Rabu, 31 Desember 2014

Stem Cell Collection And Hyperbaric Oxygen Treatment

Stem Cell Collection And Hyperbaric Oxygen Treatment

23 CommentsBy 
Published: Jan 11, 2011 4:25 pm

My husband was diagnosed in June 2008 with multiple myeloma at the age of 48 after having severe back pain, which turned out to be a vertebral compression fracture.
The local general oncologist started him on a thalidomide (Thalomid) anddexamethasone (Decadron) regimen in addition to radiation on the lesion on his spine to alleviate the tremendous pain. He could move better after each treatment.
When we began consulting for treatment that included stem cell transplantation, we learned that Dave had received “extensive radiation” and that this would make collecting his stem cells “difficult,” “arduous,” and “potentially problematic.” Great! Just great! When I mentioned this to the oncologist still in charge of our care, he blew me off completely. He said, “No, no, we weren’t radiating the ‘long bones,’ which is where most stem cells come from in collection.” That’s funny, his own attending physician from his residency whom he had referred us to, disagreed. Frustrating.
When we got to Little Rock, Arkansas for our consultation, I asked what they do when a patient comes in with lesions and tremendous pain. How do they shrink the lesions and reduce the pain? They said, “We simply start immediate treatment of the multiple myeloma. We never, never, ever, radiate someone who will be doing a transplant, and we have written numerous medical papers on why. It’s incredibly disappointing to us how many patients come here with radiation treatment. Don’t feel bad, you are not alone.”
A dear friend of mine in the horse business in Lexington contacted me and said to get Dave into hyperbaric oxygen treatment (HBOT) before his stem cell collection. Her farm was next door to an equine rehab facility. They had an HBO chamber for horses and had seen some pretty amazing miracles!
I was fascinated, and we had some very interesting discussions about the use of this alternative treatment therapy—from treating strokes to autism and brain injuries as well as the more understood and accepted treatment of fractures and open wounds.
When you are injured or have a wound, stem cells mobilize in your bone marrow, spill into the blood stream, and travel to the injury to heal it, like a little army. When a wound won’t heal, HBOT can step in and dramatically improve the outcome.
The horse rehab center sent me a paper from the University of Pennsylvania by Dr. Stephen R. Thom called “Stem cell mobilization by hyperbaric oxygen,” which was published in June 2005. I’m not a scientist, but the abstract and the conclusions were clear to me. Including 20 HBOTs for Dave would potentially increase his “stem cell mobilization” eight-fold.
I located a facility near where we live and contacted them for an appointment. When I mentioned it to the doctor in Little Rock, he shrugged and said, “Sure, if you want to do that, go ahead. I’m going to do the collection process the way I always do.”
Honestly, I didn’t really know enough about any of what we were embarking on to make these decisions with full confidence. I worked off what I learned, what made sense (to me), my instincts, and the most important part - HBOT wouldn’t hurt Dave.
In addition to mobilizing stem cells, HBOT can also help heal radiation damage. So it’s a twofer (two for one) as they say. I just couldn’t find the downside, except the out-of-pocket cost.
We decided to go ahead with it. The problem was, Dave was scheduled to begin treatment in Little Rock in mid-November, and it was October. We didn’t have a lot of time to get in 20 treatments, and he was back at work. It was exhausting for him to squeeze treatments in every single day to get the targeted 20.  We ultimately only were able to get in 19 before we left for Arkansas.
The actual treatments were easy. He said that his ears would feel pressure, like while flying in an airplane. The chamber was clear, and he could watch TV during his 90 minute sessions.  He would be ravishingly hungry when he was done, even though he would have eaten before he went in. Afterward, he was “hyper alert” mentally. Under ideal circumstances, these treatments would not be so condensed.
During the stem cell collection – for those of you who have not been through it – your immune system is wiped out with chemotherapy.  Then you are given Neupogen (growth hormone) shots to help facilitate an overproduction of stem cells so that they spill out into your blood stream and are available for collection. When your white blood cell (WBC) count gets up to 2.0 or higher, they will run a special test called a “ProCOUNT” (CD34 on your labs), which is basically an estimation of how many stem cells you have in your blood for collection. One of the physical manifestations of this process for the patient is some pretty intense bone pain. The cells are building up in the bone marrow; they are jammed in there and are very overcrowded. This causes them to spill out into the blood stream to become available for the aphaeresis process used to capture them and extract them from your blood.
In Little Rock they don’t do the ProCOUNT until your WBC count is over 2.0, but Dave had been up all night in a chair with extra pain meds because of bone pain discomfort. We did not wait for our regular appointment in the infusion center but went in at 6:30 a.m.
Dave’s WBC count jumped from below 2.0 to over 13 during the night! They ran the ProCOUNT test, and Dave’s was at 50 million cells available for collection! The collection doctor said that in 20 years of doing this she had never seen anyone with his extensive radiation history with those numbers!
We were unable to get everything needed done to get the collection started that day. So more drugs, no more growth factor shots, and home we went for the night, ready to collect early the next morning. Overnight Dave developed a very high fever that was gone by the time we got in for collection. They scheduled his collection for only 45 minutes. Normally, collection is a number of hours spread over days.
In Little Rock, they always collect a second day in order to make sure that in case there is a problem, they have another collection. They try to collect enough cells for six transplants, which equates to 20 million cells, with an average of 3 to 4 million per transplant and 2 million the bare minimum.  On the second day, they scheduled Dave for only 30 minutes of collection.
Over those 75 minutes, Dave collected 47 million stem cells (11 transplants worth). When they did a post collection ProCOUNT, he had 90 million cells still available in his blood stream for collection! His bone pain, which should normally ease immediately upon collection, was still uncomfortable. He jokingly begged them to please take out more and said they could throw them away and that he promised not to tell. Within about 24 hours, he was back to normal. All his cells were deemed “viable” for transplant.
I learned later that Little Rock began to experiment with its hard-to-collect patients by sending them to a nearby hospital for HBOT. What I learned was that if they had a patient who could only collect say 30,000 stem cells, after HBOT they were able to collect 300,000. This is still not enough for even one transplant. However, a patient who could collect 300,000 cells before HBOT might be able to produce around 3 million cells after HBOT, as the paper describes.
The more humorous part of this story is that I wrote to Dr. Thom at the University of Pennsylvania and shared with him our experience and results, thanks to his paper. He wrote me back and thanked me for the information. He then said, “This is exactly what our findings were, but we have very little human data.”  What a crack up!
The HBO doctor recommended we do 20 treatments post transplants, therapeutically. We are planning to do this. It will presumably help with Dave’s fatigue and low WBC numbers.
I suspect that Dave would have collected enough stem cells over a week’s time, but there was no way for me to know that. All I knew was what I was told: that he would have problems due to his “extensive radiation” (around 12 treatments). The problem with this is you don’t really know if there will be a problem until you try to collect. We were proactive in our complimentary therapy in approaching this potential barrier.  We believe there were other benefits, but it is candidly anecdotal.
If you are interested in contributing an article for publication in the opinion section of The Myeloma Beacon, guidelines can be requested by emailing opinions@myelomabeacon.com.












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Published: Jan 11, 2011 4:25 pm http:/www.blogger.com/blogger.g?blogID=3695782512871826223#editor/target=post;postID=6778092938086073884

tayang ulang oleh : dr.erick supondha (hyperbaric and diving medicine consultant) dokter ahli hiperbarik dan kesehatan penyelaman , jakarta, indonesia, 021 99070050


Selasa, 23 Desember 2014

Hyperbaric oxygen therapy is effective in correcting ischemia and hypoxia caused by PVD

Peripheral Vascular Disease

Peripheral vascular disease.
source: http://odlarmed.com/
Many medical conditions affect the network of arteries and veins that carry blood to and from the body’s tissue.  Such damage is generally referred to as peripheral vascular disease (PVD).
Compromised peripheral blood supply leads to tissue ischemia (lack of circulation) and tissue hypoxia (lack of oxygen). As the result of those effects, there is a change in microcirculation and occurrence of edema (swelling). Edema further compresses capillaries and aggravates ischemia and loss of sensitivity (neuropathy).
Warning signs of PVD are pain, swelling, skin discoloration, itching and decreased hair. Frequent cold hands and feet, as well as dry flaky skin are usual signs of poor circulation. In such cases little cuts or wounds may not be able to heal in a “normal” period and may turn into “chronic”, frequently complicated with infections and finally to the gangrene of the limb. If left untreated, gangrene progresses and the amputation of extremity (partial or complete) are unavoidable.  See case reports on PVD ulcers below
Hyperbaric oxygen therapy is effective in correcting ischemia and hypoxia caused by PVD, promoting microcirculation, reducing swelling and inflammation and directly fighting infection tospeed up wound healing.
Benefit of hyperbaric oxygen therapy in PVD:
  • improves tissue oxygenation and elimination of toxic substances, that were accumulated due to poor circulation and hypoxia
  • relieves pain
  • reduces swelling and inflammation
  • improves sensitivity and reduces numbness
  • triggers new capillary formation for improved local circulation and blood supply
  • improves quality of blood and prevents blood clotting and chances of thrombosis
  • enhances immune system response and increases the effect of antibiotics
  • prevents/reduces infection rate
  • reduces incidence of ulcer development
When wounds are developed, HBO is beneficial to:
  • stop further tissue damage
  • provide optimal oxygen environment for all phases of wound closure
  • promote new tissue growth and fast wound closure
  • prevent excessive scar formation (caused by slow healing)
  • prepare a host for skin grafting and increase chances of graft survival
  • prevent/stop infection


Treatment protocol for hyperbaric oxygen therapy:
Medical hyperbaric oxygen sessions are two hours long at depth of 2.4 to 2.8 ATA of pure oxygen pressure.  At BaroMedical HBO sessions are given in mono-place chambers for better monitoring, comfort and safety.  Number of HBO sessions needed depend on the seriousness of the condition and can be determined upon evaluation of the microcirculation.  At BaroMedical, the screening of the clients and the progress of the therapy are monitored with most advanced equipment: Laser Doppler blood flow, tissue oxygen monitor and digital camera.


BaroMedical Venous ulcer - before HBO BaroMedical Venous ulcer - after HBO
Peripheral Vascular Disease: Chronic Venous Insufficiency (CVI)

Chronic Venous Insufficiency is a venous disease that can cause venous ulcer. Origin of CVI is venous valve malfunction leading to blood pooling and hypertension of venous system. This increased venous pressure can cause micro-vascular lack of blood perfusion (ischemia) and swelling. Swelling can further impair tissue nutrition and oxygen diffusion causing hypoxia.
Ischemia and hypoxia together can lead to non-healing ulcer which can be further complicated with infection.
Symptoms: leg swelling and varicose veins, leg discomfort and pain (burning, itching, dull ache) sensation of leg heaviness and pressure, skin changes (hyper-pigmentation, fibrosis etc.). Main effect of hyperbaric oxygen therapy in venous ulcers is correction of hypoxia and ischemia, reduced swelling, pain and inflammation.
[Medical background text
Case:  Chronic Venous Insufficiency Ulcer
Male 60 years old non smoker, fisherman, diabetic for 15 years has reoccurring ulcers on his both lower legs above ankles.
Currently he has 6 open infected ulcers on left leg on medial and lateral sides. He is taking antibiotic therapy and wearing compression stocking. Leg is painful and swollen, skin around the ulcers is inflamed.  Microvascular assessment on both legs shows reduced blood flow and oxygen levels (L: moderate ischemia and mild hypoxia; R: mild ischemia and mild hypoxia) as well as impaired sensitivity tested with 10 gram monofilament.  In response to hemodynamic tests of elevation and dependency oxygen levels in both legs are impaired. With 100% oxygen breathing through the mask all oxygen levels in measured points double which qualifies the client for hyperbaric oxygen therapy.
(Please see Pictures below).
Hyperbaric oxygen therapy is generally recommended in peripheral vascular problems for wound healing, infection control, inflammation control and swelling.
BaroMedical Venous ulcer - before HBO BaroMedical Venous ulcer - after HBO
Peripheral Vascular Disease: Peripheral Arterial Disease (PAD)

Peripheral Arterial Disease (PAD) is an ischemic disease of the extremities, mainly legs. The most common causes are atherosclerotic narrowing or obstruction of the lumen in the arteries (in arteriosclerosis obliterans) or arterial obstruction caused by segmental inflammatory and proliferative lesion of the medium and small vessels (Buerger`s disease – strong association with smoking). Reason can be also traumatic arterial occlusion of an extremity or allergic vasculitis, collagen vascular disease, granulomatous angiitis and other vasculopathies.
Poor blood supply (ischemia) results in a reduced oxygen supply (hypoxia) and retention of carbon dioxide as well as other products of tissue metabolism. This can lead to impaired microcirculation and swelling, which further compresses capillaries and aggravates ischemia. Ischemia and hypoxia are common denominator of non-healing ulcer, infection and in worst-case gangrene. If left untreated, gangrene progresses and amputation of extremity (partial or complete) is unavoidable.
Symptoms: Major symptoms are pain and cramping combined with numbness and weakness in the affected limb. Arterial ulcers are commonly located on the tips of the toes/fingers or pressure points, and depending on blood supply can rapidly develop into necrotic tissue.
Main effect of hyperbaric oxygen therapy in arterial ulcers is in providing adequate oxygen for stopping further damage and salvage of viable tissue. New capillary growth induced by HBO can counteract the reduced blood supply due to arterial disease.
[Medical background text]Male 57 years old with history of recurrent cellulitis over last 6 years reported to hyperbaric unit 4 days after wounds opened.  He was prescribed antibiotics two days prior to HBO. He is suffering from hypertension and has been diagnosed as a borderline diabetic.
[Treatment protocol and progress]Client received 12 hyperbaric oxygen sessions over 14 days. Sessions were given at 2.0 ATA pressure of medical oxygen. Lower treatment pressure was decided due to clients hypertension. Each session was 90 minutes long and was given in mono-place oxygen flow hyperbaric chamber. Overall inflammation and swelling were reduced and wound closed over the two weeks of the therapy. (Please see Pictures below).
Hyperbaric oxygen therapy is generally recommended in peripheral vascular problems for wound healing, infection control, inflammation control and swelling.
BaroMedical Peripheral Arterial Disease (PAD) - before HBO BaroMedical Peripheral Arterial Disease (PAD) - after HBO

References:
  1. Jain KK: Textbook of hyperbaric medicine: Ch 22: Hyperbaric Oxygen Therapy in Cardiovascular disease, Hogrefe & Huber Publishers, Inc., 3rdEd. 22:393 –419, 1999.
  2. Jain KK: Textbook of hyperbaric medicine: Ch 15: Hyperbaric Oxygen Therapy in Wound Healing, Plastic Surgery and, Dermatology, Hogrefe & Huber Publishers, Inc., 4th Ed. 15:157-177, 2004
  3. Ackerman NB, Brinkley FB: Oxygen tensions in normal and ischemic tissues during hyperbaric therapy. JAMA 198:142-145, 1966
  4. Babior BM: Oxygen – dependant microbial killing by phagocytes. NEJM; Vol 298, pp 659-68, 1978
  5. Bass BH: The treatment of varicose leg ulcers by hyperbaric oxygen. Postgrad Med J; 46: 407-408, 1970
  6. Bello YM, Phillips TJ: Recent advances in wound healing, JAMA; 283 (6) pp716-718, 2000
  7. Bird AD, Telfer ABM: Effect of hyperbaric oxygen on limb circulation. Lancet; 13:355-356, 1965
  8. Boykin JV Jr, Crossland MC, Cole LM: Wound healing management: enhancing patient outcomes and reducing costs. J Health Resourc Manag; 15(4): 22, 24-6, May 1997
  9. *Boykin JV et al. Hyperbaric oxygen therapy: A physiological approach to selected problem wound healing. Wounds; 8(6):183-193, 1996
  10. *Brosemer R.W. et al. The effect of oxygen tension on the growth and metabolism of a mammalian cell. Experimental Cell Research 25;101-113, 1961
  11. Cianci P, Bove A: Hyperbaric oxygen therapy in the treatment of acute and chronic peripheral ischemia. Int Med; 6: 117-137, 1985
  12. Crossland MC, Shawler LG, Boykin JV The chronic wound. ADVANCE for Nurse Practinioners; 61-65, 1998
  13. Donlin NJ, Bryson PJ: Hyperbaric oxygen therapy. J Wound Care; 4(4): 175-8, Review. Apr 1995
  14. Fisher BH: Hyperbaric oxygen for skin ulcers. Roche Med Image Commentary, 1969
  15. *Fischer BH: Treatment of ulcers on the legs with Hyperbaric oxygen. J Dermatol Surg; 1(3) pp 55-8, 1975
  16. Fry DE, Marek JM, Langsfeld M: Infection in the ischemic lower extremity. Surg Clin North Am.; 78(3): 465-79, Review, Jun 1998
  17. *Gibson JJ et al: Increased oxygen tension pontetiates angiogenesis. Plastic surgery; 68: 697-700, 1997
  18. Halm M, Zearley C: Assessment and follow-up of problem wounds in the hyperbaric oxygen setting. Ostomy Wound Manage; 37:51-9 Nov-Dec 1991
  19. Hammarlund C, Sundberg T: Hyperbaric oxygen reduced size of chronic leg ulcers: a randomized double-blind study. Plast Reconstr Surg; 93(4):829-33; discussion 834. Apr 1994
  20. Hammarlund C: Hyperbaric Oxygenation and Wound Repair in Man: Effects on the dermal microcirculation. Doctoral Dissertation; Department of Anesthesiology and Intensive care, Lund University, Sweden, 1995
  21. *Hing MC: Angiogenesis in necrotic ulcers treated with hyperbaric oxygen. Ostomy Wound Manage; 46(9):18-28, 30-32, 2000
  22. Horowitz MD, Portogues CG, Matos LA, McGowan RW: Hyperbaric oxygen: value in management of non-healing saphenectomy wounds. Ann Thorac Surg; 54(4):782-3, Oct 1992
  23. *Hunt TK et al The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surgery, Gynecology and Obstetrics; 135: 561-567,1972
  24. *Hunt TK et al The effect of differing ambient oxygen on wound infection. Ann Surg; 181(1): 35-39, 1975
  25. Hunt TK Wound healing and wound infection. Surg Clin North Am; 77(3): 587-606, 1997
  26. Hunt TK Hyperbaric oxygen and wound healing. Ch.18, Hyperbaric Surgery- Perioperative care, Ed: Bakker DJ, Cramer F; Best Publishing Company, Flagstaff, AZ; First Ed. pp:439-459, 2002
  27. Illingworth CFW: Treatment of arterial occlusion under oxygen at two atmospheres absolute. BMJ; 2:1272, 1962
  28. Jain KK: Textbook of hyperbaric medicine: Ch 22: Hyperbaric Oxygen Therapy in Cardiovascular disease, Hogrefe & Huber Publishers, Inc., 3rd Ed. 22:393 –419, 1999.
  29. Jain KK: Hyperbaric oxygen therapy in cardiovascular diseases. In Jain K.K. (ed): Textbook of Hyperbaric Medicine. Toronto: Hogrefe & Huber, pp.338-340, 1990
  30. Kawamura M., Sakakibara K., and Yusa T. Effect of increased oxygen on peripheral circulation in acute, temporary limb hypoxia. J Cardiovasc; 19:161-168, 1978
  31. Kostiunin VN, Pahkomov VI., Feoktistov PL, et al : Increasing the effectiveness of hyperbaric oxygenation in the treatment of patients with stage IV arterial occlusive disease of the lower limbs. Vestn Khir; 135: 48-51,1985.
  32. Kovacevic H: The investigation of hyperbaric oxygen influence in the patients with second degree of atherosclerotic insufficiency of lower extremities. Ph.D. diss., University of Rieka, Croatia, 1992.
  33. Magnant CM, Milzman DP, Dhindsa H: Hyperbaric medicine for out patient wound care. Emerg Med Clin North Am; 10(4): 847-60, Review, Nov 1992
  34. Monies-Chass I, Maghmonai M, et al: Hyperbaric oxygen treatment as an adjunct to reconstructive vascular surgery in trauma. Injury; 8:274-277, 1977
  35. Mottram RF: Effects of hyperbaric oxygen on limb circulation. Lancet; 13:602, 1965
  36. Nylander G., Lewis H., Nordstrom H., and Larsson J. Reduction-of post-ischemic edema with hyperbaric oxygen. Plast Reconstr Surg; 76:602-603, 1985
  37. Olejniczak .: Employment of low hyperbaric therapy in management of leg ulcers. Mich Med, 1969
  38. Quirinia A, Viidik A: The impact of ischemia on wound healing is increased in old age but can be countered by hyperbaric oxygen therapy. Mech Ageing Dev.; 91(2): 131-44, Oct 25 1996
  39. Roth RN, Weiss LD: Hyperbaric oxygen and wound healing. Clin Dermatol; 12(1): 141-56, Review, Jan-Mar 1994
  40. Schraibman IG, Ledingham FRC, Ledingham, IMA: Hyperbaric oxygen and regional vasodilation in pedal ischemia. Surg Gynecol Obstet; 125:761-767,1969.
  41. Stalker CG. Ledingham IMA: The effect of increased oxygen in prolonged acute limb ischemia. Br J Surg; 60:959-963, 1973
  42. Uhl E, Sirsjo A, Haapaniemi T, Nilsson G, Nylander G: Hyperbaric oxygen improves wound healing in normal and ischemic skin tissue. Plast Reconstr Surg;93(4):835-841, Apr 1994
  43. Urayama H, Takemura H, Kasaima F, et al: Hyperbaric oxygen therapy for chronic occlusive disease of the extremities. Nippon Geka Gakkai Zasshi; 993:429-433, 1992
  44. Wattel F, Mathieu D, Coget JM, Billard V: Hyperbaric oxygen therapy in chronic vascular wound management. Angiology; 41(1): 59-65 Jan 1990
  45. Yefuni SN, Lyskin GI, Fokina TS: Hyperbaric oxygenation in treatment of peripheral vascular disorders. Int Angiol; 4:207-209












Peripheral Vascular Disease: Chronic Venous Insufficiency (CVI)

Chronic Venous Insufficiency is a venous disease that can cause venous ulcer. Origin of CVI is venous valve malfunction leading to blood pooling and hypertension of venous system. This increased venous pressure can cause micro-vascular lack of blood perfusion (ischemia) and swelling. Swelling can further impair tissue nutrition and oxygen diffusion causing hypoxia.
Ischemia and hypoxia together can lead to non-healing ulcer which can be further complicated with infection.
Symptoms: leg swelling and varicose veins, leg discomfort and pain (burning, itching, dull ache) sensation of leg heaviness and pressure, skin changes (hyper-pigmentation, fibrosis etc.). Main effect of hyperbaric oxygen therapy in venous ulcers is correction of hypoxia and ischemia, reduced swelling, pain and inflammation.
[Medical background text
Case:  Chronic Venous Insufficiency Ulcer
Male 60 years old non smoker, fisherman, diabetic for 15 years has reoccurring ulcers on his both lower legs above ankles.
Currently he has 6 open infected ulcers on left leg on medial and lateral sides. He is taking antibiotic therapy and wearing compression stocking. Leg is painful and swollen, skin around the ulcers is inflamed.  Microvascular assessment on both legs shows reduced blood flow and oxygen levels (L: moderate ischemia and mild hypoxia; R: mild ischemia and mild hypoxia) as well as impaired sensitivity tested with 10 gram monofilament.  In response to hemodynamic tests of elevation and dependency oxygen levels in both legs are impaired. With 100% oxygen breathing through the mask all oxygen levels in measured points double which qualifies the client for hyperbaric oxygen therapy.
(Please see Pictures below).
Hyperbaric oxygen therapy is generally recommended in peripheral vascular problems for wound healing, infection control, inflammation control and swelling.
BaroMedical Venous ulcer - before HBO BaroMedical Venous ulcer - after HBO
Peripheral Vascular Disease: Peripheral Arterial Disease (PAD)

Peripheral Arterial Disease (PAD) is an ischemic disease of the extremities, mainly legs. The most common causes are atherosclerotic narrowing or obstruction of the lumen in the arteries (in arteriosclerosis obliterans) or arterial obstruction caused by segmental inflammatory and proliferative lesion of the medium and small vessels (Buerger`s disease – strong association with smoking). Reason can be also traumatic arterial occlusion of an extremity or allergic vasculitis, collagen vascular disease, granulomatous angiitis and other vasculopathies.
Poor blood supply (ischemia) results in a reduced oxygen supply (hypoxia) and retention of carbon dioxide as well as other products of tissue metabolism. This can lead to impaired microcirculation and swelling, which further compresses capillaries and aggravates ischemia. Ischemia and hypoxia are common denominator of non-healing ulcer, infection and in worst-case gangrene. If left untreated, gangrene progresses and amputation of extremity (partial or complete) is unavoidable.
Symptoms: Major symptoms are pain and cramping combined with numbness and weakness in the affected limb. Arterial ulcers are commonly located on the tips of the toes/fingers or pressure points, and depending on blood supply can rapidly develop into necrotic tissue.
Main effect of hyperbaric oxygen therapy in arterial ulcers is in providing adequate oxygen for stopping further damage and salvage of viable tissue. New capillary growth induced by HBO can counteract the reduced blood supply due to arterial disease.
[Medical background text]Male 57 years old with history of recurrent cellulitis over last 6 years reported to hyperbaric unit 4 days after wounds opened.  He was prescribed antibiotics two days prior to HBO. He is suffering from hypertension and has been diagnosed as a borderline diabetic.
[Treatment protocol and progress]Client received 12 hyperbaric oxygen sessions over 14 days. Sessions were given at 2.0 ATA pressure of medical oxygen. Lower treatment pressure was decided due to clients hypertension. Each session was 90 minutes long and was given in mono-place oxygen flow hyperbaric chamber. Overall inflammation and swelling were reduced and wound closed over the two weeks of the therapy. (Please see Pictures below).
Hyperbaric oxygen therapy is generally recommended in peripheral vascular problems for wound healing, infection control, inflammation control and swelling.
BaroMedical Peripheral Arterial Disease (PAD) - before HBO BaroMedical Peripheral Arterial Disease (PAD) - after HBO








Sumber : http://baromedical.ca/medical/dermatology/peripheral-vascular-disease/

dr.erick supondha (hyperbaric and diving medicine consultant) dokter ahli hiperbarik dan kesehatan penyelaman , jakarta, indonesia, 021 99070050


Kamis, 18 Desember 2014

Hyperbaric Oxygen Therapy and Peripheral Arterial Disease

Hyperbaric Oxygen Therapy and Peripheral Arterial Disease







The Role of Hyperbaric Oxygen Therapy in Patients with Peripheral Arterial Disease
Tom Carrico, M.D., F.A.C.S.
Medical Director, CENTRA Center for Wound Care and Hyperbaric Medicine

                Hyperbaric oxygen therapy (HBO) has been available in our community since April, 2003.  Our chambers are located within the CENTRA Center for Wound Care and Hyperbaric Medicine on the second floor of Virginia Baptist Hospital.  Our Center is fully accredited by the Undersea and Hyperbaric Medical Society’s Facility Accreditation Program.  We are one of six accredited programs in the Commonwealth of Virginia and the only one west of Richmond.  This therapy has been successfully utilized for a variety of conditions including diabetic foot and lower extremity ulcers, problem healing in irradiated fields and osteomyelitis (as well as other less frequent indications).  So what is the role of HBO in patients with peripheral arterial disease?

 What is Hyperbaric oxygen therapy and how does it work?   
            
                  HBO is the breathing of pure oxygen at increased atmospheric pressure.  We utilize “monoplace” chambers, in which the entire patient is sealed in an acrylic tube (or “chamber”).  We replace the ambient air within the chamber with 100% oxygen and increase the pressure to 2.0 – 2.4 atmospheres.  In comparison, this pressure would be about the same as a scuba dive to about 50 feet of water.  In this environment, hemoglobin molecules are saturated with oxygen and even more oxygen is dissolved into the plasma of the blood.  This allows the delivery of super-oxygenated blood (about 15 times the amount of oxygen delivered to the tissues if the patient were breathing room air at 1 atmosphere of pressure) to the capillary beds.  This has many beneficial effects on wound healing.  These include improved fibroblast function and collagen deposition, more efficient leukocyte function, an increase in the amounts of growth factors in the wound bed, and a synergistic bactericidal effect with some antibiotics.  Oxygen in concentrations achieved in the HBO chamber actually diffuses into bone and also has a bactericidal effect in patients with osteomyelitis.  The most important effect in our diabetic patients and in the patients with wounds in irradiated tissues is angiogenesis which is most likely mediated by stem cell recruitment from bone marrow.  A new capillary bed can be achieved in diabetics with small vessel disease and in patients with localized tissue ischemia from radiation therapy.

 What role does HBO play in acute arterial ischemia?   

              A patient can develop acute arterial ischemia through trauma (crush injury or direct arterial trauma) or from emboli.  After the acute arterial injury or blockage is corrected a compartment syndrome can develop.  HBO can play a role in these patients post-revascularization by reducing edema and increasing the oxygenation of injured tissues.  Often fasciotomy can be avoided and tissue salvaged before frank necrosis can occur.  This usually involves a short course of hyperbaric therapy, sometimes on a twice daily schedule, until edema resolves and all tissue is viable.

What role does HBO play in peripheral arterial disease and tissue loss (ulcer)? 

              Patients often present to the Wound Care Center with lower extremity ulceration and non-palpable pulses.  If the rest of the history and physical exam indicates significant peripheral arterial disease, then non-invasive testing is ordered.  This may include a test we perform in the Center, a trans-cutaneous oxygen measurement (or “TCOM”) as well as the standard lower extremity arterial Doppler study (LEAS).  We would also consider performing a TCOM in a diabetic patient with palpable pulses to see if they have significant small vessel disease secondary to their diabetes.  If the patient has very low tissue oxygenation at the distal leg or foot level or critical limb ischemia is determined on LEAS study then revascularization (either surgical bypass or endovascular revascularization) would be needed before we would anticipate that these ulcers would heal.  Hyperbaric oxygen therapy is NOT going to be beneficial in the patient with critical limb ischemia which cannot be corrected.  Once a patient with an arterial ulcer has been successfully revascularized, then HBO would be indicated to help speed healing when there is also deep tissue involvement, osteomyelitis or persistent small vessel disease after the inflow has been corrected.
      
        In summary, Hyperbaric Oxygen Therapy is a useful adjunctive treatment in patients with acute arterial ischemia, patients with arterial ulcer and deep tissue involvement after successful revascularization and in diabetic patients with good inflow but significant small vessel distal disease. 
      
        Referrals for wound care and consideration for hyperbaric oxygen therapy or trans-cutaneous oxygen testing can be obtained by calling our Center at 434-200-1800.

Center for Wound Care and Hyperbaric Medicine Staff - Virginia Baptist Hospital, Lynchburg, Virginia





























SUMBER : http://tomcarrico.blogspot.com/2012/06/hyperbaric-oxygen-therapy-and.html
dr.erick supondha (hyperbaric and diving medicine consultant) dokter ahli hiperbarik dan kesehatan penyelaman , jakarta, indonesia, 021 99070050

Rabu, 10 Desember 2014

Effect of Hyperbaric Oxygen Therapy on Nerve Regeneration in Early Diabetes.

Effect of Hyperbaric Oxygen Therapy on Nerve Regeneration in Early Diabetes.

Aydin A, Ozden BC, Karamursel S, Solakoglu S, Aktas S, Erer M.

Nerve regeneration in diabetes is essential for reversal of neuropathy as well as the recovery of nerves from injury due to acute nerve compression and entrapment. Endoneural hypoxia due to hyperglycemia‐induced blood flow reductions is observed early in the course of diabetes, and the resultant ischemia plays a role in the diminished neural regeneration. Hyperbaric oxygen therapy is capable of producing tissue hyperoxia by raising oxygen tensions in ischemic tissues, and was shown to be beneficial in the reversal of experimental ischemic neuropathy. In this study, an experimental diabetes model was used to evaluate the functional and histomorphological effects of hyperbaric oxygen therapy on early diabetic nerve regeneration. Our results indicate that there is significant histomorphological impairment of nerve regeneration, even in very early stages of diabetes. 







sumber : Aydin A, Ozden BC, Karamursel S, Solakoglu S, Aktas S, Erer M.
,ditayangkan ulang oleh dr.erick supondha (hyperbaric &diving medicine consultant) dokter ahli hiperbarik dan kesehatan penyelaman , jakarta indonesia 021 99070050

Selasa, 02 Desember 2014

Hyperbaric Oxygen Therapy Improves Peripheral Nerve Regeneration

Hyperbaric Oxygen Therapy Improves Peripheral Nerve Regeneration

Several studies have documented the effectiveness of hyperbaric oxygen in models of acute and delayed crush injury. Intermittent exposure to hyperbaric hyperoxia serves to interrupt the injury cycle of edema, ischemia and tissue necrosis, as well as hemorrhagic hypotension, which in turn leads to former edema and ischemia. Tissue ischemia is countered by the ability of hyperbaric oxygen to elevate tissue oxygen tensions. Furthermore, edema is reduced, secondary to hyperoxia‐induced arteriolar vasoconstriction, leading to improved tissue viability, thereby reducing necrosis. Hyperbaric oxygen has also been studied in models of peripheral nerve injury. Researchers from the US Air Force School Aerospace Medicine and Louisiana State University recently sought to determine what, if any, morphologic changes are associated with hyperbaric oxygen treated peripheral nerve injury. Their model involved a crushed sciatic nerve in the rabbit.  

Exposure to hyperbaric oxygen across the range of current clinical dose schedules was compared to untreated, and pressure (hyperbaric air) controls. A pathologist blinded as to group documented the oxygen extent of nerve regeneration via morphologic analysis of electron micrographs. All of the animals exposed to hyperbaric were reported to demonstrate advanced stages of a healed nerve, in contrast to both control groups. As this research was limited to a determination of regeneration of morphology, the exact effects of hyperbaric oxygen were not known. The authors speculate, however, that there may be several suggesting increased myelination, decreased edema, reduced internal collagen and improvements in neurofilamentous material density. They conclude that this study provides additional evidence of a link between tissue oxygen levels from hyperbaric oxygen treatment and the health of peripheral nerves.   ... 

all animals exposed to hyperbaric oxygen "demonstrated characteristics expected of in the advanced stages of a healed nerve"    














sumberhttp://sarasgarden.org/wp-content/uploads/2013/12/Peripheral-Artery-Disease HBOT.pdf  ditayangkan ulang oleh dr.erick supondha (hyperbaric &diving medicine consultant) dokter ahli hiperbarik dan kesehatan penyelaman , jakarta indonesia 021 99070050