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Scientific Abstracts
Abstract
Hyperbaric oxygen and thrombolysis in myocardial infarction: the 'HOT MI' randomized multicenter study.
Authors: Stavitsky Y , Shandling AH , Ellestad MH , Hart GB , Van Natta B , Messenger JC , Strauss M , Dekleva MN , Alexander JM , Mattice M , Clarke D
Department of Cardiology, Long Beach Memorial Medical Center, Long Beach, Calif., USA.
Cardiology 1998 Oct;90(2):131-6
Abstract: In a previous pilot study, we demonstrated that adjunctive treatment with hyperbaric oxygen (HBO) appears to be feasible and safe in patients with acute myocardial infarction (AMI) and may result in an attenuated rise in creatine phosphokinase (CPK), more rapid resolution of pain and ST changes. This randomized multicenter trial was organized to further assess the safety and feasibility of this treatment in human subjects. Patients with an AMI treated with recombinant tissue plasminogen activator (rTPA) or streptokinase (STK), were randomized to treatment with HBO combined with either rTPA or STK, or rTPA or STK alone. An analysis included 112 patients, 66 of whom had inferior AMIs (p = NS). The remainder of the patients had anterior AMIs. The mean CPK at 12 and 24 h was reduced in the HBO patients by approximately 7.5% (p = NS). Time to pain relief was shorter in the HBO group. There were 2 deaths in the control and 1 in those treated with HBO. The left ventricle ejection fraction (LVEF) on discharge was 51.7% in the HBO group as compared to 48.4% in the controls (p = NS). The LVEF of the controls was 43.4 as compared to 47.6 for those treated, approximately 10% better (no significant difference). Treatment with HBO in combination with thrombolysis appears to be feasible and safe for patients with AMI and may result in an attenuated CPK rise, more rapid resolution of pain and improved ejection fractions. More studies are needed to assess the benefits of this treatment.
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Abstract
Hyperbaric oxygen therapy mitigates the adverse effect of cigarette smoking on the bone healing of tibial lengthening: an experimental study on rabbits.
Authors: Ueng SW , Lee SS , Lin SS , Wang CR , Liu SJ , Tai CL , Shih CH
Department of Orthopaedic Surgery and Hyperbaric Oxygen Therapy Center, Chang Gung Memorial Hospital, Taiwan, Republic of China.
J Trauma 1999 Oct;47(4):752-9
Abstract: OBJECT: We investigated whether -intermittent hyperbaric oxygen (HBO) therapy can mitigate the adverse effects of cigarette smoking on the bone healing of tibial lengthening by using a previously validated rabbit model. METHODS: Eighteen male rabbits were randomly divided into three groups of six animals each. Group 1 (smoking plus HBO) went through intermittent cigarette smoke inhalation and hyperbaric oxygen therapy, group 2 (control) did not go through intermittent cigarette smoke inhalation or hyperbaric oxygen therapy and group 3 (smoking) went through intermittent cigarette smoke inhalation. Each animal's right tibia was lengthened 5 mm by using an uniplanar lengthening device. Bone mineral density (BMD) study was performed for all the animals at 1 day before operation and 3, 4, 5, and 6 weeks after operation. All of the animals were killed at 6 weeks postoperatively for biomechanical testing. RESULTS: By using the preoperative BMD as an internal control, we found that the BMD of group 1 (smoking plus HBO)and group 2 (control) was superior to that of group 3 (smoking). The mean %BMD at 3, 4, 5, and 6 weeks were 58.6%, 66.6%, 73.7%, and 83.8%, respectively, in group 1, whereas the mean %BMD were 52.0%, 64.3%, 70.1%, and 76.2%, respectively, in group 2, and the mean %BMD were 46.2%, 54.0%, 64.9%, and 69.4%, respectively, in group 3 (two-tailed t test, p > 0.05, p > 0.05, p > 0.05, and p < 0.05 at 3, 4, 5, and 6 week respectively between group 1 and group 2, p < 0.01,p < 0.01,p < 0.01, and p < 0.01 at 3, 4, 5, and 6 week, respectively, between group 1 and group 3 and p < 0.05, p < 0.05, p < 0.05, and p < 0.05 at 3, 4, 5, and 6 week respectively between group 2 and group 3). By using the contralateral nonoperated tibia as an internal control, we found that the torsional strength of group 1 (smoking plus HBO) and group 2 (control) was superior to that of group 3 (smoking). The mean percentage of maximum torque was 80.9% in group 1 (smoking plus HBO) and was 78.0% in group 2 (control), whereas the mean percentage of maximum torque was 59.6 % in group 3 (smoking) (two-tailed t test, p < 0.05 between groups land 3 and between groups 2 and 3, whereas p > 0.05 between groups 1 and 2). CONCLUSION: This study suggests that smoke inhalation delays the bone healing in tibial lengthening; however, HBO mitigates the delayed healing effect of smoke inhalation and, thus, helps the smoking animal in achieving an expeditious bone healing in tibial lengthening.
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Abstract
Hyperbaric oxygen therapy for hepatic artery thrombosis after liver transplantation in children.
Authors: Mazariegos GV , O'Toole K , Mieles LA , Dvorchik I , Meza MP , Briassoulis G , Arzate J , Osorio G , Fung JJ , Reyes J
Department of Surgery, Thomas E. Starzl Transplantation Institute, the University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, PA, 15213, USA.
Liver Transpl Surg 1999 Sep;5(5):429-36
Abstract: Early hepatic artery thrombosis (HAT) after pediatric orthotopic liver transplantation (OLT) can cause significant morbidity and mortality, leading to liver failure or septic complications requiring urgent retransplantation. Experimental evidence that hyperbaric oxygen (HBO) may ameliorate hepatic ischemic-reperfusion injury led to this study of HBO in pediatric liver transplant recipients who developed HAT. Children undergoing OLT under primary tacrolimus immunosuppression and University of Wisconsin organ preservation between August 1, 1989, and December 31, 1998, who developed HAT were the basis for this study. Patients who developed HAT between March 1, 1994, and December 31, 1998, were treated with HBO therapy until signs of ischemia resolved (absence of fever, normalizing liver injury test results) or for 2 weeks. The pediatric OLTs performed from August 1, 1989, to February 28, 1994, who developed HAT served as a control group. Primary outcome measures were survival, retransplantation rate, time to retransplantation, incidence of hepatic gangrene, and days to collateral formation. Three hundred seventy-five consecutive pediatric patients underwent 416 OLTs between August 1, 1989, and December 31, 1998. Thirty-one patients (7.5%) developed HAT at a mean time of 8.2 days (range, 1 to 52 days) post-OLT. In 17 patients, HBO treatment was begun within 24 hours of HAT or immediately after the revascularization attempt and performed twice daily for 90 minutes at 2.4 atmospheres pressure. Fourteen patients were treated without HBO. None of the HBO-treated patients developed hepatic gangrene. Eight HBO patients (47%) were bridged to retransplantation at a mean time of 157 days (range, 3 to 952 days) after initial OLT and all survived. Mean time to retransplant in the control group was 12.7 days (range, 1 to 64 days). HBO was well tolerated without significant complications. Although there was no significant difference in survival or retransplantation rates, HBO significantly delayed retransplantation, potentially by hastening the development of hepatic artery collaterals.
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Abstract
Exposure to hyperbaric oxygen induces cell cycle perturbation in prostate cancer cells.
Authors: Kalns JE , Piepmeier EH Davis
Hyperbaric Laboratory, Brooks Air Force Base, San Antonio, Texas 78235-5119, USA.
In Vitro Cell Dev Biol Anim 1999 Feb;35(2):98-101
Abstract: Cell cycle synchronization of tumor cells by exposure to hyperbaric oxygenation (HBO) may increase the efficacy of chemotherapy or radiation by placing cells into a chemosensitive portion of the cycle. The purpose of the current study was to examine oxygen pressure-dependent relationships with respect to the cell cycle in prostate tumor cells in vitro. LNCaP cells were grown in an incubator at 21% O2 and then exposed to 100% oxygen at pressures up to 6 atmospheres (atm) for 1.5 h. Cells were then returned to the incubator and evaluated for DNA content by propidium iodide and new DNA synthesis with a pulse-chase experiment. Cell cycle effects were evaluated by flow cytometry. Exposure to HBO increased the percentage of cells synthesizing new DNA in a dose-dependent fashion: 0 atm, 44%; 6 atm, 65%. Cells that synthesize new DNA accumulate in G2/M as a function of partial pressure of oxygen. These results suggest that HBO induces cells to enter the cell cycle and accumulate in G2/M. Cell cycle synchronization and entry of senescent cells into the cell cycle suggest that HBO may be a useful adjuvant to chemotherapy or radiation in the treatment of prostate cancer. There are two potential mechanisms of action that may make HBO efficacious in the treatment of prostate cancer. HBO may potentiate cancer chemotherapeutic agents that cause damage to DNA during DNA synthesis or HBO may inhibit cell division causing accumulation in G2/M.
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Abstract
Effect of hyperbaric oxygen therapy as a monitoring technique for digital replantation survival.
Author: Kiyoshige Y
Department of Orthopaedic Surgery, Saiseikai Yamagata Hospital, Japan.
J Reconstr Microsurg 1999 Jul;15(5):327-30
Abstract: There have been few clinical reports of successful replantation assisted with hyperbaric oxygen (HBO) therapy. In order to improve replant survival, the author has used HBO in ten digital replantations of crush, avulsion, and degloving amputations. Seven of ten replants survived and the other three failed. The failed three digits demonstrated remarkable color changes during HBO therapy. No color changes were observed in six of the seven surviving digits under HBO. The remaining digit showed a slight color difference between pre- and post-therapy. It appears that hyperbaric oxygen is potentially effective in distinguishing "uneventful" replants in which color does not change during HBO therapy, while hyperbaric oxygen could not salvage those "congestion to necrosis" replants in which the color became bright vermilion under hyperbaric oxygen therapy. The difference in digital color reaction to hyperbaric oxygen may be helpful in early decisions to employ salvaging procedures.
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Abstract
Treatment of mandibular osteoradionecrosis by cancellous bone grafting.
Authors: Jisander S , Grenthe B , Salemark L
Department of Oral and Maxillofacial Surgery, University Hospital, Lund, Sweden.
J Oral Maxillofac Surg 1999 Aug;57(8):936-42; discussion 942-3
Abstract: PURPOSE: This study was undertaken to evaluate a new method in the treatment of mandibular osteoradionecrosis. PATIENTS AND METHODS: Eight patients, seven male and one female, with a mean age of 64 years (range, 43 to 67 years), suffering from osteoradionecrosis of the mandible, two bilaterally and six unilaterally, were treated. Five initially had hyperbaric oxygen (HBO) followed by sequestrectomy, and three had sequestrectomy alone. Because healing failed to occur, all patients were treated by removal of the necrotic bone in the affected part of the mandible and filling the defect with compressed particulated cancellous bone and marrow from the tibia. The patients were observed for an average period of 39 months (range, 20 to 93 months). RESULTS: Primary healing was achieved in two patients with unilateral osteoradionecrosis and HBO treatment. In another patient treated with HBO primary healing occurred on one side while the other healed secondarily. In the remaining five patients, complete secondary healing took place, but it was complicated in three patients by fistulas, two of which were associated with fractures of the mandibular body. The fistulas were excised, and complete healing of the soft tissues occurred, but the fractures resulted in pseudarthrosis. CONCLUSIONS: The technique presented in this study can be useful in the treatment of osteoradionecrosis as an alternative to continuity resection and reconstruction with free osteocutaneous flaps, but, whenever possible, it should be proceeded by HBO treatment.
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Abstract
Infection due to Absidia corymbifera in a patient with a massive crush trauma of the foot.
Authors: Scalise A , Barchiesi F , Viviani MA , Arzeni D , Bertani A , Scalise G
Clinica di Chirurgia Plastica e Ricostruttiva Universita degli Studi di Ancona, Italy.
J Infect 1999 May;38(3):191-2
Abstract: We report the case of a patient with a massive crushing trauma of the right foot who developed a local infection due to Absidia corymbifera. Systemic and local antifungal therapy with ketoconazole associated with hyperbaric oxygen therapy (HBO) yielded a rapid clinical and microbiological resolution. Controlled clinical studies are warranted to further elucidate the potential utility of HBO/antifungal combination therapy.
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Abstract
Management of clostridial gas gangrene and the role of hyperbaric oxygen.
Authors: Korhonen K , Klossner J , Hirn M , Niinikoski J
Department of Surgery, University of Turku, Finland.
Ann Chir Gynaecol 1999;88(2):139-42
Abstract: BACKGROUND AND AIMS: Clostridial gas gangrene is one of the most dreaded infections in surgery. The aim of this study was to investigate the efficacy of surgery, antibiotic treatment, surgical intensive care and especially the role of hyperbaric oxygen in the management of clostridial gas gangrene. MATERIAL AND METHODS: 53 patients, 42 of them submitted from other hospitals in Finland. After the diagnosis had been made the patients underwent surgical debridement, broad spectrum antibiotic therapy and a series of hyperbaric oxygen (HBO) treatments at 2.5 ATA pressure. The necrotic tissue was excised and incisions were made in the affected areas. Amputations were performed when necessary. RESULTS: Twelve patients died (22.6%). Hyperbaric oxygen therapy decreased the systemic toxicity and prevented further extension of the infection thereby improving the overall outcome of the patients. CONCLUSION: Hyperbaric oxygen therapy of gas gangrene seems to be life-, limb- and tissue saving. Early diagnosis remains essential. Patient survival can be improved if the disease is recognized early and appropriate therapy applied promptly. Surgical and antibiotic therapy as well as HBO treatment combined with surgical intensive care must be started as soon as possible.
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Abstract
Effects of radiotherapy after hyperbaric oxygenation on malignant gliomas.
Authors: Kohshi K , Kinoshita Y , Imada H , Kunugita N , Abe H , Terashima H , Tokui N , Uemura S
Department of Neurosurgery, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.
Br J Cancer 1999 Apr;80(1-2):236-41
Abstract: The purpose of this non-randomized trial was to evaluate the efficacy of radiotherapy combined with hyperbaric oxygen (HBO) in patients with malignant glioma. Between 1987 and 1997, 29 patients in whom computerized tomography (CT) or magnetic resonance imaging (MRI) scans showed post-operative residual tumours were locally irradiated with nitrosourea-based chemotherapy. Treatments were consecutively combined with HBO at two institutions since 1991 and 1993. Fifteen patients were irradiated daily after HBO, and the periods of time from decompression to irradiation were within 15 and 30 min in 11 and four patients respectively. Fourteen other patients were treated without HBO. Tumour responses were assessed by CT or MRI scans and survival times were compared between the treated groups. In the HBO group, 11 of 15 patients (73%) showed > or = 50% tumour regression. All responders were irradiated within 15 min after decompression. In the non-HBO group, four of 14 patients (29%) showed tumour regression. The median survivals in patients with and without HBO were 24 and 12 months, respectively, and were significantly different (P < 0.05). No serious side-effects were observed in the HBO patients. In conclusion, irradiation after HBO seems to be a useful form of treatment for malignant gliomas, but irradiation should be administered immediately after decompression.
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Abstract
Long-term effect of hyperbaric oxygenation treatment on chronic distressing tinnitus.
Authors: Tan J , Tange RA , Dreschler WA , v.d. Kleij A , Tromp EC
Department of Otorhinolaryngology/Head and Neck Surgery, Academic Medical Center, University Hospital of Amsterdam, The Netherlands. t.h.tan@amc.uva.nl
Scand Audiol 1999;28(2):91-6
Abstract: Tinnitus is still a phenomenon with an unknown pathophysiology with few therapeutic measures. During the last two decades, hyperbaric oxygenation therapy (HBO) has been used in the treatment of sudden deafness and chronic distressing tinnitus. In this study, we prescribed HBO to 20 patients who had had severe tinnitus for more than one year and who had already had other forms of tinnitus therapy with unsatisfactory results. Four patients could not cope with the pressure gradient. The effect of HBO was assessed using subjective evaluation and VAS scores before and after HBO. Follow-up continued until one year after treatment. Six patients had a reduction of tinnitus and accompanying symptoms, eight patients did not notice any change and two patients experienced an adverse effect. Any outcome persisted with minor changes until one year after treatment. HBO may contribute to the treatment of severe tinnitus, but the negative effect on tinnitus should be weighed carefully.
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Abstract
[Hyperbaric oxygenation in subcortical frontal syndrome due to small artery disorders with leukoaraiosis (see comments)]
Authors: Vila JF , Balcarce PE , Abiusi GR , Dominguez RO , Subbotina N , Pisarello JB
Departamento de Neurociencias, Hospital Naval CM Dr. Pedro Mallo, Buenos Aires, Argentina. abuisi@bigfoot.com
Rev Neurol 1999 Apr 1-15;28(7):655-60
Abstract: INTRODUCTION: Frontal leukoaraiosis (LA) is a common finding in patients with subcortical small-vessel disease and currently its pathogenesis is attributed to ischemic-hypoxic mechanisms. It associates to a vascular subcortical frontal syndrome (VSFS) for which an effective treatment does not exist. CLINICAL CASES: We present four subjects from a prospective patient-blind controlled pilot trial to study efficacy and safety of hyperbaric oxygen therapy (HBO) vs hyperbaric air in VSFS with LA. All of them had frontal or extended LA on computed tomography scan and lacunes in basal ganglia and centrum ovale, with moderate to severe gait disorders, urinary dysfunction, cognitive impairment, and dependence in the daily living activities. Deficits had begun two to ten years before and had remained stable three months previous to the treatment. Patients were assessed with validated scales and tests one week before and after being administrated ten daily sessions of HBO at 2.5 atmospheres absolute for 45 minutes with a multiplace chamber. Serious adverse effects did not occur. After treatment a noticeable gait, urinary and cognitive improvement was observed in all subjects, increasing their independence. They remained clinically improved during four to five months, after which the previous deficits reappeared. Then, three patients received ten daily sessions of air at 1.1 atmospheres absolute for 45 minutes (controls) and the other a new HBO regimen, which improved as the first time. From the controls, there were no changes in two, while the other did only improve cognitively. CONCLUSION: These patients show that HBO is effective and safety in reversing, at least partially, although at great length, chronic neurological deficits associated to vascular frontal LA, highlighting that a functional reserve therapeutically useful exists.
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Abstract
A role for oxygen-induced osmosis in hyperbaric oxygen therapy.
Author: Hills BA
Paediatric Respiratory Research Centre, Mater Children's Hospital, Brisbane, Australia.
Med Hypotheses 1999 Mar;52(3):259-63
Abstract: The principles of gas-induced osmosis, demonstrated in the 1970s, have been applied to the very large steady-state gradients of O2 arising between arterial blood and hypoxic tissue during hyperbaric oxygen (HBO) therapy to produce a fluid 'pump' in the desired direction for resolving accompanying oedema. Thus, in soft-tissue injuries, an oxygen-induced fluid pump would break the vicious cycle between ischaemia, hypoxia and oedema at the point of oedema rather than hypoxia, as hitherto assumed. This osmotic mechanism enables the successes of HBO therapy in hypoxic disorders to be reconciled with early failures in such areas as hyperbaric radiotherapy, where substitution of O2 for N2 in inspired air was clearly not reflected at the tissue level. This argument also applies to the success of HBO in treating air embolism and decompression sickness over simple compression. The oxygen pump would seem to offer a more plausible explanation for the success of HBO therapy than theories based upon O2 delivery by the circulation, especially when considering cardiovascular reflexes to elevated PaO2 and the marginal increase in blood O2 content upon switching to HBO from normobaric oxygen breathing.
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Abstract
Hyperbaric oxygen in the treatment of life-threatening soft-tissue infections.
Authors: Clark LA , Moon RE
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Respir Care Clin N Am 1999 Jun;5(2):203-19
Abstract: Necrotizing soft-tissue infections are rapidly spreading bacterial infections that account for a relatively small proportion of infections, but are aggressive in nature and nearly uniformly fatal if left untreated. Prompt recognition, antibiotic therapy, aggressive surgical debridement, and hyperbaric oxygen (HBO) therapy have reduced the mortality resulting from these infections. Oxygen, at increased pressures, augments tissue oxygen partial pressure, allowing increased bacterial killing by providing substrate for the formation of oxygen free radicals and augmenting respiratory burst. During the healing process, hyperoxia causes increased formation of capillaries for oxygen, nutrient, and antibiotic delivery, leading to increased efficacy of some antibiotics in the high oxygen environment, and possibly more rapid overall wound healing. Although there are no randomized trials of HBO in these infections, in vitro data and meta-analysis of clinical cases strongly support the use of HBO.
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Abstract
Osseointegrated implants in irradiated bone: a case-controlled study using adjunctive hyperbaric oxygen therapy.
Authors: Granstrom G , Tjellstrom A , Br~anemark PI
Department of Otolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. gosta.granstrom@orlss.gu.se
J Oral Maxillofac Surg 1999 May;57(5):493-9
Abstract: PURPOSE: The current investigation was undertaken to study whether osseointegration of implants in irradiated tissues is subject to a higher failure rate than in nonirradiated tissues. It further aimed to study whether hyperbaric oxygen treatment (HBO) can be used to reduce implant failure. PATIENTS AND METHODS: Seventy-eight cancer patients who were rehabilitated using osseointegrated implants between 1981 and 1997 were investigated. Three groups of patients were compared: irradiated (A), nonirradiated (B), and irradiated and HBO-treated (C). In addition, 10 irradiated patients who had lost most of their implants received new ones after HBO treatment. These were compared as a case-control group. RESULTS: Implant failures were highest in group A (53.7%). Implant failure was 13.5% in group B and 8.1% in group C. The difference between group A and the other two groups was statistically significant (P = .001 to .0023, Mantell's test). HBO significantly improved implant survival in the case-control group from 34 of 43 implants lost to 5 of 42 lost (P = .0078). CONCLUSIONS: Implant insertion in irradiated bone is associated with a higher failure rate. Adjuvant HBO treatment can reduce the failures.
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Abstract
Treatment of decompression illness and latrogenic gas embolism.
Authors: Moon RE , de Lisle Dear G , Stolp BW
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
Respir Care Clin N Am 1999 Mar;5(1):93-135
Abstract: The mainstay of treatment of gas bubble disease is therapeutic recompression while the patient is breathing oxygen. The patient should be recompressed as soon as possible; however, patients should be considered for recompression even after several days' delay. Treatments should be repeated if possible until symptoms have either resolved or stabilized. Appropriate hydration is essential. The use of HBO is generally safe, relatively nontoxic, and is possible even in neonates. Pharmacologic agents (e.g., anticoagulants, lidocaine, antiplatelet agents, corticosteroids, inhibitors of calcium flux) may be useful adjuncts to recompression therapy but they require further study. For patients who respond poorly to recompression therapy, the next advance in the treatment of DCI-induced neural injury is likely to be due to the development of agents that reduce the effects of reperfusion injury and delayed cell death.
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Abstract
Hyperbaric oxygen therapy: from the nineteenth to the twenty-first century.
Authors: Moon RE , Camporesi EM
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
Respir Care Clin N Am 1999 Mar;5(1):1-5
Abstract: Hyperbaric oxygen technology now occupies a legitimate place in modern medical practice, and the number of clinically active hyperbaric facilities has grown. We estimate that more than 200 monoplace (single-patient) chambers and over two dozen multiplace facilities are presently active in the United States. Nevertheless, the majority of patients suffering from syndromes amenable to HBO therapy are treated in hospitals devoid of such modalities. This situation stems in part from the significant cost of appropriate facilities, the relative scarcity of trained personnel, and the difficulties in obtaining appropriate compensation in an era of rapidly changing reimbursement paradigms. Frequently, patients undergoing HBO therapy require mechanical ventilation, vasoactive drug infusions, sophisticated monitoring, and accurate fluid and electrolyte therapy during treatment. The demonstrated efficacy of HBO as an important part of the treatment of certain acute disease processes, however, justifies the facilities and skilled personnel necessary for the care of critically ill patients in a hyperbaric environment.
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Abstract
Laryngeal radionecrosis and hyperbaric oxygen therapy: report of 18 cases and review of the literature.
Authors: Filntisis GA , Moon RE , Kraft KL , Farmer JC , Scher RL , Piantadosi CA
Duke Hyperbaric Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
Ann Otol Rhinol Laryngol 2000 Jun;109(6):554-62
Abstract: Laryngeal radionecrosis is a difficult late complication of radiotherapy. It is associated with hoarseness, edema, pain, weight loss, and upper airway obstruction. The medical treatment options are limited, and in severe cases, the patient may require tracheostomy or laryngectomy. We report clinical results in 18 patients treated with adjunctive hyperbaric oxygen (HBO) therapy for severe radionecrosis of the larynx. Of these 18 patients, 2 had grade 3 and 16 had grade 4 radionecrosis. The patients received a mean number of 41 HBO treatments (range, 6 to 80) at 2 atmospheres absolute for 2 hours, twice a day, 6 days a week. Thirteen patients (72.2%) had a major improvement after HBO therapy, and none of them required total laryngectomy. All patients preserved their voice and deglutition in good or normal condition. Five patients (27.8%) failed to have a good response to HBO and underwent total laryngectomy. One of these patients had local recurrence of his cancer 4 months later, and the other 3 had significant concurrent medical problems. The remaining patient received only 6 HBO treatments because of emergency heart surgery. These encouraging results are comparable to those of smaller previous studies suggesting that HBO has a beneficial effect in the management of advanced laryngeal radionecrosis.
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Abstract
Hyperbaric oxygen reduces the progression and accelerates the regression of atherosclerosis in rabbits.
Authors: Kudchodkar BJ , Wilson J , Lacko A , Dory L
Department of Molecular Biology & Immunology, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
Arterioscler Thromb Vasc Biol 2000 Jun;20(6):1637-43
Abstract: We studied the effect of hyperbaric oxygen (HBO) treatment on the extent of diet-induced accumulation of lipid oxidation products in rabbit plasma and tissues, on plasma paraoxonase activity, and on the extent of progression and regression of atherosclerotic lesions in the rabbit aorta. HBO treatment of cholesterol-fed rabbits dramatically reduces the development of arterial lesions despite having little or no effect on plasma or individual lipoprotein cholesterol concentrations. Compared with no treatment in cholesterol-fed animals, HBO treatment also substantially reduces the accumulation of lipid oxidation products (conjugated dienes, trienes, and thiobarbituric acid-reactive substances) in plasma, in the low density lipoprotein and high density lipoprotein fractions of plasma, in the liver, and in the aortic tissues. In addition, HBO treatment prevents the decrease in plasma paraoxonase activity observed in rabbits fed cholesterol-rich diets. Similarly, in regression studies, HBO treatment has no effect on the rate of plasma (or lipoprotein) cholesterol decline but significantly accelerates aortic lesion regression compared with no treatment. Direct measures of aortic cholesterol content support these morphological observations. On the basis of these results, we conclude that repeated, but relatively short, exposure to HBO induces an antioxidant defense mechanism(s) that is responsible for retarding the development or accelerating the regression of atherosclerotic lesions.
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Abstract
[Hyperbaric oxygen treatment for radiation reactions]
Authors: Aanderud L , Thorsen E , Brattebo G , Forland M , Kristensen G
Yrkesmedisinsk avdeling Haukeland Sykehus, Bergen.
Tidsskr Nor Laegeforen 2000 Mar 30;120(9):1020-2
Abstract: BACKGROUND: A national hyperbaric centre was established in 1994 at Haukeland Hospital with responsibility for all hyperbaric oxygen (HBO) treatment in Norway. In hypoxic tissues with symptomatic radiation reactions, hyperbaric oxygen induces the formation of collagen and angiogenesis resulting in permanently improved local microcirculation. MATERIAL AND METHODS: 234 patients received elective HBO treatment at Haukeland Hospital in 1997 with a total of 4,048 treatments. All 47 patients treated for radiation reactions in the pelvic area in 1997 received a questionnaire 3-15 months after HBO therapy; 81% responded. RESULTS: Rectal bleeding and haematuria were reported as much improved in 61% and 55% respectively, while bladder incontinence was much improved in 46%. INTERPRETATION: This treatment modality may be an alternative in symptomatic radiation reactions of the urinary bladder and the bowel when conventional treatment has given unsatisfactory results.
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Abstract
Hyperbaric oxygen and photodynamic therapy in the treatment of advanced carcinoma of the cardia and the esophagus.
Authors: Maier A , Anegg U , Fell B , Rehak P , Ratzenhofer B , Tomaselli F , Sankin O , Pinter H , Smolle-Juttner FM , Friehs GB
Department of Surgery, Division of Thoracic and Hyperbaric Surgery, University Medical School, Graz, Austria.
Lasers Surg Med 2000;26(3):308-15
Abstract: BACKGROUND AND OBJECTIVE: The photochemical reaction of photodynamic therapy (PDT) depends on the presence of molecular oxygen. Because of anoxic regions in tumor tissue and vascular shutdown during PDT, the efficiency is limited. Therefore, the use of hyperbaric oxygen, which increases the oxygen in tumor tissue, as well as the amount of singlet oxygen, may enhance the efficiency of PDT. STUDY DESIGN/MATERIALS AND METHODS: After diagnostic work-up, photosensitization was carried out with a hematoporphyrin-derivate 2 mg/kg body weight 48 hours before PDT. The light dose was calculated as 300 J/cm of fiber tip. Twenty-three patients were treated by PDT alone and 29 patients received PDT under hyperbaric oxygen at a level of two absolute atmospheric pressures. RESULTS: Improvement regarding dysphagia and stenosis-diameter could be obtained in both treatment arms with no significant difference (P = 0.43 and P = 0. 065, respectively). The tumor length also decreased in both groups and showed a significant difference in favour of the PDT/HBO group (P = 0.002). The mean overall survival was 11.3 months. The mean survival time for the PDT group was 8.7 months and for the PDT/HBO group 13.8 months (P = 0.021). CONCLUSION: According to this pilot study, combined PDT/HBO represents a new approach in the treatment of esophageal and cardia cancer, which appears to have enhanced the efficiency of PDT. Copyright 2000 Wiley-Liss, Inc.
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Abstract
Hyperbaric oxygen therapy for trauma: crush injury, compartment syndrome, and other acute traumatic peripheral ischemias.
Author: Myers RA|
R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore 21201, USA.
Int Anesthesiol Clin 2000 Winter;38(1):139-51
Abstract: In the future, the indications for HBO therapy in acute peripheral ischemic injuries will likely be based on objective criteria rather than, as at present, on clinical diagnoses alone. This chapter offers objective criteria for using HBO in crush injuries and compartment syndromes. The pathophysiology of ATPI are well defined. Hyperbaric oxygen mediates the effects of ATPI through four mechanisms: hyperoxygenation, vasoconstriction, reperfusion, and host factors. The cost benefits of using HBO will be substantial, since complications from ATPI are very expensive. As objective criteria replace the presently used subjective criteria, hyperbaric oxygen therapy will become an integral part of trauma management of these injuries.
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Abstract
Basic mechanisms of hyperbaric oxygen in the treatment of ischemia-reperfusion injury.
Author: Buras J
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Int Anesthesiol Clin 2000 Winter;38(1):91-109
Abstract: HBO treatment affects many of the components involved in I/R injury, including PMNL function, endothelial CAM expression, NO production, NOS expression, cellular energetics, lipid peroxidation, and microvascular blood flow. Given the variety of models used to study the individual components involved in I/R injury, it is difficult to determine which is the predominant factor affected by HBO and which generates the observed beneficial outcomes in most systems. Experimental differences in the types of I/R injury, the timing of HBO treatment relative to the I/R injury (before, during, after, or delayed), the duration of HBO treatment pressure and duration, and the time of outcome measurements confound our ability to compare studies and determine the key beneficial factor. Upon review, it is likely that the sum of many of these effects is responsible for the final outcome. We have been presented with many of the pieces of the puzzle with respect to the beneficial effect of HBO in ischemia-reperfusion injury states. Hopefully, future studies will unite them into a clear picture of the basic mechanism(s) responsible for the benefits of hyperbaric oxygen therapy.
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Abstract
Carbon monoxide poisoning and hyperbaric oxygen therapy.
Authors: Durmaz E , Laurence S , Roden P , Carruthers S
Royal Preston Hospital.
Br J Nurs 1999 Sep 9-22;8(16):1067-72
Abstract: This article describes the treatment of carbon monoxide (CO) poisoning with hyperbaric oxygen therapy (HBO). Carbon monoxide poisoning is the commonest cause of fatal poisoning in the UK. Despite this, HBO is an underused treatment modality. Current criteria for hyperbaric treatment include any patient with neurological deficit and any episode of depressed consciousness, cardiovascular disturbance, patients initially treated with surface oxygen and who developed recurrent symptomatology and minor symptoms unresponsive to oxygen. During a 5-year period 82 patients have been treated from a wide geographical area. Of these patients 57% suffered carbon monoxide poisoning as a result of self-poisoning. Other causes of poisoning were: house fire; faulty gas appliances; industrial furnaces; and petrol generators. Of the 82 patients treated, 13 required mechanical ventilation and full haemodynamic monitoring, while the remainder were able to walk in and a few patients received intravenous sedation. In recent years the trend has been to re-treat patients more than once in the first 24 hours to increase efficacy and hopefully decrease the serious sequelae that can occur following CO poisoning.
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Abstract
Does hyperbaric oxygen enhance the effect of photodynamic therapy in patients with advanced esophageal carcinoma? A clinical pilot study.
Authors: Maier A , Anegg U , Tomaselli F , Rehak P , Sankin O , Fell B , Renner H , Pinter H , Smolle-Juttner FM , Friehs GB
Department of Thoracic and Hyperbaric Surgery, University Medical School, Graz, Austria. alfred.maier@klinikum-graz.at
Endoscopy 2000 Jan;32(1):42-8
Abstract: BACKGROUND AND STUDY AIMS: Experimental studies have shown that the cytotoxicity of porphyrins and related substances is mediated mainly by singlet oxygen and that hypoxic cells are less affected by porphyrins and light. In a clinical pilot study we assessed the use of photodynamic therapy (PDT) under hyperbaric oxygen (HBO), compared with PDT under normobaric conditions, in patients with advanced esophageal carcinoma. PATIENTS AND METHODS: After diagnostic work-up and staging, photosensitization in all patients was carried out using hematoporphyrine derivate (HpD) (2 mg/kg bodyweight 48 hours prior to PDT). We then applied light at 630 nm (KTP-Nd: YAG laser with DYE box) at dose of 300 J/cm, delivered by a fiber with a radial light-diffusing cylinder (length 1 cm), inserted through the biopsy channel of the endoscope. Of the patients, 14 (12 with stage III cancers, and two with stage IV cancers) were treated by PDT alone, and 17 patients (15 with stage III cancers, and two with stage IV cancers) received PDT under HBO at a level of 2 absolute atmospheric pressures (ATA). Transcutaneous PO2 levels of 500-750 mm Hg under HBO, compared with transcutaneous PO2 levels of 60-75 mm Hg under normobaric conditions, were measured. RESULTS: Improvements regarding dysphagia and stenosis diameter were obtained in both treatment arms with no significant differences (P = 0.36 and 0.14, respectively). The tumor length also decreased in both groups and showed a significant difference in favour of the PDT/ HBO group (P = 0.002). Kaplan-Meier statistics showed median overall survival for the PDT group and the PDT/HBO group as 7.0 and 12 months respectively. The 12-month survival rate was 28.6% for the PDT group and 41.2% for the PDT/HBO group. Logrank test showed a difference in survival in favor of the PDT/HBO group (P = 0.059). No major treatment-related complication occurred, and the 30-day mortality rate was 0%.CONCLUSIONS: Combined PDT/HBO represents a new approach in the treatment of esophageal cancer which, in this pilot study, appears to have enhanced the efficiency of PDT.
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Abstract
Hyperbaric oxygen in the prevention of osteoradionecrosis of the jaws
Authors: Vudiniabola S , Pirone C , Williamson J , Goss AN
Oral and Maxillofacial Surgery Unit, University of Adelaide.
Aust Dent J 1999 Dec;44(4):243-7
Abstract: Patients who have had their jaws irradiated as part of management of head and neck malignancy are at risk of osteoradionecrosis (ORN) following tooth extraction. Thirty-seven patients with a history of irradiation to the jaws were managed during a four year period. Twenty-nine patients received hyperbaric oxygen therapy (HBO) consisting of 20 treatments before surgery and ten treatments after. Only one (4 per cent) developed ORN. Seven patients who did not have HBO and one who did (15 per cent) developed ORN. The need for prophylactic treatment with HBO is discussed. It is recommended that prophylactic HBO is used prior to surgery for irradiated facial bones.
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Abstract
Complications and side effects of hyperbaric oxygen therapy.
Authors: Plafki C , Peters P , Almeling M , Welslau W , Busch R
Dept. of Orthopedic Surgery, Marien-Krankenhaus, Duesseldorf, Germany.
Aviat Space Environ Med 2000 Feb;71(2):119-24
Abstract: BACKGROUND: Despite ongoing controversy, hyperbaric oxygen (HBO) therapy is frequently administered in various clinical situations. Probably because of the unique atmospheric conditions to which the patient is exposed, there are concerns about the safety aspects of this therapy. Possible complications during HBO therapy include barotraumatic lesions (middle ear, nasal sinuses, inner ear, lung, teeth), oxygen toxicity (central nervous system, lung), confinement anxiety, and ocular effects (myopia, cataract growth). METHODS: To analyze the medical safety of HBO therapy, this report reviewed complications and side effects of 782 patients treated for various indications with a total of 11,376 HBO therapy sessions within a multiplace chamber. The absolute treatment pressure was 240 or 250 kPa 114 or 15 msw). The compression was performed in a linear manner with 14 to 15 kPa (1.4 to 1.5 msw) x min(-1). All data were gathered prospectively within a special database. RESULTS: More than 17% of all patients experienced ear pain or discomfort as an expression of problems in equalizing the middle ear pressure. Most episodes were not related to a persistent eustachian tube dysfunction since they only occurred once. Barotraumatic lesions on visual otological examinations (ear microscopy) were verified in 3.8% of all patients. Patients with sensory deficits involving the ear region need special attention, because they seem to be at risk for rupture of the tympanic membrane (three cases documented). A barotrauma of the nasal sinuses occurred rarely and no barotraumatic lesions of the inner ear, lung, or teeth were noted. Oxygen toxicity of the CNS manifested by generalized seizures affected four patients without any recognizable risk factors or prodromes. None of the patients suffered recurrences or sequelae.Regular checks of the blood glucose in diabetics failed to reveal episodes of hypoglycemia as a cause for seizures. Lung function tests of patients undergoing prolonged treatment (average 52.8 sessions) did not deteriorate. CONCLUSION: Patients scheduled for HBO therapy need a careful pre-examination and monitoring. If safety guidelines are strictly followed, HBO therapy is a modality with an acceptable rate of complications. The predominant complication is represented by pressure equalization problems within the middle ear. Serious complications rarely occur.
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Abstract
Differential lung ventilation and emergency hyperbaric oxygenation for repair of a tracheal tear.
Authors: Ratzenhofer-Komenda B , Offner A , Kaltenbock F , Maier A , Pinter H , Prause G , Smolle-Juttner FM
Department of Anesthesiology, University Medical School of Graz, Austria. beatrice.ratzenhofer@kfunigraz.ac.at
Can J Anaesth 2000 Feb;47(2):169-75
Abstract: PURPOSE: To report the anaesthetic management of a case of tracheal rupture, using different types of ventilation and additional hyperbaric oxygenation (HBO). CLINICAL FEATURES: An 8 cm postintubation tracheal tear was repaired in a 66-yr-old woman with acute myocardial reinfarction, mediastinal and subcutaneous emphysema, cardiac failure and unrecognized lymphoma. Intraoperative monitoring included dual oximetry: arterial (SaO2) and mixed venous saturations (SvO2). Maintenance of free surgical access and a series of life-threatening events like dislocation of the jet catheter required many ventilation modes. An episode of supraventricular tachycardia was interrupted by cardioversion. Differential lung ventilation with a combination of conventional and high-frequency jet ventilation (HFJV) modes preserved oxygenation (PO2 139.2 mm Hg, PCO2 42.4 mm Hg, FiO2 1.0) until acute tube obstruction and decrease of saturation values (SaO2 58%, SvO2 45%) required emergency HBO: immediate cardiac and respiratory stabilization was provided by double-lung HFJV and apneic oxygenation under hyperbaric conditions at 2.5 atmospheres absolute for 35 min (SaO2 100%). The patient recovered from surgery but died of non-Hodgkin lymphoma. CONCLUSION: The combination of different ventilation modes including HFJV and the additional use of HBO resulted in sufficient oxygenation during tracheal repair.
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Abstract
Cervical necrotizing fasciitis of odontogenic origin: a case report and review of 12 cases.
Authors: Whitesides L , Cotto-Cumba C , Myers RA
Hyperbaric Medicine, R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore 21201, USA.
J Oral Maxillofac Surg 2000 Feb;58(2):144-51; discussion 152
Abstract: PURPOSE: This article reviews the demographics, presentation, cause, clinical findings, and treatment of 12 cases of cervical necrotizing fasciitis of odontogenic origin. PATIENTS AND METHODS: A retrospective chart review of 12 cases treated between 1987 and 1997 was done. RESULTS: Most cases resulted from an abscessed mandibular molar. The most common significant medical conditions in the patient's history were diabetes, hypertension, obesity, and substance abuse. All patients were treated surgically within 24 hours of admission. Hyperbaric oxygen (HBO) was used as adjunctive treatment in all cases. The average length of hospital stay was 31 days. All patients recovered. CONCLUSION: Early surgical intervention and the use of HBO decreases morbidity and improves the clinical outcome.
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Abstract
Hyperbaric oxygen downregulates ICAM-1 expression induced by hypoxia and hypoglycemia: the role of NOS.
Authors: Buras JA , Stahl GL , Svoboda KK , Reenstra WR
Department of Emergency Medicine, Brigham and Women's Hospital, Boston 02115, Massachusetts, USA. jburas@massmed.org
Am J Physiol Cell Physiol 2000 Feb;278(2):C292-302
Abstract: Hyperbaric oxygen (HBO) is being studied as a therapeutic intervention for ischemia/reperfusion (I/R) injury. We have developed an in vitro endothelial cell model of I/R injury to study the impact of HBO on the expression of intercellular adhesion molecule-1 (ICAM-1) and polymorphonuclear leukocyte (PMN) adhesion. Human umbilical vein endothelial cell (HUVEC) and bovine aortic endothelial cell (BAEC) induction of ICAM-1 required simultaneous exposure to both hypoxia and hypoglycemia as determined by confocal laser scanning microscopy, ELISA, and Western blot. HBO treatment reduced the expression of ICAM-1 to control levels. Adhesion of PMNs to BAECs was increased following hypoxia/hypoglycemia exposure (3. 4-fold, P < 0.01) and was reduced to control levels with exposure to HBO (P = 0.67). Exposure of HUVECs and BAECs to HBO induced the synthesis of endothelial cell nitric oxide synthase (eNOS). The NOS inhibitor nitro-L-arginine methyl ester attenuated HBO-mediated inhibition of ICAM-1 expression. Our findings suggest that the beneficial effects of HBO in treating I/R injury may be mediated in part by inhibition of ICAM-1 expression through the induction of eNOS.
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Abstract
Hyperbaric oxygen: a means of decreasing ischemic epiphyseal damage in a pediatric rabbit model.
Authors: Weiss DD , Stevens DM , Yan JG , Lynch KL , Warnock GR , Matloub HS
Department of Plastic and Reconstructive Surgery, Naval Medical Center, Portsmouth, VA, USA.
J Hand Surg [Am] 2000 Jan;25(1):159-65
Abstract: The effect of hyperbaric oxygen on epiphyseal ischemia was evaluated using a pediatric rabbit model. Forty-five animals were compared in this study: 23 from a control pilot study and 22 hyperbaric exposed animals. In each animal the right distal femoral and proximal tibial epiphyses were isolated on a popliteal vascular pedicle. The left leg acted as the control. The growth difference between the rabbit's hindlimbs was the means of comparison throughout the groups established. Warm ischemia was induced by applying a vascular clamp to the right popliteal artery for 12 hours (20 animals) and 7 hours (17 animals). The remaining 8 animals underwent a sham operation without interruption of epiphyseal perfusion. On completion of the ischemic period hyperbaric oxygen therapy (HBOT) was performed on 12 12-hour (12h-HBOT) and 10 7-hour (7h-HBOT) animals at 2 atmospheres for 90 minutes twice per day for 4 postoperative days. The animals were killed on either postoperative day 14 or 90. Measurement of longitudinal bone growth was performed on the 90-day animals from serial radiographs at the time of surgery and then at 1 month, 2 months, and 3 months after surgery. There was no significant difference in longitudinal bone growth between the sham-operated and the 7h-HBOT animals at 1, 2, and 3 months. There was a statistically significant difference, however, between the normal growth of the 7h-HBOT group compared with the abnormal growth of the 7-hour, 12-hour, and 12h-HBOT animals. Histology was consistent, with the bone growth data demonstrating relative normalcy of the 7h-HBOT group epiphyseal plates versus severe architectural aberrance and necrosis of the 12h-HBOT group epiphyses. Our experimental data indicate that a clinical trial should be instituted using HBO for pediatric replantation patients when warm ischemia exceeds 7 hours. (J Hand Surg 2000; 25A:159-165. Copyright 2000 by the American Society for Surgery of the Hand.).
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Abstract
Preservation of tumour oxygen after hyperbaric oxygenation monitored by magnetic resonance imaging.
Authors: Kinoshita Y , Kohshi K , Kunugita N , Tosaki T , Yokota A
Department of Neurosurgery, University of Occupational and Environmental Health, Japan.
Br J Cancer 2000 Jan;82(1):88-92
Abstract: Hyperbaric oxygen (HBO) has been proposed to reduce tumour hypoxia by increasing the dissolved molecular oxygen in tissue. Using a non-invasive magnetic resonance imaging (MRI) technique, we monitored the changes in MRI signal intensity after HBO exposure because dissolved paramagnetic molecular oxygen itself shortens the T1 relation time. SCCVII tumour cells transplanted in mice were used. The molecular oxygen-enhanced MR images were acquired using an inversion recovery-preparation fast low angle shot (IR-FLASH) sequence sensitizing the paramagnetic effects of molecular oxygen using a 4.7 tesla MR system. MR signal of muscles decreased rapidly and returned to the control level within 40 min after decompression, whereas that of tumours decreased gradually and remained at a high level 60 min after HBO exposure. In contrast, the signal from the tumours in the normobaric oxygen group showed no significant change. Our data suggested that MR signal changes of tumours and muscles represent an alternation of extravascular oxygenation. The preserving tumour oxygen concentration after HBO exposure may be important regarding adjuvant therapy for cancer patients.
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© Copyright 2007 Hyperbaric Medical Center of New Mexico
The information provided by Hyperbaric Medical Center of New Mexico does not constitute a medical recommendation. It is intended for informational purposes only, and no claims, either real or implied, are being made.
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