Nobuaki Furuyama

Analysis of risk factors associated with complications of hyperbaric oxygen therapy

PURPOSE The aim of this study was to verify independent risk factors of pressure equalization problems associated with hyperbaric oxygen (HBO(2)) therapy. METHODS We reviewed a single-institutional study of 1609 patients with 17604 treatments who had HBO(2) therapy in a multiplace chamber, in which the factors examined and their relationship to complications were assessed, using multivariate analyses, to determine the significantly independent risk factors of complications related to HBO(2) therapy. RESULTS The compression rate was 0.067 atmospheres absolute/min (6.8 kPa/min). Pressure equalization problems of the middle ear, expressed as pain or discomfort, such as cranial sinus pain, and teeth pain were observed in 156 patients (9.7%). Sixty-six of them could not continue HBO(2) therapy because of these problems. Peripheral circulatory disorders with refractory ulcers or nonhealing wounds and the interval between clinical symptoms and the first day of HBO(2) therapy were independent risk factors of pressure equalization problems. Independent risk factors of cessation due to pressure equalization problems were identified as age more than 61 years, female sex, and interval between symptoms and the first day of HBO(2) therapy. CONCLUSION It is suggested that chamber compression must be performed with particular care when patients have peripheral circulatory disorders and have short interval between clinical symptoms and the first day of HBO(2) therapy.

Hyperbaric oxygen therapy as a prophylactic and treatment against ileus and recurrent intestinal obstruction soon after surgery to relieve adhesive intestinal obstruction.

Background and Aim:  Nonoperative management of cases of adhesive intestinal obstruction would be ideal, especially for patients who have recently undergone surgery to relieve the same condition. We aimed to examine whether hyperbaric oxygen (HBO) therapy might have therapeutic potential for the treatment of postoperative paralytic ileus and recurrent adhesive intestinal obstruction soon after surgery, to relieve adhesive intestinal obstruction, because of its unique mechanisms in these contexts.

CLINICAL EVALUATION OF THE SURGICAL TREATMENT IN CROHN'S DISEASE

当科で経験したCrohn病手術症例27例 (小腸型13例, 大腸型7例, 小腸大腸型7例) について臨床的検討を加えた.手術適応として初回手術では閉塞症状, 再手術では内外瘻孔形成によるものが多かった. 手術々式は主として病変部を中心とした腸切除が行われたが, 当初の広範囲切除から次第に小範囲切除の傾向を示し, さらに最近では病変部を空置してバイパス手術兼粘液瘻造設術が試みられ, 良好な経過が得られた. 全症例の再手術率は27例中13例, 48,1%であり, このうち小腸大腸型が7例中4例, 57.1%と最も高率であった. 腸切除範囲の大小による累積再手術率に有意の差を認めなかった.

Effective colostomy irrigation using a new devised appliance.

新しく開発した吸引式洗腸器の有用性を知る目的で, 従来より使用されていたストッパー式洗腸器と比較検討した.対象はMiles手術後の結腸終端人工肛門保有者で, それぞれの洗腸器を使用していた15症例 (計30症例) について対面調査を行った.その結果, 吸引式洗腸器の長所としては穿孔の危険が少いこと, 速やかに完全な洗腸が行えること, 臭気もなく清潔に行えることが挙げられた.一方, ストッパー式洗腸器に比べ十分な指導を必要とするなど, いくつかの短所も示唆された.以上の結果から, 本洗腸器は若い知識人に適しており, さらに狭窄様人工肛門症例の洗腸にも威力を発揮していることが明らかとなった.