Fw: Scelodrema and Hyperbaric Oxygen, Study at our center woman was explanted

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----- Original Message -----

From: " Kathi " <pureheart@...>

Sent: Sunday, October 06, 2002 12:48 PM

Subject: Scelodrema and Hyperbaric Oxygen, Study at our center woman was

explanted

> Occasional Review

>

> Use of Hyperbaric Oxygen in Rheumatic Diseases: And Critical Analysis

>

>

> D.J. Wallace 1,2 S. Silverman.2* J.Goldstein 3,and D. 4

>

>

> 1Department of Medicine Cedar-Sinai Medical Center 2UCLA School of

> Medicine,

> Los Angeles, CA. 3 The Chronic Fatigue Syndrome Institute. Anaheim CA.

> And 4

> The Hyperbaric Oxygen Institute, San Bernardino, CA USA

>

>

>

>

> Hyperbaric Oxygen has been used in patients with Rheumatic Disease for

> many

> years with out reports of untoward or unusual complications for a

> variety of

> Non Rheumatic indications. Recent evidence that hyperbaric oxygen

> inhibits

> the actions of certain cyctokins. Acts as an immune doculator and may

> help

> cognitive dysfunction has resulted in a re-examination of its potential

> role

> in rheumatic diseases. A case report of a LUPUS/ Scleroderma crossover

> patient is presented whose cognitive dysfunction improved after

> hyperbaric

> oxygen therapy. The history of hyperbaric oxygen and its physiology are

> related, along with a focused review of its effects on the immune and

> central nervous systems. Areas, which might warrant further

> consideration by

> Rheumatologists, are outlined, as well of areas of concern.

>

>

> Keywords: hyperbaric oxygen: Scleroderma: rheumatic Diseases

>

>

> Introduction:

>

>

> Hyperbaric Oxygen Therapy is defined as the subjecting of patients to

> pure

> oxygen breathing at ambient temperatures, which are greater than normal

> atmospheric pressure.

>

>

> Although concepts of hyperbaric oxygen therapy were first employed in

> 1662,

> its modern use other than for decompression dates from 1956 when

> hyperbaric

> oxygen was used to perform cardiac surgery in Holland 1 . Mechanically,

> the

> most common applications of hyperbaric oxygen are to dissolve air or gas

>

> emboli and treat divers with " bends " or decompression illness.

>

>

> New insights into the biochemical and immune interactions of hyperbaric

> oxygen have increased interest in its potential applications over the

> past

> decade. The United States Medicare System has approved hyperbaric oxygen

> for

> 13 indications ranging from acute Carbon Monoxide intoxications, Gas

> gangrene, and osteroradionecroisis to acute arteriolar insufficiency.

> Over

> the last 20 years, patients with a variety of conditions, especially

> Multiple Sclerosis, have reported cognitive improvement after undergoing

>

> hyperbaric oxygen. One Lupus/ Scleroderma crossover patient, whose case

> is

> reported here, underwent hyperbaric oxygen therapy specifically for

> cognitive impairment. And experienced subjective and objective

> improvements.

> Her case is presented and our concepts of hyperbaric oxygen and the

> immune

> and central systems are reviewed.

>

>

> Case Report:

>

>

> A 53 year old Caucasian Woman flight attendant who was in her usual

> state of

> health in 1979 when she underwent Thyroidectomy and inadvertent

> parathyroidectomy for Graves disease. In February of 1980, her Heyer

> Schulte

> saline breast implants (place in 1977 for cosmetic purposes) were

> replaced

> with -Uphoff Silicone prostheses. She was well until 1986 when she

> presented to UCLA Medical Center with subcutaneous arthritis, Raynaud's

> phenomenon, Sclerodactyly, inflammatory arthritis, and erythermatous

> rashes.

> A work-up demonstrated an ANA of 1:40 (speckled), elevated sedimentation

>

> rates (averaging in the high 30's) and persistently decreased IgA

> levels.

> She was diagnosed as having a Lupus/ Scleroderma crossover. Although the

>

> possibility of Eosinophilic fascuiitis was considered. (It was

> ultimately

> ascertained that she occasionally took L-troptophan to sleep after long

> fights.) No disease modifying therapy was given: supportive diuresis and

> not

> steroidal anti- inflammatory agents were prescribed. Over the following

> 7

> seven years, Her ANA rose to 1:1280 (homogeneous) a positive IgG

> anticardiolipin antibody was found and her course was complicated by

> percarditis and supraventrocular tachyarrhythmias. The latter of the two

>

> items were felt to be suggestive of cardiac sclerodrema: anti RNP was

> negative and her inflammatory arthritis subsided. CD3 levels. B cell and

>

> natural killer cell values do not change. Similar findings have been

> found

> in mice in two separate studies. 9.10 Interestingly, the administration

> of

> Immunoglobulin production by spleen cells 9 Long terms hyperbaric oxygen

>

> delayed the development of Proteinuria, facial erythema, and

> lymphadenopathy

> in MRI/ 1pr. Mice. Iamoto et al showed that hyperbaric oxygen has

> immunosuppressive properties modulated by decreasing interluekin 1 and

> prostaglandin E2 production, but interleukin 6 in production was not

> altered. 11

>

>

> How does Hyperbaric Oxygen Affect the Central Nervous System?

>

>

> Studies of hyperbaric oxygen on the central nervous system show that at

> tensions of 1.2- 1.5 atmospheres absolute (ATA), it decreases blood flow

> by

> 1-20% (mean of various studies is about 10%), 2 other physiologic

> changes

> occur. These include greater permeability of the blood brain barrier to

> medications and increased oxygen tensions tissues that far outweigh the

> net

> effects of mild vasoconstriction. The deformability of erythrocytes is

> increased resulting in improved transportation in the microvasculature

> circulation and lactate removal. 12 Hyperbaric oxygen stimulates the

> metabolism of nerve cells deprived of oxygen. As early as the 1960's,

> Meijne

> reported cognitive improvement in patients to performing mathematical

> calculations and demonstrated increased typewriter skills after

> hyperbaric

> oxygen 13 An area of controversy among Hyperbaricists concerns the

> possibility that once 1.5 ATA is exceeded, anaerobic metabolism is

> favored

> and thus cognitive do not improve as well as they would at lower

> pressures.

> Di Sabato et al 14 performed a controlled study (with Sham hyperbaric

> controls) on patients with cluster headaches. The dramatic improvement

> was

> attributed to vasoconstriction, decreased edema, increased serotoin

> synthesis, and decreased cerebral hypoxia. Additionally, in the central

> nervous system hyperbaric oxygen decreases adrenaline and monoamine

> oxidase

> levels as well as promoting axonal regeneration 15.

>

>

> Hyperbaric Oxygen for Multiple Sclerosis and other autoimmune diseases:

>

>

> As hyperbaric oxygen decreases demyelination from per-vascular edema,

> over

> 6000 patients with multiple sclerosis have undergone this therapy in the

>

> past 10 years. A published trial by The New England Journal of Medicine

> Suggesting improvement with hyperbaric oxygen in 40 patients in 1983

> stimulated considerable interest. 16 However, it was evident that even

> though hyperbaric oxygen increased helper T lymphocyte levels, patient

> liked

> the treatment and reported subjective improvements (especially in the

> sense

> of well-being, cognitions and bladder function), Four separated

> placebo -controlled double -blind trials failed to demonstrate any

> objective

> benefits of using the Kutz Disability status Scale or any other

> parameters

> 17-20 This was also confirmed in a 22 institution multicenter registry

> 312

> patients followed for 2 years. 21

>

>

> Occasionally patient with other rheumatic syndromes and associated

> complications have been held to respond to hyperbaric oxygen. Aseptic

> necrosis complicating system lupus, for example, appears to be worthy of

>

> greater scrutiny. Abstracts and presentations at seminars and meetings

> of

> hyperbaric oxygen claim benefits for pneumatosis cystoid intestinal in

> sclerodrema, livedo reticularis with Vasculitis and Raynaud's

> phenomenon.

> Articles have appeared advocating hyperbaric oxygen for Crohn's disease

> and

> cyclophophadmide-associated hemorrhagic cystitis

>

>

> How save is hyperbaric oxygen?

>

>

> Hyperbaric Oxygen is generally quite safe, but serious complications can

>

> occur.24 Absolute contraindications to hyperbaric oxygen include

> pregnancy,

> underlying malignancy, untreated PNEUMOTHORAX, concomitant therapy with

> doxorubicin, cis-platinum, or disulfiram. Special considerations need to

> be

> taken into account if the patient has upper respiratory tract infections

> or

> chronic sinusitis (which make clearing of the ears and sinuses

> problematic)

> low seizure thresholds (with high fevers or epilepsy, emphysema with CO

> 2

> retention (which suppresses breathing). And congenital spherocytosis

> (hempolysis can result) The most common complication of hyperbaric

> oxygen is

> barotrauma to the ears and sinuses caused by pressure changes, which has

>

> been reported in about 5% of the cases. Occurring in 0.1- 5% of the

> patients

> are hypersensitivity reactions confinement anxiety, central nervous

> system

> oxygen toxicity, pulmonary oxygen toxicity and temporary changes in

> eyesight. To minimize risks, patients are advised to have an ear, nose

> and

> throat examination by the treating Physician before therapy, not to

> drink

> alcohol or take any medication for 4hours prior to treatment, and to

> wear

> 100% cotton clothing.

>

>

> Is there a potential role for hyperbaric oxygen in Rheumatic Diseases?

>

>

> Very little is known about the influence of hyperbaric oxygen on the

> immune

> system. Animal models of autoimmune disease and normal mice are

> conductive

> to hyperbaric oxygen studies. Hyperbaric oxygen might be useful in

> combination with other therapeutic modalities. Further study is needed

> in

> these areas before proceeding to human trials. Nevertheless, anecdotal

> testimonials that hyperbaric oxygen helps people think more clearly

> should

> be taken seriously and ultimately subjected to a prospective trial.

>

>

> Systemic lupus erthematosus (SLE) is an autoimmune disorder that affects

>

> several hundred thousand Americans. Nearly half manifest in similar

> cognitive deficits that do not respond to CORTICOSTEROIDS. 26 In the

> past

> few years, the development of single photon emission computerized

> tomography

> (SPECT) has shown hypoperfusion abnormalities bitemporally and

> bifrontally

> in patients with SLE and incidentally, with fibromyalgia/ Chronic

> Fatigue

> syndromes. 26-29

>

>

> Hyperbaric Oxygen is a well -characterized, old technology whose

> immunodulatory properties and effects on cognition have never been

> adequately studied. Although relatively expensive, this reasonably safe

> procedure might have potential heretofore-unrealized applications to the

>

> patients with rheumatic disease.

>

>

> Permission to print

> Reference: 1-29. Upon request.

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