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Cracchiolo AN, Palma DM, Palmeri M, Tantillo D, Lo Bue R, Braconi A, Caramanna C, Solazzo L, Genco F, Mirto P. Hyperbaric oxygen therapy as adjuvant therapy for odontogenic necrotizing myositis: A case report. Clin Case Rep 2021; 9:e04726. [PMID: 34484762 PMCID: PMC8405431 DOI: 10.1002/ccr3.4726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
In a young man affected by skin soft tissue infections complicated with myositis, the use of hyperbaric oxygen treatment as an adjuvant therapy to surgical debridement and antibiotic therapy could improve management and prognosis.
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Affiliation(s)
- Andrea N. Cracchiolo
- UOC Emergenza Urgenza 118 Servizio di Medicina IperbaricaARNAS Ospedale Civico Di Cristina BenfratelliPalermoItaly
| | - Daniela Maria Palma
- UOS Terapia Intensiva e Trauma Center ARNAS Ospedale Civico Di Cristina BenfratelliPalermoItaly
| | - Marco Palmeri
- UOC Emergenza Urgenza 118 Servizio di Medicina IperbaricaARNAS Ospedale Civico Di Cristina BenfratelliPalermoItaly
| | - Diego Tantillo
- UOC Emergenza Urgenza 118 Servizio di Medicina IperbaricaARNAS Ospedale Civico Di Cristina BenfratelliPalermoItaly
| | - Rosalia Lo Bue
- UOC Emergenza Urgenza 118 Servizio di Medicina IperbaricaARNAS Ospedale Civico Di Cristina BenfratelliPalermoItaly
| | - Andrea Braconi
- UOC Chirurgia Maxillo‐Faciale ARNAS Ospedale Civico Di Cristina BenfratelliPalermoItaly
| | - Claudio Caramanna
- UOC Chirurgia Maxillo‐Faciale ARNAS Ospedale Civico Di Cristina BenfratelliPalermoItaly
| | - Luigi Solazzo
- UOC Chirurgia Maxillo‐Faciale ARNAS Ospedale Civico Di Cristina BenfratelliPalermoItaly
| | - Fabio Genco
- UOC Emergenza Urgenza 118 Servizio di Medicina IperbaricaARNAS Ospedale Civico Di Cristina BenfratelliPalermoItaly
| | - Paola Mirto
- Basingstoke and North Hampshire HospitalHampshireUK
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Cocanour CS, Chang P, Huston JM, Adams CA, Diaz JJ, Wessel CB, Falcione BA, Bauza GM, Forsythe RA, Rosengart MR. Management and Novel Adjuncts of Necrotizing Soft Tissue Infections. Surg Infect (Larchmt) 2017; 18:250-272. [PMID: 28375805 PMCID: PMC5393412 DOI: 10.1089/sur.2016.200] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Necrotizing soft tissue infections (NSTI) have been recognized for millennia and continue to impose considerable burden on both patient and society in terms of morbidity, death, and the allocation of resources. With improvements in the delivery of critical care, outcomes have improved, although disease-specific therapies are lacking. The basic principles of early diagnosis, of prompt and broad antimicrobial therapy, and of aggressive debridement have remained unchanged. Clearly novel and new therapeutics are needed to combat this persistently lethal disease. This review emphasizes the pillars of NSTI management and then summarizes the contemporary evidence supporting the incorporation of novel adjuncts to the pharmacologic and operative foundations of managing this disease.
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Affiliation(s)
| | - Phillip Chang
- Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Jared M Huston
- Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Charles A Adams
- Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Jose J Diaz
- Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Charles B Wessel
- Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Bonnie A Falcione
- Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Graciela M Bauza
- Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Raquel A Forsythe
- Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
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Abstract
Hyperbaric oxygen (HBO2) is the inhalation of 100% oxygen at pressures > 1.4 times atmospheric pressure. Hyperbaric oxygen can be delivered in monoplace (single person) or multiplace (multi-person) chambers. Most clinical HBO2 exposures are between 2 and 2.4 atm abs for approximately 2 hours. Hyperbaric oxygen causes the blood and tissue oxygen levels to increase, reduces the volume of intravascular and tissue bubbles (to treat decompression sickness [DCS] and arterial gas embolism [AGE]), and accelerates wash-out of other gases, such as nitrogen or carbon monoxide (CO), which is important for DCS, AGE, and CO poisoning. Hyperbaric oxygen favorably modulates ischemia-reperfusion injury by transiently inhibiting neutrophil-endothelial interactions, which is important for patients with DCS, AGE, CO poisoning, and potentially other acute ischemic conditions. Because of enhanced oxygen delivery, HBO2 is used for acute crush injury, ischemic flaps and grafts, acute central retinal arterial occlusion, other acute arterial occlusions, and idiopathic sudden sensorineural hearing loss. Hyperbaric oxygen has antimicrobial effects and is offered for patients with limb- or life-threatening infections, such as clostridial gas gangrene and necrotizing fasciitis. The most common US indication for HBO2 is the treatment of ischemic wounds (eg, diabetic lower extremity wounds, late effects of radiation, and refractory osteomyelitis). In ischemic wounds, HBO2 can deliver sufficient oxygen to the nonhealing wound to stimulate angiogenesis and healing through multiple mechanisms, including increased collagen production, increased growth factor receptor numbers, upregulation of vascular endothelial growth factor, increased circulating endothelial progenitor cells, and improvement in neutrophil-mediated host defense. Clinical trials support efficacy of HBO2 for acute CO poisoning, diabetic lower extremity wounds, crush injury, and radiation necrosis. Most hyperbaric chambers are associated with wound care centers and may be hospital based or nonhospital based. We review some of the disorders treated with HBO2 that hospital-based clinicians may be asked to evaluate.
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Affiliation(s)
- Lindell K Weaver
- Medical Director and Division Chief, Hyperbaric Medicine, LDS Hospital, Salt Lake City, UT; Intermountain Medical Center, Murray, UT; Professor of Medicine, University of Utah School of Medicine, Salt Lake City, UT.
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Chocs toxiques dans les infections à cocci à Gram positif. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0460-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gnerlich JL, Ritter JH, Kirby JP, Mazuski JE. Simultaneous necrotizing soft tissue infection and colonic necrosis caused by Clostridium septicum. Surg Infect (Larchmt) 2011; 12:501-6. [PMID: 22142321 DOI: 10.1089/sur.2010.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Clostridial myonecrosis is an uncommon, highly lethal necrotizing soft tissue infection. The source may be occult at the time of clinical presentation. In cases caused by Clostridium septicum, there is an association with colorectal malignant disease, suggesting that underlying colonic pathology frequently is the source of the infection. METHODS Case report and literature review. CASE REPORT A 37-year old man with acquired immunodeficiency syndrome, end-stage renal disease, and C. difficile colitis presented to the Emergency Department (ED) with a primary complaint of abdominal pain and incidental right forearm pain. While undergoing evaluation in the ED, he developed progressive erythema, edema, and emergence of bullae over his right forearm. After rapid imaging of his abdomen, he underwent guillotine amputation of his right upper extremity because of extensive myonecrosis and total abdominal colectomy secondary to right colonic necrosis and C. difficile colitis. Blood cultures were positive for C. septicum. Microscopic examination of both the necrotic colon and the right forearm musculature demonstrated invasion of gram-positive bacilli throughout. CONCLUSIONS Myonecrosis caused by C. septicum frequently occurs in the presence of colonic pathology, typically malignant disease. This case report illustrates the development of this pathological process in an immunosuppressed patient who did not have colon cancer, but rather colonic mucosal inflammation produced by C. difficile.
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Affiliation(s)
- Jennifer L Gnerlich
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Modern Concepts of the Diagnosis and Treatment of Necrotizing Fasciitis. J Emerg Med 2010; 39:261-5. [DOI: 10.1016/j.jemermed.2008.06.024] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 05/08/2008] [Accepted: 06/11/2008] [Indexed: 11/18/2022]
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Affiliation(s)
- D.P. Kuffler
- Institute of Neurobiology, University of Puerto Rico San Juan, Puerto Rico
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Krieg A, Röhrborn A, Schulte Am Esch J, Schubert D, Poll LW, Ohmann C, Braunstein S, Knoefel WT. Necrotizing fasciitis: microbiological characteristics and predictors of postoperative outcome. Eur J Med Res 2009; 14:30-6. [PMID: 19258208 PMCID: PMC3352202 DOI: 10.1186/2047-783x-14-1-30] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Necrotizing fasciitis is a life threatening soft-tissue infection with a high morbidity and mortality. Prompt treatment based on extensive surgical debridement and antibiotic therapies are the therapeutic principles. METHODS The medical records of patients with necrotizing fasciitis (n = 26) from 1996 to 2005 were retrospectively analyzed. RESULTS The localization of necrotizing fasciitis was most commonly the trunk (42.3 %). Type I polymicrobial infection was the dominating infection. The involvement of anaerobic bacteria was associated with an increase in the number of surgical revisions (p = 0.005). Length of postoperative intensive care unit stay, duration of postoperative ventilation and mortality were significantly increased in the ASA IV-V group. Computed tomography displayed only a limited significance as diagnostic tool for initial diagnosis. CONCLUSIONS In severe cases the combination of necrotic skin and soft tissue gas facilitates the correct diagnosis, which should than be followed by immediate - and most often - repeated debridement. If anaerobes are isolated an early and aggressive second look is necessary.
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Affiliation(s)
- Andreas Krieg
- Department of General Surgery, Heinrich Heine University, Moorenstr. 5, 40225 Duesseldorf, Germany.
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Abstract
Hyperbaric oxygen (HBO) therapy is defined by the Undersea and Hyperbaric Medical Society (UHMS) as a treatment in which a patient intermittingly breathes 100% oxygen under a pressure that is greater than the pressure at sea level [a pressure greater than 1 atmosphere absolute (ATA)]. HBO has been shown to be a potent means to increase the oxygen content of blood and has been advocated for the treatment of various ailments, including air embolism, carbon monoxide poisoning, wound healing and ischemic stroke. However, definitive established mechanisms of action are still lacking. This has led to uncertainty among clinicians, who have understandingly become hesitant in regard to using HBO therapy, even in situations where it could prove beneficial. Therefore, this review will summarize the literature regarding the effects of HBO on brain oxygenation, cerebral blood flow and intracranial pressure in both the healthy and injured brains, as well as discuss how changes in these three factors can impart protection.
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Affiliation(s)
- John W Calvert
- Department of Physiology, Division of Neurosurgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
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Barili F, Polvani G, Topkara VK, Dainese L, Cheema FH, Roberto M, Naliato M, Parolari A, Alamanni F, Biglioli P. Role of Hyperbaric Oxygen Therapy in the Treatment of Postoperative Organ/Space Sternal Surgical Site Infections. World J Surg 2007; 31:1702-6. [PMID: 17551783 DOI: 10.1007/s00268-007-9109-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A prospective trial was designed to evaluate the effect of hyperbaric oxygen (HBO) therapy on organ/space sternal surgical site infections (SSIs) following cardiac surgery that requires sternotomy. METHODS A total of 32 patients who developed postoperative organ/space sternal SSI were enrolled in this study from 1999 through 2005. All patients were offered HBO therapy. Group 1 included the patients who accepted and were able to undergo HBO therapy (n = 14); group 2 included patients who refused HBO therapy or had contraindications to it (n = 18). RESULTS The two groups were well matched at baseline with comparable preoperative clinical characteristics and operative factors. Staphylococcus was the most common pathogen for both groups. The duration of infection was similar in groups 1 and 2 (31.8 7.6 vs. 29.3 5.7 days, respectively, p = 0.357). The infection relapse rate was significantly lower in group 1 (0% vs. 33.3%, p = 0.024). Moreover, the duration of intravenous antibiotic use (47.8 +/- 7.4 vs. 67.6 +/- 25.1 days, p = 0.036) and total hospital stay (52.6 +/- 9.1 vs. 73.6 +/- 24.5 days, p = 0.026) were both significantly shorter in group 1. CONCLUSION Hyperbaric oxygen is a valuable addition to the armamentarium available to physicians for treating postoperative organ/space sternal SSI.
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Affiliation(s)
- Fabio Barili
- Department of Cardiovascular Surgery, University of Milan, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy.
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Fatimi S, Sheikh S, Shafiq M, Shah Z. Non-Clostridial Gas Gangrene of the Neck and Mediastinum. Asian Cardiovasc Thorac Ann 2007; 15:e12-3. [PMID: 17244906 DOI: 10.1177/021849230701500128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Herein we report a case of gas gangrene of the neck and mediastinum in a poorly managed Type II diabetic with concomitant chronic renal failure and a recent history of mucormycosis. Despite the burden of co-morbidities and the gravity of the illness, the patient was successfully treated and remained free of complications in the long term.
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Affiliation(s)
- Saulat Fatimi
- Juma Building, Aga Khan University, Stadium Road, Karachi, Pakistan
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Huang KC, Hsu WH, Peng KT, Huang TJ, Hsu RWW. Hyperbaric oxygen therapy in orthopedic conditions: an evaluation of safety. ACTA ACUST UNITED AC 2006; 61:913-7. [PMID: 17033562 DOI: 10.1097/01.ta.0000196702.26858.56] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because of the documented cellular and biochemical benefits of hyperbaric oxygen (HBO), HBO therapy is applied now with increasing frequency to various orthopedic conditions. Many traumatologists and orthopedic surgeons might refer their patients for adjuvant HBO therapy. However, the potential risks and risk-benefit ratio have often been underemphasized in therapeutic trials. METHODS From October 2002 to September 2004, 240 patients with a total of 4,638 treatments received HBO therapy at the hyperbaric medicine center of our institution on an identical treatment protocol. HBO therapy patient treatment logs were reviewed to analyze the incidence of complications during HBO treatment. RESULTS The overall incidence of complications was 1.83%. Over 94% of treatment complications were mild to moderate and designated as minor complications; fewer than 6% were severe or life threatening and designated as major complications. The incidence of major complications (central nervous system [CNS] oxygen toxicity in this series) was 0.109%. There was no mortality. Two patients with unusual presentation of CNS oxygen toxicity were observed during the study period. CONCLUSIONS HBO therapy in orthopedic conditions is considered as a safe treatment because of a very low complication rate; however, analysis of patients with CNS oxygen toxicity revealed its unpredictability and inevitability. Although it is common sense that patients who develop a seizure in the hospital need help from the medical staff, it cannot be done in a monoplace hyperbaric chamber because of pressure unequalization. Therefore, a multiplace chamber equipped with an antechamber for medical contingency is possibly the better facility in consideration of safety.
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Affiliation(s)
- Kuo-Chin Huang
- Department of Orthopaedics, Chang Gung Memorial Hospital at Chia-Yi, Taiwan.
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The effect of hyperbaric oxygenation on thein vitro growth ofEscherichia coli in environments with and without blood cells. ANN MICROBIOL 2006. [DOI: 10.1007/bf03174974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
Recent studies show that low oxygen tension levels in cell culture up-regulate the replication of human B19 parvovirus, Kaposi's sarcoma, and human immunodeficiency viruses as well as the expression of viral oncogenic proteins. The mechanisms of this regulation proceed with the major hypoxia-related factor, HIF-1 (hypoxia inducible factor-1). HIF-1 misregulation is implicated in the oncogenesis potential of some of these viruses.
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Affiliation(s)
- Sylvie Pillet
- Laboratoire de bactériologie-virologie, Hôpital Nord et Faculté de médecine Jacques Lisfranc, CHU de Saint-Etienne, 27, boulevard Pasteur, 42100 Saint-Etienne, France.
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Gaggl AJ, Rainer H, Grund E, Chiari FM. Local Oxygen Therapy for Treating Acute Necrotizing Periodontal Disease in Smokers. J Periodontol 2006; 77:31-8. [PMID: 16579700 DOI: 10.1902/jop.2006.77.1.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The main aim of treatment for acute necrotizing periodontal disease is fast and effective reduction of anaerobic destructive microorganisms to avoid periodontal damage. The effect of adjunctive local oxygen therapy in the treatment of necrotizing periodontal disease was examined in this study. METHODS Thirty patients with acute necrotizing periodontal disease were treated with the systemic antibiotics amoxicillin, clavulanic acid, and metronidazole. In 15 out of 30 patients, adjunctive local oxygen therapy was administered. The patients were followed from the first to 10th day of treatment with clinical and bacteriological examinations. The clinical examination registered gingival bleeding, periodontal probing depth, and attachment loss; to follow up microbiological colonization of the periodontal sulcus, five representative bacteria were registered by a semiquantitative DNA polymerase chain reaction test. RESULTS In both groups of patients, colonization with Prevotella intermedia, Tannerella forsythensis, and Treponema denticola was initially positive. None of these three microorganisms were completely eradicated in any of the patients in the group without oxygen therapy within the first 10 days of treatment. In the group with adjunctive oxygen therapy, all patients either showed a reduction in or complete eradication of the microorganisms, resulting in more rapid clinical restitution with less periodontal destruction. CONCLUSIONS Adjunctive oxygen therapy results in early eradication of pathogenic anaerobic microorganisms in cases of acute necrotizing periodontal disease. The damage to periodontal tissue is reduced.
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Affiliation(s)
- Alexander J Gaggl
- Department of Oral and Maxillofacial Surgery, General Hospital/LKH Klagenfurt, Klagenfurt, Austria.
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