RESUMEN
Hyperbaric oxygen can be a useful adjuvant in the management of diabetic foot wounds when coordinated with medical-surgical management of the patient. Elevated tissue oxygen tensions improve leukocyte bacterial killing efficiency and enhance connective tissue regenerative systems for wound healing. An algorithm for the management of diabetic foot wounds is proposed in this article.
Asunto(s)
Pie Diabético/terapia , Úlcera del Pie/terapia , Oxigenoterapia Hiperbárica , Glucemia/metabolismo , Pie Diabético/fisiopatología , Úlcera del Pie/fisiopatología , Humanos , Oxígeno/fisiología , Cicatrización de Heridas/fisiologíaRESUMEN
We reviewed all known published reports or studies related to a possible cancer-causing or growth-enhancing effect by hyperbaric oxygen. Published articles were retrieved using Medline searches for the period 1960-1993. Additional references were obtained from bibliographies included in those articles discovered in the computer search. Also, hyperbaric medicine text books and the published proceedings of international hyperbaric conferences were visually searched. Studies and reports discovered in this fashion and related to the topic were included in the review. Twenty-four references were found: 12 were clinical reports, 11 were animal studies, and 1 reported both an animal study and a clinical report. Three clinical reports suggested a positive cancer growth enhancement, whereas 10 clinical reports showed no cancer growth enhancement. Two animal studies suggested a positive cancer-enhancing effect, and 10 animal studies showed no such effect. (The report that included both animals and humans is counted in both groups). The vast majority of published reports show no cancer growth enhancement by HBO exposure. Those studies that do show growth enhancement are refuted by larger subsequent studies, are mixed studies, or are highly anecdotal. A review of published information fails to support a cancer-causing or growth-enhancing effect by HBO.
Asunto(s)
Oxigenoterapia Hiperbárica/efectos adversos , Neoplasias/etiología , Oxígeno/efectos adversos , Animales , Humanos , Metástasis de la Neoplasia , Fármacos Sensibilizantes a Radiaciones/efectos adversosRESUMEN
Laryngeal necrosis is a rare complication of therapeutic radiation, but when it does occur there is no established, definitive treatment and laryngectomy is frequently required. This report is a retrospective review of all patients referred for hyperbaric oxygen (HBO) therapy to a single hyperbaric medicine unit for treatment of their laryngeal necrosis between 1980 and 1985. Nine patients were in this series. One patient had had a vertical hemilaryngectomy and another a supraglottic laryngectomy before referral. Eight of the nine patients had a Chandler grade IV necrosis and the ninth had a Chandler grade III necrosis. All nine patients were able to maintain their voice until death or last follow up. Seven of the nine patients maintained good voice quality while two exhibited some hoarseness. All patients with tracheostomies were able to be decannulated, and all patients with fistulae had these closed. No untoward reactions to HBO occurred. Based on this review, HBO is recommended as a therapeutic option whenever laryngeal necrosis occurs and there is a chance to save the larynx.
Asunto(s)
Oxigenoterapia Hiperbárica , Laringe/patología , Traumatismos por Radiación/terapia , Anciano , Anciano de 80 o más Años , Terapia Combinada , Humanos , Neoplasias Laríngeas/radioterapia , Laringe/efectos de la radiación , Masculino , Persona de Mediana Edad , Necrosis , Estudios RetrospectivosRESUMEN
A questionnaire was sent to 179 clinical hyperbaric medicine facilities to survey treatment policies and referral patterns for patients with a history of malignancy. Eighty-five surveys were returned. Most respondents indicated that they would accept patients with a history of malignancy for either adjuvant or emergent hyperbaric oxygen (HBO). Depending on specific circumstances, from about one third to one half of respondents believed that such patients should be informed of a theoretical potential for tumor acceleration or reactivation. An overwhelming majority had not personally attended nor had they been told by colleagues of cases of patients whose malignancy had been activated or accelerated by HBO. A large majority felt that referring physicians did not believe that HBO was carcinogenic, and that referrals were not prevented by such concerns. Seven percent believed that HBO is potentially carcinogenic. Forty-two percent of respondents felt that they might be at risk for malpractice litigation if a patient had reactivation or acceleration of a malignancy. Among respondents to the questionnaire, there is a consensus that HBO does not have cancer-promoting or accelerating properties.