Number 5

  DOI: 10.22462/9.10.2017.18

  DOI: 10.22462/9.10.2017.17

  DOI: 10.22462/9.10.2017.16

  DOI: 10.22462/9.10.2017.15

  DOI: 10.22462/9.10.2017.14

  DOI: 10.22462/9.10.2017.13

  DOI: 10.22462/9.10.2017.12

  DOI: 10.22462/9.10.2017.11

 DOI: 10.22462/9.10.2017.10

  DOI: 10.22462/9.10.2017.9

We report the case of a 49-year-old patient who presented with ischemia-reperfusion injury (IRI) of her right hand following a dialysis access-steal syndrome treated by arteriovenous fistula ligation. Subsequently, she was treated with three daily 90-minute hyperbaric oxygen treatments and had remarkable improvement in her symptoms of pain, numbness and swelling. The patient demonstrated regain of function at three-weeks post-treatment, with full recovery of function at six months post-treatment. The non-invasive and relatively safe nature of hyperbaric oxygen therapy supports its use as a potential treatment for IRI. DOI: 10.22462/9.10.2017.8

Artisanal fishermen around the world employ scuba and surface- supplied diving for their livelihoods and often undergo provocative dive profiles due to economic pressures. Consequently, rates of decompression sickness (DCS) are much greater than in recreational scuba divers. Here we present the case of a surface-supplied diving fisherman from the Yucatán Peninsula of Mexico who suffered a significant episode of spinal DCS and underwent hyperbaric oxygen therapy treatments, with a favorable outcome. Additionally, we review the proposed mechanisms underlying spinal DCS. DOI: 10.22462/9.10.2017.7

Objective: The aim was to investigate the influence of repetitive scuba diving in fresh water on the middle ear mucosa. The prevalence of middle ear barotrauma (MEB) and risk factors for MEB were evaluated.  Study design: Prospective cohort study, Level of evidence 1b. Methods: During three days, 23 divers made 144 repetitive dives in a freshwater lake. Participants underwent otoscopic examinations and were questioned about ENT-related complaints in the morning before the first dive, in between the dives and after the last dive. Otoscopic findings were documented and classified according to the TEED scale (0 = normal eardrum to 4 = perforation), for the right and the left ear separately.  Results: In total, 416 examinations were performed. ENT-related complaints during diving, mostly failed pressure equalization (74%), were reported after 10% of all dives. Most common pathology was MEB (TEED 1-3, 26%). Valsalva maneuver was possible during all exams. Significant increase of MEB (TEED>0) occurred with an increasing cumulative number of dives per day (P < .0001). Diving depth significantly influenced the MEB distribution (P = .035). MEB with higher TEED levels (2 and 3) was present only in the less experienced and intermediate divers. With increasing TEED level, more participants reported ENT-related problems (P < .0001). However, ..

Background: While residential carbon monoxide (CO) alarms are now required in a majority of states, the cost effectiveness of the devices is unknown. This analysis was performed to determine the degree of prevention efficacy necessary from home carbon monoxide alarms for their expense to be cost-effective.  Methods: Data regarding numbers of individuals affected in the United States annually from accidental, non-fire, residential non-fatal and fatal carbon monoxide poisoning were obtained from published literature. Federal governmental estimates of societal costs associated with medical care, lost wages and earnings, value of pain and suffering, and value of a statistical life were applied. The cost of uniform residential carbon monoxide alarm installation was compared to those societal costs in order to calculate what degree of efficiency makes alarms cost-effective. Results: Societal costs for accidental, non-fire, residential CO poisoning are approximately $3.47 billion annually. With an estimated cost of $348 million annually for alarms, prevention of greater than 10% of residential CO poisoning costs must be achieved in order for alarms to be cost-effective. Conclusions: While the true effectiveness of residential carbon monoxide alarms has yet to be determined, current state legislation requiring residential installation of CO alarms is probably cost-effective.  DOI: 10.22462/9.10.2017.4

Despite the fact that current decompression schedules reduce the risk of decompression sickness (DCS), recreational scuba divers continue to experience DCS. Therapy outcomes in these divers are difficult to track. Our study aims to understand the efficacy of the United States Navy (USN) Treatment Tables (5, 6, 6A, 9) in providing symptomatic relief among recreational scuba divers. We conducted a single-center retrospective review of recreational divers treated from 2003 to 2013. A total of 187 divers were identified: 84 divers were excluded, and the charts of the remaining 103 divers were independently reviewed by three clinicians. For these 103 divers, the response variable, therapy outcome, was categorized as no relief, partial relief, or complete relief of symptoms. In a population of 76 males and 27 females with an average of three dives and three treatments, 53 patients achieved complete symptomatic relief, 45 patients had partial relief, and five patients reported no relief at the end of all recompression treatments. Among the patients who achieved complete symptomatic relief, 28 (53%) needed only one recompression treatment. The depth of the diver’s first dive and the change in symptoms within the first 20 minutes of the first recompression treatment were found to be explanatory variables of the treatment outcome. DOI: 10.22462/9.10.2017.5

A pilot study was conducted in mid-Michigan to evaluate know-ledge of appropriate hyperbaric oxygen therapy referrals in “first contact” physicians who did not have additional hyperbaric training.  The hypothesis for this study is that many first-contact physicians have little or no exposure to hyperbaric oxygen (HBO2) therapy and its indications. A survey was distributed regarding accepted indications combined with conditions not currently approved or contraindicated for HBO2. Answers were tallied for correct identification of approved indications, missed approved indications, and inappropriate identification of unapproved indications.  Ninety surveys were distributed and 62 physicians of various specialties responded. There were notably high percentages of missed indications, as high as 93%. Many emergent/urgent indications were missed as well. The highest percentage of wrong indications was 32%. Very concerning is the 13% who chose refractory pneumothorax as a condition responsive to HBO2 therapy. This study showed significant lack of familiarity of HBO2 treatment indications among physicians who did not have additional hyperbaric training. Inclusion of hyperbaric education during residencies may increase HBO2 referrals and improve outcomes for various disorders. DOI: 10.22462/9.10.2017.3

Background: Hyperbaric oxygenation (HBO2) involves breathing 100% oxygen under elevated ambient pressure in a hyperbaric chamber, thereby dissolving oxygen in the plasma. This results in an increase of arterial partial pressure of oxygen (pO2). Though well established in experimental studies, HBO2 treatment for ischemic stroke is still under discussion. Methods: From 2002-2014 HBO2 (2.2 bar, 90 minutes one/day; average number per patient: 4.7) was applied in 49 consecutive patients (32 males, 17 females, mean age: 68.8 years, range 31.2 – 83.9) with acute neurological deficit following cardiac surgery (CABG 15; combined surgery 14; valve surgery 11; aneurysm repair 8; malformation 1). Patients’ history including TIA or stroke and carotid artery pathology were documented. Both degree and type of neurological deficit was evaluated by a scoring system (0-4) before and after HBO2 treatment.  Results: Before HBO2 therapy, the average motor deficit score was 2.45 and the average speech disorder score was 0.55, as compared with an average motor deficit of 1.12 and an average speech disorder of 0.27 afterward (α=0.0001, α=0.009). The majority of patients had an overall improvement of 2 score-points after HBO2 therapy (n=23 patients). Probit analysis showed that for a 50% response/probability (LC50) of having an overall outcome of ≥2 scoring points, an estimate of ..

These organizations have been made aware of the following position statement from the ADA that is to be released in the upcoming year. . . . We take issue with the conclusions of the statement. . . DOI: 10.22462/9.10.2017.1