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The optimal hyperbaric oxygen (HBO2) treatment protocol for acute carbon monoxide (CO) poisoning is unknown. This is indicated by one study that found 18 different protocols to treat CO poisoning by North American multiplace hyperbaric facilities. A pilot study was conducted to evaluate the feasibility of randomizing patients to different protocols and to determine whether any large differences in clinical outcome were present between the two most common protocols.Adult patients with accidental CO poisoning resulting in transient loss of consciousness, presentation to the emergency department within 12 hours, primary language English, high school education, and residence within 100 miles of the hyperbaric facility were recruited. Enrolled patients were randomized to one HBO2 treatment at 2.4 atmospheres absolute (atm abs) pressure with 90 minutes of 100% oxygen breathing vs. treatment by the US Air Force CO protocol (3.0 atm abs maximum pressure). A neurocognitive screening test was performed immediately after hyperbaric treatment and repeated 14-21 days later.From 1995 to 2002, 30 patients age 21 to 88 years were randomized, 18 to treatment at 2.4 atm abs and 12 to 3.0 atm abs. Average carboxyhemoglobin level for the population was 24.8 +/- 8.8% (mean +/- SD). Delay to hyperbaric treatment averaged 313 +/- 129 minutes. Neither variable was different between treatment groups. Six patients had abnormal neurocognitive testing immediately following hyperbaric treatment, 4 in the 2.4 atm abs group (22%) and 2 in the 3.0 atm abs group (17%) (P=0.71). One patient in each group demonstrated abnormality on delayed testing (p=0.75). One in each group did not return for follow-up.It is feasible to randomize CO-poisoned patients to different hyperbaric treatment protocols. Determination of differences in efficacy between treatment protocols will require a large multicenter trial with the use of detailed neurocognitive testing.

From 1989-91, the Divers Alert Network monitored recreational divers for Doppler-detected venous gas emboli (VGE) and depth-time profiles following multi-day, repetitive, multi-level exposures. A Spencer score0 occurred in 61 of 67 subjects (91%) and 205 of 281 dives (73%). No subject developed decompression sickness (DCS) on monitored days although 102 dives (36.3%) scored at Spencer Grades 2 or 3 (High Bubble Grade, HBG). We recorded the depth-time profiles with Suunto dive computers and estimated exposure severity with a probabilistic decompression algorithm. The HBG incidence increased 53% over the range of exposure severity (p0.001) in the divers, was approximately 20% higher for repetitive dives than for first dives, and decreased approximately 25% over the 6-8 days of multi-day diving (p0.001) suggesting a phenomenon similar to DCS adaptation. The observed HBG incidence was approximately 20% higher for males than females. Older male divers had a 25% increase in observed incidence of HBG while older female divers showed a 55% increase when compared to their younger counterparts.

Diving conditions, dive profiles, and symptoms of decompression sickness (DCS) in a group of Miskito Indian underwater seafood harvesters are described. Dive profiles for 5 divers were recorded with dive computers, and DCS symptoms were assessed by neurological examination and interview. Divers averaged 10 dives a day over a 7-day period with a mean depth of 67 +/- 7 FSW (306 +/- 123 kPa) and average in-water time of 20.6 +/- 6.3 minutes. Limb pain was reported on 10 occasions during 35 man-days of diving. Symptoms were typically managed with analgesic medication rather than recompression. Indices of the decompression stress were estimated from the recorded profiles using a probabilistic model. We conclude that the dives were outside the limits of standard air decompression tables and that DCS symptoms were common. The high frequency of limb pain suggests the potential for dysbaric bone necrosis for these divers.

Depressive illness and related suicide attempts have been reported to have seasonal variation, possibly related to weather. This study sought to determine the effects of weather and time of year on suicide attempts by carbon monoxide (CO) poisoning. Cases of patients in western Washington State attempting suicide by CO poisoning and referred to a regional hyperbaric oxygen treatment center from 1981-1995 were reviewed retrospectively. Information from the National Climatic Data Center was used to compare date of treatment to local weather data on the day of attempted suicide and on each day of the preceding week. The study population consisted of 264 patients attempting suicide by CO poisoning on 251 days of the 15-yr period. Mean and total precipitation in the preceding 7 days strongly correlated with attempted suicide rate, with incident rate ratios ranging from 1.75 to 2.77 and 1.14 to 1.75, respectively (P values0.05). A decrease in minimum daily temperature also correlated with attempted suicide rate. No other weather variables showed significant correlation with dates of CO suicide attempts. February, March, and October were seen to be separate factors related to a higher incidence of attempted suicide by CO poisoning. Precipitation in Seattle, change in minimum temperature, and month of the year correlated with the regional incidence of suicide attempts with CO poisoning.

To compare the effect of a dentifrice containing 0.3% triclosan and 1100 ppm fluoride and a control dentifrice containing 1100 ppm fluoride on plaque, gingiva and the oral microflora in a long-term study simulating clinical usage.159 subjects entered the clinical study and 80 were randomly selected to participate in the microbiological evaluation. 71 subjects completed the detailed evaluation of the oral microflora after 6 months use. Plaque was collected at baseline, 3 months, and 6 months, and examined by darkfield microscopy, Gram stain, immunofluorescence, and selective and non-selective media. Changes in antimicrobial susceptibilities were determined for the first 6-month period and for 6 months post-therapy for 68 subjects who completed the entire study. Susceptibilities of whole plaque samples and MIC values for two pre-designated common plaque organisms, A. viscosus and V. parvula were performed.Multivariate ANOVA and non-parametric analyses revealed no statistical differences for any factor tested. No detrimental shifts were found in either; (1) the compositional make up of the normal flora, (2) the periodontopathic or cariogenic flora, or (3) the opportunistic flora in either group of dentifrice users. Both treatments resulted in decreases in Gram positive cocci over time. There was a reduction in spirochetes in the triclosan/fluoride group as compared to the control group. No overgrowth in opportunists, periodontal pathogens, or cariogenic flora was found in either group. No increase in the proportion of the whole plaque flora resistant to triclosan was found nor was an increase in the MIC values of either A. viscosus or V. parvula in either group. Overall, there appeared to be a general decrease in plaque bacteria in both groups over the course of the experiment.

The aim of this study was to determine the effect of subgingival scaling and root planing on healing of the distal surface of second molars following extraction of third molars. Twenty-eight patients with contralateral erupted third molars and pocket depths greater than or equal to 3 mm on the distal surface of the second molars participated in this study. Measurements of supragingival bacterial plaque, bleeding on probing, pocket depth, and relative attachment level were performed at baseline and 2 months after treatment. Extraction of contralateral third molars was carried out simultaneously. The experimental site received thorough scaling and root planing of the distal surface of the second molar, while the control site received extraction alone. Experimental sites showed significant improvement in all clinical parameters assessed compared to the control sites. In conclusion, periodontal lesions on the distal of second molars can be significantly improved following scaling and root planing after extraction of third molars.

To describe the case characteristics of a series of patients poisoned with carbon monoxide (CO) resulting from indoor burning of charcoal briquets.Cases of patients with unintentional CO poisoning referred for treatment with hyperbaric oxygen were reviewed. Cases that occurred as the result of indoor burning of charcoal briquets were analyzed.A private, urban, tertiary care center.Seventy-nine patients ranging from 3 months to 87 years of age referred from 10 counties within the state of Washington between October 1982 and October 1993.Of 509 patients treated for acute unintentional CO poisoning, 79 cases occurred in 32 incidents as a result of indoor burning of charcoal briquets, for the purpose of either home heating or cooking. A majority of cases occurred in the months of October through January, commonly during power outages or when electricity was intentionally disconnected. Patients of minority races were disproportionately represented compared with the general population of the region.Carbon monoxide poisoning is a significant hazard from indoor use of charcoal briquets. All cases are avoidable and public awareness of the risk should be enhanced.

Eighty-one human subjects completed a double-blind study which examined the effects of a 0.3% triclosan/2% Gantrez copolymer/0.243% sodium fluoride dentifrice on the microflora of supragingival dental plaque. Subjects were divided into an experimental group which performed normal oral hygiene with the triclosan/copolymer/fluoride dentifrice and a control group which also performed normal oral hygiene with the same dentifrice minus the triclosan/copolymer. At baseline, 10 weeks, and 28 weeks, supragingival dental plaque was collected from buccal and lingual surfaces of the four first molar teeth and assayed for: 1) bacterial morphotypes by phase contrast microscopy, 2) Actinobacillus actinomycetemcomitans, Actinomyces species, Bacteroides forsythus, Bacteroides gingivalis, Bacteroides intermedius, Streptococcus mutans, Streptococcus sanguis, and Wolinella recta by immunofluorescence microscopy, and 3) Lactobacillus, yeast, enterics, Staphylococcus, aerobes and anaerobes by bacterial culture. After 28 weeks' use of their respective dentifrices, changes in the supragingival plaque microflora of the subjects were similar between the triclosan/copolymer/fluoride dentifrice group and the control dentifrice group, except for statistically significant reductions in fusiforms, spirochetes and staphylococci and significant increases in S. sanguis in the triclosan/copolymer/fluoride dentifrice group, as compared to the control dentifrice group. The subject population was unusual in the presence of enteric species and anaerobes found in supragingival plaque sites. This study indicates that the use of a dentifrice containing 0.3% triclosan and 2% Gantrez copolymer over an extended period of time (28 weeks) does not result in shifts in the microflora of supragingival plaque favoring the growth of either opportunistic or pathogenic bacterial species.