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Biomedical subjects

Jacek Kot

Publications and source records attributed to Jacek Kot.

12 recordsLinked to original sources
PubMed2006

Value of hyperbaric oxygen in bacterial and fungal malignant external otitis treatment.

Malignant external otitis (MEO) is an invasive, morbidity, even mortality, mainly pseudomonal infection of the external auditory canal, frequently involving the base of the skull, multiple cranial nerve and the meninges. In many cases conventional therapy has been prolonged, intensive and relatively ineffective, especially in infections other than bacterial (mainly fungal). We presented theoretical principles of hyperbaric oxygen (HBO) treatment in MEO, our own experience and others' experience in applying this treatment method. We treated eight patients with MEO applying pharmacotherapy, topical management, surgery in one case and also adjunct HBO. In six patients, infection was caused by Pseudomonas aeruginosa, in one by Staphylococcus sp. and in one by Aspergillus sp. Complete recovery was achieved in seven patients. In the patient with MEO caused by Aspergillus sp., intracranial complications developed and the patient died. Our experiences in employing HBO in bacterial-caused MEO have confirmed the role of HBO as a valuable, beneficial, supporting classical treatment method. Small number of patients with MEO, especially with non-bacterial infection, and unforeseen clinical course of disease make our experience difficult to objectivize.

Adult↗
PubMed2006

Prognostic factors in sudden sensorineural hearing loss: our experience and a review of the literature.

OBJECTIVES: We investigated prognostic factors in sudden sensorineural hearing loss (SSNHL). METHODS: Our study group consisted of 133 patients with SSNHL who were treated at our department between 1980 and 2000. Eighty-one of them (group B) were treated between 1980 and 1996; they received vasodilators and small doses of steroids. The others (52 patients; group A) were treated between 1997 and 2000; they received vasodilators, steroids at high doses, and hyperbaric oxygen. A multivariate stepwise linear regression was used to identify the prognostic factors that were related to hearing improvement as measured by objective change of gain in the overall average (0.5, 1, 2, 4, 6, 8 kHz), the pure tone average (0.5, 1, 2 kHz), the high tone average (4, 6, 8 kHz), and the pure middle tone average (0.5, 1, 2, 4 kHz). The following factors were included in the analysis: group (method of treatment), age, gender, seasonal occurrence of disease, presence of tinnitus and vestibular symptoms, time delay before first visit, type of initial audiogram, and type of caloric reaction. In group A, an additional analysis was conducted to include the results of certain laboratory tests: blood morphology parameters, erythrocyte sedimentation rate, glucose level, coagulogram, lipidogram, thyroid-stimulating hormone, autoantibodies (antimitochondrial antibodies, smooth muscle antibodies, and anti-brush border antibodies), and immunoglobulins G, A, and M. Values for p of less than .05 were considered significant. RESULTS: Our analysis suggests the presence of the following prognostic factors for SSNHL: method of SSNHL treatment (better results in group A); time delay before the start of treatment (better results when treatment started within 10 days of the first symptoms of SSNHL); and type of caloric reactions (worse results in patients with canal paresis). In group A, the factors for poor prognosis for absolute hearing improvement were as follows: delayed treatment, labyrinth responsiveness disorders, and decreased level of thyroid-stimulating hormone. In group A, better hearing improvement was observed in those patients in whom SSNHL was diagnosed in the spring. CONCLUSIONS: A short time delay before starting treatment (within 10 days), treatment with high doses of steroids and hyperbaric oxygen, preserving complete caloric function of the labyrinths, normal function of the thyroid, and seasonal occurrence of the disease in the spring were positive prognostic factors for hearing recovery in SSNHL.

Acute Disease↗
PubMed2005

Pneumoperitoneum after diving--two clinical cases and literature review.

Pneumoperitoneum after diving is a rare symptom. Diagnosis and treatment strongly depends on the primary source of the air in the abdominal cavity. There are two main sources of air entering the perineum: perforation of the gastrointestinal tract and pulmonary barotrauma. The management is different and additionally, in both cases, the decompression sickness and arterial gas embolism as consequences of inappropriate decompression phase of the diving should be included in the clinical diagnosis and treatment. The multidisciplinary team including hyperbaric physicians and surgeons is necessary for proper management of such cases. In this paper two cases of pneumoperitoneum of different origins are presented and similar cases reported in the literature are discussed.

Adult↗
PubMed2004

Usefulness of high doses of glucocorticoids and hyperbaric oxygen therapy in sudden sensorineural hearing loss treatment.

OBJECTIVE: We investigated the effect of pharmacologic (steroids, vasodilators, vitamins, and Betaserc) and hyperbaric oxygen therapy on patients with sudden sensorineural hearing loss. METHODS: The pharmacologic arm of the study consisted of 52 patients with defined sudden sensorineural hearing loss treated simultaneously in the ENT Department and National Center for Hyperbaric Medicine of the Medical University of Gdansk, Poland, from 1997 to 2000 (Group A). The hyperbaric oxygen therapy consisted of exposure to 100% oxygen at a pressure of 250 kPa for a total of 60 minutes in a multiplace hyperbaric chamber. The control group included 81 patients with defined sudden sensorineural hearing loss treated in the ENT Department, Medical University of Gdansk, from 1980 to 1996 (Group B). Both groups were comparable regarding the age of the patients, season of hearing loss occurrence, tinnitus and vestibular symptom frequency, delay before therapy, and average threshold loss before the start of treatment. The treatment results (hearing gain) were estimated using pure-tone audiometry. We retrospectively analyzed the audiograms of all patients. RESULTS: Patients from Group A (blood flow-promoting drugs, glucocorticoids in high doses, betahistine, and hyperbaric oxygen therapy) showed significantly better recovery of hearing levels compared with those from Group B (blood flow-promoting drugs and glucocorticoids in low doses) at seven frequencies (500, 1,000, 2,000, 3,000, 4,000, 6,000, and 8,000 Hz) (p < 0.05) and four groups of frequencies (pure-tone average, high-tone average, pure middle-tone average, and overall average) (p < 0.05). Percentage hearing gain in all investigated frequencies was also better in Group A versus Group B, and the differences were statistically significant (p < 0.05). CONCLUSION: We conclude that hyperbaric oxygen therapy with high doses of glucocorticoids improves the results of conventional sudden sensorineural hearing loss treatment and should be recommended. In addition, the best results are achieved if the treatment is started as early as possible.

Adolescent↗
PubMed2004

[Sudden sensorineural hearing loss: a treatment protocol including glucocorticoids and hyperbaric oxygen therapy].

The aim of this study was to evaluate the efficacy of pharmacological treatment (corticosteroids, vasodilators, vitamins, Betaserc) combined with hyperbaric oxygen therapy (HBO) in the sudden sensorineural hearing loss (SSNHL). We reviewed 52 patients with SSNHL treated pharmacologically and with HBO (group A) between 1997 and 2000. All patients in this group received once daily, five days a week, 100% oxygen in a multiplace chamber under pressure of 2.5 ATA for 60 minutes (plus two 5 minutes air breaks). The other group (group B) consisted of 81 patients treated only pharmacologically between 1980 and 1997. Both groups were similar regarding age, season of the year in which deafness occurred, presence of vestibular symptoms and tinnitus, therapeutic delay from initial symptoms to start of treatment, and initial hearing loss, however there were significant differences in gender and shape of hearing loss. The improvement after treatment was measured by tonal audiometry. The retrospective analysis of audiometries performed in all patients was conducted. The improvement of hearing loss was statistically significantly better for group A (vasodilators, high-dose of corticosteroids, vitamins, Betaserc, HBO) than group B (vasodilators, lower-dose of corticosteroids, vitamins) in any single frequency (500-1000-2000-3000-4000-6000-8000 Hz) and in 4 ranges of frequencies (PTA, HTA, PMTA, OAA) both for relative and absolute values. We concluded that the combined therapy of high-dose corticosteroids and HBO improved the clinical results of treatment in the SSNHL, and therefore should be performed in such cases. We also observed that therapeutic delay and flat hearing loss are predictors of poor clinical outcome.

Adult↗
PubMed2004

Delayed treatment of bubble related illness in diving--review of standard protocol.

The basic treatment of diver with bubble related illness consists of recompression in medical hyperbaric facility. However transportation of injured diver to hyperbaric chamber can last for several hours. During that time the process induced by gas bubbles spread out and finally result in activation of many pathophysiological events. Currently approved standard of treatment before starting of recompression consists of normobaric oxygenation, intravenous or oral fluids and general stabilization of the patient condition. Usage of several pharmacological agents is promising, including corticosteroids, antiplatelet and anticoagulant therapy or lidocaine. Those drugs are most often used in some centres but still there is lack of randomized controlled studies concerning their efficacy in decompression illness of divers. The review of available bibliography presented in this paper leads to conclusion that recommendations of the Second European Consensus Conference on Hyperbaric Medicine "The Treatment of Decompression Accidents in Recreational Diving" published in 1996 in Marseille, France for fluid replacement and drug therapy for decompression accidents are still valid. This protocol includes the fluid treatment, normobaric oxygen and intensive therapy. Other drugs (aspirin, lidocaine, heparin, steroids, calcium channel blockers, antioxidants) should still be treated as an option considered by clinician, but without strong evidences from clinical studies.

Decompression Sickness↗
PubMed2004

A European code of good practice for hyperbaric oxygen therapy.

In 2001 the Working Group (WG) "Safety" was created within the European COST Action B14 "Hyperbaric Oxygen Therapy" with the main objectives to elaborate recommendations of good practice for hyperbaric medicine and to follow the European normalisation process of hyperbaric chambers. During three years of preparation of the European Code of Good Practice (ECGP) for HBO, the relevant documents concerning safety in hyperbaric chambers from each European country have been revised. The initial document drew on the BHA "Health and Safety for Therapeutic Hyperbaric Facilities: A Code-of Practice" (2000), and later on it was modified using national regulations and standards (from Belgium, Finland, France, Germany, Greece, Italy, Portugal, and Spain), as well as European Norms and existing experience from experts of hyperbaric centres, committees, professional and scientific associations. The ECGP for HBO consists of chapters dedicated to staffing (including responsibilities, competencies and education, minimum team during hyperbaric sessions, fitness and health surveillance), equipment, gas supply, risk management and procedures (including standard and emergency operating procedures, maintenance, record keeping, and patient safety). It also includes ECHM Educational and Training Standards for the Staff of Hyperbaric Centres (1997), ECHM Recommendation for Safety in Multiplace Medical Hyperbaric Chambers (1998), as well as COST B14 Working Group "Technical Aspects" Final Report (2001) including a risk analysis conducted specifically for therapeutic hyperbaric facilities. Many efforts have been spent to make the ECGP for HBO compatible with the new project of the European Norm prEN 14931 "Pressure vessels for human occupancy (PVHO)--Multiplace pressure chamber system for hyperbaric therapy--Performance, safety requirements and testing", which has been prepared at the same time by the CEN/BT/TF 127. Both groups (CEN/BT/TF 127 and COST B14 WG "Safety") cooperated extensively in the field of safety aspects of using hyperbaric chambers as medical devices, and both final versions of documents include many cross references. Being prepared by international Working Group "Safety" and after acceptation by all members of the COST B14 action, the ECGP for HBO represents a harmonised European view on safety in therapeutic hyperbaric facilities and can be used as a reference document for European countries for Guidelines, Regulations, and Standards in hyperbaric medicine.

Decompression Sickness↗
PubMed2003

The maximum tissue half-time for nitrogen elimination from divers' body.

Both the longest tissue half-time (T1/2max) and the maximum allowable pressure gradient (deltaP) define the safe rate of decompression (DR) after saturation expositions. The mathematical relation between them (DR = -k x deltaP, where: k = ln(2)/(T1/2max)) suggests that experimentally established decompression rate can be hypothetically described by the infinite number of T1/2max and deltaP combinations. The observed number of decompression sickness after saturation decompressions forced to change those parameters subsequently and finally led to values far outside physiological range. Therefore the aim of this study was to compare values of the longest tissue half-time of nitrogen desaturation from diver's body published since 1908 in order to present the evolution of opinions concerning desaturation process. Non-physiological values of T1/2max (from 75 to 1280 minutes) have been published during historical evolution of decompression tables and systems. The currently accepted values of T1/2max (in the range of 320-480 minutes) for saturation and non-saturation air and nitrox divings and hypobaric decompressions, still need to be precised. The discrepancy between T1/2max values obtained using isobaric decompression method and decompressions after diving indicates different physiological phenomena during nitrogen elimination in both methods.

Decompression↗
PubMed2003

Oxidative stress during oxygen tolerance test.

Reactive oxygen species, including oxygen free radicals are normally generated in human cells during aerobic metabolism. Their production may increase during breathing of hyperoxic mixtures. The 'oxidative stress' has been postulated to be an important contributor to CNS oxygen toxicity. One of the highest partial pressure of oxygen used in healthy humans is 280 kPa(a) during 30 min of 'oxygen tolerance tests' (OTT). This test is conducted in order to detect some individuals with an increased sensitivity to high partial pressures of oxygen leading them to develop CNS oxygen toxicity earlier than others. The purpose of this study was to investigate whether the OTT (30 min of breathing pure oxygen at 280 kPa(a)) would significantly induce oxidative stress in healthy population. The first group consisted of 52 subjects, in whom total antioxidant status (TAS) was measured. The second group consisted of 44 subjects, in whom protein carbonyls (PC), total thiol (t-SH) and heat shock proteins (HSP70) were measured. All measurements were done just before and immediately after the OTT. There was no statistically significant change of TAS. We observed a small, however statistically significant increase of PC and decrease of t-SH. A significant decrease of HSP70 was detected, however false positives of initial measurements are suspected. In summary, in young healthy subjects 30 min of breathing oxygen under pressure of 280 kPa(a) induces oxidative stress which can be detected by increase of protein carbonyls and by decrease of total thiol. In our study this stress was not reflected in measurement of total oxidative status and heat shock proteins.

Adult↗
PubMed2003

[An application of hyperbaric oxygen therapy in otolaryngological oncology].

Postradiation changes in the tissues and delayed wound healing were presumed by all hyperbaric medicine societies including Undersea and Hyperbaric Medical Society (UHMS) and European Committee for Hyperbaric Medicine (ECHM) as one of the basic indications for hyperbaric oxygen therapy (HBO). The authors estimated the influence of hyperbaric oxygen on molecular, biochemical and cellular changes in injured tissues including that after radiotherapy. Reviewing the references the authors tried to state the actual role of HBO in oncology of head and neck tumors. The authors referred their experiences in adjuvant therapy of head and neck neoplasms with HBO: 1] postradiation changes of head and neck after adjuvant radiotherapy (7 cases) and after primary radiotherapy (1 case); 2] delayed postoperative wound healing (1 case).

Adult↗
PubMed2002

Evolution of relation P1(P2) describing saturation decompressions after air hyperbaric expositions.

The basic problem in decompression is the limit of maximum tolerable change of pressure after diving. Due to the number of parameters involved in decompression models (bottom time, ambient pressure, exposition profile, content of breathing mixtures, properties of inert gases) the number of possible solutions is theoretically unlimited. Since the beginning of modern decompression models the starting point has been direct saturation decompression using air. The generally accepted form of solution is the linear relation between tolerable pressure P2 after saturation exposition to pressure P1 described by the equation in the form P1 = P2 x A + B, where A and B are parameters obtained by experiments. Since the introduction of this equation values of parameters have been changing in order to decrease the rate of decompression illness. The aim of this study was to analyse and interpret the trend of those changes. Sixteen published models, including the one developed in our center, were compared and gradual change of parameters was identified. This trend should result in safer decompression systems.

Decompression↗