Julius H. Jacobson

The protective effect of hyperbaric oxygenation in experimentally produced cerebral edema and compression.

Publisher Summary Recent studies indicate that hyperbaric oxygenation may be beneficial in the management of ischemic disorders of the brain. Other reports have appeared suggesting that hyperbaric oxygenation has a protective effect in cerebral trauma. The cerebral vasoconstriction caused by hyperbaric oxygenation combination with increased available oxygen are factors which might be of value in the treatment of cerebral edema. The purpose of the present study has been to evaluate the effect of hyperbaric oxygenation on cerebral edema and compression produced by acutely and slowly expanding intracranial space-occupying lesions. In the present study, duration of treatments and atmospheric pressures used were arbitrarily chosen to avoid oxygen toxicity. It seems likely that a superior treatment schedule can be developed. Hyperbaric oxygenation appears to decrease the mortality of experimentally produced cerebral edema and compression. Mechanisms involved may be related to the dual effect of hyperbaric oxygenation in increasing available oxygen while decreasing cerebral blood flow by vasoconstriction.

Liver Cell Damage Produced by Portacaval Shunts.

Summary Diversion of the portal blood flow from the liver in rats by construction of end-to-side portacaval shunts increased DNA synthesis in hepatocytes, presumably as a response to liver cell damage. Electron microscopically increased variability in staining and electron density, cytoplasmic vacuoles and mitochondrial changes were noted. The liver cell damage associated with diversion of the portal flow may account in part for some of the undesirable side effects associated with portacaval shunts in man.

Hip pain caused by buttock claudication : relief of symptoms by transluminal angioplasty

Two patients with severe hip pain proved to have buttock claudication resulting from isolated stenosis of the hypogastric artery. This diagnosis may be elusive if distal pulses are palpable, directing the clinicians suspicion away from vascular pathology. Diagnosis requires angiography. The patients were successfully treated by transluminal angioplasty. Angioplasty is the initial treatment of choice for these patients because the hypogastric artery is usually readily and safely accessible from either the femoral or axillary artery.

THE HISTORICAL PERSPECTIVE OF HYPERBARIC THERAPY

Hyperbaric oxygenation promises to be a major therapeutic advance; it remains to be seen if it will rank with such milestones of progress as blood transfusion, antibiotics, and extracorporeal circulation. The construction of large chambers by Boerema’ in Amsterdam, and Smith and Illingworth2 in Glasgow, have profoundly excited the medical profession. It seems probable that in the next five to ten years, similar installations will be made in hospitals throughout the world. Before proceeding with the historical aspects, inasmuch as this is the opening paper of this monograph, it seems worthwhile to briefly review the terminology used for recording pressures and the basic physiology of hyperbaric oxygenation.

EXPERIMENTAL HEPATIC SIDEROSIS FOLLOWING PORTACAVAL SHUNT.

Summary To determine the role of portacaval shunts in the development of hepatic siderosis, rats were subjected to end-to-side and side-to-side portacaval shunts. Hepatic siderosis developed only in rats with end-to-side shunts, while visible liver cell damage and cirrhosis were absent. It is concluded that shunting of the portal blood flow per se results in hepatic siderosis, even in the absence of cirrhosis.

Infected false aneurysms of the subclavian artery: A complication in drug addicts

Two cases of infected false aneurysms of the subclavian artery in drug addicts are described. The clinical findings related to the location of these rare lesions are presented, together with an attempt to explain their pathophysiology. The signs and symptoms include a tender supraclavicular mass in an obviously septic patient associated with brachial plexus palsy, a swollen edematous arm, Horners syndrome, and hemoptysis. Because of the complexity of symptoms, delay in diagnosis is common. It is emphasized that the recognition of this constellation of symptoms should prompt the physician to perform emergency angiography followed by immediate surgery.

Hemodynamic Effects of Hyperbaric Oxygenation in Experimental Acute Myocardial Infarction

The hemodynamic effects of hyperbaric oxygenation were investigated in anesthetized dogs with acute myocardial embolism and infarction produced by injecting plastic spheres 325 micra in diameter. In 50 “control” animals with acute myocardial infarction induced while breathing either air at one atmosphere, 100% oxygen at one atmosphere or 7% oxygen at three atmospheres, 24-hour mortality was 85 to 90%. In 23 animals that received the same dose of microspheres and breathed 95 to 100% oxygen at three atmospheres for two hours following embolization, there was significantly less 24-hour mortality (30%), less ventricular fibrillation, and less advanced atrioventricular block. Hyperbaric oxygenation afforded protection against immediate mortality from ventricular fibrillation and also against later death, in shock, occurring within 24 hours of coronary embolization but after the immediate postembolization period had passed. In the animals exposed to hyperbaric oxygenation, declines of cardiac output and of central aortic pressure occurring 60 and 90 minutes after coronary embolization were significantly less than in the other animals. In normal animals, hyperbaric oxygenation reduced cardiac output moderately, increased systemic vascular resistance, and elevated aortic pressure slightly. The anatomic extent of the infarction did not differ detectably between the “control” animals and those treated with hyperbaric oxygenation. It is concluded that hyperbaric oxygenation provides protection against mortality in the early period after coronary embolization by preventing ventricular fibrillation. In addition, prevention of major declines in aortic pressure and cardiac output during the later postembolization period in the group with hyperbaric oxygenation was associated with diminished rates of late mortality.

A registry for carbon monoxide poisoning in New York City

In 1983 the North American Hyperbaric Center (affiliated with Bronx Municipal Hospital Center) was designated to provide Hyperbaric oxygen (HBO) for carbon monoxide (CO) patients meeting Emergency Medical System (EMS) criteria: 1. Unconscious or CNS derangement, any carboxyhemoglobin level [( COHb]); 2. [COHb] 25% or more; 3. Pregnant, any [COHb]. Through 1984, 39 CO patients received HBO; in 1985 81 were treated including 8 pregnant and 16 pediatric. CO sources were: fire, 43; heater, 21; engine, 17. 42 of 59 acute patients were initially in coma; 16 required CPR. Time to HBO averaged 4.5 hrs. Mean hospital [COHb] was 31% for acute, 28% for subacute/chronic, 15% for pregnant; mean maximum [COHb] was estimated: 51% for acute, 40% for subacute/chronic patients. Mean half life for [COHb] was 2.1 hrs. HBO typically was 46 min at 3ATA (2 [COHb] half lives), presented few problems, and gave rapid clinical improvement. 13 of 19 patients comatose before HBO were responsive after HBO (mean [COHb] was 1.8%). Four pediatric deaths occurred; brain damage was noted in two other patients. EMS efforts to make HBO available for CO is a success.

Ultrasonography of the brachiocephalic arteries.

Sixteen patients with various lesions involving the brachiocephalic arteries were studied ultrasonographically. The examination was very useful in diagnosing aneurysms of the peripheral arteries and in differentiating an aneurysm from other causes of palpable pulsatile masses, such as a tortuous artery and tumor beneath an artery. The ultrasound technique used for evaluation of these lesions is described.

The effect of a pressurized environment (hyperbaric chamber) on pulmonary emphysema

Abstract The role of a pressurized environment (hyperbaric chamber) in the treatment of emphysema was evaluated. Five patients with silent type emphysema were observed during five consecutive days of treatment in the hyperbaric chamber, then during and after six weeks of intermittent treatment in the chamber. Although hypercapnia and acidosis were noted while the patients were in the chamber, there was no lasting adverse or beneficial effect on lung volumes or dynamics, diffusing capacities, arterial blood gas levels, oxygen consumption, minute ventilation, ventilation equivalent, pulmonary perfusion by scan technic, blood counts, electrocardiograms or blood chemistries. It was concluded that the hyperbaric chamber is not indicated in the treatment of emphysema. However, its use would not be contraindicated if a patient with emphysema required the chamber for another treatable condition.