Anterior thoracic or thoracolumbar spinal surgery by retropleural approach always carries a risk of pneumothorax as its consequence. Conventionally, the Aerospace Medicine Association and the British Thoracic Society recommend 2 weeks delay of air travel for a patient with resolved postoperative pneumothorax. They also label active pneumothorax as an absolute contraindication for commercial air travel. Such a delay always causes psychological and financial stress to patients and family who are far from home. Here, we report three patients with postoperative pneumothorax, who insisted on early air travel despite being informed of the possible consequences.
Telemedicine, ie 'the delivery of healthcare and sharing of medical knowledge using telecommunication systems' has penetrated every field of medicine. As a result, tele-echocardiography, the study of the heart via telemedicine started expanding. Ironically, space became the next frontier for mankind's new innovations and technology pursuit. However, the microgravity environment of space is known to be challenging to astronauts hearts. As such, new tele-echocardiography techniques have evolved. The main aim was to research a system that can be operated by a layperson but still be able to provide high yield diagnostic information in real time to specialists on earth. This spin-off space technology is recognized to have a positive impact, especially in developing countries with vast terrain. It is now utilized in hospitals and other terrestial locations where patients in remote regions can have their hearts analysed and data relayed to specialists in bigger centres for interpretation and further management.
Researchers have in recent years pointed to microgravity as presenting a unique opportunity for better disease prevention and treatments. Spaceflight can induce many changes in human physiological systems. In particular, the cardiovascular system is especially affected by spaceflight due to changes at the cellular level. Endothelial cells are very sensitive to microgravity. Morphological and functional changes in endothelial cells have been extensively studied since they are believed to be the source of many cardiovascular diseases. Studies have also shown that endothelial cells play a key role in angiogenesis, which can be stimulated in a clinostat-induced microgravity environment. This is a review of studies, based on different research approaches, on human umbilical vein endothelial cells. The myriad molecular cascades and signalling pathways involving gene regulation, proteins, inflammatory response activation, alteration of endothelial behaviour, and cell senescence are highlighted. Age-related disorders experienced on earth are very similar to the changes induced in space by microgravity. As we seek solutions to medical problems, the most innovative and beneficial at present are in space medicines and therapies.
This study investigates the effects of aircraft cabin pressure on intracranial pressure (ICP) elevation of a pneumocephalus patient. We propose an experimental setup that simulates the intracranial hydrodynamics of a pneumocephalus patient during flight. It consists of an acrylic box (skull), air-filled balloon [intracranial air (ICA)], water-filled balloon (cerebrospinal fluid and blood) and agarose gel (brain). The cabin was replicated using a custom-made pressure chamber. The setup can measure the rise in ICP during depressurization to levels similar to that inside the cabin at cruising altitude. ΔICP, i.e. the difference between mean cruising ICP and initial ICP, was found to increase with ICA volume and ROC. However, ΔICP was independent of the initial ICP. The largest ΔICP was 5 mmHg; obtained when ICA volume and ROC were 20 ml and 1,600 ft/min, respectively. The postulated ICA expansion and the subsequent increase in ICP in pneumocephalus patients during flight were successfully quantified in a laboratory setting. Based on the quantitative and qualitative analyses of the results, an ICA volume of 20 ml and initial ICP of 15 mmHg were recommended as conservative thresholds that are required for safe air travel among pneumocephalus patients. This study provides laboratory data that may be used by doctors to advise post-neurosurgical patients if they can safely fly.
Two cases of cerebral arterial gas embolism (CAGE) occurred after a decompression incident involving five maintenance crew during a cabin leakage system test of a Hercules C-130 aircraft. During the incident, the cabin pressure increased to 8 in Hg (203.2 mm Hg, 27 kPa) above atmospheric pressure causing intense pain in the ears of all the crew inside. The system was rapidly depressurized to ground level. After the incident, one of the crew reported chest discomfort and fatigue. The next morning, he developed a sensation of numbness in the left hand, with persistence of the earlier symptoms. A second crewmember, who only experienced earache and heaviness in the head after the incident, developed retrosternal chest discomfort, restlessness, fatigue and numbness in his left hand the next morning. Both were subsequently referred to a recompression facility 4 d after the incident. Examination by the Diving Medical Officer on duty recorded left-sided hemianesthesia and Grade II middle ear barotrauma as the only abnormalities in both cases. Chest X-rays did not reveal any extra-alveolar gas. Diagnoses of Static Neurological Decompression Illness were made and both patients recompressed on a RN 62 table. The first case recovered fully after two treatments, and the second case after one treatment. Magnetic resonance imaging (MRI) of the brain and bubble contrast echocardiography performed on the first case 6 mo after the incident were reported to be normal. The second case was lost to follow-up. Decompression illness (DCI) generally occurs in occupational groups such as compressed air workers, divers, aviators, and astronauts. This is believed to be the first report of DCI occurring among aircraft's ground maintenance crew.