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España Fuente L, Méndez Redondo R, Gutiérrez Corral N, Fernández Martínez D. Ischaemic stroke in a post-surgical patient after replacement of a parenteral nutrition bag. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2018.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Ictus isquémico tras el recambio de una nutrición parenteral en un paciente postoperado. Neurologia 2020. [DOI: 10.1016/j.nrl.2018.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Açiksari K, Eğin S, Hepgül G, Mirasoğlu B, Tanriverdi G, Kanber DS, Demirci S, Doğan H, Özüçelik DN, Toklu AS, Seçkin İ, Yanar HT. Protective effect of hyperbaric oxygen treatment on rat intestinal mucosa after mesenteric ischaemia and reperfusion. Diving Hyperb Med 2020; 49:253-258. [PMID: 31828743 DOI: 10.28920/dhm49.4.253-258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/25/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Mesenteric ischaemia results from a lack of adequate blood flow to and oxygenation of the mesentery and intestines. The aim of the present study was to evaluate the effect of hyperbaric oxygen treatment (HBOT) on the healing process in intestinal mucosa of rats undergoing mesenteric ischaemia and reperfusion. METHODS Thirty-two Wistar-Albino rats were divided into four groups of eight: 1) ischaemia/reperfusion (I/R); 2) sham operation; 3) I/R+HBOT started 6 hours after reperfusion; 4) I/R+HBOT started 12 hours after reperfusion. In the I/R groups, a vascular clamp was placed across the superior mesenteric artery to occlude arterial circulation for 60 minutes, followed by reperfusion. A dose of HBOT consisted of 100% oxygen breathing for 90 minutes at 2.5 atmospheres absolute pressure. Thirteen doses of HBOT were administered after ischaemia. The rats were sacrificed on the eighth day, and their intestinal tissues were harvested for histopathologic analysis. The tissue levels of catalase, malondialdehyde, and glutathione were determined. RESULTS The histopathological scores (HSCORE) were consistent with macroscopic examinations. The scores were significantly higher (worse) in Group 1 compared to Group 2, Group 3, and Group 4 (for all comparisons, P < 0.05). Group 4's HSCORE was significantly higher than those of Group 2 and Group 3 (for both comparisons P < 0.05). Group 3's HSCOREs were only marginally higher than Group 2. Group 3 exhibited higher glutathione levels than Group 1 (P < 0.05). There were no significant differences across the groups with respect to malondialdehyde and catalase levels. CONCLUSION A beneficial effect of HBOT was observed on oxidative stress and inflammation in acute mesenteric ischaemia-reperfusion.
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Affiliation(s)
- Kurtuluş Açiksari
- Department of Emergency Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.,Corresponding author: Department of Emergency Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey,
| | - Seracettin Eğin
- Department of General Surgery, MoH Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Gülçin Hepgül
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Bengüsu Mirasoğlu
- Department of Underwater and Hyperbaric Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gamze Tanriverdi
- Department of Histology and Embryology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Devrim S Kanber
- Department of Biophysics, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Demirci
- Department of Histology and Embryology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Doğan
- Department of Emergency Medicine, MoH Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Akın S Toklu
- Department of Underwater and Hyperbaric Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - İsmail Seçkin
- Department of Histology and Embryology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan T Yanar
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Izzat MB. Effective handling of substantial arterial air embolization during extracorporeal perfusion. Clin Case Rep 2019; 7:2568-2570. [PMID: 31893101 PMCID: PMC6935650 DOI: 10.1002/ccr3.2510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 11/05/2022] Open
Abstract
This report highlights the need for a coordinated approach to substantial arterial air embolization, considering the high risk of neurologic injury. Appropriate management may involve systemic hypothermia, hyperoxia, and retrograde cerebral perfusion.
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The Effect of Hyperbaric Oxygen Therapy on Functional Impairments Caused by Ischemic Stroke. Neurol Res Int 2018; 2018:3172679. [PMID: 30402285 PMCID: PMC6198568 DOI: 10.1155/2018/3172679] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/24/2018] [Indexed: 11/23/2022] Open
Abstract
Background While research suggests a benefit of hyperbaric oxygen therapy (HBOT) for neurologic injury, controlled clinical trials have not been able to clearly define the benefits. Objective To investigate the effects of HBOT on physical and cognitive impairments resulting from an ischemic stroke. Methods Using a within-subject design a baseline for current functional abilities was established over a 3-month period for all subjects (n=7). Each subject then received two 4-week periods of HBOT for a total of 40 90-minute treatments over a 12-week period. Subjects completed a battery of assessments and had blood drawn six times over the 9-month total duration of the study. Results We found improvements in cognition and executive function as well as physical abilities, specifically, improved gait. Participants reported improved sleep and quality of life following HBOT treatment. We also saw changes in serum levels of biomarkers for inflammation and neural recovery. In the functional domains where improvement was observed following HBOT treatment, the improvements were maintained up to 3 months following the last treatment. However, the physiological biomarkers showed a pattern of more transient changes following HBOT treatment. Conclusions Findings from this study support the idea of HBOT as a potential intervention following stroke.
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Niyibizi E, Kembi GE, Lae C, Pignel R, Sologashvili T. Delayed hyperbaric oxygen therapy for air emboli after open heart surgery: case report and review of a success story. J Cardiothorac Surg 2016; 11:167. [PMID: 27919270 PMCID: PMC5139121 DOI: 10.1186/s13019-016-0553-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/23/2016] [Indexed: 12/21/2022] Open
Abstract
Background The current case describes a rare diagnosis of iatrogenic air emboli after elective cardiopulmonary bypass that was successfully treated with delayed hyperbaric oxygen therapy, with good clinical evolution in spite of rare complications. Case presentation A 35 years old male was admitted to the intensive care unit (ICU) for post-operative management after being placed on cardiopulmonary bypass (CPB) for an elective ventricular septal defect closure and aortic valvuloplasty. The patient initially presented with pathologically late awakening and was extubated 17 h after admission. Neurologic clinical status after extubation showed global aphasia, mental slowness and spatio-temporal disorientation. The injected cerebral CT scan was normal; the EEG was inconclusive (it showed metabolic encephalopathy without epileptic activity); and the cerebral MRI done 48 h after surgery showed multiple small subcortical acute ischemic lesions, mainly on the left fronto- parieto- temporo-occipital lobes. He was taken for hyperbaric oxygen therapy (HOT) over 54 h after cardiac surgery. The first session ended abruptly after 20 min when the patient suffered a generalised tonico-clonic seizure, necessitating a moderately rapid decompression, airway management, and antiepileptic treatment. In total, the patient received 7 HOT sessions over 6 days. He demonstrated full neurological recovery at 4 weeks and GOS (Glasgow Outcome Scale) of 5 out of 5 even after a long delay in initial management. Convulsions are a rare complication of HOT either due to reperfusion syndrome or hyperoxic toxicity and can be managed. Prior imaging by MRI or tympanic paracentesis (myringotomy) should not add further delay of treatment. Conclusion HOT should be initiated upon late awakening and/or neurologic symptoms after CPB heart surgery, after exclusion of formal counter-indications, even if the delay exceeds 48 h.
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Affiliation(s)
- Eva Niyibizi
- Division of Emergency Medecine, County Hospital, University of Geneva, Geneva, Switzerland. .,Emergency Medicine Division, Hopitaux Universitaires de Genève, Rue Gabrielle-Perret.Gentil 4, 1205, Geneva, Switzerland.
| | - Guillaume Elyes Kembi
- Department of Anesthesiology Pharmacology and Intensive Care, County Hospital, University of Geneva, Geneva, Switzerland
| | - Claude Lae
- Department of Emergency and Primary Care Medecine, County Hospital, Hyperbaric Center, University of Geneva, Geneva, Switzerland
| | - Rodrigue Pignel
- Department of Emergency and Primary Care Medicine, County Hospital, Hyperbaric Center, University of Geneva, Geneva, Switzerland
| | - Tornike Sologashvili
- Division of Cardiac Surgery, County Hospital, University of Geneva, Geneva, Switzerland
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Weiner MM, Wicker J, Fischer GW, Adams DH, Bronster D, Evans AS, Murkin JM, Grocott HP. CASE 5–2015. J Cardiothorac Vasc Anesth 2015; 29:791-6. [DOI: 10.1053/j.jvca.2014.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Indexed: 01/19/2023]
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Esquinas Requena JL, Muñoz-Tornero Rodriguez J, Rayo Gutierrez M, Fernandez Martínez N, Martín Marquez J. [Venous air embolism: a rare cause of acute ischemic stroke]. Rev Esp Geriatr Gerontol 2015; 50:98-99. [PMID: 25660588 DOI: 10.1016/j.regg.2014.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 09/22/2014] [Indexed: 06/04/2023]
Affiliation(s)
| | | | - Manuel Rayo Gutierrez
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | | | - Jacinta Martín Marquez
- Servicio de Geriatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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Detection of cerebral arterial gas embolism using regional cerebral oxygen saturation, quantitative electroencephalography, and brain oxygen tension in the swine. J Neurosci Methods 2014; 228:79-85. [PMID: 24680890 DOI: 10.1016/j.jneumeth.2014.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/15/2014] [Accepted: 03/18/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cerebral air emboli occur as a complication of invasive medical procedures. The sensitivity of cerebral monitoring methods for the detection of air emboli is not known. This study investigates the utility of electroencephalography and non-invasively measured cerebral oxygen saturation in the detection of intracerebrovascular air. NEW METHOD In 12 pigs oxygen saturation was continuously measured using transcranial near-infrared spectroscopy and oxygen tension was continuously measured using intraparenchymal probes. Additionally, quantitative electroencephalography and microdialysis were performed. Doses of 0.2, 0.4, 0.8, and 1.6 ml of air were injected into the cerebral arterial vasculature through a catheter. RESULTS Oxygen saturation and electroencephalography both reacted almost instantaneously on the air emboli, but were less sensitive than the intraparenchymal oxygen tension. There was reasonable correlation (ρ ranging from 0.417 to 0.898) between oxygen saturation, oxygen tension, electroencephalography and microdialysis values. COMPARISON WITH EXISTING METHODS Our study is the first to demonstrate the effects of cerebral air emboli using multimodal monitoring, specifically on oxygen saturation as measured using near-infrared spectroscopy. CONCLUSIONS Our results show that non-invasively measured oxygen saturation and quantitative electroencephalography can detect the local effects of air emboli on cerebral oxygenation, but with reduced sensitivity as compared to intraparenchymal oxygen tension. Prospective human studies using multimodal monitoring incorporating electroencephalography and oxygen saturation should be performed.
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Al-Ali WM, Browne T, Jones R. A case of cranial air embolism after transthoracic lung biopsy. Am J Respir Crit Care Med 2013. [PMID: 23204380 DOI: 10.1164/ajrccm.186.11.1193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Nussinovitch U, Ronen B, Farber E, Yanir Y. Transfusion medicine illustrated. Devastating air embolism. Transfusion 2012; 52:2516. [PMID: 23231673 DOI: 10.1111/j.1537-2995.2012.03617.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Udi Nussinovitch
- Israel Naval Medical Institute, IDF Medical Corps, Haifa, Israel.
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Embolia aérea por mecanismo venoso retrógrado como causa de ictus isquémico. Neurologia 2012; 27:119-21. [DOI: 10.1016/j.nrl.2011.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/16/2011] [Accepted: 05/19/2011] [Indexed: 11/19/2022] Open
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Pellisé A, Ustrell X, Ruiz V, Guedea A. Retrograde venous cerebral air embolism as a cause of stroke. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2011.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:293-304. [DOI: 10.1097/spc.0b013e328340e983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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