Medicine

Background. Hyperbaric oxygen (HBO) therapy, which is used for many conditions, may also have immunosuppressive effects and could be used for prevention or treatment of graft-versus-host disease (GvHD). If HBO is immunosuppressant, then we hypothesize that HBO therapy will delay the T-cell mediated skin graft rejection. Methods. C57/BL6 black-coated (H2B) mice received skin graft from CBA (H2D) white-coated mice. Mice were treated with either 19 session of 240 kpa oxygen or 29 session of 300 kpa oxygen, for 90 minutes. Mice were housed either 4 per cage or separately, to prevent friction and mechanical factors that may affect graft survival. Skin grafts were assessed daily. Results. There was no difference in length of graft survival between mice that received either regimens of HBO therapy and mice that did not receive HBO therapy. Conclusions. HBO therapy, as a sole agent, did not delay skin graft rejection in a highly immunogenic mouse model.

To explore physicians' knowledge of and attitudes toward hyperbaric oxygen therapy (HBOT) in order to better understand current diabetic foot ulcer management practices and to determine potential barriers to HBOT use. A 24-item questionnaire. Primary Care Today conference in Toronto, Ont, in May of 2006. Physician attendees, 313 of whom completed the survey. Self-reported knowledge of and attitudes toward HBOT. Less than 10% of respondents had a good knowledge of HBOT, but 57% had a good attitude toward HBOT. Knowledge of and attitude toward HBOT were positively correlated (P < .0001). Good knowledge of HBOT was associated with sex (P = .0334), age younger than 40 years (P = .0803), years in medical practice (P = .0646), patient requests for HBOT referrals (P = .0127), and having previously referred patients for HBOT (P < .001). Twenty years or more in medical practice (P = .0593) and receiving patient requests for HBOT (P = .0394) were multivariate predictors of having go...

Bisphosphonate-associated osteonecrosis (BON) may result in serious oral complications, such as osteomyelitis and chronic exposure of necrotic bone. Dentists must be familiar with this disorder and pay special attention to all patients on bisphosphonate therapy due to their defective osteoclast function and reduced osseous tissue vascularity, leading to impaired wound healing. The purpose of this paper is to review the history and pathogenesis of BON, discuss its differential diagnosis, provide guidance to dentists on possible measures to prevent BON and review the management of patients with BON.

Hyperbaric oxygen (HBO) therapy is recognized as an adjunctive treatment for osteoradionecrosis (ORN). It may also be used prophylactically in patients who require dental extractions and are at high risk for developing ORN. This article reviews the treatment outcomes of patients treated with HBO therapy at the Toronto General Hospital from 1985 to 1997. A total of 297 charts of patients treated with HBO were reviewed. Criteria assessed included age of patient, gender, original diagnosis, radiation dose, time between radiation treatment and onset of ORN, presence or absence of fracture, orocutaneous fistula, pain, history of a precipitating event triggering ORN, medical status, HBO therapy (total oxygen time, number of dives), method of treatment of ORN and follow-up period. Minimum patient follow-up time for inclusion in the study was 6 months. Adequate information to meet the inclusion criteria was obtained for 75 patients. Group A (51 patients) had been treated for overt ORN with ...

Endolymphatic sac tumors (ELSTs) are rare neuroectodermal neoplasms arising within the posterior petrous bone. We present a case of a 21-year-old man who presented with a 6-month history of intermittent morning headaches, fatigue, diplopia, and gait ataxia. Imaging and surgical pathology identified an adenocarcinoma of the endolymphatic sac compressing the cerebellum and brain stem. The tumor and multiple metastases were treated with surgery, radiation, and radiosurgery. Following insertion of a ventriculoperitoneal shunt for hydrocephalus, he developed symptomatic tension pneumocephalus secondary to radionecrosis of his petrous bone, requiring flap reconstruction and use of a programmable shunt valve complemented by hyperbaric oxygen (HBO) therapy. We document here a young patient with a rare adenocarcinoma of the endolymphatic sac. This case is unique for its initial presentation without any vestibuloauditory symptoms. Metastatic spread of ELSTs is also rare. While osteoradionecro...

Mental health, mental illness and stress-related disability are especially ill-defined, complex and controversial issues when considered in the context of the workplace. A multi-determined disorder such as major depressive disorder (MDD) does not fit a simple cause and effect model, but is similar to other complex occupational illnesses such as low back pain. Currently, a knowledge gap exists between mental health professionals and employers regarding symptom-based models of illness and function-based models of work performance. As a result, psychiatric disorders affecting workers are under-identified and under-treated and likely result in unmitigated impairment and disability. The authors examine several conceptual models for workplace mental illness across medical and psychological disciplines and propose a unifying construct. The utility of the existing screening methods for common workplace illnesses and their potential application are reviewed. The challenges of diagnosis and e...

Anal strictures with fibrotic induration have been shown to develop in up to 50% of all patients with Crohn's disease (CD) with anal ulceration. We evaluate the technical feasibility, safety and long-term efficacy of bougie dilation for a subgroup of patients with symptomatic Crohn's-related fibrotic anal strictures. Bougie dilation is simple to perform, relatively inexpensive and has a low risk of complications.