RESUMEN
PURPOSE: To examine the safety and efficacy of hyperbaric oxygen as the primary and sole treatment for severe radiation-induced haemorrhagic cystitis. MATERIALS AND METHODS: Hyperbaric oxygen was prospectively applied as primary treatment in 38 patients with severe radiation cystitis. Our primary endpoint was the incidence of complete and partial response to treatment, while the secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. RESULTS: All patients completed therapy without complications with a mean follow-up of 29.33 months. Median number of sessions needed was 33. Complete and partial response rate was 86.8% and 13.2%, respectively. All 33 patients with complete response received therapy within 6 months of the haematuria onset. One patient needed cystectomy, while 33 patients were alive at the end of follow-up. CONCLUSIONS: Our study suggests the early primary use of hyperbaric oxygen for radiation-induced severe cystitis as an effective and safe treatment option.
Asunto(s)
Cistitis/terapia , Oxigenoterapia Hiperbárica/métodos , Traumatismos por Radiación/terapia , Anciano , Anciano de 80 o más Años , Cistectomía , Cistitis/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Traumatismos por Radiación/complicaciones , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
PURPOSE: To examine the safety and efficacy of hyperbaric oxygen as the primary treatment for Grade IV radiation-induced haemorrhagic cystitis. MATERIALS AND METHODS: Hyperbaric oxygen was prospectively applied as a primary treatment option in 11 patients with Grade IV radiation cystitis. Primary endpoint was the incidence of complete and partial response to treatment. Secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. RESULTS: All patients completed therapy without complications for a mean follow-up of 17.82 months (range 3 to 34). Mean number of sessions needed was 32.8 (range 27 to 44). Complete and partial response rate was 81.8% and 18.2%, respectively. However, in three patients the first treatment session was not either sufficient or durable giving a 72.7% rate of durable effect. Interestingly, all 9 patients with complete response received therapy within 6 months of the haematuria onset compared to the two patients with partial response who received therapy at 8 and 10 months from the haematuria onset, respectively (p = 0.018). The need for blood transfusion (p = 0.491) and the total radiation dose (p = 0.259) were not correlated to success-rate. One patient needed cystectomy, while all patients were alive at the end of follow-up. CONCLUSIONS: Early primary use of hyperbaric oxygen to treat radiation-induced grade IV cystitis is an effective and safe treatment option.
Asunto(s)
Cistitis/terapia , Hemorragia/terapia , Oxigenoterapia Hiperbárica/métodos , Traumatismos por Radiación/terapia , Anciano , Anciano de 80 o más Años , Cistitis/etiología , Estudios de Factibilidad , Femenino , Hematuria/etiología , Hematuria/terapia , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Dosis de Radiación , Traumatismos por Radiación/complicaciones , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Hyperbaric oxygen is considered an adjunctive treatment to medical and surgical care. We present a unique case in which a male patient with decompression illness affecting inner ear and spinal cord presented a worsened unilateral hydrocele synchronously with the neurological pathology. At the Diving and Hyperbaric Medicine Department, the patient was initially recompressed using a modified United States Navy Treatment Table 6A; on the following days he was treated for decompression illness using hyperbaric oxygen. Hyperbaric oxygen treatment has not been used for the treatment of hydrocele, but disappearance of the hydrocele occurred during the time he was treated with hyperbaric oxygen for decompression illness. He was discharged on Day 8, free of symptoms, having a normal neurological examination.
Asunto(s)
Enfermedad de Descompresión/terapia , Buceo/efectos adversos , Hidrocele Testicular , Adulto , Oído Interno/lesiones , Humanos , Oxigenoterapia Hiperbárica/métodos , Masculino , Remisión Espontánea , Enfermedades de la Médula Espinal/etiología , Enfermedades de la Médula Espinal/terapia , Hidrocele Testicular/diagnóstico por imagen , UltrasonografíaRESUMEN
A probable case of decompression illness with associated cutis marmorata is presented, which regressed over a few hours with oxygen breathing and after intravenous methylprednisolone and fluid resuscitation without recompression. He was eventually transferred for hyperbaric treatment some 10 hours post dive. Cutaneous decompression illness is not associated with high mortality per se, but prompt and accurate recognition is warranted, as it may represent a prodromal feature of potentially life-threatening complications. However, in this case, as differential diagnosis, an allergic reaction remains possible.
Asunto(s)
Enfermedad de Descompresión/etiología , Buceo/efectos adversos , Enfermedades Cutáneas Vasculares/etiología , Glucocorticoides/administración & dosificación , Humanos , Oxigenoterapia Hiperbárica , Masculino , Metilprednisolona/administración & dosificación , Persona de Mediana Edad , Enfermedades Cutáneas Vasculares/terapiaRESUMEN
ABSTRACT Purpose To examine the safety and efficacy of hyperbaric oxygen as the primary and sole treatment for severe radiation-induced haemorrhagic cystitis. Materials and methods Hyperbaric oxygen was prospectively applied as primary treatment in 38 patients with severe radiation cystitis. Our primary endpoint was the incidence of complete and partial response to treatment, while the secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results All patients completed therapy without complications with a mean follow-up of 29.33 months. Median number of sessions needed was 33. Complete and partial response rate was 86.8% and 13.2%, respectively. All 33 patients with complete response received therapy within 6 months of the haematuria onset. One patient needed cystectomy, while 33 patients were alive at the end of follow-up. Conclusions Our study suggests the early primary use of hyperbaric oxygen for radiation-induced severe cystitis as an effective and safe treatment option.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Traumatismos por Radiación , Cistitis/terapia , Oxigenoterapia Hiperbárica/métodos , Traumatismos por Radiación/complicaciones , Índice de Severidad de la Enfermedad , Cistectomía , Estudios Prospectivos , Resultado del Tratamiento , Cistitis/etiología , Persona de Mediana EdadRESUMEN
Purpose To examine the safety and efficacy of hyperbaric oxygen as the primary treatment for Grade IV radiation-induced haemorrhagic cystitis. Materials and Methods Hyperbaric oxygen was prospectively applied as a primary treatment option in 11 patients with Grade IV radiation cystitis. Primary endpoint was the incidence of complete and partial response to treatment. Secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results All patients completed therapy without complications for a mean follow-up of 17.82 months (range 3 to 34). Mean number of sessions needed was 32.8 (range 27 to 44). Complete and partial response rate was 81.8% and 18.2%, respectively. However, in three patients the first treatment session was not either sufficient or durable giving a 72.7% rate of durable effect. Interestingly, all 9 patients with complete response received therapy within 6 months of the haematuria onset compared to the two patients with partial response who received therapy at 8 and 10 months from the haematuria onset, respectively (p = 0.018). The need for blood transfusion (p = 0.491) and the total radiation dose (p = 0.259) were not correlated to success-rate. One patient needed cystectomy, while all patients were alive at the end of follow-up. Conclusions Early primary use of hyperbaric oxygen to treat radiation-induced grade IV cystitis is an effective and safe treatment option. .