Undersea and Hyperbaric Medicine最新文献_第6页

Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) and Potential for Future Research. 迟发性辐射损伤（软组织和骨坏死）及其未来研究潜力。

IF 0.6 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2026-01-01

John J Feldmeier, Laurie B Gesell

{"title":"Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) and Potential for Future Research.","authors":"John J Feldmeier, Laurie B Gesell","doi":"","DOIUrl":"","url":null,"abstract":"The application of hyperbaric oxygen (HBO₂) to the treatment and prevention of late radiation injury (LRTI) is the focus for this chapter. Additional miscellaneous topics related to radiation exposure and HBO₂ will also be explored, including areas of interest for research. We will also discuss some of the pertinent literature demonstrating the safety of HBO₂ for the cancer patient. A review of billing records from CMS demonstrates that delayed radiation injuries continue to be the most frequent indication for hyperbaric treatments in the United States, constituting about 40% of all their billings [1]. Hyperbaric oxygen should not be the sole treatment modality for many cases of radiation injury. The management of delayed radiation injury, especially when bone is involved, will likely require a multi-disciplinary approach. Importantly, each aspect of treatment including surgical technique must be optimized to give the best chance for a successful therapeutic effort. For radiation injuries, surgical intervention may require tissue flaps and skin grafts to compensate for tissues lost due to frank necrosis or previous cancer surgery. Free flap procedures employing microsurgical vascular anastomoses are being employed more and more often when done in radiated fields. Hyperbaric oxygen is still of benefit here. In the pages that follow, the etiology of delayed radiation injury, the specific mechanisms whereby HBO₂ is effective, positive clinical results, the effects of HBO₂ on cancer growth and potential areas for research will be reviewed. Publications reporting negative results for HBO₂ in the treatment of LRTI will also be analyzed and any errors, questionable methodologies in study design, or other shortcomings including inadequate HBO₂ protocols will be noted and explained.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"53 1","pages":"155-198"},"PeriodicalIF":0.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

High-altitude decompression illness following recreational diving: a case report from Lake Van. 休闲潜水后的高空减压病：凡湖一例报告。

IF 0.6 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2026-01-01

Recep Özkan, Buyçe Kaya

{"title":"High-altitude decompression illness following recreational diving: a case report from Lake Van.","authors":"Recep Özkan, Buyçe Kaya","doi":"","DOIUrl":"","url":null,"abstract":"Rationale: Decompression sickness (DCS) is a clinical syndrome caused by inert gas bubble formation following a rapid reduction in ambient pressure, with an increased risk in high-altitude diving due to lower barometric pressure. Although neurological symptoms are well-documented, respiratory involvement is less frequently reported.Patient presentation: A 54-year-old male recreational diver performed his first-ever dive in Lake Van, descending to approximately 30 meters and remaining at depth for several minutes before ascending rapidly to the surface without a decompression stop. Immediately after surfacing, he experienced sudden weakness in both legs and shortness of breath. He aspirated water and recalled calling for help before losing awareness. Located approximately 300 meters from shore, he was towed back by his dive team. Finding no pulse, the team initiated CPR and rescue breathing. Upon arrival, emergency medical services found the patient with spontaneous respiration and a palpable pulse. Within 30 minutes, he was transported approximately 16 kilometers to the nearest hospital. High- flow oxygen treatment via a non-rebreather mask was initiated, and he was transferred to the emergency department. In the emergency department, the patient stated he remembered seeing lights but could not recall the intervening events. Due to neurological deficits and suspected DCS, he was immediately referred to a hyperbaric unit. A single hyperbaric oxygen (HBO₂) treatment session was administered according to the US Navy Table 5 protocol, resulting in marked symptom resolution. The patient was transferred from intensive care to the general ward and discharged at his request after declining further HBO₂ sessions.Conclusion: This case underscores the risk of high-altitude DCS and highlights the importance of altitude-specific dive planning and timely HBO₂ intervention. Increased awareness among recreational divers is essential to prevent such complications.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"53 1","pages":"31-34"},"PeriodicalIF":0.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Recompression and Adjunctive Therapies in DCI Management in Divers: A Review of RCTs. 潜水员DCI治疗中的再压迫和辅助治疗：rct综述。

IF 0.7 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2025-04-01

Thomas Fairhead

{"title":"Recompression and Adjunctive Therapies in DCI Management in Divers: A Review of RCTs.","authors":"Thomas Fairhead","doi":"","DOIUrl":"","url":null,"abstract":"Background: Decompression illness (DCI) poses significant risks for divers, particularly in remote locations with limited resources. Few randomized controlled trials (RCTs) exist, necessitating a review to consolidate current evidence and support evidence-based treatment protocols. This review evaluates RCT evidence on the effectiveness of recompression treatment and adjunctive therapies for diving-related DCI.Methods: This review included RCTs assessing recompression treatment or adjunctive therapies in managing DCI. Exclusions were non-human studies, trials on DCI prevention, non-English publications, incomplete trials, and those involving non-diving DCI. Databases searched from inception to May 15, 2023, included Ovid MEDLINE, CENTRAL, CINAHL, and EMBASE. Citation chasing was performed on June 1, 2023, using Web of Science. Risk-of-bias assessments were guided by considering the Cochrane risk-of- bias tool for randomized trials.Results: Two RCTs were identified. One trial (n=180) indicated that tenoxicam might reduce the number of required recompressions from three (range 1-8) to two (range 1-6). The other trial (n=41) showed that a shorter initial recompression treatment table could decrease the number of recompressions (median one vs. two) in cases of mild DCI.Discussion: Limitations included unblinded participants, small participant numbers, non-protocol interventions, participant blinding, and incomplete outcome data. Recommendations for future research include reaching a consensus on a universal scoring system to support the clear definition and selection of participants, subgroup analyses, and inter-trial comparisons.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"52 4","pages":"607-615"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Necrotizing Soft Tissue Infections. 坏死性软组织感染。

IF 0.7 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2025-04-01

Caesar A Anderson, Irving Jacoby

{"title":"Necrotizing Soft Tissue Infections.","authors":"Caesar A Anderson, Irving Jacoby","doi":"","DOIUrl":"","url":null,"abstract":"e initial terminology used to describe 2,642 cases of necrotizing infections as \"hospital gangrene\" was coined by Dr. Joseph Jones, surgeon of the Confederate Army in 1871 [1]. Later in 1883, Dr. Jean- Alfred Fournier characterized necrotizing infections to the perineum. Necrotizing fasciitis was initially described and named \"hemolytic streptococcal gangrene\" by Meleney in 1924 [2]. He described an illness characterized by gangrene of subcutaneous tissues, followed by rapid necrosis of the overlying skin from involvement of the blood vessels supplying the skin, which are found in the affected fascial layers. All his patients grew hemolytic streptococci on cultures, and the patients were all seriously ill. Surgical extirpation appeared to be the best therapeutic approach then and remains so. The actual term Necrotizing Fasciitis was credited to Dr. Wilson much later in 1952 [3]. Media often refers to this entity as infection with «Flesh-eating bacteria.\"The annual incidence of NSTI varies considerably but is often reported at approximately four per 100,000 in developed countries [4]. Mortality rates highlight the severity of disease with a 90-day mortality of 18% reported in a multi-center study including more than 400 patients [5].","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"52 4","pages":"627-639"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Myocardial Ischemia-Associated Arterial Embolism Management from Pulmonary Cryotherapy. 肺冷冻治疗引起心肌缺血相关动脉栓塞的处理。

IF 0.7 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2025-04-01

Brock Preheim, Siamak Moayedi, Kin Wah Chew, Kinjal Sethuraman

引用次数: 0

Refractory Osteomyelitis. 耐火材料骨髓炎。

IF 0.7 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2025-04-01

William H Tettelbach, Brett B Hart

{"title":"Refractory Osteomyelitis.","authors":"William H Tettelbach, Brett B Hart","doi":"","DOIUrl":"","url":null,"abstract":"Chronic refractory osteomyelitis, according to the Centers for Medicare & Medicaid Services' (CMS) National Coverage Determination (NCD) 20.29, is an identified condition covered for treatment with adjunctive hyperbaric oxygen (HBO₂) therapy. Within the NCD (20.29) chronic refractory osteomyelitis is outlined as being unresponsive to conventional medical and surgical management [1]. From a practical perspective, patients can be appropriately diagnosed with chronic refractory osteomyelitis when they demonstrate no significant improvement or demonstrate worsening of the underlying osteomyelitis despite 30 days of combined conventional surgical and medical treatment that included systemic antimicrobial therapy. To date, no conclusive randomized clinical trials examining the effects of HBO₂ therapy on refractory osteomyelitis exist. Additionally, many of the initial studies that resulted in positive outcomes were conducted in hospital settings safeguarding compliance, and thus, not unexpectedly, the outcomes have not translated exactly to the outpatient clinic setting. Nonetheless, based on a comprehensive review of the scientific literature, the addition of HBO₂ therapy to routine surgical and antibiotic treatment of previously refractory osteomyelitis appears to be both safe and ultimately improves infection resolution rates. In most cases, the best clinical results are obtained when HBO₂ treatment is administered concomitantly with culture-directed antibiotics and initiated soon after clinically indicated surgical debridement. In situations where extensive surgical debridement or removal of fixation hardware is relatively contraindicated (i.e., cranial, spinal, sternal, or pediatric osteomyelitis), a trial of systemic culture-directed antibiotics and HBO₂ therapy prior to undertaking more than limited surgical interventions provides a reasonable prospect for osteomyelitis cure.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"52 4","pages":"641-668"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reversal of a Globus Pallidus Injury in a Severe Carbon Monoxide Poisoned Patient. 严重一氧化碳中毒患者苍白球损伤的逆转。

IF 0.7 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2025-04-01

Charles S Graffeo, Matthew J Petitt, Lexie E Neubauer, Gail D Steckler, Barry J Knapp

引用次数: 0

Decompression at 1.3 versus 1.6 bar and Nitrogen Elimination and Venous Gas Emboli: A Randomized Controlled Trial. 1.3 bar和1.6 bar减压、氮消除和静脉气体栓塞：一项随机对照试验。

IF 0.7 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2025-04-01

Oscar Plogmark, Carl Hjelte, Max Olsson, Magnus Ekström, Oskar Frånberg

{"title":"Decompression at 1.3 versus 1.6 bar and Nitrogen Elimination and Venous Gas Emboli: A Randomized Controlled Trial.","authors":"Oscar Plogmark, Carl Hjelte, Max Olsson, Magnus Ekström, Oskar Frånberg","doi":"","DOIUrl":"","url":null,"abstract":"Introduction: The optimal depth for decompression stops is unclear. We hypothesize that a decompression stop at 1.3 bar, compared with 1.6 bar, decreases post-dive whole-body nitrogen washout volumes and venous gas emboli (VGE).Methods: In this randomized crossover trial, divers performed wet air dives of 40 minutes at 3.4 bar (340 kPa) with a seven-minute-long decompression stop at either 1.3 bar (Deco 1.3) or 1.6 bar (Deco 1.6) in randomized order. The primary outcome was the difference in post-dive whole body nitrogen washout volume, analyzed using multilevel linear regression. The secondary outcome was the difference in peak VGE detected by cardiac two-dimensional ultrasound, graded using the Eftedal-Brubakk scale, and analyzed with Wilcoxon matched-pairs signed-rank tests.Results: Sixteen divers completed both Deco 1.3 and Deco 1.6. Post-dive whole body nitrogen washout volumes were measured in eight of the 16 participants and were lower with Deco 1.3 than Deco 1.6 (696 ml [95% confidence interval [CI], 601 to 790] versus 1068 ml [95% CI, 962 to 1174]), mean difference of 373 ml (95% CI, 243 to 502). Deco 1.3 had lower peak bubble grades than Deco 1.6 (interquartile range 2-3 versus 3-4; P=0.005), but the median grade was the same at 3.Conclusions: Decompression stop at 1.3 bar instead of 1.6 bar decreased post-dive whole body nitrogen washout volume and VGE. These findings may inform the development of future decompression models.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"52 4","pages":"577-585"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Systematic Review of Otologic Adverse Events in Hyperbaric Oxygen Therapy. 高压氧治疗中耳科不良事件的系统回顾。

IF 0.7 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2025-04-01

Andrew Voigt, Matteo Laspro, Erika Thys, Daniel Jethanamest, Ernest S Chiu

{"title":"Systematic Review of Otologic Adverse Events in Hyperbaric Oxygen Therapy.","authors":"Andrew Voigt, Matteo Laspro, Erika Thys, Daniel Jethanamest, Ernest S Chiu","doi":"","DOIUrl":"","url":null,"abstract":"Objectives: Hyperbaric Oxygen (HBO₂) Therapy has been associated with some risks and adverse events. Previous studies examining otologic complications from HBO₂ therapy vary in their reported incidence of adverse events. This study aims to systematically review the otologic complications associated with HBO₂ therapy and investigate contributing risk and protective factors.Review method: A systematic review was conducted to identify studies reporting otologic adverse effects due to HBO₂ therapy. Utilizing PRISMA 2020 guidelines, titles and abstracts were screened before conducting a full-text analysis. Studies reporting the incidence of otologic complications and studies reporting risk or protective factors for otologic complications were included.Results: A search for articles on HBO₂ therapy otologic complications yielded 2,027 articles, of which 183 were relevant to the research question. Ultimately, 54 studies met the inclusion criteria. Fifteen percent of the 18,284 patients treated with HBO₂ therapy experienced adverse events. Of the middle ear barotrauma (MEB) that occurred, 42.8% was mild, and 6.4% was severe. The major risk factors were increasing age, female sex, head and neck pathology, sensory neuropathy, and pre-treatment difficulty equalizing ear pressure. The main protective factor was experience with effective equalization techniques.Conclusions: 15% of patients experienced otologic complications due to HBO₂ therapy. Older age, female sex, and a history of head and neck or neurological conditions may increase the risk for MEB. Increased monitoring of higher-risk patients during initial treatment sessions and proper equalization techniques may help prevent MEB during HBO₂ therapy. This is the most comprehensive systematic review on the topic to date.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"52 4","pages":"537-547"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cold Urticaria Preventing Clearance For Scientific Diving. 科学潜水防寒性荨麻疹清除。

IF 0.7 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2025-04-01

Daniel A Popa, Abigail R Winn, Thomas C Masters, Christopher Logue

{"title":"Cold Urticaria Preventing Clearance For Scientific Diving.","authors":"Daniel A Popa, Abigail R Winn, Thomas C Masters, Christopher Logue","doi":"","DOIUrl":"","url":null,"abstract":"Case description: We present a case of a 39-year-old healthy female scientific diver who developed cold urticaria (CU) 8 months prior, when immediately postpartum. She had extensive diving experience but discontinued diving during pregnancy and sought to resume diving. Before our consultation, she had seen a dermatologist and allergist for evaluation for an underlying etiology and management.Intervention: Initial management included diphenhydramine and cetirizine with topical triamcinolone based on dermatology recommendations. Her allergist later advised discontinuing diphenhydramine and remaining on cetirizine 10mg up to four times daily, given breastfeeding concerns. Epinephrine was prescribed in case of anaphylaxis.Outcome: The workup revealed no underlying pathology, and she was not cleared for diving until her CU was resolved. Despite antihistamines, she continues to be symptomatic, including in pools heated to 90⁰F. Although drysuit certified, we could not clear her for scientific diving and advised against recreational diving given the risk of anaphylaxis.Discussion: CU is an uncommon but under-reported and under-recognized condition with potentially fatal consequences for swimmers and divers. Although symptom management focuses on antihistamines, corticosteroids and omalizumab (Xolair®) may prove helpful. Nonetheless, the risk of anaphylaxis remains, so CU should be a disqualifying condition for divers. Associated and causative conditions require specialist evaluation, with many patients reporting spontaneous resolution within several years. Hyperbaric physicians should be aware of CU as a disqualifying condition and an etiology of a post-diving rash that could be mistaken for skin manifestations of decompression sickness.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":"52 4","pages":"621-625"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0