Transcutaneous oximetry values in chronic ulcer patients during Hyperbaric treatment at 1.4 ATA compared to 2 ATA.

Chronic wounds have a significant impact on a patient's quality of life. Different pathologies, such as poor blood supply and tissue breakdown, may lead to inadequate oxygenation of the wound. Hyperbaric oxygen (HBO2) is a widely used treatment for an increasing number of medical practices. A new so-called "hyperbaric treatment" trend has emerged. The use of low-pressure, soft-sided, or inflatable chambers represents a growing trend in hyperbaric medicine. Used in professional settings as well as directly marketed to individuals for home use, they are promoted as equivalent to clinical hyperbaric treatments provided in medical centers. However, these chambers are pressurized to 1.3 atmospheres absolute (ATA) on either air or with an oxygen concentrator, both generate oxygen partial pressures well below those used in approved hyperbaric centers for UHMS-approved indications. A total of 130 consecutive patients with chronic ulcers where tested. TcPO2 was measured near the ulcer area while the patient was breathing 100% O2 at 1.4 ATA for five and 10 minutes. The average TcPO2 at 1.4 ATA after 10 minutes of O2 breathing was 161 mmHg (1-601 mmHg, standard deviation 137.91), compared to 333 mmHg in 2 ATA (1-914±232.56), p < 0.001. Each electrode tested was also statistically significant, both after five minutes of O2 breathing and after 10 minutes. We have not found evidence supporting the claim that 1.4 ATA treatment can benefit a chronic ulcer patient. The field of HBO2 is constantly evolving. We have discovered new ways to treat previously incurable ailments. Nevertheless, it is important to note that new horizons must be examined scientifically, supported by evidence-based data. The actual effect of 1.4 ATA on many ailments is yet to be determined.

Carbon monoxide intoxication with a CO-Hb of 30% while smoking waterpipe: a case report.

Carbon monoxide (CO) poisoning is a significant public health issue and a considerable economic burden in developed countries. While the majority of non-fire-related CO poisonings are attributed to gas heating, there are several other less recognized sources that should be considered in the initial differential diagnosis.The patient in this case was a 21-year-old who experienced a brief episode of loss of consciousness and was subsequently admitted to the Emergency department. Upon evaluation, the patient was diagnosed with CO poisoning, which necessitated hyperbaric oxygen therapy to mitigate the effects of this toxic exposure.Despite exhibiting harmful symptoms initially, the patient stated in a phone interview two and a half years post-incident that they have not experienced any enduring effects such as cardiac arrhythmia or concentration deficits. While their understanding of the risks associated with waterpipe smoking has increased, it has not influenced any major changes in their waterpipe smoking habits.

Evaluation of the effects of hyperbaric on human attention functions based on eye movements recorded using an infrared camera.

BACKGROUND: This study aimed to assess the influence of elevated atmospheric pressure on the functions of attention of medical personnel working in hyperbaric chambers. We enrolled 15 participants who met the inclusion criteria. The test consisted of performing the same medical procedure under 2 conditions. For each of these test conditions, right eye movements were recorded using an oculograph. The obtained results revealed a relationship between elevated atmospheric pressure and the ability of medical personnel to focus. OBJECTIVES: To assess the influence of hyperbaric oxygen (HBO2) on visual attention in medical personnel during medical activities performed under normobaric (1 absolute atmosphere (1 ATA)) and hyperbaric (4 ATA) conditions inside a hyperbaric chamber. MATERIAL AND METHODS: Each participant had a valid license to act as a medical attendant during therapeutic hyperbaric sessions. Fifteen individuals, 10 men and 5 women aged between 28 and 65 years, participated in the study. The participants were asked to perform a medical procedure involving the preparation of a syringe with a drug administered by an infusion pump under 2 test conditions: 1 ATA corresponding to the atmospheric pressure on land, and 4 ATA corresponding to an underwater depth of 30 m. The order of test conditions was random. Both test conditions were performed inside a hyperbaric chamber. RESULTS: The number of fixations in the area of interest (AOI) varied between stages (1, 2 and 3) and task conditions (1 ATA and 4 ATA), with lower values for the 4 ATA condition. Under 1 ATA, 30% of eye fixations were in the AOI, as compared to only 6% under 4 ATA. CONCLUSIONS: The obtained results indicate that elevated atmospheric pressure has negative effects on the attention of medical personnel.

A conservative treatment for eosinophilic cystitis.

Introduction: Eosinophilic cystitis is a rare condition which causes common symptoms and may mimic other conditions. Eosinophilic cystitis has several causes such as hypereosinophilic syndrome, inflammatory diseases, neoplasia, parasites or fungal infection, IgE-related diseases, Drug Reaction and Eosinophilia and Systemic Symptoms (DRESS) syndrome, or Churg-Strauss syndrome. Therefore, differential diagnosis is difficult. Case presentation: We report the case of a middle-aged man affected by eosinophilic cystitis with persistent hematuria and other peculiar symptoms that may be brought back to hypereosinophilic crisis. Conclusion: Conservative approach is preferred, avoiding radical cystectomy rather than corticosteroid, antihistaminic and second line therapy. Hyperbaric therapy is an innovative approach for severe relapsing gross hematuria without specific literature and should be studied for further indications.

Which Role for Hyperbaric Oxygen Therapy in the Treatment of Fournier's Gangrene? A Retrospective Study.

Purpose: In Fournier's gangrene, surgical debridement plus antimicrobial therapy is the mainstay of treatment but can cause a great loss of tissue. The disease needs long hospital stays and, despite all, has a high mortality rate. The aim of our study is to investigate if factors, such as hyperbaric therapy, can offer an improvement in prognosis. Methods: We retrospectively evaluated data on 23 consecutive patients admitted for Fournier's gangrene at the University Hospital "P. Giaccone" of Palermo from 2011 to 2018. Factors related to length of hospital stay and mortality were examined. Results: Mortality occurred in three patients (13.1%) and was correlated with the delay between admission and surgical operation [1.7 days (C.I. 0.9-3.5) in patients who survived vs. 6.8 days (C.I. 3.5-13.4) in patients who died (p = 0.001)]. Hospital stay was longer in patients treated with hyperbaric oxygen therapy [mean 11 (C.I. 0.50-21.89) vs. mean 25 (C.I. 18.02-31.97); p = 0.02] without an improvement in survival (p = 1.00). Conclusion: Our study proves that a delay in the treatment of patients with Fournier's gangrene has a correlation with the mortality rate, while the use of hyperbaric oxygen therapy seems to not improve the survival rate, increasing the hospital stay instead.

Delayed-Onset Portal Venous Thrombosis After Ingestion of 3% Hydrogen Peroxide.

BACKGROUND: Identification of portal venous gas on radiographic imaging is well documented after the ingestion of hydrogen peroxide, as is its resolution after hyperbaric therapy. Although hyperbaric therapy may resolve the gastrointestinal symptoms associated with the presence of portal venous gas, the principle rationale for performing hyperbaric therapy is to prevent subsequent central nervous system oxygen embolization. CASE REPORT: We describe a patient with portal venous gas identified by computed tomography after the ingestion of 3% hydrogen peroxide, managed without hyperbaric therapy, who subsequently developed portal venous thrombosis. We are not aware of this complication being previously described from hydrogen peroxide ingestion. The case is complicated by the coexistence of a self-inflicted stab wound, leading to exploratory laparotomy in a patient predisposed to arterial vascular occlusion. Why Should an EmergencyPhysicianBeAware of This? Emergency physicians will encounter patients after the ingestion of hydrogen peroxide who, despite not having symptoms of central nervous system emboli, have portal venous gas identified on radiographic imaging. Being aware that the principle rationale for prophylactic utilization of hyperbaric therapy is to prevent subsequent central nervous system emboli, and that in at least one case, delayed-onset portal venous thrombosis has occurred without hyperbaric therapy may help contribute to clinical decision-making.

Superficial glans ischemia after penile prosthesis successfully treated by conservative treatment.

Glandular ischemia is an extremely uncommon dreaded postoperative complication of inflatable penile prosthesis surgery that may lead to penile gangrene and organ loss, whose incidence is difficult to determine. We report the case of a 56-year-old male admitted to our department with complaints of cold and painful glans penis after penile implant one month before. A color Doppler examination revealed the normal intracavernosal arteries with no vascularity in the superficial glans tissues. Due to the mild severity of the ischemia, conservative management was suggested, and consisted of oral pentoxifylline and hyperbaric therapy for 10 days, achieving a significant improvement at 4 months of follow-up.

Efeito da terapia hiperbárica em modelo experimental de retalho cutâneo em ratos com congestão venosa ou isquemia arterial / Effect of hyperbaric therapy in experimental cutaneous retail model in rats with venous congestion or arterial ischemia / Efecto de la terapia hiperbárica en modelo experimental de retrato cutáneo en ratos con congestión venosa o isquemia arterial

Introdução: A utilização de tecido autólogo em reconstruções mamárias tem sido cada vez mais difundida, principalmente devido aos resultados estéticos melhores e mais duradouros; porém fatores de risco como: diabetes, tabagismo e obesidade acabam complicando este tipo de reconstrução. Objetivo: Avaliar a angiogênese tanto no modelo animal de isquemia arterial como no modelo animal de congestão venosa após a utilização de terapia hiperbárica no retalho cutâneo da parede abdominal de ratos. Material: Utilizamos o modelo animal para demonstrar o efeito da terapia hiperbárica na recuperação das áreas de necrose tecidual tanto no modelo de isquemia arterial quanto de congestão venosa. Os ratos foram divididos em 3 grupos e os resultados comparados. Resultados: Ficou demonstrado que a utilização de terapia hiperbárica permite a diminuição da área de necrose tecidual, principalmente no grupo com congestão venosa. Contudo, não está claro qual mecanismo permite que a terapia hiperbárica apresente melhores resultados no grupo com congestão venosa. Conclusão: Há necessidade de pesquisar novos marcadores teciduais para avaliar a resposta tecidual à adaptação ao microambiente com hipoxia e o efeito da terapia hiperbárica nesta situação.(AU)

Introduction: The use of autologous tissue in breast reconstruction has been increasingly widespread, mainly due to better and more durable aesthetic results; but risk factors such as diabetes, smoking and obesity complicate this type of reconstruction. Objective: To evaluate angiogenesis in animal models of arterial ischemia and venous congestion after the use of hyperbaric therapy in the skin flap of the abdominal wall of rats. Material: We used the animal model to demonstrate the effect of hyperbaric therapy on the recovery of areas of tissue necrosis in arterial ischemia and venous congestion. The rats were divided into 3 groups and the results compared. Results: It has been demonstrated that the use of hyperbaric therapy allows the reduction of the area of tissue necrosis, especially in the group with venous congestion. However, it is not clear which mechanism allows hyperbaric therapy to show better results in the group with venous congestion. Discussion: It is not clear which mechanism allows hyperbaric therapy to present better results in the group with venous congestion. Conclusion: There is a need to investigate new tissue markers to evaluate the tissue response to adaptation to the hypoxic microenvironment and the effect of hyperbaric therapy in this situation.(AU)

Introducción: La utilización de tejido autólogo en reconstrucciones de las mamas ha sido cada vez más difundida, principalmente debido a los resultados estéticos mejores y más duraderos; pero factores de riesgo como: diabetes, tabaquismo y obesidad acaban complicando este tipo de reconstrucción. Objetivo: Evaluar la angiogénesis tanto en el modelo animal de isquemia arterial como en el modelo animal de congestión venosa después del uso de terapia hiperbárica en el colgajo de piel de la pared abdominal de ratas. Material: Utilizamos el modelo animal para demostrar el efecto de la terapia hiperbárica en la recuperación de las áreas de necrosis tisular tanto en el modelo de isquemia arterial y de congestión venosa. Los ratones fueron divididos en 3 grupos y los resultados comparados. Resultados: Se ha demostrado que la utilización de terapia hiperbárica permite la disminución del área de necrosis tisular, principalmente en el grupo con congestión venosa. Sin embargo, no está claro qué mecanismo permite que la terapia hiperbárica muestre mejores resultados en el grupo con congestión venosa. Conclusión: Hay necesidad de investigar nuevos marcadores teciduales para evaluar la respuesta tisular a la adaptación al microambiente con hipoxia y el efecto de la terapia hiperbárica en esta situación.(AU)

Indicação de oxigenioterapia hiperbárica como auxiliar na cicatrização de úlceras de membro inferiores / Indication of hyperbaric oxygen therapy as an aid in healing lower limb wounds

Esse artigo refere-se a um caso de perícia médica solicitada por motivo de ação judicial movida por paciente do sexo masculino de 49 anos de idade contra o município de Ipatinga, MG. O periciando é sabidamente portador de Doença Mista do Tecido Conjuntivo e Síndrome de Anticorpo Antifosfolípide, tendo desenvolvido, como consequência dessa última patologia, úlcera venosa crônica em membro inferior, não cicatrizada mesmo após duas cirurgias de enxertia. O paciente requer perante o juízo, por indicação de sua médica reumatologista, que o município arque com o procedimento de oxigenioterapia hiperbárica, considerando-se sua eficácia potencial na cicatrização de feridas. Deixando as considerações jurídicas do caso à parte, como médica perita do banco de peritos do Tribunal de Justiça de Minas Gerais, depois de avaliar clinicamente o paciente, realizei revisão da literatura médicocientífica no que diz respeito aos benefícios e indicações dessa forma de terapia para o mesmo. O objetivo desse artigo é descrever acerca desse procedimento médico, bem como esclarecer suas indicações e limitações, especialmente no que tange ao caso concreto apresentado. (AU)

This paper refers to a medical inquiry related to a lawsuit against Ipatinga County (MG), in which a male patient aged 49 years old requests the right to receive 60 sessions of hyberbaric oxygen therapy (HBOT), as an aid to healing wounds. The patient has been previously diagnosed with Mixed Disease of the Connective Tissue and Antiphospholipid Syndrome, having developed, as result of the latter disease, a chronic venous ulcer in the lower limb, not healed even after two grafting surgeries. Towards the Court, the patient requires the delivery of HBOT, considering its potential effectiveness in wound healing. Leaving apart the legal considerations of the case, as a medical expert of the Justice Court of Minas Gerais (TJMG), after a detailed clinical evaluation of the patient, I reviewed the medical literature regarding the benefits and indications of this form of therapy, correlating them to this concrete case. The aim of this article is to describe this relatively new medical procedure, and to clarify its indications and limitations, particularly with regard to the present case. (AU)

Acute Ischemia of the Glans Penis after Circumcision Treated with Hyperbaric Therapy and Pentoxifylline: Case Report and Revision of the Literature.

Acute severe ischemia of glans penis after circumcision is a very rare event and, if not treated, can lead to irreversible necrosis with severe consequences such as loss of part of the penis. The possible causes for this condition could be blood-vessel binding or cauterization, dorsal penile nerve block (DPNB), local anesthesia with vasoconstricting agents and wound dressing compression. The aim of the treatment is to provide good blood supply and thus, oxygen delivery to the ischemic penis. The therapeutic options include hyperbaric therapy (HBOT), pentoxifylline (PTX), enoxaparina, iloprost, antiplatelet, corticosteroids and peridural anesthesia. We report the case of a 24-year-old male who developed an acute severe glans penis ischemia after circumcision done under DPNB. The patient was successfully treated with HBOT in combination with PTX.

Aortic air embolus following pulmonary tumor radiofrequency ablation.

Aortic air embolism following a computed tomography (CT) guided percutaneous transthoracic procedure is a rare occurrence, but one that can have dire consequences. We present a case of a 48-year old female diagnosed with aortic air embolism during percutaneous radiofrequency ablation of a pulmonary mass. A large amount of intra-aortic air can be seen on the CT images just before the patient suffered acute cardiac arrest. Although this is a rare occurrence, recognition and management of this complication is important for physicians who perform any percutaneous transthoracic procedures.

Air embolism: a complication of computed tomography-guided transthoracic needle biopsy.

Air embolism is a pathological condition caused by the entry of gas into vascular structures. It is a rare but feared complication due to its serious morbidity. We report two male patients who were diagnosed with air embolism as a complication of computed tomography-guided transthoracic needle biopsy. Both patients referred respiratory symptoms minutes after the procedure. The chest computed tomography of one of the patients showed air in the left ventricle and ascending aorta, and in the other, air was noted only in the left ventricle. Both patients suffered myocardial infarction without associated mortality. One patient showed anthracotic dust deposits in the lung biopsy suggestive of pneumoconiosis, and there was no definitive diagnosis in the other. We strongly believe that because of the very low incidence but high mortality of this entity, all physicians should be aware of this complication in order to know how to proceed in this situation.

Initial blood lactate correlates with carboxyhemoglobin and clinical severity in carbon monoxide poisoned patients.

OBJECTIVE: The aim of this study was to assess the role of blood lactate levels at admission in carbon monoxide (CO)-poisoned patients for establishing severity of poisoning and short term prognosis. METHOD: All cases of CO poisoning visited in the emergency department during the years 2012 and 2013 were retrieved from the hospital database. The concentration of COHb and lactate was assessed in arterial blood in all patients with suspected CO poisoning, along with the plasma concentration of troponin I (TnI). The control population for TnI results consisted in 125 blood donors. RESULTS: Twenty three (61%) out of 38 CO-poisoned patients underwent hyperbaric oxygen (HBO) treatment, and 10 (26%) were admitted to a hospital ward. A significant correlation was found between lactate and COHb (r=0.54; p<0.001), and between lactate and TnI (r=0.44; p=0.001). A significant correlation was also found between COHb and TnI (r=0.38; p=0.020). Blood lactate levels were higher in patients treated with HBO and hospital admission. In multivariate analysis, none of the parameters was associated with HBO treatment, whereas increased value of blood lactate (p=0.036) was the only significant predictor of hospital admission. Twenty five (66%) patients had detectable TnI levels compared to 13% controls (p<0.001), whereas 16% CO-poisoned patients had TnI levels >99th percentile compared to 2% controls (p=0.003). The odds ratio for detectable TnI and TnI >99th percentile in CO-poisoned patients were 13.1 (p<0.001) and 7.6 (p=0.006), respectively. CONCLUSION: Initial blood lactate level may be useful for risk stratification of CO-poisoned patients, especially for predicting hospitalization.

Osteomielitis mandibular como complicación de la enfermedad de Albers-Schõmberg / Mandibular osteomyelitis as a complication of Albers-Schomberg disease

La enfermedad de Albers-Schõmberg u osteopetrosis es un raro padecimiento óseo. La osteomielitis mandibular es una infrecuente complicación de esta enfermedad. Por ello y por lo interesante de la presentación clínica de ambas entidades, nos propusimos como objetivo presentar este caso. Este paciente masculino de 32 años con antecedentes de enfermedad de Albers- Schõmberg de tipo adulta benigna que dos años atrás acudió a consulta y refirió haberse realizado una exodoncia once meses antes, a partir de lo cual presentó aumento de volumen facial y dolor de intensidad variable con períodos de agudización. Luego del estudio clínico e imagenológico se llegó al diagnóstico de una osteomielitis mandibular como complicación de su enfermedad de base. Se aplicó terapia antimicrobiana, exéresis del hueso necrótico y oxígeno hiperbárico. A los dos años acudió a consulta con una reagudización del proceso, se le produjo la expulsión espontánea de un secuestro óseo y se decidió la realización de una mandibulectomía parcial más reconstrucción con placa mandibular. En estos momentos el paciente no presenta signos de reagudización del proceso y se mantiene bajo vigilancia estricta a los tres meses de realizada la intervención quirúrgica(AU)

Albers-Schomberg disease or osteopetrosis is a rare bone condition. Mandibular osteomyelitis is an infrequent complication of this disease. It was for this reason, alongside the peculiar clinical presentation of both entities, that we decided to present this case. A male 32-year-old patient with a history of benign adult Albers-Schomberg disease attended consultation two years ago and stated to have undergone exodontia eleven months before, after which he had had facial swelling and pain of variable intensity with acute episodes. Clinical and imaging studies led to the diagnosis of mandibular osteomyelitis as a complication of his underlying condition. Treatment consisted of antimicrobial therapy, exeresis of the necrotic bone and hyperbaric oxygen. Two years later the patient came back to consultation with a relapse of the acute pain process. Spontaneous expulsion of an osseous sequestrum was performed, followed by partial mandibulectomy and reconstruction with a mandibular plate. At this moment the patient does not present any signs of relapse of the acute pain process. Three months after surgery, he remains under strict surveillance(AU)

Osteomielitis mandibular como complicación de la enfermedad de Albers-Schõmberg / Mandibular osteomyelitis as a complication of Albers-Schomberg disease

La enfermedad de Albers-Schõmberg u osteopetrosis es un raro padecimiento óseo. La osteomielitis mandibular es una infrecuente complicación de esta enfermedad. Por ello y por lo interesante de la presentación clínica de ambas entidades, nos propusimos como objetivo presentar este caso. Este paciente masculino de 32 años con antecedentes de enfermedad de Albers- Schõmberg de tipo adulta benigna que dos años atrás acudió a consulta y refirió haberse realizado una exodoncia once meses antes, a partir de lo cual presentó aumento de volumen facial y dolor de intensidad variable con períodos de agudización. Luego del estudio clínico e imagenológico se llegó al diagnóstico de una osteomielitis mandibular como complicación de su enfermedad de base. Se aplicó terapia antimicrobiana, exéresis del hueso necrótico y oxígeno hiperbárico. A los dos años acudió a consulta con una reagudización del proceso, se le produjo la expulsión espontánea de un secuestro óseo y se decidió la realización de una mandibulectomía parcial más reconstrucción con placa mandibular. En estos momentos el paciente no presenta signos de reagudización del proceso y se mantiene bajo vigilancia estricta a los tres meses de realizada la intervención quirúrgica(AU)

Albers-Schomberg disease or osteopetrosis is a rare bone condition. Mandibular osteomyelitis is an infrequent complication of this disease. It was for this reason, alongside the peculiar clinical presentation of both entities, that we decided to present this case. A male 32-year-old patient with a history of benign adult Albers-Schomberg disease attended consultation two years ago and stated to have undergone exodontia eleven months before, after which he had had facial swelling and pain of variable intensity with acute episodes. Clinical and imaging studies led to the diagnosis of mandibular osteomyelitis as a complication of his underlying condition. Treatment consisted of antimicrobial therapy, exeresis of the necrotic bone and hyperbaric oxygen. Two years later the patient came back to consultation with a relapse of the acute pain process. Spontaneous expulsion of an osseous sequestrum was performed, followed by partial mandibulectomy and reconstruction with a mandibular plate. At this moment the patient does not present any signs of relapse of the acute pain process. Three months after surgery, he remains under strict surveillance(AU)