Retinal artery occlusion: visual outcome after treatment with hyperbaric oxygen.

METHODS: We describe a case series of 11 patients with retinal artery occlusion treated with hyperbaric oxygen therapy (HBOT) at Intermountain Dixie Regional Medical Center between 2005 and 2009. We then combined data from our case series with data from two other case series to report on a combined total of 51 patients. RESULTS: Eight of our 11 patients achieved improved visual acuity. Analysis of the combined case series showed that 74 % of patients treated with HBOT had improvement in visual acuity (P < 0.0001) with 53 % improving two lines or more on a modified Snellen value. The combined case series also showed that visual acuity improved in all time-from-occlusion to treatment categories, ranging from less than 8 hours to six days. CONCLUSIONS: We recommend consideration of HBOT for patients who present with recent retinal artery occlusion. Hyperbaric centres treating these patients should consider forming a central registry of standardised data to prospectively study the results of therapy.

Diagnosis and Treatment of Type II Necrotizing Fasciitis in a Child Presenting With a Minor Abrasion, Edema, and Apparent Bruising .

 Pyoderma gangrenosum (PG) is associated with systemic disease, mostly rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), in many patients (more than 50%). Lesions associated with arthritis are often ulcerative. Although these lesions typically affect the lower limbs, they can also affect the entire body. Successful therapy involving monoclonal antibodies seems to favor an autoimmune etiopathogenesis that has disorders of neutrophils' chemotactic activity and interleukins, which are acted upon by TNF-α cytokines. The ulcers grow rapidly, exacerbate after trauma, and necrosis can invade each skin layer up to the fascia. Therefore, debridement is contraindicated because it introduces the so-called "pathergy" mechanism. The diagnosis is quite difficult and is often made late due to the lack of indicative clinical and laboratory findings. The following is a report of a case of multiple, ulcerative, PG ulcers induced by arthritis. The ulcers occurred over several occasions with large and aggressive necrosis reaching the osseous plane in the heel and elbow. The high IgE values (between 2000 UI/mL and 3000 UI/mL) suggested that a type I immunitary reaction, such as in-skin anaphylaxis, was involved. Nevertheless, the antigen remains unknown and the genesis may be multifactorial. A corticosteroid (prednisolone) was the first-line systemic treatment used in this case and caused rapid improvement. Further investigations will be necessary to understand the meaning of this immunologic disorder .

Combined Treatment Modalities of Hyperbaric Oxygen Therapy, Bilayer Matrix Wound Dressing, and Negative Pressure Therapy in Patients with Failed Temporoparietal Fascia Flaps.

Temporoparietal fascia flaps are reported to have a 94% success rate in auricular reconstruction. Bilayer matrix (Integra™, Integra LifeSciences, Plainsboro, NJ) dermal graft alone has an average success rate of 76.6%. When combined with fibrin glue and negative pressure therapy (V.A.C.® Freedom®, KCI, San Antonio, Tex) the flaps have a success rate of up to 98% in patients with a variety of wound types and sites. Two patients are presented with failed temporoparietal fascia flaps. In addition, one also had prior failure of a split-thickness skin graft; the second also had failure of prior Integra split-thickness skin graft, and hyperbaric oxygen therapy. All 3 treatment modalities of bilayer dermal graft, negative pressure therapy, and hyperbaric oxygen used simultaneously allowed both flaps to heal.