Efficiency of hyperbaric oxygen and steroid therapy in treatment of hearing loss following acoustic trauma.

INTRODUCTION: Most commonly used treatment modalities for acute acoustic trauma (AAT) include steroid and hyperbaric oxygen (HBO2) therapy. The aim of this study is to investigate the effectiveness of combined steroid and HBO2 therapy in patients who develop AAT during firearms training and the effect of delay to treatment on treatment success. MATERIALS AND METHODS: Patients admitted with the complaint of hearing loss after firearms training between January 2011 and April 2013 were evaluated retrospectively. Patients were grouped according to date of admission; patients admitted within the first 10 days were included in Group A and those admitted between Days 11 and 30 in Group B. RESULTS: A total of 48 patients (73 ears) with AAT were included. There were 37 ears in Group A and 36 ears in Group B. The number of ears with complete treatment response, partial treatment response and treatment failure (unchanged) were one (2.7%), 7 (18.9%) and 29 (78.4%) in Group A and 0 (0%), 3 (8.3%) and 33 (91.7%) in Group B, respectively. There was no statistically significant difference between the groups (p = 0.095). Late-term results (at Week 6) demonstrated Group A showed higher hearing gain on high frequencies than Group B (p < 0.05), but this result was not consistent with clinical outcome results. CONCLUSION: The success rate of combined HBO2 and steroid therapy was very low in our study. However, early initiation of treatment results in better outcomes. Protective measures have great importance in preventing AAT.

Serum neuron-specific enolase and S-100ß levels as prognostic follow-up markers for oxygen administered carbon monoxide intoxication cases.

Serum neuron-specific enolase (NSE) and S-100ß levels are considered novel biochemical markers of neuronal cell injury. In this study, the initial and post-treatment levels of NSE and S-100ß were compared in carbon monoxide (CO) poisoning patients, who received normorbaric oxygen (NBO) or hyperbaric oxygen (HBO) therapy. Forty consecutive patients with acute CO poisoning were enrolled in this prospective, observational study. According to their clinical symptoms and observations, twenty patients were treated with NBO, and the other twenty with HBO. Serum S-100ß and NSE levels were measured both at time of admission and 6 h later (post-treatment). Serum NSE and S-100ß values decreased significantly in both of the therapeutic modalities. The initial and post-treatment values of NSE and S-100ß in NBO or HBO patients were comparable. A clear negative correlation was observed between the decrease of NSE and S-100ß levels and initial blood carboxyhemoglobin levels. In conclusion, the present results suggested the use of serum S-100ß and NSE levels as indicators for brain injury. Due to the significant increase of their values with oxygen therapy, they may also be useful as prognostic follow-up markers. However, the current findings reflected no difference between the efficacy of NBO or HBO therapy.

The efficacy of hyperbaric oxygen therapy in the management of chronic fatigue syndrome.

OBJECTIVE: Chronic fatigue syndrome (CFS) is a chronic disease with social components that ensue secondary to the incapacity of the person to fulfill work, social and family responsibilities. Currently, there is no consensus regarding its treatment. The aim of this study was to determine the efficacy of hyperbaric oxygen (HBO2) therapy in CFS. DESIGN: Sixteen patients included in the study were diagnosed with CFS according to the Fukuda criteria. Patients received 15 treatment sessions of HBO2 therapy over a period of three consecutive weeks (five days per week). The outcome measures (visual analog fatigue scale (VAFS). Fatigue Severity Scale (FSS) and Fatigue Quality of Life Score (FQLS) were assessed before the treatment and after completion of the 15 sessions. RESULTS: HBO2 therapy was well tolerated, with no complications. After treatment, patients' scores were found to have improved with respect to VAFS, FSS and FQLS (all p<0.005). CONCLUSIONS: We ,may infer that HBO2 therapy decreases the severity of symptoms and increases the life quality of CFS patients. It may be a new treatment modality for the management of CFS. However, further studies with larger sample sizes and control groups are definitely awaited.

Hyperbaric oxygen treatment in delayed post-hypoxic encephalopathy following inhalation of liquefied petroleum gas: a case report.

Delayed post-hypoxic encephalopathy can occur after an episode of anoxia or hypoxia. Symptoms include apathy, confusion, and neurological deficits. We describe a 47-year-old male patient who inhaled gas from a kitchen stove liquid petroleum gas cylinder. He was diagnosed with hypoxic ischaemic encephalopathy 12 hours after his emergency department admission. He received six sessions of hyperbaric oxygen treatment (HBOT) and was discharged in a healthy state after six days. Fifteen days later, he experienced weakness, loss of appetite, forgetfulness, depression, balance problems, and inability to perform self-care. One week later, he developed urinary and fecal incontinence and was diagnosed with post-hypoxic encephalopathy. After 45 days from the onset of symptoms, he was referred to the Underwater and Hyperbaric Medicine Department for HBOT. The patient exhibited poor self-care and slow speech rate, as well as ataxic gait and dysdiadochokinesia. Hyperbaric oxygen was administered for twenty-four sessions, which significantly improved the patient's neurological status with only hypoesthesia in the left hand remaining at the end of treatment. Hyperbaric oxygen has been reported as successful in treating some cases of delayed neurological sequelae following CO intoxication. It is possible that HBO therapy may also be effective in delayed post-hypoxic encephalopathy from other causes. This may be achieved through mechanisms such as transfer of functional mitochondria to the injury site, remyelination of damaged neurons, angiogenesis and neurogenesis, production of anti-inflammatory cytokines, and balancing of inflammatory and anti-inflammatory cytokines.

Evaluation of the oxidative effect of long-term repetitive hyperbaric oxygen exposures on different brain regions of rats.

Hyperbaric oxygen (HBO(2)) exposure affects both oxidative and antioxidant systems. This effect is positively correlated with the exposure time and duration of the treatment. The present study aims enlightening the relation of HBO(2) with oxidative/antioxidant systems when administered in a prolonged and repetitive manner in brain tissues of rats. Sixty rats were divided into 6 study (n = 8 for each) and 1 control (n = 12) group. Rats in the study groups were daily exposed 90-min HBO(2) sessions at 2.8 ATA for 5, 10, 15, 20, 30 and 40 days. One day after the last session, animals were sacrificed; their whole brain tissue was harvested and dissected into three different regions as the outer grey matter (cortex), the inner white matter and cerebellum. Levels of lipid peroxidation and protein oxidation and activities of superoxide dismutase and glutathione peroxidase were measured in these tissues. Malondialdehyde, carbonylated protein and glutathione peroxidase levels were found to be insignificantly increased at different time-points in the cerebral cortex, inner white matter and cerebellum, respectively. These comparable results provide evidence for the safety of HBO treatments and/or successful adaptive mechanisms at least in the brain tissue of rats, even when administered for longer periods.

Long-term exposure to repetitive hyperbaric oxygen results in cumulative oxidative stress in rat lung tissue.

CONTEXT: Despite its known benefits, hyperbaric oxygen (HBO) is also reported to enhance the production of reactive oxygen species and can cause oxidative stress in several tissues. Previous studies had shown that HBO-induced oxidative stress is directly proportional to both its exposure pressure and duration. Nevertheless, these studies were usually performed with single-session HBO exposure but its clinical use commonly depends on long-term exposure periods. OBJECTIVE: To clarify the oxidative effect of long-term repetitive HBO in the lung tissue of rats. MATERIALS AND METHODS: Male Sprague-Dawley rats were divided into six study groups exposed to consecutive HBO sessions (2.8 atm/90 min) for 5, 10, 15, 20, 30, and 40 days. Animals were sacrificed 24 h after the last HBO session. An additional control group was set to obtain normal data. Lung malondialdehyde (MDA) and carbonylated protein (PCC) levels were determined as measures of oxidative stress along with the activities of the antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase. RESULTS: None of the measured parameters showed any changes among the groups exposed to 5-15 HBO sessions. However, MDA, PCC, and SOD were found to be significantly increased in the 20 to 40 session groups. DISCUSSION AND CONCLUSION: These results indicate that repetitive treatment with HBO may cause oxidative stress in critical tissues including the lung. Although HBO-mediated free radicals are accepted to be responsible for the benefits of this therapeutic modality, especially in cases with prolonged exposure, possible injurious effects of supranormal values of bio-oxidative products need to be considered.

Comparison of the effect of topical and systemic melatonin administration on delayed wound healing in rats that underwent pinealectomy.

OBJECTIVES: Melatonin is a hormone which has many systemic effects in addition to its strong antioxidant properties. The aim of the present study was to investigate the difference between sytemic and topical administration of melatonin by forming a chronic wound model in rats whose release of basal melatonin was supressed by pinealectomy. MATERIAL AND METHODS: Experimental animals used in the study were divided into four equal groups: (i) a group of normal animals with wound formation (control), (ii) a group of animals who underwent pinelaectomy and wound formation (PINx), (iii) a group that underwent PINx + systemic melatonin administration, and (iv) a group that underwent PINx + topical melatonin administration. Fifteen days after pinealectomy, a bipediculed flap was formed on the back of the rats under anesthesia and then six excisional skin wounds were produced in all groups. Following the treatment that lasted 7 days, on day 8 the wound surface areas were measured and wound tissues were removed under anesthesia. In these tissues the levels of malondialdehit (MDA) and hydroxyproline (OH-proline) and the activities of superoxide dismutase(SOD) and glutathion peroxidase (GSH-Px) were measured. RESULTS: In the PINx group, OH-prolin levels decreased significantly compared to the control group and wound surface areas increased. MDA levels increased compared to the control group, and SOD and GSH-Px decreased accordingly. Conversely, in two melatonin groups in which melatonin was administered systemically or topically MDA decreased while SOD ve GSH-Px enzymes increased. CONCLUSION: In conclusion, in the present study it was shown that wound healing was prolonged in experimental animals deprived of melatonin through pinealectomy. Melatonin exerts positive effects on wound healing, whether it is administered topically or systemically.

The changes in pulmonary functions in occupational divers: smoking, diving experience, occupational group effects.

BACKGROUND: Diving challenges the respiratory system because of the pressure changes, breathing gases, and cardiovascular effects. We aimed to analyse the long term effect of occupational diving on pulmonary functions in terms of diving experience (year), smoking history, and occupational groups (commercial divers and SCUBA instructors). MATERIALS AND METHODS: We retrospectively analysed respiratory system examination results of the experienced occupational divers who were admitted to the Undersea and Hyperbaric Medicine Department for periodic medical examination between January 1, 2013 and February 28, 2019. RESULTS: Sixty-four divers applied to our department. Candidate divers were not included in our study. The mean diving experience (year) was 13.6 ± 7.3. None of the divers complained of pulmonary symptoms. Pulmonary auscultation and chest radiography were normal in all cases. In divers with 20 years or more experience, the FEV1/FVC ratio and FEF25-75(%) was significantly lower (p < 0.001, p < 0.05, respectively). In addition, there was a statistically significant negative correlation between FEV1/FVC ratio and FEF25-75(%) and diving experience (year) (p < 0.05, r = -0.444, p < 0.05, r = -0.300, respectively). As the diving experience increase per 1 year, the FEF25-75(%) value decreases by 1.04% according to linear regression analyses. However, smoking and occupational groups did not show any significant influence on pulmonary function test parameters. CONCLUSIONS: Occupational diving seems to create clinically asymptomatic pulmonary function test changes related to small airway obstruction after long years of exposure.

Urethral stripping caused by stent removal and its successful treatment with hyperbaric oxygen therapy: a case report.

Urethral stents usually provide initial, dramatic relief from obstructive voiding symptoms. However, complications such as recurrent urinary tract infections, stent migration, encrustation and recurrent urethral strictures are not rare, and stents should be removed when complications occur. Urethral stent removal is associated with potential risks of urethral injury, bleeding and external sphincter trauma. Hyperbaric oxygen therapy (HBO) accelerates wound healing by increasing tissue microcirculation, decreasing capillary pressure and resolving tissue edema. Although HBO has been used in various urologic applications, there is no report of HBO therapy being used to treat isolated urethral injuries. Here we present a case of urethral stripping caused by endoscopic stent removal, and its conservative treatment with HBO therapy.

Effects of Hyperbaric Oxygen and Preconditioning on Wound Healing in Colonic Anastomoses.

AIM: The purpose of this study was to evaluate the effects of hyperbaric oxygen (HBO) and HBO preconditioning (pre-HBO) on experimental wound healing and tensile strength in the colonic anastomosis of rats. MATERIALS AND METHODS: A total of 21 Sprague-Dawley rats were divided into three random groups of equal numbers: sham operation, pre-HBO, and HBO. Sham group was given standard left colon resection and end-to-end anastomosis; pre-HBO group received HBO as one dose + colonic resection + anastomosis; HBO group was given colonic resection + anastomosis + HBO. HBO was administrated at 24-hr intervals and relaparatomy was performed on the fifth day. Malondialdehyde (MDA), myeloperoxidase (MPO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), interleukin (IL)-10, IL-6, tumor necrosis factor-alpha (TNF-α), and hydroxy (OH)-proline levels and anastomotic burst pressure were evaluated. RESULTS: Burst pressure and OH-proline levels markedly increased in the HBO group compared with the sham and pre-HBO groups. When compared with the sham group, MDA and MPO levels were significantly decreased in the HBO and pre-HBO groups. In contrast to these findings, SOD and GSH-Px levels were increased in the HBO group as compared with the sham and pre-HBO groups. TNF-α, IL-6, and IL-10 values were detected at low levels in the HBO group as compared with other groups. CONCLUSIONS: HBO administration accelerated wound healing and strengthened the anastomotic tissue. In the light of these results, the HBO administration has beneficial effects and contributed to wound healing in colonic anastomosis. But, as expected, pre-HBO did not alter the results significantly.

A new utilization area for hyperbaric oxygen? Improving quality of stored blood.

BACKGROUND/AIM: Since blood bags have the ability for diffusion of gases, we investigated whether hyperbaric oxygen (HBO) exposure affects several vital parameters of stored blood. MATERIALS AND METHODS: Bloods obtained from the same persons were used as both control and HBO groups and stored in pediatric bags with citrate-phosphate-dextrose solution. HBO administration was performed at 2.5 atm for 90 min, started 1 day after blood collection and repeated every 2 days for a total of 10 times. The study was terminated on the 21st day. Complete blood count, glucose, pH, and osmotic fragility values were measured every week. RESULTS: Glucose and pH levels decreased in stored blood. In the HBO-exposed group, these decreases were less than in the control. In addition, mean corpuscular and platelet volumes tended to increase during storing process, but with HBO, these indexes remained lower, near physiologic levels. Another interesting finding of the study was the relative stable osmotic fragility ratio in the HBO group compared to the control blood. CONCLUSION: HBO exposure has positive effects on pH, stability of erythrocytes, and energy source (glucose) of the medium. Thus, we concluded that HBO may be a useful application for life and quality of stored blood.

Association between the development of diabetic foot and serum fetuin­A levels.

INTRODUCTION: Fetuin­A is a glycoprotein secreted from hepatocytes, which affects diabetes and peripheral arterial disease. However, there has been no studies regarding the relation between diabetic foot and fetuin­A levels. OBJECTIVES: We aimed to analyze the association between diabetic foot development and serum fetuin­A levels. PATIENTS AND METHODS: Following the approval of the local ethical board, 137 patients were included in the study. Patients were divided into 3 groups: diabetes group (n = 49), diabetic foot group (n = 57), and control group (n = 31). In all patients, serum fetuin­A, C­reactive protein, magnesium, and hemoglobin A1c (HbA1c) levels were measured. Diabetic foot wounds were classified according to the Wagner classification and lower extremity arteries were evaluated by ultrasonography. RESULTS: Median fetuin­A levels in patients with diabetic foot were significantly higher than in those with diabetes. However, the differences in HbA1c levels between both groups were not statistically significant. A positive correlation was found between the Wagner classification and ultrasound evaluation of the peripheral arteries (degree of atherosclerosis) in patients with diabetic foot. In the diabetic foot group, fetuin­A levels were also found to be positively correlated with ultrasound evaluation. CONCLUSIONS: We observed a positive correlation between serum fetuin­A levels and the development of diabetic foot.

DNA integrity in patients undergoing hyperbaric oxygen (HBO) therapy.

Hyperbaric oxygen (HBO) therapy is successfully applied for a wide variety of diseases. However, recent studies in humans undergoing (HBO) therapy have revealed that HBO is able to induce oxidative DNA damage especially in lymphocytes while the biological significance of this outcome is still not clear. HBO mediated DNA damage in lymphocytes has been determined by using the alkaline version of the comet assay in order to detect DNA strand breakages in patients undergoing HBO therapy. Blood samples were obtained from 100 voluntary patients and were drawn by venipuncture before and immediately after the first session of HBO treatment. The DNA damaging effect of HBO has also been evaluated in the fifth session of HBO therapy. DNA strand breakages were significantly increased after the first session of HBO treatment. However the elevated DNA strand breaks returned to their normal levels in lymphocytes after two hours of in vitro incubation. The elevated DNA strand breaks consistently decreased and reached to the baseline levels after the fifth session of HBO therapy. The results of this study, conducted in patients undergoing HBO therapy, support the existence of the previously reported cellular adaptive response against HBO mediated oxidative DNA damage in experimental studies.