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Introduction: Avascular necrosis (AVN) is a rare progressive degenerative disease leading to bone and joint destruction. Patients often require surgical intervention. Femoral AVN is the most common anatomical location. Hyperbaric oxygen treatment (HBOT) has been shown to be effective in AVN. We present data collected from one centre over a 30-year period and compare the results with other published data. Methods: A retrospective chart review of all patients receiving HBOT for AVN at Fremantle and Fiona Stanley Hospitals since 1989 was performed. The primary outcome was radiological appearance using the Steinberg score, with secondary outcomes being subjective improvement, the need for joint replacement surgery and rates of complications. Results: Twenty-one joints in 14 patients (14 femoral heads and seven femoral condyles) were treated with HBOT since 1989. Two patients were excluded. Within the femoral head group, nine of the 14 joints (64%) had stable or improved magnetic resonance imaging (MRI) scans post treatment and at six months (minimum); 10 joints (71%) had good outcomes subjectively, three joints required surgical intervention, and three patients developed mild aural barotrauma. Within the femoral condyle group, all five joints had stable or improved post-treatment MRI scans (four had visible improvement in oedema and/or chondral stability), four joints reported good outcomes subjectively, none of the patients required surgical intervention (follow-up > six months). Conclusions: This single centre retrospective study observed prevention of disease progression in femoral AVN with the use of HBOT, comparable to other published studies. This adds to the body of evidence that HBOT may have a significant role in the treatment of femoral AVN. [ABSTRACT FROM AUTHOR]

To report the complication of carpal bone tunnel collapse in scapholunate reconstruction. The authors present six cases of carpal collapse or bone necrosis after bone tunneling for ligamentous reconstruction, three in the scaphoid bone and three in the lunate. All six cases were secondary to ligament reconstruction for chronic scapholunate dissociations, none of which had preoperative structural scaphoid or lunate deformities. Although the incidence of this occurrence is unknown, the consequences could be substantial; therefore, patients should be warned of this possibility when discussing complications of ligament reconstruction for chronic scapholunate instability requiring the creation of a bone tunnel. Therapeutic V. [ABSTRACT FROM AUTHOR]

Introduction: Artisanal diving fishermen in Yucatán, Mexico have high rates of decompression sickness as a result of frequently unsafe diving practices with surface supplied compressed air. In this study, we investigated the prevalence of dysbaric osteonecrosis (DON), a type of avascular necrosis, in the most susceptible joints in a cohort of these fishermen. Methods: We performed radiographs of bilateral shoulders, hips, and knees of 39 fishermen in Mexico and surveyed them about their medical and diving histories. We performed pairwise correlations to examine if the fishermen’s diving behaviours affected the numbers of joints with DON. Results: The radiographs revealed Grade II or higher DON in 30/39 (76.9%) of the fishermen. Twenty-two of 39 fishermen (56.4%) had at least two affected joints. The number of joints with DON positively correlates with the lifetime maximum diving depth and average bottom time. Conclusions: These findings represent among the highest prevalence rates of DON in divers and reflect the wide-spread scale of decompression sickness among these fishermen. Through this work, we hope to further educate the fishermen on the sequelae of their diving with the aim of improving their diving safety. [ABSTRACT FROM AUTHOR]

Copyright of Serbian Dental Journal / Stomatološki Glasnik Srbije is the property of National Library of Serbia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Serbian Dental Journal / Stomatološki Glasnik Srbije is the property of National Library of Serbia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In head and neck cancer patients with late radiation injury, hyperbaric oxygen (HBO) is used for therapeutic or prophylactic reasons against soft-tissue and osteoradionecrosis (ORN). Twenty-nine departments of oncology, ENT, oral and maxillofacial (OMF) surgery were surveyed using the Enalyzer tool , of whom 21 responded. Data were incomplete in four returns. Within the previous year, 14 departments had referred at least one patient for hyperbaric oxygen therapy (HBOT). There appears to be a generally positive attitude in Danish OMF, ENT and oncology departments towards referral of patients with ORN for HBOT. However, there is an increasing desire for better evidence for its role in head and neck cancer in the prevention and treatment of soft-tissue injury and osteonecrosis following radiotherapy. [ABSTRACT FROM AUTHOR]

Purpose: Diagnosis and treatment remain controversial for Kienböck disease. A few reports have correlated magnetic resonance imaging (MRI), which is essential for early diagnosis, and histopathology of Kienböck biopsy specimens, but histopathological correlations of whole lunate bones or histological slices compared with MRI images are lacking. The purpose of this study was to compare presurgical MRI scans with corresponding histological slices of Kienböck-diseased lunates. Methods: We excised whole lunates at the time of surgery from 6 patients with Kienböck disease (stage IIIB) undergoing tendon-ball replacement or a Graner procedure. We stained paraffin-embedded, coronally sectioned specimens with hematoxylin-eosin and compared them with presurgical coronal scans using MRI with a 47-mm microscopy surface coil. Results: Toward the center of the lunates, the signal intensity in the proton density–weighted images was reduced, whereas the dorsal and palmar sides of the lunates exhibited no changes in intensity. In correlation, histopathological findings revealed strongly disrupted trabeculae toward the center of the lunates and intact trabeculae in the dorsal side of the lunates. Likewise, the necrotic and vitalized bone exhibited low and high signal intensities, respectively, in the proton density–weighted images; however, in the fast-field echo images, there were no correlations with histopathological observations. Conclusions: Proton density–weighted MRIs but not fast-field echo images using a 47-mm microscopy coil reflected the extent and localization of the necrotic area in Kienböck-diseased lunates, as evidenced by comparison with histological analyses of the lunate specimens. Clinical relevance: Proton density–weighted MRIs accurately reflect the vascular status of the lunate and may help plan treatment on a case-by-case basis. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of the European Committee for Hyperbaric Medicine (ECHM) workshop on controversial issues in hyperbaric oxygen, which was held in Istanbul, Turkey in 2010. The workshop focused on conditions that are not yet regarded as indications for hyperbaric oxygen therapy (HBOT). General introductory reports were presented by experts to recognise the inclusion of indications in the ECHM recommendations for use of HBOT. Statements made by specialists were presented to the ECHM Executive Board for approval.

A paraformaldehyde preparation (Toxavit®) was applied to an inflamed and symptomatic pulp of the mandibular right first molar (tooth #46), in a 30-year-old woman. Leakage from the product was responsible for marked necrosis of the gingiva and the alveolar cortical bone, which resulted in loss of the tooth. [ABSTRACT FROM AUTHOR]

A quiz on hyperbaric oxygen therapy for delayed post-radiation injury for physicians subscribing to the journal "Diving and Hyperbaric Medicine (DHM) is presented.

The article evaluates a study that investigated whether the administration of hyperbaric oxygen results in improving the symptoms of patients with Fiscat stage II idiopathic femoral head necrosis (FHN). Cohort follow up of all subject patients who received hyperbaric oxygen therapy (HBOT) suggests gains were maintained and no patient required joint replacement during the time. Although the clinical significance of the study is unclear, it suggests that patients with FHN benefit from HBOT.

The article provides a critical appraisal of a study on the improvement of both pain scores and range of motion in patients with early idiopathic femoral head necrosis by hyperbaric oxygen therapy (HBOT). Subjects who acquired sham therapy were given HBOT following completion of the initial 30 treatments. Results were measured following 10 and 20 treatments as well as on completion. All patients reported minimal pain and no reduction in activities of daily living.