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Background/Aim. Hyperbaric oxygen therapy (HBOT) is a method which increases oxygen solubility in plasma up to 20 times. This effect is very important in the treatment of circulatory disorders, which reduces oxygenation and leads to increased production of inflammatory mediators and free oxygen radicals. The aim of this study was to examine the impact of HBOT on the oxidative stress parameters in the patients with systemic lupus erythematosus (SLE). Methods. This prospective study included 18 females with SLE [American College of Rheumatology (ACR) criteria], average age 52.2 ± 8.82 years, treated with HBOT for 60 min/day, with average partial oxygen pressure of 2.2 atmospheres absolute (ATA), during 10 days, in combination with appropriate medication therapy for SLE. The following parameters were determined in the serum: C-reactive protein (CRP), hemoglobin, creatinine, albumin, complement 3 (C3), antinuclear antibodies (ANA), glomerular filtration rate (GFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. In the urine, parameters of oxidative stress were spectrofotometrically determined: levels of superoxide anion radical (O2 •–), hydrogen peroxide (H2O2), nitrites (NO2-) and concentration of thiobarbituric acid reactive substances (TBARS). In hemolysate, the parameters of antioxidant protection: superoxide dismutase (SOD), catalase (CAT) and reduced gluthatione (GSH), were measured. The samples for the analysis were collected three times: before HBOT (initial values), after 10 days of HBOT and 1 month after beginning the treatment in relation to the initial value. Results. We noticed a statistically significant (p < 0.05) decrease in a level of O2 •–, both after 10 days and after 1 month of HBOT (8.26 ± 13.62; 8.39 ± 4.94; 11.92 ± 6.86 nmol/mL, respectively). Values of other parameters of oxidative stress such as NO2-, TBARS and H2O2- showed no significant difference during the monitored period. Regarding the parameters of antioxidant the protection, we revealed slightly higher value of GSH after treatment (initial value: 66.34 ± 16.31; after 10 days of HBOT 79.43 ± 36.77; after 1 month of HBOT69.72 ± 22.32 μmol/mL red blood cells) which was held after a month, but it was not statistically significant. Activity of SOD and CAT, before and after HBOT, did not change significantly. Conclusion. Our results suggested the potential beneficial effects of HBOT on redox status in the patients with SLE by decreasing the levels of O2•–.

Introduction. Polycystic kidney disease is a hereditary kidney disease characterized by the occurrence of cysts (fluid-filled enlargements) in cortex or medula of the kidney, and is inherited in an autosomal dominant or autosomal recessive manner. In addition to multiple cysts in kidneys, there may be many extra-renal manifestations (cysts of the liver, pancreas, lungs, heart, etc.), among which the most serious one is intracranial aneurysms. Case report. A 57-year-old female patient with polycystic kidney disease and stage IV renal failure was hospitalized at our clinic due to decreased renal function, the development of urinary tract infections, headaches and unregulated blood pressure despite the usual treatment. This patient also had a number of associated diseases: obesity, diabetes mellitus (the insulindependent type), hypothyroidism, and depression syndrome. After better regulation of blood pressure, resolved urinary tract infections and improved renal function, there were still persistent headaches (resulting in the excessive use of analgesics). With adequate preparation, multislice computed tomography (MSCT) angiography of blood vessels of the head was performed. As a result, we diagnosed the saccular intracranial aneurysm (IA) with anterior localization. Regarding the symptoms, age and comorbidity, digital subtraction angiography (DSA) was performed, and showed saccular IA (5.2 mm × 4 mm), with wide neck affecting both middle cerebral artery branches (MCA). During the procedure the stent was placed, which filled the aneurysm with spirals, cutting it off from circulation. After the successful procedure and without further complications, the patient no longer had headaches and blood pressure was maintained within the required limits with stable parameters of chronic renal failure. Conclusion. The case of the patient with polycystic kidney disease, stage IV chronic renal failure, with a number of comorbidities (headache, obesity, hypertension, diabetes mellitus, hypothyroidism) and diagnosed with symptomatic intracranial aneurysm was successfully solved with a multidisciplinary approach, emphasizing the importance of teamwork in daily practice.

Introduction. Oxygen is an essential element of life in aerobic organisms. However, if not controlled, inhalation of oxygen under increased pressure in conditions of hyperbaric oxygen therapy can lead to serious damage and even death. Case report. We presented a 20-year-old male who had begun exhibiting symptoms of epilepsy during diving test in a hyperbaric chamber while inhaling 100% oxygen. He was immediately taken off oxygen mask and started breathing air and began rapid decompression. He lost consciousness, began foaming at the mouth, and had a series of tonic spasms. The patient was previously completely healthy and not on any medications. He was admitted for emergency treatment in our hospital, where he was treated for epilepsy. On admission, he complained of muscle and joint pain, and had erythematous changes on the forehead, neck and chest. All these changes occurred after leaving the hyperbaric chamber. Bloodwork revealed leukocytosis with neutrophil (Leukocytosis 16.0 ´ 109/L (reference values 4.00-11.00 ´ 109/L), Neutrophili 13 ´ 109/L (reference values 1.9-8.0 ´ 109/L), with elevated enzymes aspartate aminotransferase (AST) 56 U/L (reference values 0-37 U/L), alanin aminotransferase (ALT) 59 U /L, (reference values 25-65 U/L), creatine kinase (CK) 649 U/L, (reference values 32-300 U /L), lactate dehydrogenase (LDH) 398 U/L (reference values 85- 227 U/L). Because of pain and his condition we began treatment in a hyperbaric chamber at a pressure of 2.0 ATA for 70 minutes, resulting in a reduction of symptoms and objective recovery of the patient. Within 24 h, repeated laboratory tests showed a reduction of leukocytosis (13 ´ 109/L and neutrophils (7.81 ´ 109/L), and the gradual reduction of the enzymes AST (47 U/L), ALT (50 U/L, CK (409 U/L), LDH (325 U/L). Since head CT and EEG were normal, epilepsy diagnosis was ruled out. This fact, along with medical tests, facilitated the differential diagnosis and confirmed that this was a case of neurotoxic effects of oxygen while the patient was in a hyperbaric chamber, not epileptic seizures. Conclusion. This case report suggests that in patients with symptoms of epileptic seizures while undergoing treatment in a hyperbaric chamber, it is always important to think of neurotoxic effects of pure oxygen which occurs at higher pressures and with a longer inhalation of 100% oxygen. In these patients, reexposure to hyperbaric conditions leads to recovery. This effect is important in daily inhalation of 100% oxygen under hyperbaric conditions which is why the use of pure oxygen is controlled and diving is allowed in shallow depths and for a limited time.