Hyperbaric Oxygen as Adjunctive Therapeutic in Management of Craniocervical Necrotizing Fasciitis: Case Series and Treatment Protocol

Objective: To review our management of cervical necrotizing fasciitis (CNF) with the use of adjunctive hyperbaric oxygen therapy (HBO). Study Design: Case series with chart review. Subjects and Methods: Evaluation of ten patients with CNF between 2001 to 2006. Results: There were five male and six female patients. Mean age was 43 ± 11 years. Eight cases resulted from an odontogenic source. Comorbidities included diabetes mellitus, hypertension, and substance abuse. All patients had computed tomography scans performed, received intravenous antibiotics, and underwent surgical debridement. Eight patients underwent surgery within 24 hours. The average number of debridements was 2.2 ± 0.8. Hospitalization was twice as long for diabetic patients (15.5 ± 8.16 days) compared with nondiabetic patients (7.5 ± 1.6 days, P = 0.029). Nine patients had HBO therapy. Combined data revealed a possible decrease in length of hospitalization with HBO therapy ( P < 0.001). No mortality was documented. Conclusion: In addition to early and aggressive medical management and surgical debridement, this study suggests that HBO therapy is a beneficial adjunct by potentially decreasing length of hospitalization. Randomized trials are still needed to demonstrate its efficacy.

Download Full-text

Hyperoxic myopia: a case series of four divers

Undersea and Hyperbaric Medicine ◽

10.22462/04.06.2020.12 ◽

2020 ◽

pp. 261-265

Author(s):

Jonathan W. Brügger ◽

Glenn A. Rauscher ◽

John P. Florian ◽

Keyword(s):

Hyperbaric Oxygen ◽

Prolonged Exposure ◽

Case Series ◽

Oxygen Toxicity ◽

Hyperbaric Oxygen Treatment ◽

Subjective Data ◽

Residual Symptoms ◽

Oxygen Treatment ◽

Blurry Vision ◽

Record Review

Hyperoxic myopia is a phenomenon reported in individuals who have prolonged exposure to an increased partial pressure of oxygen (PO2) and subsequently have a myopic (nearsighted) change in their vision. To date, there are numerous accounts of hyperoxic myopia in dry hyperbaric oxygen treatment patients; however, there have been only three confirmed cases reported in wet divers. This case series adds four confirmed cases of hyperoxic myopia in wet divers using 1.35 atmospheres (ATM) PO2 at the Navy Experimental Diving Unit (NEDU). The four divers involved were the first author’s patients at NEDU. Conditions for two divers were confirmed via record review, whereas the other two divers were diagnosed by the first author. All subjects were interviewed to correlate subjective data with objective findings. Each subject completed five consecutive six-hour hyperoxic (PO2 of 1.35 ATM) dives with 18-hour surface intervals. Each individual was within the U. S. Navy Dive Manual’s standards for general health. Visual acuity was measured prior to diving. Within three to four days after diving, the individuals reported blurry vision with an associated myopic refraction shift. Each diver had spontaneous resolution of his myopia over the next two to three weeks, with no significant residual symptoms. The divers in this case series were exposed to an increased PO2 (1.35 ATM for 30 hours over five days), a lesser exposure than that in other reports of hyperoxic myopia in wet divers diagnosed with hyperoxic myopia (1.3-1.6 ATM for 45-85 hours in 12-18 days). Furthermore, this pulse of exposure was more concentrated than typically seen with traditional hyperbaric oxygen therapy. Hyperoxic myopia continues to be a risk for those conducting intensive diving with a PO2 between 1.3-1.6 ATM. Additional investigation is warranted to better define risk factors and PO2 limits regarding ocular oxygen toxicity.

Download Full-text

63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

British Journal of Surgery ◽

10.1093/bjs/znab134.222 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E Lau ◽

Z Arshad ◽

A Aslam ◽

A Thahir ◽

M Krkovic

Keyword(s):

Economic Impact ◽

Treatment Protocol ◽

Case Series ◽

Consecutive Series ◽

Financial Loss ◽

Patient Demographics ◽

Tertiary Centre ◽

The Mean ◽

Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

Download Full-text

Contrast-Induced Encephalopathy after Cerebral Angiogram: A Case Series and Review of Literature

Case Reports in Neurology ◽

10.1159/000516062 ◽

2021 ◽

pp. 405-413

Author(s):

Cecelia Allison ◽

Vaibhav Sharma ◽

Jason Park ◽

Clemens M. Schirmer ◽

Ramin Zand

Keyword(s):

Rare Complication ◽

General Pattern ◽

Treatment Protocol ◽

Case Series ◽

Altered Mental Status ◽

Cortical Blindness ◽

Neurological Deficits ◽

Cerebral Angiogram ◽

Iodinated Contrast Medium ◽

Iodinated Contrast

Contrast-induced encephalopathy (CIE) is a rare complication that arises from exposure to iodinated contrast medium and can result in a range of symptoms, including cortical blindness, aphasia, focal neurological deficits, and altered mental status. We present 4 individual cases of CIE who presented with stroke-mimic symptoms following surgery with localized iodixanol or ioversol injection. We outline a clinical timeline of all patients, showing that CIE follows a general pattern of delayed onset, worsening symptomology, and ultimately full recovery. All patients received IV hydration, corticosteroids, or both as part of their treatment protocol.

Download Full-text

Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcome

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.63.05.422 ◽

2017 ◽

Vol 63 (5) ◽

pp. 422-426 ◽

Cited By ~ 3

Author(s):

Yahia Abuowda ◽

Raquel Sousa Almeida ◽

Ana Alves Oliveira ◽

Petra Pego ◽

Cristina Santos ◽

...

Keyword(s):

Systemic Sclerosis ◽

Treatment Protocol ◽

Treatment Strategies ◽

Case Series ◽

Tissue Loss ◽

Repeated Treatment ◽

Digital Ulcers ◽

Case Series Study ◽

Clinical Description ◽

Soft Tissue Loss

Summary Introduction: In systemic sclerosis (SSc), digital ulcers (DU) are debilitating and recurrent. They are markers of prognosis and are associated with disability and mortality. Treatment strategies have been developed to block the proposed mechanisms of this complication. Objective: Clinical description of a population of SSc patients with DU, treatment, complications and outcome. Method: Analysis of 48 SSc patients meeting 2013 ACR-EULAR criteria, followed between 1999-2015; 13 patients had DU. Treatment protocol applied included cycles of 21 days of alprostadil, which can be repeated in the absence of DU healing. After DU healing, bosentan was initiated. Results: DU healing was achieved with intravenous prostanoid in 12 patients; seven patients required repeated treatment for DU healing. Twelve patients were later treated with bosentan; three of them experienced recurrence of DU, while one was anti-B2-GPI positive. Four patients had soft tissue loss and three other suffered digital amputation, these being late diagnosis. Conclusion: Younger patients and early referrals had better outcomes. Endothelin receptor antagonist toxicity should be monitored, particularly in patients previously exposed to hepatotoxic drugs.

Download Full-text

Modified Graded Motor Imagery for Musicians’ Focal Dystonia: A Case Series

Medical Problems of Performing Artists ◽

10.21091/mppa.2021.1002 ◽

2021 ◽

Vol 36 (1) ◽

pp. 10-17

Author(s):

Marina Ramella ◽

Francesca Borgnis ◽

Giulia Giacobbi ◽

Anna Castagna ◽

Frncesca Baglio ◽

...

Keyword(s):

Motor Imagery ◽

Treatment Protocol ◽

Case Series ◽

Focal Dystonia ◽

Rehabilitative Treatment ◽

Cortical Organization ◽

Cortical Motor ◽

Home Based ◽

Before And After ◽

Graded Motor Imagery

PURPOSE: This study aimed to assess the effectiveness of the “modified graded motor imagery” (mGMI) protocol as a rehabilitative treatment of musician’s focal dystonia (MFD). METHODS: Six musicians with MFD (age 43.83±17.24 yrs) performed the home-based mGMI protocol (laterality training, imagined hand movements and visual mirror feedback) once a day for 4 weeks. The mMGI protocol was designed to sequentially activate cortical motor networks and improve cortical organization. Subjects were evaluated before and after treatment with the dystonia evaluation scale (DES), arm dystonia disability scale (ADDS), Tubiana-Chamagne scale (TCS), and performing scale (PS). RESULTS: All participants were compliant with the mGMI treatment protocol without any adverse events. A significant improvement was measured in ADDS (p=0.047) and TCS scores (p=0.014) but not in DES (p=0.157). The severity of MFD decreased from moderate to mild in four patients. After mGMI treatment, all musicians were able to play easy pieces (TCS: median 3.5, IR 3.5–4). CONCLUSION: The findings from this pilot study suggest that home-based mGMI treatment is a feasible and promising rehabilitative approach for patients with mild to moderate MFD.

Download Full-text

When To Start Tacrolimus Ointment For Vernal Keratoconjunctivitis? A Proposed Treatment Protocol

10.21203/rs.3.rs-694131/v1 ◽

2021 ◽

Author(s):

Roee Arnon ◽

Irit Rozen - Knisbacher ◽

Tal Yahalomi ◽

Nir Stanescu ◽

Yulia Niazov ◽

...

Keyword(s):

Clinical Signs ◽

Treatment Protocol ◽

Topical Steroid ◽

Case Series ◽

Topical Steroids ◽

Line Treatment ◽

Tacrolimus Ointment ◽

Disease Remission ◽

The Mean ◽

Topical Treatments

Abstract PurposeThe aim of this study was to compare treatment regimens of tacrolimus and of topical steroids for VKC and suggest a treatment protocol according to our clinical experience.MethodsThis retrospective, nonrandomized case series enrolled 85 Patients with VKC. Patients were classified clinically according to severity (mild, moderate, severe) and were treated according to a suggested protocol. Analysis was made according to treatment received: tacrolimus ointment as first line treatment (tacrolimus 1st line), tacrolimus ointment after topical steroid drops treatment (tacrolimus 2nd line) and topical steroid drops or artificial tears alone (topical steroid and tears group). Results Significant improvements in clinical signs and symptoms were achieved under tacrolimus treatment 14 months in the moderate group and 5 months in the severe group. The longest duration of treatment was for tacrolimus 2nd line group (p=0.031) and the mean number of visits in the clinic was the highest. The mean number of topical treatments per day was higher in the topical steroid and tears group (2.6 times) than in the two tacrolimus groups (1.3 times for both). The mean time needed to achieve disease remission or relief did not differ between the tacrolimus 1st line and 2nd line groups.ConclusionTacrolimus treatment is effective and safe for VKC. Tacrolimus as 1st line treatment may be preferred for severe cases, for faster disease remission compared to tacrolimus as 2nd line treatment; and with fewer topical treatments per day compared to topical steroids.

Download Full-text

The effect of hyperbaric oxygen treatment on late radiation tissue injury after breast cancer: A case-series of 67 patients

Diving and Hyperbaric Medicine Journal ◽

10.28920/dhm50.3.206-213 ◽

2020 ◽

Vol 50 (3) ◽

pp. 206-213

Author(s):

Nicole E Spruijt ◽

◽

Roy van den Berg ◽

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Hyperbaric Oxygen ◽

Tissue Injury ◽

Case Series ◽

Shoulder Abduction ◽

Hyperbaric Oxygen Treatment ◽

Normal Tissues ◽

Oxygen Treatment ◽

Shoulder Motion

Introduction: Late radiation tissue injury (LRTI) after breast cancer may benefit from hyperbaric oxygen treatment (HBOT). This study aimed to report the LRTI symptom scores up to 12 months after HBOT and identify risk factors for poor scores. Methods: A case-series of 67 patients who underwent a mean of 44 sessions of HBOT was analysed. LRTI symptoms were scored at four time points using the LENT-SOMA scale (Late Effects in Normal Tissues – Subjective, Objective, Management, and Analytic), a visual analog scale for pain, and the range of shoulder motion. Results: Between starting HBOT and 12 months after HBOT 57 patients (85%) reported at least one point improvement in their LENT-SOMA score. Median pain and fibrosis scores improved significantly between the start and end of HBOT (P < 0.001), and remained stable three and 12 months after HBOT. The median breast oedema score improved significantly 12 months after HBOT (P = 0.003). Median shoulder abduction increased significantly from 90 to 165 degrees (P = 0.001) and median shoulder anteflexion increased significantly from 115 to 150 degrees (P = 0.004). Various risk factors were identified for poor scores despite HBOT; the most common risk factor was a poor score at start of HBOT. Conclusions: In this case-series, patients who underwent HBOT for LRTI after breast cancer reported significant improvement in pain, fibrosis, oedema, and shoulder movement. The improvement persisted up to 12 months after HBOT. A poor score at the start of HBOT was predictive for a poor score 12 months after HBOT.

Download Full-text

Multiple Victims of Carbon Monoxide Poisoning in the Aftermath of a Wildfire: A Case Series

Acta Médica Portuguesa ◽

10.20344/amp.9811 ◽

2018 ◽

Vol 31 (3) ◽

pp. 146 ◽

Cited By ~ 3

Author(s):

Luís Ramos dos Santos ◽

Magna Alves-Correia ◽

Margarida Câmara ◽

Manuela Lélis ◽

Carmo Caldeira ◽

...

Keyword(s):

Carbon Monoxide ◽

Hyperbaric Oxygen ◽

Clinical Symptoms ◽

Carbon Monoxide Poisoning ◽

Case Series ◽

Neurological Syndrome ◽

High Flow Oxygen ◽

Lost To Follow Up ◽

Mean Time

Introduction: Carbon monoxide poisoning may occur in several contexts.Material and Methods: Retrospective of 37 carbon monoxide poisoning cases that underwent hyperbaric oxygen during wildfires in Funchal in August 2016.Results: The studied sample included 37 patients, mean age of 38 years, 78% males. Ten were firefighters, four children and two pregnant victims. Neurological symptoms were the most reported. Median carboxyhemoglobin level was 3.7% (IQR 2.7). All received high-flow oxygen from admission to delivery of hyperbaric oxygen. Persistence of symptoms was the main indication for hyperbaric oxygen. Median time to hyperbaric oxygen was 4.8 hours (IQR 9.5), at 2.5 ATA for 90 minutes, without major complications. Discharge in less than 24 hours occurred in 92% of the cases. Thirty days follow-up: five patients presented clinical symptoms of late neurological syndrome; twelve patients were lost to follow-up. Carboxyhemoglobin levels on admission and mean time to hyperbaric oxygen were no different between those who did and did not develop the syndrome at 30 days (p = 0.44 and p = 0.58, respectively).Discussion: Late neurological syndrome at 30 days occurred in 20% and no new cases were reported at 12 months.Conclusion: Use of hyperbaric oxygen appears to have reduced the incidence of the syndrome. This seems to be the first Portuguese series reporting use of hyperbaric oxygen in carbon monoxide poisoning due to wildfires. The authors intend to alert to the importance of referral of these patients because the indications and benefits of this treatment are well documented. This is especially important given the ever-growing issue of wildfires in Portugal.

Download Full-text

Outcomes of Steroid Therapy in Combination with Endoscopic Optic Nerve Decompression Surgery for Direct Traumatic Optic Neuropathy: A Case-Series

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.07.12657 ◽

2021 ◽

Vol 104 (7) ◽

pp. 1166-1171

Keyword(s):

Visual Acuity ◽

Optic Nerve ◽

Optic Neuropathy ◽

Poor Prognosis ◽

Combined Treatment ◽

Treatment Protocol ◽

Case Series ◽

Light Perception ◽

Traumatic Optic Neuropathy ◽

Nerve Decompression

Background: Direct traumatic optic neuropathy (TON) carries a poor prognosis. However, the outcome of this injury is diverse and is related to time to treatment and treatment protocol. Objective: To evaluate the outcomes of the combined treatment protocol in patients with direct TON. Materials and Methods: The authors retrospectively reviewed the medical records of patients between January 2015 and August 2019. Main outcome was visual acuity (VA) improvement after the treatment. Results: Thirteen patients (15 eyes) were included. The mean age was 38.61 years with a range of 13 to 65 years. Initial VA varied from no light perception (NPL) in seven eyes of six patients, light perception (PL) in one eye, counting fingers in two eyes, 20/200 in three eyes, and 20/60 in two eyes. Average timing to treatment was 2.8 days (range 0 to 7 days). There were no side effects of high-dose corticosteroids treatment in all patients. During a follow-up period of three months, six of 13 patients (46.1%) had VA improvement. Conclusion: Despite poor prognosis of direct TON, the combined treatment protocol provides a favorable successful rate with most patients on having stable vision, and some having visual improvement from reducing intracanalicular pressure of the optic nerve. Keywords: Endoscopic optic nerve decompression; Traumatic optic neuropathy; Visual acuity; Case series

Download Full-text