When Aunt Minnie turns out to be a Zebra: distal bile duct adenomyoma stimulating pancreas head tumor.

A 55-year-old female patient with a history of ethyl and nicotine abuse presented with chronic diarrhoea, significant weight loss and abnormal liver tests. Ultrasound examination revealed dilatation of the bile ducts and computed tomography scan with IV contrast further established simultaneous dilatation of the common bile duct and pancreatic duct (double duct sign). The dilatation abruptly stopped at the level of the pancreatic head which demonstrated a small irregular hypovascular zone (1.2 cm), suspected for malignancy. The following week, a radical pancreaticoduodenectomy was performed. Anatomopathological analysis revealed an adenomyoma (12 mm) located distal to the common bile duct, without arguments for malignancy.

Don't burn the blanket to kill a flea: a case of intra-abdominal desmoid fibromatosis.

A 39-year-old woman presented to the Emergency Department with dysuria and persistent abdominal pain for several weeks. The pain increased with palpation. Physical examination was otherwise normal. Computerized tomography (CT) scan revealed a round structure of unknown origin against the caecum and terminal ilium suspect for a GIST tumor and a fluid-filled right uterine tube suggestive of pyosalpinx. The following day a laparoscopic surgery with removal of the pyosalpinx and complete right hemi-colon including the suspected lesion was performed and biopsies of the surrounding peritoneum, meso and ileum were taken. Immunohistochemical tests (CD117/DOG1) and molecular analysis (KIT/PDGFRA) ruled out GIST. SMA and desmin were also negative. ß-catenin along with next generation sequencing which revealed a likely pathogenic mutation in exon 3 of the CTNNB1 gene, suggested a diagnosis of desmoid-type fibromatosis (DF). Biopsies of the lymph nodes were negative.

Endovascular management of an isolated dissection of the celiac artery following a blunt deceleration-type trauma.

A 29-year-old, otherwise healthy male was brought to the emergency department after suffering an injury from falling from the roof of his house. Whole-body computed tomography (CT) showed a small ostial dissection of the celiac artery (CA) associated with a pseudoaneurysm, thrombosis, and retroperitoneal periaortic hematoma. The celiac trunk was otherwise normal with good distal patency and no signs of intestinal ischemia. The patient was successfully managed via an endovascular approach with the placement of a covered stent in the CA.

The protective effects of different treatments on rat salivary glands after radiotherapy.

This study was aimed to evaluate the efficacy of treatment modalities for minimizing salivary gland damage caused by radiotherapy. Forty rats were divided into five groups. Group 1 had no irradiation or any treatment. Group 2 underwent only 15 Gy single dose radiotherapy. N-acetylcysteine, dexamethasone, hyperbaric oxygen treatment were given, respectively to the group 3, 4 and 5 for 5 days. 15 Gy single dose radiotherapy was applied to the group 3, 4 and 5 on the second day. Pyknosis, lysis, and vacuolization were examined in ductal cells and pyknosis, lysis, vacuolization, inflammation and collective duct damage in acinar cells. Dexamethasone and hyperbaric oxygen did not prove to have a positive effect on acinar and ductal cell. N-acetylcysteine-applied group had statistically significantly lower amount of damage. We determined that the decrease of ductal and acinar cell damage in parotid glands of N-acetylcysteine-applied rats was more distinct and statistically.

Hyperbaric oxygen therapy in the treatment of osteonecrosis of the femoral head: a review of the current literature.

OBJECTIVE: To review the current literature on the use of hyperbaric oxygen (HBO2) therapy in the treatment of osteonecrosis of the femoral head (ONFH). SEARCH STRATEGY: We searched PubMed, Directory of Open Access Journals (DOAJ), EMBASE, Web of Science, Academic Search Complete, CINAHL and MEDLINE through April 2015. We hand-searched relevant textbooks, conference proceedings and the reference lists of review articles and clinical studies STUDY ELIGIBILITY CRITERIA: Randomized controlled trials (RCT) and observational studies (cohort study, case-control study, case series) that reported the outcome of patients who received HBO2therapy for ONFH were included. Only English-language articles were included. Study quality was not used as an exclusion criterion. STUDY APPRAISAL AND SYNTHESIS METHODS: Two authors independently assessed trials for inclusion, extracted data and presented to other authors. Disagreements were resolved by consensus. RESULTS: We identified eight clinical studies; two randomized controlled trials (RCTs); one historically controlled study; and five case series. The majority of the studies were small-scale, heterogeneous and methodologically weak. In four of the studies HBO2therapy was combined with other treatment modalities, making it impossible to draw firm conclusions on the specific effects of HBO2therapy. Hip survivorship in studies wherein HBO2therapy was used alone was 95.5% in Steinberg Stage I lesions, 89% in Steinberg Stage II lesions and 100% in Ficat Stage II lesions. CONCLUSIONS: There is a room for HBO2therapy in the management ONFH. Further RCTs, however, are required to better elucidate the role of HBO2therapy in the treatment of ONFH.

The use of hyperbaric oxygen therapy for carbon monoxide poisoning in Europe.

BACKGROUND: The aim of this survey was to identify practice differences in the treatment of carbon monoxide (CO) poisoning with hyperbaric oxygen (HBO2) therapy among centers in Europe. MATERIALS AND METHODS: Using a commercial online survey website (surveymonkey.com), we created a questionnaire and invited the medical directors of hyperbaric centers in Europe by email to complete the survey. RESULTS: Sixty-eight centers from 23 countries participated in the survey. While transient or prolonged unconsciousness was unanimously recognized as an indication for HBO2 therapy, positive neurological findings, ECG suggesting acute ischemia and pregnancy were considered important indications of HBO2 therapy in more than 95% of the centers. Twenty-three (44%) centers reported that they used carboxyhemoglobin (COHb) levels as a criterion for patient selection. Among responders, 39% (18/46) reported delivering a single session within the first 24 hours of CO poisoning, and nine (19%) reported delivering three sessions in the first day. The majority of the centers (52%) replied that they initially gave a single session per patient, which was repeated if symptoms persisted. We identified a total of 21 different HBO2 profiles used in European centers. CONCLUSION: Our results showed that the indications of CO poisoning for HBO2 therapy are still not universally recognized. Additionally, HBO2 therapy protocols used at European hyperbaric centers varied significantly, suggesting a need for more education regarding the published guidelines.

Early treatment response predicts outcome in patients with idiopathic sudden sensorineural hearing loss treated with hyperbaric oxygen therapy.

Hyperbaric oxygen (HBO2) therapy is used in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). Some patients, however, do not benefit from HBO2 therapy despite several weeks of treatment. We hypothesized that early treatment response could predict treatment failure. We conducted a retrospective chart review and identified patients diagnosed with ISSNHL and recorded the pure tone average (PTA) levels prior to, after the first week and at completion of HBO2 therapy. Early treatment response (ETR) was assessed after the first week of HBO2 therapy, and an increase ⟨10 decibels (dB) in mean PTA level was defined as a negative ETR. Factors associated with no recovery were determined using logistic regression analysis. Overall, 39 patients (22 males; mean age (±SD) 41.9 ±14.3 years) were assessed. At treatment completion, the improvement in hearing was 'very substantial' (≥20 dB) for 21 patients (53.8%), 'substantial' (10-19 dB) for eight (20.5%), 'minimal' (⟨10 dB) for five (12.8%) and absent for five (12.8%) patients. After the first week of HBO2 therapy, 18 (46.2%) patients displayed negative ETR. Multivariate logistic regression analysis revealed 'negative ETR' as the only significant predictor of treatment failure (odds ratio (95% confidence interval): 6.98 (1.59-30.61), p=0.010) in patients with ISSNHL treated with HBO2. In conclusion, we found that patients who fail to benefit from an initial set of HBO2 sessions were less likely to benefit from additional HBO2 sessions. Further prospective studies are necessary to confirm our findings.

Antibiotherapy with and without bone debridement in diabetic foot osteomyelitis: A retrospective cohort study.

BACKGROUND AND OBJECTIVE: The treatment of diabetic foot osteomyelitis (DFO) is a controversial issue, with disagreement regarding whether the best treatment is surgical or conservative. The purpose of this study was to compare the outcome of patients with DFO who were treated with antibiotherapy alone and those who underwent concurrent minor amputation. METHODS: Hospital records of patients who were diagnosed as having DFO within a 2-year study period were retrospectively reviewed. Patients were divided into two groups: those who received antibiotherapy alone and those who underwent concurrent minor amputation. Groups were compared in terms of duration in hospitalization, antibiotherapy, and wound healing. RESULTS: Thirty seven patients were included in the study. These comprised patients who received antibiotherapy alone (ABG, n=15) and patients who underwent concurrent minor amputation (AB-MAG, n=22). Hospitalization duration was 37.2 (± 16.2) days in ABG and 52.8 (± 40.2) days in AB-MAG (p = 0.166). Mean duration of antibiotherapy was 45.0 (± 21.7) days in ABG and 47.7 (± 19) days in AB-MAG (p = 0.689). Wound healing duration was 265.2 (± 132.7) days in ABG and 222.6 (± 85.9) days in AB-MAG (p = 0.243). None of the outcome measures were significantly different between ABG and AB-MAG. CONCLUSIONS: Our results have shown similar outcomes for both patient groups who received antibiotherapy alone and who underwent concurrent minor amputations. Considering the small sample sizes in this study, it is important to confirm these results on a larger scale.

Piperacillin/tazobactam-induced neutropenia, thrombocytopenia, and fever during treatment of a diabetic foot infection.

Piperacillin/tazobactam (PTZ) is frequently used in patients with diabetic foot infections. Herein, we report a patient who developed severe neutropenia, thrombocytopenia, and fever while receiving PTZ for a diabetic foot infection. We recommend vigilance when long-term PTZ use is planned in patients with diabetic foot infections.

The implications of the presence of osteomyelitis on outcomes of infected diabetic foot wounds.

AIM: To assess the effect of the presence of osteomyelitis in patients with a diabetic foot infection. METHODS: We reviewed the records of diabetic patients hospitalized at our medical center for a foot infection over a 2-y period. Using clinical, imaging, and microbiology results, we classified each patient as having diabetic foot osteomyelitis (DFO) or not. We then compared several outcome criteria of interest between the 2 groups. RESULTS: Among 73 eligible patients, 37 were in the DFO group (DFO group), while the other 36 were in the soft tissue infection group (STI group). In comparison to the STI group, the DFO group had a significantly longer length of stay (LOS) in the hospital (42 (28.5-51) days vs 19.5 (13.2-29.5) days, p < 0.001), longer duration of antibiotic therapy (46.6 ± 19.9 days vs 22.0 ± 14.6 days, p < 0.001), longer duration of intravenous antibiotic therapy (32.3 ± 16.3 days vs 13.6 ± 14.3 days, p < 0.001), longer duration of wound before admission (44 (31-64.5) days vs 33 (23-45.5) days, p = 0.034), and longer time to wound healing (239.8 ± 108.2 days vs 183.1 ± 73 days, p = 0.011). There were more surgical procedures in the DFO group than in the STI group (24/37 (64.8%) vs 11/36 (30.5%), p = 0.003), and during hospitalization, 22 patients in the DFO group and 5 patients in STI group underwent minor amputation (59.4% vs 13.8%, p < 0.001). CONCLUSION: The presence of osteomyelitis negatively affects both the treatment and outcome of diabetic foot infections.

Fate of abstracts presented at the annual scientific meeting of the Undersea and Hyperbaric Medical Society.

INTRODUCTION: The full-text publication of abstracts presented at any given scientific meeting in peer-reviewed journals is accepted as a measure of scientific quality of that particular meeting. The aim of this study is to determine the full-text publication rate of abstracts presented at the 2005 Scientific Meeting of the Undersea and Hyperbaric Medical Society (UHMS). METHODS: We identified the scientific abstracts presented at the 2005 UHMS meeting and searched the PubMed database (June 2005 to July 2010) for their corresponding full-text publication. We recorded the following parameters for each of the abstracts: number of authors, number of centers involved in the study, statistical methods used, country of origin of the study, study type, and subject of the abstract. We recorded the time to publication and the title of the journal if the abstract had been published in a peer-reviewed journal. RESULTS: Overall, we identified 187 abstracts presented at the 2005 UHMS meeting. Two of the abstracts were excluded from the study because they had been retracted from the meeting and six more because they had been already published as full-text articles at the time the meeting was held. Of the 179 abstracts, 62 (34.6%) were published as full-text articles within the succeeding five years. The mean (+/- SD) time to publication was 18.5 (+/- 13.6) months. Multivariate analysis with logistic regression identified "country of origin" and "the subject of the abstract" as independent predictors of full-text publication. CONCLUSION: We found that only one-third of the abstracts presented at the 2005 UHMS meeting were published as full-text articles within the succeeding five years. Although this rate is consistent with similar studies from various disciplines, further research is needed to identify the specific barriers to full-text publication of abstracts in the field of underwater and hyperbaric medicine.

Influence of hyperbaric oxygen therapy on central corneal thickness.

BACKGROUND/AIMS: Hyperbaric oxygen (HBO) therapy is used in the treatment of several disorders. Little is known about the effects of HBO treatment on corneal thickness. The aim of this study was to investigate the effect of HBO treatment on central corneal thickness. METHODS: Thirty-two subjects (18 males and 14 females, mean age 57.3 ± 16.7 years) undergoing HBO treatment were consecutively enrolled. The subjects were assigned into diabetic (n = 16) and nondiabetic groups (n = 16). Best-corrected visual acuity was recorded before HBO treatment, and anterior and posterior segment examinations were performed on a slit lamp biomicrosope. Central corneal thickness was measured with an ultrasonic pachymeter before and immediately after HBO treatment, which lasted 120 min at 2.4 atmospheres absolute with three 30-min oxygen and two 5-min air breathing periods. RESULTS: HBO treatment did not change the central corneal thickness in diabetic subjects (547.6 ± 34.5 vs. 548.6 ± 34.6 µm; p = 0.606). In nondiabetic subjects, however, the central corneal thickness was significantly reduced after HBO treatment (576.5 ± 34.8 vs. 569.0 ± 34.8 µm; p < 0.001). CONCLUSION: A single exposure to HBO treatment reduced the central corneal thickness in nondiabetic subjects but not in diabetic subjects. However, the change in central corneal thickness was minor.

There may be a role for hyperbaric oxygen therapy in transient osteoporosis of the hip.

Transient osteoporosis of the hip (TOH) is a rare clinical condition with usually an unknown aetiology and which typically develops in middle-aged men, or in women in the third trimester of their pregnancy. It is characterized by transient osteopenia and by gradually increasing pain associated with a limitation of the range of motion of the hip. Bone marrow oedema is a typical but nonspecific finding in TOH. A 33-year-old female patient presented with severe hip pain one month after delivery. Her history was unremarkable except for a Hashimoto's Disease of 8 years' duration. Magnetic resonance imaging (MRI) showed significant bone marrow oedema with increased signal intensity in the femoral head on T2-weighted images. A diagnosis of TOH was made and the patient received a total of 30 sessions of hyperbaric oxygen (HBO) at 2.4 ATA, 2 hours each, in a multiplace chamber. Over the course of HBO treatment, her pain was gradually relieved and she became asymptomatic after one month together with a complete recovery of the range of motion of the hip. MRI of the hips 10 weeks after onset of HBO therapy showed normal signal intensity on T2-weighted images.

Paranasal sinus mucosal hypertrophy in experienced divers.

INTRODUCTION: Due to the increasing popularity in recreational diving long-term health consequences of this sport have aroused interest in the diving community. Although not as important as dysbaric osteonecrosis, ischemic brain lesions, or neurophysiological symptoms, paranasal sinus mucosal hypertrophy (PSMH) has also been discussed as being more prevalent among divers. In this study, we used magnetic resonance imaging (MRI) to compare asymptomatic divers with control subjects for PSMH. METHODS: We enrolled 79 male divers (34.0 +/- 5.7 yr) and 79 nondiving age- and sex-matched controls (33.8 +/- 6.1 yr). We used a questionnaire to elicit diving history. Divers with a history of sinus barotrauma, subjects with a history of chronic sinusitis or nasal allergies, and those with retention cysts, nasal polyps, or mastoiditis were excluded. T1-, T2-weighted axial and coronal images of the paranasal sinuses were taken with a 1.5-T MRI device. The threshold for PSMH was defined as mucosal thickness above 3 mm. RESULTS: MRI revealed PSMH in 33 (41.8%) divers and 18 (22.8%) controls. There were no significant differences between the groups with respect to age, smoking history, or alcohol consumption. PSMH identified in divers did not show an association with age or diving history. DISCUSSION: The higher rate of PSMH identified in divers suggests that diving may cause changes in the paranasal sinus mucosa.