Hyperbaric oxygen treatment: Results in seven patients with severe bacterial postoperative central nervous system infections and refractory mucormycosis

Introduction: Resistant bacterial infections following brain and spine surgery and spontaneous mucormycosis with central nervous system (CNS) involvement represent a serious treatment challenge and more efficient therapeutic approaches ought to be considered. Hyperbaric oxygen treatment (HBOT) has shown promise as a complementary therapy. This case series evaluated whether HBOT contributed to infection resolution in seven patients with refractory CNS infectious conditions. Methods: Clinical results for seven patients referred for HBOT between 2010 to 2018 to treat refractory postoperative brain and spine infections or spontaneously developing mucormycosis were retrospectively analysed. The patients’ clinical files and follow-up consultations were reviewed to assess evolution and outcome. Results: Seven patients were referred with a median age of 56 years. The median follow-up was 20 months. Four patients had postoperative infections and three had rhino-orbital-cerebral mucormycosis (ROCM). HBOT was used as an adjunctive treatment to antimicrobial therapy in all patients. Prior to HBOT, all patients had undergone an average of four operations due to infection refractoriness and had completed an average of five months of antimicrobial therapy. After HBOT, infection resolution was obtained in six patients without additional operations, while one patient with ROCM stopped HBOT after the third session due to intolerance. Three patients stopped antimicrobial therapy while four were maintained on prophylactic treatment. Conclusions: Infection resolution was reached in the six patients that completed HBOT as prescribed. HBOT may serve as an effective complementary treatment in CNS refractory postoperative and spontaneous infections.

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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.

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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.

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Action observation therapy in pediatric patients with neuromotor deficits of the upper limbs secondary to central nervous system tumors

Tumori Journal ◽

10.1177/0300891619880603 ◽

2019 ◽

Vol 105 (6) ◽

pp. NP75-NP78

Author(s):

Marco Chisari ◽

Raffaella Sensi ◽

Carlo Alfredo Clerici ◽

Fulvia Angela Gariboldi ◽

Filippo Spreafico ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Mirror Neurons ◽

Action Observation ◽

Case Series ◽

Central Nervous System Tumor ◽

Assessment Tests ◽

System Tumor ◽

Positive Results

This study reports a case series of patients with upper limb neuromotor deficits following pediatric central nervous system tumor and treated with rehabilitative therapy according to action observation therapy (AOT). AOT is based on the “mirror neurons” system and had positive results in various non-oncologic neurologic pathologies. This study is the first experience in the oncology field, and included 6 patients, 4 of whom were fully evaluated at 6-month follow-up. In all patients, therapy showed improvement in all assessment tests. These promising results lead to further studies to confirm their effectiveness.

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Acute disseminated encephalomyelitis followed by recurrent or monophasic optic neuritis in pediatric patients

Multiple Sclerosis Journal ◽

10.1177/1352458512466317 ◽

2012 ◽

Vol 19 (7) ◽

pp. 941-946 ◽

Cited By ~ 91

Author(s):

Peter Huppke ◽

Kevin Rostasy ◽

Michael Karenfort ◽

Brenda Huppke ◽

Rainer Seidl ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Optic Neuritis ◽

Pediatric Patients ◽

Case Series ◽

Acute Disseminated Encephalomyelitis ◽

Oligoclonal Bands ◽

Central Nervous System Disorders ◽

Established Disease

Background: Some pediatric patients with inflammatory demyelinating central nervous system disorders cannot be classified under any of the established disease entities, making their treatment and prognosis difficult. Objective: The objective of this study is to characterize a subgroup of pediatric patients with recurrent demyelinating central nervous system disorders. Methods: This study includes a case series of pediatric patients with monophasic or recurrent acute disseminated encephalomyelitis (ADEM) who later presented with either monophasic or recurrent optic neuritis (ON). Results: We describe seven patients with a median follow-up of six years (five females, two males) who presented at a median age of 6 years (range 4–8 years) with monophasic ( n = 4) or recurrent ADEM (two to four attacks) followed by monophasic ( n = 3) or recurrent ON (two to nine attacks). Cranial magnetic resonance imaging (MRI) was typical for ADEM ( n = 6) with complete or almost complete resolution of lesions on follow-up. Cerebrospinal (CSF) studies at the time of ADEM showed a pleocytosis in six patients and were negative for oligoclonal bands (OCBs) in all. In all patients high titers for serum anti-MOG antibodies were detected. Conclusion: ADEM followed by ON is a rare but distinct clinical phenotype among pediatric patients. Further studies are needed to allow recommendations on treatment or prognosis.

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Hyperbaric oxygen treatment for mastectomy flap ischaemia: A case series of 50 breasts

Diving and Hyperbaric Medicine Journal ◽

10.28920/dhm51.1.2-9 ◽

2021 ◽

Vol 51 (1) ◽

pp. 2-9

Author(s):

Nicole E Spruijt ◽

◽

Lisette T Hoekstra ◽

Johan Wilmink ◽

Maarten M Hoogbergen ◽

...

Keyword(s):

Risk Factors ◽

Surface Area ◽

Hyperbaric Oxygen ◽

Case Series ◽

Skin Surface ◽

Randomised Control Trial ◽

Hyperbaric Oxygen Treatment ◽

Additional Operation ◽

Oxygen Treatment ◽

Mastectomy Flap

Introduction: Hyperbaric oxygen treatment (HBOT) has been suggested as an effective intervention to limit necrosis of ischaemic skin flaps after mastectomy. The purpose of this study was to evaluate outcomes of HBOT in the largest series of patients to date with mastectomy flap ischaemia. Methods: A retrospective analysis was performed of 50 breasts requiring HBOT for mastectomy flap ischaemia. The severity of the ischaemia or necrosis was evaluated by four independent observers using the skin ischaemia necrosis (SKIN) score. Multivariate logistic regression analyses were used to assess associations between risk factors and re-operation. Results: HBOT was started a median of 3 days (range 1–23) after surgery and continued for a median of 12 sessions (range 6–22). The breast SKIN surface area scores (n = 175 observations by the independent observers) improved in 34% (of observations) and the depth scores deteriorated in 42% (both P < 0.01). Both the surface area and depth scores were associated with the need for re-operation: higher scores, reflecting more severe necrosis of the mastectomy flap, were associated with increased need for re-operation. Twenty-nine breasts (58%) recovered without additional operation. Pre-operative radiotherapy (OR 7.2, 95% CI 1.4–37.3) and postoperative infection (OR 15.4, 95% CI 2.6–89.7) were risk factors for re-operation in multivariate analyses. Conclusions: In this case series, the surface area of the breast affected by ischaemia decreased during HBOT, and most breasts (58%) did not undergo an additional operation. A randomised control trial is needed to confirm or refute the possibility that HBOT improves outcome in patients with mastectomy flap ischaemia.

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Clinical Course, Imaging Characteristics, and Therapeutic Response in Myelin Oligodendrocyte Glycoprotein Antibody Disease: A Case Series

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1701371 ◽

2020 ◽

Vol 11 (01) ◽

pp. 205-210

Author(s):

Joe James ◽

James Jose ◽

V. Abdul Gafoor ◽

B. Smita ◽

Neetha Balaram ◽

...

Keyword(s):

Multiple Sclerosis ◽

Central Nervous System ◽

Nervous System ◽

Therapeutic Response ◽

Clinical Course ◽

Case Series ◽

Autoimmune Disorder ◽

Myelin Oligodendrocyte Glycoprotein ◽

Imaging Characteristics

Abstract Myelin oligodendrocyte glycoprotein (MOG) antibody disease is a novel central nervous system autoimmune disorder which forms part of aquaporin 4 (AQP-4) negative, neuromyelitis optica (NMO) spectrum disorder. It has a distinct clinical profile, neuroimaging features and courses from AQP-4 positive NMO and multiple sclerosis. This article is a case series of six patients with MOG antibody disease with longitudinal follow-up for up to 8 months.

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Hyperbaric oxygen treatment in three cases of necrotizing infection of the neck

Infectious Disease Reports ◽

10.4081/idr.2012.e21 ◽

2012 ◽

Vol 4 (1) ◽

pp. 21 ◽

Cited By ~ 1

Author(s):

Torbjørn Nedrebø ◽

Trond Bruun ◽

Rune Skjåstad ◽

Gunhild Holmaas ◽

Steinar Skrede

Keyword(s):

Hyperbaric Oxygen ◽

University Hospital ◽

Adjunctive Treatment ◽

Hyperbaric Oxygen Treatment ◽

Culture Techniques ◽

Conventional Culture ◽

Oxygen Treatment ◽

Microbiological Characteristics ◽

Care Facilities ◽

Significant Clinical Improvement

Necrotizing infections of the head and neck are rare conditions in our hospital. Clinical and microbiological characteristics of three consecutive cases treated in Haukeland University Hospital in western Norway in the year 2010 are described. Two cases of Lemierre’s syndrome and one case with a descending necrotizing mediastinitis (DNM) were diagnosed. All three cases were treated with broad spectrum antibiotics and in two cases surgery was possible. Hyperbaric oxygen treatment (HBOT) with intensive care facilities became recently available at our hospital, and this treatment was used in all these patients regardless of surgery. In one case we describe the use of HBOT on the basis of strong clinical suspicion of anaerobic infection only. Bacterial identification by partial sequencing of the 16SrDNA gene proved to be a useful supplement to conventional culture techniques. All the cases all demonstrated a significant clinical improvement after introduction of HBOT. When HBOT is available, it should be considered as adjunctive treatment in extensive infections with anaerobes.

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Adjunctive hyperbaric oxygen treatment for necrotising soft-tissue infections: A systematic review and meta-analysis

Diving and Hyperbaric Medicine Journal ◽

10.28920/dhm51.1.34-43 ◽

2021 ◽

Vol 51 (1) ◽

pp. 34-43

Author(s):

Morten Hedetoft ◽

◽

Michael H Bennett ◽

Ole Hyldegaard ◽

◽

...

Keyword(s):

Soft Tissue ◽

Hospital Mortality ◽

Hyperbaric Oxygen ◽

Meta Analysis ◽

Major Amputation ◽

Adjunctive Treatment ◽

Soft Tissue Infections ◽

Hyperbaric Oxygen Treatment ◽

Oxygen Treatment ◽

Necrotising Soft Tissue Infections

Introduction: Surgical intervention, broad-spectrum antibiotics and intensive care support are the standard of care in the treatment of necrotising soft-tissue infections (NSTI). Hyperbaric oxygen treatment (HBOT) may be a useful adjunctive treatment and has been used for almost 60 years, but its efficacy remains unknown and has not been systematically appraised. The aim was to systematically review and synthesise the highest level of clinical evidence available to support or refute the use of HBOT in the treatment of NSTI. Methods: The review was prospectively registered (PROSPERO; CRD42020148706). MEDLINE, EMBASE, CENTRAL and CINAHL were searched for eligible studies that reported outcomes in both HBOT treated and non-HBOT treated individuals with NSTI. In-hospital mortality was the primary outcome. Odds ratio (ORs) were pooled using random-effects models. Results: The search identified 486 papers of which 31 were included in the qualitative synthesis and 21 in the meta-analyses. Meta-analysis on 48,744 patients with NSTI (1,237 (2.5%) HBOT versus 47,507 (97.5%) non-HBOT) showed in-hospital mortality was 4,770 of 48,744 patients overall (9.8%) and the pooled OR was 0.44 (95% CI 0.33–0.58) in favour of HBOT. For major amputation the pooled OR was 0.60 (95% CI 0.28–1.28) in favour of HBOT. The dose of oxygen in these studies was incompletely reported. Conclusions: Meta-analysis of the non-random comparative data indicates patients with NSTI treated with HBOT have reduced odds of dying during the sentinel event and may be less likely to require a major amputation. The most effective dose of oxygen remains unclear.

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