Hyperbaric Medicine in Pediatrics — reality of a Portuguese reference center / Medicina Hiperbárica em Pediatria — realidade de um centro de referência português

ABSTRACT Objective: To identify and characterize the population of Pediatric patients referred to our hyperbaric oxygen therapy center. Methods: Retrospective and observational study, including pediatric patients treated with hyperbaric oxygen therapy, from 2006 to 2021, at the hyperbaric medicine reference center in the north of Portugal. Variables of interest were extracted from electronic medical records. Results: Our study included 134 patients. The most frequent reasons for referral were carbon monoxide poisoning (n=59) and sudden sensorineural hearing loss (n=41). In 75 cases (56%), treatment was initiated in an urgent context. Symptom presentation at Emergency Department varied among patients, the most frequent being headache and nausea/vomiting. Concerning carbon monoxide poisoning, the most common sources were water heater, fireplace/brazier, and boiler. Regarding adverse effects, it was identified one case of intoxication by oxygen and four cases of middle ear barotrauma. Conclusions: The most frequent cause for referral was carbon monoxide poisoning. All patients evolved favorably, with few side effects being reported, emphasizing the safety of this therapy. While most pediatricians may not be aware of the potential benefits arising with hyperbaric oxygen therapy, it is of upmost importance to promote them, so that this technique is increasingly implemented.

RESUMO Objetivo: Identificar e caracterizar a população de casos pediátricos encaminhados para o nosso centro de oxigenoterapia hiperbárica. Métodos: Estudo retrospetivo e observacional, que incluiu doentes pediátricos tratados com oxigenoterapia hiperbárica, de 2006 a 2021, no centro de referência de medicina hiperbárica do norte de Portugal. As variáveis de interesse foram extraídas dos processos clínicos eletrônicos. Resultados: O nosso estudo incluiu 134 casos. Os motivos de encaminhamento mais frequentes foram intoxicação por monóxido de carbono (n=59) e surdez súbita neurossensorial (n=41). Em 75 casos (56%) o tratamento foi iniciado em contexto de urgência. Os sintomas de apresentação à admissão variaram entre os diferentes casos, sendo os mais frequentes cefaleias e náuseas/vômitos. No que diz respeito à intoxicação por monóxido de carbono, as fontes mais comuns foram o aquecedor, lareira/braseiro e caldeira. Com relação aos efeitos adversos, foram identificados um caso de intoxicação por oxigênio e quatro casos de barotrauma do ouvido médio. Conclusões: A causa mais frequente de encaminhamento foi a intoxicação por monóxido de carbono. Todos os pacientes evoluíram favoravelmente e foram registrados poucos efeitos adversos, o que enfatiza a segurança desta terapia. Uma vez que a maioria dos pediatras pode não estar informada sobre os potenciais benefícios da oxigenoterapia hiperbárica, é de extrema importância promovê-los para que esta técnica seja cada vez mais implementada.

Effects of different treatment measures on the efficacy of diabetic foot ulcers: a network meta-analysis.

Introduction: Through a network meta-analysis, we compared different treatment measures for patients with diabetic foot ulcers (DFU), assessing their impact on the healing of DFU and ranking them accordingly. Methods: We searched the PubMed, the China National Knowledge Infrastructure (CNKI), Embase, the WanFang and the WeiPu database. The retrieval time was from database establishment to January 2024, and retrieval entailed subject and free words. Randomized controlled trials (RCTs) with different treatment measures for DFU were included. Data extraction and evaluation were based on the PRISMA guidelines. Meta-analyses using pairwise and network methods were employed to compare and rank the effectiveness of different treatments for DFU. Results: Ultimately, we included 57 RCTs involving a total of 4,826 patients with DFU. When it comes to ulcer healing rates, compared to standard of care(SOC),platelet-rich plasma(PRP), hyperbaric oxygen therapy(HBOT), topical oxygen therapy(TOT), acellular dermal matrix(ADM), and stem cells(SCs) in both direct meta-analysis(DMA) and network meta-analysis(NMA) can effectively increase the complete healing rate. For Scs+PRP, a statistically significant improvement was only observed in the NMA. Moreover, when compared to the negative pressure wound therapy(NPWT) group, the PRP+NPWT group was more effective in promoting the complete healing of ulcers. In terms of promoting the reduction of ulcer area, no statistical differences were observed among various treatment measures. When it comes to ulcer healing time, both PRP and NPWT can effectively shorten the healing time compared to SOC. Furthermore, when compared to the NPWT group, the combined treatment of PRP and ultrasonic debridement(UD) with NPWT is more effective in reducing healing time. In terms of amputation rates and adverse reactions, the PRP group effectively reduced the amputation rate and adverse reactions for patients with DFU. Additionally, compared to the NPWT group, the combined treatment of PRP and UD with NPWT reduced the incidence of adverse reactions. However, no significant differences were observed among other treatment measures in terms of amputation rates and adverse reactions. The ranking results showed that the efficacy of PRP+NPWT and UD+NPWT in promoting ulcer healing, reducing ulcer area, shortening healing time, decreasing amputation rates and adverse reactions is superior to that of the alone PRP group, NPWT group, and UD group. Conversely, the SOC group demonstrates the least effective performance in all aspects. Conclusion: Due to the particularity of the wound of DFU, the standard of care is not effective, but the new treatment scheme has a remarkable effect in many aspects. And the treatment of DFU is not a single choice, combined with a variety of methods often achieve better efficacy, and will not bring more adverse reactions.

Hyperbaric oxygen therapy as a neuromodulatory technique: a review of the recent evidence.

Hyperbaric oxygen therapy (HBOT) has recently emerged as a promising neuromodulatory modality for treating several neurological and psychological disorders. Various studies indicate that HBOT can promote brain recovery and neuroplasticity through the modulation of key cellular and molecular mechanisms. HBOT affects multiple primary pathways and cellular functions including mitochondrial biogenesis and function (increased Bcl-2, reduced Bax, and enhanced ATP production), neurogenesis (upregulation of Wnt-3 and VEGF/ERK signaling), synaptogenesis (elevated GAP43 and synaptophysin expression), and anti-inflammatory responses (reduced TNF-α and IL-6). These mechanisms contribute to significant clinical benefits, such as enhanced cognitive function, improved recovery from traumatic brain injury and post-concussion syndrome, and symptom reduction in conditions like post-traumatic stress disorder and fibromyalgia. By influencing these molecular targets, HBOT offers a novel approach to neuromodulation that warrants further exploration. This review discusses the representative mechanisms of action of HBOT and highlights its therapeutic neuromodulatory effects and potential clinical applications across various neurological and psychiatric conditions.

New insights into the mechanisms and prevention of central nervous system oxygen toxicity: A prospective review.

Hyperbaric oxygen therapy (HBOT) elevates the pressure of life-sustaining oxygen (pO2), thereby saving lives. However, HBOT can also cause toxic effects like lung and retinal damage (peripheral oxygen toxicity) and violent myoclonic seizures (central nervous system (CNS) toxicity). The mechanisms behind these effects are not fully understood, hindering the development of effective therapies and preventive strategies. Herein, we critically reviewed the literature to understand CNS oxygen toxicity associated with HBOT to elucidate their mechanism, treatment, and prevention. We provide evidence that (1) increased pO2 increases reactive oxygen species (ROS) concentration in tissues, which irreversibly alters cell receptors, causing peripheral oxygen toxicity and contributing to CNS oxygen toxicity. Furthermore, (2) increased ROS concentration in the brain lowers the activity of glutamic decarboxylase (GD), which lowers concentrations of inhibitory neurotransmitter γ-aminobutyric acid (GABA), thereby contributing to the onset of HBOT-derived seizures. We provide long-overlooked evidence that (3) elevated ambient pressure directly inhibits GABAA, glycine and other receptors, leading to the rapid onset of seizures. Additionally, (4) acidosis facilitates the onset of seizures by an unknown mechanism. Only a combination of these mechanisms explains most phenomena seen in peripheral and CNS oxygen toxicity. Based on these proposed intertwined mechanisms, we suggest administering antioxidants (lowering ROS concentrations), pyridoxine (restoring GD activity), low doses of sedatives/anesthetics (reversing inhibitory effects of pressure on GABAA and glycine receptors), and treatment of acidemia before routine HBOT to prevent peripheral and CNS oxygen toxicity. Theoretically, similar preventive strategies can be applied before deep-sea diving to prevent life-threatening convulsions.

Cerebral air embolism following a hemodialysis session successfully treated with hyperbaric oxygen: a case report.

We describe here the first case of cerebral air embolism (CAE) due to a dysfunctional long-term central venous catheter for hemodialysis in a 39-year-old woman with a history of lung transplantation. Air emboli are rare but potentially fatal complications of hemodialysis, in particular, when they involve the brain. Early management with hyperbaric oxygen therapy (HBOT) is critical to prevent deterioration of the patient's condition. In this case, our patient presented her first symptoms, likely a seizure due to multiple cerebral air emboli, during her hemodialysis session. She was then monitored in the Nephrology Intensive Care Unit in accordance to the medical reference center (with HBOT). Twelve hours later, she experienced secondary deterioration, presenting with acute aphasia, left hemineglect syndrome, and hemiplegia. She was rapidly transferred to the medical reference center for HBOT. The patient fully recovered after receiving three sessions of HBOT. She also presented a seizure during each HBOT session, attributed to hyperoxia. She never experienced another seizure after the episode of CAE. This case highlights the importance of considering patients who have a lung transplant to be at increased risk for air emboli during hemodialysis and the need to rapidly recognize symptoms and start treatment, including HBOT, to optimize recovery.

Impacts of Hyperbaric Oxygen Therapy (HBOT) on Verbal Scores in Children With Autism: A Secondary Analysis of the HBOT Trial Using Multivariate Analysis of Variance (MANOVA).

Introduction A secondary analysis employing advanced statistical methodologies constitutes a robust means of validating initial findings in systematic empiricism. The current research will undertake a secondary analysis of the impacts of Hyperbaric Oxygen Therapy (HBOT) on verbal behaviors in children with autism using the original dataset. This approach aims to enhance the robustness of the initial results, thereby providing a deeper understanding of the data and potentially uncovering additional insights. Materials and methods From January 2018 to July 2021, all cohorts of autistic children (n = 65) were scheduled, evaluated, and treated at The Oxford Center (TOC) in Brighton and Troy, Michigan, USA. Trained research assistants retrospectively extracted pretest and posttest data from electronic medical records from the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) and the Assessment of Basic Language and Learning Skills (ABLLS). This data collection focused on children with autism who received either non-HBOT control with Applied Behavior Analysis (ABA) treatment only or ABA + HBOT interventions. For the VB-MAPP, the experimental group (ABA + HBOT) included 23 children, while the control group (ABA only) included 12 children. For the ABLLS, the experimental group (ABA + HBOT) consisted of nine children, compared to 21 children in the control group (ABA only). Demographic information was systematically summarized. Two independent sample t-tests were recomputed from the original study. Multivariate Analysis of Variance (MANOVA) were conducted, followed by one-way Analyses of Variance (ANOVA) post hoc analyses to elucidate the findings. Results The ages in both groups ranged from 2 to 17 years (M = 5.7 years ± 3.08), with median ages of four years for the experimental group and five years for the control group. The p-values and effect sizes indicated that the two independent sample t-tests from the original study and the MANOVAs from the current research are in agreement. This concordance provided confirmatory evidence for the validity of the pretest and posttest differences in VB-MAPP and ABLLS scores for the control group (ABA only) and the experimental group (ABA + HBOT), highlighting the impact of HBOT on verbal scores in children with autism. Conclusions The results from the two independent sample t-tests from the initial study exhibited high alignment with those derived from the current study's MANOVAs. Both statistical methodologies were applied to the same VB-MAPP and ABLLS datasets. The convergence of results from these two distinct statistical analyses may reinforce the credibility of the original research findings. It supports the hypothesis that the combined ABA and HBOT intervention may offer additional benefits over ABA therapy alone, with verbal milestone behaviors in children with autism.

Critical flicker fusion frequency results during oxygen decompression in standard HBOT session - observational study.

Most hyperbaric medicine reports concentrate on the patient and his morbidities. In addition to the well-known indications for hyperbaric oxygen therapy (HBOT), we cannot discount possible side effects. Among medical staff regularly exposed to hyperbaric conditions the best described so far is decompression sickness. A non-invasive and easily available way to assess cognitive functioning involves the use of the critical flicker fusion frequency (CFFF) test. In the current study, the flicker test was performed several times on 21 subjects, both under normobaric and hyperbaric conditions. The test was conducted using the device that flickering was programmed according to the method of limits. While in the hyperbaric chamber, 15 of the participants breathed oxygen to reduce the risk of decompression sickness. Flicker and fusion frequencies differed from each other in both normo- and hyperbaric conditions (p < 0.01). CFFF results were dependent on oxygen breathing during decompression.

Hyperbaric oxygen therapy enhances restoration of physical functional in patients with recurrent glioma: A case report.

Patients with recurrent glioblastoma often opt for hypofractionated stereotactic radiosurgery, which can cause various adverse reactions. The pharmacological interventions used to manage these adverse reactions are usually unsatisfactory. The present study reports the case of a patient with recurrent glioblastoma who underwent hyperbaric oxygen therapy followed by immediate hypofractionated stereotactic radiosurgery. Grip strength, isokinetic muscle testing and gait analysis were evaluated during the treatment period, spanning an interval of 7 days in March 2023. Assessments before and after treatment revealed improvements in all three parameters compared with pre-treatment levels. In summary, combining hyperbaric oxygen therapy with hypofractionated stereotactic radiosurgery may enhance muscle strength in patients with recurrent glioblastoma. This treatment approach can lead to significant improvements in gait parameters, promoting better motor coordination. Furthermore, the combined therapy could offer a promising alternative for managing muscle weakness and mobility issues after glioblastoma recurrence.

A comprehensive evaluation of efficacy of hyperbaric oxygen therapy in non-arteritic central retinal artery occlusion using enhanced depth imaging optical coherence tomography.

This study aimed to assess the efficacy of hyperbaric oxygen therapy (HBOT) in patients with central retinal artery occlusion (CRAO) by analyzing changes in visual acuity (VA) and enhanced depth imaging optical coherence tomography (EDI-OCT) parameters. A comparative retrospective study was conducted by reviewing the medical records of all HBO-treated RAO patients in our department and comparing them with matched RAO patients who did not receive HBO treatment. All patients treated with HBO received treatment within 7 days of the onset of visual symptoms. Baseline characteristics were compared, and VA and OCT parameters were evaluated at baseline and follow-up visits. A total of 50 eyes from 50 patients were included, with 29 eyes in the HBOT group and 21 eyes in the control group. The mean BCVA of the HBOT group at the initial visit was 2.03 logMAR, which improved to 1.55 logMAR at 6 months, with the change being statistically significant (P < 0.01), while the control group's BCVA remained almost unchanged, from 2.1 to 2.11 logMAR (P = 0.762). The central choroidal thickness increased significantly in the HBOT group over the subsequent period. The central fovea, and outer retinal layer thickness in the HBOT group were significantly greater than those in the control group at the 6-month follow-up after treatment. HBOT appears to be effective in improving VA and inducing favorable changes in OCT parameters in patients with CRAO. It helps to preserve retinal layer thickness, especially in the outer retinal layer.

Efficacy of combined hyperbaric oxygen therapy and topical haemoglobin spray in treating hard-to-heal sloughy wounds.

OBJECTIVE: This study examined the effectiveness of a combination of hyperbaric oxygen therapy (HBOT) and topical haemoglobin spray in treating hard-to-heal, sloughy diabetic foot ulcers (DFUs). METHOD: Patients with hard-to-heal DFUs at least 25% sloughy or necrotic were included in the study. We compared the results of patients who received standard of care and HBOT with topical haemoglobin spray (oxygen group) to an equal number of patients who only received standard personalised wound care (control group). The initial values of haemoglobin A1C and C-reactive protein, wound culture results and SINBAD (site, ischaemia, neuropathy, bacterial infection, area, depth) scores were documented. Wounds were considered healed when completely closed within 16 weeks. RESULTS: The oxygen group (n=21) had a mean SINBAD score of 5.00±0.89, while the control group (n=21) had a mean score of 4.62±0.80 (p=0.155). After 16 weeks, 85.7% of wounds in the oxygen group showed complete recovery, compared with 52.4% in the control group (p=0.02). CONCLUSION: In this study, a greater number of wounds in the oxygen group healed. Combining HBOT with topical haemoglobin spray provides oxygenation to the wound for longer, primarily because patients can receive 90 minutes of HBOT daily. This ensures that patients benefit from both systemic and local oxygen. This combination therapy may effectively address the problem of hypoxia and promote healing in hard-to-heal wounds.

Refractory Crohn's Disease: Perspectives, Unmet Needs and Innovations.

Crohn's disease (CD) is a complex, chronic inflammatory bowel disease characterized by unpredictable flare-ups and periods of remission. Despite advances in treatment, CD remains a significant health burden, leading to substantial direct healthcare costs and out-of-pocket expenses for patients, especially in the first-year post-diagnosis. The impact of CD on patients' quality of life is profound, with significant reductions in physical, emotional, and social well-being. Despite advancements in therapeutic options, including biologics, immunomodulators, and small molecules, many patients struggle to achieve or maintain remission, leading to a considerable therapeutic ceiling. This has led to an increased focus on novel and emerging treatments. This context underscores the importance of exploring advanced and innovative treatment options for managing refractory CD. By examining the latest approaches, including immunomodulators, combination therapies, stem cell therapies, and emerging treatments like fecal microbiota transplantation and dietary interventions, there is an opportunity to gain a comprehensive understanding of how best to address and manage refractory cases of CD.

The Impact of Poststroke Aphasia on Quality of Life: A Comparative Cross-Sectional Study.

OBJECTIVES: The study aimed to analyze the impact of aphasia on quality of life (QoL) in persons with ischemic stroke per radiological severity, compare equally severe but nonaphasic stroke survivors, and analyze the impact of hyperbaric oxygen therapy (HBOT) exposure. Methods: Patients with first-ever middle cerebral artery (MCA) stroke were categorized by radiological severity into high, intermediate, and low Alberta Stroke Program Early CT Score (ASPECTS). The Stroke Aphasia Quality of Life (SAQoL) Scale was used for outcome analysis. Inclusion criteria were age 40-65, 12-16 months after stroke, MCA distribution, first stroke, and ischemic stroke. Exclusion criteria were mixed vessel involvement and concomitant neurological, orthopedic, or psychiatric comorbidities. RESULTS: Among 93 patients with ischemic stroke, 87% presented with intermediate-to-low ASPECTS. According to the SAQoL, locomotion and transfers were the most compromised. QoL was significantly negatively correlated with higher ASPECTS and greater stroke impact in those with aphasia overall (p = 0.001). Those who received HBOT overall were significantly better than those who did not, regardless of group (p = 0.02 and 0.03). CONCLUSION: The present study shows that the radiological severity of stroke relates to QoL in those with poststroke aphasia. Among those with equal radiological severity, those with aphasia are worse off. Those who receive HBOT have better QoL.

Photodynamic Therapy Healing a Refractory Radiation-Induced Ulcer on the Chest Wall Postmastectomy Radiotherapy for Breast Cancer: A Case Report and Literature Overview.

Photodynamic therapy (PDT) has been used to treat cancers. It has also been used to treat infectious diseases and inflammatory conditions. PDT promotes wound healing, while clinical use of PDT for wound healing is uncommon and not thoroughly investigated. We report a 75-year-old female with a radiation-induced non-healing ulcer for five years on the chest wall postmastectomy radiotherapy. Biopsy showed epidermal erosion with dermal inflammation but no recurrent cancer. She was referred from the wound care clinic after multiple unsuccessful attempts to manage wound healing for two years involving daily home nursing visits. PDT was discussed with the patient who consented to PDT instead of hyperbaric oxygen therapy (HBOT) for fear of its side effects. Her wound improved after a total of three treatments and the process of wound healing continued for 14 months since her first treatment session. The presented case supports the beneficial effects of PDT on chronic ulceration impeding healing of a postmastectomy radiotherapy wound. To our knowledge, this report is unique in documenting details of PDT healing a chronic refractory ulcer of five years, which developed after cancer therapy (mastectomy and radiotherapy). Further clinical study of PDT is needed on wound healing post-surgery and radiation in cancer patients. An overview of HBOT in comparison with PDT for wound healing is presented.

Limb Salvage in Extensive Necrotizing Soft Tissue Infection with Adjuvant Hyperbaric Oxygen Therapy.

A necrotizing soft tissue infection (NSTI) can be life-threatening if not treated promptly, posing a high risk of limb amputation. Here, we report a case of an NSTI extending from the buttocks and perineum down to the left lower limb. The case involved a 48-year-old male patient who presented with fever, altered consciousness, and limb swelling. Computed tomography showed the infection had spread to the perifascial, intermuscular, and intramuscular regions, making it difficult to save the patient's life and limb. Despite prompt surgery and antibiotic treatment, multidrug-resistant bacteria presented difficult wound management challenges. Hyperbaric oxygen therapy (HBO) was initiated, which resulted in dramatic wound improvement and successful skin grafting. Due to limb preservation, the patient was able to recover his preadmission activities of daily living and successfully reintegrate into society. Standard treatments for NSTI include early surgical treatment, antibiotics, and intensive support. The adjunctive use of HBO therapy may have contributed to the successful outcome in this case.

Radiation effects in head and neck and role of hyperbaric oxygen therapy: An adjunct to management.

Background: Radiotherapy is considered an essential treatment modality in cancers, especially head and neck cancers. Radiotherapy can be given as a definitive, supportive, or adjuvant therapy for various cancers. Radiation damage is an avoidable complication in many patients, after or during radiotherapy. It may be either dose-related, duration-related, or frequency-related. The effects of radiation damage are mainly caused by ischemic necrosis, and once settled it is difficult to manage due to the low vascularity of the affected area. Aim: To find out the effectiveness of hyperbaric oxygen therapy (HBOT) in the management of radiation damage in the head and neck region. Materials and Methods: Retrospective data of patients attending the HBOT clinic for postradiotherapy changes were recorded in an Excel sheet and analyzed in this study. Statistical analysis was done. Result: Our study showed that HBOT is effective in postradiation trismus, xerostomia, discharge, foul smell, discharging sinus, etc., However, it was not found to be significant in the closure of fistula with exposed bone. Conclusion: HBOT is an effective adjunct modality for the management of postradiation changes in the head and neck region.

Successful management of renal abscess secondary to diabetes mellitus with surgical treatment and hyperbaric oxygen therapy.

Renal abscess (RA) is a collection of infective fluid in or around the renal parenchyma. It typically occurs in immunocompromised patients, including those with diabetes mellitus (DM), poor nutritional status, or steroid administration. We herein report a case of RA associated with DM in which hyperbaric oxygen (HBO2) therapy greatly contributed to the resolution of this disease. The patient was an 85-year-old man with poorly controlled type 2 DM. Contrast-enhanced computed tomography for postoperative follow-up of appendiceal cancer showed a mass lesion with poor contrast enhancement extending from the upper pole of the left kidney to the dorsal side. Therefore, a diagnosis of RA was established. The lesion was percutaneously punctured, and a drainage tube was placed. Antibiotics following sensitivity testing were administered. The catheter was removed six days after its placement. However, pus discharge continued from the catheter removal site, with persistent redness around the wound. Therefore, a lumbotomy incision for abscess drainage was performed on the 49th day. However, the pus discharge persisted, and we decided to perform HBO2 therapy, expecting decreases in bacterial proliferation, reduction in local edema, and improvement of host defense. HBO2 therapy for 90 min at two atmospheres absolute was performed ten times. The amount of pus discharge decreased, and redness improved from the fifth day after HBO2 therapy. One month after starting HBO2 therapy, the wound was closed, and the pus discharge resolved completely. Four years have passed since the HBO2 therapy, and there have been no symptomatic or imaging relapses of RA.

Effects of Hyperbaric Oxygen Therapy for Malignant Bowel Obstruction Caused by Peritoneal Dissemination.

INTRODUCTION: This study aimed to investigate the efficacy of hyperbaric oxygen therapy (HBOT) in patients presenting with malignant bowel obstruction (MBO) and peritoneal dissemination. MATERIALS AND METHODS: We retrospectively examined whether HBOT affects prognosis following MBO with peritoneal dissemination. This study included 44 patients diagnosed with MBO secondary to peritoneal dissemination at our hospital between January 2013 and December 2022. Among these patients, 30 underwent HBOT. The treatment protocol involved daily HBOT administration, comprising 100% oxygen at 2.5 atmospheres absolute for 60 min. RESULTS: In a univariate analysis of HBOT and non-HBOT groups, the proportion of patients able to resume eating was significantly higher in the HBOT group. Therefore, the percentage of patients in the non-HBOT group whose MBO did not improve was significantly higher than that in the HBOT group. The percentage of patients undergoing surgery or receiving anticancer treatment did not differ significantly between the groups, whereas overall survival was significantly longer in the HBOT group. Furthermore, when examining inoperable patients, significantly more individuals in the HBOT group could resume eating, and their overall survival was significantly prolonged. CONCLUSIONS: HBOT may increase the spontaneous resolution rate and improve long-term prognoses of patients with MBO secondary to peritoneal dissemination.

Oxidative hemolytic crises in a dog due to fragrance products: clinical insights and treatment approaches.

IMPORTANCE: This is the first reported case of fragrance products-induced recurrent oxidative hemolytic anemia in a dog, detailing the successful therapeutic approach employed. CASE PRESENTATION: A 4-year-old intact female Pomeranian dog presented with brown tongue, pigmenturia, peripheral edema, and vomiting. Blood smears revealed a high count of eccentrocytes and Heinz bodies, along with a precipitous decline in packed cell volume and an increase in blood methemoglobin levels, suggesting an oxidative hemolytic crisis. This clinicopathological pattern recurred several times after the patient returned home. Antioxidants, methylene blue, hyperbaric oxygen (HBO) therapy, and blood transfusion were successfully employed to address recurrent hemolytic anemia; however, oxidative hemolytic crises recurred. After the owner removed exposure to various home remedies and fragrances, the clinical signs and hemolytic crises did not recur. CONCLUSIONS AND RELEVANCE: Recurring oxidative hemolytic crises should raise suspicions of environmental toxicity, which, although harmless in small quantities to humans, can be devastating to small-breed dogs. In addition to removing the causative agents, methylene blue and other antioxidants, along with HBO, may be beneficial in the acute management of oxidative hemolytic anemia.

Hyperbaric Oxygen Therapy during Pregnancy for Critical Anemia Secondary to Sickle Cell Disease with Post-Transfusion Hyperhemolysis: A Case Report.

Background: Sickle cell disease is the most common human monogenetic disease, and its risks are amplified during pregnancy. Methods: This report describes a 35-year-old woman with HgbSS sickle cell disease who developed hyperhemolysis syndrome after undergoing an exchange transfusion during pregnancy. Results: In addition to conventional medical treatment, the patient received prepartum hyperbaric oxygen therapy (HBOT), totaling 17 treatments for the indication of severe anemia. She experienced significant clinical improvement while undergoing HBOT and ultimately delivered a healthy preterm infant by cesarean section. Conclusions: The risks, benefits, and challenges of using HBOT in this unique context are discussed.