HYPERACTIVE BLADDER SYNDROME SECONDARY TO BAROTRAUMA AND CHRONIC STRESS.

OBJECTIVE: The aim: To improve the results of treatment of hyperactive bladder syndrome in men of working age on the background of barotrauma and stress, as a consequence of combat trauma. PATIENTS AND METHODS: Materials and methods: An analysis of the questionnaire and the results of the clinical examination of 32 patients, injured servicemen and people who were injured in combat zones was carried out. The drug solifenacin succinate was used in the treatment complex, which is a specific antagonist of M3 subtype cholinergic receptors. Its influence allows you to achieve relaxation of the bladder detrusor and reduce the contractility of hyperactive bladder. RESULTS: Results: The main criterion for the effectiveness of the treatment was a decrease in the number of urgent cases, the frequency of urination and manifestations of nocturia by 50% or more, which was considered a positive effect. At the same time, the positive effect was differentiated as follows : an improvement of these parameters by 75% or more from the initial value which is a good result; reduction of symptoms in the range of 50-75% is satisfactory; less than 50% is an unsatisfactory result. A positive effect from the treatment after 8 weeks was observed in 88% of patients, of which 52% had a good result and 36% had a satisfactory result. CONCLUSION: Conclusions: The proposed complex of treatment of hyperactive bladder syndrome as a result of combat trauma against the background of barotrauma with neurological consequences and chronic stress allows to achieve a pronounced clinical effect in the vast majority of male patients of working age. And the diagnostic complex allows you to emphasize aspects of clinical vigilance, both for doctors of a specialized branch and of doctors of a general direction.

The ineffectiveness of applying moisture to the ear on the incidence and severity of otic barotrauma for air passengers.

OBJECTIVE: The application of moisture to the ear is anecdotally claimed to relieve the pain from otic barotrauma that can arise during aircraft descent. This claim was tested in a randomised double-blind study on an aircraft with eight participants heavily predisposed to barotrauma. METHODS: On the outward flight, half the participants wore 'active' devices that applied moisture to the external ear; the remainder wore placebo devices that contained no moisture, but were otherwise identical. On the return flight, the groups were reversed. Participants wore the devices from just before descent until landing, unless they experienced symptoms of barotrauma, in which case they switched to what they knew was an active device. RESULTS: There were no significant differences between conditions regarding the appearance of the tympanic membrane on landing or the discomfort levels immediately before and after any switch. CONCLUSION: Applying moisture is ineffective for passengers heavily predisposed to otic barotrauma.

Pneumomediastinum and pneumothorax during emergency tracheotomy under spontaneous ventilation: Macklin meets Müeller? / Neumomediastino y neumotórax en la traqueotomía urgente en ventilación espontánea. Cuando Macklin encontró a Müeller

Potentially serious complications associated to emergency tracheotomy continue being a matter of concern. We review the pathogenesis of gas leakage in this setting and discuss about the possible mechanisms involved in its cause. We present two cases of pneumomediastinum, subcutaneous emphysema and pneumothorax in the context of emergency tracheotomy under spontaneous ventilation, finally resolved by chest drainage. The combination of overly negative pleural pressures due to extreme inspiratory efforts in the context of an almost completely obstructed airway together with over-pressurized alveoli because of gaseous entrapment secondary to serious expiratory obstruction appears to be the most plausible primary cause of air leaks in our patients. Understanding the underlying mechanisms evolved in its production will help clinicians to suspect and diagnose this phenomenon (AU)

Las complicaciones graves asociadas a la traqueotomía urgente continúan siendo un desafío clínico. En este trabajo revisamos y discutimos la fisiopatología de la fuga aérea en el contexto de la traqueotomía urgente. Presentamos dos casos de neumomediastino, enfisema subcutáneo y neumotórax en el curso de sendas traqueotomías urgentes realizadas sobre pacientes en ventilación espontánea que se resolvieron tras inserción de drenaje pleural. Nuestra conclusión es que la combinación de presiones pleurales inspiratorias muy negativas por el esfuerzo inspiratorio contra una vía aérea obstruida junto con la presencia de alveolos hiper-presurizados por el atrapamiento gaseoso espiratorio constituyen la base etiopatogénica del proceso. La comprensión de los mecanismos que subyacen en la generación del neumotórax y neumomediastino en este contexto facilitará que los clínicos sospechen y diagnostiquen el cuadro (AU)

Diagnosis and management of headache attributed to airplane travel.

The headache attributed to airplane travel, also named "airplane headache", is characterized by the sudden onset of a severe head pain exclusively in relation to airplane flights, mainly during the landing phase. Secondary causes, such as upper respiratory tract infections or acute sinusitis, must be ruled out. Although its cause is not thoroughly understood, sinus barotrauma should be reasonably involved in the pathophysiological mechanisms. Furthermore, in the current International Classification of Headache Disorders, rapid descent from high altitude is not considered as a possible cause of headache, although the onset of such pain in airplane travellers or aviators has been well known since the beginning of the aviation era. On the basis of a survey we conducted with the courteous cooperation of people who had experienced this type of headache, we proposed diagnostic criteria to be added to the forthcoming revision of the International Classification of Headache Disorders. Their formal validation would favour further studies aimed at improving knowledge of the pathophysiological mechanisms involved and at implementing preventative measures.

Topical application of betahistine improves eustachian tube function in an animal model.

CONCLUSION: Betahistine dihydrochloride, a drug used widely in the systemic treatment of balance disorders such as Ménière's disease, was found to improve eustachian tube function when applied topically in the nasopharynx of rats. OBJECTIVES: The study tested the effect of betahistine, a histamine receptor agonist, on eustachian tube function and tested the involvement of H1 and H3 histamine receptors. METHODS: Eustachian tube function was measured in anaesthetized rats while middle ear pressure was increased and then monitored during induced swallowing. Betahistine and other drugs were applied topically in the nasopharynx, bulla and epipharynx, and administered intraperitoneally. RESULTS: Systemic application of betahistine hardly changed eustachian tube function, but topical application significantly improved it. The action of topical betahistine was unaffected by the HI receptor antagonist mepyramine and was mimicked by the H3 agonist, ciproxifan.

Therapeutic effect of edaravone on inner ear barotrauma in the guinea pig.

Inner ear barotrauma (IEB) that is caused by acute pressure changes can often lead to permanent severe sensorineural hearing loss (SNHL). However, the mechanism that causes IEB is still unknown. In the current study, we assessed the involvement of reactive oxygen species (ROS) in IEB and the therapeutic effect of 3-methyl 1-phenyl-2-pyrazolin-5-one (edaravone), which is a free radical scavenger. To create the IEB model, guinea pigs were subjected to quick pressure changes that resulted in acute SNHL. The animals were then divided into two groups, an edaravone-treated IEB group and a non-treated IEB group that only received normal saline. Immunohistochemical analyses for 8-hydroxy-2-deoxyguanosine (8-OHdG) and 4-hydroxy-2-nonenal (4-HNE) were performed to examine the amount of oxidative DNA damage and lipid peroxidation that occurred in guinea pig cochlea. To assess the curative efficacy of edaravone, auditory brainstem response (ABR) testing was performed to evaluate auditory function. Strong immunoreactivities against 8-OHdG and 4-HNE were observed in the inner ear tissues of the non-treated IEB group. Lesser amounts of immunoreactivity were observed in the same region of the edaravone-treated IEB group as compared to the non-treated IEB group. Furthermore, ABR measurement revealed that there was a faster improvement in the threshold shift for the edaravone-treated IEB group as compared to that of the non-treated IEB group. At the final 7-week time point, the threshold shift for the edaravone-treated IEB group was significantly smaller as compared to the non-treated IEB group. These results strongly suggest that ROS is produced in the cochlea in response to acute pressure changes and that ROS plays an important role in the pathophysiology of IEB. Furthermore, edaravone treatment had a therapeutic effect on IEB-induced acute SNHL and thus, edaravone might possibly be able to be used as a therapeutic treatment for IEB.

Therapeutic effects of eustachian tube surfactant in barotitis media in guinea pigs.

BACKGROUND: Previous research has shown that the eustachian tube (ET) in animals and humans is lined with a substance that lowers surface tension and thus facilitates the opening of the eustachian tube and aeration of the middle ear. The aims of the present study were to observe the role of eustachian tube surfactant (ETS) on the opening of the ET and to explore the therapeutic effect of natural and artificial ETS on barotitis media (BOM). METHODS: BOM was successfully established in 50 guinea pigs by simulated ascent in an altitude chamber. Subsets of the affected ears were treated by flushing with natural ETS, artificial ETS, artificial phospholipid, or saline. The effects were evaluated by measuring eustachian tube pressure opening level (POL). Other animals with BOM were treated with artificial ETS on one side and saline in the other, after which the clinical signs were observed. RESULTS: The POL of the saline group remained unchanged. Natural ETS decreased the POL from 11.98 to 6.11 kPa (p < 0.01); artificial ETS reduced the POL from 11.91 to 6.67 kPa (p < 0.01); there was no significant difference between the two treatments. Artificial phospholipid was less effective, decreasing POL from 11.86 to 8.61 kPa (p < 0.05). Clinical observations showed that after 1 wk of treatment with artificial ETS, the congestion in the tympanic membrane was alleviated, the hearing threshold improved, and the effusion in tympanic cavity diminished. CONCLUSION: Artificial ETS was as effective as natural ETS in facilitating the opening of eustachian tube and had definite therapeutic effects on BOM in this model.

[An experimental study on the therapeutic effects of eustachian tube surfactant in barotitis media].

OBJECTIVE: To observe the effect of surfactant on eustachian tube (ET) on the opening of ET as well as it's therapeutic role in barotitis media (BM). METHOD: 50 guinea pigs were successfully established as BM models by stimulated ascending in altitude chamber. Parts of the models were treated with by middle ear flushing with nature ETS, artificial ETS, artificial phospholipid and saline, after which the eustachian tube pressure opening level (POL) of each group was tested. Others were injected with 1 ml artificial ETS in on side of the middle ear, and 1 ml of saline in the other served as control. RESULT: Natural ETS decreased the POL from 11.98 to 6.11 kPa (P < 0.01); Artificial ETS reduced the POL from 11.91 to 6.67 kPa (P < 0.01), there were no significant differences between the two groups. Artificial phospholipid decreased the POL from 11.86 to 8.61 kPa (P < 0.05), which was not as effective as natural ETS. While the POL of saline group remained unchanged. After one week of artificial ETS treatment, the congestion in drum membrane alleviated, the hearing threshold of ETS group improved and the effusion in tympanic cavity lessened. CONCLUSION: The results suggest that artificial ETS is as effective as nature ETS to facilitates the opening of eustachian tube. Artificial ETS may exert therapeutic effects on BM.

Ventilator-induced lung injury upregulates and activates gelatinases and EMMPRIN: attenuation by the synthetic matrix metalloproteinase inhibitor, Prinomastat (AG3340).

Mechanical ventilation has become an indispensable therapeutic modality for patients with respiratory failure. However, a serious potential complication of MV is the newly recognized ventilator-induced acute lung injury. There is strong evidence suggesting that matrix metalloproteinases (MMPs) play an important role in the development of acute lung injury. Another factor to be considered is extracellular matrix metalloproteinase inducer (EMMPRIN). EMMPRIN is responsible for inducing fibroblasts to produce/secrete MMPs. In this report we sought to determine: (1) the role played by MMPs and EMMPRIN in the development of ventilator-induced lung injury (VILI) in an in vivo rat model of high volume ventilation; and (2) whether the synthetic MMP inhibitor Prinomastat (AG3340) could prevent this type of lung injury. We have demonstrated that high volume ventilation caused acute lung injury. This was accompanied by an upregulation of gelatinase A, gelatinase B, MT1-MMP, and EMMPRIN mRNA demonstrated by in situ hybridization. Pretreatment with the MMP inhibitor Prinomastat attenuated the lung injury caused by high volume ventilation. Our results suggest that MMPs play an important role in the development of VILI in rat lungs and that the MMP-inhibitor Prinomastat is effective in attenuating this type of lung injury.

In vivo role of glucocorticoids in barotrauma vascular repair and fibrosis.

To determine the important repair events leading to vascular collagen accumulation following barotrauma, in vivo changes were assessed during dexamethasone (DEX) treatment, as well as physiological healing. Hypercholesterolemic rabbits underwent bilateral iliac artery endothelial denudation, followed by angioplasty. Messenger ribonucleic acid (RNA) (procollagen types I, III and transforming growth factor [TGF]beta1), and bio-histometric composition of iliac arteries of animals treated with DEX (2, 7 and 7 days; 1 mg/kg1/day1), were compared to that in controls 2, 7 and 30 days after angioplasty. Type I and III procollagen mRNA transcripts were up-regulated following injury in either group. Similarly, TGFbeta1 mRNA levels were also elevated; however, treatment with DEX led to down-regulation at day 30 post-angioplasty. Linear regression and correlation of the densitometric ratios of procollagen alpha1(I) and TGFbeta1 mRNA during repair were observed significantly in either group (DEX-treated, r2= 0.84; non-treated, r2=0.79). Biochemically derived total vascular RNA concentration decreased transiently (7 days), with DEX-treatment (P = 0.003). Arterial lumen cross-sectional area was reduced between days 2 and 30 (P=<0.02), accompanied by an increase in fibrillar collagen concentration in both groups of animals post-angioplasty. These results suggest that during barotrauma repair, administration of DEX (approximately 1 week), does not affect vascular intimal hyperplasia or fibrosis, and that despite treatment, significant production of type I procollagen mRNA continues, influencing subsequent collagen deposition. The data also confirm a strong correlation between TGFbeta1 and type I procollagen mRNA expression, and modestly with type III procollagen during post-angioplasty repair.

Efficacy of pseudoephedrine for the prevention of barotrauma during air travel.

STUDY OBJECTIVE: To determine the efficacy of decongestant prophylaxis in the prevention of symptoms of middle ear barotrauma (aerotitis media) during air travel. DESIGN: Prospective, parallel, double-blind, randomized trial. SETTING: Two commercial airports in Michigan. TYPE OF PARTICIPANTS: Two hundred fifty volunteers with a history of recurrent ear discomfort during air travel. INTERVENTIONS: Following randomization, each subject received 120 mg pseudoephedrine or placebo 30 minutes before flight departure. Recorded data included subject demographics, history of ear discomfort, and otologic examination. After arrival at their final destinations, volunteers were asked to complete a questionnaire and return it by mail to the investigators. Questions included the intensity and duration of otologic symptoms experienced while flying and possible drug side effects. MEASUREMENTS AND MAIN RESULTS: One hundred ninety subjects completed the study; 96 received 120 mg of pseudoephedrine and 94 received a placebo. The two treatment groups were similar with regard to age, sex, weight, and flight profile (P > .1). Ear discomfort was present in 32% (31 of 96) of those receiving pseudoephedrine versus 62% (58 of 94) of the control group (chi 2 = 15.34; P = .0001). Adverse effects were minimal; seven patients experienced drowsiness. CONCLUSION: Our results suggest that use of an oral decongestant before flying decreases the incidence of middle ear barotrauma associated with ambient pressure changes during air travel.

The use of dexamethasone in full-term infants with severe respiratory failure and pulmonary barotrauma.

Eight full-term infants (mean gestation 39.9 weeks [range 37-42] and mean birthweight 3642 g [range 3060-4200]) with severe respiratory failure (median oxygenation index 28 [range 16-65] and median arterial/alveolar PO2 ratio (a/APO2) 0.094 [range 0.038-0.165]) and pulmonary barotrauma were treated with Dexamethasone, 0.5 mg/kg per day, from the median age of 5 days (range 3-22). Six of the eight (75%) infants survived. They were weaned from mechanical ventilation and extubated a median of 2.5 days after commencing treatment with Dexamethasone. Two infants died and one of them suffered recurrent pneumothoraces. There was a significant improvement in oxygenation in the seven infants who survived the 72 h period of observation. Their median oxygenation index was 24 when Dexamethasone was commenced compared with 8 after 12 h (P less than 0.05) and 10 after 36 h (P less than 0.025). Their a/APO2 ratio was 0.095 when Dexamethasone was commenced compared with 0.289 after 12 h (P less than 0.05) and 0.207 after 36 h (P less than 0.025). There was a significant increase in the infants' arterial mean blood pressure associated with Dexamethasone therapy and one infant developed Staphylococcus aureus septicaemia. In this uncontrolled study of eight full-term infants with severe respiratory failure and pulmonary barotrauma, the use of Dexamethasone was associated with significant improvement in oxygenation and rapid weaning from mechanical ventilation.

Pressure chamber tympanometry in diving candidates.

The currently recommended examination for diving fitness ascertains middle ear autoinflation ability only under surface pressure conditions. The purpose of our study was to document and quantify middle ear pressure equalization failure during simulated dives among diving candidates who had otherwise met the otologic criteria for diving fitness. Forty-two candidates for regular naval diving activity were included in the study. Tympanograms of both ears at 1 and 1.1 absolute atmospheres (ATA) were taken inside a pressure chamber with the subjects in two positions: seated and supine. At a pressure of 1 ATA, type A tympanograms were found in all 84 ears examined. At a pressure of 1.1 ATA, with subjects in the upright position, 19 (22.9%) of the ears had type C and 2 (2.4%) type B tympanograms, while with subjects recumbent during descent, 6 of the ears (7.2%) had type C and 7 (8.4%) type B. Our results suggest that successful autoinflation at surface ambient pressure does not necessarily reflect middle ear pressure equalization ability during descent in a dive.