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Theodoraki MN, Brand M. [The otolaryngologist's role in evaluating diving fitness]. HNO 2024:10.1007/s00106-024-01496-x. [PMID: 38951143 DOI: 10.1007/s00106-024-01496-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
Scuba diving and other modes of device-supported diving are popular activities that can be especially demanding and hazardous for people with preexisting physical conditions. Due to the high ambient pressure, the temperature differences, and potential unpredictable events, which have manifold effects on the organism, diving carries a high risk of life-threatening disease. A special risk is present if the body does not readily equalize air pressure changes. Therefore, prior to diving, all divers should undergo detailed education regarding the physical principles of the sport as well as specific physical examination. Consultation of an otolaryngologist is of exceptional relevance because many otorhinolaryngologic diseases can lead to (usually temporary) unfitness to dive. The role of the modern otorhinolaryngologist trained in diving medicine is to correctly advise the patient and restore fitness for diving via conservative or invasive methods.
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Affiliation(s)
- Marie-Nicole Theodoraki
- Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland.
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Universität Ulm, Ulm, Deutschland.
| | - Matthias Brand
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Universität Ulm, Ulm, Deutschland
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Dossi E, Blauwblomme T, Moulard J, Chever O, Vasile F, Guinard E, Le Bert M, Couillin I, Pallud J, Capelle L, Huberfeld G, Rouach N. Pannexin-1 channels contribute to seizure generation in human epileptic brain tissue and in a mouse model of epilepsy. Sci Transl Med 2019; 10:10/443/eaar3796. [PMID: 29848662 DOI: 10.1126/scitranslmed.aar3796] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 11/02/2017] [Accepted: 05/10/2018] [Indexed: 01/08/2023]
Abstract
Epilepsies are characterized by recurrent seizures, which disrupt normal brain function. Alterations in neuronal excitability and excitation-inhibition balance have been shown to promote seizure generation, yet molecular determinants of such alterations remain to be identified. Pannexin channels are nonselective, large-pore channels mediating extracellular exchange of neuroactive molecules. Recent data suggest that these channels are activated under pathological conditions and regulate neuronal excitability. However, whether pannexin channels sustain or counteract chronic epilepsy in human patients remains unknown. We studied the impact of pannexin-1 channel activation in postoperative human tissue samples from patients with epilepsy displaying epileptic activity ex vivo. These samples were obtained from surgical resection of epileptogenic zones in patients suffering from lesional or drug-resistant epilepsy. We found that pannexin-1 channel activation promoted seizure generation and maintenance through adenosine triphosphate signaling via purinergic 2 receptors. Pharmacological inhibition of pannexin-1 channels with probenecid or mefloquine-two medications currently used for treating gout and malaria, respectively-blocked ictal discharges in human cortical brain tissue slices. Genetic deletion of pannexin-1 channels in mice had anticonvulsant effects when the mice were exposed to kainic acid, a model of temporal lobe epilepsy. Our data suggest a proepileptic role of pannexin-1 channels in chronic epilepsy in human patients and that pannexin-1 channel inhibition might represent an alternative therapeutic strategy for treating lesional and drug-resistant epilepsies.
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Affiliation(s)
- Elena Dossi
- Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNR UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, 75005 Paris, France
| | - Thomas Blauwblomme
- Assistance Publique-Hopitaux de Paris (AP-HP), Department of Pediatric Neurosurgery, Necker Hospital, INSERM U1129, Paris Descartes University, PRES Sorbonne Paris Cité, 75015 Paris, France.,INSERM U1129, Paris Descartes University, PRES Sorbonne Paris Cité, CEA, 75015 Paris, France
| | - Julien Moulard
- Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNR UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, 75005 Paris, France
| | - Oana Chever
- Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNR UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, 75005 Paris, France
| | - Flora Vasile
- Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNR UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, 75005 Paris, France
| | - Eleonore Guinard
- Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNR UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, 75005 Paris, France.,INSERM U1129, Paris Descartes University, PRES Sorbonne Paris Cité, CEA, 75015 Paris, France
| | - Marc Le Bert
- CNRS UMR7355, Experimental and Molecular Immunology and Neurogenetics, 45067 Orléans, France
| | - Isabelle Couillin
- CNRS UMR7355, Experimental and Molecular Immunology and Neurogenetics, 45067 Orléans, France
| | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital and IMA-BRAIN, INSERM U894, Paris Descartes University, PRES Sorbonne Paris Cité, 75014 Paris, France
| | - Laurent Capelle
- Department of Neurosurgery, University Pierre and Marie Curie, La Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Universités, 75013 Paris, France
| | - Gilles Huberfeld
- Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNR UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, 75005 Paris, France.,INSERM U1129, Paris Descartes University, PRES Sorbonne Paris Cité, CEA, 75015 Paris, France.,Department of Neurophysiology, La Pitié-Salpetrière Hospital, Sorbonne Universités, University Pierre and Marie Curie, AP-HP, 75013 Paris, France
| | - Nathalie Rouach
- Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNR UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, 75005 Paris, France.
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Eichhorn L, Leyk D. Diving medicine in clinical practice. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:147-57; quiz 158. [PMID: 25797514 DOI: 10.3238/arztebl.2015.0147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/30/2014] [Accepted: 10/30/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diving is a popular sport, and some recreational divers have medical risk factors. Their health can be endangered by high extracorporeal (ambient) pressure and its many systemic effects. METHODS We review relevant publications on free (breath-hold) diving, scuba diving, medical evaluation for diving, barotrauma, decompression sickness, and diving with medical risk factors, which were retrieved by a selective search of PubMed. RESULTS Free diving or scuba diving, even at seemingly innocuous depths, puts considerable stress on the cardio - vascular system, ears, and lungs. Unexpected events while diving, diminished functional reserve, and pre-existing medical illnesses increase the risk of a diving accident. An international survey revealed that minor incidents occur in 1.3% of all dives, and decompression accidents in 2 of every 10 000 dives. A properly conducted medical examination to determine diving fitness, followed by appropriate counseling, can make a life-threatening diving accident less likely. CONCLUSION To be able to certify diving fitness and give competent medical advice about diving, physicians must be well informed about the physical and physiological changes of diving and the associated risks to health, and they need to know how to perform a medical evaluation of prospective divers. In Germany, any licensed physician may judge a person fit to dive. It is recommended that this be done in adherence to the relevant evaluation standards and recommendations of the medical specialty associations. Randomized controlled trials on the effect of preventive behavior would be desirable, as would a central registry of diving accidents.
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Affiliation(s)
- Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Central Institute of the German Armed Forces' Medical Service, Department IV-Military Ergonomics and Exercise Physiology-Koblenz, Research Group Epidemiology of Performance, Institute for Physiology and Anatomy, German Sport University Cologne
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