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Emphysematous cystitis is an uncommon acute infection of the underlying bladder musculature and mucosa, caused by gas-producing organisms. Here we describe an 87-year-old woman with diabetes mellitus and emphysematous cystitis who was successfully treated with hyperbaric oxygen (HBO2) therapy. Her predisposition of diabetes and infection with gas-producing bacteria was considered to precede the development of emphysematous cystitis. Computed tomography revealed gas accumulation in the bladder wall and lumen. Antibiotics and HBO2therapy were administered. HBO2 therapy may be beneficial due to the improvement in oxygenation of the tissues affected by the disease. HBO2 is a useful adjunct therapy for the management of severe emphysematous cystitis. DOI: 10.22462/11.12.2018.13

Facial necrotizing fasciitis is a rare bacterial infectious disease. Rapid necrosis of the tissues and suppurative fasciitis is pathognomonic. It can be seen following odontogenic infection. Early aggressive debridements and wide-spectrum antibiotic therapy are currently accepted treatments. A 60-year-old man was admitted to the otolaryngology clinic for facial pain and swelling after odontogenic infection. Inflamed left maxilla and orbit were seen, and abscess contents spontaneously drained into the mouth. It was determined that infectious markers were increased inthe blood. On MRI, a broad abscess with edema and gas formation were seen. Debridement of the necrotic tissue was performed immediately and wide-spectrum antibiotic therapy was started. Infection was stopped and wound was closed, with four weeks of antibiotic therapy, three sessions of debridement, and 30 sessions of hyperbaric oxygen (HBO2) therapy. HBO2 therapy must not replace the combination of early aggressive debridements and wide-spectrum antibiotic therapy, but rather must be considered as an important adjuvant treatment. DOI: 10.22462/11.12.2018.12

Introduction: Carbon monoxide (CO) poisoning is one of the most common forms of intoxication around the world. One of the complications associated with CO exposure is direct toxicity to the skeletal muscles. Though compartment syndrome induced by CO intoxication is rare, it is a well-known complication. In this study, we present a case of CO poisoning in a patient who developed compartment syndrome in his forearm. Case report: A 22-year-old man was found unconscious in a motel where a briquette had burned. He was later diagnosed with rhabdomyolysis associated with CO poison- ing. After he regained consciousness, he experienced difficulty in moving his left arm, with sensory impairment in the same arm. He was diagnosed with compartment syndrome, and an emergency fasciotomy was performed. One month later, electromyography was performed which revealed left median, ulnar, radial and musculocutaneous nerve palsy. Discussion: Compartment syndrome induced by CO intoxication is rare but is a well-known complication. Compartment syndrome is a limb-threatening and life- threatening condition. If untreated, the pressure in the muscle may rise, which can lead to tissue necrosis. Generally, nerve paralysis does not occur in CO poisoning. In our case, it occurred as median, ulnar, radial and musculocutaneous nerve palsy. Conclusion: Side effects of CO poisoning can be extant, ..

Air gas embolism (AGE) is a rare complication of cardiac surgery with high morbidity and mortality. We present a case of suspected AGE following orthotopic heart transplant. The patient received hyperbaric oxygen therapy with near complete resolution of symptoms at follow-up. This case exemplifies the difficulty in diagnosis of AGE, the considerations involved in the treatment of a critical care patient in a hyperbaric chamber, and utility in treating a patient for AGE even after a delay in diagnosis. DOI: 10.22462/11.12.2018.10

We previously published our method of performing continuous bladder irrigation (CBI) in a monoplace hyperbaric chamber [1]. This method entailed the use of an IV pump to infuse saline into the monoplace chamber. The specter of causing iatrogenic rupture of the bladder was raised following such a case, reported herein, of a woman with hemorrhagic radiation cystitis leading to cystectomy. Due to the danger of bladder rupture while providing CBI with a pump, we retract our previously reported method and encourage the use of either a gravity-fed system or delay in hyperbaric oxygen therapy treatment until CBI is no longer necessary. DOI: 10.22462/11.12.2018.9

Middle ear barotrauma is the most common diving-related injury. It is estimated to occur in more than 50% of ex- perienced divers. Although divers learn how to effectively equalize their ears with various maneuvers, airway congestion may impede the ability to equalize the middle ear space via the Eustachian tube. In this case, one may have to avoid diving or abort a dive due to inability to descend. If difficulty with middle ear equalization occurs during the bottom phase of the dive, which may transpire during a multilevel cave or wreck dive, a diver may need to descend before he can exit the water. In this case, it is imperative that the middle ear can be equalized, or one risks middle ear barotrauma, tympanic membrane rupture, possible accrual of decompression and dwindling breathing gas reserves. A 46-year-old diver encountered difficulty with equalization during a cave dive and was able to administer oxymetazoline intranasally to facilitate middle ear equalization. Although effective for this individual, this maneuver is not without risks, which include disorientation, loss of buoyancy, coughing, sneezing, laryngospasm, and a theoretical increased susceptibility to CNS oxygen toxicity. DOI: 10.22462/11.12.2018.8

Myocardial injury is a frequent consequence of moderate to severe CO (carbon monoxide) poisoning and a significant predictor of mortality in CO injury. Electrocardiography (ECG) is an easily accessible diagnostic tool for evaluating myocardial damage. Increased QT interval and QT dispersion are related to heterogeneity of regional ventricular repolarization and can develop into arrhythmias. It has been reported that QT interval and QT dispersion increase in patients with CO poisoning. Hyperbaric oxygen (HBO2) therapy has been used successfully in treating patients with CO poisoning. The aim of this study was to investigate change of corrected QT (QTc) interval and QTc dispersion after HBO2 therapy. This study included 31 patients with CO poisoning. QTc dispersion increased in patients with CO poisoning. The mean QTc dispersion was 54.94 milliseconds (ms) on admission. The mean QTc dispersion decreased to 35.74 ms after HBO2 therapy (P=0.003). There was also a correlation between carboxyhemoglobin level and QTc dispersion (P=0.029). HBO2 therapy, which decreases QTc dispersion, may improve the myocardial electrical homogeneity and reduce the risk of ventricular arrhythmia and cardiac death. Physicians should be aware of the effect of HBO2 therapy on myocardial damage when treating patients with CO poisoning. The ECGs should be examined carefully before referring or excluding HBO2 therapy. DOI: 10.22462/11.12.2018.7

Objective: The purpose of this study is to determine the utility of using indocyanine green fluorescence angiography (IGFA) in assessing perfusion of chronic wounds after hyperbaric oxygen (HBO2) therapy. Method: From May 2016 to January 2018, 26 patients underwent both HBO2 and IGFA. A near-infrared charge- coupled camera measured the flow of intravenous indo- cyanine green into the wound. IGFA was done pre-HBO2, after approximately 10 HBO2 sessions, and upon completion of HBO2. The ingress rate at baseline, mid-therapy and post-HBO2 values were compared using descriptive statistics. Results: A total of 26 chronic wounds were identified. Baseline median ingress rate was 0.90 units/second (IQR: 0.28 to 6.10). Median ingress rate after approximately of 10 HBO2 sessions was 2.45 units/sec (IQR: 0.48 to 6.35). Six of 11 patients, however, exhibited a decrease in ingress rate from baseline to mid-therapy. Finally, median ingress rate post-HBO2 was 3.70 units/second (IQR: 0.30 to 9.90). Median increase in ingress and rate from baseline to mid-HBO2 treatment 0.30 units/second (IQR: -0.25 to 3.10) and from mid- to post-HBO2 was -0.40 units/second (IQR: -1.50 to 2.60). Conclusion: This preliminary study shows capability of IGFA to detect changes in blood flow to wounds following HBO2 therapy. Results support the use of IGFA to evaluate the changes in perfusion of patients undergoing HBO2 for chronic ..

Objective: Analyze the influence of the hyperbaric environment on skeletal muscle mitochondrial bioenergetic end-points of rats submitted to muscle contusion. Methods: Twelve female Wistar rats were randomly assigned to three groups. All rats were submitted to muscle contusion in the right gastrocnemius through a standard protocol. The control group (C) remained under normo- baric conditions without any treatment. The hyperbaric air (HB) and the hyperbaric oxygen (HBO2) groups had four sessions of HBO2 therapy 60 minutes, six, 12, 24 and48 hours after the injury at 253.25 kPa (2.5 atmospheres absolute/ATA) with air or 100% oxygen, respectively. The animals were sacrificed 48 hours after muscle injury, and both muscles (injured and non-injured) were analyzed. Muscle mitochondrial bioenergetics and mitochondrial permeability transition pore (MPTP) susceptibility were evaluated. Results: Significant differences were found in all parameters between the injured and the non-injured gastrocnemius in the C group. In the HB group, significantly better results concerning bioenergetics-related end points with complex I and II substrates where found in the right gastrocnemius, whereas in the HBO2 group the time to Vmax (time that elapsed until the faster swelling kinetics starts) was significantly higher and the swelling amplitude was significantly smaller than in other groups, which suggest a lower susceptibility to MPTP opening. Conclusion: The ..

Carbon monoxide (CO) is one of the most common causes of death due to intoxications. No biochemical marker is available to evaluate the severity of CO intoxication. We measured high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and interleukin-10 (IL-10) levels in patients with different degrees of CO poisoning. We prospectively included 40 CO-poisoned patients admitted to emergency services. Blood samples were collected from the patients at admission (0 hour) and after treatment (six hours). While all patients received normobaric oxygen (NBO2) therapy, patients with severe CO poisoning received additional sessions of hyperbaric oxygen (HBO2) therapy. Blood samples were also collected from a group of healthy volunteers (n=40). Serum IL-6 and IL-10 levels were measured with the ELISA method while hs-CRP was quantified by turbidimetric analysis. At admission, IL-6 levels were significantly higher in the patient group compared to the control group (P=0.001), but IL-10 and hs-CRP levels were not significantly different between the groups. Compared to admission levels, IL-6 levels were higher at six hours (P=0.014). The patients were grouped according to treatment type (NBO2, HBO2) and history of syncope, but no significant differences were detected in patient subgroups regarding IL-6, IL-10 and hs-CRP levels. A weak positive correlation was found between COHb ..

Introduction: Hyperbaric oxygen (HBO2) therapy is emerging internationally as the primary treatment modality for inflammatory pathways related to neurological disorders. Currently, literature concerning its effectiveness in autistic children is limited. Using neurocognitive tests and clinical-diagnostic evaluations, this study evaluates the clinical, cognitive and behavioral effects of HBO2 on children diagnosed with autism. Methods: An experimental HBO2 group (EXP: F = 1; M = 7; mean age: 7 ± 2.33; years) and a control non-HBO2 group of autistic children (CTRL: F = 2; M= 5; mean age: 6.6 ± 2.7 years) correctly completed the Aberrant Behavior Checklist-Community (ABC) before HBO2 (T0), after 40 sessions of HBO2 (T1), and one month after the end of treatments (T2). Additionally, the experimental HBO2group was evaluated with the Childhood Autism Rating Scale at T0 and T2. Results: Total ABC score was lower at T2 (mean ± SD: 50.38 ± 18.55; p < 0.001) compared to scores obtained at T0 (mean ± SD: 57.5 ± 19.01). Similarly, in the control group the total ABC score differed statistically (p < 0.05) between T0 (103.6 ± 20.38) and (T2: 59 ± 25.25). Conclusions: Despite the improvements reported in both groups, our results do not support the utility of HBO2 in children diagnosed with autism. DOI: 10.22462/11.12.2018.3

In any kind of diving there is a risk of accidents, as the move from the topside environment to underwater can affect a diver’s physiological and psychological condition. It is important to investigate dive accidents to clarify the causative factors and determine preventive measures.  In this study, autopsy files of fatal dive accident cases were reviewed to evaluate demographic data, type of diving, purpose of dive, seasonal distribution, autopsy findings, and causes of death. We reviewed 56 fatal dive accident files from autopsy units in cities where dive activities are concentrated and from the archive of the Turkish Underwater Federation. Four cases were excluded from the study since we were unable to obtain autopsy reports. Of 52 cases there were 20 scuba divers, two surfacesupplied divers and 30 breath-hold divers. The majority of cases involved males (94%). The average age of 50 cases was 38.6; age estimation for two cases could not be determined due to advanced putrefaction. Of these fatal dive accidents 75% took place over a period of six months between May and October. Drowning was recorded as the primary cause of death in these cases. X-ray imaging was used in four (8%) cases. A special autopsy technique was used for nine (17%) cases, to detect possible pulmonary barotrauma and arterial gas embolism. The forensic specialist who is planning to conduct the autopsy ..

Introduction/Background: Artisanal fishermen dive for sustenance. The lifetime prevalence of decompression sickness (DCS) in this population is alarmingly high. We wanted to understand the level of decompression stress fishermen in this region of the Yucatán experience in their daily fishing effort. We used a mathematical model to quantify nitrogen-loading in a nine-tissue compartment model. Materials and methods: Approved by the UCLA IRB 2#13-000532, this study was conducted during fishing seasons 2012 through 2017. Diving fishermen were instructed to attach dive recorders to their waists every fishing day during the study period. Sensus Ultra dive recorders (ReefNet Inc.), with an accuracy of ± 1 foot of ;seawater (fsw), 0.304 meters, and an activation depth of 10 fsw, 3.04 meters, were used to record dive parameters. Sampling interval was set to 10 seconds. A program in RStudio was created to extract the dive profiles of each fishing day and curtail into single-line outputs: pressure, time, date, start of dive and end of dive. An exponential decay formula was used to calculate the nitrogen-loading pressures for nine theoretical tissue compartments. Final nitrogen pressure, controlling compartments, decompression stop and time at stop were calculated. Results: Fishermen completed 4,961 dives over 1,758 diving days during the study ..