Emmanuel Gempp

Emmanuel Gempp
Sainte Anne Military Teaching Hospital · Department of diving and hyperbaric medicine

MD

About

78
Publications
20,721
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1,142
Citations
Citations since 2016
19 Research Items
632 Citations
2016201720182019202020212022020406080100
2016201720182019202020212022020406080100
2016201720182019202020212022020406080100
2016201720182019202020212022020406080100
Additional affiliations
September 2014 - present
French Navy Diving school
Position
  • Diving medical officer
September 2009 - August 2014
Sainte Anne Military Teaching Hospital
Position
  • Consultant

Publications

Publications (78)
Article
Background Decompression sickness (DCS) with spinal cord involvement has an unfortunately high rate of long-term sequelae. The objective of this study was to determine the association of prehospital variables on the outcome of spinal cord DCS, especially the influence of the initial clinical presentation and the time to recompression. Methods This...
Article
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Background: Pulmonary immersion oedema is a frequent diving accident. Although its outcome is generally favourable within 72 h, it can nonetheless lead to heart failure or sudden death. Cases of transient myocardial dysfunction have been reported in the literature. This phenomenon is similar to Takotsubo syndrome in many ways. It is characterised b...
Article
Background: Immersion can cause immersion pulmonary edema (IPE) in previously healthy subjects. We performed a case-control study to better identify IPE risk factors. Methods: We prospectively included recreational scuba divers who had presented signs of IPE and control divers who were randomly chosen among diving members of the French Underwate...
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Circulating mitochondrial DNA (mtDNA) is receiving increasing attention as a danger-associated molecular pattern in conditions such as autoimmunity or trauma. In the context of decompression sickness (DCS), the course of which is sometimes erratic, we hypothesize that mtDNA plays a not insignificant role particularly in neurological type accidents....
Article
Introduction: Ultrasonic detection of venous gas emboli (VGE) in the precordial (PRE) region is commonly used in evaluation of decompression stress. While subclavian (SC) VGE detection can also be used to augment and improve the evaluation, no study has rigorously compared VGE grades from both sites as decompression stress indicators. Methods: T...
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Background: Immersion pulmonary edema is potentially a catastrophic condition; however, the pathophysiological mechanisms are ill-defined. This study assessed the individual and combined effects of exertion and negative pressure breathing on the cardiovascular system during the development of pulmonary edema in SCUBA divers. Methods: Sixteen mal...
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Objectives: The aim of this study was to investigate the relationship between right-to-left shunt (RLS) and the clinical features of decompression sickness (DCS) in scuba divers and to determine the potential benefit for screening this anatomical predisposition in primary prevention. Methods: 634 injured divers treated in a single referral hyper...
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This study assessed the relationship between altered cardiac function and the development interstitial pulmonary edema in SCUBA divers. Fifteen healthy males performed a 30-min SCUBA dive in open sea. They were instructed to fin for 30 min and were wearing wet suits. Before and immediately after immersion, cardiac indices and extravascular lung wat...
Article
Introduction Massive bubble formation after diving can lead to decompression sickness (DCS) that can result in neurological disorders. In experimental dives using hydrogen as the diluent gas, decreasing the body's H2 burden by inoculating hydrogen-metabolizing microbes into the gut reduces the risk of DCS. In contrast, we have shown that gut bacter...
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BACKGROUND: Inner ear decompression sickness (IEDCS) in scuba diving results in residual vestibulocochlear deficits with a potential impact on health-related quality of life. The aim of this study was to determine the predictive factors for poor clinical recovery and to try to establish a prognostic score on initial physical examination. METHODS: T...
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After the careful reading of a recent and interesting article published by Balestra and Germonpre (2016) suggesting the lack of correlation between white-matter brain MRI hyperintensities, neuro-psychometric alterations, and the presence of persistent foramen ovale (PFO) screened by contrast transoesophageal echocardiography in recreational scuba d...
Article
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Immersion pulmonary edema (IPE) is a misdiagnosed environmental illness caused by water immersion, cold, and exertion. IPE occurs typically during SCUBA diving, snorkeling, and swimming. IPE is sometimes associated with myocardial injury and/or loss of consciousness in water, which may be fatal. IPE is thought to involve hemodynamic and cardiovascu...
Article
Introduction: Onset of cochleovestibular symptoms (hearing loss, dizziness or instability, tinnitus) after a dive (scuba or breath-hold diving) warrants emergency transfer to an otology department. One priority is to investigate the possibility of the development of decompression sickness with a view to hyperbaric oxygen treatment of bubble-induced...
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Massive bubble formation after diving can lead to decompression sickness (DCS). During dives with hydrogen as a diluent for oxygen, decreasing the body’s H2 burden by inoculating hydrogen-metabolizing microbes into the gut reduces the risk of DCS. So we set out to investigate if colonic fermentation leading to endogenous hydrogen production promote...
Article
Lettres à la rédaction / Revue du rhumatisme 82 (2015) 422–426 423 ostéoarticulaire par voie hématogène ou par continuité [4,5]. Cependant les examens paracliniques ne plaident en cette faveur. L'atteinte ostéoarticulaire peut être la lésion princeps entraînant une atteinte vasculaire par extension : les lombalgies précédaient la rupture de l'anévr...
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The occurrence of neurological symptoms, even transient, within 24 hours after diving must be considered as diving injuries, particularly decompression illness. The early administration of oxygen and transportation to the nearest hyperbaric facility is strongly recommended to initiate hyperbaric oxygen treatment. However, even with a rapid recompre...
Chapter
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Vascular gas bubbles are considered the principal element in decompression sickness (DCS) development. Traditionally these bubbles were called VGE (venous gas emboli), however scientific knowledge indicates that similar bubbles may also be present in the arterial circulation, therefore we propose to use “VGE” for “Vascular Gas Emboli”, and we will...
Article
Les accidents de décompression de l’oreille interne après plongée sous-marine ne sont pas inhabituels et se caractérisent par un syndrome vestibulaire aigu périphérique, parfois accompagné de signes cochléaires, qui nécessitent un traitement en urgence par oxygénothérapie hyperbare. Un infarctus cérébelleux peut également se présenter sous la forme...
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Background: Prior reports have shown that decompression sickness (DCS) in scuba divers is accompanied by vascular endothelium damage attributed to gas emboli formation, resulting in capillary leak with hemoconcentration. The significance of serum albumin as a biomarker of vascular permeability in this condition has been insufficiently investigated...
Article
Introduction: Inner ear decompression sickness following scuba diving is not uncommon and the characteristic features of this disorder are acute peripheral vestibular syndrome, sometimes associated with cochlear signs, requiring urgent hyperbaric oxygen therapy. Cerebellar infarction can also mimic isolated peripheral vestibulopathy. Case report:...
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Neuron-specific enolase (NSE) and S100B protein are brain-origin proteins commonly described to assess the presence and severity of neurological injury. To date, there are limited data examining the influence of scuba diving on these biomarkers, particularly when symptoms of decompression sickness (DCS) occur. The purpose of this controlled study w...
Article
Study design: Retrospective case-control study. Objectives: The intent of this study was to investigate the relationships between vertebral degenerative changes resulting in spinal canal stenosis, spinal cord lesions and the development of spinal cord decompression sickness (DCS) in scuba divers. Setting: Referral hyperbaric facility, Toulon,...
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Haemoptysis and pulmonary oedema following deep breath-hold diving have been described in recent years. We describe the case of a 33-year-old healthy military diver who presented symptoms suggestive of pulmonary oedema after two breathhold dives, the first lasting 0.5-1 min and the second 1-2 min, to 6 metres' depth in the sea. The diagnosis was pr...
Article
Background: Post-decompression shock with plasma volume deficit is a very rare event that has been observed under extreme conditions of hypobaric and hyperbaric exposure in aviators and professional divers. Case report: We report a case of severe hypovolemic shock due to extravasation of plasma in a recreational scuba diver presenting with inner...
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Vascular bubble formation after decompression contributes to endothelial injuries which form the basis for the development of decompression sickness (DCS). Nitric oxide (NO) is a powerful vasodilator that contributes to vessel homeostasis. It has been shown that NO-releasing agent may reduce bubble formation and prevent serious decompression sickne...
Article
Immersion pulmonary edema in scuba divers is a rare disorder that tends to recur and can be potentially fatal, even in the absence of underlying cardiac disease. Anecdotal cases of reversible myocardial dysfunction have been described in this setting, but little is known of its pathogenesis. The purpose of the present study was to determine the cli...
Article
Inner ear decompression sickness (IEDCS) in scuba divers is increasingly observed, but epidemiological data are limited to small case series and the pathogenesis remains elusive. We report our experience over a 13-year period. We also thought to demonstrate that the development of this injury is mainly attributed to a mechanism of vascular origin....
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Individual or environmental factors that predispose to the recurrence of neurological decompression sickness (DCS) in scuba divers are not known and preventives measures designed to mitigate the risk of a subsequent episode remain empirical. The aim of this controlled study was to examine some potential risk factors predictive of recurrent DCS even...
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A low-grade process of coagulation activation in association with severe neurological decompression sickness (DCS) in divers has been anecdotally observed. We aimed to investigate whether measurement of plasma D-dimers and other hemostatic parameters in injured scuba divers were effective as prognostic biomarkers of neurological DCS, and we compare...
Article
Bubble-induced platelet aggregation offers an index for evaluating decompression severity in humans and in a rat model of decompression sickness. Endothelial cells, blood platelets, or leukocytes shed microparticles (MP) upon activation and during cell apoptosis. The aim was to study blood platelet MP (PMP) release and bubble formation after a scub...
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Decompression sickness often manifests as central nervous system impairment. We report a 49-year-old woman who developed an unusual case of spinal cord decompression sickness presenting as complete Brown-Sequard syndrome. Initial MRI revealed increased signal intensity in the left side of the cervical cord at the level of C2-C3. A second MRI at 10...
Article
Preventive measures to reduce the risk of decompression sickness can involve several procedures such as oxygen breathing during in-water decompression. Theoretical predictions also suggest that brief periods of recompression during the course of decompression could be a method for controlling bubble formation. The aim of this study was to get clear...
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This study was designed to examine the influence of short delay to recompression and other risk factors associated with the development of severe neurological decompression sickness (DCS) in military divers. Fifty-nine divers with DCS treated in less than 6 hours from onset of symptoms to hyperbaric recompression were included retrospectively. Divi...
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This study aims to determine the potential risk factors associated with the development of severe diving-related spinal cord decompression sickness (DCS). Two hundred and seventy nine injured recreational divers (42 ± 12 years; 53 women) presenting symptoms of spinal cord DCS were retrospectively included from seven hyperbaric centers in France and...
Article
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Rebreathers are routinely used by military divers, which lead to specific diving injuries. At present, there are no published epidemiologic data in this field of study. Diving disorders with rebreathers used in the French army were retrospectively analyzed since 1979 using military and medical reports. One hundred and fifty-three accidents have bee...
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We conducted a controlled study to assess the prevalence of brain MRI hyperintense signals and their correlation with right-to-left shunting (RLS) in military divers. We prospectively enrolled 32 asymptomatic military divers under 41 yr of age and 32 non-diving healthy subjects matched with respect to age and vascular disease risk factors. We exami...
Article
The outcome of spinal cord decompression sickness after scuba diving is unpredictable during the 24 first hours with a high risk of incomplete recovery. The treatment is defined on first aid normobaric oxygen when neurological symptoms occur, rehydration and prompt recompression in hyperbaric chamber. The presence of initial motor impairment, the a...
Article
Full-text available
Scuba divers are at risk of decompression sickness due to the excessive formation of gas bubbles in blood and tissues following ascent, with potentially subsequent neurological injuries. Since nonprovocative dive profiles are no guarantor of protection against this disease, novel means are required for its prevention including predive procedures th...
Article
The outcome of spinal cord decompression sickness after scuba diving is unpredictable during the 24 first hours with a high risk of incomplete recovery. The treatment is defined on first aid normobaric oxygen when neurological symptoms occur, rehydration and prompt recompression in hyperbaric chamber. The presence of initial motor impairment, the a...
Article
Various therapies take place in autism treatment. Cerebral hypoperfusion, neuro-inflammation and oxidative stress findings in autistic children have led clinicians to experiment hyperbaric oxygen therapy. To date, except two single case descriptions, only available results are about five case series, three of whom very briefly described, and two ra...
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Dysbaric osteonecrosis (DON) is a complication that usually occurs in professional divers or compressedair workers. Its correlation with a previous musculoskeletal decompression injury (i.e., 'limb bend') remains a controversial subject. There is little information about the prevalence of DON and its relationship to decompression sickness (DCS) in...
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The preconditioning of divers to reduce post-dive decompression sickness (DCS) has gained increased interest in diving medical research over the last few years. The beneficial effects of physical exercise, oxygen breathing, hyperbaric exposure, heat exposure, hyperhydration, or nitroglycerin administration before the dive are only a few examples of...
Article
This study was designed to determine the recompression strategy and the potential risk factors associated with the development of severe diving-related spinal cord decompression sickness (DCS). Sixty-three injured recreational divers (52 men and 11 women; 46 +/- 12 years) presenting with symptoms of spinal involvement were retrospectively included....
Article
We report the case of a 64-year-old healthy male diver who presented an unusual diving-related pulmonary edema induced by a painless myocardial infarction with normal coronary arteriography. We review the related literature and discuss the pathophysiologic mechanisms that would contribute to provoke this myocardial injury during diving.
Article
We report the case of a 64-year-old healthy male diver who presented an unusual diving-related pulmonary edema induced by a painless myocardial infarction with normal coronary arteriography. We review the related literature and discuss the pathophysiologic mechanisms that would contribute to provoke this myocardial injury during diving.
Article
Introduction: The mechanism of immersion pulmonary oedema occurring in healthy divers is a matter of debate. Among consecutive injured divers admitted to our hyperbaric centre, we analysed prospective data about pulmonary oedema. Method: A total of 22 divers suffering from immersion pulmonary oedema without cardiac disease were included. The occurr...
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Oxygen pre-breathing is routinely employed as a protective measure to reduce the incidence of altitude decompression sickness in aviators and astronauts, but the effectiveness of normobaric oxygen before hyperbaric exposure has not been well explored. The objective of this study was to evaluate the effect of 30-min normobaric oxygen (O(2)) breathin...
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This study investigated the influence of a far infrared-ray dry sauna-induced heat exposure before a simulated dive on bubble formation, and examined the concomitant adjustments in hemodynamic parameters. There were 16 divers who were compressed in a hyperbaric chamber to 400 kPa (30 msw) for 25 min and decompressed at 100 kPa x min(-1) with a 4-mi...
Article
Full-text available
Decompression sickness (DCS) affecting the spinal cord is the most dangerous form of diving-related injury with potential sequelae. This study was conducted to evaluate the relationship between spinal cord lesions on MRI and clinical findings in divers with spinal DCS. We studied 45 cases of DCS that were referred to our hyperbaric facility with cl...
Article
Full-text available
The role of right-to-left shunting (RLS) in spinal cord decompression sickness (DCS) remains uncertain and could differ according to the distribution of lesion in spinal cord with a higher risk of upper spinal cord involvement in divers presenting a large patent foramen ovale. The aims of this study were to assess the prevalence of RLS with transcr...
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Full-text available
Exercise at depth and during decompression is a commonly accepted factor that affects the risk of decompression sickness in divers and aviators, but data documenting these effects are limited and conflicting. The mechanisms may be complex and influenced by several factors, such as the type and nature of exercise, the temporal course of the exercise...
Article
Exercise at depth and during decompression is a commonly accepted factor that affects the risk of decompression sickness in divers and aviators, but data documenting these effects are limited and conflicting. The mechanisms may be complex and influenced by several factors, such as the type and nature of exercise, the temporal course of the exercise...
Article
To investigate whether prehydration 90 min before a dive could decrease bubble formation, and to evaluate the consequent adjustments in plasma volume (PV), water balance and plasma surface tension (ST). Eight military divers participated in a crossover trial of pre-dive hydration using saline-glucose beverage (protocol 1) and a control dive with no...
Article
Paradoxical gas embolism through right-to-left (R/L) shunts is considered as a potential cause of certain types of decompression sickness. To assess whether 4 months of repetitive diving and strenuous exercises would lead to an increased prevalence of R/L shunting in a group of military divers. Using a standardised contrast-enhanced transcranial Do...
Article
Objectifs L'ostéonécrose dysbarique est une complication osseuse associée à des expositions prolongées et répétées en environnement hyperbare et la corrélation avec un accident de décompression ostéomyoarticulaire antérieur reste un sujet controversé. Après avoir évalué les principaux facteurs de risque des accidents ostéomyoarticulaires chez les p...
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To evaluate the effects of a submaximal exercise performed 2 h before a simulated dive on bubble formation and to observe the haemodynamic changes and their influence on bubble formation. 16 trained divers were compressed in a hyperbaric chamber to 400 kPa for 30 min and decompressed at a rate of 100 kPa/min with a 9 min stop at 130 kPa (French Nav...