Are we witnessing a paradigm shift in leprosy: Two atypical presentations of histoid hansen's disease.

Hansen's disease is a chronic infectious granulomatous disease with varied clinical presentation. In the postelimination era, histoid Hansen's disease is an important emerging lepromatous subset known to mimic varied dermatoses, thereby making clinical diagnosis difficult and often delayed. We report two cases of histoid Hansen's disease bereft of clinical cardinal signs of leprosy.

Effects of Endovascular Stent-Assisted Effects of Various Frequencies of Abdominal Naprapathy on Changes in Gastrointestinal Mucosal Cells in Spleen-Deficient Rabbits.

BACKGROUND At certain frequencies, abdominal naprapathy effectively alleviates functional dyspepsia with spleen deficiency. The present study explored the effects of various frequencies of abdominal naprapathy on gastrointestinal mucosal cells in spleen-deficient rabbits. MATERIAL AND METHODS The model of spleen deficiency was established by the method of bitter cold and catharsis. The rabbits were treated with various frequencies (50 - 100 and 201 - 250 vibrations/min) of abdominal naprapathy.  RESULTS In model rabbits, gastrointestinal mucosal thickness was changed, mucosal epithelial cells were necrotic significantly, a large number of inflammatory cells were infiltrated, and duodenal villus were destroyed. The gastrointestinal mucosal cells had different degrees of regeneration and remodeling under various frequencies of abdominal naprapathy intervention. Among them, the abdominal naprapathy with manipulation frequency of 101 - 150 times/min showed the best effect. CONCLUSIONS The abdominal naprapathy, especially with frequency of 101~150 times/min, repairs gastrointestinal mucosal injury of spleen-deficiency rabbits.

Topical Application of High-Dose Mesna Prevents Adhesion Formation: An Experimental Animal Study.

BACKGROUND: Adhesion formation is a common complication of abdominal surgeries. Mesna is a drug with fibrinolytic properties which has been used in surgical field to facilitate tissue dissection. The aim of this experimental animal study was to investigate the effect of mesna on prevention of intra-abdominal adhesion in rats. MATERIALS AND METHODS: Twenty-eight Wistar albino rats were used in the study. To create abdominal adhesion, cecum was abraded in all rats. No additional surgical procedure was performed other than adhesion in group 1 (only adhesion). In the other groups, rats were treated topically by administering 0.9% saline (group 2), 40 mg/kg mesna (group 3), and 400 mg/kg mesna (group 4). All rats were sacrificed on postoperative 21st day. Histopathological and macroscopic evaluations of adhesion formation were performed. RESULTS: Quantity of adhesion scores (P = 0.022), severity of adhesion scores (P = 0.041), total adhesion scores (P = 0.023), and histopathological adhesion grading scores (P < 0.001) were reduced by 400 mg/kg mesna. CONCLUSIONS: This is the first study for mesna on prevention of abdominal adhesion formation in rats. We concluded that dose-dependent reduction of adhesion was achieved by mesna. With future studies, topical administration of mesna during open abdominal surgeries may be used to prevent adhesion formation.

Preclinical evaluation of local prolonged release of paclitaxel from gelatin microspheres for the prevention of recurrence of peritoneal carcinomatosis in advanced ovarian cancer.

Patients with advanced ovarian cancer develop recurrence despite initial treatment response to standard treatment of surgery and intravenous/intraperitoneal (IP) chemotherapy, partly due to a limited peritoneal exposure time of chemotherapeutics. Paclitaxel-loaded genipin-crosslinked gelatin microspheres (PTX-GP-MS) are evaluated for the treatment of microscopic peritoneal carcinomatosis and prevention of recurrent disease. The highest drug load (39.2 µg PTX/mg MS) was obtained by immersion of GP-MS in aqueous PTX nanosuspension (PTXnano-GP-MS) instead of ethanolic PTX solution (PTXEtOH-GP-MS). PTX release from PTX-GP-MS was prolonged. PTXnano-GP-MS displayed a more controlled release compared to a biphasic release from PTXEtOH-GP-MS. Anticancer efficacy of IP PTX-GP-MS (PTXEtOH-GP-MS, D = 7.5 mg PTX/kg; PTXnano-GP-MS D = 7.5 and 35 mg PTX/kg), IP nanoparticular albumin-bound PTX (D = 35 mg PTX/kg) and controls (0.9% NaCl, blank GP-MS) was evaluated in a microscopic peritoneal carcinomatosis xenograft mouse model. PTXnano-GP-MS showed superior anticancer efficacy with significant increased survival time, decreased peritoneal carcinomatosis index score and ascites incidence. However, prolonged PTX release over 14 days from PTXnano-GP-MS caused drug-related toxicity in 27% of high-dosed PTXnano-GP-MS-treated mice. Dose simulations for PTXnano-GP-MS demonstrated an optimal survival without drug-induced toxicity in a range of 7.5-15 mg PTX/kg. Low-dosed PTXnano-GP-MS can be a promising IP drug delivery system to prevent recurrent ovarian cancer.

Transient Pigmentary Lines of the Newborn in a Postmortem Examination: A Case Report.

Sudden unexplained death in infancy is a leading cause of death among infants between 1 month and 1 year of age in the United States. The medical examiner is frequently given the difficult task of attempting to rule out other causes of death such as infantile trauma or child abuse. A thorough postmortem examination of the skin is a crucial component of the autopsy, as is sufficient knowledge of both benign and traumatic skin pathologies. In addition to lifesaving interventions performed by medical personnel, traditional remedies may also be performed that could be confused with trauma. Eastern medicinal therapies such as coining, cupping, or spooning may leave unusual markings on the patient. Transient pigmentary lines of the newborn are a rare but benign dermatologic finding of unknown etiology that should also be kept in the differential diagnoses. The authors present a case of this unique skin condition seen on a 1-month-old African American male infant who was found unresponsive, in addition to a current literature review.

[A newborn with abdominal distention and bilious vomiting]. / Een pasgeborene met een bolle buik en gallig braken.

A newborn girl presented within the first 24 hours after birth with a distended abdomen and bilious vomiting. These symptoms resolved spontaneously after a contrast enema, which showed obstruction of the left colon. This finding and the fact that the mother had been diagnosed with gestational diabetes mellitus led to the diagnosis of neonatal small left colon syndrome.

Reliability of modified adheremeter and digital pressure algometer in measuring normal abdominal tissue and C-section scars.

OBJECTIVE: This study tested inter- and intrarater reliability of the digital pressure algometer and modified adheremeter and concurrent validity in the algometer in both normal abdominal tissue and in chronically painful C-section scars. STUDY DESIGN: Correlational Reliability/Validity. BACKGROUND: The algometer is used to measure pressure-pain threshold (PPT). The adheremeter is a tool to measure tissue extensibility. Painful abdominal scars are being treated successfully with soft-tissue techniques yet reliable measurement tools for this tissue have not been reported. METHODS AND MEASURES: 59 subjects with normal abdominal tissue were marked at a point 2 inches inferolateral to the umbilicus. Two separate testers measured PPT twice with an algometer and tissue extensibility in superior/left/inferior/right directions with a modified adheremeter. 29 subjects with painful C-section scars were marked at 2.5 cm intervals along the scar. A total of 115 points were measured in the same manner as above. C-section subjects also were asked to rate their pain using the numeric pain rating scale (NPRS). Each tester was blinded to all other measurements. RESULTS: For PPT, intraclass correlations (ICC's) ranged from 0.814 to 0.933 with a standard error of measurement (SEM) ranging from 1.65N to 5.9 N. For tissue mobility, ICC's ranged from 0.430 to 0.914; SEM ranging from 1.67 mm to 3.7 mm. All but 2 measures had ICCs that were good-excellent. Inferior glide in C-section tissues showed the least and multi-directional measurement the strongest reliability. The PPT had a moderate negative correlation (r = -0.551) with the NPRS. CONCLUSIONS: The algometer showed excellent inter- and intra-rater reliability on normal abdominal tissue and C-section scars. It showed moderate criterion validity when compared against the NPRS. The modified adheremeter showed good-excellent inter- and intra-rater reliability on both normal abdominal tissue and C-section scars. Both measures have clinical and research applications for women's health practitioners.

Anti-inflammatory effect of Naravelia zeylanica DC via suppression of inflammatory mediators in carrageenan-induced abdominal oedema in zebrafish model.

The traditional herbal medicines are receiving great importance in the health care sector, especially in Indian system of medicine, i.e, Ayurveda. The present study focused on the standardization of Naravelia zeylanica (L.) DC in terms of its active phytochemicals and to evaluate the anti-inflammatory activity of ethanol extract of N. zeylanica (ENZ). An analytical method was developed by high-performance liquid chromatography for simultaneous determination of ß-sitosterol, lupeol and oleanolic acid in ENZ. The cell viability of ENZ was investigated using MTT assay. IC50 value of ENZ on cell viability was found to be 653.01 µg/mL. To determine the anti-inflammatory activity of ENZ by in vitro method, LPS was added to the macrophage cells to induce activation and ENZ was further added to observe the recovery of inflamed cells. These cells when treated with ENZ, the percentage of viable cells were considerably increased to 74.68%. Loss of mitochondrial membrane potential on treatment with LPS and its recovery by ENZ was studied and found that the number of cells that were damaged on treatment with ENZ + LPS was comparatively lesser than treatment with LPS only. An in vivo anti-inflammatory study was carried out in carrageenan-induced abdominal oedema method in adult zebrafish which revealed the percentage inhibition of inflammation at graded dose levels of ENZ as 23.5% at 100 mg/kg, 62.4% at 200 mg/kg and 87.05% at 350 mg/kg when compared with standard of diclofenac which showed 85% inhibition at 100 mg/kg. The PCR amplification of DNA extracted from adult zebrafish showed that increased concentration of ENZ considerably downregulates the expression of TNF-α and iNOS, the mediators of inflammation.

Pomegranate seed oil nanoemulsions improve the photostability and in vivo antinociceptive effect of a non-steroidal anti-inflammatory drug.

The combination of pomegranate seed oil and ketoprofen in nanoemulsions aiming to improve the antinociceptive effect was evaluated according to the writhing test and Complete Freud's Adjuvant induced paw inflammation in mice. The formulations showed adequate characteristics and improved ketoprofen's photostability against UVC radiation exposure. The dialysis bag technique showed that 100% of the drug was released from the nanoemulsions after 3h and the oil amount had no influence on the releasing. Furthermore, time- and dose-response curves were obtained to determine the antinociceptive effect of the formulations. In the post-test, the nanoemulsion containing ketoprofen significantly reduced abdominal constrictions in time-response curve, showing effect up to 12h while the free ketoprofen showed effect up to 3h. In addition, the blank nanoemulsion presented a reduction of abdominal constriction up to 1h of pre-treatment. Regarding the dose-response curve, the free ketoprofen presents effect at 0.5mg/Kg dose and nanoemulsion at 1.0mg/Kg dose. Time- and dose-response curves were performed to determine the antinociceptive effect in inflammatory pain. After the evaluation of mechanical allodynia testing at the Von Frey Hair, the free ketoprofen showed effect up to 6h while nanoemulsions presented effect up to 10h. Moreover, acute toxicity was performed with ALT and AST activity evaluations and urea levels. After 7 days of treatment, no toxic effects for nanoemulsions were found. In conclusion, ketoprofen-loaded pomegranate seed oil nanoemulsions presented adequate characteristics and a high antinociceptive activity in the animal models tested.

Masa abdominal en un adolescente / Abdominal mass in an adolescent

No disponible

Patterns of Brain Activation and Meal Reduction Induced by Abdominal Surgery in Mice and Modulation by Rikkunshito.

Abdominal surgery inhibits food intake and induces c-Fos expression in the hypothalamic and medullary nuclei in rats. Rikkunshito (RKT), a Kampo medicine improves anorexia. We assessed the alterations in meal microstructure and c-Fos expression in brain nuclei induced by abdominal surgery and the modulation by RKT in mice. RKT or vehicle was gavaged daily for 1 week. On day 8 mice had no access to food for 6-7 h and were treated twice with RKT or vehicle. Abdominal surgery (laparotomy-cecum palpation) was performed 1-2 h before the dark phase. The food intake and meal structures were monitored using an automated monitoring system for mice. Brain sections were processed for c-Fos immunoreactivity (ir) 2-h after abdominal surgery. Abdominal surgery significantly reduced bouts, meal frequency, size and duration, and time spent on meals, and increased inter-meal interval and satiety ratio resulting in 92-86% suppression of food intake at 2-24 h post-surgery compared with control group (no surgery). RKT significantly increased bouts, meal duration and the cumulative 12-h food intake by 11%. Abdominal surgery increased c-Fos in the prelimbic, cingulate and insular cortexes, and autonomic nuclei, such as the bed nucleus of the stria terminalis, central amygdala, hypothalamic supraoptic (SON), paraventricular and arcuate nuclei, Edinger-Westphal nucleus (E-W), lateral periaqueduct gray (PAG), lateral parabrachial nucleus, locus coeruleus, ventrolateral medulla and nucleus tractus solitarius (NTS). RKT induced a small increase in c-Fos-ir neurons in the SON and E-W of control mice, and in mice with surgery there was an increase in the lateral PAG and a decrease in the NTS. These findings indicate that abdominal surgery inhibits food intake by increasing both satiation (meal duration) and satiety (meal interval) and activates brain circuits involved in pain, feeding behavior and stress that may underlie the alterations of meal pattern and food intake inhibition. RKT improves food consumption post-surgically that may involve modulation of pain pathway.

Predictors of successful air enema reduction of intussusception in infants younger than 4 months.

OBJECTIVES: Intussusception is rare in infants younger than 4 months, and the use of air enema for reduction of intussusception has been limited. In this retrospective study, we analyzed the predictors of successful reduction of intussusception using air enema in infants younger than 4 months. METHODS: This is a retrospective chart review of 97 intussusception patients of younger than 4 months between January 2008 and December 2012. Demographic data, clinical presentation, and outcomes of air enemas were collected and analyzed. We used univariate and multivariate logistic regression analyses for significant predictors of successful reduction of intussusception using air enemas. RESULTS: Of the 97 infants younger than 4 months (median age 97.6 days, age range 41-119 days), 63 (65%) were boys and 34 (35%) were girls. The duration of symptoms ranged from 5 to 53 hours, with a median of 16.3 hours. The clinical features included paroxysmal crying (75%), vomiting (68%), bloody stools (61%), and palpable abdominal masses (32%). The duration of symptoms, bloody stools, and the shape of the intussusceptum were found to be significantly predictive of the outcome of air enema reduction of intussusception. CONCLUSIONS: The rate of successful reduction of intussusception using air enemas in infants younger than 4 months is low. Factors such as the duration of symptoms, bloody stools, and the shape of the intussusceptum are predictive of the outcome of air enema reduction of intussusception.

The spectrum of pigmented purpuric dermatosis and mycosis fungoides: atypical T-cell dyscrasia.

We report the case of a healthy 17-year-old adolescent boy with an unremarkable medical history who presented with an asymptomatic fixed rash on the abdomen, buttocks, and legs. The rash initially developed in a small area on the right leg 2 years prior and had progressed slowly. Prior biopsies were consistent with pigmented purpura. Clinical examination revealed multiple annular purpuric patches on the abdomen, buttocks, and legs covering approximately 20% of the body surface area without lymphadenopathy or hepatosplenomegaly. Additional biopsies demonstrated changes consistent with mycosis fungoides (MF). T-cell receptor g gene rearrangements demonstrated clonality. The patient was diagnosed with stage IB MF of the pigmented purpura-like variant. The patient responded well to psoralen plus UVA therapy. It has been proposed that pigmented purpuric dermatosis (PPD) is a form of cutaneous T-cell lymphoid dyscrasia and that T-cell gene rearrangement studies should be obtained for prognostic evaluation in patients with widespread disease. In our patient, the clinical appearance of the lesions, pathologic findings, and gene rearrangement studies led to the diagnosis of MF. Until the potential for evolution of PPD to malignant disease is better understood, further evaluation of MF in patients with an unusual presentation of pigmented purpura is warranted.

An unusual cuticular tumor-like growth on the abdomen of a lobster, Homarus americanus.

Tumors are rare in crustaceans, and whereas a few have been reported from the lobster Homarus americanus none have been adequately described. A lobster with an unusual, large, blue-colored tumor-like growth projecting laterally outward from the first abdominal somite was caught off Stonington, Maine, USA. The growth was rugose and covered by a relatively normal appearing cuticle with dispersed focal melanization. The underlying stroma consisted of an internal area of rescaffolded fibrous connective tissue, restructured muscle fibers, few arterioles, and an epidermal area comprised of columnar, highly vacuolated epithelial cells. No infectious pathogens or unusual inclusions were observed with microscopy and no eukaryotic pathogens were detected via molecular sequencing. Given the nature of the histology and the appearance of the growth, we identify the mass as a benign papilliform hamartoma that likely originated as a result of abnormal wound repair possibly initiated around ecdysis. This represents the first tumor-like hamartoma reported from a lobster, and the second hamartoma reported from a crustacean.

Woman with hemorrhagic spots on her abdomen.

Abstract Lipodissolve is a product that is composed of phosphatidylcholine and deoxycholate mixture, and other adjuvant. Lipodissolve injection seems to be performed in many countries for local fat reduction without any legal and scientific evidences of its safety and efficacy despite the US FDA warning.1 Herein, we report a case with agitation and metabolic acidosis following lipodissolve injection.

Quiste renal simple infectado. A propósito de un caso / Infected simple renal cyst. Case report

OBJETIVO: Presentar un nuevo caso de quiste renal simple infectado, su diagnóstico y el tratamiento aplicado. MÉTODOS. Paciente femenina de 30 años de edad, ingresada en sala de Medicina Interna por síndrome febril prolongado. Al examen físico presentaba taquicardia y dolor a la palpación profunda del hipocondrio izquierdo. El ultrasonido abdominal informó la existencia de un quiste renal izquierdo de gran tamaño con contenido de alta ecogenicidad, corroborándose hiperdensidad del líquido en la tomografía axial computarizada simple y contrastada. RESULTADOS. Se realizó la punción del quiste por vía lumbar, obteniéndose aproximadamente 400 mililitros de un líquido amarillo claro e inodoro; luego se le esclerosó con etanol. El estudio microbiológico del líquido extraído fue negativo. La evolución clínica de la paciente ha sido satisfactoria y los controles ultrasonográficos renales normales. CONCLUSIONES. Ante un quiste renal simple infectado, cuya localización permita el abordaje lumbar percutáneo, el tratamiento recomendado es la punción y esclerosis sincrónicos, más antibióticoterapia parenteral con ciprofloxacina(AU)

OBJECTIVE: To present a new case of an infected simple renal cyst, its diagnosis and the treatmentcarried out. METHODS: 30 year-old female patient admitted to the Internal Medicine ward suffering a prolonged fever syndrome. On physical examination she presented tachycardia and pain in the left hypochondrium on deep palpation. Abdominal ultrasound revealed the existence of a great size left renal cyst with a highly echogenic content; this liquid hyperdensity was confirmed by simple and i.v. contrastCT scan. RESULTS: Cyst punction was performed through a lumbar via, getting approximately 400 millilitres of a clear and odourless yellow liquid; then it was sclerosed with ethanol. The microbiological study of the extracted liquid was negative. The patient’s clinical evolution has been satisfactory and renal ultrasound controls were normal. CONCLUSIONS: Faced with a simple infected renal cyst whose location allows percutaneous lumbar approach, punction with synchronic sclerosis plus parenteral antibiotic therapy with ciprofloxacin is the recommended treatment(AU)

Effectiveness of external respiratory surrogates for in vivo liver motion estimation.

PURPOSE: Due to low frame rate of MRI and high radiation damage from fluoroscopy and CT, liver motion estimation using external respiratory surrogate signals seems to be a better approach to track liver motion in real-time for liver tumor treatments in radiotherapy and thermotherapy. This work proposes a liver motion estimation method based on external respiratory surrogate signals. Animal experiments are also conducted to investigate related issues, such as the sensor arrangement, multisensor fusion, and the effective time period. METHODS: Liver motion and abdominal motion are both induced by respiration and are proved to be highly correlated. Contrary to the difficult direct measurement of the liver motion, the abdominal motion can be easily accessed. Based on this idea, our study is split into the model-fitting stage and the motion estimation stage. In the first stage, the correlation between the surrogates and the liver motion is studied and established via linear regression method. In the second stage, the liver motion is estimated by the surrogate signals with the correlation model. Animal experiments on cases of single surrogate signal, multisurrogate signals, and long-term surrogate signals are conducted and discussed to verify the practical use of this approach. RESULTS: The results show that the best single sensor location is at the middle of the upper abdomen, while multisurrogate models are generally better than the single ones. The estimation error is reduced from 0.6 mm for the single surrogate models to 0.4 mm for the multisurrogate models. The long-term validity of the estimation models is quite satisfactory within the period of 10 min with the estimation error less than 1.4 mm. CONCLUSIONS: External respiratory surrogate signals from the abdomen motion produces good performance for liver motion estimation in real-time. Multisurrogate signals enhance estimation accuracy, and the estimation model can maintain its accuracy for at least 10 min. This approach can be used in practical applications such as the liver tumor treatment in radiotherapy and thermotherapy.

Mechanisms of attenuation of abdominal sepsis induced acute lung injury by ascorbic acid.

Bacterial infections of the lungs and abdomen are among the most common causes of sepsis. Abdominal peritonitis often results in acute lung injury (ALI). Recent reports demonstrate a potential benefit of parenteral vitamin C [ascorbic acid (AscA)] in the pathogenesis of sepsis. Therefore we examined the mechanisms of vitamin C supplementation in the setting of abdominal peritonitis-mediated ALI. We hypothesized that vitamin C supplementation would protect lungs by restoring alveolar epithelial barrier integrity and preventing sepsis-associated coagulopathy. Male C57BL/6 mice were intraperitoneally injected with a fecal stem solution to induce abdominal peritonitis (FIP) 30 min prior to receiving either AscA (200 mg/kg) or dehydroascorbic acid (200 mg/kg). Variables examined included survival, extent of ALI, pulmonary inflammatory markers (myeloperoxidase, chemokines), bronchoalveolar epithelial permeability, alveolar fluid clearance, epithelial ion channel, and pump expression (aquaporin 5, cystic fibrosis transmembrane conductance regulator, epithelial sodium channel, and Na(+)-K(+)-ATPase), tight junction protein expression (claudins, occludins, zona occludens), cytoskeletal rearrangements (F-actin polymerization), and coagulation parameters (thromboelastography, pro- and anticoagulants, fibrinolysis mediators) of septic blood. FIP-mediated ALI was characterized by compromised lung epithelial permeability, reduced alveolar fluid clearance, pulmonary inflammation and neutrophil sequestration, coagulation abnormalities, and increased mortality. Parenteral vitamin C infusion protected mice from the deleterious consequences of sepsis by multiple mechanisms, including attenuation of the proinflammatory response, enhancement of epithelial barrier function, increasing alveolar fluid clearance, and prevention of sepsis-associated coagulation abnormalities. Parenteral vitamin C may potentially have a role in the management of sepsis and ALI associated with sepsis.

An in vivo histopathological comparison of single and double pulsed modes of a fractionated CO(2) laser.

INTRODUCTION: Studies examining the histopathological changes that occur in human skin following fractional laser treatment have been performed mainly in animals or abdominal tissue prior to abdominoplasty. This study looks at the effect of double pulse fractional CO(2) laser compared to single pulse treatments to assess differences in tissue injury in the face and abdomen. METHODS: Twelve healthy subjects randomized into two groups, had two 1 cm(2) areas (infraumbilical and forehead) treated with the fractional CO(2) laser (Deep Fx, Lumenis). Settings used were 15 mJ double pulse, and 30 mJ single pulse, 300 Hz, 10% density and compared to the historic control of 15 patients treated at 15 mJ single pulse [Bailey et al. (2011), Lasers Surg Med 43: 99-107]. Treated sites were biopsied and analyzed with H&E and TUNEL staining to measure width and depth of the microthermal zones (MTZ) of ablation. RESULTS: When comparing 15 mJ double pulse to single pulse there were significant differences both in depth (abdominal skin, P = 0.002 and facial skin, P = 0.001) and width (facial skin, P = 0.0002) of MTZ. When comparing double pulsing at 15 mJ with single pulsing at 30 mJ there were significant differences between MTZ depths in the abdomen (P < 0.01) but not in either the MTZ depth (P = 0.69) or the width in the face (P = 0.502). DISCUSSION: This study demonstrates the differences between histopathological laser injury patterns in the face compared to the abdomen when single pulsing is used. It also demonstrates that double pulsing at 15 mJ is statistically similar to single pulsing at 30 mJ in the face. We think this could have ramifications for clinical practice where by double pulsing at lower energies may result in better clinical outcomes than increasing energies or using multiple passes at single pulse. Clinical studies needs to be performed to investigate this further.

Hyperbaric oxygen therapy and delayed radiation injuries (soft tissue and bony necrosis): 2012 update.

Informal surveys at CME meetings have shown that approximately one-third of patients in the United States receive hyperbaric oxygen (HBO2) for delayed radiation injury. More than 600,000 patients receive radiation for malignancy in our country annually, and about one-half will be long-term survivors. Serious radiation complications occur in 5-10% of survivors. A large population of patients is therefore at risk for radiation injury. HBO2 has been applied to treat patients with radiation injury since the mid-1970s. Published results are consistently positive, but the level of evidence for individual publications is usually not high level, consisting mostly of case series and case reports. Only a rare randomized controlled trial has been accomplished. Radiation injury is one of the UHMS "approved" indications, and third-party payors will usually reimburse for this application. This updated review summarizes the publications available reporting results in treating radiation-injured patients. Mechanisms of HBO2 in radiation injury are discussed briefly. Outcome is reported on a mostly anatomic basis though due to the nature of the injury a positive outcome at one anatomic site is supportive of HBO2 at other sites. The potential benefit of prophylactic HBO2 before frank damage is also discussed in high-risk patients. The concerns of HBO2 enhancing growth of or precipitating recurrence of malignancy is discussed and largely refuted.