Number 1

[guidelines] DOI: 10.22462/01.02.2018.20

[letter] DOI: 10.22462/01.02.2018.18

[letter/response] DOI: 10.22462/01.02.2018.17

[letter] DOI: 10.22462/01.02.2018.16

[book review] DOI: 10.22462/01.02.2018.15

Objective: This case report presents a patient with central retinal artery occlusion (CRAO) who was successfully treated with hyperbaric oxygen (HBO2) but subsequently suffered a recurrence of his visual loss. Methods: CRAO may be treated successfully with HBO2  if treatment is undertaken promptly after the onset of vision loss. The goal ofHBO2 therapy is to oxygenate the ischemic inner retinal layers via diffusion from the hyperoxygenated choroidal circulation until recanalization of the central retinal artery occurs. Results: A 71-year-old man presented with hand motion vision and fundus findings of CRAO in his left eye. Treatment with HBO2 was initiated approximately 9.5 hours after loss of vision. The patient experienced return of vision to a near-normal level during HBO2. His vision loss recurred, however, 15 minutes after the HBO2 session. There was a delay to follow-up HBO2 treatments, and the improvement of vision that resulted from these subsequent HBO2 sessions was much less than that experienced during his initial HBO2 treatment. Conclusions: Recovery of vision during initial HBO2 treatment indicated that this patient’s retina had not yet suffered irreversible ischemic damage at that point in time. CRAO patients with a good result from initial HBO2 treatment should be admitted to a stroke center and should have their visual status monitored hourly. Should vision loss recur, ..

The vast clinical manifestations of carbon monoxide (CO) poisoning can involve the neurological, neuropsychological and cardiac systems as well as others. In this case report, we describe our management of a 64-year-old woman exposed to CO in her apartment. Her presentation was unusual in that she had symmetric globus pallidus lesions, no evidence of thrombosis, but the lateralizing neurologic manifestation of severe hemiplegia. DOI: 10.22462/01.02.2018.13

Introduction: Left-ventricular assist devices (LVAD) are becoming a common therapy for end-stage heart failure. These devices are not tested for pressurization in a hyperbaric chamber by the manufacturer. In this article, we present an approach to modify the power supply in order to safely treat a patient with an LVAD. Materials and methods: Our patient had a HeartMate IITM LVAD and presented for hyperbaric oxygen treatments for severe radiation cystitis. In order to modify this patient’s equipment to be compliant with NFPA6 safety standards we made several modifications. In brief, this included eliminating the usage of lithium-ion batteries, modifying the cord to be compatible with Fink chamber outlets, and enclosing the power module in a nitrogen purge. We then used a mock circulatory system to test our modifications and make sure the LVAD continued to have appropriate flow rates. We then conducted training for staff and developed a disaster plan should the LVAD fail at any point. Results: Once we felt comfortable with the modifications and had a plan developed should any problems arise, we then proceeded to treat our patient in the hyperbaric chamber. He successfully underwent 44 hyperbaric treatments for radiation cystitis without complications. Conclusion: This case is the second reported patient in the literature ..

Neuropsychiatric sequelae have been reported in 15%-45% of survivors of carbon monoxide (CO) poisoning. Hyperbaric oxygen (HBO2) therapy reduces the incidence of cognitive and neurological a dysfunction. The efficacy of providing HBO2 beyond the first one to two days after initial insult is unknown. However, some evidence exists for the benefit of this treatment. We report on treating a patient 14 months after CO injury, who responded with markedly improved neurologic status. A 27-year-old scholar was found comatose due to CO poison- ing (carboxyhemoglobin = 31.7%). He received five acute HBO2 treatments. After discharge, he developed chorea, Parkinsonism, dystonia, memory loss, slowed processing speed and verbal fluency, leaving him disabled. After the patient reached a clinical plateau, HBO2 was tried again at 90 minutes at 2.4 ATA plus air breaks. Neuropsychological testing was performed at baseline and after each 20 HBO2 cycles, five of which were per- formed during the period from 14-22 months after CO exposure. After the first 20 treatments, Parkinsonism and dystonia improved. After 40 sessions, further improvements were seen on mental speed, verbal fluency, and fine motor movements. The outcome following 100 treatments was that the patient regained independence, including the ability to drive and to become gainfully employed. Our case calls ..

Introduction: In April 2016 the Association of Diving Contractors International (ADCI) consensus guidelines began recommending annual cardiovascular risk stratification of commercial divers using the Framingham Risk Score (FRS). For those at elevated risk, further testing is recommended. This approach has raised concerns about potential operational and financial impacts. However, the prevalence of elevated cardiovascular risk and need for additional testing among commercial divers is not known. Methods: Clinical data required to calculate the FRS was ab- stracted for 190 commercial divers in two cohorts. Population demographics, FRS distribution, contributions of risk factors and effect of interventions on reducing risk-factor burden were assessed. Results: Mean FRS score was 1.68 ± 6.35 points, with 13 divers (6.8%) at intermediate risk and none at high 10-year risk. In these 13 divers, the mean contributions to the FRS were from age (6.5 points), cholesterol (3.1 pts.), smoking (1.3 pts.), high-density lipoprotein (1 pt.), and systolic blood pressure (0.8 pts). The youngest age group had a significantly higher modifiable risk score than the oldest age group (5.87 vs 1.2 points, P < 0.001). All 13 intermediate risk divers could have been reclassified as low-risk with successful treatment of modifiable risk factors. Discussion: The prevalence of elevated cardiovascular risk among commercial divers ..

Introduction: Numerous reports have documented cervicocranial artery dissection (CCAD) associated with scuba diving. The question remains as to whether there are risk factors unique to scuba diving related to the occurrence of CCAD. Objectives: This article aims to perform an examination of the reported cases to demonstrate any commonality among the injured divers and association with known risk factors for CCAD. Methods: A PubMed search was performed utilizing the key words: carotid artery dissection, dissection, arterial dissection, cranial artery dissection, scuba, diving, scuba diving. Articles including reports, reviews, trials, case series, and letters were considered. Each report was critically dissected for information specific to the dive itself and the diver and analyzed for similarities and consistency with known risks. Results: Twelve (12) reports of CCAD associated with scuba diving were identified. Activities involved with scuba diving appear to be consistent with CCAD risk factors. It is unclear if hyper- baric stress and physiological changes during a dive present specific risk. Trauma – e.g., environmental protection and activities associated with diving – was identified as a common risk factor in all cases. Ten (10) cases involved arteries at anatomic sites commonly associated with dissections. Seven divers documented to have dive profiles suspicious of decompression sickness were identified. Conclusion: There appears ..

A number of competitive water sports are performed while breath-holding (apnea). Such performances put large demands on the anaerobic system, but the study of lactate accumulation in apneic sports is limited. We therefore aimed to determine and compare the net lactate accumulation (NLA) during com- petition events in six disciplines of competitive freediving (FD) and three disciplines of synchronized swimming (SSW). The FD disciplines were: static apnea (STA; n = 14); dynamic apnea (DYN; n = 19); dynamic apnea no fins (DNF; n = 16); constant weight no fins (CNF; n = 8); free immersion (FIM; n =10) The SSW disciplines were solo (n = 21), duet (n = 31) and team (n = 34). Capillary blood lactate concentration wasmeasured before and three minutes after competition performances, and apneic duration and performance variables were recorded. In all nine disciplines NLA was observed. The highest mean (SD) NLA (mmol•L-1) was found in CNF at 6.3 (2.2), followed by CWT at 5.9 (2.3) and SSW solo at 5 (1.9). STA showed the lowest NLA 0.7 (0.7) mmol•L-1 compared to all otherdisciplines (P < 0.001). The NLA recorded shows that sportsinvolving apnea involve high levels of anaerobic activity. The highest NLA was related to both work done by large muscle ..

Purpose: This study evaluated the influence of hyperbaric exposure chambers on selected parameters of oxidative stress in divers’ blood. Methods: 25 healthy men (non-smoking experienced divers) ages 18-40 took part in the experiment. Subjects were exposed to hyperbaric conditions similar to those at 30 meters of depth while diving. A control group consisted of 20 healthy men who have never dived or been exposed to hyperbaric conditions. Blood was drawn from the cubital vein after overnight fasting. Superoxide dismutase (SOD-1) activity and malondialdehyde (MDA) concentration were marked in red blood cells (RBCs), carbonyl group concentration marked in serum proteins, and nitrate/nitrite concentrations were estimated in plasma. Results: Statistically significant differences were found between the divers and the control group in MDA concentration in erythrocytes and carbonyl group concentration in serumproteins. Nitrite/nitrate concentrations in plasma plus SOD-1 activity in RBCs decreased significantly in the diver group compared with the control group. After hyperbaric exposure MDA concentration in erythrocytes increased considerably in the test group and a significant increase in SOD-1 activity was observed. A significant increase of nitrite/nitrate concentration was noted in plasma as well as an increase in the carbonyl group in serum proteins. Conclusion: Considerably weak enzymatic antioxidative defense was observed in the RBCs of individuals exposed ..

Background: Decompression sickness (DCS) is a rare condition that is often difficult to diagnose in deep-sea divers. Because of this, prevention and early diagnosis are important. In this case-control study, we examined the risk and preventive factors associated with DCS. Methods: Our original questionnaire survey was conducted among 269 recreational divers in Okinawa. Divers who were diagnosed with DCS by a physician (n = 94) were compared with healthy recreational divers (n = 175). The questionnaire consisted of 30 items and included a dive profile. Odds ratios and multiple logistic regression analysis were used to estimate the relative risk of DCS. Results: Logistic regression analysis revealed the following risk factors for DCS: a past history of DCS, drinking alcohol the evening before diving, indicating decompression stops, cold exposure after the dive, and maximum depth. Preventive factors included hydration before the dive, deep stops, safety stops and using nitrox gas. The results were reliable according to the Hosmer-Lemeshow and omnibus tests. Conclusion: We identified certain risk factors, together with their relative risks, for DCS. These risk factors may facilitate prevention of DCS among Okinawa divers. DOI: 10.22462/01.02.2018.6

Introduction: The Republic of China Navy instituted the pressure test as one of the selection tools for diving troops and submarine crews. We analyzed factors associated with failure in the pressure test. Methods: This was a retrospective cohort study designed to investigate pressure test failure in Navy recruits between January 2010 and August 2015. The recruits received pressurization in a hyperbaric chamber to a simulated depth of 112 feet of seawater (fsw) at a rate of 25 fsw/minute. Data describing trainee demographics, disease history, causes and depth of failure, as well as type of injury, were extracted from case notes and facility databases for statistical analysis. Results: Of 3,608 trial cohorts, there were 435 failures, with an overall failure rate of 12.06%. About 95% of these failure trials were within a simulated depth of 60 fsw. Fifty- seven (57) failures did not record causes of failure. Among the other 378 failures, the most commonly identified causes were ear barotrauma (365 trials, 96.56 %) and sinus barotrauma (10 trials, 2.65%). Statistical analysis revealed that recent upper respiratory tract infection, allergic rhinitis, and cigarette smoking were all significantly associated with higher incidence of middle ear barotrauma. Conclusions: Our results suggest that pressure testing to a depth of ..

Introduction: Necrosis, wound breakdown, and infection represent major complications associated with radical vulvectomy. We aimed to analyze the feasibility of hyperbaric oxygen (HBO2) therapy as an adjunctive treatment for such complica- tions. Methods: We performed a retrospective analysis of the medical records, clinical charts, and operative records of vulvar cancer patients who underwent hyperbaric oxygen therapy after extensive surgical resection in our institute between 2012 and 2016, with a comparison of the clinical outcomes of patients with similar surgical procedures and severe wound complications who did not undergo HBO2. Results: A total of 16 patients were included in the study. In the subgroup treated with HBO2, seven patients were identified. Two patients had primary surgery, while five had recurrent surgery (of these, two had previously undergone radiation therapy). Six patients received reconstructive flaps (five myocutaneous and one fasciocutaneous), while one patient had primary suture. Dehiscence, ischemia and necrosis were estimated to cover 30%-80% of the surgical surface area. Surgical debridement was performed in six patients. Daily 90-minute sessions in the hyperbaric chamber were per- formed at a pressure of 2.2 atmospheres absolute, with partial oxygen pressure of 1672 mbar. Infection control and satisfactory healing were achieved using 10-61 sessions. All patients in the subgroup ..

In the present study, a tympanometry-based anti-barotrauma (ABT) device was designed using eardrum admittance measurements to develop an objective method of preventing barotrauma that occurs during hyperbaric oxygen (HBO2) therapy. The middle ear space requires active equalization, and barotrauma of these tissues during HBO2 therapy constitutes the most common treatment-associated injury. Decongestant nasal sprays and nasal steroids are used, but their efficacy is questionable to prevent middle ear barotrauma (MEB) during HBO2 treatment. Accordingly, a tympanometry-based ABT device was designed using eardrum admittance measurements to develop an objective method for preventing MEB, which causes pain and injury, and represents one of the principal reasons for patients to stop treatment. This study was conducted to test a novel technology that can be used to measure transmembrane pressures, and provide chamber attendants with real-time feedback re- garding the patient’s equalization status prior to the onset of pain or injury. Eardrum admittance values were measured according to pressure changes inside a hyperbaric oxygen chamber while the system was fitted to the subject. When the pressure increased to above 200 daPa, eardrum admittance decreased to 16.255% of prepressurization levels. After pressure equalization was achieved, eardrum admittance recovered to 95.595% of prepressurization levels. A one-way repeated measures analysis of variance ..

Taking into consideration that a high concentration of oxygen can express toxic effects due to production of reactive oxygen species (ROS), the aim of our investigation was to establish the influence of hyperbaric oxygenation on oxidative stress parameters and antioxidant enzymes in patients with diabetes mellitus (DM) type 2. Investigation included50 patients with DM type 2 divided into two groups. The first group consisted of 25 patients, mean age 70 years, mean duration of illness 12 years and without manifest peripheral vascular complications (Wagner 0). The second group consisted of 25 patients, mean age 74 years, mean duration of illness 17 years and with manifest peripheral vascular complications (Wagner 1-5). All patients underwent the same therapeutic protocol, which included 10 hyperbaric oxygenation therapies, once a day for a duration of 60 minutes, with an average partial oxygen pressure of 1.7 atmospheres absolute (ATA). In blood samples the following parameters of redox balance were determined: levels of nitrites (NO2-), index of lipid peroxidation (TBARS), superoxide anion radical (O2-), hydrogen peroxide (H2O2) and antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT). Our results clearly show that hyperbaric oxygen (HBO2) therapy does not have a pro-oxidative effect. Additionally, it seems that this procedure strongly ..

Objective: To provide an update on the status of provider participation in the US Wound Registry (USWR) and its speci- alty registry the Hyperbaric Oxygen Therapy Registry (HBOTR), which provide much-needed national benchmarking and quality measurement services for hyperbaric medicine. Methods: Providers can meet many requirements of the Merit-Based Incentive Payment System (MIPS) and simultaneously participate in the HBOTR by transmitting Continuity of Care Documents (CCDs) directly from their certified elec- tronic health record (EHR) or by reporting hyperbaric quality measures, the specifications for which are available free of charge for download from the registry website as electronic clinical quality measures for installation into any certified EHR. Computerized systems parse the structured data transmitted to the USWR. Patients undergoing hyperbaric oxygen (HBO2) therapy are allocated to the HBOTR and stored in that specialty registry database. The data can be queried for benchmarking, quality reporting, public policy, or specialized data projects. Results: Since January 2012, 917,758 clinic visits have captured the data of 199,158 patients in the USWR, 3,697 of whom underwent HBO2 therapy. Among 27,404 patients with 62,843 diabetic foot ulcers (DFUs) captured, 9,908 DFUs (15.7%) were treated with HBO2 therapy. Between January 2016 and September 2017, the benchmark rate for the 1,000 DFUs treated with HBO2 was ..