Hyperbaric oxygen therapy and the diabetic foot.

Common causes for non-healing of diabetic foot ulcers are infection and/or ischaemia. Diabetic patients are compromised hosts as far as wound healing is concerned. Diabetes mellitus is associated with a defective cellular and humoral immunity. In particular, decreased chemotaxis, decreased phagocytosis, impaired bacterial killing and abnormal lymphocytic function have been observed, resulting in a reduced inflammatory reaction and defective wound healing. The potential benefits of hyperbaric oxygen therapy (HBO) in diabetic patients with a foot ulcer are discussed. Oxygen plays an important role in the physiology of wound healing. HBO can raise tissue oxygen tensions to levels where wound healing can be expected. Hyperbaric oxygen increases also the killing ability of leucocytes, is lethal for certain anaerobic bacteria and inhibits toxin formation in other anaerobes. Multiple anecdotal reports and retrospective studies in HBO therapy in diabetic patients suggest that HBO can be an effective adjunct in the management of diabetic wounds. Prospective studies also show the beneficial effects of HBO. Because most published studies suffer from methodological problems, there is an urgent need for a collaborative, international, randomised prospective clinical trial for the application of HBO in diabetic foot lesions, as part of a multidisciplinary treatment approach, before we can recommend HBO as standard therapy in patients with foot ulcers.

Hyperbaric oxygen treatment for haemorrhagic radiation cystitis.

Radiation-induced severe haemorrhagic cystitis is difficult to treat. Conventional treatments may decrease haematuria but do not affect the radiocystitis itself. Hyperbaric oxygen treatment has been reported to do both. We report the results of a prospective study of hyperbaric oxygen (20 sessions of 100% oxygen inhalation at 3 bar for 90 min in a multiplace hyperbaric chamber) to 40 patients with biopsy-proven radiation cystitis and severe haematuria. Haematuria disappeared completely or improved in 37 patients after treatment. Mean follow-up was 23.1 months (range 1-74); and the recurrence rate was 0.12/year. There were no adverse effects. Hyperbaric oxygen treatment should be considered for patients with severe radiation-induced haematuria.

Hyperbaric oxygen treatment of osteoradionecrosis of the mandible. Experience in 29 patients.

In recent years hyperbaric oxygen has gained an important role in the treatment of osteoradionecrosis of the mandible. In the treatment of 29 patients with osteoradionecrosis of the mandible, a combination of surgical debridement, antibiotics, and hyperbaric oxygen was used in 27 cases. In 20 of the 29 patients the osteoradionecrosis was considered to be resolved after treatment. In 31% of the patients, the continuity of the mandible was lost. It was concluded that combined treatment of surgical debridement, antibiotics, and hyperbaric oxygen gives acceptable results and may, when used in an early phase of the disease, limit the number of patients who lose continuity of the mandible.

Hyperbaric oxygen treatment of osteoradionecrosis of the mandible with repeated pathologic fracture. Report of a case.

Treatment of patients with osteoradionecrosis of the mandible with a pathologic fracture consists in almost all cases of a continuity resection of the mandible. This leads to functional and esthetic problems that can only be solved by often extensive surgery. In this case report we present a 38-year-old woman who developed osteoradionecrosis of the mandible with a pathologic fracture 1 1/2 years after combined surgical and radiation therapy of an adenocarcinoma of the right parotid gland. The patient had a subcondylar pathologic fracture together with osteolysis in the right mandibular body, normally an indication for partial resection of the mandible. Because of the absence of denuded bone, fistulation, and the poor quality of the surrounding soft tissues, a more conservative approach was chosen. Treatment consisted of hyperbaric oxygen and dental extractions with alveolectomy with the patient under local anesthesia. During follow-up, a second pathologic fracture occurred in the region of the right first and second molar. No additional treatment was given. Six and one-half years after the initial treatment and 5 1/2 years after the last fracture, the patient is free of complaints, the fractures have healed and both esthetic and functional results are good.

Red blood cell velocity in nailfold capillaries during hyperbaric oxygenation.

Microcirculatory hemodynamics of the skin during hyperbaric oxygenation were assessed by determination of nailfold capillary red blood cell velocity (Vrbc). Under hyperbaric conditions a continuous increase in Vrbc was found. Control values, 0.43 +/- 0.12 mm. sec-1 (mean +/- sem), were significantly (P < 0.05) lower compared with Vrbc at the end of hyperbaric oxygenation (0.62 +/- 0.16 mm.sec-1).

Skeletal muscle PO2 in anaerobic soft tissue infections during hyperbaric oxygen therapy.

In the present study skeletal muscle PO2 measurements were performed in patients with gas gangrene and anaerobic soft tissue infections before, during and after hyperbaric oxygen therapy. Polarographic PO2 needle electrodes appeared to be suitable for application during different ambient pressures. We found that patients with gas gangrene revealed higher skeletal muscle PO2 values than patients with an anaerobic soft tissue infection. This may be explained by a higher metabolic rate within the anaerobically infected soft tissues. The higher PO2 values in gas gangrene may be caused by alpha toxins, affecting cellular and intracellular membranes thus destroying PO2 diffusion barriers.

Diffuse sclerosing osteomyelitis of the mandible: a new concept of its etiology.

Diffuse sclerosing osteomyelitis of the mandible is a disease of unknown etiology. The clinical and radiographic findings suggest an infectious origin, but bacteriologic and histologic findings do not support this concept. Analysis of clinical symptoms, localization of the condition, and posttreatment findings in a group of 27 patients suggest a chronic tendoperiostitis due to muscular overuse as an etiologic factor in diffuse sclerosing osteomyelitis of the mandible. This hypothesis was supported by the initial results of muscle relaxation treatment in 13 of these patients.

Successful treatment of radiation cystitis with hyperbaric oxygen.

This report describes the results of hyperbaric oxygen therapy in 10 patients with radiation-induced cystitis. Severe macroscopic hematuria was present in all patients and was resistant to current therapy. Previously 8 patients had been treated for bladder carcinoma and 2 for prostatic carcinoma with 60 Gy radiotherapy. Hyperbaric oxygen therapy consisted of 20 sessions of 100% oxygen inhalation at 3 bar pressure for 90 min. In 6 patients the macroscopic hematuria stopped completely and it decreased in the other patients. These 4 patients had recurrent or residual bladder malignancies.

Alterations in molecular species of cholesterol esters formed via plasma lecithin-cholesterol acyltransferase in human subjects consuming fish oil.

The influence of a dietary supplement of n-3 polyunsaturated fatty acids containing eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3) on the molecular species of cholesteryl esters (CE) formed via the plasma lecithin (phosphatidylcholine)-cholesterol acyltransferase (LCAT; EC 2.3.1.43) reaction was evaluated. For this purpose, one group of eight subjects received an encapsulated fish lipid concentrate (MaxEPA) and another group of eight volunteers in the control group received encapsulated olive oil for 22 days. Plasma lipid profiles and fatty acid compositions of plasma phosphatidylcholine (PC) and CE were measured at day 0 and day 22 in all subjects. A decrease in plasma triglyceride (by 34%) and a moderate rise in high-density lipoprotein (HDL)-cholesterol (by 13%) was observed in the MaxEPA group. For characterization of the plasma LCAT-derived reaction products formed in vitro, [14C]cholesterol was used as the substrate and the newly formed molecular species of [14C]CE were separated by argentation thin-layer chromatography. Marked shifts were found in the abundance of the various classes of LCAT-derived products in the MaxEPA group whereas no significant changes were observed in the controls. The proportion of the [14C]CE as pentaenoic (EPA) species rose by 9-fold (from 1.5% at day 0 to 14.4% at day 22) as the dienoic (linoleate) species fell (from 50.6 to 39.2%); a moderate rise in the hexaenoic (DHA) species (from 1.7 to 2.4%) with no significant change in the tetraenoic (arachidonate) (AA) species was observed. The LCAT results were in the order of the observed shifts in the fatty acid patterns of the plasma CE.(ABSTRACT TRUNCATED AT 250 WORDS)

Whole-lung lavage under hyperbaric oxygen conditions for alveolar proteinosis with respiratory failure.

Whole-lung lavage under hyperbaric oxygen conditions was performed in two patients suffering from severe respiratory insufficiency in pulmonary alveolar proteinosis. Under these conditions, gas exchange was maintained and the mixed venous partial pressure of oxygen and oxygen saturation showed increases to acceptable levels. This enabled us to limit the FIO2 in order to extend the oxygen tolerance and to perform lavage procedures more effectively. Both patients showed a very significant improvement of their clinical course, and we conclude that elective use of hyperbaric oxygen in unilateral lung lavages should be considered in these severe cases.

Hyperbaric oxygen treatment of chronic osteomyelitis of the jaws.

A review of the literature on treatment of chronic osteomyelitis of the jaws shows that hyperbaric oxygen is often recommended as an adjunct in treatment of this disease. Definite criteria to indicate this treatment and to evaluate the results have not been reported. The results of hyperbaric oxygen treatment of chronic osteomyelitis of the jaws in 16 patients are presented. In contrast to the good results reported in the literature, only 7 of our patients could be considered as cured. The reasons for this discrepancy are discussed. Our results, as well as the data from the literature, indicate that a combined antibiotic and surgical approach is the treatment of choice in chronic suppurative osteomyelitis. However, in chronic diffuse sclerosing osteomyelitis and in patients in whom decortication and antibiotic therapy have failed, hyperbaric oxygen treatment in combination with antibiotics and surgery seems to be indicated.