Background: Scleroderma is an autoimmune condition in which collagen deposits in abnormally high concentration in the subcutaneous tissue and other areas of the body. In some cases, this restricts blood supply to the skin and prevents normal wound healing. Wounds fester and become infected, decreasing oxygen delivery even further. Hyperbaric oxygen delivers oxygen to ischemic, marginal wounds and is known to accelerate wound healing by as much as 50%. Additionally, hyperbaric oxygen is an immunomodulator, which decreases the production of ICAM and Tumor Necrosis Factor alpha by vascular endothelial cells and neutrophils (Refs 1,2,3,4,5).

 

Study Design: A 50 year-old white female ceramic artist with diffuse scleroderma for 10 years was referred to our Institution for evaluation of more than 10 open wounds in both her upper extremities, present for at least 6 months, and refractory to every conventional therapy.

A 46 year-old white male trumpet player with cutaneous scleroderma for 7 years was referred to our Institution for symptoms of Raynaud and ulcers on his fingertips lasting the entire winter season, associated with numness in his fingers on both hands.

Each patient was given 50 consecutive 90 min. sessions of Hyperbaric Oxygen with a mild hyperbaric chamber at 1.3 ATA.

 

Results: In both cases, initial oxygen saturation readings were not obtainable in any of the fingers, which were pale and insensate. Both patients had 5 to 10 episodes of Raynaud per day. No change was observed during the first 10 treatments. After the 20th, it was observed that the episodes of Raynaud, which had been decreasing, had completely abated. Oxygen saturation readings became obtainable and improved slowly. At 30 treatments, both patients showed definite evidence of healing their wounds. Additionally, sensation returned to the tip of their fingers. At 40 treatments, their pulse oxymeter readings were consistently 98% in all fingers, and there was a dramatic progress in wound healing. Therapy was stopped at 50 sessions. Approximately a year after hyperbaric oxygen therapy was discontinued, wounds remained healed and pulse oxymeter readings continued to be 98%, suggesting that new capillary growth had been permanently achieved. New wounds did not get infected and healed rapidly. Though before their treatments, both patients had experienced a slow progression of their disease, no new symptoms had appeared. In fact, there appeared to be a regression in the amount of deposited collagen.

 

Conclusions: Although scleroderma is not an approved indication for hyperbaric oxygen therapy, the ischemia it causes can be combated by hyperbaric oxygen. The diffusion of oxygen in areas of the body, ischemic because of scleroderma, may change the number and distribution of capillaries in these areas, thus allowing healing. Additionally, hyperbaric oxygen may ameliorate this debilitating chronic autoimmune condition.

 

1. Buras JA, Stahl GL, Svoboda KK, Reenstra WR. Hyperbaric oxygen downregulates ICAM-1 expression induced by hypoxia and hypoglycemia: the role of NOS. Am. J. Cell. Physiol. 2000 Feb;278(2):C292-302.

 2. Hong JP, Kwon H, Chung YK, Jung SH. The effect of hyperbaric oxygen on ischemia-reperfusion injury: an experimental study in a rat musculocutaneous flap. Ann. Plast. Surg. 2003 Nov;51(5):478-487.

3. Yamashita M, Yamashita M. Hyperbaric oxygen treatment attenuates cytokine induction after massive hemorrhage. Am. J. Physiol. Endocrinol. Metab. 278:E811-E816, 2000.

4. Wallace DJ, Silverman S, Goldstein J, Hughes D. Use of hyperbaric oxygen in rheumatic diseases: case report and critical analysis. Lupus 1995 Jun;4(3):172-175.

5. Thom SR, Mendiguren I, Hardy K, et al. Inhibition of human neutrophil beta2 integrin-dependent adherence by hyperbaric O2. Am J Physiol. 1997;272(3 Pt 1):C770-777.

 

 

Background: Ischemic stroke is common, debilitating, and disruptive. Recent advances in medical therapy have reduced mortality, but complete recovery, though frequent, may take weeks or, more commonly, months. HBO, though not an approved therapeutic modality, has been known to increase rate of wound healing by as much as 50%. We tested the hypothesis that the same could be true for ischemic strokes. 

 

Study Design: Three patients with recent ischemic strokes were entered in this study. Another two patients with similar symptoms could not, or would not receive HBO and were followed clinically. The times of all strokes varied between 8 and 32 days. Disabilities ranged from hemianopsia to unilateral lower extremity weakness. All patients complained of short term memory loss, difficulty in maintaining concentration and disorientation. Patients underwent 20 consecutive daily sessions of HBO at 1.3 ATA for  90 min. or no HBO therapy.

 

Results: In the HBO group, no benefit was seen for the first 10 sessions. At times varying between the 12th and 15th session, disorientation and confusion lifted, with return to clear decision-making and active participation in their physical rehabilitation. After the 20th session, field of vision demonstrated a 15 and 25% improvement (2 patients), motor strength was improved (1 patient), sense of well-being had returned in all patients. Symptoms of disorientation and weakness were still present in both non-HBO patients two months after their stroke, though they had some return of their muscular tone. 

 

Conclusions: Though HBO in the proper dose, in the face of an acute stroke, is as effective as tPA, (1) it cannot recover neurons after they have died. However, it may accelerate the speed of recovery, possibly by decreasing cerebral edema (2) and inducing growth of new capillaries.

 

References:

1. Boer KM, Boer RC Jr, Strauss MB, Jimenez A, Minkiewitz KM. Hyperbaric oxygen therapy for acute ischemic stroke. Undersea Hyperb Med. 1998;5(suppl):13.Abstract.

2. Pearson RR, Goad RF. Delayed cerebral edema complicating cerebral arterial gas embolism: case histories. Undersea Biomed Res. 1982;9;283-296. 

 

Other stroke references: 

 

1. Nighoghossian N, Trouillas P, Adeleine P, Salord F. Hyperbaric oxygen in the treatment of acute ischemic stroke: a double-blind pilot study. Stroke. 1995;26:1369-1372.

2. Rogatsky GG, Shifrin EG, Mayevsky A. Optimal dosing as a necessary condition for the efficacy of hyperbaric oxygen therapy in acute ischemic stroke: a critical review. Neurol Research. 2003;25:95-98.

3. Holbach KH, Caroli A, Wassmann H. Cerebral energy metabolism in patients with brain lesions in normo- and hyperbaric oxygen pressures. J Neurol. 1977;217-17-30.

4. Thom SR. Antagonism of carbon dioxide-mediated brain lipid peroxidation by hyperbaric oxygen. toxicol Appl Pharmacol. 1990;105:340-344.

5. Ronning OM, Guldvog B. Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial. Stroke. 1999;30:2033-2037.

6. Anderson DC, Bottini AG, Jagiella WM, et al. A pilot study of hyperbaric oxygen in the treatment of human  stroke. Stroke. 1991;22:1137-1142.

 

 

 

Background: Ulcerative colitis (UC) affects 1.2 million people in the USA, mostly teen-agers to young adults. It is a disease in which the last 3 feet of our bowel, the colon, lose their inner layer, the mucosa. Inflammation, or cryptitis, of the budding portion of the mucosa, is a hallmark of the disease. Mayor complications are sclerosing cholangitis, which leads to liver failure necessitating transplant, and colon cancer. Its cause is unknown. Hyperbaric oxygen, by decreasing inflammation and promoting healing, could improve this condition. 

 

Case Report: Two white males, 30 and 27 year-old, diagnosed with UC three and seven years prior to their hyperbaric treatment, were referred to our Center. They had failed every therapy, and were on 40 mg of prednisone or 30 mg of 5MP a day. In spite of it, they were having 7-9 bloody bowel movements a day, and were home-confined, disabled, not being able to maintain employment. They underwent 45 to 65 sessions of HBO at 1.3 ATA, 120 min twice a day, in their own home.

 

Results: In both patients, no improvement was seen for the first 15 sessions. By the 20th, bleeding subsided. By the 30th, the number of bowel movements was reduced to 2 per day. By the 40th, the stool was solid, without blood. Patients' stool leukocyte count (2,3) was improved (3-5/hpf), suggesting decreased inflammation. In the patient on prednisone, liver function tests revealed a 35% decrease in alkaline phosphatase (280 to 182) suggesting an improvement of his sclerosing cholangitis. Both patients could leave their house for the first time in years, and return to work. Both are off steroid and antimetabolitic drugs.

 

Conclusions: Mild HBO is effective in the treatment of Ulcerative Colitis. Inflammation is reduced, or, as in our cases, truncated.

 

S.G., 57 years old male reports regarding his experience with HBOT in treating his Crohn's Disease. 

 

References:

1. Logan R.Inflammatory bowel disease incidence: up, down or unchanged?

Gut. 1998, March;42:309-311.

2. Silberer H, Kuppers B, Mickisch O, Baniewicz W, Drescher M, Traber L, Kempf A, Schmidt-Gayk H. Fecal leukocyte proteins in inflammatory bowel disease and irritable bowel syndrome.Clin Lab.2005;51(3-4):117-126.

3. Hanauer S. Update on the Etiology, Pathogenesis and Diagnosis of Ulcerative Colitis. Nat Clin Pract Gastroenterol Hepatol.2004;1(1):26-31. 

 

 

 

Background: Lyme disease affects two hundred thousand people a year in the United States. Diagnosis is frequently delayed and treatment complex, involving years of therapy. Though rarely life-threatening, it constantly interferes with daily life.

 

Study Design: A twenty-four year old woman, diagnosed with Lyme disease a year prior, but symptomatic for more than three, was referred to our clinic for treatment. She slept four hours a night, was weak and listless, couldn't hold a job, and had severe joint and muscle pains. After a thorough history and physical exam, she was cleared for hyperbaric treatment. A minimum of 40, 120 min. treatment were administered. The patient never received antibiotics, or any other treatment.

 

Results: Benefit was seen almost immediately. By the the tenth session, the patient was sleeping a full night sleep, and the joint and muscle pains had subsided completely. Activity level increased steadily, as well as her well being.   

 

Conclusions: HBO may be effective in the treatment of Lyme disease in selected patients.

 

 

Background: Multiple sclerosis (1) is a progressive, debilitating autoimmune disease in which the myelin of peripheral nerves is destroyed. It has periods of relative quiescence alternated with reactivation. Though HBO has been used and researched with this disease (2), controversy exists about its benefit. We propose the hypthesis that, because loss of nerve function leads to disappearance of neuromuscular placques and consequent loss of musculature, early treatment, within 1 year of diagnosis, has the best chance of success. We further propose that, since HBO diminishes inflammation and levels of inflammatory mediators, discontinuation of HBO may lead to return of progression of the disease. 

 

Study Design: Three female patients with MS age 42, 48 and 53 were diagnosed with MS 3 to 12 months prior to HBO therapy. Symtoms ranged from transient difficulty focusing to intermittent weakness of their upper extremities, to inability to control bladder function and didn't improve with traditional medical thrapy. Each underwent 42-60, 120 min. daily sessions with complete resolution of their symptoms. Two patients continued daily therapy to 100 and 120 sessions, then tapered down to 2 weekly sessions, without return of symptoms. One patient interrupted her therapy at 49 sessions, and felt well.

 

Results: At 1 year, symptoms had not returned in the treated patients, but did in the third, who had stopped therapy.

 

Conclusions: This small study suggests that with thorough patient selection and adequate therapy, HBO may be beneficial in patients with early MS.

 

F: CHRONIC SYMPATHETIC DYSTROPHY: A TREATABLE DEBILITATING DISEASE. CASE REPORT

Sympathetic dystrophy starts innocently: a sprained ankle, a toe infection, a torn ligament, but the pain doesn't end, even when the injury has healed. It continues, and migrates upward, jumps to the unaffected limb. As a result, the sufferer is relegated to bed, treated with pain medications.

 

We report a case of a teenage girl who didn't respond well to conventional therapy, but began to feel better after 20 sessions of HBO at 2 ATA, and had remarkable results after another 20. But her life was upside down with daily travel. A trial of 20 sessions in a mild hyperbaric chamber convinced her that she could live symptoms free at home with ther own chamber. To this date, she has responded as well to daily 2-hour sessions in a mild (1.3 ATA)hyperbaric oxygen chamber, and her symtoms have not returned.

 

Gianna Scannell MD