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Turhan N, Sümen SG, Zaman T, Memişoğlu E, Yılmaz KB. Would hyperbaric oxygen therapy be a supportive treatment method for refractory idiopathic granulomatous mastitis? Asian J Surg 2024:S1015-9584(24)00757-7. [PMID: 38704271 DOI: 10.1016/j.asjsur.2024.04.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Refractory IGM causes patients to use antibiotics, steroid therapy, immunosuppressive agents for a very long time and even leads to surgical procedures resulting in the loss of breast tissue. Hyperbaric Oxygen Therapy (HBOT) is a frequently used method in the treatment of wounds that are difficult to heal. We thought that HBOT would be an alternative treatment method for refractory IGM patients. METHODS It is a retrospective cohort study on refractory IGM patients conducted at three tertiary care treatment centers between January 2021 and July 2023. The patients were evaluated in two groups: those who only took steroid treatment and those who received HBOT and steroid treatment. The demographic and clinical characteristics of the patients, the types of treatment applied and their responses to treatment were evaluated. RESULTS There were no significant differences generally in the demographic and clinical features in both groups. The incidence of multicentric GM was found to be higher in the HBOT group (66.67 %; p = 0.044). Although the recovery results were similar in both groups, the average daily steroid dose and duration of drug use were found to be higher in the group receiving only steroid treatment (16 mg vs. 4 mg and 270 days vs. 30 days) (p < 0.001). CONCLUSION In our study, we showed for the first time in the literature that HBOT is effective in the treatment of refractory IGM patients. Our study needs to be supported by prospective studies evaluating cost effectiveness and possible long term complications.
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Affiliation(s)
- Nihan Turhan
- Sancaktepe Martyr Prof.Dr. İlhan Varank Training and Research Hospital, General Surgery, Turkey.
| | - Selin Gamze Sümen
- Kartal Lütfi Kırdar City Hospital, Underwater Medicine and Hyperbaric Medicine, Turkey
| | - Taylan Zaman
- Gülhane Training and Research Hospital, Underwater Medicine and Hyperbaric Medicine, Turkey
| | - Ecem Memişoğlu
- Kartal Lütfi Kırdar City Hospital, General Surgery, Turkey
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Jeyaraman M, Sami A, Nallakumarasamy A, Jeyaraman N, Jain VK. Hyperbaric Oxygen Therapy in Orthopaedics: An Adjunct Therapy with an Emerging Role. Indian J Orthop 2023; 57:748-761. [PMID: 37128570 PMCID: PMC10147865 DOI: 10.1007/s43465-023-00837-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
Introduction Hyperbaric oxygen therapy (HBOT) has emerged as an adjunct treatment modality in various orthopedic and rheumatological conditions. Undersea and Hyperbaric Medical Society (UHMS) defined the minimum number of HBOT cycles, dose, and frequency for various diseases. UHMS laid the 14 absolute indications for HBOT. This article deals with the mechanism of actions of HBOT and evidence of various musculoskeletal disorders where HBOT was utilized to accelerate the healing process of the diseases. Materials and methods The review literature search was conducted by using PubMed, SCOPUS, and other database of medical journals for identifying, reviewing, and evaluating the published clinical trial data, research study, and review articles for the use of HBOT in musculoskeletal disorders. Results Various clinical researchers documented cellular and biochemical advantages of HBOT which possess allodynic effects, anti-inflammatory, and prooxygenatory effects in patients with musculoskeletal conditions. Studies on the usage of HBOT in avascular necrosis and wound healing provide a platform for exploring the plausible uses of HBOT in other musculoskeletal conditions. Literature evidence states the complications associated with HBOT therapy. Conclusion The existing HBOT protocols have to be optimized for various musculoskeletal disorders. Large scale blinded RCTs have to be performed for demonstrating the level of evidence in the usage of HBOT in various musculoskeletal clinical scenarios.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu 600056 India
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045 USA
| | - Abdus Sami
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
| | - Arulkumar Nallakumarasamy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Naveen Jeyaraman
- Department of Orthopaedics, Rathimed Specialty Hospital, Chennai, Tamil Nadu 600040 India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
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Wójcik B, Superata J, Nguyen HB, Szyguła Z. Exploration of Different Rehabilitation Routes for Sepsis Survivors with Monitoring of Health Status and Quality of Life: RehaSep Trial Protocol. Adv Ther 2019; 36:2968-2978. [PMID: 31410778 PMCID: PMC6822832 DOI: 10.1007/s12325-019-01047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Indexed: 11/29/2022]
Abstract
Introduction This project addresses the important problem of sepsis sequelae resulting in frequent hospital readmissions and higher mortality rate in the post-discharge period. However, neither specific diagnostic methods nor standards for rehabilitation of sepsis patients have been introduced yet. The aim of this study is to evaluate the effectiveness of two different multiparameter-monitored rehabilitation treatments in order to improve the health status and quality of life of sepsis survivors. Methods Decades of failed randomized controlled trials involving sepsis patients strongly suggest the need for a paradigm change. Therefore, we designed a prospective, interventional, controlled, pragmatic, patient-centred trial based on the principles of personalized medicine. Sixty post-sepsis patients after hospital discharge will be individually assigned to a control group (without intervention) and two groups with 3-month diagnostically monitored rehabilitation programs based either on the recumbent cycloergometer training or on the experimental hyperbaric oxygen therapy. In all of the patients a wide range of physiological (spirometry, ECG/cycloergometer exercise test), haematological (microscopy) and biochemical (blood tests) parameters will be assessed at hospital discharge and during subsequent 3 months in order to monitor changes of their physical capacity, immunity and degree of post-sepsis organ damage/recovery. For quality of life monitoring a novel tool—“Life After Sepsis Survey”—will be applied. Planned Outcomes A set of composite quantitative indices resulting from laboratory measurement data combined with the quality of life questionnaire data will constitute the primary outcomes whereas mortality rate and hospital readmission number will be counted as the secondary outcomes. Conclusions Critical analysis of past trials prompted us to implement multiple improvements in tools and procedures. The results of this trial will contribute to the development of rehabilitation therapy addressing not only weakness but also organ damage problems of sepsis survivors. Trial Registration ANZCTR (http://www.anzctr.org.au): ACTRN12618000347268, U1111-1210-6110. Funding This research was funded by the National Science Center, Poland.
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Affiliation(s)
- Barbara Wójcik
- University of Physical Education in Krakow, Al. Jana Pawla II 78, 31-571, Kraków, Poland.
| | - Jerzy Superata
- University of Physical Education in Krakow, Al. Jana Pawla II 78, 31-571, Kraków, Poland
| | - H Bryant Nguyen
- Loma Linda University, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Zbigniew Szyguła
- University of Physical Education in Krakow, Al. Jana Pawla II 78, 31-571, Kraków, Poland
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Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient: An Indication for Hyperbaric Oxygen Therapy. Ann Plast Surg 2019; 80:S106-S112. [PMID: 29461288 DOI: 10.1097/sap.0000000000001351] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Carbon monoxide (CO) is a small molecule poison released as a product of incomplete combustion. Carbon monoxide binds hemoglobin, reducing oxygen delivery. This effect is exacerbated in the burned pregnant patient by fetal hemoglobin that binds CO 2.5- to 3-fold stronger than maternal hemoglobin. With no signature clinical symptom, diagnosis depends on patient injury history, elevated carboxyhemoglobin levels, and alterations in mental status. The standard of care for treatment of CO intoxication is 100% normobaric oxygen, which decreases the half-life of CO in the bloodstream from 5 hours to 1 hour. Hyperbaric oxygen (HBO2) is a useful adjunct to rapidly reduce the half-life of CO to 20 minutes and the incidence of delayed neurologic sequelae. Because of the slow disassociation of CO from hemoglobin in the fetus, there is a far stronger indication for HBO2 in the burned pregnant patient than in other burn patient populations.Cyanide intoxication is often a comorbid disease with CO in inhalation injury from an enclosed fire, but may be the predominant toxin. It acts synergistically with CO to effectively lower the lethal doses of both cyanide and CO. Diagnosis is best made in the presence of high lactate levels, carboxyhemoglobin concentrations greater than 10%, injury history of smoke inhalation from an enclosed fire, and alterations in consciousness. While treatment with hydroxocobalamin is the standard of care and has the effect of reducing concomitant CO toxicity, data indicate cyanide may also be displaced by HBO2.Carbon monoxide and cyanide poisoning presents potential complications impacting care. This review addresses the mechanism of action, presentation, diagnosis, and treatment of CO and cyanide poisonings in the burned pregnant patient and the use of HBO2 therapy.
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Faunø Thrane J, Ovesen T. Scarce evidence of efficacy of hyperbaric oxygen therapy in necrotizing soft tissue infection: a systematic review. Infect Dis (Lond) 2019; 51:485-492. [PMID: 30985236 DOI: 10.1080/23744235.2019.1597983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Necrotizing soft tissue infection (NSTI) is a rare and potentially life-threatening disease. Rapid surgical intervention, antibiotics and intensive care are the mainstay of treatment. Hyperbaric oxygen therapy (HBOT) is used as adjuvant therapy in some centres but there is a lack of research-based evidence of efficacy. Methods: Following the PRISMA guideline we conducted a systematic review on the efficacy of HBOT on NSTI with mortality as primary outcome. Through January 2019 major databases were searched and relevant literature assessed. The criteria for study inclusion were research of any design and any period of time comparing HBOT vs. non-HBOT in a population of NSTI-patients. Studies were analysed using the modified Delphi method and risk of bias in non-randomized studies - of interventions tool. Relative risk (RR) on mortality was calculated for each study individually. Results: A number of 1733 studies were identified through database search. Ultimately, 21 studies were included of which 19 were case series with a control group. The majority of the studies performed poor in quality assessment and all featured a high to critical risk of bias. The association of HBOT on mortality was generally reported as positive, however, the results should be considered with great scepticism. Conclusions: The evidence of HBOT in NSTI is poor and biased. There is a strong need for randomized controlled trials (RCTs) to shed light on a potential life-saving treatment.
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Affiliation(s)
- Jens Faunø Thrane
- a Department of Otorhinolaryngology, Head & Neck Surgery , Aarhus University Hospital , Aarhus , Denmark.,b Department of Otorhinolaryngology, Head & Neck Surgery , Aalborg University Hospital , Aalborg , Denmark
| | - Therese Ovesen
- c Department of Clinical Medicine , Aarhus University , Aarhus , Denmark.,d Department of Otorhinolaryngology, Head & Neck Surgery , Region Hospital Holstebro , Holstebro , Denmark
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Brugniaux JV, Coombs GB, Barak OF, Dujic Z, Sekhon MS, Ainslie PN. Highs and lows of hyperoxia: physiological, performance, and clinical aspects. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1-R27. [PMID: 29488785 DOI: 10.1152/ajpregu.00165.2017] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Molecular oxygen (O2) is a vital element in human survival and plays a major role in a diverse range of biological and physiological processes. Although normobaric hyperoxia can increase arterial oxygen content ([Formula: see text]), it also causes vasoconstriction and hence reduces O2 delivery in various vascular beds, including the heart, skeletal muscle, and brain. Thus, a seemingly paradoxical situation exists in which the administration of oxygen may place tissues at increased risk of hypoxic stress. Nevertheless, with various degrees of effectiveness, and not without consequences, supplemental oxygen is used clinically in an attempt to correct tissue hypoxia (e.g., brain ischemia, traumatic brain injury, carbon monoxide poisoning, etc.) and chronic hypoxemia (e.g., severe COPD, etc.) and to help with wound healing, necrosis, or reperfusion injuries (e.g., compromised grafts). Hyperoxia has also been used liberally by athletes in a belief that it offers performance-enhancing benefits; such benefits also extend to hypoxemic patients both at rest and during rehabilitation. This review aims to provide a comprehensive overview of the effects of hyperoxia in humans from the "bench to bedside." The first section will focus on the basic physiological principles of partial pressure of arterial O2, [Formula: see text], and barometric pressure and how these changes lead to variation in regional O2 delivery. This review provides an overview of the evidence for and against the use of hyperoxia as an aid to enhance physical performance. The final section addresses pathophysiological concepts, clinical studies, and implications for therapy. The potential of O2 toxicity and future research directions are also considered.
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Affiliation(s)
| | - Geoff B Coombs
- Centre for Heart, Lung, and Vascular Health, University of British Columbia , Kelowna, British Columbia , Canada
| | - Otto F Barak
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Zeljko Dujic
- Department of Integrative Physiology, School of Medicine, University of Split , Split , Croatia
| | - Mypinder S Sekhon
- Centre for Heart, Lung, and Vascular Health, University of British Columbia , Kelowna, British Columbia , Canada.,Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia , Vancouver, British Columbia , Canada
| | - Philip N Ainslie
- Centre for Heart, Lung, and Vascular Health, University of British Columbia , Kelowna, British Columbia , Canada
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Akdag M, Gül A, Bakir S, Ozkurt FE, Alabalik U, Topcu I. The Histomorphologic Effects of Hyperbaric Oxygen Therapy on Submandibular, Thyroid Glands and Trachea. BIOTECHNOL BIOTEC EQ 2013. [DOI: 10.5504/bbeq.2013.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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