The most commonly used treatment for sensorineural sudden hearing loss (SSHL) in clinical practice is the administration of steroids; however, a favorable result is not always obtained. We studied 58 patients who failed to recover after primary treatment with IV steroids, 44 of these met our inclusion criteria (mean age 50.7, 27 males, range 30-74). We treated 23 patients (mean age 47.3, 16 males, age range 22-74) with hyperbaric oxygen therapy (HBO) (2.5 ATA for 60 min for 15 treatments), while 21 (mean age 54.5, 11 males, age range 22-71) patients refused to be treated and served as a non-randomized control group. Patients treated with HBO had a mean improvement of 15.6 dB (SD ± 15.3), with 1 of them completely healed, 5 with a good recovery, 10 with a fair recovery and 7 unchanged. Patients who were not treated had a spontaneous mean improvement of 5.0 dB (SD ± 11.4) with 3 patients with a good recovery, 1 patient with a fair recovery and 17 patients unchanged. Mean improvement was significantly better in patients treated with HBO compared to controls (p = 0.0133). Patients with worst hearing had the greater degree of improvement whether or not they were treated in the first 10 days after the onset of the hearing loss or between 11 and 30 days. In conclusion, hyperbaric oxygen therapy can lead to significant improvement of pure tone hearing thresholds in patients with SSHL who failed primary corticosteroid treatment and are within 4 weeks of the onset of deafness.
VINE IS P , TERRACINI B, C ICCO NE G, CIGNE1TI A, COLOM BO E, DONNA A, MA FFI L, PIS A R, RICCI P , ZANINI E, CO MBA P . Pheno xy herb icides and soft-tissue sa rcomas in female rice weeders: A pop ulat ion-b ased case-referent study. Scand J Work Environ Health 13 (1987) 9 -17. A populat ionbased case-referent study was conducted in a n a rea of northern Italy where rice growing is the predom inant agric ultural activ ity and ph enoxy herb icides have been used since 1950. Manual rice weedin g was for merly performed by a seaso nal female working population; in the early 1950s these women were concurrently exposed to chem ical herb icides. Sixty-eight persons repre sentin g incident and histologically revised cases (31 women ) and 158 popul atio n referents (73 women) were intervie wed . Th e cases were histologica lly conf irmed indepe nde nt ly by two blinded path ologists, and expos ure to pheno xy her bicides was assessed by two blind ed pesticid e resea rchers. An age-adj usted odds ratio 01'0_91 was found fo r the living men (with suspect exposures; no man diagnosed as a case had been exposed with certainty to phenoxy herbicides). Among the living women the relative risk was 2.7 (90 "70 confidence interv al 0.59 -12.37), an d it further increased when att ention was restricted to women exposed in the whole 1950 -1955 period and to younger age groups.
Hepatic artery thrombosis (HAT) after liver transplantation (LT) is a severe complication occurring more frequently in pediatric patients or when partial livers (split, living donor graft) are used [1]. Hyperbaric oxygen therapy (HBO) has been described to be effective in relation to treatment of hepatic artery thrombosis after liver transplantation [2][3][4]: it has been shown to reduce hepatocellular necrosis [5] and promote liver regeneration in living donor liver transplantation (LDLT) [6] and in a massive hepatectomy model in rats [7].We successfully used HBO therapy in a case of late HAT after split LT. A 64-year-old HCV+ woman underwent LT in May 2005; the weight of the left graft (segments I-II-III-IV) was 480 g and the graft-to recipient body weight (GRBW) ratio was 0.9. The donor common hepatic artery was end-to-end anastomosed to the recipient common hepatic artery. The first postoperative course turned out without complications and the patient was discharged on postoperative day (POD) 11.Twenty months after LT, Cholangio-MR evidenced the presence of biliary sludge associated with a dilatation of intrahepatic biliary ducts; Doppler ultrasonic (US) and CT Scan showed normal hepatic artery flow. The patient was submitted to a percutaneous transhepatic dilatation of an anastomotic stricture, but the procedure was not effective. Three months later a Roux-en-Y hepaticojejunal anastomosis was performed, and an intra-operative laceration of the hepatic artery next to the hilum occurred. The damaged tract was removed and an endto-end anastomosis with interposition of an iliac arterial graft was performed. Doppler US at the end of surgery showed a regular patency of intrahepatic arterial blood flow. Patient was started on systemic heparin. On POD 1, Doppler US showed the absence of intrahepatic arterial flow; a spiral high-resolution CT-scan confirmed the absence of arterial flow inside the graft and evidenced a complete occlusion of the interposed graft without any collateral circulation; ischemic areas in the contest of segments II-III were also present. Given the technical impossibility to perform a surgical revision, HBO was proposed to reduce the ischemic damages. After ensuring the absence of contraindications [8], the patient underwent 20 HBO sessions, performed once a day in a multiplace chamber (Drass s.p.a. Type 1502). Doppler US showed the presence of intrahepatic arterial blood flow since the 4th day after beginning of HBO. A CT scan performed at the end of HBO showed a significant decrease of ischemic areas and the presence of intrahepatic arterial vascularization by collateral vessels. Eighteen months after HBO, Doppler US and CT scan confirmed the presence of arterial flow inside the graft; ischemic areas completely disappeared.Our experience suggested that HBO was a safe technique and it contributed to the development of collateral vessels, avoiding a late retransplantation and reducing the risk of hepatic necrosis; the ability of the liver to spontaneously recruit collateral arterial supply in...
Background: Carbon Monoxide (CO) poisoning is a frequent cause of intoxication. However, CO poisoning incidence is globally underreported, as well as its features, especially in Italy. The aim of this study was to investigate such characteristics of CO intoxication and foster the creation of the Italian Registry of Carbon Monoxide Poisonings. Methods: A data collection tool was developed and organized in five sections: Patient’s characteristics; CO intoxication modality; emergency medical service and emergency department; hyperbaric facility; outcomes. The tool was validated through a retrospective analysis, including CO intoxicated patients treated in 14 Italian hyperbaric facilities between 2015 and 2016. Results: A total of 1383 patients were included. The high completion ratio (85%) of the collection tool suggests its feasibility in practical terms. CO intoxications were mostly accidental (93.64%) and caused by solid fuel (48.59%). There was not a uniform application of hyperbaric oxygen treatment protocols, but most of the patients were adequately treated at least at 2.5 ATA for more than 60 min (44.97%). Conclusion: This analysis provided new information that was previously unavailable in this country. Furthermore, this tool proved to be a valid base for future registry aiming to consolidate the body of knowledge about CO intoxications in Italy.
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