Doppler recordings after diving to depth of 30 meters at high altitude of 4,919 meters (16,138 feet) during the Tilicho Lake Expedition 2007.

When going to high altitude (higher than 2,400 meters above mean sea level [about 8,200 feet]), human physiology is strongly affected by changes in atmospheric conditions, including decreased ambient pressure and hypobaric hypoxia, which can lead to severe hypoxemia, brain and/or pulmonary edema, negative changes in body and blood composition, as well as disturbances in regional microcirculation. When adding other factors, such as dehydration, physical exercise and exposure to low temperature, it is likely that nitrogen desaturation after diving at such environmental conditions is far from optimal, There are only single reports on diving at high alti-tudes. In 2007 a Polish team of climbers and divers participated in the Tilicho Lake and Peak Expedition to the Himalaya Mountains in Nepal. During this expedition, four divers conducted six dives in the Tilicho Lake at altitude of 4,919 meters above mean sea level equivalent (16,138 feet) to a maximum depth of 15 meters of fresh water (mfw) (equivalent to 28 mfw at sea level by the Cross Correction method) and 30 mfw (equivalent to 57 mfw at sea level "by Cross correction). Decompression debt was calculated using Cross Correction with some additional safety add-ons. Precordial Doppler recordings were taken every 15 minutes until 90 minutes after surfacing. No signs or symptoms of decompression sickness were observed after diving but in one diver, very high bubble grade Doppler signals were recorded. It can be concluded that diving at high altitude should be accompanied by additional safety precautions as well as taking into account personal sensitivity for such conditions.

Hyperbaric oxygen therapy in the treatment of complications of irradiation in head and neck area.

BACKGROUND AND PURPOSE: We have investigated the treatment results of hyperbaric oxygen (HBO2) to patients with radiation-induced tissue complications. MATERIAL AND METHODS: Eight patients (1.4%) from 548 with head and neck cancers treated surgically with post- or preoperative radiotherapy or radiotherapy alone in standard doses who developed postradiation complications (6 patients with laryngeal chondroradionecrosis, 1 patient with osteoradionecrosis of the temporal bone, and 1 patient with soft tissue radionecrosis) are presented. To evaluate radiation reactions occuring in the head and neck region, we used the Chandler grading system for classification of postradiation larynx injuries and SOMA/LENT score for classification of postradiation injuries of mucosa of upper aerodigestive tract. Grades I and II in those grading systems are expected side effects of radiation therapy, thus our cases were all in grades III and IV. The HBO2 was performed after failure of the conventional treatment (antibiotics, steroids, topical therapy). The number of HBO2 expositions was from 8 to 39 and the delay to therapy from 2 to 22 months. RESULTS: Symptoms resolved in all treated patients. Six patients with laryngeal chondroradionecrosis had no symptoms after therapy and in three of them after partial laryngectomy the decannulation was performed. In one patient with mucosal radionecrosis after total laryngectomy, the esophageal fistula was closed and in one patient with osteoradionecrosis of the temporal bone, wound debridement followed. CONCLUSION: The authors' experience supports the increasing clinical evidence that HBO2 is an effective adjunct therapy for treatment of complications of irradiation in head and neck area.

[Hyperbaric oxygen therapy as a method of treatment of laryngeal and pharyngeal radionecrosis]. / Hiperbaria tlenowa jako metoda leczenia zmian popromiennych gardla i krtani.

The authors described two cases of palatine tonsil carcinoma treated with surgery and subsequent radiation therapy after which occurred severe radionecrosis of the larynx, pharynx and oral cavity. These subjects were treated with hyperbaric oxygen therapy (HBO). Complete resolution of postradiation changes was observed. The authors described: 1) basic changes in the tissues caused by radiation therapy; 2) the mechanisms of healing activity of hyperbaric oxygen.

Multifocal necrotizing fasciitis - case report.

PURPOSE: Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection, characterized by rapidly spreading inflammation, with secondary necrosis of the fascia and surrounding tissues. It is mostly caused by group A beta-haemolytic streptococci or multibacterial. A case of the 25-year-old man admitted on September 2006 to the Department of Dermatology and Venereology with suspicion of erysipelas of the left upper limb and left foot is presented. On admission the pain, erythema, diffuse oedema of the left upper limb and erythema of the left foot were observed. Laboratory results revealed elevated: ESR, acute phase parameters (C-reactive protein, D-dimer), CPK and fibrinogen. Within 72-hours, despite treatment with antibiotics and anticoagulants, the oedema and pain increased, initial necrosis of the skin and extreme local tenderness appeared. Suspecting NF the patient had been transported to the Department of Surgery from where, after surgical debridement of devitalized tissue, was moved to the Intensive Care Unit and then transferred to the National Centre of Hyperbaric Medicine of the Medical University of Gdansk. Despite of repeated debridement, aggressive antibiotic therapy and hyperbaric oxygen therapy, necrosis was spreading. The patient developed sepsis and acute respiratory distress syndrome. Amputation of the left upper limb was performed. Five months later patient was admitted to ICU in Bialystok after a suicide attempt. After next four months he died. The dramatic course of the disease is the evidence, that having an adequate knowledge about early symptoms of NF can save patient's life.

Selected problems of health and safety of divers in the light of Polish regulations.

The work addresses legal aspects of employing amateurs (diving clubs members) at underwater works, and lack of standards and regulations regarding light diving equipment for diving teams. New legislation is needed to lay down pensionable age for divers, regulate the employment of women for underwater works in some professions, and medical aspects of fitness certification for divers.

Effect of nitrox saturation diving upon platelet hemostasis.

Two nitrox saturation exposures (seven- and nine-days) at a pressure equivalent to 40 and 45 m (pO2 40-50 kPa) with three divers were carried out. During one exposure 6 excursions from the plateau to the depth of 70 m (one hour) and 60 m (four hours) were made. Before and after the exposures blood platelet count, aggregation and adhesion of blood cells were determined. After the first series of diving a slight increase of adhesion and aggregation was observed, after the other one, despite the larger depth and the excursions from the saturation plateau to 60 and 70 m, a slight decrease of adhesion occurred. This allows to conclude that the phenomenon is related to the decompression load degree as well as to the condition of the divers. Finding about the effect of decompression upon the processes of hemostasis may be useful for the evaluation of the verified system of saturation decompression.

Efficacy of hyperbaric oxygenation in atopic dermatitis.

Ten patients (5 with atopic dermatitis and 5 with asthma-prurigo) aged 8-38 years, were treated with hyperbarie oxygenation, at the Institute of Maritime and Tropical Medicine. Daily one exposure was applied at 0.1 MPa pure oxygen, during 15 days. Parallelly to the clinical evaluation also G, M, E immunoglobulins and the level of C3 and C4 complement were determined. All patients given this treatment improved clinically. In 9 of them, the level of IgE immunoglobulin decreased. The complement levels also decreased.

The effect of hyperbaric oxygen on nasal mucociliary transport.

Nasal mucociliary transport was measured in a group of 30 adult patients (eight women and 22 men; age range 21-78 years, mean 47.9 years) treated with hyperbaric oxygen (HBO) therapy and in a control group of 32 adult subjects (two women and 30 men; age range 20-50 years, mean 32.0 years) compressed in a hyperbaric chamber without oxygen therapy. The treated patients breathed 100% oxygen at 250 kPa pressure for 60 min. Subjects from the control group were compressed in the hyperbaric chamber at 250 kPa for 70 min. Nasal mucociliary transport was measured with the saccharin clearance test. After exposure to HBO, the nasal mucociliary transport time was significantly decreased by 26% (P < 0.01) and returned to the original value after 24 h (increased by 8.3%, P = 0.25). In the control group, compressed in air, there were no statistically significant changes. This study shows that simultaneous compression and pure oxygen cause an increase in nasal mucociliary transport. The mechanism of activation of mucociliary clearance is probably the increased oxygenation of blood plasma and enhancement of metabolism in ciliated epithelium.

Case of carbon monoxide poisoning treated with oxygen hyperbarism.

A case of heavy carbon monoxide poisoning is reported, with disorders in the central nervous system and circulatory disturbances (brain oedema), disfunction of the cardiac muscle and of platelet haemostasis). The level of carboxyhaemoglobin was over 45%. The patient was given hyperbaric treatment at 0.15 MPa (2.5 ATA). On the first day of treatment, the time of stay in the hyperbaric chamber was 90 minutes. During the session the patient regained consciousness. Hyperbaric treatment was continued for 4 days more. At completion of the treatment, the disturbances in both the central nervous system and blood circulation recessed.

Preliminary reports on hyperbaric oxygen therapy in multiple sclerosis.

Preliminary clinical examinations comprised 16 patients suffering from multiple sclerosis, the mean duration of the disease 9.33 years, of the manifestations at different stages of the development--evaluated on the basis of Kurtzke scale. The patients were subjected exclusively to the treatment with oxygen hyperbary--all in all 25-30 exposures, with the intervals of 24 hours, under the O2 pressure of 2 ata. The qualification for the purposes of treatment and the classification of the symptoms present were carried out according to Fisher, the results obtained were evaluated in conformity with standard version of the Disability Status Scale of Kurtzke. Apart from the routine clinical and laboratory tests the programme of the examinations included also a quantitative determination of immunoglobulins level, complement activity as well as the determination of T and B lymphocytes. An eminent change for the better was found in 14 afflicted persons, in one patient after 15 exposures a worsening was observed and the treatment was arrested. As to the immunological parameters investigated, a general decrease of IgG, IgM, IgA in serum, increase of the complement fraction and its 50% hemolysis determined activity were observed, whereas quantitatively investigated T and B lymphocytes did not show any typical changes. The authors discuss the results.

Effect of saturated air and nitrox diving on selected parameters of haemostasis.

The objective of the study was to evaluate decompression stress after air and nitrox saturated divings on the basis of the parameters of haemostasis. Before and after each diving the following examinations were performed: blood platelet count, aggregation, fibrinogen level and coagulation factors VII, X and XII. After the air saturated dives a slight reduction of factor X and XII and of fibrinogen was observed. Evaluation of haemostatis may be one of the basic elements in the assessment of decompression sickness risk.