Kiyotaka Kohshi

Successful treatment of radiation-induced brain necrosis by hyperbaric oxygen therapy.

We describe a 68-year-old man who underwent hyperbaric oxygen (HBO) therapy to manage radiation necrosis of the brain, which developed after two treatments with stereotactic radiosurgery (SRS) to the same lesion. The necrosis was subsequently treated with steroids alone for 2 months; however, he progressed clinically and radiographically. Improvement again was noted with the reinstitution of HBO therapy. This case suggests that HBO therapy is an important therapeutic option in the treatment of brain radiation necrosis caused by SRS.

Fractionated stereotactic radiotherapy using gamma unit after hyperbaric oxygenation on recurrent high-grade gliomas.

BackgroundTo reduce this complication and to enhance the radiation effect to hypoxic cells of high-grade gliomas, the authors performed noninvasive fractionated stereotactic radiotherapy (FSRT) using a Gamma unit combined with hyperbaric oxygen (HBO) therapy for the treatment of recurrent disease.Patients and methodsTwenty-five consecutive patients who had previously received radiotherapy with chemotherapy for recurrent high-grade gliomas, including 14 patients with anaplastic astrocytoma (AA) and 11 with glioblastoma multiforme (GBM), underwent Gamma FSRT immediately after HBO therapy (2.5 atmospheres absolute for 60xa0min). The Gamma FSRT was repeatedly performed using a relocatable head cast. Median tumor volume was 8.7 cc (range, 1.7–159.3 cc), and the median total radiation dose was 22 Gy (range, 18–27 Gy) to the tumor margin in 8 fractions.ResultsActuarial median survival time after FSRT was 19xa0months for patients with AA and 11xa0months for patients with GBM, which was significantly different (Pxa0=xa00.012, log-rank test). Two patients underwent subsequent second FSRT for regional or remote recurrence. Seven patients (28%) underwent subsequent craniotomies and resections at a mean of 8.4xa0months after FSRT treatment, and 4 of them had radiation effects without viable cells and remained alive for 50–78xa0months.ConclusionGamma FSRT after HBO therapy appears to confer a survival benefit for patients with recurrent high-grade gliomas and warrants further investigation.

Old but new methods in radiation oncology: hyperbaric oxygen therapy

The presence of hypoxic tumor cells is widely regarded as one of the main reasons behind the failure to control malignant tumors with radiotherapy treatments. Since hyperbaric oxygenation (HBO) improves the oxygen supply to the hypoxic tumor cells, HBO therapy has previously been used in combination with simultaneous radiotherapy to treat malignant tumors. In some clinical trials, significant improvements in local control and survival have been seen in cancers of the head and neck and the uterine cervix. However, the delivery of simultaneous HBO therapy and radiotherapy is both complex and time-consuming, with some trials reporting increased side effects. As a result, the regimen of HBO therapy in combination with simultaneous radiotherapy has yet to be used as a standard treatment for malignant tumors. In recent years, however, radiotherapy immediately after HBO therapy has been emerging as an attractive approach for overcoming hypoxia in cancer treatment. Several studies have reported that radiotherapy immediately after HBO therapy was safe and seemed to be effective in patients with high-grade gliomas. Also, this approach may protect normal tissues from radiation injury. To accurately estimate whether the delivery of radiotherapy immediately after HBO therapy can be beneficial in patients with high-grade gliomas and other cancers, further prospective studies are warranted.

Influence of tea and coffee on biomonitoring of toluene exposure

BACKGROUNDnThe intake of some benzoic acid-containing foods or drinks such as green tea and coffee is known to increase urinary hippuric acid (HA) concentrations, and, unless this can be accounted for, may result in false-positive findings during the biological monitoring of toluene exposure.nnnAIMSnTo investigate the influence of green tea and coffee ingestion on urinary HA concentrations.nnnMETHODSnTime-weighted average exposures to toluene were monitored by measuring urinary HA in 245 car painters in 2005 and again in 2006. Samples of both urine and blood were collected during work hours. All the participants were also asked about their alcohol intake, smoking and dietary and beverage habits, especially green tea and coffee. To clarify the relationship between green tea and coffee ingestion, workers were prohibited from consuming green tea and coffee for 1 day before the health check-up in 2006.nnnRESULTSnThe frequency of positive urinary HA concentrations (>1.0 g/l) in heavy consumers of green tea and/or coffee was significantly higher than that of the non-consumer or light consumers (OR 2.34, 95% CI 1.15-4.74). Prohibiting green tea and coffee ingestion was effective in decreasing the frequency of falsely elevated urinary HA concentrations (P < 0.01).nnnCONCLUSIONSnThe consumption of green tea and/or coffee can result in an overestimation of urinary HA concentrations and cause false-positive results during the biological monitoring of workers exposed to low doses of toluene.

Brain Damage in Commercial Breath-Hold Divers

Background Acute decompression illness (DCI) involving the brain (Cerebral DCI) is one of the most serious forms of diving-related injuries which may leave residual brain damage. Cerebral DCI occurs in compressed air and in breath-hold divers, likewise. We conducted this study to investigate whether long-term breath-hold divers who may be exposed to repeated symptomatic and asymptomatic brain injuries, show brain damage on magnetic resonance imaging (MRI). Subjects and Methods Our study subjects were 12 commercial breath-hold divers (Ama) with long histories of diving work in a district of Japan. We obtained information on their diving practices and the presence or absence of medical problems, especially DCI events. All participants were examined with MRI to determine the prevalence of brain lesions. Results Out of 12 Ama divers (mean age: 54.9±5.1 years), four had histories of cerebral DCI events, and 11 divers demonstrated ischemic lesions of the brain on MRI studies. The lesions were situated in the cortical and/or subcortical area (9 cases), white matters (4 cases), the basal ganglia (4 cases), and the thalamus (1 case). Subdural fluid collections were seen in 2 cases. Conclusion These results suggest that commercial breath-hold divers are at a risk of clinical or subclinical brain injury which may affect the long-term neuropsychological health of divers.

Cerebrospinal vascular diseases misdiagnosed as decompression illness: the importance of considering other neurological diagnoses

The diagnosis of decompression illness (DCI), which is based on a history of decompression and clinical findings, can sometimes be confounded with other vascular events of the central nervous system. The authors report three cases of divers who were urgently transported to a hyperbaric facility for hyperbaric oxygen treatment of DCI which at admission turned out to be something else. The first case, a 45-year-old experienced diver with unconsciousness, was clinically diagnosed as having experienced subarachnoid hemorrhage, which was confirmed by CT scan. The second case, a 49-year-old fisherman with a hemiparesis which occurred during diving, was diagnosed as cerebral stroke, resulting in putaminal hemorrhage. The third case, a 54-year-old fisherman with sensory numbness, ataxic gait and urinary retention following sudden post-dive onset of upper back pain, was diagnosed as spinal epidural hematoma; he also showed blood collection in the spinal canal. Neurological insults following scuba diving can present clinically with confusing features of cerebral and/or spinal DCI. We emphasize the importance of considering cerebral and/or spinal vascular diseases as unusual causes of neurological deficits after or during diving.