The effect of hyperbaric oxygen therapy on a burn wound model in human volunteers.

A previous nonblinded study has suggested beneficial effects from hyperbaric oxygen treatment of superficial partial-thickness radiation burns in human volunteers. This protocol was designed to either confirm or challenge these previous findings in a randomized, blinded format. Twelve healthy, nonsmoking volunteers (7 males, 5 females) participated. All were screened for contraindications to hyperbaric oxygen therapy (acute sinusitis, otitis media, pneumonia, pregnancy, active cancer, pneumothorax) and given a single test hyperbaric exposure. A standardized wound model was employed for the painless creation of a volar forearm lesion on volunteers by applying a suction device to form a blister, excising its epidermal roof, and irradiating the exposed dermis with ultraviolet light. Subjects were randomized into either a hyperbaric oxygen group (100% oxygen at 2.4 ATA, n = 6) or the sea-level air-breathing equivalent control group (8.75% oxygen at 2.4 ATA, n = 6). Both groups then underwent standard hyperbaric therapy. The subjects, the hyperbaric oxygen chamber operators, and the monitoring clinicians were all blinded to the oxygen concentration administered. Each subject received two dives per day over a 3-day period. The wounds were studied noninvasively prior to treatment and once per day over 6 days for size, hyperemia, and exudation, with epithelialization as the endpoint. The averages for each measurement of the hyperbaric oxygen group versus the control group were computed by means of a one-tail t test; p was considered significant at less than 0.05. Daily wound size, hyperemia, and exudation measurements were significantly different on day 2. The hyperbaric oxygen group showed a 42 percent reduction in wound hyperemia, a 35 percent reduction in the size of the lesion, and a 22 percent reduction in wound exudation (p values of 0.05, 0.03, and 0.04, respectively). No significant difference was noted for epithelialization. Observed differences in wound size, hyperemia, and exudation were attributable to hyperbaric oxygen therapy. This study further supports earlier conclusions that hyperbaric oxygen therapy is beneficial in a superficial dermal wound.

Continuous ambulatory peritoneal dialysis.

Many patients with end-stage renal disease are maintained on continuous ambulatory peritoneal dialysis (CAPD). This technique offers a number of advantages over hemodialysis, but it is associated with certain potential complications. Peritonitis and other infectious complications are the most commonly seen in the emergency department. The evaluation and management of other emergency problems may also need to be modified in patients on CAPD.

Pharyngoesophageal perforation after blunt neck trauma.

Pharyngoesophageal perforation secondary to blunt neck trauma is an uncommon injury that can cause serious morbidity and mortality if not recognized and treated. Pharyngeal perforation secondary to blunt trauma sustained while boxing is reported. Review of the world literature found 10 cases of pharyngoesophageal perforation secondary to blunt neck trauma. Analysis of these cases indicates that perforations less than 2 cm and limited to the pharynx may be treated medically with close observation. Large perforations and those perforations that extend to the esophageal inlet or involve the esophagus exclusively are best treated surgically.

Furosemide overdose and maximal allowable weight standards.

Adherence to the Maximal Allowable Weight (MAW) standards established by regulation can be difficult for many active duty personnel. We have discovered some members of this group utilizing the potentially dangerous rapid weight loss methods that are commonly seen in patients with bulimia and anorexia nervosa. Two cases of furosemide (Lasix) overdose in active duty members are presented in an effort to enlighten military clinicians concerning this hazardous practice in our patient population. Furosemide overdose related to a scheduled or mandatory weight measurement has not been previously reported.

Endometriosis arising in abdominal incisions.

The differential diagnosis of an incisional mass arising in a female includes endometriosis. The occurrence of abdominal scar endometriosis following hysterotomy is uncommon, being reported in less than 0.5% of patients undergoing cesarean section. Three cases of this unusual problem are reported, the experience at David Grant USAF Medical Center evaluated, and pertinent literature reviewed. The principles of surgical management include obtaining an accurate diagnosis and adequate excision.

A comparison of patients with endoscopic esophageal perforations and patients with Boerhaave's syndrome.

A review was conducted to ascertain whether patients who suffered spontaneous postemetic esophageal rupture (Boerhaave's syndrome) experienced higher morbidity and mortality than patients who had endoscopic iatrogenic esophageal perforations. Review of the records of three medical centers from 1960 to 1985 identified 11 patients with Boerhaave's syndrome (group B) and 19 with iatrogenic perforations (group E). In group B, four patients were diagnosed greater than 24 h after perforation. Nine were treated surgically; of these one died. Two group B patients who were treated conservatively survived. In group E, only four patients were diagnosed greater than 24 h after perforation. Of 19 patients, 15 were treated surgically and four, medically. In group E, three patients died (one surgically and two conservatively treated). This study suggests that there is little difference in mortality between the two groups of patients as long as the diagnosis is made early and therapy is instituted promptly.