The Effects of Rapid Decompression on Total Plasma Phospholipids and Selected Hematological Parameters in Dogs
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Urinary Problems in Decompression Sickness*
Paraplegia 23 (1985) 20-25 © 1985 International Medical Society of Paraplegia Urinary Problems in Decompression Sickness* Athanasios Dounis, M.D. and Dionisios Mitropoulos, M.D. The Naval Medical Hyperbaric Center) Piraeus Naval Hospital and Department of Urology) Athens Naval Hospital) Greece Summary The records of 25 patients with type II decompression sickness and urinary problems have been reviewed. Seventeen patients were professionals and 8 were above the age of 40. The disease appeared within the 1st hour of emergence from the water in 70% of the cases and within the first 4 hours in the remaining 30%. Nine patients were diagnosed as paraplegic and two as tetraplegic. All patients had urinary disturbances and 14 were on Foley-catheter drainage during the decompression while 11 were on intermittent catheterisation. Fifteen patients had improved urinary function after recompression) 8 had some difficulty) 2 underwent a sphincterotomy and one a transurethral prostatectomy. The low percentage of complete recovery was due to the delayed arrival at the decompression chamber. Key words: Diving; Decompression sickness; Urinary disturbances. Introduction Diving for sponge fishery is the main professional occupation of the young men in the South-East Aegean islands. Although the use of recompression has decreased the number of decompression sickness victims, patients with remaining neurological problems still present. During the last 20 years, although there is a decrease of the professional divers' accidents there is an increase of the number of patients with decompression sickness. This is due to the continuously increasing numbers of sport divers in Greece. In Greece, the field of underwater medicine is covered mainly by the Naval Medical Service. -
A Novel Lipid Screening Platform That Provides a Complete Solution for Lipidomics Research
A Novel Lipid Screening Platform that Provides a Complete Solution for Lipidomics Research The Lipidyzer™ Platform, powered by Metabolon® Baljit K Ubhi1, Alex Conner1, Eva Duchoslav3, Annie Evans1, Richard Robinson1, Paul RS Baker4 and Steve Watkins1 1SCIEX, CA, USA, 2Metabolon, USA, 3SCIEX, Ontario, Canada and 4SCIEX, MA, USA INTRODUCTION MATERIALS AND METHODS A major challenge in lipid analysis is the many isobaric Applying the kit for simplified sample extraction and preparation, interferences present in highly complex samples that confound a serum matrix was used following the protocols provided. A identification and accurate quantitation. This problem, coupled QTRAP® System with SelexION® DMS Technology (SCIEX) with complicated sample preparation techniques and data was used for targeted profiling of over a thousand lipid species analysis, highlights the need for a complete solution that from 13 different lipid classes (Figure 2) allowing for addresses these difficulties and provides a simplified method for comprehensive coverage. Two methods were used covering analysis. A novel lipidomics platform was developed that thirteen lipid classes using a flow injection analysis (FIA); one includes simplified sample preparation, automated methods, and injection with SelexION® Technology ON and another with the streamlined data processing techniques that enable facile, SelexION® Technology turned OFF. The lipid molecular species quantitative lipid analysis. Herein, serum samples were analyzed were measured using MRM and positive/negative switching. quantitatively using a unique internal standard labeling protocol, Positive ion mode detected the following lipid classes – a novel selectivity tool (differential mobility spectrometry; DMS) SM/DAG/CE/CER/TAG. Negative ion mode detected the and novel lipid data analysis software. -
Heat Stroke Heat Exhaustion
Environmental Injuries Co lin G. Ka ide, MD , FACEP, FAAEM, UHM Associate Professor of Emergency Medicine Board-Certified Specialist in Hyperbaric Medicine Specialist in Wound Care The Ohio State University Wexner Medical Center The Most Dangerous Drug Combination… Accidental Testosterone Hypothermia and Alcohol! The most likely victims… Photo: Ralf Roletschek 1 Definition of Blizzard Hypothermia of Subnormal T° when the body is unable to generate sufficient heat to sustain normal functions Core Temperature < 95°F 1979 (35°C) Most Important Temperatures Thermoregulation 95°F (35° C) Hyper/Goofy The body uses a Poikilothermic shell to maintain a Homeothermic core 90°F (32°C) Shivering Stops Maintains core T° w/in 1.8°F(1°C) 80°F (26. 5°C) Vfib, Coma Hypothalamus Skin 65°F (18°C) Asystole Constant T° 96.896.8-- 100.4° F 2 Thermoregulation The 2 most important factors Only 3 Causes! Shivering (10x increase) Decreased Heat Production Initiated by low skin temperature Increased Heat Loss Warming the skin can abolish Impaired Thermoregulation shivering! Peripheral vasoconstriction Sequesters heat Predisposing Predisposing Factors Factors Decreased Production Increased Loss –Endocrine problems Radiation Evaporation • Thyroid Conduction* • Adrenal Axis Convection** –Malnutrition *Depends on conducting material **Depends on wind velocity –Neuromuscular disease 3 Predisposing Systemic Responses CNS Factors T°< 90°F (34°C) Impaired Regulation Hyperactivity, excitability, recklessness CNS injury T°< 80°F (27°C) Hypothalamic injuries Loss of voluntary -
Environmental Injuries
Environmental Injuries Colin G. Kaide, MD, FACEP, FAAEM, UHM Associate Professor of Emergency Medicine Board-Certified Specialist in Hyperbaric Medicine Specialist in Wound Care The Ohio State University Wexner Medical Center 1 The Most Dangerous Drug Combination… Testosterone and Alcohol! The most likely victims… Photo: Ralf Roletschek Accidental Hypothermia 2 Blizzard of 1979 Definition of Hypothermia Subnormal T° when the body is unable to generate sufficient heat to sustain normal functions Core Temperature < 95°F (35°C) 3 Most Important Temperatures 95°F (35° C) Hyper/Goofy 90°F (32°C) Shivering Stops 80°F (26.5°C) Vfib, Coma 65°F(18F (18°C) AtlAsystole Thermoregulation The body uses a Poikilothermic shell to maintain a Homeothermic core Maintains core T° w/in 1.8°F(1°C) Hypothalamus Skin CttTConstant T° 96. 8- 100.4° F 4 Thermoregulation The 2 most important factors Shivering (10x increase) Initiated by low skin temperature Warming the skin can abolish shivering! Peripheral vasoconstriction Sequesters heat Only 3 Causes! Decreased Heat Production Increased Heat Loss Impaired Thermoregulation 5 Predisposing Factors Decreased Production –Endocrine problems • Thyroid • Adrenal Axis –Malnutrition –Neuromuscular disease Predisposing Factors Increased Loss RRditiadiation Evaporation Conduction* Convection** *DDdepends on cond dtitilucting material **Depends on wind velocity 6 Predisposing Factors Impaired Regulation CNS injury Hypothalamic injuries Peripheral Injury Atherosclerosis Neuropathy Interfering Agents Systemic Responses CNS -
Traveler Information
Traveler Information QUICK LINKS Marine Hazards—TRAVELER INFORMATION • Introduction • Risk • Hazards of the Beach • Animals that Bite or Wound • Animals that Envenomate • Animals that are Poisonous to Eat • General Prevention Strategies Traveler Information MARINE HAZARDS INTRODUCTION Coastal waters around the world can be dangerous. Swimming, diving, snorkeling, wading, fishing, and beachcombing can pose hazards for the unwary marine visitor. The seas contain animals and plants that can bite, wound, or deliver venom or toxin with fangs, barbs, spines, or stinging cells. Injuries from stony coral and sea urchins and stings from jellyfish, fire coral, and sea anemones are common. Drowning can be caused by tides, strong currents, or rip tides; shark attacks; envenomation (e.g., box jellyfish, cone snails, blue-ringed octopus); or overconsumption of alcohol. Eating some types of potentially toxic fish and seafood may increase risk for seafood poisoning. RISK Risk depends on the type and location of activity, as well as the time of year, winds, currents, water temperature, and the prevalence of dangerous marine animals nearby. In general, tropical seas (especially the western Pacific Ocean) are more dangerous than temperate seas for the risk of injury and envenomation, which are common among seaside vacationers, snorkelers, swimmers, and scuba divers. Jellyfish stings are most common in warm oceans during the warmer months. The reef and the sandy sea bottom conceal many creatures with poisonous spines. The highly dangerous blue-ringed octopus and cone shells are found in rocky pools along the shore. Sea anemones and sea urchins are widely dispersed. Sea snakes are highly venomous but rarely bite. -
Dysbarism - Barotrauma
DYSBARISM - BAROTRAUMA Introduction Dysbarism is the term given to medical complications of exposure to gases at higher than normal atmospheric pressure. It includes barotrauma, decompression illness and nitrogen narcosis. Barotrauma occurs as a consequence of excessive expansion or contraction of gas within enclosed body cavities. Barotrauma principally affects the: 1. Lungs (most importantly): Lung barotrauma may result in: ● Gas embolism ● Pneumomediastinum ● Pneumothorax. 2. Eyes 3. Middle / Inner ear 4. Sinuses 5. Teeth / mandible 6. GIT (rarely) Any illness that develops during or post div.ing must be considered to be diving- related until proven otherwise. Any patient with neurological symptoms in particular needs urgent referral to a specialist in hyperbaric medicine. See also separate document on Dysbarism - Decompression Illness (in Environmental folder). Terminology The term dysbarism encompasses: ● Decompression illness And ● Barotrauma And ● Nitrogen narcosis Decompression illness (DCI) includes: 1. Decompression sickness (DCS) (or in lay terms, the “bends”): ● Type I DCS: ♥ Involves the joints or skin only ● Type II DCS: ♥ Involves all other pain, neurological injury, vestibular and pulmonary symptoms. 2. Arterial gas embolism (AGE): ● Due to pulmonary barotrauma releasing air into the circulation. Epidemiology Diving is generally a safe undertaking. Serious decompression incidents occur approximately only in 1 in 10,000 dives. However, because of high participation rates, there are about 200 - 300 cases of significant decompression illness requiring treatment in Australia each year. It is estimated that 10 times this number of divers experience less severe illness after diving. Physics Boyle’s Law: The air pressure at sea level is 1 atmosphere absolute (ATA). Alternative units used for 1 ATA include: ● 101.3 kPa (SI units) ● 1.013 Bar ● 10 meters of sea water (MSW) ● 760 mm of mercury (mm Hg) ● 14.7 pounds per square inch (PSI) For every 10 meters a diver descends in seawater, the pressure increases by 1 ATA. -
Asphyxia Neonatorum
CLINICAL REVIEW Asphyxia Neonatorum Raul C. Banagale, MD, and Steven M. Donn, MD Ann Arbor, Michigan Various biochemical and structural changes affecting the newborn’s well being develop as a result of perinatal asphyxia. Central nervous system ab normalities are frequent complications with high mortality and morbidity. Cardiac compromise may lead to dysrhythmias and cardiogenic shock. Coagulopathy in the form of disseminated intravascular coagulation or mas sive pulmonary hemorrhage are potentially lethal complications. Necrotizing enterocolitis, acute renal failure, and endocrine problems affecting fluid elec trolyte balance are likely to occur. Even the adrenal glands and pancreas are vulnerable to perinatal oxygen deprivation. The best form of management appears to be anticipation, early identification, and prevention of potential obstetrical-neonatal problems. Every effort should be made to carry out ef fective resuscitation measures on the depressed infant at the time of delivery. erinatal asphyxia produces a wide diversity of in molecules brought into the alveoli inadequately com Pjury in the newborn. Severe birth asphyxia, evi pensate for the uptake by the blood, causing decreases denced by Apgar scores of three or less at one minute, in alveolar oxygen pressure (P02), arterial P02 (Pa02) develops not only in the preterm but also in the term and arterial oxygen saturation. Correspondingly, arte and post-term infant. The knowledge encompassing rial carbon dioxide pressure (PaC02) rises because the the causes, detection, diagnosis, and management of insufficient ventilation cannot expel the volume of the clinical entities resulting from perinatal oxygen carbon dioxide that is added to the alveoli by the pul deprivation has been further enriched by investigators monary capillary blood. -
Failure of Hypothermia As Treatment for Asphyxiated Newborn Rabbits R
Arch Dis Child: first published as 10.1136/adc.51.7.512 on 1 July 1976. Downloaded from Archives of Disease in Childhood, 1976, 51, 512. Failure of hypothermia as treatment for asphyxiated newborn rabbits R. K. OATES and DAVID HARVEY From the Institute of Obstetrics and Gynaecology, Queen Charlotte's Maternity Hospital, London Oates, R. K., and Harvey, D. (1976). Archives of Disease in Childhood, 51, 512. Failure of hypothermia as treatment for asphyxiated newborn rabbits. Cooling is known to prolong survival in newborn animals when used before the onset of asphyxia. It has therefore been advocated as a treatment for birth asphyxia in humans. Since it is not possible to cool a human baby before the onset of birth asphyxia, experiments were designed to test the effect of cooling after asphyxia had already started. Newborn rabbits were asphyxiated in 100% nitrogen and were cooled either quickly (drop of 1 °C in 45 s) or slowly (drop of 1°C in 2 min) at varying intervals after asphyxia had started. When compared with controls, there was an increase in survival only when fast cooling was used early in asphyxia. This fast rate of cooling is impossible to obtain in a human baby weighing from 30 to 60 times more than a newborn rabbit. Further litters ofrabbits were asphyxiated in utero. After delivery they were placed in environmental temperatures of either 37 °C, 20 °C, or 0 °C and observed for spon- taneous recovery. The animals who were cooled survived less often than those kept at 37 'C. The results of these experiments suggest that hypothermia has little to offer in the treatment of birth asphyxia in humans. -
The Post-Mortem Appearances in Cases of Asphyxia Caused By
a U?UST 1902.1 ASPHYXIA CAUSED BY DROWNING 297 Table I. Shows the occurrence of fluid and mud in the 55 fresh bodies. ?ritfinal Jlrttclcs. Fluid. Mud. Air-passage ... .... 20 2 ? ? and stomach ... ig 6 ? ? stomach and intestine ... 7 1 ? ? and intestine X ??? Stomach ... ??? THE POST-MORTEM APPEARANCES IN Intestine ... ... 1 Stomach and intestine ... ... i CASES OF ASPHYXIA CAUSED BY DROWNING. Total 46 9 = 55 By J. B. GIBBONS, From the above table it will be seen that fluid was in the alone in 20 LIEUT.-COL., I.M.S., present air-passage cases, in the air-passage and stomach in sixteen, Lute Police-Surgeon, Calcutta, Civil Surgeon, Ilowrah. in the air-passage, stomach and intestine in seven, in the air-passage and intestine in one. As used in this table the term includes frothy and non- frothy fluid. Frothy fluid is only to be expected In the period from June 1893 to November when the has been quickly recovered from months which I body 1900, excluding three during the water in which drowning took place and cases on leave, 15/ of was privilege asphyxia examined without delay. In some of my cases were examined me in the due to drowning by it was present in a most typical form; there was For the of this Calcutta Morgue. purpose a bunch of fine lathery froth about the nostrils, all cases of death inhibition paper I exclude by and the respiratory tract down to the bronchi due to submersion and all cases of or syncope was filled with it. received after into death from injuries falling The quantity of fluid in the air-passage varies the water. -
Respiratory and Gastrointestinal Involvement in Birth Asphyxia
Academic Journal of Pediatrics & Neonatology ISSN 2474-7521 Research Article Acad J Ped Neonatol Volume 6 Issue 4 - May 2018 Copyright © All rights are reserved by Dr Rohit Vohra DOI: 10.19080/AJPN.2018.06.555751 Respiratory and Gastrointestinal Involvement in Birth Asphyxia Rohit Vohra1*, Vivek Singh2, Minakshi Bansal3 and Divyank Pathak4 1Senior resident, Sir Ganga Ram Hospital, India 2Junior Resident, Pravara Institute of Medical Sciences, India 3Fellow pediatrichematology, Sir Ganga Ram Hospital, India 4Resident, Pravara Institute of Medical Sciences, India Submission: December 01, 2017; Published: May 14, 2018 *Corresponding author: Dr Rohit Vohra, Senior resident, Sir Ganga Ram Hospital, 22/2A Tilaknagar, New Delhi-110018, India, Tel: 9717995787; Email: Abstract Background: The healthy fetus or newborn is equipped with a range of adaptive, strategies to reduce overall oxygen consumption and protect vital organs such as the heart and brain during asphyxia. Acute injury occurs when the severity of asphyxia exceeds the capacity of the system to maintain cellular metabolism within vulnerable regions. Impairment in oxygen delivery damage all organ system including pulmonary and gastrointestinal tract. The pulmonary effects of asphyxia include increased pulmonary vascular resistance, pulmonary hemorrhage, pulmonary edema secondary to cardiac failure, and possibly failure of surfactant production with secondary hyaline membrane disease (acute respiratory distress syndrome).Gastrointestinal damage might include injury to the bowel wall, which can be mucosal or full thickness and even involve perforation Material and methods: This is a prospective observational hospital based study carried out on 152 asphyxiated neonates admitted in NICU of Rural Medical College of Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra from September 2013 to August 2015. -
Seasonal Growth and Lipid Storage of the Circumgiobal, Subantarctic Copepod, Neocalanus Tonsus (Brady)
Deep-Sea Research, Vol. 36, No. 9, pp, 1309-1326, 1989. 0198-0149/89$3.00 + 0.00 Printed in Great Britain. ~) 1989 PergamonPress pie. Seasonal growth and lipid storage of the circumgiobal, subantarctic copepod, Neocalanus tonsus (Brady) MARK D. OHMAN,* JANET M. BRADFORDt and JOHN B. JILLETr~ (Received 20 January 1988; in revised form 14 April 1989; accepted 24 April 1989) Abstraet--Neocalanus tonsus (Brady) was sampled between October 1984 and September 1985 in the upper 1000 m of the water column off southeastern New Zealand. The apparent spring growth increment of copepodid stage V (CV) differed depending upon the constituent con- sidered: dry mass increased 208 Ixg, carbon 162 Ixg, wax esters 143 Itg, but nitrogen only 5 ltg. Sterols and phospholipids remained relatively constant over this interval. Wax esters were consistently the dominant lipid class present in CV's, increasing seasonally from 57 to 90% of total lipids. From spring to winter, total lipid content of CV's increased from 22 to 49% of dry mass. Nitrogen declined from 10.9 to 5.4% of CV dry mass as storage compounds (wax esters) increased in importance relative to structural compounds. Egg lipids were 66% phospholipids. Upon first appearance of males and females in deep water in winter, lipid content and composition did not differ from co-occurring CV's, confirming the importance of lipids rather than particulate food as an energy source for deep winter reproduction of this species. Despite contrasting life histories, N. tonsus and subarctic Pacific Neocalanus plumchrus CV's share high lipid content, a predominance of wax esters over triacylglycerols as storage lipids, and similar wax ester fatty acid and fatty alcohol composition. -
Perinatal Asphyxia Neonatal Therapeutic Hypothermia
PERINATAL ASPHYXIA NEONATAL THERAPEUTIC HYPOTHERMIA Sergio G. Golombek, MD, MPH, FAAP Professor of Pediatrics & Clinical Public Health – NYMC Attending Neonatologist Maria Fareri Children’s Hospital - WMC Valhalla, New York President - SIBEN ASPHYXIA From Greek [ἀσφυξία]: “A stopping of the pulse” “Loss of consciousness as a result of too little oxygen and too much CO2 in the blood: suffocation causes asphyxia” (Webster’s New World Dictionary) On the influence of abnormal parturition, difficult labours, premature birth, and asphyxia neonatorum, on the mental and physical condition of the child, especially in relation to deformities. By W. J. Little, MD (Transactions of the Obstetrical Society of London 1861;3:243-344) General spastic contraction of the lower Contracture of adductors and flexors of lower extremities. Premature birth. Asphyxia extremities. Left hand weak. Both hands awkward. neonatorum of 36 hr duration. Hands More paralytic than spastic. Born with navel-string unaffected. (Case XLVII) around neck. Asphyxia neonatorum 1 hour. (Case XLIII) Perinatal hypoxic-ischemic encephalopathy (HIE) Associated with high neonatal mortality and severe long-term neurologic morbidity Hypothermia is rapidly becoming standard therapy for full-term neonates with moderate-to-severe HIE Occurs at a rate of about 3/1000 live-born infants in developed countries, but the rate is estimated to be higher in the developing world Intrapartum-related neonatal deaths (previously called ‘‘birth asphyxia’’) are the fifth most common cause of deaths among children under 5 years of age, accounting for an estimated 814,000 deaths each year, and also associated with significant morbidity, resulting in a burden of 42 million disability adjusted life years (DALYs).