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Martani L, Giovanniello A, Bosco G, Cantadori L, Calissi F, Furfaro D, Pedrazzini M, Vaschetto R, Camporesi EM, Paganini M. Delayed Neurological Sequelae Successfully Treated with Adjuvant, Prolonged Hyperbaric Oxygen Therapy: Review and Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095300. [PMID: 35564694 PMCID: PMC9104642 DOI: 10.3390/ijerph19095300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
Carbon Monoxide (CO) intoxication is still a leading cause of mortality and morbidity in many countries. Due to the problematic detection in the environment and subtle symptoms, CO intoxication usually goes unrecognized, and both normobaric and hyperbaric oxygen (HBO) treatments are frequently administered with delay. Current knowledge is mainly focused on acute intoxication, while Delayed Neurological Sequelae (DNS) are neglected, especially their treatment. This work details the cases of two patients presenting a few weeks after CO intoxication with severe neurological impairment and a characteristic diffused demyelination at the brain magnetic resonance imaging, posing the diagnosis of DNS. After prolonged treatment with hyperbaric oxygen, combined with intravenous corticosteroids and rehabilitation, the clinical and radiological features of DNS disappeared, and the patients' neurological status returned to normal. Such rare cases should reinforce a thorough clinical follow-up for CO intoxication victims and promote high-quality studies.
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Affiliation(s)
- Luca Martani
- Vaio Hospital, 43036 Fidenza, Italy; (L.M.); (L.C.); (M.P.)
| | | | - Gerardo Bosco
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy;
- Correspondence:
| | - Luca Cantadori
- Vaio Hospital, 43036 Fidenza, Italy; (L.M.); (L.C.); (M.P.)
| | | | | | | | - Rosanna Vaschetto
- Department of Translational Sciences, University of Eastern Piedmont, 28100 Novara, Italy;
| | | | - Matteo Paganini
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy;
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Liao SC, Shao SC, Yang KJ, Yang CC. Real-world effectiveness of hyperbaric oxygen therapy for delayed neuropsychiatric sequelae after carbon monoxide poisoning. Sci Rep 2021; 11:19212. [PMID: 34584153 PMCID: PMC8479087 DOI: 10.1038/s41598-021-98539-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/07/2021] [Indexed: 12/30/2022] Open
Abstract
To assess real-world effectiveness of hyperbaric oxygen therapy (HBOT) on delayed neuropsychiatric sequelae (DNS) after carbon monoxide (CO) poisoning we conducted a retrospective review of patients with CO poisoning admitted to Linkou Chang-Gung Memorial Hospital, Taiwan's largest medical center, during 2009-2015. We included patients developing DNS after CO poisoning and compared improvements in neuropsychiatric function, with and without HBOT, after 12 months post-DNS to understand differences in recovery rates. DNS improvement-associated factors were also evaluated. We used receiver operating characteristic (ROC) curve analysis to assess the role of time elapsed between DNS diagnosis and HBOT initiation in predicting DNS improvement. A total of 62 patients developed DNS, of whom 11 recovered while the rest did not. Possible factors predicting DNS improvement included receiving HBOT post-DNS (72.7% vs 25.5%; P = 0.006), and treatment with more than three HBOT sessions during acute stage CO poisoning (81.8% vs 27.5%; P = 0.003). The relevant area under the ROC curve was 0.789 (95% CI 0.603-0.974), and the best cut-off point was 3 days post-DNS diagnosis, with 87.5% sensitivity and 61.5% specificity. Early HBOT in patients who developed DNS after CO poisoning significantly improved their DNS symptoms, with treatment effects sustained for 1 year after DNS diagnosis.
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Affiliation(s)
- Shu-Chen Liao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Chieh Shao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kun-Ju Yang
- Division of Hyperbaric Oxygen Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chen-Chang Yang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road Section 2, Taipei, 11217, Taiwan.
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Rhee B, Kim HH, Choi S, Min YG. Incidence patterns of nervous system diseases after carbon monoxide poisoning: a retrospective longitudinal study in South Korea from 2012 to 2018. Clin Exp Emerg Med 2021; 8:111-119. [PMID: 34237816 PMCID: PMC8273670 DOI: 10.15441/ceem.20.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/16/2020] [Indexed: 01/25/2023] Open
Abstract
Objective To analyze the incidence patterns of nervous system diseases in survivors of carbon monoxide (CO) poisoning using nationwide claims data from South Korea. Methods A national cohort was abstracted from a database that includes patients diagnosed with CO poisoning between January 2012 and December 2018. For all nervous system diseases, we investigated the frequency, pattern of incidence, effect of intensive care unit admission, and the standardized incidence ratios (SIRs) to estimate the risk of nervous system disease after CO poisoning. Results Of 26,778 patients, 18,720 (69.9%) were diagnosed with nervous system diseases after CO poisoning. The most common disease was disorders of sleep initiation and maintenance (n=701, 3.74%), followed by tension-type headache (n=477, 2.55%) and anoxic brain injury (n=406, 2.17%). Over half of the nervous system diseases occurred within the first year after CO poisoning. The cumulative hazard ratio for nervous system diseases in patients admitted to the intensive care unit was 2.25 (95% confidence interval [CI], 2.07–2.44). Among the frequent nervous system diseases after CO poisoning, patients had a higher risk of disorders of initiating and maintaining sleep (SIR, 1.61; 95% CI, 1.52–1.71), tension-type headache (SIR, 2.41; 95% CI, 2.23–2.61), anoxic brain injury (SIR, 58.76; 95% CI, 53.95–63.88), and post-zoster neuralgia (SIR, 1.94; 95% CI, 1.70–2.20). Conclusion Patients who experience CO poisoning are at higher risk for several nervous system diseases. Therefore, monitoring for specific nervous system diseases is important after CO poisoning within the first year.
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Affiliation(s)
- Bangshill Rhee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Hyuk-Hoon Kim
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Sangchun Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Young Gi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
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Liu CC, Hsu CS, He HC, Cheng YY, Chang ST. Effects of intravascular laser phototherapy on delayed neurological sequelae after carbon monoxide intoxication as evaluated by brain perfusion imaging: A case report and review of the literature. World J Clin Cases 2021; 9:3048-3055. [PMID: 33969090 PMCID: PMC8080739 DOI: 10.12998/wjcc.v9.i13.3048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Delayed neurological sequelae (DNS) caused by carbon monoxide (CO) intoxication poses considerable treatment challenges for clinical practitioners. In this report, we used nuclear medicine imaging and the Mini-Mental State Examination (MMSE) to evaluate the effectiveness of intravascular laser irradiation of blood (ILIB) therapy for the management of DNS.
CASE SUMMARY A 51-year-old woman presented to our medical center experiencing progressive bradykinesia, rigidity of limbs, gait disturbance, and cognitive impairment. Based on her neurological deficits, laboratory tests and imaging findings, the patient was diagnosed with delayed neurological sequelae of CO intoxication. She received intensive rehabilitation and ILIB therapy during 30 sessions over 2 mo after diagnosis. Brain single-photon emission computed tomography was performed both prior to and after ILIB therapy. The original hypoperfusion area in bilateral striata, bilateral frontal lobe, right parietal lobe, and bilateral cerebellum showed considerable improvement after completion of therapy. The patient’s MMSE score also increased markedly from 6/30 to 25/30. Symptoms of DNS became barely detectable, and the woman was able to carry out her daily living activities independently.
CONCLUSION ILIB therapy could facilitate recovery from delayed neurological sequelae in patients with CO intoxication, as demonstrated by improved cerebral blood flow and functional outcomes in our patient.
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Affiliation(s)
- Chuan-Ching Liu
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chun-Sheng Hsu
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
| | - Hsin-Chen He
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
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Yoon SJ, Noh J, Son HY, Moon JH, Kim EH, Park SW, Kim SH, Chang JH, Huh YM, Kang SG. Ambient carbon monoxide exposure and elevated risk of mortality in the glioblastoma patients: A double-cohort retrospective observational study. Cancer Med 2020; 9:9018-9026. [PMID: 33161654 PMCID: PMC7724304 DOI: 10.1002/cam4.3572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 10/11/2020] [Indexed: 02/01/2023] Open
Abstract
An increasing number of studies indicate air pollutants infiltrate into the brain. We aimed to find the association of cumulative air pollution exposure in the main body of primary brain tumor: glioblastoma (GBM). In this double-cohort, retrospective analysis study with a protocol, we compared the health effect of air pollution on the GBM patients from the SEER (Surveillance, Epidemiology, and End Results Program) in 27 U.S. counties from 10 states and GBM patients of Severance cohort of Korea. From 2000 to 2015, 10621 GBM patients of the SEER were individually evaluated for the cumulative average exposure for each pollutant, and 9444 (88.9%) mortality events were reported. From 2011 to 2018, 398 GBM patients of the Severance with the same protocol showed 259 (65.1%) mortality events. The multi-pollutant models show that the association level of risk with CO is increased in the SEER (HR 1.252; 95% CI 1.141-1.373) with an increasing linear trend of relative death rate in the spline curve. The Severance GBM data showed such a statistically significant result of the health impact of CO on GBM patients. The overall survival gain of the less exposure group against CO was 2 and 3 months in the two cohorts. Perioperative exposure to CO may increase the risk of shorter survival of GBM patients of the SEER and the Severance cohort.
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Affiliation(s)
- Seon-Jin Yoon
- Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Juhwan Noh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Young Son
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eui-Hyun Kim
- Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sahng Wook Park
- Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Min Huh
- Department of Biochemistry and Molecular Biology, Yonsei University College of Medicine, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,YUHS-KRIBB Medical Convergence Research Institute, Seoul, Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Medical Science, Yonsei University Graduate School, Seoul, Korea
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Shen CM, Li Y, Liu Z, Qi YZ. Effective administration of cranial drilling therapy in the treatment of fourth degree temporal, facial and upper limb burns at high altitude: A case report. World J Clin Cases 2020; 8:5062-5069. [PMID: 33195683 PMCID: PMC7642563 DOI: 10.12998/wjcc.v8.i20.5062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/16/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Fourth degree burns damage the full thickness of the skin and affect underlying tissues. Skin grafting after debridement is often used to cover the wounds of salvageable severe burns. A granulation wound can be formed by drilling the skull to the barrier layer to solve the problem of skull exposure. Low oxygen levels present at high altitudes aggravate ischemia and hypoxia which can negatively impact wound healing. The impaired healing in such cases can be ameliorated by hyperbaric oxygen therapy.
CASE SUMMARY We describe a patient who presented with fourth degree burns to the left temporal and facial regions upon admission in December 2018. The periosteum of the skull and the deep fascia of the face were exposed. After the first stage of debridement and skin grafting, the temporal skin did not survive well. Granulation was induced by cranial drilling, and then a local flap was transferred to cover the wound. The left temporal and facial wounds were completely covered and the patient recovered well.
CONCLUSION Skin grafting and flap transfer after early debridement to cover the wound and control infection were of great significance. In the later stages of the patient’s treatment, survival of the skin graft and skin flap was observed. The second stage repair was performed to achieve successful skin grafting by cranial granulation. Granulation was formed by drilling the skull, and then the wound was closed, which is suitable for cases with skull exposure and wounds with poor blood supply. We consider that hyperbaric oxygen treatment and improving tissue oxygen supply were beneficial in this patient.
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Affiliation(s)
- Cong-Mo Shen
- Department of Burns and Plastic Surgery, Affiliated Hospital of Qinghai University, Xi’ning 810016, Qinghai Province, China
| | - Yi Li
- Department of Burns and Plastic Surgery, Affiliated Hospital of Qinghai University, Xi’ning 810016, Qinghai Province, China
| | - Zhou Liu
- Department of Cardiology, Affiliated Hospital of Jiangnan University, Wu’xi 214000, Jiangsu Province, China
| | - Yong-Zhang Qi
- Department of Burns and Plastic Surgery, Affiliated Hospital of Qinghai University, Xi’ning 810016, Qinghai Province, China
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Is "delayed" hyperbaric therapy effective for "delayed" encephalopathy after carbon monoxide intoxication? eNeurologicalSci 2020; 18:100219. [PMID: 31890907 PMCID: PMC6926208 DOI: 10.1016/j.ensci.2019.100219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/02/2019] [Indexed: 12/28/2022] Open
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