hyperbaric chamber hyperbaric oxygenation in stomatology in the treatment of digestive pathologies selected.
Author: Dr. Bada Elvys Perez They scheduled a course of treatment with hyperbaric oxygenation of 15 sessions at 2 ATA, except where ulcerative colitis treatment cycles were scheduled every 3 months. All patients were maintained on conventional treatment had at the time of the investigation.
hyperbaric oxygen proved to be a useful therapeutic alternative and shortened the developmental period of these entities regardless of the use or non-traditional treatment used on them.
INTRODUCTION:
In recent decades, scientific advances have developed many techniques for gastrointestinal diseases the application of molecular methods for the prevention, diagnosis and treatment of these diseases to therapeutic interventions is not radiological and endoscopic surgery, minimal bloody surgery and organ transplants. However, despite these advances, even the cornerstone of medicine is efficient patient care and selection of appropriate therapeutic options. (1, 2, 3.4). Within
digestive diseases frequently are hepatitis etiologies whose main hepatotropic viruses (A, B, C, D, E, G), toxic causes and other diseases that affect less frequently liver parenchyma. In the case of viral hepatitis, caused by the hepatitis B virus remains a major health problem worldwide, evolving with acute and chronic despite immunization policies on risk groups (5, 6.7). Moreover, the hepatitis C is responsible for 50% of cases of chronic hepatitis worldwide, has reported its carcinogenic nature with a high incidence in the susceptible population. (5, 6.8).
Given this wide range of etiologies and clinical, in the case of hepatotropic virus, there is only specific treatment for some forms of hepatitis B and C (interferon alpha and nucleoside analogues). Interferon alpha has been described as a treatment of choice for some clinical forms and the emergence of nucleoside analogues (Ribavirin, Lamivudine) and its combination with the first has allowed different therapeutic regimens have been tested but the overall results are relatively disappointing. For all other etiological forms do not have an effective therapy even in those patients who evolve unfavorably, with the exception of general measures for all critically ill patients. (9,10).
Peptic ulcer is a challenge for medicine due to its high incidence and high cost. Because of this have emerged new diagnostic techniques among which are: various methods for the demonstration of Helicobacter pylori, endoscopic techniques and therapeutic strategies aimed at the eradication of this germ and the restoration of the defense mechanisms of the gastrointestinal tract. Despite these advances in diagnosis and therapy, about 1% of ulcer patients experienced any complications each year so the likelihood of this varies from 20-30% over the natural evolution of the disease, increasing the risk from the time when the first complication occurs. Against this background have launched various schemes treatment, but so far none has shown absolute effectiveness. (11,12).
immune Ulcerative colitis is a chronic inflammatory disorder that evolves with exacerbations and remissions in which up to 10% of patients may develop a fulminant with perforation, massive bleeding, sepsis and toxemia in the initial attack. Therefore we have made many efforts to try to find an effective treatment regimen, but so far remains a chronic, incurable from a medical standpoint. (13,14).
The Hyperbaric Oxygen is breathing pure oxygen (100%) at pressures above normal in an airtight container, which is achieved by the dissolution of additional quantities of the same blood and body fluids under the law of Henry. This law states that the dissolution of a gas (constant temperature) in body fluids is directly proportional to the partial pressure of which is under the same, which is accomplished by a high diffusion gradient of the gas from the blood tissues and provides a reservoir of oxygen bound to hemoglobin. This hyperoxia causes several beneficial effects including: the correction of hypoxia, vasoconstriction without affecting tissue oxygenation, which reduces swelling, stimulates repair processes and scarring, oxygen-dependent bactericidal activity of polymorphonuclear cells and macrophages and promotes the synthesis of natural interferons. (15, 16,17).
Given the variability of the effectiveness of conventional treatment alternatives diseases described above, and based on the beneficial effects of hyperbaric oxygenation decided to use this therapeutic modality for the treatment of these entities.
OBJECTIVES:
General:
1 - Assess the utility of hyperbaric oxygenation in some digestive diseases such as acute hepatitis complicated peptic ulcer and ulcerative colitis immune.
Specific:
1 -. To determine the clinical and laboratory examinations of each pathology.
2 -. Compare the results of treatment with hyperbaric oxygenation when used as single therapy with those obtained when it is combined with conventional treatment.
3 -. Analyze the costs of treatment.
MATERIAL AND METHODS:
were treated at University Hospital "Celestino Hernandez Robau" of Santa Clara in the period from January 200 to December 2006 a total of 198 patients with the following criteria:
1 - . Acute viral hepatitis torpid evidenced by:
a) clinical and humoral signs of liver failure.
b) Cholestasis of two months or more without improving trend.
c) Persistence of enzymatic alterations with no tendency to normalization after three months.
2 -. Duodenal ulcer refractory to conventional treatment or complications during her debut.
3 -. Gastric ulcer.
4 -. Ulcerative colitis with acute diarrheal immune at the time of the study or frequent.
Patients with acute hepatitis underwent glutamic pyruvic transaminase (GPT) and total bilirubin (if jaundice) initiation of treatment with hyperbaric oxygenation) in the 8th session and at the end of it. To analyze the behavior of these numbers in graphs, are found the average value at each time of treatment. Was also carried surface antigen for HBV and HCV antibody before and during the treatment regimen in order to classify serologically liver disease. Seronegative hepatitis were considered those that did not correspond to these viruses. Among other causes were considered particularly toxic.
All patients with peptic ulcers were diagnosed endoscopically (they did Histological all gastric ulcers) and this test was repeated 10 to 15 days after completion of the last session.
Patients suffering from ulcerative colitis were diagnosed immune endoscopic and histological and radiological study was performed were the colon when it was relevant.
All patients were maintained on treatment for each disease if they had, except for patients with ulcerative colitis under treatment with steroids, which was suspended or reduced to minimum dose. They scheduled a course of treatment with hyperbaric oxygenation in a daily session from Monday through Friday, except in patients with liver failure which provided 2 sessions of treatment per day and in the case of patients with ulcerative colitis where treatment cycles were scheduled every three months. There were a total of fifteen sessions. The teams were compressed to 2 atmospheres absolute pressure (ATA) for 50 minutes isopressure (1 hour in liver failure) with fast compression and decompression of 0.1-0.2 FGR x cm2 x min. The treatment was done in Soviet-made car cameras.
The course of treatment effectiveness was assessed according to criteria of the National Hyperbaric Medicine:
A) Satisfactory resolution and clinical examinations laboratory.
B) Regular: no objective clinical improvement confirmed by laboratory tests.
C) Not satisfactory: No clinical response or additional. To
effectiveness analysis took into account the cases assessed as satisfactory.
Results and presented in tables and graphs from the statistical point of view applied the Mantel-Hanzel method in order to determine whether there were significant differences between treatment effects loe (Hyperbaric oxygen with or without conventional treatment) adjusted for clinical forms. The research was conducted with a significance level of 5% in case there Significant differences were calculated adjusted relative risk.
RESULTS AND DISCUSSION
Table No. 1 shows the distribution of patients by sex and average age in the different pathologies studied. The mean age was 35.6 years, being higher that of those patients with gastric ulcer 48.4 years. There was a predominance of males (69.5%), more evident in the duodenal ulcer (77%) and acute hepatitis (73.7%)
The average age of our sample corresponds with what was expected because it is diseases predominantly affecting young adults, except for gastric ulcer which are reported in later ages. This predominance of old evidence that this research focused on a socially active population group in which the cure or shorten the course of the disease of great economic and social importance.
tabal In No. 2 we can observe the distribution of clinical and etiological forms of acute hepatitis. The total (110), 71 corresponded to seronegative hepatitis, second hepatitis B are the number of 30 (27.3%), while the most frequent clinical forms was extended to 57 patients (51.8%) followed by the colostásica with 45 (40.9%).
Figures 1 and 2 shows the evolution of the total bilurribina tgp and in acute hepatitis. Each curve represents the clinical forms. The decrease was significant figures and bilirubin tgp how long. The reduction of the average values \u200b\u200bof tgp and bilirubin was evident from the second sampling, which corresponded with clinical improvement in patients who had 3 or more months with no tendency to improve clinical and humoral.
This positive development can be attributed to some of the effects of hyperbaric oxygenation on liver parenchyma in the literature. Hyperbaric oxygen restores the tissue levels of this gas in the liver inflamed, reduces edema secondary to inflammation due to physiological hyperoxic vasoconstriction without affecting tissue oxygenation due to the high levels of dissolved oxygen in the blood (3 times higher than normal). This leads to an improvement in microcirculation. Also described a stimulation in hepatic lipid detoxification capacity, and an increase in the synthesis of natural interferons. This sum of effects results in a restoration of liver function (15, 16,17).
Treatment outcomes for each clinical form described in Table 3 in which we can see that there were positive results (92.8% and 100%) for hepatitis colostasicas prolonged evolution, respectively, while in patients with well-developed liver failure 75% of them. 99% of patients who used hyperbaric oxygen therapy alone responded favorably while 80% of those who used combined with interferon showed satisfactory results. Statistical analysis showed that for each clinical form significant differences (X2 = 6.4580) between both treatment groups and frequency of treatment failure associated with interferon Hyperbaric oxygen is greater than when it is used alone. overall effectiveness of both treatment groups was 97.3%
In our study, the Hyperbaric Oxygen demonstrated efficacy in the management of patients with acute hepatitis torpid, regardless of etiology and although there were significant differences between treatment groups think that this might be influenced by the smallest number of patients treated with the combination of interferon and Hyperbaric Oxygen. Moreover, most of these cases involved patients with acute hepatitis B or C is known tend to evolve less favorable. Hyperbaric Oxygenation with or without interferon shortened the developmental period of acute hepatitis independence its etiology.
predisposing factors, the duration of symptoms and complications of peptic ulcer are shown in Table 4. The median time to progression was 59.4 months (4.95 years) and 87% of patients had a predisposing factor. 77% of them had previous complications or the debut. Most of these patients (84.4%) had duodenal ulcer and 14.3% in the stomach.
toxic habits such as smoking, alcohol consumption, coffee, ulcerogenic drugs, as the profession itself were evaluated as predisposing factors. The behavior of those in the sample was studied as described in the literature.
Nearly half of patients with duodenal ulcer debuted or had complications, mostly gastrointestinal bleeding in one case there was a pre-drilling and 3 of them had undergone surgery.
The results of treatment of different types of ulcer and ulcerative colitis are immune shown in Table 5. In the case of peptic ulcer overall effectiveness of treatment was 80.5% highlighting the results of gastric ulcer (90.9%), followed by duodenal (78.5%). All gastric ulcers treated with combination therapy. 75% of duodenal ulcer patients treated with conventional therapy Hyperbaric oxygen and a favorable outcome, while 92.3% of patients in the hyperbaric chamber which was used as a single treatment, the ulcer healed.
90.9% of patients with ulcerative colitis showed clinical remission immune evident.
Statistical analysis showed no significant differences between treatment groups in the case of peptic ulcer disease for each clinical form and the immune ulcerative colitis. (X2 = 3.21).
There are many schemes for ulcer treatment ulcer and also provides diagnostic and novel techniques that have enabled a step forward in the diagnosis and treatment of the entity. The cure rates of these ranges between 77 and 91% (2, 18,19)
The beneficial effects of hyperbaric oxygen on the ulcers are due to an injury is hypoxic colitis, a fact that the camera is corrected also stimulates the healing by fibroblast proliferation and increased synthesis of collagen, increases the oxygen-dependent bactericidal activity of macrophages polimorfonicleares and also their likely effect on the growth of Helicobacter pylori is a microaerophilic germ. (15, 16,17).
immune Ulcerative colitis is a disease difficult to treat because a low percentage of patients presents with a single attack without recurrence. In his treatment have been tried several schemes of drugs and surgical techniques. (20).
In our series showed the hyperbaric chamber effective when associated or not to conventional treatment of this entity, being remarkable that at one year 90.9% of patients had presented no clinical relapse after several courses of treatment. This result is attributed to its beneficial effect on wound healing reduction of edema and stimulation wing of the synthesis of natural interferons (15, 16,17)
Table 6 shows the costs of treatment used compared with conventional treatment, bearing in mind that our study showed that in 2 pathology represented no significant differences between treatment groups in both the Hyperbaric Oxygen is a cheaper alternative, you should consider this approach for the treatment of these entities
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