1
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Fujiyoshi S, Homma S, Yoshida T, Ichikawa N, Shibata K, Matsui H, Taketomi A. A Study of risk factors of postoperative ileus after laparoscopic colorectal resection. Ann Gastroenterol Surg 2023; 7:949-954. [PMID: 37927918 PMCID: PMC10623944 DOI: 10.1002/ags3.12705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/30/2023] [Accepted: 05/19/2023] [Indexed: 11/07/2023] Open
Abstract
Aim Postoperative ileus (POI) is a common complication after abdominal surgery. However, the risk factors for POI after laparoscopic colorectal resection are unclear. We therefore investigated the risk factors for POI after laparoscopic colorectal surgery. Methods This retrospective study involved 484 patients who underwent laparoscopic surgery for primary colorectal cancer at Hokkaido University Hospital. We categorized the patients into a POI group (n = 19) and non-POI group (n = 465). We compared sex, age, smoking, chronic obstructive pulmonary disease (COPD), diabetes mellitus, body mass index (BMI), cardiac disorder, serum albumin, American Society of Anesthesiologists-physical status, tumor location, tumor stage, operative duration, stoma formation, lymph node dissection, operator, and bleeding as potential risk factors for POI between the POI group and non-POI group by univariate and multivariate analyses. Results The univariate analysis results showed that the POI group had a higher incidence of male sex (P = 0.036), COPD (P = 0.029), and a BMI of <20 kg/m2 (P = 0.0487) as well as a higher bleeding volume (P = 0.014). The multivariate analysis results showed that male sex (odds ratio [OR], 0.2799; 95% confidence interval [CI], 0.089-0.993; P = 0.0298), COPD (0.2866; 0.095-0.862; P = 0.0262), and a BMI of <20 kg/m2 (0.2985; 0.112-0.794; P = 0.0154) were independent risk factors for POI after laparoscopic colorectal resection. Conclusion Our findings suggest that male sex, COPD, and a BMI of <20 kg/m2 are independent risk factors for POI after laparoscopic colorectal surgery for treatment of colorectal cancer.
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Affiliation(s)
- Sunao Fujiyoshi
- Department of Gastroenterological Surgery IHokkaido University Graduate School of MedicineSapporoJapan
| | - Shigenori Homma
- Department of Gastroenterological Surgery IHokkaido University Graduate School of MedicineSapporoJapan
| | - Tadashi Yoshida
- Department of Gastroenterological Surgery IHokkaido University Graduate School of MedicineSapporoJapan
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery IHokkaido University Graduate School of MedicineSapporoJapan
| | - Kengo Shibata
- Department of Gastroenterological Surgery IHokkaido University Graduate School of MedicineSapporoJapan
| | - Hiroki Matsui
- Department of Gastroenterological Surgery IHokkaido University Graduate School of MedicineSapporoJapan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery IHokkaido University Graduate School of MedicineSapporoJapan
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2
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Tuluy Y, Aksoy A, Sir E. Effects of external bleeding and hyperbaric oxygen treatment on Tamai zone 1 replantation. Diving Hyperb Med 2023; 53:2-6. [PMID: 36966516 PMCID: PMC10318177 DOI: 10.28920/dhm53.1.2-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/08/2022] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Tamai zone 1 replantation poses a challenge due to the very small size of the vascular structures; often there is no vein for anastomosis. Replantation may have to be done with only an arterial anastomosis. In our study, we aimed to evaluate the success of replantation by combining external bleeding and hyperbaric oxygen treatment (HBOT) in Tamai zone 1 replantation. METHODS Between January 2017 and October 2021, 17 finger replantation patients who underwent artery-only anastomosis due to Tamai zone 1 amputation received 20 sessions of HBOT with external bleeding after the 24th postoperative hour. Finger viability was assessed at the end of treatment. A retrospective review of outcomes was performed. RESULTS Seventeen clean-cut finger amputation patients were operated on under digital block anaesthesia with a finger tourniquet. No blood transfusion was required. In one patient, complete necrosis developed and stump closure was performed. Partial necrosis was observed in three patients and healed secondarily. Replantation in the remaining patients was successful. CONCLUSIONS Vein anastomosis is not always possible in fingertip replantation. In Tamai zone 1 replantation with arteryonly anastomosis, post-operative HBOT with induced external bleeding appeared to shortened the hospital stay and was associated with a high proportion of successful outcomes.
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Affiliation(s)
- Yavuz Tuluy
- Department of Plastic Reconstructive and Aesthetic Surgery, Turgutlu State Hospital, Manisa, Turkey
- Corresponding author: Dr Yavuz Tuluy, Plastic, Reconstructive and Aesthetic Surgery, Manisa Turgutlu State Hospital, Turgutlu, Manisa, 45000, Turkey
| | - Alper Aksoy
- Konur Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Bursa, Turkey
| | - Emin Sir
- İzmir Kavram Vocational School, Department of Plastic Reconstructive and Aesthetic Surgery, İzmir, Turkey
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3
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Wilson M, Bindler RJ, Stanek K, Layton ME, Quock RM. Hyperbaric Oxygen Therapy for Pain, Opioid Withdrawal, and Related Symptoms: A Pilot Randomized Controlled Trial. Pain Manag Nurs 2022; 23:616-624. [PMID: 35393218 DOI: 10.1016/j.pmn.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/01/2022] [Accepted: 03/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pain, drug cravings, and opioid withdrawal symptoms can interfere with substance use disorder or opioid tapering treatment goals. AIM This pilot study investigated the feasibility of a protocol designed to test opioid withdrawal symptom relief relative to a sham condition after two consecutive days of hyperbaric oxygen therapy (HBOT) for adults prescribed daily methadone for opioid use disorder. METHOD Using a double-blind protocol, eight adults were randomized to receive either a full 90-minute HBOT dose in a pressurized chamber with 100% oxygen at 2.0 atmospheres absolute (ATA) or a sham condition receiving 21% oxygen (equivalent to room air within the chamber) at a minimal pressure of ≤1.3 ATA. Measures included study retention, treatment satisfaction, and pre- and post-intervention effects for opioid withdrawal symptoms, drug cravings, pain intensity and interference, sleep quality, and mood. RESULTS Study retention and treatment satisfaction was high. All measurements improved more, on average, for participants receiving full-dose HBOT treatment than among participants receiving sham treatments except for clinically observed withdrawal symptoms. The largest positive effects were observed in measurements of pain intensity and drug craving. CONCLUSIONS These pilot results provide evidence to support a fully powered study of HBOT as a potential treatment adjunct for adults receiving methadone for opioid use disorder. Trends towards symptom improvements were detected from pre- to post-HBOT in the full treatment arm versus sham condition. More research into novel non-pharmacologic options to relieve distressing symptoms related to pain and opioid use disorder is essential to improve clinical outcomes.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington; Program of Excellence in Addictions Research, Washington State University, Spokane, Washington; Sleep and Performance Research Center, Washington State University, Spokane, Washington.
| | - Ross J Bindler
- College of Nursing, Washington State University, Spokane, Washington.
| | - Karen Stanek
- Spokane Hyperbaric Center, Spokane Valley, Washington
| | - Matthew E Layton
- Program of Excellence in Addictions Research, Washington State University, Spokane, Washington; Sleep and Performance Research Center, Washington State University, Spokane, Washington; Department of Translational Medicine and Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Raymond M Quock
- Department of Psychology, Washington State University, Pullman, Washington
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Abstract
ABSTRACT Opioid withdrawal symptoms can interfere with substance use disorder treatment goals. This study investigated the acceptability, feasibility, and treatment effects of hyperbaric oxygen therapy (HBOT) as an adjunct to reduce withdrawal symptoms for adults initiating a medically supervised methadone dose reduction. Adults prescribed methadone for opioid use disorder were randomized into either a hyperbaric oxygen group (n = 17) or an attention control group (n = 14). The study site was an outpatient opioid treatment program in the northwestern United States. Participants were asked to attend five consecutive daily 90-minute HBOT sessions offered at 2.0 atmospheres absolute with 100% oxygen in a pressurized chamber. Treatment attendance and reported satisfaction were measures of acceptability and feasibility. Medication doses were tracked posttreatment at 1 week, 1 month, and 3 months. Withdrawal symptoms were assessed at baseline and daily during the 5-day intervention period. After randomization, 13 (76.5%) followed through with medical screening and HBOT sessions, and of those, nine (69.2%) completed all five 90-minute HBOT sessions. At 3 months, the treatment group maintained, on average, a 4.3-mg methadone dose reduction compared with an average reduction of 0.25 mg for control group participants. Opioid withdrawal symptoms were reduced after Day 1 of HBOT by twice as much, on average, compared with the control condition. Satisfaction surveys found participants were generally satisfied with ease and comfort of the treatment. The evidence that HBOT is an acceptable, feasible adjunct warrants future trials to determine more conclusively effects on withdrawal symptoms associated with methadone dose taper.
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5
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Hampson NB, Moon RE. Arterial gas embolism breathing compressed air in 1.2 metres of water. Diving Hyperb Med 2020; 50:292-294. [PMID: 32957133 DOI: 10.28920/dhm50.3.292-294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/02/2020] [Indexed: 11/05/2022]
Abstract
Arterial gas embolism (AGE) may result when diving while breathing compressed gas and ascending rapidly or with a closed glottis. Pulmonary over-pressurisation can result in lung stretch injury with entry of bubbles into the pulmonary venous circulation and subsequently the systemic arterial circulation. We present the case of an individual who suffered AGE while breathing compressed air at 1.2 metres' fresh water (mfw) in a swimming pool and discuss the factors determining the depth at which this form of injury may occur. This case serves to underscore the fact that risk of AGE exists at shallow depths.
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Affiliation(s)
- Neil B Hampson
- Virginia Mason Medical Center, Seattle, Washington, USA.,Corresponding author: Dr Neil Hampson, Virginia Mason Medical Center H4-CHM, 1100 Ninth Avenue, Seattle WA 98101, USA,
| | - Richard E Moon
- Duke University Medical Center, Durham, North Carolina, USA
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6
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Thibodeaux K, Speyrer M, Raza A, Yaakov R, Serena TE. Hyperbaric oxygen therapy in preventing mechanical ventilation in COVID-19 patients: a retrospective case series. J Wound Care 2020; 29:S4-S8. [PMID: 32412891 DOI: 10.12968/jowc.2020.29.sup5a.s4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE A pandemic afflicts the entire world. The highly contagious SARS-CoV-2 virus originated in Wuhan, China in late 2019 and rapidly spread across the entire globe. According to the World Health Organization (WHO), the novel Coronavirus (COVID-19)has infected more than two million people worldwide, causing over 160,000 deaths. Patients with COVID-19 disease present with a wide array of symptoms, ranging from mild flu-like complaints to life threatening pulmonary and cardiac complications. Older people and patients with underlying disease have an increased risk of developing severe acute respiratory syndrome (SARS) requiring mechanical ventilation. Once intubated, mortality increases exponentially. A number of pharmacologic regimens, including hydroxychloroquine-azithromycin, antiviral therapy (eg, remdesevir), and anti-IL-6 agents (e.g., toclizumab), have been highlighted by investigators over the course of the pandemic, based on the therapy's potential to interrupt the viral life-cycle of SARS-CoV-2 or preventing cytokine storm. At present, there have been no conclusive series of reproducible randomised clinical trials demonstrating the efficacy of any one drug or therapy for COVID-19. CASES COVID-19 positive patients (n=5) at a single institution received hyperbaric oxygen therapy (HBOT) between 13 and 20 April 2020. All the patients had tachypnoea and low oxygen saturation despite receiving high FiO2. HBOT was added to prevent the need for mechanical ventilation. A standard dive profile of 2.0ATA for 90 minutes was employed. Patients received between one and six treatments in one of two dedicated monoplace hyperbaric chambers. RESULTS All the patients recovered without the need for mechanical ventilation. Following HBOT, oxygen saturation increased, tachypnoea resolved and inflammatory markers fell. At the time of writing, three of the five patients have been discharged from the hospital and two remain in stable condition. CONCLUSION This small sample of patients exhibited dramatic improvement with HBOT. Most importantly, HBOT potentially prevented the need for mechanical ventilation. Larger studies are likely to define the role of HBOT in the treatment of this novel disease.
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Affiliation(s)
- Kerry Thibodeaux
- The Wound Treatment Center, LLC @ Opelousas General Health System, Opelousas, LA, US
| | - Marcus Speyrer
- The Wound Treatment Center, LLC @ Opelousas General Health System, Opelousas, LA, US
| | - Amer Raza
- Opelousas General Health System, Opelousas, LA, US
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7
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DeLuca M, Barkhuff D, Duggan NM, Miller ES, Wittels K, Wilcox SR. Case Presentations of the Harvard Affiliated Emergency Medicine Residencies: Weakness after Diving. J Emerg Med 2019; 56:332-336. [PMID: 30685219 DOI: 10.1016/j.jemermed.2018.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Michael DeLuca
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel Barkhuff
- Division of Emergency Medicine, University of Vermont Medical Center, Burlington, Vermont
| | - Nicole M Duggan
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily S Miller
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathleen Wittels
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan R Wilcox
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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8
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Hamamoto Y, Nagasao T, Aizezi N, Tamai M, Kogure T, Morotomi T, Tagichi N, Tanaka Y. Normobaric oxygen therapy increases cartilage survival ratio in auricular composite grafting in rat models. JPRAS Open 2018; 18:28-37. [PMID: 32158835 PMCID: PMC7061664 DOI: 10.1016/j.jpra.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/03/2018] [Accepted: 07/18/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aims to clarify whether normobaric oxygen therapy improves the survival of auricular composite grafts in rats. METHODS For 10 male SD rats, 1.5 cm2 composite grafts were harvested from bilateral ear regions including whole auricles. The harvested grafts were transferred caudally and sutured there. The 10 rats were randomly divided into two groups and kept for 21 days in two different circumstances. The first group (Control group: five rats carrying 10 grafts) was kept in room air (20% oxygen) throughout the 21 days, and the second group-named NBO (normobaric oxygen) group (five rats carrying 10 grafts)-was kept in normobaric 60% oxygen for 3 days and then in room air for 18 days. All the 10 rats were sacrificed on the 21st day. Surviving areas of the grafts and the height of the surviving auricular cartilage were examined for statistical comparison of the two groups. Furthermore, the conditions of chondrogenesis occurring around the perichondrium were compared between the two groups. RESULTS Surviving areas did not present statistically significant differences between the two groups. The height of surviving cartilage was significantly greater for the NBO group (2610 ± 170 SD µm) than that for the Control group (1720 ± 190 SD µm). Chondrogenesis occurred at positions more distant from the recipient bed in the NBO group than that in the Control group. CONCLUSION Normobaric oxygen therapy increases the thickness of surviving cartilage in auricular composite grafting in rats, thus suggesting that NBO therapy may also be effective in composite grafting for humans.
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Affiliation(s)
- Yusuke Hamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Kida County, Miki-Cho Ikenobe 1750-1, Takamatsu, Kagawa, Japan
| | - Tomohisa Nagasao
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Kida County, Miki-Cho Ikenobe 1750-1, Takamatsu, Kagawa, Japan
| | - Niyazi Aizezi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Kida County, Miki-Cho Ikenobe 1750-1, Takamatsu, Kagawa, Japan
| | - Motoki Tamai
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Kida County, Miki-Cho Ikenobe 1750-1, Takamatsu, Kagawa, Japan
| | - Tetsukuni Kogure
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Kida County, Miki-Cho Ikenobe 1750-1, Takamatsu, Kagawa, Japan
| | - Tadaaki Morotomi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kindai University, Sayama City, Ono‐higasi 377‐2, Osaka, Japan
| | - Noriyuki Tagichi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Kida County, Miki-Cho Ikenobe 1750-1, Takamatsu, Kagawa, Japan
| | - Yoshio Tanaka
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Kida County, Miki-Cho Ikenobe 1750-1, Takamatsu, Kagawa, Japan
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9
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Gajendrareddy PK, Junges R, Cygan G, Zhao Y, Marucha PT, Engeland CG. Increased oxygen exposure alters collagen expression and tissue architecture during ligature-induced periodontitis. J Periodontal Res 2016; 52:644-649. [PMID: 27573480 DOI: 10.1111/jre.12408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to evaluate the effects of increased oxygen availability on gene expression and on collagen deposition/maturation in the periodontium following disease. MATERIAL AND METHODS Male Wistar rats had ligatures placed around their molars to induce periodontal disease, and a subset of animals underwent hyperbaric oxygen (HBO) treatment for 2 h twice per day. At 15 and 28 d, tissue gene expression of COL1A1, transforming growth factor-β1 and alkaline phosphatase was determined; other histological samples were stained with Picrosirius red to evaluate levels of collagen deposition, maturation and thickness. RESULTS In animals that underwent HBO treatment, type I collagen expression was higher and collagen deposition, maturation and thickness were more robust. Reduced mRNA levels of transforming growth factor-beta1 and alkaline phosphatase in HBO-treated rats on day 28 suggested that a quicker resolution in both soft tissue and bone remodeling occurred following oxygen treatment. No differences in inflammation were observed between groups. CONCLUSIONS The extracellular matrix regenerated more quickly in the HBO-treated group as evidenced by higher collagen expression, deposition and maturation.
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Affiliation(s)
- P K Gajendrareddy
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA.,Center for Wound Healing and Tissue Regeneration, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - R Junges
- Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Faculty of Dentistry, Department of Oral Biology, University of Oslo, Oslo, Norway
| | - G Cygan
- Department of Oral and Maxillofacial Surgery, West Virginia University, Morgantown, WV, USA
| | - Y Zhao
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA.,Center for Wound Healing and Tissue Regeneration, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - P T Marucha
- Center for Wound Healing and Tissue Regeneration, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA.,School of Dentistry, Oregon Health and Science University, Portland, OR, USA
| | - C G Engeland
- Center for Wound Healing and Tissue Regeneration, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA.,Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA.,College of Nursing, The Pennsylvania State University, University Park, PA, USA
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10
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Desmons SO, Delfosse CJ, Rochon P, Buys B, Penel G, Mordon S. Laser preconditioning of calvarial bone prior to an X-ray radiation injury: A preliminary in vivo study of the vascular response. Lasers Surg Med 2008; 40:28-37. [DOI: 10.1002/lsm.20595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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11
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Kaigler D, Wang Z, Horger K, Mooney DJ, Krebsbach PH. VEGF scaffolds enhance angiogenesis and bone regeneration in irradiated osseous defects. J Bone Miner Res 2006; 21:735-44. [PMID: 16734388 DOI: 10.1359/jbmr.060120] [Citation(s) in RCA: 231] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
UNLABELLED Bone regeneration is challenging in sites where the blood supply has been compromised by radiation. We examined the potential of a growth factor (VEGF) delivery system to enhance angiogenesis and bone formation in irradiated calvarial defects. VEGF-releasing polymers significantly increased blood vessel density and vascular perfusion in irradiated defects and increased bone formation relative to control conditions. INTRODUCTION Radiation therapy causes damage to tissues and inhibits its regenerative capacity. Tissue injury from radiation is in large part caused by a compromised vascular supply and reduced perfusion of tissues. The aim of this study was to determine if delivery of vascular endothelial growth factor (VEGF) from a biodegradable PLGA (copolymer of D,L-lactide and glycolide) scaffold could enhance neovascularization and bone regeneration in irradiated osseous defects. MATERIALS AND METHODS An isolated area of the calvarium of Fisher rats was irradiated (12 Gy) 2 weeks preoperatively, and two 3.5-mm osseous defects were created in this area, followed by the placement of PLGA scaffolds or VEGF scaffolds (PLGA scaffolds with incorporated VEGF) into the defects. Laser Doppler perfusion imaging was performed to measure perfusion of these areas at 1, 2, and 6 weeks. Implants were retrieved at 2, 6, and 12 weeks, and histologic and muCT analyses were performed to determine neovascularization and bone regeneration. RESULTS Histological analyses revealed statistically significant increases in blood vessel formation (>2-fold) and function (30%) within the VEGF scaffolds compared with PLGA scaffolds. Additionally, evaluation of bone regeneration through bone histomorphometric and muCT analyses revealed significantly greater bone coverage (26.36 +/- 6.91% versus 7.05 +/- 2.09% [SD]) and increased BMD (130.80 +/- 58.05 versus 71.28 +/- 42.94 mg/cm(3)) in VEGF scaffolds compared with PLGA scaffolds. CONCLUSIONS Our findings show that VEGF scaffolds have the ability to enhance neovascularization and bone regeneration in irradiated osseous defects, outlining a novel approach for engineering tissues in hypovascular environments.
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Affiliation(s)
- Darnell Kaigler
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, 48109, USA
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12
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Wahl MJ. Osteoradionecrosis prevention myths. Int J Radiat Oncol Biol Phys 2006; 64:661-9. [PMID: 16458773 DOI: 10.1016/j.ijrobp.2005.10.021] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 09/30/2005] [Accepted: 10/05/2005] [Indexed: 11/25/2022]
Abstract
PURPOSE To critically analyze controversial osteoradionecrosis (ORN) prevention techniques, including preradiation extractions of healthy or restorable teeth and the use of prophylactic antibiotics or hyperbaric oxygen (HBO) treatments for preradiation and postradiation extractions. METHODS The author reviewed ORN studies found on PubMed and in other article references, including studies on overall ORN incidence and pre- and postradiation incidence, with and without prophylactic HBO or antibiotics. RESULTS Owing in part to more efficient radiation techniques, the incidence of ORN has been declining in radiation patients over the last 2 decades, but the prevention of ORN remains controversial. A review of the available literature does not support the preradiation extraction of restorable or healthy teeth. There is also insufficient evidence to support the use of prophylactic HBO treatments or prophylactic antibiotics before extractions or other oral surgical procedures in radiation patients. CONCLUSIONS To prevent ORN, irradiated dental patients should maintain a high level of oral health. A preradiation referral for a dental evaluation and close collaboration by a multidisciplinary team can be invaluable for radiation patients. As with most other dental patients, restorable and healthy teeth should be retained in irradiated patients. The use of prophylactic HBO or antibiotics should be reconsidered for preradiation and postradiation extractions.
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13
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Abu-Serriah MM, McGowan DA, Moos KF, Bagg J. Extra-oral craniofacial endosseous implants and radiotherapy. Int J Oral Maxillofac Surg 2003; 32:585-92. [PMID: 14636607 DOI: 10.1054/ijom.2003.0429] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper discusses the use of extra-oral endosseous craniofacial implant (EOECI) therapy in irradiated bone. The survival rate of EOECIs in irradiated bone is reviewed and the controversy over the optimal time prior to place implants is described. The advantages and disadvantages of pre- and post-implant radiotherapy are addressed. The EOECI rehabilitation and osteoradionecrosis and the evidence of the potential role of hyperbaric oxygen are reviewed. Strategies for improving the clinical outcome of EOECIs are suggested.
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Affiliation(s)
- M M Abu-Serriah
- Oral & Maxillofacial Surgery, Glasgow Dental Hospital and School, UK
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14
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Hatfield RB, Frias VV, Wazen JJ, Isaacson SR, Asher ES, Wright RF. A radiation-shielding device for craniofacial implant placement. J Prosthet Dent 2001; 86:348-51. [PMID: 11677527 DOI: 10.1067/mpr.2001.119417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The use of radiation shields in the head and neck cancer patient receiving adjuvant radiation therapy is a treatment alternative for protecting anticipated prosthetic implant sites. Shields can be fabricated easily as part of an interdisciplinary treatment protocol. In this article, the methods used to fabricate an extraoral radiation shield are described, and a patient treatment that illustrates possible uses of the shield for both extraoral and intraoral sites is presented.
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Affiliation(s)
- R B Hatfield
- School of Dental and Oral Surgery, Columbia University, New York, NY 10032, USA
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16
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Abstract
The presence of a heel ulcer in the diabetic patient is usually due to neuropathy, vasculopathy, or both. Diagnostic testing including noninvasive assessment by nerve conduction velocity and Doppler pressure measurements can provide the basis for subsequent treatment. The diagnosis of osteomyelitis is assisted by plain radiographs, isotope definition, and/or magnetic resonance imaging (MRI). The loss of the calcaneus may mean loss of the functioning foot. Reconstructive arterial surgery for heel lesions in the diabetic patient has limited success. Prevention and local wound care, along with patient education, will result in limb salvage and the prevention of disability.
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Affiliation(s)
- J J Cevera
- Department of Surgery, Medical College of Pennsylvania/Hahnemann University Hospital/Allegheny University of the Health Sciences, Philadelphia 19102-1192, USA
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17
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Keller EE. Placement of dental implants in the irradiated mandible: a protocol without adjunctive hyperbaric oxygen. J Oral Maxillofac Surg 1997; 55:972-80. [PMID: 9294509 DOI: 10.1016/s0278-2391(97)90073-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- E E Keller
- Mayo Medical Center, Rochester, MN 55905, USA
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18
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Marker P, Siemssen SJ, Bastholt L. Osseointegrated implants for prosthetic rehabilitation after treatment of cancer of the oral cavity. Acta Oncol 1997; 36:37-40. [PMID: 9090963 DOI: 10.3109/02841869709100729] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The treatment of oral cancer usually involves extensive resection of the mandible, excision of oro-facial soft tissue and often radiotherapy. This causes difficulty in the subsequent oral rehabilitation. The present paper reports our experience with implant treatment of this patient group. The material comprises 38 implants in 12 patients. Four patients died during follow-up, two before loading the implants. The observation time after implantation was 7 to 47 months with a median of 14 months. Six of the patients had been subjected to preoperative radiation therapy. All 38 implants osseointegrated without complications. It is concluded that healing after implantation in irradiated mandibles can be achieved without hyperbaric oxygen. Provided certain guidelines are complied with i.e. careful surgical technique, use of antibiotics and prolonged period of healing prior to loading of the implants, a radiation dosage of up to 50 Gy appears to be of little significance.
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Affiliation(s)
- P Marker
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Odense University Hospital, Denmark
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19
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Abstract
Hyperbaric oxygen therapy, an established therapeutic intervention in diving medicine, is being investigated in wound management, where oxygen is an integral part of the healing process. Currently, the evidence is controversial as to whether there is a basis for using hyperbaric oxygen in normal wounds. This review explains the rationale for the use of hyperbaric oxygen therapy and reports on the initial research in the area of hyperbaric oxygen in sports-induced injury. In addition to the increased dissolved content of oxygen in the plasma, the combination of pressure and oxygen seems to promote systemic vasoconstriction and yet inhibition of vasoconstriction in the injured area, which will limit oedema. The safety of hyperbaric oxygen in otherwise healthy athletes is examined. Potential contraindications to hyperbaric oxygen therapy include individuals who are febrile, suffer from upper respiratory infections, or have suffered a trauma to the chest where a pneumothorax is suspected or have a predisposition to tension pneumothorax. The initial human and animal model studies have shown promising, and in some instances significant, acceleration of healing. The potential benefits for sports injuries appear to be a blunting of initial injury, possibly by controlling the neutrophil adhesion and release of oxygen free radicals as well as an enhancement of healing processes requiring oxygen-like collagen formation phagocytosis.
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Affiliation(s)
- J Staples
- Allan McGavin Sports Medicine Centre, Division of Sports Medicine, University of British Columbia, Vancouver, Canada
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20
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Abstract
Endosseous implants have been placed at the Mayo Clinic Department of Dental Specialties for over 12 years. On the basis of the clinical success of the osseointegration program, the use of implants has been expanded to include placement into tissue beds that have been exposed to therapeutic radiation. This article details preliminary data regarding implant survival in the previously radiated tissue beds. Presurgical evaluation and surgical technique are described and postprosthetic reconstruction complications are also related. Consideration is given to the relatively small number of patients in this review. It is suggested that the results should be shared among multiple institutions to create a meaningful data bank.
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Affiliation(s)
- S E Eckert
- Department of Dental Sciences, Mayo Clinic, Rochester, Minn., USA
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21
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Young T. Hyperbaric oxygen therapy in wound management. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 1995; 4:796, 798-803. [PMID: 7655271 DOI: 10.12968/bjon.1995.4.14.796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hyperbaric oxygen therapy is emerging as a possible treatment in wound management. It may be delivered systemically or topically. A review of the literature is undertaken to establish the extent of the research base of this practice.
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