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Biomedical subjects

E P Kindwall

Publications and source records attributed to E P Kindwall.

At least 19 recordsLinked to original sources
PubMed1996

The distribution of limb pain in decompression sickness.

BACKGROUND: For many years there has been a widely held but largely unsubstantiated belief that pain in the upper limb in decompression sickness (DCS) is associated with bounce diving, whereas compressed air workers, saturation divers and high altitude aviators are more susceptible to involvement of the lower limbs. HYPOTHESIS: The hypothesis of counter current exchange of inert gas, modulated by changes in tissue temperature, has been evaluated as a possible mechanism to explain the reported distribution of limb pain in DCS. METHODS: An extensive review of over 19,000 cases of limb pain decompression illness has been undertaken from case reports stored in the diving accident database at the Institute of Naval Medicine, in the published literature, and from unpublished clinical and experimental reports. RESULTS: There was a predominance of upper limb involvement in bounce divers and, in contrast to traditional teaching, in aviators. By contrast, the lower limbs were more commonly involved in compressed air workers and saturation divers. CONCLUSION: Each of the occupational exposures has been discussed individually with reference to counter-current exchange and other factors as potential influences on the distribution of disease. We conclude that counter-current exchange of inert gas may be implicated in the distribution of limb pain in DCS.

Acid-Base Equilibrium↗
PubMed1993

Hyperbaric oxygen.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1993

Hyperbaric oxygen's effect on radiation necrosis.

A great deal of knowledge has been gained regarding the effects of hyperbaric oxygen therapy on the healing process. It is important, however, that surgeons use this new form of treatment properly and time surgical intervention appropriately. This article discusses the techniques and effects of this new therapy in the management of radiation necrosis.

Adolescent↗
PubMed1993

Hyperbaric oxygen treatment of radiation cystitis.

There are very few reports of radiation cystitis treated with hyperbaric oxygen. It appears to be the only form of treatment that reverses the basic vascular pathophysiology induced by radiation. This article reviews the development of the treatment and known cases in which it has been used.

Cystitis↗
PubMed1992

Creating a hyperbaric oxygen treatment unit in a major medical center: a personal experience.

Hyperbaric oxygen therapy has regained the interest of physicians and surgeons, including plastic surgeons, after some years of disinterest and suspicion on the part of many. Under the leadership of the Undersea and Hyperbaric Medical Society, the rationale for hyperbaric oxygen treatment has been subjected to rigorous review. Interest in hyperbaric oxygen therapy on the part of plastic surgeons is largely related to its adjunctive use in the management of compromised tissue. When the decision is made to install a hyperbaric unit in a hospital, the next most critical decisions will be the choice of a medical director who has whole-hearted enthusiasm for the project, the choice of a monoplace or multiplace chamber, a suitable site for the unit, ancillary equipment to support the unit, and staffing that is appropriate to the uses conceived for the unit. Pitfalls and problems are described.

Education, Medical↗
PubMed1991

Treatment of multiple sclerosis with hyperbaric oxygen. Results of a national registry.

Three hundred twelve patients were entered into a long-term study of effects of hyperbaric oxygen on multiple sclerosis. The protocol called for an initial 20 treatments in either the monoplace or multiplace chamber on a daily basis followed by monthly booster treatments for 2 years. One hundred seventy neurologists and 22 institutions provided data for this study. There was no control group, but the study was based on Schumacher's postulation that a scientifically valid study to test the efficacy of a new therapy was possible by choosing patients who were definitively diagnosed with multiple sclerosis and following them up for 2 years after the imposed treatment. If the overwhelming majority of the subjects failed to get worse over the 2-year observation period, the efficacy of the treatment would be manifest. The expanded Kurtzke Disability Status Scale (EDSS) was used to assess the severity of the disease state. The dropout rate was high with only 76% (237 of 312 patients) finishing the initial 20 treatments. Twenty-two percent (69 of 312) finished 1 year of booster therapy, and 9% (28 of 312) completed 2 years of monthly boosters. The mean deterioration on the Kurtzke EDSS score was 0.93 or almost a full step from the beginning of treatment until the last evaluation. There was no difference in outcome between those who had the shortest and longest periods of time between onset of symptoms and hyperbaric oxygen treatment. Treatment pressure made no difference in outcome. Changes in the Kurtzke EDSS score bore no relationship to the use of booster treatment. Patients who were reasonably well off at the onset of treatment with initial Kurtzke EDSS scores of 1 or 2 (n = 21) deteriorated by an average of 1.7 Kurtzke points. Those patients whose initial Kurtzke EDSS scores were greater than 2 (n = 164) deteriorated on an average of 0.82 points. Of interest was that 19.5% (39 of 200) of the patients reported a temporary improvement in bladder function, but improvement was maintained in only 11 patients (5.5%) at 2-year follow-up. Fifteen patients (7.5%) indicated long-term worsening. There was no significant change in the working status of the patients following hyperbaric oxygen treatment. Although this study treated the patients in accordance with protocols reported to produce a benefit in multiple sclerosis, we were unable to substantiate any useful long-term effect of hyperbaric oxygen therapy.

Adolescent↗
PubMed1991

Hyperbaric oxygen therapy in plastic surgery: a review article.

The most important effects of hyperbaric oxygen (HBO), for the surgeon, are the stimulation of leukocyte microbial killing, the enhancement of fibroblast replication, and increased collagen formation and neovascularization of ischemic tissue. Preoperative hyperbaric oxygen induces neovascularization in tissue with radionecrosis. Refractory osteomyelitis and necrotizing fasciitis appear to respond to adjunctive hyperbaric oxygen. Crush injury and compartment syndrome appear to benefit through preservation of ATP in cell membranes, which limits edema. Hyperbaric oxygen in burn injury permits shorter hospital stays, a reduced number of surgeries, and less fluid replacement. Skin grafts and flaps are reported to take more completely and more rapidly. The same mechanisms may apply in ischemic problem wounds such as infected diabetic extremities. Contraindications and side effects are described. Hyperbaric oxygen will not heal normal wounds more rapidly but may, under certain circumstances, induce problem wounds to heal more like normal ones.

Burns↗
PubMed1986

Adjunct hyperbaric oxygen therapy in periorbital reconstruction.

The abundant blood supply normally found in the periorbital region grants the reconstructive surgeon many options for repair. When this blood supply is altered by such factors as thermal damage or scar formation, classic methods of lid reconstruction may not suffice. In such situations, treatment with hyperbaric oxygen accelerates the process of primary revascularization of full-thickness skin grafts and large composite grafts. Augmentation of capillary budding occurs because hyperbaric oxygen therapy raises the tissue oxygen tension in hypoxic areas to the level needed for extracellular deposition of collagen, which is needed for support of endothelial cells. Hyperbaric oxygen also appears to improve the survival of ischemic skin flaps of the face, although the exact mechanism of this action is unclear. Since 1982, a total of six patients needing periorbital reconstruction has been treated postoperatively with adjunct hyperbaric oxygen. Although the results have been uniformly favorable, a matched series comparing the results with and without hyperbaric oxygen therapy will be required to prove the efficacy of this treatment regimen.

Adolescent↗
PubMed1986

Aseptic necrosis in caisson workers: a new set of decompression tables.

There is a high incidence of aseptic necrosis and decompression sickness among caisson workers due to inadequate decompression using the current OSHA decompression tables (1-7). Because of this, a new set of tables--Autodec III-O2--was developed which more effectively eliminates nitrogen from the body and, therefore, should decrease the incidence of both bends and aseptic necrosis. The Autodec III-O2 schedule's superiority was statistically significant at a level of 0.08 compared to the OSHA table. It is our conclusion that OSHA should adopt the Autodec III-O2 schedule as a replacement for the current decompression tables.

Adult↗
PubMed1982

Aseptic necrosis in compressed air tunnel workers using current OSHA decompression schedules.

Aseptic necrosis (dysbaric osteonecrosis) was discovered in two compressed air tunnel workers who had used the present Occupational Health and Safety Administration (OSHA) decompression tables for compressed air tunneling at pressures greater than 36 pounds per square inch gauge (psig). A roentgenographic study was made of 21 men who had worked at pressures up to 43 psig using the OSHA schedules. Bone scanning was also included. Seven of the men (33%) were found to have aseptic necrosis involving the shoulders, hips or distal femoral shafts and proximal tibia. It became evident that the present OSHA schedules caused not only an unacceptable incidence of decompression sickness but also aseptic necrosis at pressures over 36 psig. New interim tables that are more conservative and that use either air or oxygen as a breathing gas during decompression are undergoing laboratory and worksite evaluation.

Adult↗
PubMed1982

Survival following accidental decompression to an altitude greater than 74,000 feet (22,555 m).

A man was accidentally decompressed to an altitude greater than 22,555 m (74,000 ft) in an industrial vacuum chamber. He experienced burst lung, massive decompression sickness, and sustained ebulism. He remained at altitude for a period of 3-5 min. By 5.5 h following the accident, he was still profoundly unconscious. He was subsequently treated in a hyperbaric chamber with recompression on a modified U.S. Navy Table 6A and had eventual clinical recovery. The CPK peaked at 8000 units 2 d after the accident, demonstrating substantial barotrauma to the tissues.

Accidents, Occupational↗
PubMed1975

Management of severe decompression sickness with treatment ancillary to recompression: case report.

Recompression remains the primary form of treatment in decompression sickness, but severe cases require ancillary treatment. The case of a compressed air worker with decompression sickness is presented who, in addition to recompression, required 5.5 of I.V. fluids in the first 8 h, heparin, digitalis, steroids, and respiratory support, to prevent death. The report includes a description of the precipitation causes, the course during recompression, the drugs and dosages used, and comments on respirator treatment.

Adult↗
PubMed1975

Measurement of helium elimination from man during decompression breathing air or oxygen.

Air breathing was compared with oxygen breathing during decompression from an 80-20% helium-oxygen dive to a depth equivalent to 120 fsw (4.6 ATA) in a dry chamber to see which was the most efficient gas for helium elimination. Helium elimination was measured in a closed circuit system for 90 min at the 40-fsw (2.2 ATA) stop. No significant difference was found in the efficiency of helium elimination breathing either air or oxygen in the five subjects tested.

Adult↗
PubMed1975

Nitrogen elimination in man during decompression.

The effect of ambient pressure on inert gas elimination during decompression was investigated using human subjects breathing air in a dry hyperbaric chamber. This was done by measuring nitrogen recovery during three different decompression schedules following identical simulated dives. Five subjects were used, each with normal pulmonary function. In each case the simulated dives consisted of exposure for 40 min to air at 4 ATA corresponding to a depth of about 100 fsw and 28 degrees C. Following these exposures each subject was decompressed in different experiments to 50 fsw (2.515 ATA) and to 10 fsw (1.303 ATA) while breathing a mixture of 80:20 helium-oxygen. In addition, two of these subjects were denitrogenated isobarically, at 100 fsw, breathing 80:20 helium-oxygen. Significant differences in nitrogen-elimination rate were observed, with nitrogen removed most effectively at 50 fsw and least at 100 fsw. To explained these unexpected results it is tentatively suggested asymptomatic bubble formation occurred at both 10 and 50 fsw.

Decompression↗