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Mink van der Molen DR, Batenburg MCT, Maarse W, van den Bongard DHJG, Doeksen A, de Lange MY, van der Pol CC, Evers DJ, Lansdorp CA, van der Laan J, van de Ven PM, van der Leij F, Verkooijen HM. Hyperbaric Oxygen Therapy and Late Local Toxic Effects in Patients With Irradiated Breast Cancer: A Randomized Clinical Trial. JAMA Oncol 2024; 10:464-474. [PMID: 38329746 PMCID: PMC10853873 DOI: 10.1001/jamaoncol.2023.6776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/29/2023] [Indexed: 02/09/2024]
Abstract
Importance Hyperbaric oxygen therapy (HBOT) is proposed as treatment for late local toxic effects after breast irradiation. Strong evidence of effectiveness is lacking. Objective To assess effectiveness of HBOT for late local toxic effects in women who received adjuvant radiotherapy for breast cancer. Design, Setting, and Participants This was a hospital-based, pragmatic, 2-arm, randomized clinical trial nested within the prospective UMBRELLA cohort following the trials within cohorts design in the Netherlands. Participants included 189 women with patient-reported moderate or severe breast, chest wall, and/or shoulder pain in combination with mild, moderate, or severe edema, fibrosis, or movement restriction 12 months or longer after breast irradiation. Data analysis was performed from May to September 2023. Intervention Receipt of 30 to 40 HBOT sessions over a period of 6 to 8 consecutive weeks. Main Outcomes and Measures Breast, chest wall, and/or shoulder pain 6 months postrandomization measured by the European Organization for Research and Treatment of Cancer QLQ-BR23 questionnaire. Secondary end points were patient-reported fibrosis, edema, movement restriction, and overall quality of life. Data were analyzed according to intention-to-treat (ITT) and complier average causal effect (CACE) principles. Results Between November 2019 and August 2022, 125 women (median [range] age at randomization, 56 [37-85] years) with late local toxic effects were offered to undergo HBOT (intervention arm), and 61 women (median [range] age at randomization, 60 [36-80] years) were randomized to the control arm. Of those offered HBOT, 31 (25%) accepted and completed treatment. The most common reason for not accepting HBOT was high treatment intensity. In ITT, moderate or severe pain at follow-up was reported by 58 of 115 women (50%) in the intervention arm and 32 of 52 women (62%) in the control arm (odds ratio [OR], 0.63; 95% CI, 0.32-1.23; P = .18). In CACE, the proportion of women reporting moderate or severe pain at follow-up was 32% (10 of 31) among those completing HBOT and 75% (9.7 of 12.9) among control participants expected to complete HBOT if offered (adjusted OR, 0.34; 95% CI, 0.15-0.80; P = .01). In ITT, moderate or severe fibrosis was reported by 35 of 107 (33%) in the intervention arm and 25 of 49 (51%) in the control arm (OR, 0.36; 95% CI, 0.15-0.81; P = .02). There were no significant differences in breast edema, movement restriction, and quality of life between groups in ITT and CACE. Conclusions and Relevance In this randomized clinical trial, offering HBOT to women with late local toxic effects was not effective for reducing pain, but was effective for reducing fibrosis. In the subgroup of women who completed HBOT, a significant reduction in pain and fibrosis was observed. A smaller than anticipated proportion of women with late local toxic effects was prepared to undergo HBOT. Trial Registration ClinicalTrials.gov Identifier: NCT04193722.
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Affiliation(s)
| | - Marilot C. T. Batenburg
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
| | - Wiesje Maarse
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Annemiek Doeksen
- Department of Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Daniel J. Evers
- Department of Surgery, Hospital Group Twente, Hengelo, the Netherlands
| | | | - Jacco van der Laan
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
| | - Peter M. van de Ven
- The Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - Femke van der Leij
- Department of Radiation Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
| | - Helena M. Verkooijen
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
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2
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Spronk I, Wood FM, Fear MW, Lansdorp CA, Edgar DW. The Short- and Long-Term Outcome Priorities of a Western Australian Adult Burn Population. J Burn Care Res 2024; 45:451-458. [PMID: 37936534 PMCID: PMC10911694 DOI: 10.1093/jbcr/irad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Indexed: 11/09/2023]
Abstract
To optimize patient recovery, understanding which outcomes are most important to burn patients is key. However, research to determine what outcomes are patient priorities is limited. Therefore, we assessed what outcomes are most important to Western Australian burn patients, separately in the short-term (<6 months) and long-term (6-24 months) after injury. Adult patients who had a burn injury 3-36 months ago completed a survey, rating the importance of 36 short- and long-term outcomes. The survey items were ranked according to the number of patients reporting the outcome as "very important." Results were compared between subgroups based on age, gender, burn size, and number of surgeries. Ninety-three patients were included. In the short-term, "not having a wound infection" (87.1%), "good wound healing" (83.9%), and "walking or moving around" (74.7%) were the most important outcomes. "Lifting or moving something" (67.6%), "walking or moving around" (66.2%), and "being independent" (66.2%) were reported as most important in the long-term. Scar-related outcomes were more important to females and to patients with multiple surgeries; mental health outcomes were priorities for females and patients with major burns; walking and moving around to males and older patients; and social and financial outcomes were rated highly by patients with major burns and multiple surgeries. In conclusion, the most important outcomes were consistent across time periods, indicating the importance of core outcomes in longitudinal follow-up. The wide range of priority outcomes and differences between subgroups underlines the need for multidisciplinary care and a patient-centered approach to support patients.
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Affiliation(s)
- Inge Spronk
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, 3000CA, The Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, 3007AC, The Netherlands
- Dutch Burns Foundation, Beverwijk, 1941AJ, The Netherlands
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Murdoch, WA 6150, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Murdoch, WA 6150, Australia
| | - Corine A Lansdorp
- Department Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, 1007MB, The Netherlands
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, WA 6150, Australia
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia
- Fiona Wood Foundation, Murdoch, WA 6150, Australia
- Institute for Health Research, Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, WA 6959, Australia
- Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, WA 6992, Australia
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Spronk I, van Uden D, van Dammen L, van Baar ME, Nieuwenhuis M, Pijpe A, Visser I, van Schie C, van Zuijlen P, Haanstra T, Lansdorp CA. Outcomes that matter most to burn patients: A national multicentre survey study in the Netherlands. Burns 2024; 50:31-40. [PMID: 37985268 DOI: 10.1016/j.burns.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/09/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The use of patient-reported outcomes to improve burn care increases. Little is known on burn patients' views on what outcomes are most important, and about preferences regarding online Patient Reported Outcome Measures (PROMs). Therefore, this study assessed what outcomes matter most to patients, and gained insights into patient preferences towards the use of online PROMs. METHODS Adult patients (≥18 years old), 3-36 months after injury completed a survey measuring importance of outcomes, separately for three time periods: during admission, short-term (<6 months) and long-term (6-24 months) after burn injury. Both open and closed-ended questions were used. Furthermore, preferences regarding the use of patient-reported outcome measures in burn care were queried. RESULTS A total of 140 patients were included (response rate: 27%). 'Not having pain' and 'good wound healing' were identified as very important outcomes. Also, 'physical functioning at pre-injury level', 'being independent' and 'taking care of yourself' were considered very important outcomes. The top-ten of most important outcomes largely overlapped in all three time periods. Most patients (84%) had no problems with online questionnaires, and many (67%) indicated that it should take up to 15 minutes. Patients' opinions differed widely on the preferred frequency of follow-up. CONCLUSIONS Not having pain and good wound healing were considered very important during the whole recovery of burns; in addition, physical functioning at pre-injury level, being independent, and taking care of yourself were deemed very important in the short and long-term. These outcomes are recommended to be used in burn care and research, although careful selection of outcomes remains crucial as patients prefer online questionnaires up to 15 minutes.
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Affiliation(s)
- I Spronk
- Erasmus MC University Medical Centre Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands; Dutch Burns Foundation, Beverwijk, the Netherlands.
| | - D van Uden
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - L van Dammen
- Dutch Burns Foundation, Beverwijk, the Netherlands
| | - M E van Baar
- Erasmus MC University Medical Centre Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - M Nieuwenhuis
- Association of Dutch Burn Centres, Martini Hospital, Groningen, the Netherlands; University of Groningen, University Medical Centre Groningen, Department of Human Movement Sciences, Groningen, the Netherlands; Hanze University of Applied Sciences, Groningen Research Group Healthy Ageing Allied Health Care and Nursing, Groningen, the Netherlands
| | - A Pijpe
- Burn Centre Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam Movement Sciences (AMS) Institute Amsterdam UMC, Amsterdam, the Netherlands
| | - I Visser
- Dutch Association of Burn Survivors, Beverwijk, the Netherlands
| | - C van Schie
- Dutch Burns Foundation, Beverwijk, the Netherlands
| | - P van Zuijlen
- Burn Centre Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Amsterdam Movement Sciences (AMS) Institute Amsterdam UMC, Amsterdam, the Netherlands; Department of Plastic Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location University of Amsterdam, Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam, the Netherlands
| | - T Haanstra
- Dutch Burns Foundation, Beverwijk, the Netherlands; Department of Dermal Therapy, Faculty of Health Nutrition & Sport, The Hague University of Applied Sciences, The Hague, the Netherlands; Research Group Relational Care Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - C A Lansdorp
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, Amsterdam, the Netherlands
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4
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Parra RS, Féres O, Lansdorp CA. Hyperbaric oxygen therapy: More hope than hype for future treatment of perianal fistulizing Crohn's disease? United European Gastroenterol J 2022; 10:346-347. [PMID: 35253391 PMCID: PMC9004236 DOI: 10.1002/ueg2.12219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Affiliation(s)
- Rogério Serafim Parra
- Department of Surgery and AnatomyRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoSão PauloBrazil
| | - Omar Féres
- Department of Surgery and AnatomyRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoSão PauloBrazil
| | - Corine A. Lansdorp
- Department of Anesthesiology/Hyperbaric MedicineAmsterdam UMC, Location AMCAmsterdamThe Netherlands
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Lansdorp CA, Buskens CJ, Gecse KB, Löwenberg M, Stoker J, Bemelman WA, D'Haens GRAM, van Hulst RA. Hyperbaric oxygen therapy for the treatment of perianal fistulas in 20 patients with Crohn's disease: Results of the HOT-TOPIC trial after 1-year follow-up. United European Gastroenterol J 2022; 10:160-168. [PMID: 35146959 PMCID: PMC8911540 DOI: 10.1002/ueg2.12189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022] Open
Abstract
Background Previously published short‐term results (week 16) of this trial showed a significant improvement in clinical, radiologic and biochemical outcomes in Crohn's disease patients with therapy‐refractory perianal fistulas after treatment with hyperbaric oxygen therapy. Objective To assess the long‐term (week 60) efficacy, safety and feasibility of hyperbaric oxygen therapy in perianal fistula in Crohn's disease. Methods Crohn's disease patients with high perianal fistula(s) failing conventional treatment >6 months were included. Exclusion criteria were presence of a stoma, rectovaginal fistula(s) and recent changes in treatment regimens. Patients received 40 hyperbaric oxygen sessions and outcomes were assessed at week 16 and week 60. Results Twenty patients were included (median age 34 years). At week 16, median scores of the perianal disease activity index and modified Van Assche index (co‐primary outcomes) decreased from 7.5 (95% CI 6–9) to 4 (95% CI 3–6, p < 0.001) and 9.2 (95% CI 7.3–11.2) to 7.3 (95% CI 6.9–9.7, p = 0.004), respectively. At week 60, the respective scores remained significantly lower than baseline: 4 (95% CI 3–7, p < 0.001) and 7.7 (95% CI 5.2–10.2, p = 0.003). Perianal disease activity index score of 4 or less (representing inactive perianal disease) was observed in 13 patients at week 16 and 12 patients at week 60. Using fistula drainage assessment, 12 and 13 patients showed a clinical response at week 16 and 60, respectively, and clinical remission was achieved in four patients for both time points. At week 16, a statistically significant biochemical improvement (C‐reactive protein and faecal calprotectin levels) was found, but this effect was no longer significant at week 60. Conclusions The clinical and radiologic improvement of perianal fistula in Crohn's disease, that was found at week 16 after treatment with hyperbaric oxygen therapy, is maintained at 1‐year follow‐up.
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Affiliation(s)
- Corine A Lansdorp
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Christianne J Buskens
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Rob A van Hulst
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
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Lansdorp CA, Buskens CJ, Gecse KB, D'Haens GRAM, van Hulst RA. Hyperbaric oxygen therapy for the treatment of rectovaginal fistulas in patients with Crohn's disease: results of the HOT-REVA pilot study. BJS Open 2021; 5:6287303. [PMID: 34046674 PMCID: PMC8160532 DOI: 10.1093/bjsopen/zrab042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/14/2021] [Indexed: 12/16/2022] Open
Abstract
Background Positive effects of hyperbaric oxygen (HBO) on perianal fistulas in Crohn’s disease (CD) have been described, but the effect on rectovaginal fistulas (RVFs) has not yet been studied. The aim was to investigate the efficacy, safety and feasibility of HBO in patients with RVF in CD. Methods In this prospective study, consecutive CD patients between November 2018 and February 2020 presenting with RVF at the outpatient fistula clinic of the Amsterdam University Medical Centre were included and selected to receive treatment with 30 daily HBO sessions, if fistulas were actively draining and any concomitant treatment regimen was stable at least 6 weeks prior to start of HBO. Patients with a stoma were excluded. The primary endpoint was clinical closure at 3-month follow-up, defined as cessation of complaints and/or closure of the external orifice if visible at baseline. Secondary outcomes were improvement of concomitant perianal fistulas as measured by the perianal disease activity index (PDAI) and fistula drainage assessment (FDA), as well as improvement in patient-reported outcomes (visual analogue scale (VAS), inflammatory bowel disease questionnaire (IBDQ), faecal incontinence quality of life scale (FIQL) and female sexual functioning index (FSFI)) at 3-month follow-up. Results Out of 14 eligible patients, nine patients (median age 50 years) were treated, all of whom had previously had one or more unsuccessful medical and/or surgical treatments for their RVF. Clinical closure occurred in none of the patients at 3-month follow-up. There was no improvement in PDAI and patient-reported outcomes (VAS, IBDQ, FIQL and FSFI). Two patients had concomitant perianal fistulas; using FDA, one patient had a clinical response and one patient was in clinical remission 3 months after HBO. There were two treatment-related adverse events during HBO concerning claustrophobia and fatigue. Furthermore, two patients had a surgical intervention due to RVF and two patients were treated with antibiotics for a urinary tract infection during follow-up. One patient had a dose reduction of ustekinumab because of decreased luminal complaints. Conclusion Treatment with HBO was feasible, but in this therapy-refractory cohort without deviating ostomy no clinical closure of RVF or improvement in quality of life was seen 3 months after HBO. Treatment with HBO alone in this specific group of patients therefore appears to be ineffective.
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Affiliation(s)
- C A Lansdorp
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - C J Buskens
- Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - K B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - G R A M D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - R A van Hulst
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
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Lansdorp CA, Gecse KB, Buskens CJ, Löwenberg M, Stoker J, Bemelman WA, D’Haens GR, van Hulst RA. Hyperbaric oxygen therapy for the treatment of perianal fistulas in 20 patients with Crohn's disease. Aliment Pharmacol Ther 2021; 53:587-597. [PMID: 33326623 PMCID: PMC7898636 DOI: 10.1111/apt.16228] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/24/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Positive effects of hyperbaric oxygen on perianal fistulas in Crohn's disease have been reported. AIM To assess efficacy, safety and feasibility of hyperbaric oxygen in Crohn's disease patients with therapy-refractory perianal fistulas. METHODS Twenty consecutive patients were recruited at the out-patient fistula clinic of the Amsterdam UMC. Crohn's disease patients with high perianal fistula(s) failing conventional treatment for over 6 months were included. Exclusion criteria were presence of a stoma, rectovaginal fistula(s) and recent changes in treatment regimens. Patients received treatment with 40 hyperbaric oxygen sessions and outcome parameters were assessed at Week 16. RESULTS Seven women and 13 men were included (median age 34 years). At Week 16, median scores of perianal disease activity index and modified van Assche index (co-primary outcome parameters) decreased from 7.5 (95% CI 6-9) to 4 (95% CI 3-6, P < 0.001), and from 9.2 (95% CI 7.3-11.2) to 7.3 (95% CI 6.9-9.7, P = 0.004) respectively. Perianal disease activity index scores ≤4 (representing inactive perianal disease) were observed in 13/20 patients (65%). Twelve patients showed a clinical response (60%) and four (20%) clinical remission, assessed with fistula drainage assessment. Median C-reactive protein and faecal calprotectin levels decreased from 4.2 mg/mL (95% CI 1.6-8) to 2.2 (95% CI 0.9-4.3, P = 0.003) and from 399 µg/g (95% CI 52-922) to 31 (95% CI 16-245, P = 0.001), respectively. CONCLUSIONS We found significant clinical, radiological and biochemical improvement in Crohn's disease patients with therapy-refractory perianal fistulas after treatment with hyperbaric oxygen. CLINICAL TRIAL REGISTRATION www.trialregister.nl/trial/6489.
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Affiliation(s)
- Corine A. Lansdorp
- Department of Anesthesiology/Hyperbaric MedicineAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Krisztina B. Gecse
- Department of Gastroenterology and HepatologyAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | | | - Mark Löwenberg
- Department of Gastroenterology and HepatologyAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear MedicineAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Willem A. Bemelman
- Department of SurgeryAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Geert R.A.M. D’Haens
- Department of Gastroenterology and HepatologyAmsterdam UMC, location AMCAmsterdamThe Netherlands
| | - Rob A. van Hulst
- Department of Anesthesiology/Hyperbaric MedicineAmsterdam UMC, location AMCAmsterdamThe Netherlands
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Dapena JC, Lansdorp CA, Mitchell SJ. Persistent extravascular bubbles on radiologic imaging after recompression treatment for decompression sickness: A case report. Diving Hyperb Med 2020; 50:424-430. [PMID: 33325027 DOI: 10.28920/dhm50.4.424-430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/25/2020] [Indexed: 11/05/2022]
Abstract
Decompression sickness (DCS) is a condition arising when dissolved inert gas in tissue forms extravascular and/or intravascular bubbles during or after depressurisation. Patients are primarily treated with 100% oxygen and recompression, which is often assumed to lead to resolution of bubbles. After this, repeated hyperbaric exposures can be provided in case of persistent symptoms, with oxygen delivery to ischaemic tissues, anti-inflammatory properties and reduction of oedema considered the main mechanisms of action. In this case report we present the history and imaging of a diver diagnosed with DCS that was treated with two US Navy Treatment Table 6 recompressions, but who still had multiple extravascular bubbles apparent on CT-imaging after these hyperbaric treatments. Based on these findings we hypothesise that, contrary to general belief, it is possible that large extravascular bubbles can persist after definitive treatment for DCS.
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Affiliation(s)
- Juan C Dapena
- Navy Medicine Operational Training Center, Hyperbaric Medicine Department, Pensacola (FL), USA.,Corresponding author: Dr Juan C Dapena, Navy Medicine Operational Training Center, Hyperbaric Medicine Department, 220 Hovey Rd, Pensacola, Florida, 32508, USA,
| | - Corine A Lansdorp
- Amsterdam University Medical Centre, location AMC, Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam, The Netherlands
| | - Simon J Mitchell
- Department of Anaesthesiology, School of Medicine, University of Auckland, New Zealand.,Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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Lansdorp CA, van Hulst RA. Hyperbaric oxygen therapy for Crohn's disease complications: What do we know? -Authors' reply. United European Gastroenterol J 2020; 8:972-973. [PMID: 32686609 PMCID: PMC7707871 DOI: 10.1177/2050640620945090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C A Lansdorp
- Amsterdam UMC, location AMC, Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam, the Netherlands
| | - R A van Hulst
- Amsterdam UMC, location AMC, Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam, the Netherlands
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Lansdorp CA, Buskens CJ, Gecse KB, D'Haens GRAM, van Hulst RA. Letter: off-label use of hyperbaric oxygen therapy in inflammatory bowel disease. Aliment Pharmacol Ther 2020; 52:215-216. [PMID: 32529770 DOI: 10.1111/apt.15775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Corine A Lansdorp
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | | | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Rob A van Hulst
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
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Lansdorp CA, Buskens CJ, Gecse KB, D'Haens GR, Van Hulst RA. Wound healing of metastatic perineal Crohn's disease using hyperbaric oxygen therapy: A case series. United European Gastroenterol J 2020; 8:820-827. [PMID: 32529922 PMCID: PMC7435003 DOI: 10.1177/2050640620934915] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Metastatic Crohn’s disease (CD) is a rare manifestation of CD. It involves inflammatory skin lesions with histopathological findings (granulomas) similar to CD, without connection to the gastrointestinal tract. Hyperbaric oxygen therapy (HBO) has been suggested as a possible treatment option. Objective This study aimed to identify and treat a consecutive series of patients with biopsy-proven metastatic CD and monitor wound healing using prospectively acquired outcomes. Methods Pathology results of all patients with ongoing perineal wound-healing problems after proctectomy between 2005 and 2018 at the Amsterdam University Medical Centre were assessed for metastatic CD. Patients with a biopsy-proven diagnosis of perineal metastatic CD were offered HBO (40 daily sessions of 100% oxygen at 2.4 atmosphere absolute). Wound healing was monitored using photographs and standardised questionnaires (the Inflammatory Bowel Disease Questionnaire, EuroQol Visual Analogue Scale and the Female Sexual Function Index) at baseline and 1 and 3 months after HBO. Results Out of 13 patients in the cohort with persisting perineal wounds after proctectomy, six (46%) had biopsy results consistent with metastatic CD. Of these, three accepted treatment with HBO. All three patients were female. One patient had complete healing of her perineal wound; another patient showed initial improvement but had a flare of luminal and perineal disease at the 3-month follow-up. The third patient showed improvement solely in the questionnaires, with higher scores on all three questionnaires. Conclusion A high rate of metastatic CD was found in patients with ongoing wound-healing problems after proctectomy, implying that the disease might not be as rare in these selected patients as previously thought. HBO might be beneficial in the treatment of metastatic CD.
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Affiliation(s)
- Corine A Lansdorp
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Christianne J Buskens
- Department of Surgery, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Geert Ram D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
| | - Rob A Van Hulst
- Department of Anaesthesiology/Hyperbaric Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
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12
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van Rijn KL, Lansdorp CA, Tielbeek JAW, Nio CY, Buskens CJ, D'Haens GRAM, Löwenberg M, Stoker J. Evaluation of the modified Van Assche index for assessing response to anti-TNF therapy with MRI in perianal fistulizing Crohn's disease. Clin Imaging 2019; 59:179-187. [PMID: 31821976 DOI: 10.1016/j.clinimag.2019.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/04/2019] [Accepted: 10/03/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Structured evaluation of magnetic resonance imaging (MRI) is important to guide clinical decisions of perianal fistulas in Crohn's disease (CD) patients. PURPOSE To evaluate the recently developed modified Van Assche index to assess clinical responses to anti-tumor necrosis factor (TNF) therapy in patients with perianal fistulizing CD. METHODS A search of medical records identified patients with fistulizing perianal CD who underwent baseline and follow-up MRI while receiving anti-TNF treatment. Patients were divided into clinical responders and non-responders based on physician's assessment. MRI-scans were scored using the original and modified Van Assche index and scores between baseline and follow-up were compared within clinical responders and non-responders. RESULTS Thirty cases were included (48% female, median age 27 years). Clinical responders (n = 16) had a median modified Van Assche score of 9.6 (IQR 5.8-12.7) at baseline and 5.8 (IQR 3.5-8.5) at follow-up (p = 0.008). In non-responders (n = 14), corresponding scores were 7.7 (IQR 5.8-13.5) and 8.2 (IQR 5.8-11.5) (p = 0.624). In clinical responders, 6/16 showed no drop in modified Van Assche score at follow-up. Scores obtained with the original Van Assche index dropped between baseline and follow-up in clinical responders (13.0 vs. 9.6, p = 0.011), whereas no decrease was observed in non-responders (11.5 vs. 11.5, p = 0.324). CONCLUSIONS While the modified Van Assche index overall decreases significantly in patients with perianal fistulas responding to anti-TNF treatment, one third of responders had unaltered scores at follow-up. Also, outcomes were comparable to the original Van Assche index. Further optimization of the modified Van Assche index is needed before application in larger studies.
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Affiliation(s)
- Kyra L van Rijn
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Corine A Lansdorp
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jeroen A W Tielbeek
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - C Yung Nio
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Christianne J Buskens
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, the Netherlands
| | - Geert R A M D'Haens
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mark Löwenberg
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jaap Stoker
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
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13
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Uittenbogaard D, Lansdorp CA, Bauland CG, Boonstra O. Hyperbaric oxygen therapy for dermal ischemia after dermal filler injection with calcium hydroxylapatite: a case report. Undersea Hyperb Med 2019; 46:207-210. [PMID: 31051067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Dermal injection of fillers is a popular and relatively safe aesthetic procedure. Severe complications are rare, but they do occur. One of the most threatening complications after dermal filler injection is skin necrosis due to vascular occlusion. Different treatment options are available, including the use of hyperbaric oxygen (HBO2) therapy. A 46-year-old female received facial dermal filler injections with calcium hydroxylapatite at an aesthetic clinic. A few days after injection she developed a burning pain, numbness of the skin and white discoloration in the injected area. Two days after injection treatment was started with hyaluronidase and warm compresses. In addition, the patient received prednisolone, sildenafil and nifedipine. After the start of these treatments, the pain, numbness and discoloration of the skin persisted. Because of dermal ischemia and to improve healing she was referred for HBO2. Treatment consisted of 10 sessions of 100% oxygen for 90 minutes in a multiplace chamber at 2.5 atmospheres absolute pressure. During HBO2 the discoloration resolved, pain and numbness disappeared, and the tissue healed completely. After a six-month follow-up she had an excellent cosmetic outcome. Given the pathophysiologic mechanisms of vascular complications after dermal filler injection, HBO2 should be considered when treating these complications.
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Affiliation(s)
- D Uittenbogaard
- Institute for Hyperbaric Oxygen (IvHG), Rotterdam, The Netherlands
| | - C A Lansdorp
- Institute for Hyperbaric Oxygen (IvHG), Rotterdam, The Netherlands
| | - C G Bauland
- Department of Plastic Surgery, Faceland, Capelle aan den IJssel, The Netherlands
| | - O Boonstra
- Institute for Hyperbaric Oxygen (IvHG), Rotterdam, The Netherlands
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Lansdorp CA, Gecse KB, Buskens CJ, Land Wenberg M, Stoker J, Bemelman WA, D'Haens GRAM, van Hulst RA. Hyperbaric oxygen therapy for the treatment of perianal fistulas in Crohn's disease (HOT-TOPIC): study protocol of a prospective interventional cohort study with one-year follow-up. Undersea Hyperb Med 2019; 46:45-53. [PMID: 31154684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Perianal fistulizing Crohn's disease (pCD) has a significant impact on patients' health and quality of life. Current treatment options have a relatively low success rate and a high recurrence risk. Positive effects of hyperbaric oxygen (HBO2) therapy have been indicated in animal studies as well as in small case series. METHODS/DESIGN This is a non-randomized, controlled pilot study. A total of 20 patients with pCD who have been refractory to standard therapy for at least six months will be included. Patients with a seton and stable treatment regimen will be included. Patients with anal strictures, rectovaginal fistulas, stoma or deep ulceration of the rectum will be excluded. Patients who are eligible but refuse HBO2 will be asked to serve as controls. Patients in the HBO2 group will be treated with 40 sessions of HBO2 therapy at 243-253 kPa, with the seton being removed after 30 sessions. Co-primary endpoints are changes in the perianal disease activity index and MRI-scores. Secondary outcomes are fistula drainage assessment, laboratory findings and patient-reported outcomes. Assessment will be done at baseline, 16 weeks, 34 weeks and 60 weeks after finishing HBO2. DISCUSSION The aim of this study is to investigate the feasibility and therapeutic effect of HBO2 on pCD. The one-year follow-up should provide information on the effect durability. A comparison between patients treated with HBO2 and patients who continue to receive standard care will be made. The risk of bias will be limited by using clearly defined inclusion and exclusion criteria, baseline characteristics and consecutive recruitment of patients through an outpatient fistula clinic. TRIAL REGISTRATION The HOT-TOPIC trial has been approved by the local Medical Ethical Committee of the Academic Medical Centre in Amsterdam, the Netherlands. The trial has been registered at the Netherlands Trial Register (www.trialregister.nl), registration number: NTR 6676. Protocol version: August 2017, version 3.0.
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Affiliation(s)
- C A Lansdorp
- Academic Medical Center, Department of Anesthesiology/Hyperbaric Medicine, Amsterdam, the Netherlands
| | - K B Gecse
- Academic Medical Center, Department of Gastroenterology, Amsterdam, the Netherlands
| | - C J Buskens
- Academic Medical Center, Department of Surgery, Amsterdam, the Netherlands
| | - M Land Wenberg
- Academic Medical Center, Department of Gastroenterology, Amsterdam, the Netherlands
| | - J Stoker
- Academic Medical Center, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - W A Bemelman
- Academic Medical Center, Department of Surgery, Amsterdam, the Netherlands
| | - G R A M D'Haens
- Academic Medical Center, Department of Gastroenterology, Amsterdam, the Netherlands
| | - R A van Hulst
- Academic Medical Center, Department of Anesthesiology/Hyperbaric Medicine, Amsterdam, the Netherlands
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15
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Lansdorp CA, van Hulst RA. Double-blind trials in hyperbaric medicine: A narrative review on past experiences and considerations in designing sham hyperbaric treatment. Clin Trials 2018; 15:462-476. [PMID: 29865904 PMCID: PMC6136075 DOI: 10.1177/1740774518776952] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Hyperbaric oxygen therapy, which consists of breathing 100% oxygen under a
higher atmospheric pressure than normal, is utilized worldwide in the
treatment of several diseases. With the growing demand for evidence-based
research, hyperbaric oxygen therapy has been criticized for delivering too
little high-quality research, mainly in the form of randomized controlled
trials. While not always indispensable, the addition of a sham-controlled
group to such a trial can contribute to the quality of the research.
However, the design of a sham (hyperbaric) treatment is associated with
several considerations regarding adequate blinding and the use of pressure
and oxygen. This narrative review discusses information on the sham profile
and the blinding and safety of double-blind trials in hyperbaric medicine,
irrespective of the indication for treatment. Methods MEDLINE, Embase and CENTRAL were searched for sham-controlled trials on
hyperbaric oxygen therapy. The control treatment was considered sham if
patients were blinded to their allocation and treatment took place in a
hyperbaric chamber, with no restrictions regarding pressurization, oxygen
levels or indication. Studies involving children or only one session of
hyperbaric oxygen were excluded. Information on (the choice of) treatment
profile, blinding measures, patient’s perception regarding allocation and
safety issues was extracted from eligible studies. Results A total of 42 eligible trials were included. The main strategies for sham
treatment were (1) use of a lower pressure than that of the hyperbaric
oxygen group, while breathing 21% oxygen; (2) use of the same pressure as
the hyperbaric oxygen group, while breathing an adjusted percentage of
oxygen; and (3) use of the same pressure as the hyperbaric oxygen group,
while breathing 21% oxygen. The advantages and disadvantages of each
strategy are discussed using the information provided by the trials. Conclusion Based on this review, using a lower pressure than the hyperbaric oxygen group
while breathing 21% oxygen best matches the inertness of the placebo.
Although studies show that use of a lower pressure does allow adequate
blinding, this is associated with more practical issues than with the other
strategies. The choice of which sham profile to use requires careful
consideration; moreover, to ensure proper performance, a clear and detailed
protocol is also required.
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Affiliation(s)
- C A Lansdorp
- Department of Anesthesiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Rob A van Hulst
- Department of Anesthesiology, Academic Medical Centre, Amsterdam, The Netherlands
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Lansdorp CA, Roukema GR, Boonstra O, Dokter J, van der Vlies C. Delayed treatment of frostbite with hyperbaric oxygen: a report of two cases. Undersea Hyperb Med 2017; 44:365-369. [PMID: 28783893 DOI: 10.22462/7.8.2017.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Frostbite is an injury caused by the freezing of tissue, causing varied levels of tissue damage and necrosis. Case reports have shown a positive effect of hyperbaric oxygen (HBO₂) in such injuries, in acute cases as well as delayed (up to 21 days) presentation with complications. In this case report we present the course of hyperbaric treatment of two patients (a brother and sister, age 58 and 62) who sustained frostbite injuries to both feet 28 days earlier while hiking in the Himalayas. They were initially treated in Nepal following local protocol; afterward their primary care in the Netherlands was managed by the Burn Centre at Maasstad Hospital in Rotterdam. Both patients were treated with daily sessions of in total 80 minutes of 100% oxygen at 2.5 atmospheres absolute. The female patient (age 62) received 25 sessions and showed a remarkable preservation of tissue and quick demarcation. Only partial surgical amputation of the second toe on the right was needed. In the male patient (age 58) both front feet were already mummified to a larger extent before start of treatment. During hyperbaric oxygen therapy 30 sessions) demarcation progressed quickly, resulting in early surgical amputation. Both patients experienced no side effects of HBO₂ treatment. Given that both patients showed a quick progress and demarcation of their wounds, with remarkable tissue preservation in the female patient, we suggest that hyperbaric oxygen therapy should be considered in treating frostbite injuries, in acute as well as delayed cases, even four weeks after initial injury.
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Affiliation(s)
| | - Gert R Roukema
- Maasstad Hospital, Department of Burn and Trauma Surgery, Rotterdam, The Netherlands
| | - Onno Boonstra
- Institute for Hyperbaric Oxygen (IvHG), Rotterdam, The Netherlands
| | - Jan Dokter
- Maasstad Hospital, Department of Burn and Trauma Surgery, Rotterdam, The Netherlands
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