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Komentář [l1]: H Komentář [l2]: U Komentář [L7]: 正确的称 ... [1] Odstraněno: Table of ... [2] Contents ¶ Komentář [l3]: 是否加 of Komentář [l5]: 删除 Komentář [l6]: 的 Odstraněno: 45 年前也就是... [3] Odstraněno: 荷兰阿姆斯特... [4] Odstraněno: 请 Odstraněno: 各国同仁积极... [5] Odstraněno: Odstraněno: 了最初被 Ite... [6] Odstraněno: 纯 Odstraněno: 氧浸泡 Odstraněno: 透法 Invited Lecture Odstraněno: ”的高压氧疗法 Odstraněno: Odstraněno: 在不同病种中... [7] Odstraněno: 用于不同症状... [8] Odstraněno: 。¶ 大会发言 Odstraněno: ，“高压纯氧浸... [9] Odstraněno: 当时高压氧疗... [10] Odstraněno: 用途是 Odstraněno: 适应症为以厌... [11] Odstraněno: 学 Odstraněno: 疗 Odstraněno: 法 Odstraněno: 和高温疗法治... [12] Odstraněno: 各种传染病，例... [13] Odstraněno: 应用高压氧治... [14] Odstraněno: ，科研和临床... [15] Odstraněno: 同时也对 Odstraněno: 与研究 Odstraněno: 这种新疗法的 Odstraněno: 同时，大家还也... [16] Odstraněno: 生理、药理以及... [17] Odstraněno: 的 ... [18] ... [19] ... [20] ... [21] ... [22] B1 The use of Hyperbaric Oxygen in Necrotising Soft Tissue Infections: A Historical Perspective with an Update anno 2008 D. J. Bakker, MD, PhD. Amsterdam, the Netherlands Introduction: Necrotizing soft tissue infections caused by aerobic, anaerobic and mixed bacterial floras are a still increasing problem in surgical and medical practice. They occur with increasing frequency and seriousness, especially in immune-compromised patients. The clinical picture can vary considerably from patient to patient. Treatment is difficult, often irrational and very often "one step behind the facts," because early recognition is difficult and etiology , bacteriology, and the clinical course are aetiology sometimes not well understood or expected to evolve in a different and more favourable way. Hyperbaric Oxygen Odstraněno: treatment (HBOT) is a highly controversial issue in the literature. Considerable morbidity occurs in these diseases and the mortality can be very high, from 20% up to 70 or 80%. History: For a proper understanding it is necessary to give a short review of the history of these infections including the bacteriology and the various forms of treatment that have been advocated and practised. In this review we will pay attention to the works of Hippocrates from the 5 th century BC, Baurienne (1764), Hebler (1848) and Jean Alfred Fournier (1883), a French venereologist, Also the work by the Confederate Army Surgeon Joseph Jones will be mentioned who described a variant of this disease sthese in 1869 and 1870 during the Civil War in the United States. Odstraněno: diseases Very relevant are also the works of Meleney and Cullen (1924) en Brewer and Meleney (1926). Meleney reported about his work in the Imperial Hospital In Peking (now Beijing) in China. Extensive reviews on necrotizing soft tissue infections including Fournier’s gangrene have been published and can be found in the literature (Bakker 2002, Bakker 2008). The immense confusion in the nomenclature and the classification of these diseases will be explained. The role of Hyperbaric Oxygen in the treatment of these disease started in 1959 when Boerema and Brummelkamp treated a patient with Gas Gangrene in the Hyperbaric Chamber (HBOT). The first Congress on HBOT was held in Amsterdam in 1963, now 45 years ago. Material and Methods: We will restrict ourselves in this presentation to Clostridial Myonecrosis or Gas Gangrene and Necrotising Fasciitis or Fourniers Gangrene. a. Necrotising Fasciitis (NF) is a progressive, generally rapid spreading, inflammatory process located in the deep fascia with secondary necrosis of subcutaneous tissues and skin. The infection tends to spread very rapidly along the deep fascial planes. There is confusion in the literature about the microorganisms that cause NF. Haemolytic Streptococci play a major role in the onset of the disease. Later on in the disease one can find many more microorganisms, from which their role in the disease is not clear. A rapid diagnosis is essential for treatment and prognosis. Treatment is a combination of proper, early and extensive surgery, antibiotics and adjunctive HBOT. The grade of evidence for using HBOT in the treatment will be shown from the literature data and our own experiences. b. Clostridial Myonecrosis or Gas Gangrene is an acute, rapidly progressive, non-pyogenic, gasforming and necrotising infection of muscles, subcutaneous tissues and skin. The infection is caused by anaerobic spore-forming bacteria of the genus Clostridium. Although the prognosis of the disease is improved by modern antibiotics and intensive care treatment, the mortality and morbidity is still high, especially without HBOT. A rapid diagnosis has to be made, immediately followed by HBOT, not losing any time by performing initial surgery. The patients are too ill for surgery. Treatment consists of immediate HBOT and antibiotics, followed by, if necessary, surgical measures secondarily. This treatment has proven its use in several thousands of patients treated in this way, with constant good results over the years. Here also an update will be give about the best treatment modality anno 2008 and the evidence based reasons for that from the literature and from our own results. c. Evidence based medicine in HBOT (EBHM) is the combination of old and trusted clinical skills completed by and if necessary also corrected by the critically appraised best available scientific research results and the evaluation of care. The idea is to move beyond clinical experience and physiological principles to rigorous evaluations of the consequences of clinical actions. These evaluations are in too many indications in hyperbaric medicine, non-existent. When looking for the evidence of HBOT in infectious diseases several steps have to be taken. First of all the clinical problem has to be appropriately formulated and the correct diagnosis has to be made. Therefore clinical expertise is required. Nothing can substitute for clinical expertise in determining the specific considerations relevant to the individual patient. Clinical skills are necessary for EBHM plus an understanding of how the patients values affect the balance between advantages and disadvantages of the available treatment options, and the ability to appropriately involve the patient in the decision. Every decision taken on the basis of education and experience should, however, also be based on results of trials and evaluations. In this way we can define HBOT as a primary mode of treatment or as an adjunctive mode. We must be careful not to move the focus of clinical practice away from the care of individuals to the care of populations, lacking than the ability to apply this knowledge back to our individual patient. The Randomised Controlled Clinical Trial (RCT) is nowadays the gold standard in EBHM, but we must not forget that there is more evidence than that, that has to be taken into account when judging HBOT. Conclusion: After a short description of soft tissue infections in the history of medicine, the state of the art in diagnosis and treatment of some special forms of soft tissue infections, eg. necrotising fasciitis and clostridial myonecrosis is shown. Especially the evidence based character of treatment with Hyperbaric oxygen based on own experiences and reports from the literature is described. B2 Role of Tissue Oximetry in Assessment of Problem Wounds Paul J. Sheffield, PhD; International ATMO, Inc, Nix Wound Healing Center, San Antonio, Texas, USA Transcutaneous oximetry (PtcO2) is commonly used to determine treatment options for problem wounds: surgical remedy, adjunctive hyperbaric oxygen (HBO2), or standard wound care. HBO2 wound healing candidates are selected by assessing whether the wound area is hypoxic and if it will respond to respired oxygen. There are five PtcO2 tests commonly used to evaluate wound patients. 1. Evaluate whether wound healing is complicated by severe hypoxia. Test 1: Measure a PtcO 2 baseline air value at 1 atm abs. Hypoxia exists if PtcO2 is less than 40 mmHg. The lower the PtcO2 value, the more severe is the hypoxia. 2. Evaluate whether wound healing is complicated by peripheral arterial occlusive disease. Test 2: Elevate the leg (30˚). Disease is present if PtcO2 remains diminished more than 10 mmHg while leg is elevated. 3. Evaluate whether the wound area responds to respired O2. Test 3: Conduct an oxygen challenge at 1 atm abs. Values on respired oxygen should reach at least 35 mmHg and should rise at least 50% above air PtcO2 values. 4. Evaluate whether the wound area responds to respired HBO2. Test 4 (Alternate to Test 3): Conduct an oxygen challenge at 2-2.5 atm abs. Values on HBO2 should be at least 100 mmHg (preferably 200 mmHg). 5. Evaluate whether the wound is to the point where it will heal without further HBO2 treatment. Test 5: Repeat PtcO2 baseline air value at 1 atm abs in 3-4 wk intervals. Normalized baseline values indicate that healing process is in place. PL 1 The Indication of Hyperbaric Oxygen Therapy and for Orthopaedics in Japan Mahito Kawashima, Takashi Yamaguchi Kawashima Orthopaedic Hospital, Japan In Japan, two types of standards of indication of Hyperbaric Oxygen Therapy (HBO) are set. One is established by Japanese Society of Hyperbaric and Undersea Medicine (JSHUM) and another is by the Ministry of Health, Labor and Welfare for public medical insurance. Most cases are treated with the standard of the Ministry of Health, Labor and Welfare, because of the medical serv. system for the whole nation in Japan. This standard, the disease is classified into two types, emergency/non-emergency. The fee for treatment is different between emergency and non-emergency, multiplace