Hyperbaric oxygen therapy for the management of chronic wounds: patient selection and perspectives

Enoch Huang,1 Marvin Heyboer III,2 Davut J Savaser11Hyperbaric Medicine and Chronic Wound Clinic, Legacy Emanuel Medical Center, Portland, OR, USA; 2Emergency Medicine, Division Chief, Hyperbaric Medicine & Wound Care, SUNY Upstate Medical University, Syracuse, NY, USAAbstract: The Undersea and Hyperbaric Medical Society includes “select problem wounds” as an accepted indication for the use of hyperbaric oxygen (HBO2), however, the treatment of diabetic foot ulcers (DFUs) has dominated any discussions of problem wounds because of the prevalence of DFUs in today’s patient population and the reimbursement available for their treatment. Other wound types (eg, calciphylaxis ulcers, sickle cell ulcers, and pyoderma gangrenosum) that have well-deserved reputations as problem wounds have been infrequently treated with HBO2. While there are sound fundamental reasons why additional oxygen may have benefits in the treatment of these wounds, the challenge is finding enough high quality evidence to support routine use of HBO2.Keywords: hyperbaric oxygen therapy, HBO2, oxygen, problem wounds, chronic wounds, wound healing, diabetic foot ulcers, arterial insufficiency ulcers, sickle cell disease, scleroderma, calciphylaxis, graft versus host disease, pyoderma gangrenosum, venous stasis ulcer

Persistent tachypnea in children: keep pulmonary embolism in mind

PURPOSE: Tachypnea in children is associated with respiratory disorders and nonrespiratory disorders such as cardiac disease, metabolic acidosis, fever, pain, and anxiety. Pulmonary embolism is seldom considered by pediatricians as a cause of tachypnea. PATIENTS AND METHODS: Three children of various ages with persistent tachypnea are described: a girl after orthopedic surgery for kyphoscoliosis, a boy with nephrotic syndrome, and a neonate with Hirschsprung disease. Other causes of tachypnea were diagnosed and treated before pulmonary embolism was considered. RESULTS: Ventilation-perfusion scanning appeared to be highly probable for pulmonary embolism in these patients. Anticoagulant therapy was started. CONCLUSION: Pulmonary embolism should be kept in mind in children with tachypnea, especially when other risk factors for venous thromboembolism are present, to avoid delay in anticoagulant treatment and a fatal outcom

Natural Sensations Evoked in Distal Extremities Using Surface Electrical Stimulation

Background: Electrical stimulation is increasingly relevant in a variety of medical treatments. In this study, surface electrical stimulation was evaluated as a method to non-invasively target a neural function, specifically natural sensation in the distal limbs. Method: Electrodes were placed over the median and ulnar nerves at the elbow and the common peroneal and lateral sural cutaneous nerves at the knee. Strength-duration curves for sensation were compared between nerves. The location, modality, and intensity of each sensation were also analyzed. In an effort to evoke natural sensations, several patterned waveforms were evaluated. Results: Distal sensation was obtained in all but one of the 48 nerves tested in able-bodied subjects and in the two nerves from subjects with an amputation. Increasing the pulse amplitude of the stimulus caused an increase in the area and magnitude of the sensation in a majority of subjects. A low frequency waveform evoked a tapping or tapping-like sensation in 29 out of the 31 able-bodied subjects and a sensation that could be considered natural in two subjects with an amputation. This waveform performed better than other patterned waveforms that had proven effective during implanted extra-neural stimulation. Conclusion: Surface electrical stimulation has the potential to be a powerful, non-invasive tool for activation of the nervous system. These results suggest that a tapping sensation in the distal extremity can be evoked in most able-bodied individuals and that targeting the nerve trunk from the surface is a valid method to evoke sensation in the phantom limb of individuals with an amputation for short term applications