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Entrez pubmed Results 1: Tohoku J Exp Med. 2008 Oct;216(2):127-32. Related Articles
Enhancement of glucose toxicity by hyperbaric oxygen exposure in diabetic rats.
Matsunami T, Sato Y, Morishima T, Mano Y, Yukawa M.
Department of Veterinary Medicine, Laboratory of Biomedical Science, College of Bioresource Sciences, Nihon University, Fujisawa, Japan.
The side effects of hyperbaric oxygen (HBO) treatment, such as oxidative stress and oxygen toxicity, have long been of interest. However, there are no comprehensive studies evaluating such toxic effects in diabetes mellitus (DM). The purpose of this study was to determine the effects of HBO on glucose homeostasis and histological changes in pancreatic beta-cells of experimentally induced diabetic rats. A total of 24 male Wistar rats were randomly divided into 4 groups: 1) Control group, no diabetic induction without HBO treatment; 2) HBO group, exposed to 100% oxygen at 2.8 ATA (atmosphere absolute) for 2 h once daily, for 7 days; 3) DM group, diabetes induced by streptozotocin (STZ) injection; and 4) DM + HBO group, received both STZ injection and HBO exposure. HBO treatment, with clinically recommended pressures and duration of therapy, was started on day 5 after STZ injection, when the blood glucose levels were significantly increased. After the last HBO treatment, the pancreatic tissues were immunostained to measure the areas of insulin immunoreactive beta-cells in the islets of Langerhans. The blood glucose increased significantly following exposure to HBO, with the highest levels achieved in rats, which had been treated with both HBO and diabetic induction. The area populated with insulin immunoreactive beta-cells decreased significantly following diabetic induction and/or HBO exposure, with the smallest area in DM + HBO group. Thus, HBO exposure enhanced the cytotoxic effect of STZ in the beta-cells of the pancreas. HBO should be cautiously employed in diabetic patients.
- Research Support, Non-U.S. Gov't
PMID: 18832794 [PubMed - in process]
2: Best Pract Res Clin Anaesthesiol. 2008 Sep;22(3):553-69. Related Articles
Hyperoxia and infection.
Hopf HW, Holm J.
Department of Anesthesiology, University of Utah, Room 3C444, 30 N 1900 East, Salt Lake City, UT 84132, USA. harriet.hopf@...
Surgical wound infection remains a common and serious complication of surgery. Patient factors are a major determinant of wound outcome following surgery. Co-morbidities clearly contribute, but environmental stressors as well the individual response to stress may be equally important. In particular, wounds are exquisitely sensitive to hypoxia, which is both common and preventable. Perioperative management can promote postoperative wound healing and resistance to infection. Maintaining perfusion and oxygenation of the wound is paramount. Once perfusion is assured, addition of increased inspired oxygen substantially reduces surgical site infection in at risk patients. A greater degree of hyperoxemia, achievable with administration of hyperbaric oxygen, is useful as an adjunct to the treatment of serious soft tissue and bone infections in selected patients. This article will review the basic science underlying these observations, along with the clinical data that support the use of hyperoxia in preventing and treating infections.
PMID: 18831303 [PubMed - in process]
3: Pediatr Diabetes. 2008 Sep 17; [Epub ahead of print] Related Articles
Long-term posaconazole treatment and follow-up of rhino-orbital-cerebral mucormycosis in a diabetic girl.
Tarani L, Costantino F, Notheis G, Wintergerst U, Venditti M, Di Biasi C, Friederici D, Pasquino AM.
Pediatric Department, University 'La Sapienza', Rome, Italy.
To demonstrate that the 2-yr clinical follow-up of our patient strongly suggests that long-term therapy with posaconazole (POS) is safe and beneficial in treatment and prevention of relapses of, otherwise fatal, central nervous system mucormycosis. Mucormycosis is a very rare opportunistic mycotic infection of diabetic children. We present the 30-month follow-up of a 12-yr-old girl affected by diabetic ketoacidotic coma, complicated by rhinocerebral mucormycosis and successfully treated with POS at the initial daily dose of 5 mg/kg t.i.d. with fatty food for 3 wk, followed by a daily dose of 10 mg/kg in four doses for 2 months and then 20 mg/kg/d in four doses for 16 months and in two doses for further 5 months. The previous amphotericin B, granulocyte colony-stimulating factor, hyperbaric oxygen and nasal and left maxillary sinus surgical debridement therapy was ineffective in stopping the progression of the infection to the brain. The patient improved within 10 d with reduced ocular swelling and pain, and 6 months after therapy stop, she is in good health and cultures are sterile. This article demonstrates that POS may be a useful drug in mucormycosis in children. We also strongly draw the attention to the main preventive procedure against invasive fungal infection that is the correct management of antidiabetic therapy that prevents the predisposing temporary neutrophils activity deficit, contributing to a better survival rate of diabetic children.
PMID: 18828793 [PubMed - as supplied by publisher]
4: Ann Fr Anesth Reanim. 2008 Sep 26; [Epub ahead of print] Related Articles, LinkOut
[Fatal air embolism during open eye surgery.]
[Article in French]
Dermigny F, Daelman F, Guinot PG, Hubert V, Jezraoui P, Thomas F, Milazzo S, Dupont H.
Pole d'anesthesie-reanimation, centre hospitalier universitaire d'Amiens, place Victor-Pauchet, 80054 Amiens cedex 1, France.
Gas embolism is well known for a specific subset of surgical interventions. Prevention and early detection are the main objectives of the anesthetic and surgical team. However, it may exceptionally occur during eye surgery with dramatic outcomes. We report the case of a 51-year-old man, ASA physical status 1, who presented a cardiac arrest during an open eye surgery for the extraction of a foreign body with intraocular air injection. Multiple organ failure has not been improved by hyperbaric oxygen therapy and the outcome was fatal.
PMID: 18824322 [PubMed - as supplied by publisher]
5: Injury. 2008 Oct;39 Suppl 4:40-6. Related Articles, LinkOut
Measurement of tibial endothelial cell function after cigarette smoking, cessation of smoking and hyperbaric oxygen therapy.
Yen CY, Tu YK, Ma CH, Yeh JH, Kao FC, Yu SW, Lee MS, Chou YC, Ueng SW.
E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
SUMMARY: Cigarette smoking is hazardous to a range of human tissues. For instance, cigarette smoke inhalation has been proven to delay bone healing. This study analysed the effects of cigarette smoking on tibial vascular endothelium and blood flow using the bone-chamber model. The effects of smoking cessation and hyperbaric oxygen (HBO) on the damage caused by smoking were also compared. 54 adult New Zealand rabbits were divided into three groups. Group 1: control, Group 2: 1 week smoking, and Group 3: 6 weeks' smoking. This study on rabbits confirmed that both short-term and long-term cigarette smoking is dangerous to the bony vascular endothelium of the tibia. The vasodilatation caused by nitric oxide production was significantly attenuated in Group 2 and 3's tibia. Long-term smoking damaged the vascular endothelium more severely than short-term smoking (P<.01). Cessation of smoking effectively reduces the adverse effects of smoking when the cessation time equals the smoking time. HBO also effectively reduces the adverse effects of smoking.
- Research Support, Non-U.S. Gov't
PMID: 18804585 [PubMed - in process]
6: Acta Cir Bras. 2008;23 Suppl 1:72-6; discussion 76. Related Articles, LinkOut
The role of hyperbaric oxygen therapy (hot) as an otoprotection agent against cisplatin ototoxicity.
Yassuda CC, Righetti AE, Cury MC, Hyppolito MA, de Oliveira JA, Feres O.
Ribeirao Preto Faculty of Medicine, University of Sao Paulo, Brazil.
PURPOSE: Hyperbaric oxygen therapy (HOT) consists of intermittent inhalations of 100% oxygen at a pressure higher than 1 atm. It is an important adjuvant therapy in pathological processes like soft tissue infections, radiation injury, gas gangrene, osteomyelitis and decompressive diseases. Cisplatin, a potent antineoplastic drug, widely used in cancer therapy is highly ototoxic causing bilateral, irreversible damage to the hearing of high frequency sounds (4-8 KHz). OBJECTIVE:This experimental study conducted at the Faculty of Medicine of Ribeirao Preto, University of Sao Paulo aims to evaluate Hyperbaric Oxygen Therapy as an otoprotection agent against drug toxicity. METHODS: Albino guinea pigs were divided into two groups: in Group A, 5 animals (10 cochlea) received cisplatin, i. p., 8.0 mg/kg/day during three days and afterwards were submitted to HOT; in Group B, 3 animals (6 cochlea) received cisplatin, i. p. 8.0 mg/kg/day during three days. Guinea pigs were evaluated by acoustic otoemissions (AOE) and scanning electron microscopy (SEM). RESULTS: Group B animals showed loss of auditory functions as measured by AOE and distorted outer hair cells by SEM. In Group A, outer hair cells shown by SEM images were mostly preserved. CONCLUSION: It is presumed that Hyperbaric Oxygen Therapy has a protector effect against cisplatin ototoxicity.
PMID: 18516452 [PubMed - in process]
7: Clin Sci (Lond). 2008 Sep 26; [Epub ahead of print] Related Articles, LinkOut
Hyperbaric oxygen activates discoidin domain receptor 2 via tumor necrosis factor-alpha and p38 pathway to increase vascular smooth muscle cells migration through matrix metalloproteinase 2.
Shyu KG, Wang BW, Chang H.
Discoidin domain receptor 2 (DDR2) regulates collagen turnover mediated by smooth muscle cells (SMCs) in atherosclerosis. Hyperbaric oxygen (HBO) has been used in medical practice. However, the molecular mechanism of beneficial effects of HBO is poorly understood. The effect of HBO on DDR2 has not been reported previously. We sought to investigate the cellular and molecular mechanisms of regulation of DDR2 by HBO in SMCs. Cells were exposed to 2.5 atmosphere absolute (ATA) of oxygen in a hyperbaric chamber. DDR2 protein (3.63-fold) and mRNA (2.34-fold) expression were significantly increased after exposure to 2.5 ATA HBO for 1 h. Addition of SB203580 and p38 siRNA 30 min before HBO inhibited the induction of DDR2 protein. HBO also significantly increased DNA-protein binding activity of Myc-Max. Addition of SB203580 and TNF-alpha monoclonal antibody (Ab) 30 min before HBO abolished the DNA-protein binding activity induced by HBO. HBO significantly increased secretion of TNF-alpha from cultured SMCs. Exogenous addition of TNF-alpha significantly increased DDR2 protein expression while TNF-alpha Ab and TNF-alpha receptor Ab blocked the induction of DDR2 protein expression. HBO significantly increased the SMC migration while DDR2 siRNA inhibited the migration induced by HBO. HBO increased both pro- and activated matrix metalloproteinase 2 (MMP2) protein expressions and DDR2 siRNA abolished the induction of both forms of MMP2 expression induced by HBO. In conclusion, HBO activates DDR2 expression in cultured rat SMCs. HBO-induced DDR2 is mediated by TNF-alpha and at least in part through p38 MAP kinase and Myc pathway.
PMID: 18821853 [PubMed - as supplied by publisher]
8: Anesteziol Reanimatol. 2008 Jul-Aug;(4):34-8. Related Articles, LinkOut
[Impact of hyperbaric oxygen therapy on the clinical course of acute pancreatitis and systemic inflammation response syndrome]
[Article in Russian]
[No authors listed]
Feasibility of hyperbaric oxygen therapy (HBO) as an efficient and safe adjunct to the standardized treatment protocol and its possible immunomodulatory impact were assessed in the prospective and controlled study of 44 patients with diagnosed acute pancreatitis (AP). The course of the disease was accompanied by systemic inflammatory response syndrome (AIRS) in all the patients on admission. The impact of AP and HBO on homeostasis, the number of performed operations, mortality rates, the levels of two cytokines, intraabdominal pressure, and side effects caused by HBO were evaluated. A treatment group consisted of 22 patients receiving HBO therapy for 3 days (twice a day) using a monoplace chamber under pressures of 1.7-1.9 ATA. Patients (n = 22) in the control group were managed in accordance with the standardized treatment protocol. The authors found more stable homeostasis, decreased mortality rate, and the number of operations in the HBO group. This type of additional therapy, possibly contributed to the decrease of intraabdominal pressure within the first six days after admission. The findings suggest HBO can affect an inflammatory response, by decreasing the levels pro-inflammatory cytokines and increasing those of anti-inflammatory ones.
- English Abstract
PMID: 18819393 [PubMed - in process]
9: Cerebrovasc Dis. 2008 Sep 26;26(4):447-448 [Epub ahead of print] Related Articles, LinkOut
Normalization of Brain Tissue Lactate after Hyperbaric Oxygen Therapy in a Progressive Stroke Patient.
Lee JI, Wittsack HJ, Christaras A, Miese FR, Siebler M.
Department of Neurology, Heinrich Heine University, Dusseldorf, Germany.
PMID: 18818491 [PubMed - as supplied by publisher]
10: J Appl Physiol. 2008 Sep 25; [Epub ahead of print] Related Articles, LinkOut
Effects of hyperbaric gases on membrane nanostructure and function in neurons.
D'Agosstino DP, Colomb DG, Dean JB.
University of South Florida.
This mini-review summarizes current ideas of how hyperbaric gases (>1-10 ATA) affect neuronal mechanisms of excitability through molecular interaction with membrane components. The dynamic nature of the lipid bilayer, its resident proteins, and the underlying cytoskeleton, makes each respective nanostructure a potential target for modulation by hyperbaric gases. Depending on the composition of the gas mixture, the relative concentrations of O2 and inert gas, and total barometric pressure, the net effect of a particular gas on the cell membrane will be determined by the gas' i) lipid solubility, ii) ability to oxidize lipids and proteins (O2), and iii) capacity, in the compressed state, to generate localized shear and strain forces between various nanostructures. A change in the properties of any one membrane component is anticipated to change conductance of membrane-spanning ion channels and thus neuronal function. Key words: anesthesia, barosensitivity, oxidative stress, nitrogen narcosis.
PMID: 18818382 [PubMed - as supplied by publisher]
11: Biochem Biophys Res Commun. 2008 Sep 19; [Epub ahead of print] Related Articles, LinkOut
NS-398, a selective COX-2 inhibitor, inhibits proliferation of IL-1beta-stimulated vascular smooth muscle cells by induction of EtaOmicron-1.
Choi HC, Kim HS, Lee KY, Chang KC, Kang YJ.
Department of Pharmacology and Aging-Associated Vascular Disease Research Center, College of Medicine, Yeungnam University, Daegu 705-717, Republic of Korea.
We investigated whether NS-398, a selective inhibitor of COX-2, induces HO-1 in IL-1beta-stimulated vascular smooth muscle cells (VSMC). NS-398 reduced the production of PGE(2) without modulation of expression of COX-2 in IL-1beta-stimulated VSMC. NS-398 increased HO-1 mRNA and protein in a dose-dependent manner, but inhibited proliferation in IL-1beta-stimulated VSMC. Furthermore, SnPPIX, a HO-1 inhibitor, reversed the effects of NS-398 on PGE(2) production, suggesting that COX-2 activity can be affected by HO-1. Hemin, a HO-1 inducer, also reduced the production of PGE(2) and proliferation of IL-1beta-stimulated VSMC. CORM-2, a CO-releasing molecule, but not bilirubin inhibited proliferation of IL-1beta-stimulated VSMC. NS-398 inhibited proliferation of IL-1beta-stimulated VSMC in a HbO(2)-sensitive manner. In conclusion, NS-398 inhibits proliferation of IL-1beta-stimulated VSMC by HO-1-derived CO. Thus, NS-398 may facilitate the healing process of vessels in vascular inflammatory disorders such as atherosclerosis.
PMID: 18809379 [PubMed - as supplied by publisher]
12: Masui. 2008 Sep;57(9):1157-9. Related Articles, LinkOut
[Continuous intravenous administration of fentanyl reduces tenesmus after transurethral resection of the prostate (TUR-P)]
[Article in Japanese]
Murakami T, Sakon K, Naya Y, Kanazawa M, Nobukawa Y, Ueda M, Tabata M, Yasuda Y, Suzuki H, Shigemi K.
Department of Anesthesiology, Saiseikai Suita Hospital, Suita 564-0013.
BACKGROUND: The relief from tenesmus is important after transurethral resection of the prostate (TUR-P). We evaluated the effect of continuous intravenous administration of fentanyl on the tenesmus. METHODS: Eleven patients receiving fentanyl infusion (fentanyl group) were compared with fourteen patients without fentanyl infusion (control group) retrospectively. All patients underwent TUR-P under spinal anesthesia with hyperbaric 0.5% bupivacaine 2.2-2.8 ml. In the fentanyl group, fentanyl infusion 25 microg x hr(-1) was started followed by fentanyl 50 microg administration postoperatively. RESULTS: In the fentanyl group, NSAIDs were needed in only one patient. Eleven patients in the control group, however, required NSAIDs and three of them needed additional pentazocine administration. The required amount of NSAIDs per patient was significantly smaller in the fentanyl group (Mann-Whitney U test, P < 0.01). In the fentanyl group, one patient had slight nausea but needed no care. Other side effects, such as respiratory depression, hypotension, bradycardia and somnolence were not observed. CONCLUSIONS: Continuous intravenous administration of fentanyl was very effective and safe enough for the tenesmus after TUR-EP.
- English Abstract
PMID: 18807907 [PubMed - in process]
13: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Sep 19; [Epub ahead of print] Related Articles, LinkOut
Effect of hyperbaric oxygen on grafted and nongrafted calvarial critical-sized defects.
Jan A, Sandor GK, Brkovic BB, Peel S, Evans AW, Clokie CM.
Professor and Head of Oral and Maxillofacial Surgery, University of Toronto; Coordinator, Pediatric Oral and Maxillofacial Surgery, The Hospital for Sick Children and Bloorview Kids Rehab, Toronto, Canada; Professor, Regea Institute for Regenerative Medicine, University of Tampere, Tampere, Finland; Dosent, University of Oulu, Oulu, Finland.
OBJECTIVES: This study was undertaken to evaluate the effect of hyperbaric oxygen (HBO) on the repair of critical-sized defects in the presence and absence of a nonvascularized autogenous bone graft. STUDY DESIGN: Ten New Zealand White rabbits were randomly divided into 2 groups of 5 animals each. Bilateral 15-mm calvarial defects were created in the parietal bones of each animal, resulting in 20 critical-sized defects. Autogenous bone grafts (ABG) were allocated to the left or right defect of each animal. Group 1 received HBO treatment at 2.4 ATA 100% oxygen for 90 minutes per day 5 days a week for 4 weeks. Group 2 served as a normobaric (NBO) control, breathing only room air. The animals in each group were humanely killed at 6 weeks. Calvaria were analyzed by micro-CT and histomorphometry. RESULTS: Micro-CT analysis indicated that as expected there was a higher bone mineral density (BMD) and bone mineral content (BMC) in ABG than unfilled defects (P < .05). However, there was a significant decline in the bone mineral content (BMC) of HBO-treated grafted defects compared to NBO-treated grafted defects (P < .05). Histologically complete bridging of the defect was observed in both NBO and HBO ABG grafted defects. Histomorphometic analysis showed that HBO treatment increased new bone and marrow, and reduced fibrous tissue in the defects (P < .01 for all). Examination of residual graft showed a near significant reduction in residual graft volume (11.2 +/- 4.7 versus 19.1 +/- 7.7, HBO versus NBO P = .085) in the HBO group. The use of a graft increased new bone and marrow in the NBO group (P < .001 for both); however, in the HBO-treated animals the differences between grafted and ungrafted were not significant. CONCLUSION: HBO enhances bony healing in ungrafted rabbit calvarial critical-sized defects and may increase the rate of residual graft resorption in autogenous bone-grafted defects.
PMID: 18805720 [PubMed - as supplied by publisher]
14: Biochemistry. 2008 Sep 20; [Epub ahead of print] Related Articles, LinkOut
Characterization of Quinolinate Synthases from Escherichia coli, Mycobacterium tuberculosis, and Pyrococcus horikoshii Indicates That [4Fe-4S] Clusters Are Common Cofactors throughout This Class of Enzymes.
Saunders AH, Griffiths AE, Lee KH, Cicchillo RM, Tu L, Stromberg JA, Krebs C, Booker SJ.
Department of Chemistry and Department of Biochemistry and Molecular Biology, The Pennsylvania State University, University Park, Pennsylvania 16802 Squire@..., ckrebs@....
Quinolinate synthase (NadA) catalyzes a unique condensation reaction between iminoaspartate and dihydroxyacetone phosphate, affording quinolinic acid, a central intermediate in the biosynthesis of nicotinamide adenine dinucleotide (NAD). Iminoaspartate is generated via the action of l-aspartate oxidase (NadB), which catalyzes the first step in the biosynthesis of NAD in most prokaryotes. NadA from Escherichia coli was hypothesized to contain an iron-sulfur cluster as early as 1991, because of its observed labile activity, especially in the presence of hyperbaric oxygen, and because its primary structure contained a CXXCXXC motif, which is commonly found in the [4Fe-4S] ferredoxin class of iron-sulfur (Fe/S) proteins. Indeed, using analytical methods in concert with Mossbauer and electron paramagnetic resonance spectroscopies, the protein was later shown to harbor a [4Fe-4S] cluster. Recently, the X-ray structure of NadA from Pyrococcus horikoshii was solved to 2.0 A resolution [Sakuraba, H., Tsuge, H.,Yoneda, K., Katunuma, N., and Ohshima, T. (2005) J. Biol. Chem. 280, 26645-26648]. This protein does not contain a CXXCXXC motif, and no Fe/S cluster was observed in the structure or even mentioned in the report. Moreover, rates of quinolinic acid production were reported to be 2.2 mumol min (-1) mg (-1), significantly greater than that of E. coli NadA containing an Fe/S cluster (0.10 mumol min (-1) mg (-1)), suggesting that the [4Fe-4S] cluster of E. coli NadA may not be necessary for catalysis. In the study described herein, nadA genes from both Mycobacterium tuberculosis and Pyrococcus horikoshii were cloned, and their protein products shown to contain [4Fe-4S] clusters that are absolutely required for activity despite the absence of a CXXCXXC motif in their primary structures. Moreover, E. coli NadA, which contains nine cysteine residues, is shown to require only three for turnover (C113, C200, and C297), of which only C297 resides in the CXXCXXC motif. These results are consistent with a bioinformatics analysis of NadA sequences, which indicates that three cysteines are strictly conserved across all species. This study concludes that all currently annotated quinolinate synthases harbor a [4Fe-4S] cluster, that the crystal structure reported by Sakuraba et al. does not accurately represent the active site of the protein, and that the "activity" reported does not correspond to quinolinate formation.
PMID: 18803397 [PubMed - as supplied by publisher]
15: Surg Technol Int. 2008;17:89-95. Related Articles, LinkOut
Biological basis of diabetic foot wounds.
Clemens MW, Attinger CE.
Department of Plastic Surgery, Georgetown University Medical Center, Washington, D.C. USA.
The steps to achieving a healthy healing wound include a correct diagnosis, ensuring a good local blood supply, debriding the wound to reveal a clean base, correcting the biomechanical abnormality, and nurturing the wound until it shows signs of healing. Debridement should be performed as often as necessary until the wound is deemed clean and ready for reconstruction. The repair is then dictated by how much of the foot remains post-debridement and how the foot can be closed in the most biomechanically stable construct possible. The subsequent reconstruction can then usually be accomplished by simple techniques most of the time, and with complex flap reconstruction in about 10% of cases. Wound healing adjuncts such as growth factor, cultured skin, and hyperbaric oxygen can be helpful adjuncts.
PMID: 18802887 [PubMed - in process]
16: Med Hypotheses. 2008 Sep 16; [Epub ahead of print] Related Articles, LinkOut
A novel approach in preventing the occurrence of diabetic foot infections - The finger socks.
Mutluoglu M, Uzun G, Yildiz S.
Department of Underwater and Hyperbaric Medicine, Gulhane Military Medical Academy Haydarpasa Teaching Hospital, 34668 Uskudar, Istanbul, Turkey.
PMID: 18801621 [PubMed - as supplied by publisher]
17: Nephrol Dial Transplant. 2008 Sep 17; [Epub ahead of print] Related Articles, LinkOut
Hyperbaric oxygen treatment improves GFR in rats with ischaemia/reperfusion renal injury: a possible role for the antioxidant/oxidant balance in the ischaemic kidney.
Rubinstein I, Abassi Z, Milman F, Ovcharenko E, Coleman R, Winaver J, Better OS.
Departments of Physiology and Biophysics and Cell Biology, the B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology and Rambam Medical Center, Haifa, 31096, Israel.
BACKGROUND: Ischaemic kidney injury continues to play a dominant role in the pathogenesis of acute renal failure (ARF) in many surgical and medical settings. A major event in the induction of renal injury is related to the generation of oxygen-free radicals. Hyperbaric oxygen therapy (HBO) is indicated for treatment of many ischaemic events but not for ARF. Therefore, the present study examined the effects of HBO on kidney function and renal haemodynamics in rats with ischaemic ARF. METHODS: Renal ischaemia was induced by unilateral renal artery clamping (45 min) in rats. Within 24 h following ischaemia, rats were treated twice with HBO of 100% O(2) at 2.5 absolute atmospheres for 90 min each (+HBO). Untreated rats (-HBO) served as a control. Forty-eight hours later, GFR, RBF and endothelial-dependent vasorelaxation were measured. In addition, the immunoreactive staining of 4-hydroxy-2-noneal (4-HNE), a major product of endogenous lipid peroxidation, and superoxide dismutase (SOD) were assessed. RESULTS: In the -HBO group, GFR was reduced by 94% compared with the untouched normal kidney (ischaemic: 0.06 +/- 0.03 ml/min, normal: 1.02 +/- 0.13 ml). In contrast, in the +HBO group, GFR of the ischaemic kidney (0.36 +/- 0.07 ml/min) was reduced only by 68% compared with the contralateral normal kidney (1.12 +/- 0.12 ml/min). In line with these findings, HBO improved the vasodilatory response to ACh as expressed in enhancement of both total and regional renal blood flow. In addition, HBO reduced the formation of 4-HNE by 33% and 76% and increased SOD by 30% and 70% in the cortex and outer stripe region of the medulla of the ischaemic kidney, respectively. CONCLUSION: HBO attenuates the decline in GFR following renal ischaemia, and improves endothelial-dependent vasorelaxation, suggesting that treatment with HBO may be beneficial in the setting of ischaemic ARF.
PMID: 18799609 [PubMed - as supplied by publisher]
18: Gynecol Oncol. 2008 Sep 15; [Epub ahead of print] Related Articles, LinkOut
How to make a hospital-based wound center financially viable: The Georgetown University hospital model.
Attinger CE, Hoang H, Steinberg J, Couch K, Hubley K, Winger L, Kugler M.
The Center for Wound Healing, Georgetown University Hospital, Washington, DC, USA.
As the medical need and expenditure for chronic wound care have increased markedly over the past decade, wound centers have grown exponentially throughout the country. They can be community-based or hospital-based, and in either case, can be run by the facility or by a national chain. The wound center's viability is dependent on generated revenue, and its clinical effectiveness is based on a multidisciplinary approach to wound care. By incorporating the wound center into an existing hospital system, one can take advantage of the hospital's resources to effectively treat the more complex patients. Additionally, by focusing on limb salvage, the hospital attracts the critical limb ischemia and other complex patients that often require inpatient admission. We examined the Georgetown University Hospital Center for Wound Healing performance over the first 6 years of operation. Since opening the wound center in 1999, the number of outpatient visits has doubled, the wound care inpatient census has doubled, and the operative cases have increased 3-fold. Because the outpatient segment of the wound center can at best cover its direct cost, it cannot financially justify its existence. Hyperbaric oxygen (HBO) can increase the revenue to the point where the indirect costs are covered as well and the wound center can be revenue neutral. Due to the medical complexity of limb salvage patients, the inpatient collections are much higher than those of the outpatient wound center and therefore can serve as justification for the latter's financial viability. More importantly, with the wound center in place, the hospital can provide the local/regional community with a comprehensive service that can effectively treat the most challenging wounds. The success is built on a multidisciplinary team approach, use of evidence-based treatment protocols, efficient clinical structure, and a supportive hospital system. The beneficiaries include the patient with a healed wound, the physician with a gratifying practice, the health care system with lower costs, and the hospital w
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Entrez pubmed Results 1: Respir Physiol Neurobiol. 2008 Oct 9; [Epub ahead of print] Related Articles
Estimating the effect of lung collapse and pulmonary shunt on gas exchange during breath-hold diving: The Scholander and Kooyman legacy.
Fahlman A, Hooker SK, Olszowka A, Bostrom BL, Jones DR.
Global Diving Research, Ottawa, ON, Canada K2J 5E8; Department of Zoology, The University of British Columbia, 6270 University Blvd., Vancouver, BC, Canada V6T 1Z4.
We developed a mathematical model to investigate the effect of lung compression and collapse (pulmonary shunt) on the uptake and removal of O(2), CO(2) and N(2) in blood and tissue of breath-hold diving mammals. We investigated the consequences of pressure (diving depth) and respiratory volume on pulmonary shunt and gas exchange as pressure compressed the alveoli. The model showed good agreement with previous studies of measured arterial O(2) tensions ( [Formula: see text] ) from freely diving Weddell seals and measured arterial and venous N(2) tensions from captive elephant seals compressed in a hyperbaric chamber. Pulmonary compression resulted in a rapid spike in [Formula: see text] and arterial CO(2) tension, followed by cyclical variation with a periodicity determined by Q (tot). The model showed that changes in diving lung volume are an efficient behavioural means to adjust the extent of gas exchange with depth. Differing models of lung compression and collapse depth caused major differences in blood and tissue N(2) estimates. Our integrated modelling approach contradicted predictions from simple models, and emphasised the complex nature of physiological interactions between circulation, lung compression and gas exchange. Overall, our work suggests the need for caution in interpretation of previous model results based on assumed collapse depths and all-or-nothing lung collapse models.
PMID: 18973832 [PubMed - as supplied by publisher]
2: Dig Dis Sci. 2008 Oct 30; [Epub ahead of print] Related Articles
The Effect of iNOS Inhibitors and Hyperbaric Oxygen Treatment in a Rat Model of Experimental Colitis.
Ercin CN, Yesilova Z, Korkmaz A, Ozcan A, Oktenli C, Uygun A.
Division of Internal Medicine, Department of Gastroenterology, Gulhane School of Medicine, Etlik, Ankara, Turkey, cnercin@....
Aim Our aim was to investigate the effectiveness of aminoguanidine (AMG), an inducible nitric oxide synthase inhibitor, and hyperbaric oxygen (HBO) treatment in an experimental colitis model. Methods We induced colitis in rats. In the control group, we applied 2 ml serum physiologic intraperitoneally for 7 days. In the HBO group, 100% oxygen at 2.4 atm pressure was applied for 7 days. In the AMG group, 100 mg/kg AMG was applied intraperitoneally for 7 days. In the HBO + AMG group, HBO and AMG were applied, respectively. At the end of 7 days, rats were sacrificed and the distal 10 cm part of colon was examined macro- and microscopically. Results Severity of colitis and NO activities were reduced by AMG, HBO, and HBO + AMG application. There was histologically significant improvement, especially in the HBO + AMG group Conclusions Both HBO and AMG were significantly effective in preventing weight loss, reducing NO activities, and severity of colitis, when comparing HBO and AMG separately.
PMID: 18972208 [PubMed - as supplied by publisher]
3: ANZ J Surg. 2008 Nov;78(11):947-8. Related Articles
Is early diagnosis of necrotizing fasciitis important?
Hyperbaric Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.
PMID: 18959691 [PubMed - in process]
4: B-ENT. 2008;4(3):169-74. Related Articles, LinkOut
Surgical management of surgery and radiation induced peristomal neck ulcerations.
Deganello A, Gallo O, De Cesare JM, Burali G, Gitti G, Mani R, Langendijk JA, de' Campora E.
University of Florence, Department of Otolaryngology Head & Neck surgery, Firenze, Italy. adeganello@...
PROBLEMS/OBJECTIVE: Non-healing cervical skin ulcerations with concomitant necrosis of the subcutaneous tissue and muscle is a rare but feared complication of radiotherapy that can arise in cervical regions. Constant erosion of the surrounding tissue by the expansion of the necrotic front can threaten important structures. Very few reports in the literature deal with the surgical management of these injuries. METHODOLOGY: This paper reports on two cases of non-healing, slow-growing cervical ulcerations that occurred as a result of radiotherapy and surgery. RESULTS: After unsuccessful conservative treatment, definitive surgical repair was performed to achieve reparation of the defect and protect deep structures. The onset and characteristics of the ulcerations as well as the reconstructive options are discussed. CONCLUSIONS: In the treatment of surgery and radiotherapy induced chronic cervical wounds, non surgical medical treatment should be always attempted for at least 6 months, and should always include hyperbaric oxygen therapy. If conservative methods fail, surgical repair by means of transposition of well vascularized tissue is mandatory to prevent serious complications such as major vessel rupture or fistulas.
PMID: 18949964 [PubMed - in process]
5: Klin Padiatr. 2008 Nov;220(6):380-383. Epub 2008 Oct 23. Related Articles, LinkOut
Ein neues Element bei der Behandlung der septischen Granulomatose (CGD)? - Die Behandlung der Osteomyelitis mit zusatzlicher hyperbarer Sauerstofftherapie (HBO).
Beltz K, Christaras A, Kovacevic A, Schaper J, Strelow H, Niehues T.
1Children's Hospital, HELIOS Klinikum Krefeld, Germany.
Chronic granulomatous disease (CGD) is caused by malfunctioning of the phagocyte NADPH oxidase responsible for the generation of microbicidal reactive oxygen species. It is characterized by severe recurrent infections with catalase positive bacteria. Bacterial or fungal osteomyelitis is a common complication which often does not respond sufficiently to intravenous antibiotic treatment. We report the case of a four year old boy with CGD and osteomyelitis of the mandible refractory to intravenous antibiotic therapy. Introduction of hyperbaric oxygen therapy (HBO) was well tolerated and led to resolution of the osteomyelitis.
PMID: 18949675 [PubMed - as supplied by publisher]
6: Xenobiotica. 2008 Oct 22;:1-5 [Epub ahead of print] Related Articles, LinkOut
Increased distribution of carboplatin, an anti-cancer agent, to rat brains with the aid of hyperbaric oxygenation.
Suzuki Y, Tanaka K, Neghishi D, Shimizu M, Murayama N, Hashimoto T, Yamazaki H.
Laboratory of Drug Metabolism and Pharmacokinetics, Showa Pharmaceutical University, Machida, Japan.
1. The distribution of an anti-cancer agent carboplatin to brains was investigated in combination with hyperbaric oxygenation treatment in rats. 2. After intravenous administration of carboplatin (30 mg kg(-1)) to male Wistar rats, elimination curves of plasma drug concentrations plotted against a time of 45 min were not different with or without hyperbaric oxygenation (at 0.20-0.25 MPa for last 20 min) treatments. 3. Carboplatin concentrations of livers, lungs and kidneys in each group were similar at the endpoint of hyperbaric oxygenation treatment. 4. Under these atmosphere conditions (at 0.10 MPa), carboplatin concentration was at an undetectable level in rat brains (<0.1 microg g(-1) tissue, n = 6). On the contrary, carboplatin was detected in all brains tested at the levels of 0.5 +/- 0.3 microg g(-1) tissue (mean and standard deviation (SD), n = 6), 0.8 +/- 0.5 microg g(-1) tissue, and 0.4 +/- 0.2 microg g(-1) tissue in combination with hyperbaric oxygenation at 0.20, 0.22, and 0.25 MPa, respectively, at the endpoint of hyperbaric oxygenation treatment. 5. The results suggest that carboplatin could be uptaken into rat brains at the detectable levels by the aid of hyperbaric oxygenation, consistently with the reported findings of enhanced transendothelial permeability and improved clinical efficacy of carboplatin combined hyperbaric oxygenation therapy.
PMID: 18949658 [PubMed - as supplied by publisher]
7: Adv Gerontol. 2008;21(2):306-10. Related Articles
[The estimation of thrombocytes aggregation and coagulation haemostasis of elderly and senile patients with ischemic heart disease treated with application of non-drug therapy]
[Article in Russian]
[No authors listed]
The main aim of the study is to estimate a state of thrombocytic and coagulation haemostasis of elderly and senile patients with ischemic heart disease through using a combination of magnitotherapy and hyperbaric oxygenation. 108 patients aged between 70 and 85 years are recruited so far. The range of diagnoses varies from ischemic heart disease, stable angina of II functional class. The studies indicators include thrombocytes aggregation and coagulation which are provided before and after treatment. It has been shown that the results are more positive when magnitotherapy and hyperbaric oxygenation are included in the treatment. That is effected in positive dynamic of thrombocytes spontaneous and induced aggregation, coagulation haemostasis indicators and fibrinolytic activity, which characterize improvement of cardiovascular system functioning.
- English Abstract
PMID: 18942378 [PubMed - in process]
8: Curr Opin Nephrol Hypertens. 2008 Nov;17(6):629-634. Related Articles, LinkOut
Calcific uraemic arteriolopathy: an update.
Rogers NM, Coates PT.
aTransplantation Immunology Laboratory and Department of Medicine, Australia bDepartment of Nephrology and Transplantation Services, University of Adelaide, The Queen Elizabeth Hospital (TQEH) Campus, Woodville, Australia cCentre for Stem Cell Research, University of Adelaide, Adelaide, Australia.
PURPOSE OF REVIEW: Calcific uraemic arteriolopathy (CUA) or calciphylaxis is a rare but important cause of morbidity and mortality in patients with chronic kidney disease. The prevalence of CUA is increasing in patients with renal failure, and the condition is also being recognized in nonuraemic patients. RECENT FINDINGS: There has been increasing understanding of the molecular basis of vascular calcification, in particular on the important role of the uraemic microenvironment in the factors implicated in the differentiation of vascular smooth muscle cells into osteoblasts. New options for treatment of hyperphosphataemia and secondary hyperparathyroidism in patients with chronic kidney disease have become available in the last few years and these have begun to be used in patients with CUA. These include bisphosphonates, newer noncalcium/nonaluminium-containing phosphate binders and case reports of use of cinacalcet. Other treatments for CUA that are not targeted directly at calcium/phosphate homeostasis include hyperbaric oxygen and the antioxidant cation chelator sodium thiosulphate. SUMMARY: Clinicians managing patients with CUA should consider a combination approach of treating deranged calcium/phosphate with newer therapeutic agents and promoting wound healing with other older modalities such as hyperbaric oxygen and sodium thiosulphate infusions. Randomized controlled trials for treatments in CUA are still lacking.
PMID: 18941358 [PubMed - as supplied by publisher]
9: Br J Oral Maxillofac Surg. 2008 Oct 15; [Epub ahead of print] Related Articles, LinkOut
Patterns of treatment of osteoradionecrosis with hyperbaric oxygen therapy in the United Kingdom.
Dhanda J, Hall TJ, Wilkins A, Mason V, Catling J.
Department of Maxillofacial Surgery, Worcestershire Royal Hospital, Worcester, WR5 1DD, UK.
We aimed to find out the number of patients with osteoradionecrosis (ORN) being treated by hyperbaric chambers in the UK during 2006-07, and the protocols that were being used. We did a telephone survey of 76 chambers to find out whether they treated patients with ORN, how many patients they treated in 2006-07, what chamber pressure they used, the duration of each session, and the total number of sessions/patient. A total of 25 chambers treated 273 patients with ORN in 2006-07; 10 were listed by the British Hyperbaric Association (BHA) and 15 were at multiple sclerosis (MS) centres. MS centres treated 23 (8%) of patients with ORN with a variable number of sessions of shorter duration and lower pressures than the chambers listed by the BHA. Most BHA chambers treated patients at 2.2 ATA for 90min/session with 30 preoperative and 10 postoperative sessions/patient.
PMID: 18929438 [PubMed - as supplied by publisher]
10: J Clin Anesth. 2008 Sep;20(6):452-454. Related Articles, LinkOut
Unilateral spinal anesthesia in two centenarian patients.
Karacalar S, Ture H, Sarihasan B.
Department of Anaesthesiology, Ondokuz Mayis University School of Medicine, 55139 Samsun, Turkey.
The use of unilateral spinal block with a specific hyperbaric mixture of bupivacaine and fentanyl in two centenarian women is presented. This technique was very effective in restricting sympathetic block, and it provided satisfactory analgesia and hemodynamic stability.
PMID: 18929287 [PubMed - as supplied by publisher]
11: J Clin Anesth. 2008 Sep;20(6):415-20. Related Articles, LinkOut
Comparison of spinal anesthesia with combined sciatic-femoral nerve block for outpatient knee arthroscopy.
Montes FR, Zarate E, Grueso R, Giraldo JC, Venegas MP, Gomez A, Rincon JD, Hernadez M, Cabrera M.
Department of Anesthesiology, Fundacion Cardio Infantil-Instituto de Cardiologia, Universidad del Rosario, Bogota, Colombia.
STUDY OBJECTIVE: To compare spinal anesthesia and combined sciatic-femoral nerve block for outpatient knee arthroscopy. DESIGN: Prospective, randomized, controlled study. SETTING: Postoperative recovery area at a university-affiliated medical center. PATIENTS: 50 ASA physical status I and II adult outpatients undergoing arthroscopic knee surgery. INTERVENTIONS: Study subjects were equally divided (n = 25 each) into spinal and sciatic-femoral groups. Spinal group patients received spinal anesthesia with 7.5 mg of 0.5% hyperbaric bupivacaine. Sciatic-femoral group patients received combined sciatic-femoral nerve blocks using a mixture of 20 mL of lidocaine 2% plus 20 mL of bupivacaine 0.5%. MEASUREMENTS: Times including that from arrival in the operating room to readiness for surgery, duration of surgery, recovery time, and patient satisfaction were recorded. Analgesia and occurrence of adverse events also were recorded. MAIN RESULTS: No significant differences between the two groups were found for any of the study measurements of recovery. After discharge, postoperative pain differed significantly between groups only at 6 hours (P < 0.002). Patient satisfaction was high with both techniques. CONCLUSIONS: Combined sciatic-femoral nerve block for outpatient arthroscopic knee surgery offers satisfactory anesthesia, with a clinical profile similar to that of low-dose spinal anesthesia. Sciatic-femoral nerve blocks are associated with significantly lower pain scores during the first 6 postoperative hours.
PMID: 18929280 [PubMed - in process]
12: Am J Emerg Med. 2008 Oct;26(8):966.e1-3. Related Articles, LinkOut
Lactate as a prognostic factor in carbon monoxide poisoning: a case report.
Inoue S, Saito T, Tsuji T, Tamura K, Ohama S, Morita S, Yamamoto I, Inokuchi S.
Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan. email@example.com
Carbon monoxide (CO) poisoning results in various neuropsychological impairments, including delayed encephalopathy (DE) and death. However, factors related to these outcomes are unknown. A group suicide was attempted by 3 young people--a 31-year-old man (patient 1), a 21-year-old woman (patient 2), and a 20-year-old man (patient 3)--by burning charcoal in a closed car. At the emergency department, hypotension and hyperthermia were severe in patient 1, moderate in patient 2, and absent in patient 3, although all the patients were comatose. The initial serum lactate levels were 75.1 mg/dL in patient 1, 41.9 mg/dL in patient 2, and 26.3 mg/dL in patient 3, although the carboxyhemoglobin levels were approximately equal in all the patients. Hyperbaric oxygen therapy (HBOT) was immediately initiated and continued for 10 days in all the cases; however, the outcomes of these patients varied considerably. Patient 1 remained comatose and died on day 31 because of central diabetes insipidus after shock. Patient 2 recovered from coma and was discharged; however, she was rehospitalized for DE on day 45 and recovered completely after another 10-day HBOT. Patient 3 gained consciousness and recovered completely with no sequelae during the 1-year follow-up. From these cases, we can consider that the initial blood lactate may correlate with the patient outcomes and prove to be a useful prognostic factor. Thus, we should particularly consider elevated lactate levels in CO poisoning.
PMID: 18926368 [PubMed - in process]
13: Zhejiang Da Xue Xue Bao Yi Xue Ban. 2008 Sep;37(5):437-43. Related Articles, LinkOut
[Effect of hyperbaric oxygen treatment on mitochondrial free radicals after transient focal cerebral ischemia in rats.]
[Article in Chinese]
Lou M, Wang JH, Qian QQ, Wen SQ, Ding MP.
Department of Neurology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China.
OBJECTIVE: To investigate the effect of hyperbaric oxygen(HBO)therapy on mitochondrial free radicals after transient focal cerebral ischemia in rats. METHODS: The male SD rats were randomly assigned into two groupsicontrol and HBO groups. All animals were subjected to 90 min intra-luminal middle cerebral artery occlusioneMCAOewith the regional cerebral blood flow monitored in vivo by laser Doppler flowmetry. HBO treatment was performed in a pressure chamber with 100%O(2)(3 ATM 1 h) 3 h after ischemia. Twenty-four hours after ischemiaimitochondria in the ischemic core and penumbra were isolated and the contents of H(2)O(2), O(2)(*-), MDA, SOD, GSH-PX and GSH in mitochondria were measured respectively. RESULT: After cerebral ischemia-reperfusion, contents of mitochondrial H(2)O(2), O(2)(*-), MDA increased, while the SOD, GSH-PX and GSH in the mitochondria decreased significantly both in the ischemic core and the ischemic penumbra, compared with those in the normal controls(P<0.05). In the ischemic penumbra, HBO therapy increased significantly the content of O(2)(*-)(P<0.05), enhanced the activity of SODiand decreased the level of MDA (P<0.05). HoweveriHBO therapy did not change the level of MDA, though it also increased the content of O(2)(*-) and the activity of SOD in the ischemic core. HBO therapy had no significant effect on the contents of H(2)O(2), GSH-PX and GSH in the ischemic mitochondria. Conclusion: HBO therapy initiated early after acute transient cerebral ischemia in rats can increase the mitochondrial free radicals level, but also increase the activity of the anti-radical enzymes. HBO treatment inhibits the lipid peroxidation damage of mitochondria in the ischemic penumbra, but not in the ischemic core, which indicates that the mitochondrial function plays a role in the reaction of the free radical in the ischemic area after HBO therapy.
- English Abstract
PMID: 18925708 [PubMed - in process]
14: Br J Anaesth. 2008 Oct 15; [Epub ahead of print] Related Articles, LinkOut
Comparison of hyperbaric and plain articaine in spinal anaesthesia for open inguinal hernia repair.
Bachmann M, Pere P, Kairaluoma P, Rosenberg PH, Kallio H.
Department of Anaesthesiology and Intensive Care Medicine.
BACKGROUND: /st> Fast onset and short duration are prominent properties of the amide-type local anaesthetic articaine. Similar to bupivacaine, a hyperbaric solution of articaine may produce faster onset and shorter duration of spinal anaesthesia than a plain solution. METHODS: /st> Patients undergoing open inguinal hernia repair received in random order articaine 84 mg in either hyperbaric (HyperA, n=49) or plain solution (PlainA, n=48) intrathecally. A blinded observer tested the dermatomal spread (pinprick) and motor block (Bromage scale). RESULTS: /st> Median (range) onset time to the T(10) dermatome was 2 (2-8) (n=46) and 6 (2-30) min (n=39) (P<0.001), and the duration of the sensory block at (or above) the T(10) dermatome was 86 (39-148) and 69 (15-118) min (P=0.007), in Groups HyperA and PlainA, respectively. Peak sensory block was greater in Group HyperA T(4) (L(2)-C(2)) than in Group PlainA T(8)-T(7) (L(3)-T(3)) dermatome, median (range), P<0.001. Spread of the block to the cervical dermatomes associated with hypotension occurred in three patients of Group HyperA (one patient C(2) and two C(4)). The sensory block resolved to the S(2) dermatome significantly faster in Group HyperA, 2.5 (1.5-4.5) h, than in Group PlainA, 3.5 (2.0-4.5) h (P<0.001). Median duration of the motor block was significantly shorter in Group HyperA, 2.0 (1.3-3.5) vs 3.0 (1.5-4.0) h (P<0.001). CONCLUSIONS: /st> Hyperbaric articaine 84 mg had a faster onset and shorter duration of spinal anaesthesia than the plain solution.
PMID: 18922850 [PubMed - as supplied by publisher]
15: J Appl Physiol. 2008 Oct 9; [Epub ahead of print] Related Articles, LinkOut
Oxidative stress is fundamental to hyperbaric oxygen therapy.
University of Pennsylvania.
The goal of this review is to outline advances addressing the role that reactive species of oxygen and nitrogen play in therapeutic mechanisms of hyperbaric oxygen. The review will be organized around major categories of problems or processes where controlled clinical trials have demonstrated clinical efficacy for hyperbaric oxygen therapy. Reactive species are now recognized to play a major role in cell signal transduction cascades, and the discussion will focus on how hyperbaric oxygen acts through these pathways to mediate wound healing and ameliorate post-ischemic and inflammatory injuries. Key words: wound healing, HIF, CD34, integrins.
PMID: 18845776 [PubMed - as supplied by publisher]
16: J Appl Physiol. 2008 Oct 9; [Epub ahead of print] Related Articles, LinkOut
Two faces of nitric oxide: implications for cellular mechanisms of oxygen toxicity.
Allen BW, Demchenko IT, Piantadosi CA.
Duke University Medical Center.
Recent investigations have elucidated some of the diverse roles played by reactive oxygen and nitrogen species (ROS and RNS) in events that lead to oxygen toxicity and defend against it. The focus of this review is on toxic and protective mechanisms in hyperoxia that have been investigated in our laboratories, with an emphasis on interactions of nitric oxide (NO) with other endogenous chemical species and with different physiological systems. It is now emerging from these studies that the anatomical localization of NO release, which depends in part on whether the oxygen exposure is normobaric or hyperbaric, strongly influences whether toxicity emerges and what form it takes-for example acute lung injury, CNS excitation, or both. Spatial effects also contribute to differences in the susceptibility of different cells in organs at risk from hyperoxia, especially in the brain and lungs. As additional nodes are identified in this interactive network of toxic and protective responses, future advances may open up the possibility of novel pharmacologic interventions to extend both the time and partial pressures of oxygen exposures that can be safely tolerated. The implications of a better understanding of the mechanisms by which NO contributes to CNS oxygen toxicity may include new insights into the pathogenesis of seizures of diverse etiologies. Likewise, improved knowledge of NO-based mechanisms of pulmonary oxygen toxicity may enhance our understanding of other types of lung injury associated with oxidative or nitrosative stress. Key words: Oxygen Toxicity, Nitric Oxide, Superoxide, SOD3.
PMID: 18845774 [PubMed - as supplied by publisher]
17: Chir Ital. 2008 Jul-Aug;60(4):607-15. Related Articles, LinkOut
[Fournier's gangrene in an HIV-positive patient. Therapeutic options]
[Article in Italian]
Licheri S, Erdas E, Pisano G, Garau A, Barbarossa M, Tusconi A, Pomata M.
Chirurgia Generale A, Dipartimento Chirurgico Materno-Infantile e Scienze delle Immagini, Ospedale San Giovanni di Dio, Universita degli Studi di Cagliari, Cagliari.
Fournier's gangrene is a life-threatening necrotising infection of the perineal and genital regions. The case presented here refers to an HIV-positive 42-year-old man, admitted in emergency to our department with clinical signs and symptoms of sepsis related to gangrene of the perineum and scrotum. An early wide surgical necrosectomy was performed under epidural anaesthesia. Treatment was completed by intensive care, broad-spectrum antibiotics and hyperbaric oxygen therapy. The wound was managed with advanced dressing (AQUACEL Hydrofiber) until complete healing was obtained, and the scrotum was reconstructed with skin flaps. The disease did not involve the testes, spermatic cord or anorectal canal. The satisfactory aesthetic and functional outcome prompts the authors to stress a number of features of the therapeutic approach adopted: (i) the advantages of epidural anaesthesia with an indwelling catheter that allows further necrosectomy and wound dressing to be performed totally painlessly; (ii) the possibility of avoiding faecal diversion by means of synthetic opioid drugs which are useful to reduce the frequency of defecation; and (iii) the positive impact of advanced dressing on the wound healing process in relation to patient satisfaction and cost management.
- English Abstract
PMID: 18837266 [PubMed - in process]
18: J Wound Care. 2008 Sep;17(9):399-402. Related Articles, LinkOut
Role of oxygen in wound healing.
Diving Diseases Research Centre, Hyperbaric Medical Centre, Plymouth, UK. alex.bishop@...
Acute wounds are initially hypoxic. This state triggers the diffusion of oxygenated plasma from the surrounding intact tissue to the hypoxic area, and sets in train processes resulting in oxidative killing, angiogenesis and collagen synthesis.
PMID: 18833899 [PubMed - in process]
Gene Hobbs, CHT
Rubicon Foundation, Inc
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Entrez pubmed Results 1: Heart Lung Circ. 2008 Dec 29; [Epub ahead of print] Related Articles
Protocol Based on Thromboelastograph (TEG) Out-Performs Physician Preference Using Laboratory Coagulation Tests to Guide Blood Replacement During and After Cardiac Surgery: A Pilot Study.
Westbrook AJ, Olsen J, Bailey M, Bates J, Scully M, Salamonsen RF.
Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Commercial Road, Prahran, Melbourne, Victoria 3181, Australia.
BACKGROUND: Allogenic blood transfusion may affect clinical outcomes negatively. Up to 20% of blood transfusions in the United States are associated with cardiac surgery and so strategies to conserve usage are of importance. This study compares administration according to physician's choice based on laboratory coagulation tests with application of a strict protocol based on the thromboelastograph (TEG). METHODS: Sixty-nine patients presenting for cardiac surgery were randomised to either study or control groups. In the study group a strict protocol was followed covering usage of all blood products according to TEG patterns. In the control group, the physician directed product administration with reference to activated partial thromboplastin time (APTT), international normalised ratio (INR), fibrinogen and platelet count. Bleeding, re-sternotomy, minimum haemoglobin, intubation time, and ICU stay were documented. RESULTS: TEG-based management reduced total product usage by 58.8% in the study group but this was not statistically significant. This was associated with a statistically insignificant trend towards better short-term outcomes. CONCLUSIONS: This pilot study suggests that a strict protocol for blood product replacement based on the TEG might be highly effective in reducing usage without impairing short-term outcome.
PMID: 19117801 [PubMed - as supplied by publisher]
2: Int J Oral Maxillofac Surg. 2008 Dec 29; [Epub ahead of print] Related Articles
Reply to the letter to the editor 'Does hyperbaric oxygen therapy improve quality of life?'
PMID: 19117729 [PubMed - as supplied by publisher]
3: Laryngoscope. 2008 Dec 31;119(1):54-61 [Epub ahead of print] Related Articles
Vacuum-assisted closure therapy in the management of head and neck wounds.
Dhir K, Reino AJ, Lipana J.
Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York, U.S.A.
OBJECTIVES:: The wound vacuum-assisted closure (VAC) has been used in many areas of surgery to promote healing and facilitate secondary reconstruction. Until recently, this treatment modality was overlooked in the otolaryngology literature, and the authors propose that its use should be routine in the treatment of complex head and neck wounds. STUDY DESIGN:: An unbiased cohort study without conflict of interest at two tertiary care centers. MATERIALS AND METHODS:: All patients treated by the authors presented with complex head and neck wounds from 2005 to 2007 and were subjected to wound VAC therapy. The wound VAC dressing was changed every 72 hours, and the wound etiology, wound site, history of chemotherapy and radiation, hospital duration, gender, outcome, and ancillary procedures were recorded. RESULTS:: Nineteen patients with 33 wounds were treated using VAC therapy. Eighty-four percent of these patients healed completely without the need for further surgical intervention. The mean age of this cohort was 63.2 years, with a range of 48-75 years. Males far outnumbered females in this study (17:2). Outpatient therapy commenced at discharge after an average of 11.4 days following a hospital stay ranging between 5 and 28 days. Adjunctive procedures performed during and after VAC therapy included hyperbaric oxygen treatment, dermal grafts, salivary diversion, and regional flap reconstruction. CONCLUSIONS:: This study shows the applicability and versatility of vacuum-assisted wound closure in the head and neck. Based on our results the authors feel that this mode of therapy should be a routine part of the Otolaryngologist's armamentarium for the treatment of complex and refractory head and neck wounds. Laryngoscope, 119:54-61, 2009.
PMID: 19117292 [PubMed - as supplied by publisher]
4: J Org Chem. 2008 Dec 29; [Epub ahead of print] Related Articles, LinkOut
Benzofurans as Efficient Dienophiles in Normal Electron Demand [4 + 2] Cycloadditions.
Chopin N, Gerard H, Chataigner I, Piettre SR.
UMR CNRS 6014, IRCOF, Universite de Rouen, 1 Rue Tesnieres, F-76821 Mont Saint Aignan, France, and Laboratoire de Chimie Theorique, Universite Paris VI, 3, rue Galilee, F-94200 Ivry-sur-Seine, France.
Dearomatization of electron-poor benzofurans is possible through involvement of the aromatic 2,3-carbon-carbon double bond as dienophile in normal electron demand [4 + 2] cycloadditions. The tricyclic heterocycles thereby produced bear a quaternary center at the cis ring junction, a feature of many alkaloids such as morphine, galanthamine, or lunaridine. The products arising from the reaction have been shown to depend on different factors among which the type of the electron-withdrawing substituent of the benzofuran, the nature of the reacting diene, and the method of activation. In the presence of all-carbon dienes, the reaction yields the expected Diels-Alder adducts. When thermal activation is insufficient, a biactivation associating zinc chloride catalysis and high pressure is required to generate the cycloadducts in good yields and high stereoselectivities, for instance, when cyclohexadiene is involved in the process. The use of more functionalized dienes, such as those bearing alkoxy or silyloxy substituents, also shows the limits of the thermal activation, and hyperbaric conditions are, in this case, well-suited. The involvement of Danishefsky's diene induces a competition in the site of reactivity. The aromatic 2,3-carbon-carbon double bond is unambiguously the most reactive dienophile, and the 3-carbonyl unit becomes a competitive site of reactivity with benzofurans bearing substituents prone to heterocyloaddition, in particular under Lewis acid activation. The sequential involvment of both the aromatic double bond and the carbonyl moiety as dienophiles is then possible by using an excess of diene under high-pressure activation. In line with the experimental results, DFT computations suggest that the Diels-Alder process involving the aromatic double bond is preferred over the hetero-Diels-Alder route through an asynchronous concerted transition state. However, Lewis acid catalysis appears to favor the heterocycloaddition pathway through a stepwise mechanism in some cases.
PMID: 19113816 [PubMed - as supplied by publisher]
5: Int J Oral Maxillofac Surg. 2008 Dec 26; [Epub ahead of print] Related Articles, LinkOut
Comment on Letter to the Editor: Does hyperbaric oxygen therapy improve quality of life?
Hyperbaric Medical Centre, Derriford, Plymouth, Devon, UK.
PMID: 19112007 [PubMed - as supplied by publisher]
6: Int J Oral Maxillofac Surg. 2008 Dec 26; [Epub ahead of print] Related Articles, LinkOut
Does hyperbaric oxygen therapy improve quality of life?
Vissink A, Raghoebar GM, Roodenburg JL, Reintsema H, Spijkervet FK, Witjes MJ, Schoen PJ, Bouma J, Burlage FR, Langendijk JA.
Department of Oral and Maxillofacial Surgery, University Medical Center and University of Groningen, Groningen, the Netherlands.
PMID: 19112006 [PubMed - as supplied by publisher]
7: Ear Nose Throat J. 2008 Dec;87(12):684-8. Related Articles, LinkOut
Middle ear barotrauma with hyperbaric oxygen therapy: incidence and the predictive value of the nine-step inflation/deflation test and otoscopy.
Karahatay S, Yilmaz YF, Birkent H, Ay H, Satar B.
Department of Otorhinolaryngology-Head and Neck Surgery, Gulhane Military Medical Academy, Ankara, Turkey. skarahatay@...
We conducted a prospective study to determine the incidence of middle ear barotrauma in patients who were undergoing hyperbaric oxygen therapy (HBOT). We also investigated the value of the nine-step inflation/deflation test and otoscopic findings before and immediately after the initial HBOT session in predicting barotrauma in an attempt to establish some criteria for prophylaxis. The study was conducted on 36 ears of 18 adults who had no history of eustachian tube dysfunction. Patients were being treated with HBOT for sudden hearing loss, wound-healing complications, or complications of diabetes. After 7 days of HBOT, barotrauma was seen in 12 of the 18 patients (66.7%) and in 18 of the 36 ears (50.0%). The nine-step inflation/deflation tests, which were performed before and immediately after the initial HBOT session, were not predictive of barotrauma (p = 0.095 before and p = 0.099 after). However, otoscopic findings obtained immediately after the first session of HBOT were predictive of barotrauma, with a sensitivity and specificity of 83 and 100%, respectively. We conclude that patients with even minor positive pathologic findings on otoscopy immediately following HBOT are at increased risk of middle ear barotrauma if HBOT is to be continued without prophylaxis.
PMID: 19105143 [PubMed - in process]
8: Postgrad Med J. 2008 Nov;84(997):571-8. Related Articles, LinkOut
Bubble trouble: a review of diving physiology and disease.
Levett DZ, Millar IL.
Centre for Altitude, Space and Extreme Environment Medicine, UCL, Highgate Hill, London, UK. denny.levett@...
Exposure to the underwater environment for recreational or occupational purposes is increasing. Approximately 7 million divers are active worldwide and 500,000 more are training every year. Diving related illnesses are consequently an increasingly common clinical problem with over 1000 cases of decompression illness reported annually in the USA alone. Divers are exposed to a number of physiological risks as a result of the hyperbaric underwater environment including: the toxic effects of hyperbaric gases, the respiratory effects of increased gas density, drowning, hypothermia and bubble related pathophysiology. Understanding the nature of this pathophysiology provides insight into physiological systems under stress and as such may inform translational research relevant to clinical medicine. We will review current diving practice, the physics and physiology of the hyperbaric environment, and the pathophysiology and treatment of diving related diseases. We will discuss current developments in diving research and some potential translational research areas.
PMID: 19103814 [PubMed - in process]
9: Zhonghua Er Ke Za Zhi. 2008 Sep;46(9):714-6. Related Articles, LinkOut
[Effects of neural growth factor and hyperbaric oxygen on nerve regeneration after hypoxic ischemic brain injury in newborn mice]
[Article in Chinese]
Wei LX, Cao YT, Liu HQ.
PMID: 19099869 [PubMed - in process]
10: Wilderness Environ Med. 2008 Winter;19(4):293-303. Related Articles, LinkOut
Update on high-altitude pulmonary edema: pathogenesis, prevention, and treatment.
Stream JO, Grissom CK.
Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
High-altitude pulmonary edema (HAPE) is a life-threatening noncardiogenic form of pulmonary edema (PE) that afflicts susceptible persons after rapid ascent to high altitude above 2500 m. Its pathogenesis is related to increased sympathetic tone, exaggerated hypoxic pulmonary vasoconstriction, uneven hypoxic pulmonary vasoconstriction with overperfusion of some regions of the pulmonary vascular bed, increased pulmonary capillary pressure, stress failure of pulmonary capillaries, and alveolar fluid leak across capillary endothelium resulting in interstitial and alveolar edema. Prevention of HAPE is most effectively achieved by gradual ascent with time for acclimatization, although recent small studies have highlighted a number of pharmacologic options. Inhaled salmeterol prevents HAPE presumably by increasing alveolar fluid clearance, the phosphodiesterase-5 inhibitor tadalafil works by acting as a pulmonary vasodilator, and dexamethasone seems to prevent HAPE by stabilizing the capillary endothelium, along with other potential effects. These investigations have yet to be validated in widespread clinical practice. Nifedipine, which prevents HAPE via its effects as a pulmonary vasodilator, has a longer history of clinical use. The most effective and reliable treatment of established HAPE is immediate descent and/or adequate flow supplemental oxygen to maintain arterial saturation above 90%, accompanied by rest from strenuous physical activity. Use of a portable hyperbaric chamber is an effective temporizing measure, and nifedipine may be used for treatment of HAPE, although only as an adjunct to descent and/or supplemental oxygen if these methods of treatment are not immediately available to a person with HAPE.
PMID: 19099331 [PubMed - in process]
11: Intensive Care Med. 2008 Dec 20; [Epub ahead of print] Related Articles, LinkOut
Influence of surgical treatment timing on mortality from necrotizing soft tissue infections requiring intensive care management.
Boyer A, Vargas F, Coste F, Saubusse E, Castaing Y, Gbikpi-Benissan G, Hilbert G, Gruson D.
Medical Intensive Care Unit, Hopital Pellegrin-Tripode, Place Amelie Raba Leon, 33076, Bordeaux cedex, France, alexandre.boyer@....
PURPOSE: Surgical treatment is crucial in the management of necrotizing soft tissue infections (NSTIs). The aim of this study was to determine the influence of surgical procedure timing on hospital mortality in severe NSTI. METHODS: A retrospective study including 106 patients was conducted in a medical intensive care unit equipped with a hyperbaric chamber. Data regarding pre-existing conditions, intensive care and surgical management were included in a logistic regression model to determine independent factors associated with hospital mortality. RESULTS: Overall hospital mortality was 40.6%. In multivariate analysis, underlying cardiovascular disease, SAPS II, abdominoperineal compared to limb localization, time from the first signs to diagnosis <72 h, and time from diagnosis to surgical treatment >14 h in patients with septic shock were independently associated with hospital mortality. CONCLUSION: In patients with NSTI and septic shock, hospital mortality is influenced by the timing of surgical treatment.
PMID: 19099288 [PubMed - as supplied by publisher]
12: Gan To Kagaku Ryoho. 2008 Dec;35(13):2321-5. Related Articles, LinkOut
[Urological oncology emergencies]
[Article in Japanese]
Hori N, Suzuki M.
Palliative Care Unit, Kanto Medical Center NTTEC, Tokyo, Japan.
Urologic emergencies in malignancies are difficult to treat for non-urological medical staff because of their anatomical specificity and sensational susceptibility. Urological cancer pain involves somatic and neuropathic problems. In pelvic malignancies, almost always NSAIDs, micro-2-agonisitic opioids and adjuvant analgesics are necessary for pain palliation. The inducements of hemorrhagic cystitis are radiation, chemotherapy and tumor invasion. Although there are some conservative treatments such as hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis, in emergency circumstances selective embolization of the internal iliac artery may be beneficial with fewer side effects. In uncontrollable tumor bleeding, palliative radiotherapy(maximum dose of 30-36 Gy)is effective. The most important problem in voiding disturbance is bladder outlet obstruction. Sometimes patients are treated with alfa-adrenergic blockers effectively, but eventually they may need an indwelling catheter. Obstructive nephropathy due to malignant ureteral obstruction is an ominous sign of progressive disease, especially in pelvic malignancies. The mean survival rate of 12 months was less than 30%.
- English Abstract
PMID: 19098398 [PubMed - in process]
13: Anesth Analg. 2009 Jan;108(1):240-5. Related Articles, LinkOut
A randomized trial of maximum cephalad sensory blockade with single-shot spinal compared with combined spinal-epidural techniques for cesarean delivery.
Horstman DJ, Riley ET, Carvalho B.
Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA.
BACKGROUND: Previous studies have shown more extensive cephalad sensory blockade in women receiving combined spinal-epidural (CSE) anesthesia compared with single-shot spinal (SSS) anesthesia for elective cesarean delivery. It has been postulated that introduction of the epidural needle during CSE disturbs the negative pressure in the epidural space, resulting in relatively greater cerebrospinal fluid (CSF) pressure and increased spread of intrathecal local anesthetic. We tested the hypothesis that CSE results in more extensive cephalad sensory blockade than SSS anesthesia and that loss-of-resistance during initiation of CSE anesthesia increases CSF pressure compared with SSS. METHODS: Thirty parturients scheduled for elective cesarean delivery were enrolled in this randomized, double-blind study. Patients received either SSS or CSE anesthesia with equal doses of intrathecal anesthetic (hyperbaric bupivacaine 12 mg, fentanyl 10 microg and morphine 200 microg). Before the intrathecal injection, the CSF pressure was measured with a fiberoptic pressure sensor. Maximum cephalad sensory blockade to pinprick, cold and touch was measured. The total dose of phenylephrine required to maintain baseline arterial blood pressure was also recorded. RESULTS: There were no significant differences in the median (interquartile range) pinprick sensory block height [T4 (T4-2) vs T3 (T4-1)] or CSF pressures [6 (4-12) vs 9 (8-12) mm Hg] between the SSS and CSE groups. There were no significant correlations between CSF pressure and block height or total dose of phenylephrine. CONCLUSION: The SSS and CSE techniques inserted in the lateral decubitus position resulted in similar extent of sensory blockade and CSF pressure. These findings suggest that altering the intrathecal dose is not necessary and that any difference in intrathecal pressure associated with initial placement of an epidural needle in the epidural space during CSE anesthesia is clinically inconsequential.
- Research Support, Non-U.S. Gov't
PMID: 19095857 [PubMed - in process]
14: Am J Emerg Med. 2008 Nov;26(9):981-4. Related Articles, LinkOut
Oxygen inhalation using an oxygen concentrator in a low-pressure environment outside of a hospital.
Sakaue H, Suto T, Kimura M, Narahara S, Sato T, Tobe M, Aso C, Kakinuma T, Hardy-Yamada M, Saito S.
Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
Supplementation with oxygen is fundamental in rescue and emergency medicine. However, transportation of oxygen cylinders or a rigid hyperbaric chamber requires large work forces. Also, oxygen in a cylinder may be completely consumed during a rescue action. The oxygen concentrators, which enrich the oxygen percentage of ambient air, may free rescuers from carrying heavy oxygen cylinders. In the present study, 2 types of oxygen concentrators were tested in a mountain hut located at an altitude of 3776 m. Oxygen concentration of the generated gas was 28.6% +/- 0.8% with the first machine, which was powered by an internal battery. Arterial oxygen saturation of the volunteers inhaling through the machine increased from the original 79% +/- 6% to 82% +/- 6%. When the machine was used with a semi-closed circuit, the value increased further to 90% +/- 3%. The second concentrator, which was powered by an external electric generator, outputted 90% +/- 2% oxygen. Arterial oxygen saturation of the volunteers increased to 95% +/- 1%. It is concluded that both types of oxygen concentrators were efficient at high altitude.
- Research Support, Non-U.S. Gov't
PMID: 19091263 [PubMed - in process]
15: Acta Otolaryngol. 2008 Sep;128(9):1048-52. Related Articles, LinkOut
Effects of hyperbaric oxygen therapy on facial nerve regeneration.
Vilela DS, Lazarini PR, Da Silva CF.
Otorhinolaryngology Department, Santa Casa Sao Paulo, Faculty of Medical Sciences, Sao Paulo, Brazil. ceotorrino@...
CONCLUSION: Hyperbaric oxygen treatment (HBOT) promoted an increase of the mean axonal diameter in the group evaluated 2 weeks after lesion induction, which suggests a more advanced regeneration process. However, the number of myelin nerve fibers of the facial nerve of the rabbits was similar when compared to the control and treatment groups, in both evaluation periods. OBJECTIVE: To evaluate the effect of HBOT on the histological pattern of the facial nerve in rabbits exposed to a nerve crush injury. MATERIALS AND METHODS: Twenty rabbits were exposed to facial nerve crush injury. Ten rabbits received HBOT, 10 rabbits comprised the control group. The rabbits were sacrificed 2 and 4 weeks after the trauma. Qualitative morphological analysis, measurement of the external axonal diameters and myelin fiber count were carried out in an area of 185 000 microm2. RESULTS: There was an increase in the area of the axons and thicker myelin in the 2 weeks treatment group in comparison with the control group. The mean diameter of the axons was of 2.34 microm in the control group and of 2.81 microm in the HBOT group, with statistically significant differences. The 2 week control group had a mean number of myelin fibers of 1865.2 +/- 664, and the HBOT group had a mean number of 2026.3 +/- 302; this was not statistically significant. The 4 week control group presented a mean of 2495.1 +/- 479 fibers and the HBOT group presented a mean of 2359.9 +/- 473; this was not statistically significant.
PMID: 19086199 [PubMed - in process]
16: Rev Bras Anestesiol. 2008 Nov-Dec;58(6):597-601, 593-7. Related Articles, LinkOut
Effects of the addition of subarachnoid clonidine to the anesthetic solution of sufentanil and hyperbaric or hypobaric bupivacaine for labor analgesia.
[Article in English, Portuguese]
Tebaldi TC, Malbouisson LM, Kondo MM, Cardoso MM.
Centro Obstetrico do Hospital das Clinicas (HC) da Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Sao Paulo, SP.
BACKGROUND AND OBJECTIVES: The addition of subarachnoid clonidine (alpha-agonist) prolongs the analgesia produced by the combination of sufentanil and isobaric bupivacaine in combined labor analgesia(1). The objective of this study was to compare the quality of analgesia and the prevalence of side effects after the addition of subarachnoid clonidine to the anesthetic solution in labor analgesia. METHODS: After approval by the Ethics Commission, 22 pregnant women in labor were randomly assigned to the subarachnoid administration of either 2.5 mg of 0.5% hyperbaric bupivacaine (CLON/HYPER Group; n = 11) or 2.5 mg of 0.5% isobaric bupivacaine (CLON/ISO Group; n = 11) associated with 2.5 microg of sufentanil and 30 microg of clonidine. Pain, evaluated by the Visual Analogue Scale, heart rate, and mean arterial pressure were assessed every 5 minutes during the first 15 minutes, and then every 15 minutes afterwards until delivery. The prevalence of side effects (nausea, vomiting, pruritus, and sedation) was evaluated. The study was terminated whenever the patient needed supplemental epidural analgesia (pain > 3) or upon delivery of the fetus. The Student t test, Chi-square test, Fisher exact test, and two-way ANOVA for repeated measurements were used in the statistical analysis and a p < 0.05 was considered significant. RESULTS: Anthropometric data, duration of analgesia (70.9 +/- 32.9 vs. 85.4 +/- 39.5), heart rate, and the incidence of pruritus, sedation, nausea, and vomiting were similar in both groups. Mean arterial pressure was significantly lower in the CLON/ISO Group than in the CLON/HYPER Group at 15, 30, and 45 minutes (p < 0.05). CONCLUSIONS: Under the conditions of the present study, the association of a small dose of clonidine (30 microg) with sufentanil caused a higher incidence of hypotension when the isobaric solution of the local anesthetic was used. For all other side effects, both hyperbaric and isobaric solutions showed similar behavior.
PMID: 19082406 [PubMed - in process]
17: J Emerg Med. 2008 Dec 10; [Epub ahead of print] Related Articles, LinkOut
Modern Concepts of the Diagnosis and Treatment of Necrotizing Fasciitis.
Edlich RF, Cross CL, Dahlstrom JJ, Long WB 3rd.
Director of Trauma Prevention, Education and Research, Legacy Verified Level I Shock Trauma Center at Legacy Emanuel Hospital, Portland, Oregon.
Background: Necrotizing fasciitis is a potentially fatal infection involving rapidly progressive, widespread necrosis of the superficial fascia. Objectives: The purpose of this collective review is to review modern concepts of the treatment and diagnosis of necrotizing fasciitis. Discussion: Necrotizing fasciitis is characterized by widespread necrosis of the subcutaneous tissue and the fascia. Although the pathogenesis of necrotizing fasciitis is still open to speculation, the rapid and destructive clinical course of necrotizing fasciitis is thought to be due to multibacterial symbiosis. During the last two decades, scientists have found that the pathogenesis of necrotizing fasciitis is usually polymicrobial, rather than monomicrobial. Although there has been no published well-controlled, clinical trial comparing the efficacies of various diagnostic imaging modalities in the diagnosis of necrotizing infections, magnetic resonance imaging (MRI) is the preferred technique to detect soft tissue infection. MRI provides unsurpassed soft tissue contrast and spatial resolution, has high sensitivity in detecting soft tissue fluid, and has multiplanar capabilities. Percutaneous needle aspiration followed by prompt Gram's staining and culture for a rapid bacteriologic diagnosis in soft tissue infections is recommended. Surgery complemented by antibiotics is the primary treatment of necrotizing fasciitis. Conclusion: Wide, extensive debridement of all tissues that can be easily elevated off the fascia with gentle pressure should be undertaken. Successful use of intravenous immunoglobulin has been reported in the treatment of streptococcal toxic shock syndrome. The use of adjunctive therapies, such as hyperbaric oxygen therapy, for necrotizing fasciitis infection continues to receive much attention.
PMID: 19081698 [PubMed - as supplied by publisher]
18: J Appl Physiol. 2008 Dec 12; [Epub ahead of print] Related Articles, LinkOut
Decompression to altitude: assumptions, experimental evidence and future directions.
Foster PP, Butler BD.
University of Texas Medical Branch.
Although differences exist, hypobaric and hyperbaric exposures share common physiological, biochemical and clinical features and their comparison may provide further insight into the mechanisms of decompression stress. Although altitude decompression illness (DCI) has been experienced by high-altitude Air Force pilots and is common in ground-based experiments simulating decompression profiles of extravehicular activities (EVA's) or astronauts' space walks, no case has been reported during actual EVA's in the non weight-bearing microgravity environment of orbital Space Missions. We are uncertain whether gravity influences decompression outcomes via nitrogen tissue wash-out or via alterations related to skeletal muscle activity. However, robust experimental evidence demonstrated the role of skeletal muscle exercise, activities and/or movement in bubble formation and DCI occurrence. Dualism of effects of exercise, positive or negative, on bubble formation and DCI is a striking feature in hypobaric exposure. Therefore, the discussion and the structure of this review are centered on those highlighted unresolved topics about the relationship between muscle activity, decompression and microgravity. This article also provides, in the context of altitude decompression, an overview of the role of denitrogenation, metabolic gases, gas micronuclei, stabilization of bubbles, biochemical pathways activated by bubbles, nitric oxide, oxygen, anthropometric or physiological variables, Doppler-detectable bubbles and potential arterialization of bubbles. These findings and uncertainties will produce further physiological challenges to solve in order to line up for the programmed human return to the Moon, the preparation for human exploration of Mars and the EVA's implementation in a non-zero gravity environment. Key words: Hypobaric decompression, bubble, decompression illness, exercise.
PMID: 19074573 [PubMed - as supplied by publisher]
19: Aviat Space Environ Med. 2008 Dec;79(12):1112-6. Related Articles, LinkOut
MRI findings and clinical outcome in 45 divers with spinal cord decompression sickness.
Gempp E, Blatteau JE, Stephant E, Pontier JM, Constantin P, Peny C.
Department of Hyperbaric Medicine, Military Teaching Hospital, Sainte-Anne, Toulon, France. gempp@...
BACKGROUND: Decompression sickness (DCS) affecting the spinal cord is the most dangerous form of diving-related injury with potential sequelae. This study was conducted to evaluate the relationship between spinal cord lesions on MRI and clinical findings in divers with spinal DCS. METHODS: We studied 45 cases of DCS that were referred to our hyperbaric facility with clinical evidence of spinal involvement during the period 2002-2007. The study included only patients who underwent MRI within 10 d of injury. The severity of spinal DCS for each patient was rated numerically for both the acute event and 1 mo later. The presence or absence of back pain was also noted. RESULTS: Spinal cord lesions were significantly more frequent in divers with severe DCS, and did not occur in any diver who experienced a favorable outcome (sensitivity = 67%, specificity = 100%, negative predictive value = 77%, positive predictive value = 100%). The presence of vertebral degenerative changes that impinged on the spinal cord was strongly associated with MRI abnormalities, but not with a negative outcome. Acute back pain was associated with hyperintense lesions and persistence of neurological sequelae [OR = 14 (95% CI, 3.1 to 63.5)]. CONCLUSION: The results show that MRI could be helpful in predicting clinical outcome in divers with spinal cord DCS. The presence of medullary compressive factors and vertebral back pain after surfacing indicate increased likelihood of severe myelopathy with incomplete recovery.
PMID: 19070307 [PubMed - in process]
20: Aviat Space Environ Med. 2008 Dec;79(12):1100-5. Related Articles, LinkOut
Predive sauna and venous gas bubbles upon decompression from 400 kPa.
Blatteau JE, Gempp E, Balestra C, Mets T, Germonpre P.
Hyperbaric Department, Sainte-Anne Military Hospital, 544 Avenue Ernest Roller, Toulon 83200, France. je.blatteau@...
INTRODUCTION: This study investigated the influence of a far infrared-ray dry sauna-induced heat exposure before a simulated dive on bubble formation, and examined the concomitant adjustments in hemodynamic parameters. METHODS: There were 16 divers who were compressed in a hyperbaric chamber to 400 kPa (30 msw) for 25 min and decomp
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