. No clinically important differences were found between all altitudes with the PEEP or inspiratory pressure setting. Although F(IO2) was affected by altitude, the average error did not exceed 11%, and it is unclear whether this fact is an experimental artifact.

Conclusions: We have shown that most of the new transport ventilators tested require no setting adjustment at moderate altitude and are as safe at altitude as at sea level under normal respiratory conditions. Older technologies still deliver more volume with altitude in volumetric mode.
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http://dx.doi.org/10.4187/respcare.02985DOI Listing
August 2014

Appearance of gas collections after scuba diving death: a computed tomography study in a porcine model.

Int J Legal Med 2013 Jan 30;127(1):177-84. Epub 2011 Dec 30.

Aix-Marseille Université, Faculté de Médecine, Laboratoire de Physiopathologie et Thérapeutique Vasculaire (L2PTV), Marseille, France.

Introduction: Postmortem computed tomography can easily demonstrate gas collections after diving accidents. Thus, it is often used to support the diagnosis of air embolism secondary to barotrauma. However, many other phenomenons (putrefaction, resuscitation maneuvers, and postmortem tissue offgassing) can also cause postmortem gas effusions and lead to a wrong diagnosis of barotrauma.

Objectives: The aim of this study is to determine topography and time of onset of postmortem gas collections respectively due to putrefaction, resuscitation maneuvers, and tissue offgassing.

Materials And Methods: A controlled experimental study was conducted on nine pigs. Three groups of three pigs were studied postmortem by CT from H0 to H24: one control group of nonresuscitated nondivers, one group of divers exposed premortem to an absolute maximal pressure of 5 b for 16 min followed by decompression procedures, and one group of nondivers resuscitated by manual ventilation and thoracic compression for 20 min. The study of intravascular gas was conducted using CT scan and correlated with the results of the autopsy.

Results: The CT scan reveals that, starting 3 h after death, a substantial amount of gas is observed in the venous and arterial systems in the group of divers. Arterial gas appears 24 h after death for the resuscitated group and is absent for the first 24 h for the control group. Concerning the putrefaction gas, this provokes intravenous and portal gas collections starting 6 h after death. Subcutaneous emphysema was observed in two of the three animals from the resuscitated group, corresponding to the thoracic compression areas.

Conclusion: In fatal scuba diving accidents, offgassing appears early (starting from the first hour after death) in the venous system then spreads to the arterial system after about 3 h. The presence of intra-arterial gas is therefore not specific to barotrauma. To affirm a death by barotrauma followed by a gas embolism, a postmortem scanner should be conducted very early. Subcutaneous emphysema should not be mistaken as diagnostic criteria of barotrauma because it can be caused by the resuscitation maneuvers.
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http://dx.doi.org/10.1007/s00414-011-0662-6DOI Listing
January 2013

Acute coronary syndrome and cerebral arterial gas embolism in a scuba diver.

J Cardiol Cases 2011 Feb 14;3(1):e22-e25. Epub 2010 Dec 14.

Centre de Médecine Hyperbare, Pôle RUSH, CHU Sainte Marguerite, Marseille, France.

Background: Pulmonary barotrauma is a rare but feared complication of scuba diving, with around 30% mortality.

Objective: We report an uncommon case of pulmonary barotrauma complicated by arterial gas embolism with both coronary and neurological ischemic injuries after scuba diving.

Case Report: A 46-year-old-man was admitted to our hospital for acute coronary syndrome and stroke following a scuba dive. After hyperbaric oxygen therapy, the patient recovered fully with a subsequent normal coronary angiogram.

Conclusion: Myocardial ischemia can be a complication of scuba diving, but does not always reveal significant obstructive coronary artery disease.
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http://dx.doi.org/10.1016/j.jccase.2010.10.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265155PMC
February 2011

Scuba diving and portal vein thrombosis: a case report.

Clin J Sport Med 2010 Nov;20(6):497-9

Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.

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http://dx.doi.org/10.1097/JSM.0b013e3181fab19dDOI Listing
November 2010

Hyperoxia-induced alterations in cardiovascular function and autonomic control during return to normoxic breathing.

Eur J Appl Physiol 2011 Jun 11;111(6):937-46. Epub 2010 Nov 11.

Département des Environnements Opérationnels-Environnements Extrêmes, Institut de Recherche Biomédicale des Armées (IRBA)-Antenne Toulon, Boulevard Sainte Anne BP 20548, 83041 Toulon Cedex 9, France.

Hyperoxia causes hemodynamic alterations. We hypothesized that cardiovascular and autonomic control changes last beyond the end of hyperoxic period into normoxia. Ten healthy volunteers were randomized to breathe either medical air or 100% oxygen for 45 min in a double-blind study design. Measurements were performed before (baseline) and during gas exposure, and then 10, 30, 60, and 90 min after gas exposure. Hemodynamic changes were studied by Doppler echocardiography. Changes in cardiac and vasomotor autonomic control were evaluated through changes in spectral power of heart rate variability and blood pressure variability. Cardiac baroreflex sensitivity was assessed by the sequence method. Hyperoxia significantly decreased heart rate and increased the high frequency power of heart rate variability, suggesting a chemoreflex increase in vagal activity since the slope of cardiac baroreflex was significantly decreased during hyperoxia. Hyperoxia increased significantly the systemic vascular resistances and decreased the low frequency power of blood pressure variability, suggesting that hyperoxic vasoconstriction was not supported by an increase in vascular sympathetic stimulation. These changes lasted for 10 min after hyperoxia (p < 0.05). After the end of hyperoxic exposure, the shift of the power spectral distribution of heart rate variability toward a pattern of increased cardiac sympathetic activity lasted for 30 min (p < 0.05), reflecting a resuming of baseline autonomic balance. Cardiac output and stroke volume were significantly decreased during hyperoxia and returned to baseline values (10 min) later than heart rate. In conclusion, hyperoxia effects continue during return to normoxic breathing, but cardiac and vascular parameters followed different time courses of recovery.
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http://dx.doi.org/10.1007/s00421-010-1711-4DOI Listing
June 2011

Middle-ear barotrauma after hyperbaric oxygen therapy.

Undersea Hyperb Med 2010 Jul-Aug;37(4):203-8

Hyperbaric Medicine Centre, Pôle RUSH, Sainte-Marguerite Hospital, Marseille, France.

Background: Middle-ear barotrauma (MEB) is one of the most common side effects of hyperbaric oxygen therapy (HBO2). The incidence of MEB has been shown to vary between treatment centers and patients. This study was aimed to determine which patients are at high risk of MEB.

Materials And Methods: Prospective study including all the patients treated in a multiplace HBO2 chamber between January and December 2005. Scoring of MEB before and after HBO2 by otoscopy was performed using the Haines and Harris classification.

Results: We included 130 patients: 53 Males, 37.5 +/- 20.5 years old; 76% were treated for CO poisoning, 11% for iatrogenic gas embolism, 12% for decompression sickness and 4% for necrotizing soft tissue infection. 13% were intubated. MEB occurred in 13.6% of the patients (12.4% of the conscious and 24.4% of the intubated patients, p = 0.26). Risk factors for MEB were: repetitive treatments and difficulties with pressure equalization. There was no influence of age, sex or mechanical ventilation on the occurrence of MEB.

Conclusions: MEB induced by HBO2 occurred in 13.6% of the patients. There is no difference in incidence when comparing intubated and non-intubated patients. In non-comatose patients, difficulties with equalizing pressure were predictive of MEB.
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September 2010

Valsalva maneuver-induced ptosis during water sports activities.

Clin J Sport Med 2009 Jul;19(4):329-30

Service de Médecine Hyperbare, Pôle RUSH, Hôpital Sainte Marguerite, Marseille, France.

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http://dx.doi.org/10.1097/JSM.0b013e3181aad8c5DOI Listing
July 2009

[Aspirin in decompression sickness].

Therapie 2008 Nov-Dec;63(6):419-23. Epub 2009 Feb 24.

Pôle RUSH, Assistance Publique des Hôpitaux de Marseille, Marseille, France.

Objective: We have performed a survey on the use of aspirin in decompression sickness (DCS) treatment in French hyperbaric centers'. We also conducted a review of literature to determine if aspirin was beneficial to treat human victims of DCS.

Methods: Prospective observational study investigating French hyperbaric centers' prescription of aspirin to DCS' divers victims. The question we asked by mail or phone to French hyperbaric centers was: Do you give some aspirin to a diver with DCS if this treatment has not been given yet (on the site of accident).

Results: A large majority of French hyperbaric centers (77.5%) consider aspirin in DCS treatment. However this practice is not consensual. There is no evidence from the literature to support the efficiency of aspirin in DCS.

Conclusions: Although aspirin is widely used for DCS treatment in France, more research is needed to determine if aspirin is useful.
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http://dx.doi.org/10.2515/therapie/2008067DOI Listing
May 2009

Consequences of prolonged total thermoneutral immersion on muscle performance and EMG activity.

Pflugers Arch 2008 Feb 2;455(5):903-11. Epub 2007 Oct 2.

Laboratoire de Physiopathologie Respiratoire (EA 2201), Institut Jean Roche, Faculté de Médecine, Université de la Méditerranée, Bd. Pierre Dramard, 13920, Cedex 20 Marseille, France.

We hypothesized that the changes in muscle temperature and interstitial pressure during thermoneutral immersion may affect the reflex adaptation of the motor drive during static contraction, assessed by the decrease in median frequency (MF) of electromyogram (EMG) power spectrum. Ten subjects were totally immersed for 6 h at 35 degrees C and repeated maximal voluntary contraction (MVC) and submaximal (60% MVC) leg extensions sustained until exhaustion. In vastus lateralis (VL) and soleus (SOL) muscles, the compound muscle potential evoked by muscle stimulation with single shocks (M-wave) was recorded at rest, and MF of surface EMG was calculated during 60% MVCs. We measured lactic acid and potassium venous blood concentrations and calculated plasma volume changes. Data were compared to those obtained in the same individuals exercising at 35 degrees C under dry conditions where the MF decrease during 60% MVCs was modest (-4 to-5%). During immersion, the rectal temperature remained stable, but the thigh and calf surface temperatures significantly increased. Lactic acid and potassium concentrations did not vary, but plasma volume decreased from the 180th min of immersion. The M-wave did not vary in VL but was prolonged in SOL from the 30th min of immersion. From the 220th min of immersion, the maximal MF decrease was majored in both muscles (-18 to -22%). Thus, compared to the dry condition, total body thermoneutral immersion enhances fatigue-induced EMG changes in leg muscles, perhaps through the activation of warm-sensitive muscle endings and/or the changes in interstitial pressure because of vasodilatation.
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http://dx.doi.org/10.1007/s00424-007-0335-yDOI Listing
February 2008

Consequences of prolonged total body immersion in cold water on muscle performance and EMG activity.

Pflugers Arch 2006 Apr 19;452(1):91-101. Epub 2005 Nov 19.

Laboratoire de Physiopathologie Respiratoire (EA 2201), Institut Jean Roche, Faculté de Médecine, Université de la Méditerranée, Marseilles, France.

The consequences of a prolonged total body immersion in cold water on the muscle function have not been documented yet, and they are the object of this French Navy research program. Ten elite divers were totally immerged and stayed immobile during 6 h in cold (18 and 10 degrees C) water. We measured the maximal voluntary leg extension (maximal voluntary contraction, MVC) and evoked compound muscle potential (M wave) in vastus lateralis and soleus muscles at rest, after a submaximal (60% MVC) isometric extension allowing the measurement of the endurance time (Tlim). The power spectrum of surface electromyograms (EMG) was computed during 60% MVCs. MVCs and 60% MVC maneuvers were repeated four times during the immersion. Data were compared with those obtained in a control group studied in dry air condition during a 6-h session. Total body cooling did not affect MVC nor Tlim. The M wave duration increased in the coolest muscle (soleus), but only at 10 degrees C at rest. There were no further fatigue-induced M wave alterations in both muscles. During 60% the MVCs, a time-dependant increase in the leftward shift of the EMG spectrum occurred at the two temperatures. These EMG changes were absent in the control group of subjects studied in dry air. The plasma lactate concentration was elevated throughout the 18 and mostly the 10 degrees C immersion conditions. Throughout the 18 degrees C immersion study, the resting potassium level did not significantly vary, whereas at 10 degrees C, a significant potassium increase occurred soon and persisted throughout the study. Thus, total body immersion in cold water did not affect the global contractile properties of leg muscles during static efforts but elicited significant alterations in electromyographic events which may be related to the variations of interstitial fluid composition.
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http://dx.doi.org/10.1007/s00424-005-0013-xDOI Listing
April 2006