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ISBN: 978-1-61676-361-9
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1;Table of Contents;8
2;Foreword;10
3;Foreword to the Third Edition;11
4;Preface to the Fifth Edition;13
5;Preface to the Fourth Edition;13
6;Preface to the Third Edition;14
7;Preface to the Second Edition;14
8;Preface to the First Edition;15
9;PART I: BASIC ASPECTS;16
9.1;History of Hyperbaric Medicine;18
9.1.1;Hyperbaric Therapy and Diving Medicine;19
9.1.2;The Development of Hyperbaric Air Therapy;20
9.1.3;The Development of Hyperbaric Oxygen Therapy;23
9.2;Physical, Physiological, and Biochemical Aspects of Hyperbaric Oxygenation;24
9.2.1;Introduction;25
9.2.2;Physiology of Oxygenation;25
9.2.3;Hyperbaric Oxygenation;29
9.2.4;General Effects of HBO on the Healthy Human Body;31
9.2.5;Biochemical Effects of HBO;33
9.2.6;Effect of HBO at Molecular Level;34
9.2.7;Conclusions;34
9.3;Effects of Diving and High Pressure on the Human Body;36
9.3.1;Physical Effects of Pressure;37
9.3.2;Effects of Pressure on Various Systems of the Body;37
9.3.3;Effects of High Pressure Environments on the Nervous System;39
9.3.4;Hearing and Vestibular Impairment in Hyperbaric Environments;42
9.3.5;Taste Sensation Under High Pressure;44
9.3.6;Effect of High Pressure on Effect of Drugs;44
9.3.7;Conclusions;44
9.4;Physical Exercise Under Hyperbaric Conditions;46
9.4.1;Introduction;47
9.4.2;Exercise Under Hypoxia;47
9.4.3;Exercise in Hyperbaric Environments;48
9.4.4;Exercise Under Hyperoxia;48
9.4.5;Physical Exercise Under Hyperbaric Conditions;49
9.4.6;Conclusions;51
9.5;Hypoxia;52
9.5.1;Introduction;53
9.5.2;Pathophysiology of Hypoxia;53
9.5.3;General Impact of Hypoxia;53
9.5.4;Effects of Hypoxia on the Brain;54
9.5.5;Role of HBO in the Treatment of Hypoxic States;60
9.5.6;Possible Dangers of HBO in Hypoxic States;60
9.6;Oxygen Toxicity;62
9.6.1;Introduction;63
9.6.2;Pathophysiology of Oxygen Toxicity;63
9.6.3;Pathology of Oxygen Toxicity;64
9.6.4;PulmonaryOxygen Toxicity;66
9.6.5;Oxygen-Induced Retinopathy;67
9.6.6;Factors that Enhance Oxygen Toxicity;67
9.6.7;Central Nervous System Oxygen Toxicity;68
9.6.8;Clinical Monitoring for Oxygen Toxicity;70
9.6.9;Protection Against Oxygen Toxicity;71
9.6.10;Extension of Oxygen Tolerance;72
9.6.11;Conclusion and Directions for Future Research;73
9.6.12;Equipment Used in Hyperbaric Medicine;75
9.6.13;Technique of Hyperbaric Oxygenation;81
9.6.14;Ancillary Equipment;82
9.7;Hyperbaric Chambers:Equipment,Technique,and Safety;74
9.8;Indications,Contraindications, and Complications ofHBO Therapy;90
9.8.1;Indications;91
9.8.2;Contraindications;91
9.8.3;Complications of Hyperbaric Oxygenation;92
9.8.4;Precautions in Selection of Patients for HBOTreatment;94
9.8.5;Conclusions;95
9.9;Drug Interactions with Hyperbaric Oxygenation;96
9.9.1;Oxygen as a Drug;97
9.9.2;Drugs Affecting the Central Nervous System (CNS);97
9.9.3;Interaction of HBO with Various Drugs;97
9.9.4;Practical Considerations of Drug Administration During HBO Therapy;98
9.9.5;Drugs that Enhance Oxygen Toxicity;98
9.9.6;Drugs that Protect Against Oxygen Toxicity;99
9.9.7;Conclusions;99
10;PART II: CLINICAL APPLICATIONS;100
10.1;Decompression Sickness;102
10.1.1;Introduction;103
10.1.2;Pathophysiology;103
10.1.3;Clinical Features;108
10.1.4;Diagnosis;109
10.1.5;Treatment;110
10.1.6;Management of Neurological Manifestations of Decompression Sickness;112
10.1.7;Risk Factors for DCS;117
10.1.8;Conclusions;117
10.2;Cerebral Air Embolism;118
10.2.1;Causes;119
10.2.2;Mechanisms;119
10.2.3;Pathophysiology;119
10.2.4;Clinical Features;120
10.2.5;Diagnosis;120
10.2.6;Treatment;121
10.2.7;Clinical Applications of HBO;122
10.2.8;Ancillary Treatments;122
10.2.9;Hyperbaric Treatment in Special Situations;123
10.2.10;Conclusions;125
10.3;Carbon Monoxide and Other Tissue Poisons;126
10.3.1;Classification of Tissue Poisons;127
10.3.2;Carbon Monoxide Poisoning;127
10.3.3;Controversies in the Use of HBO for CO Poisoning;144
10.3.4;Cyanide Poisoning;145
10.3.5;Hydrogen Sulfide Poisoning;146
10.3.6;Carbon Tetrachloride Poisoning;146
10.3.7;Methemoglobinemias;147
10.3.8;Miscellaneous Poisons;147
10.3.9;Conclusions: Poisoning Other than with CO;148
10.4;HBO Therapy in Infections;150
10.4.1;Host Defense Mechanisms Against Infection;151
10.4.2;HBO in the Treatment of Soft Tissue Infections;152
10.4.3;HBO in the Management of AIDS;158
10.4.4;Miscellaneous Infections;159
10.4.5;Osteomyelitis;160
10.5;HBO Therapy in Chronic Lyme Disease;164
10.5.1;Rationale for Using Hyperbaric Oxygen Therapy;166
10.5.2;Pilot Program at Texas A&M University;166
10.5.3;Ethical Considerations in Using HBO for Unproven Indications;168
10.5.4;Regulatory Aspects of HBO in Relation to Lyme Disease;169
10.5.5;Conclusions;169
10.6;HBO Therapy inWound Healing, Plastic Surgery, and Dermatology;172
10.6.1;Introduction;173
10.6.2;Wound Healing;173
10.6.3;Wound Healing Enhancement by Oxygen;174
10.6.4;Role of HBO in NonhealingWounds and Ulcers;177
10.6.5;HBO as an Aid to the Survival of Skin Flaps and Free Skin Grafts;185
10.6.6;HBO as an Adjunct in the Treatment of Thermal Burns;187
10.6.7;Applications of HBO in Dermatology;190
10.7;HBO Therapy in the Management of Radionecrosis;192
10.7.1;Introduction;193
10.7.2;Radiation Physics;193
10.7.3;Radiation Biology;193
10.7.4;Radiation Pathology;193
10.7.5;HBO Therapy for Radionecrosis;194
10.7.6;Management of Osteoradionecrosis;195
10.7.7;Management of Radionecrosis of CNS;197
10.7.8;Management of Radionecrosis of Soft Tissues;199
10.7.9;Effect of HBO on Cancer Recurrence;201
10.7.10;Conclusions;202
10.8;The Use of HBO in Treating Neurological Disorders;204
10.8.1;Effect of HBO on the Blood-Brain Barrier;207
10.8.2;Effect of HBO on Oxygen Tension in the Cerebrospinal Fluid;207
10.8.3;Rationale for the Use of HBO in Neurological Disorders;208
10.8.4;Indications for the Use of HBO in Neurological Disorders;211
10.8.5;Diagnostic Procedures Used for Assessing the Effect of HBO;212
10.8.6;Use of HBO in Miscellaneous Neurological Disorders;216
10.8.7;Neurological Disorders in Which HBO Has Not Been Found to Be Useful;217
10.9;The Role of Hyperbaric Oxygenation in the Management of Stroke;220
10.9.1;Introduction;221
10.9.2;Epidemiology of Stroke;221
10.9.3;Pathophysiology of Stroke;222
10.9.4;An Overview of the Conventional Management of Stroke;233
10.9.5;Role of HBO in the Management of Acute Stroke;236
10.9.6;HBO as a Supplement to Rehabilitation of Stroke Patients;244
10.9.7;Conclusions;247
10.10;HBO Therapy in Global Cerebral Ischemia/Anoxia and Coma;250
10.10.1;Introduction;251
10.10.2;Pathophysiology;251
10.10.3;Rational Basis of HBO Therapy;252
10.10.4;Review of Animal Experimental Studies;253
10.10.5;Review of Human Clinical Studies;270
10.10.6;Case Studies;274
10.11;HBO Therapy in Neurosurgery;290
10.11.1;Introduction;291
10.11.2;Role of HBO in the Management of Traumatic Brain Injury;291
10.11.3;Role of HBO in the Management of Spinal Cord Injury;295
10.11.4;HBO as an Adjunct to Radiotherapy of Brain Tumors;298
10.11.5;Role of HBO in the Management of CNS Infections;299
10.11.6;Role of HBO in Cerebrovascular Surgery;300
10.11.7;Conclusions;304
10.12;HBO Therapy in Multiple Sclerosis;306
10.12.1;Introduction;307
10.12.2;Pathogenesis;307
10.12.3;Rationale for HBO Therapy;307
10.12.4;Clinical Trials of HBO in Multiple Sclerosis;308
10.12.5;Conclusions;313
10.13;HBO in the Management of Cerebral Palsy;314
10.13.1;Causes of Cerebral Palsy;315
10.13.2;Oxygen Therapy in the Neonatal Period;315
10.13.3;Treatment of Cerebral Palsy with HBO;316
10.14;HBO Therapy in Headache;326
10.14.1;Introduction;327
10.14.2;Vascular Headaches;327
10.14.3;Epidemiology of Vascular Headache;327
10.14.4;Mechanisms of Vascular Headache;327
10.14.5;Commonly Used Anti-Migraine Drugs;328
10.14.6;Nonpharmacologic Approaches;328
10.14.7;Rationale for Use of HBO in Migraine;328
10.14.8;Use of Oxygen in Migraine Treatment;329
10.14.9;Use of HBO for Treatment of Cluster Headache;331
10.14.10;Conclusions;332
10.15;HBO Therapy in Cardiovascular Diseases;334
10.15.1;Introduction;335
10.15.2;Pathophysiology;335
10.15.3;Hyperbaric Oxygenation in Cardiology;335
10.15.4;HBO in Shock;342
10.15.5;HBO in Peripheral Vascular Disease;344
10.16;HBO Therapy in Hematology and Immunology;354
10.16.1;Introduction;355
10.16.2;Effect of HBO on Red Blood Cells;355
10.16.3;Effect of HBO on Leukocytes;357
10.16.4;Effect of HBO on Platelets;357
10.16.5;Effect of HBO on Stem Cells;358
10.16.6;Effect of HBO Treatment on the Immune System;358
10.16.7;Effect of HBO Treatment on Plasma and Blood Volume;359
10.16.8;Clinical Applications of HBO in Disorders of the Blood;360
10.17;HBO Therapy in Gastroenterology;362
10.17.1;Introduction;363
10.17.2;HBO in Peptic Ulceration;363
10.17.3;Clinical Assessment of HBO in Gastric and Duodenal Ulcer Patients;363
10.17.4;HBO in the Treatment of Intestinal Obstruction;364
10.17.5;Experimental Studies in Animals;365
10.17.6;HBO Therapy in Adynamic Ileus;365
10.17.7;HBO in Adhesive Intestinal Obstruction;366
10.17.8;HBO in Chronic Idiopathic Intestinal Pseudo-Obstruction;366
10.17.9;HBO in Inflammations and Infections of the Gastrointestinal Tract;366
10.17.10;HBO in Pneumatosis Cystoides Intestinalis (PCI);367
10.17.11;HBO in Ischemic Disorders of the Intestine;368
10.17.12;Use of Hyperbaric Therapy in Removal of Entrapped Intestinal Balloons;368
10.17.13;HBO in Acute Pancreatitis;369
10.17.14;HBO in Diseases of the Liver;369
10.17.15;Conclusions Regarding the Use of HBO in Gastroenterology;371
10.18;HBO and Endocrinology;372
10.18.1;Introduction;373
10.18.2;Thyroid Glands;373
10.18.3;Epinephrine/Norepinephrine;373
10.18.4;Glucocorticoid Receptors;373
10.18.5;Adrenocortical Function;373
10.18.6;Prostaglandins;373
10.18.7;Testosterone;374
10.18.8;Clinical Applications;374
10.18.9;Conclusions;375
10.19;HBO and Pulmonary Disorders;376
10.19.1;Introduction;377
10.19.2;Lung Mechanics and Pulmonary Gas Exchange;377
10.19.3;PulmonaryOxygen Toxicity;377
10.19.4;Clinical Applications;378
10.19.5;Contraindications;380
10.19.6;Conclusions;380
10.20;HBO Therapy in Pediatric Surgery;382
10.20.1;Introduction;383
10.20.2;Hyperbaric Chambers for Children;383
10.20.3;Technique of Hyperbaric Oxygenation in Children;384
10.20.4;Efficacy of HBO in Surgical Disorders of Children;386
10.20.5;Conclusions;389
10.21;Hyperbaric Oxygenation in Traumatology and Orthopedics;390
10.21.1;Introduction;391
10.21.2;Crush Injuries;391
10.21.3;Traumatic Ischemia;392
10.21.4;Peripheral Nerve Injuries;394
10.21.5;Fractures;396
10.21.6;Traumatic Amputations and Reimplantations of Body Parts;397
10.21.7;Role of HBO in Battle Casualties;398
10.21.8;Effect of HBO on Osteogenesis;398
10.21.9;HBO for Treatment of Osteonecrosis (Aseptic Necrosis);398
10.21.10;Rheumatoid Arthritis;401
10.21.11;Conclusions;401
10.22;HBO Therapy in Otolaryngology;402
10.22.1;Introduction;403
10.22.2;Tinnitus;403
10.22.3;Sudden Deafness;404
10.22.4;Acute Acoustic Trauma;406
10.22.5;Miscellaneous Disturbances of the Inner Ear;409
10.22.6;Neuro-otologicalVascular Disturbances;410
10.22.7;Menière’s Disease;410
10.22.8;Facial Palsy;411
10.22.9;Otological Complications of HBO Therapy;412
10.22.10;Miscellaneous Conditions in Head and Neck Area;412
10.22.11;Conclusions;412
10.23;HBOTherapy and Ophthalmology;414
10.23.1;Introduction;415
10.23.2;Review of Pertinent Anatomy and Physiology of the Eye;415
10.23.3;Adverse Effects of Hyperoxia;417
10.23.4;Ocular Contraindications to HyperbaricOxygen Therapy;419
10.23.5;Pre-HBOT Ocular Examination;420
10.23.6;HBO in the Treatment of Diseases of the Eye;420
10.23.7;Emergency HBO in Patients with Acute Vision Loss;434
10.23.8;Conclusions;435
10.24;Hyperbaric Oxygenation in Obstetrics and Neonatology;436
10.24.1;Introduction;437
10.24.2;HBO and Risk of Congenital Malformations;437
10.24.3;Role of HBO in Obstetrics;437
10.24.4;Use of HBO for Medical Conditions in Pregnancy;438
10.24.5;Applications of HBO in Neonatology;439
10.24.6;Conclusions;439
10.25;Hyperbaric Oxygenation in Geriatrics;440
10.25.1;Introduction;441
10.25.2;Physiology of Aging;441
10.25.3;Changes in the Brain with Aging;442
10.25.4;Applications of HBO in Geriatrics;443
10.25.5;Conclusions;444
10.26;HBO as an Adjuvant in Rehabilitation and Sports Medicine;446
10.26.1;Introduction;447
10.26.2;Role of HBO in Rehabilitation;447
10.26.3;HBO for Treatment of Sports Injuries;448
10.26.4;HBO as an Adjunct to Sports Training;448
10.26.5;Future Prospects;449
10.27;The Role of HBO in Enhancing Cancer Radiosensitivity;450
10.27.1;Introduction;451
10.27.2;Clinical Studies of HBO as Radiation Sensitizer;453
10.27.3;Combination of Other Methods with HBO and Irradiation For Cancer;455
10.27.4;Conclusions;456
10.28;HBO Therapy and Organ Transplants;458
10.28.1;Introduction;459
10.28.2;Lung Transplants;459
10.28.3;Pancreas Transplants;460
10.28.4;Renal Transplants;460
10.28.5;Liver Transplants;460
10.28.6;Miscellaneous Transplants;461
10.28.7;Clinical Application;461
10.28.8;Conclusions;461
10.29;Anesthesia in the Hyperbaric Environment;462
10.29.1;Historical Perspective;463
10.29.2;Present Indications;463
10.29.3;Physical Considerations Concerning Anesthetic Gases Under Pressure;463
10.29.4;Physiological Considerations;464
10.29.5;Practical Aspects of Anesthesia in the Pressure Chamber;465
10.29.6;Conclusions;467
10.30;HBO in Emergency Medicine;468
10.30.1;Introduction;469
10.30.2;Indications for Emergency Use of HBO;470
10.30.3;Use of HBO in Cardiopulmonary Resuscitation (CPR);474
10.30.4;Case Studies of Medical Emergencies Treated with HBO;477
10.30.5;Potential Future Uses of HBO Therapy in Emergency Medicine;496
10.31;Hyperbaric Medicine as a Specialty: Training, Practice, and Research;498
10.31.1;Introduction;499
10.31.2;Relation of Hyperbaric Medicine to Other Medical Specialties;499
10.31.3;Training in Hyperbaric Medicine;499
10.31.4;Practice of Hyperbaric Medicine;500
10.31.5;Research in Hyperbaric Medicine;501
10.31.6;Conclusions;503
10.31.7;The Future;503
10.32;Hyperbaric Medicine in the United States;506
10.32.1;Introduction;507
10.33;Hyperbaric Medicine in Japan;510
10.33.1;History of Hyperbaric Medicine in Japan;511
10.33.2;Indications for HBO Approved by the JSHM;511
10.33.3;Distribution and Number of Hyperbaric Chambers in Japan;511
10.33.4;Current Status of Research and Academic HBO Centers in Japan;512
10.33.5;Cost-Benefit Issues of HBO Therapy in Japan;512
10.33.6;Future Prospects;513
10.34;Hyperbaric Medicine in the Rest of theWorld;514
10.34.1;Introduction;515
10.34.2;Hyperbaric Medicine in Germany;515
10.34.3;Hyperbaric Medicine in China;515
10.34.4;Hyperbaric Medicine in Russia;516
11;Appendix: Diagnostic Imaging and HBO Therapy;520
12;Bibliography;536
14 HBO Therapy in Chronic Lyme Disease (S. 149-150)
Introduction
Lyme disease and its longer-term sequitur, chronic Lyme disease, is one of the most challenging arthropod-borne infectious diseases to diagnose, study, and treat. Although named after the town in Southwest Connecticut in the United States where epidemiological cluster investigations were performed in the mid 1970s, the European medical literature predating this period suggests there was considerable knowledge of this disease prior to this date. In Europe and the United States, the disease is caused by the spirochete Borrelia burgdorferi, although several other Borrelia species have been identified as causative organisms in various parts of the world (Krupka et al 2007).
The spirochete is primarily tick-borne, the most common vector being the Ixodes genus, although its presence in mosquito genera has also been reported (Halouzka et al 1999, Zakovská et al 2002). In the United States, 23,000 individuals were bitten by Borrelia-infected Ixodes ticks in 2005, which makes Lyme disease the most common arthropod-borne infectious disease in that country (Centers for Disease Control and Prevention [CDC], 2007).
Following the tick bite, an erythema migrans or “bull’seye” rash typically develops several days or weeks later, which is capable of expanding until it can measure 30 cm across. An array of flu-like symptoms appears weeks to months thereafter, the most common of which are joint swellings akin to arthritis. Unfortunately, as many as half of bitten individuals do not notice the bite, and the rash itself may not appear bull’s-eye-shaped, nor appear at all in many cases (Edlow 2002, Stricker &, Phillips 2003). Although diagnostic tests are very specific (99%–100%), and thus good for surveillance, they have relatively poor sensitivity (50%–75%) (Stricker 2007), thus, diagnosis is made clinically.
CDC recommends a 2-tiered approach of ELISA or immunofluorescence as a screening test, followed by Western blotting for confirmation if the test is positive. Prompt treatment with 14 to 30-day courses of antibiotics cures the infection in80%-90%of infected individuals(Marques 2008, Smith et al 2002). The most appropriate choices are doxycycline or ceftriaxone for adults and amoxicillin for children, although it should be stressed that other antibiotics may be better suited to different Borrelia species.Our knowledge of the efficacy of antibiotic treatment is far from adequate (Dinser et al 2005, Smith et al 2002).
Chronic Lyme Disease Despite antibiotic therapy, a minority of patients do not respond or continue to report ongoing symptoms, such as fatigue, myalgia, arthralgias, sleep disturbances, cognitive disorders, and depression (Marques 2008), and herein lies a controversy. One school of thought, endorsed by the Infectious Diseases Society of America (IDSA) (Wormser et al 2006), maintains that in patients properly treated with antibiotics, such symptoms are not caused by the persistence of the organism, but are due to the presence of preexisting conditions, such as fibromyalgia or chronic fatigue syndrome, or the presence of chronic inflammatory states induced by the Borrelia species.
