Article – 1 - Refractory Osteomyelitis
Title: Hyperbaric Oxygen Therapy for Chronic Refractory Osteomyelitis of the Sternum
Authors: Raymond C. Shields, MDemail, Francis C. Nichols, MD, William G. Buchta, MD, Paul L. Claus, MD
Digital Object Identifier (or PMID etc): PMID: 20417809
Keywords: Adult, Chronic Disease, Female, Follow-Up Studies, Humans, Hyperbaric Oxygenation/methods, Osteomyelitis/etiology, Osteomyelitis/physiopathology, Osteomyelitis/therapy, Reoperation, Risk Assessment, Severity of Illness Index, Sternotomy/adverse effects, Sternotomy/statistics & numerical data, Surgical Wound Infection/complications, Surgical Wound Infection/diagnosis, Treatment Outcome, Wound Healing/physiology
Abstract: This report describes a 32-year-old woman with chronic refractory osteomyelitis of the sternum after multiple surgical procedures including a sternotomy with underlying colonic interposition that was successfully managed with hyperbaric oxygen therapy.
Conclusion: The clinical course is reviewed, and the complexities of this diagnosis are then discussed, including a brief review of the mechanisms of management with hyperbaric oxygen therapy.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/20417809
Full text URL:
http://www.annalsthoracicsurgery.org/article/S0003-4975(09)02055-4/fulltext
Article – 2- Refractory Osteomyelitis
Title: Hyperbaric oxygen therapy in the treatment of chronic refractory osteomyelitis: a preliminary report.
Authors: Chen CE, Shih ST, Fu TH, Wang JW, Wang CJ.
Digital Object Identifier (or PMID etc): PMID: 12718388
Keywords: Adult, Aged, Chronic Disease, Female, Humans, Hyperbaric Oxygenation, Male, Middle Aged, Osteomyelitis/microbiology, Osteomyelitis/therapy, Staphylococcus aureus/isolation & purification
Abstract: Hyperbaric oxygen (HBO) has been proven to enhance bone and soft tissue healing in ischemic tissue in vitro and in vivo studies. Although only a few reports have been proven using controlled studies, this treatment modality remains encouraging for chronic refractory osteomyelitis. In this retrospective study, we reported the clinical results of HBO therapy for chronic refractory osteomyelitis. From January through August 2000, 14 patients with chronic refractory osteomyelitis of the tibias treated with HBO were available for follow-up examination. According to the Cierny-Mader classification, all patients were classified as type III or IV osteomyelitis. Adequate debridement and parenteral antibiotic treatment in conjunction with HBO therapy at 2.5 atmospheres absolute for 120 minutes, and 5 days per week regimen was used in all patients. The patients were followed-up for an average of 15 months after completion of HBO therapy.
Results: The most common infecting microorganism was Staphylococcus aureus. Mixed infections were usually found in patients with open fractures. The average number of operations before HBO therapy was 5.4 including soft tissue reconstruction in 11 patients. The average number of HBO treatments was 33.6 times. There were no HBO related complications. No recurrence of infection was noted in 11 patients, which resulted in a success rate of 79%.
Conclusion: Hyperbaric oxygen therapy is effective and safe for chronic refractory osteomyelitis provided that patients had received appropriate medical and surgical management.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/12718388
Full text URL:
http://memo.cgu.edu.tw/cgmj/2602/260205.pdf
Article – 3- Refractory Osteomyelitis
Title: Hyperbaric oxygen therapy for primary sternal osteomyelitis: a case report
Authors: Tales Rubens de Nadai, Rosemary Furlan Daniel, Mariane Nunes de Nadai, José Joaquim Ribeiro da Rocha and Omar Féres
Digital Object Identifier (or PMID etc): Nil
Keywords: Hyperbaric Oxygen Therapy; Primary Osteomyelitis; Sternum
Abstract: Primary osteomyelitis of the sternum is a rare condition, which accounts for 0.3% of all cases of osteomyelitis reported in the literature. The diagnosis requires a high degree of suspicion and confirmation by percutaneous biopsy. The treatment consists of resection of the periosteum and affected bone. Despite reports of successful conservative treatment using antibiotics alone, early surgical intervention plus bacterial control is the definitive treatment; it reduces morbidity, and is the most cost-effective approach for the patient. We report a case of primary osteomyelitis surgically treated with debridement and antibiotics, followed by hyperbaric oxygen therapy. A 39-year-old Brazilian man without a significant medical history presented with primary osteomyelitis. After a normal chest radiograph and normal laboratory test results, he was treated with 2 weeks of nonsteroidal anti-inflammatory drugs. One month later a presumptive diagnosis of Tietze syndrome was made and he was prescribed prednisolone (60mg/day) for 3 weeks. The following month he presented to our service with swelling, redness, and warmth in the area between his left third and fourth ribs. Subsequent magnetic resonance imaging revealed a large collection of liquid (8.8×6.8×20.2cm) in his chest wall, between the body and the manubrium of the sternum. An area of soft, friable tissue with a large amount of pus was found in his sternum during surgical debridement. Subsequent treatment consisted of antibiotic therapy using metronidazole and cefotaxime plus hyperbaric oxygen therapy. On postoperative day 10 the incision was sutured. The patient was discharged on postoperative day 15 on a regimen of oral ciprofloxacin, and completed hyperbaric oxygen therapy as an out-patient.
Conclusion: The satisfying outcome of this patient reflects the quick action to promote surgical debridement and use of antibiotics, which are both recommended treatments. The closure of the wound in 10 days after debridement suggests that the hyperbaric oxygen therapy might have indirectly, but not conclusively, aided in the premature closure of the wound, avoiding a longer healing by second intention or muscle flap rotation closure.
Source URL:
http://www.jmedicalcasereports.com/content/7/1/167#abs
Full text URL:
http://www.jmedicalcasereports.com/content/7/1/167
Article – 4 - Refractory Osteomyelitis
Title: The role and effectiveness of adjunctive hyperbaric oxygen therapy in the management of musculoskeletal disorders.
Authors: Wang J, Li F, Calhoun JH, Mader JT.
Digital Object Identifier (or PMID etc): PMID: 12432205
Keywords: Female, Follow-Up Studies, Humans, Hyperbaric Oxygenation/adverse effects, Hyperbaric Oxygenation/methods, Male, Musculoskeletal Diseases/diagnosis, Musculoskeletal Diseases/therapy, Neoadjuvant Therapy/methods, Osteomyelitis/diagnosis, Osteomyelitis/therapy, Risk Assessment, Sensitivity and Specificity, Severity of Illness Index, Soft Tissue Injuries/diagnosis, Soft Tissue Injuries/therapy, Treatment Outcome
Abstract: The management of musculoskeletal disorders is an increasing challenge to clinicians. Successful treatment relies on a wide range of multidisciplinary interventions. Adjunctive hyperbaric oxygen (HBO) therapy has been used as an orthopaedic treatment for several decades. Positive outcomes have been reported by many authors for orthopaedic infections, wound healing, delayed union and non-union of fractures, acute traumatic ischemia of the extremities, compromised grafts, and burn injuries. Severe side effects have also been reported with this therapy. To aid in the use of HBO therapy in orthopaedics, we reviewed 43 papers published in the past four decades and summarised the mechanisms, effectiveness, indications and contraindications, side effects, and cost impact of adjunctive hyperbaric oxygen therapy in the management of difficult musculoskeletal disorders. Adjunctive HBO therapy is an effective treatment modality for the management of some severe and refractory musculoskeletal problems. If appropriate candidates are carefully identified, hyperbaric oxygen is a limb- and sometimes life-saving therapy. HBO therapy significantly reduces the length of the patient's hospital stay, amputation rate, and wound care expenses. Thus, it is a cost-effective modality.
Conclusion: A clinician must understand the side effects and risks of HBO treatment. Close monitoring throughout the treatment is warranted to minimise the risk to the patients.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/12432205
Full text URL:
Article – 5 - Refractory Osteomyelitis
Title: De novo cataract development following a standard course of hyperbaric oxygen therapy.
Authors: Gesell, LB; Trott, A
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: A 49 y/o female underwent 48 hyperbaric oxygen (HBO2) treatments at 2.5 ATA (atmospheres absolute) (253 kPa) for 90 minutes for chronic refractory osteomyelitis of the sacrum and recurrent failure of a sacral myocutaneous flap. Prior to HBO2 therapy, formal ophthalmic exams revealed myopia but no evidence of cataract formation. Eight weeks following the completion of HBO2 therapy, on repeat ophthalmic exam, the patient was discovered to have worsening myopia. Changes of the crystalline lens, consistent with nuclear cataract development, were identified in each eye. Other common causes of cataract formation including diabetes, corticosteroid use, and excessive exposure to ultraviolet light, were excluded. While transient visual changes are known to occur during HBO2 therapy, cataract formation has only rarely been reported and only after prolonged courses of treatment (150 or more treatments).
Conclusion: This case identifies the need to further investigate the ocular effects of HBO2 therapy, especially with regard to cataract development and progression.
Article – 6 - Refractory Osteomyelitis
Title: Synergy of HBO2 and a local antibiotic carrier for experimental osteomyelitis due to Staphylococcus aureus in rats.
Authors: Mendel, V; Simanowski, HJ; Scholz, HCh
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: A standard rat model of Staphylococcus aureus-induced osteomyelitis was used to compare the effect of HBO2, a local antibiotic carrier (gentamicin-containing collagen sponge) and the combination of HBO2 with a local antibiotic carrier. For the induction of osteomyelitis, a defined Staphylococcus aureus suspension was inoculated into the medullary cavity. Arachidonic acid was used as sclerosing agent. With that procedure an infection rate of more than 95 percent was attained. Prior to the treatment interval surgical debridement of the soft-tissue infection was performed. In the control group the extent of infection was 4.9 x 10(6) CFU x g(-1) of tibial bone three weeks following implantation of organisms. Subsequent to debridement of the soft tissue infection, the bone infection decreased slightly with a value of 3.7 x 10(6) CFU x g(-1) of tibial bone at the end of the experiment. HBO2 as single-agent therapeutic reduced the infection to 1.7 x 10(5) CFU x g(-1) of tibial bone. Due to its high local antibiotic level, the gentamicin-collagen sponge achieved a reduction in organisms to 1.4 x 10(2) CFU x g(-1) of tibial bone. The effect was most marked using a 4-wk combination therapy with local application of the gentamicin-containing sponge and additional treatment with HBO2. In 9 of 11 animals, bacteria were no longer detectable in the processed bone substance. Each of the treatment modalities resulted in a significant therapeutic effect.
Conclusion: No complete healing of the infection was achieved with the flexible collagen sponge characterized by pronounced and rapid release of gentamicin. In combination with hyperbaric oxygen an additive effect was attained and thus a significant improvement of treatment.
Article – 7- Refractory Osteomyelitis
Title: Hyperbaric oxygen for osteomyelitis in a compromised host.
Authors: Delasotta LA, Hanflik A, Bicking G, Mannella WJ.
Digital Object Identifier (or PMID etc): PMID: 23730373
Keywords: Nil
Abstract: Post-traumatic osteomyelitis is a rare but debilitating complication of closed fractures. Most infections can be resolved with aggressive debridement, intravenous antibiotics, and hardware removal. However, the eradication of infection can be challenging in a patient with multiple comorbidities. Refractory infection may require suppressive therapy or amputation to control the disease. Improvements in care have led to improved survival for this population, posing new challenges in their post-traumatic care. We report on the successful use of hyperbaric oxygen therapy as an adjunct in a compromised host with recurrent post-traumatic osteomyelitis despite aggressive debridement, removal of instrumentation, and several courses of intravenous antibiotic therapy.
Conclusion: Hyperbaric oxygen may be considered as an adjunct to standard treatment protocols for refractory osteomyelitis in compromised hosts.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/23730373
Full text URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664446/
Article – 8 - Refractory Osteomyelitis
Title: Infectious diseases: pathophysiology and mechanisms of hyperbaric oxygen.
Authors: Mader, JT; Adams, KR; Sutton, TE
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: Hyperbaric oxygen (HBO) therapy has proved adjunctive along with antibiotics and surgery for the treatment of necrotizing soft tissue infections, refractory osteomyelitis, and infected ischemic wounds. The pathophysiology and mechanisms of HBO therapy explain these beneficial effects. Hyperbaric oxygen has a direct bactericidal effect on anaerobic organisms through the production of toxic oxygen radicals. Hyperbaric oxygen increases the oxygen tension in infected tissues which provides oxygen to the polymorphonuclear leukocytes to kill aerobic organisms. Hyperbaric oxygen provides oxygen to the fibroblast to allow new collagen formation and, subsequently, angiogenesis which allows hypoxic infected wounds to heal.
Conclusion: Finally, HBO potentiates certain antibiotics such as the aminoglycosides and the sulfonamides.
Article – 9 - Refractory Osteomyelitis
Title: Refractory osteomyelitis.
Authors: Strauss, MB
Digital Object Identifier (or PMID etc): Nil
Abstract: Refractory osteomyelitis is chronic osteomyelitis that has persisted or recurred after appropriate interventions or an acute osteomyelitis that has not responded to accepted management. Invariably in refractory, acute osteomyelitis the patient is a compromised host.
Conclusion: This paper discusses the pathophysiology, describes the mechanisms of hyperbaric oxygen, presents a classification system based on clinical presentations, and discusses economic considerations for refractory osteomyelitis.
Article – 10 - Refractory Osteomyelitis
Title: Therapy with hyperbaric oxygen and cefazolin for experimental osteomyelitis due to Staphylococcus aureus in rats
Authors: Mendel, V; Reichert, B; Simanowski, HJ; Scholz, HC
Digital Object Identifier (or PMID etc): PMID: 10485518
Abstract: Hyperbaric oxygen (HBO2) is used as adjunctive therapy for chronic osteomyelitis, yet its efficacy remains controversial. A recently developed rat model for osteomyelitis due to Staphylococcus aureus was used to compare the results of treatment with HBO2, cefazolin, a combination of both, or no treatment. For the induction of tibial osteomyelitis, S. aureus was inoculated into the medullary cavity. Arachidonic acid was used as the sclerosing agent. With that procedure, an infection rate of 96% was attained. For long-term antibiotic treatment, a port system was developed and implanted. Hyperbaric treatment alone reduced the colony-forming units (CFU) from 2.9 x 10(6) to 6.2 x 10(5) x g(-1) of tibial bone. The effect on the infection was more pronounced with antibiotic therapy alone, 10.5 x 10(4) CFU per g of tibial bone were measured. However, changes were most marked using a 4-wk combination therapy consisting of HBO2 and an antibiotic agent. The colony count was 2.7 x 10(3) CFU. Each of the treatment modalities resulted in a significant therapeutic effect.
Conclusion: The results not only demonstrated the effectiveness of HBO2 in the treatment of osteomyelitis, but revealed a potential additive effect with the combination of HBO2 and an antibiotic.