Christian Heiden

Malignant otitis externa: experience with hyperbaric oxygen therapy

Peter GermonpréPresident, EUBS

The

website is at www.eubs.org

Members are encouraged to log in

Acute antioxidant pre-treatment attenuates endothelial microparticle release after decompression

Bryna C R Chrismas, Adrian W Midgley, Lee Taylor, Rebecca V Vince, Gerard Laden and Leigh A Madden

min

Ballham A, Allen MJ. Air embolism in a sports diver. 1 Br J Sports Med. 1983;17:7-9.Brubakk AO, Peterson R, Grip A, Holand B, Onarheim J, 2Segadal K, et al. Gas-bubbles in the circulation of divers after ascending excursions from 300 to 250 msw. J Appl Physiol.1986;60:45-51.Barratt DM, Harch PG, Van Meter K. Decompression illness 3in divers: a review of the literature. Neurologist. 2002;8:186-202.Bakovic D, Glavas D, Palada I, Breskovic T, Fabijanic D, 4Obad A, et al. High-grade bubbles in left and right heart in an asymptomatic diver at rest after surfacing. Aviat Space Environ Med. 2008;79:626-8.Nossum V, Koteng S, Brubakk AO. Endothelial damage by 5bubbles in the pulmonary artery of the pig. Undersea Hyperb Med. 1999;26:1-8.Brubakk AO, Duplancic D, Valic Z, Palada I, Obad A, Bakovic 6D, et al. A single air dive reduces arterial endothelial function in man. J Physiol. 2005;566:901-6.Benedetti S, Lamorgese A, Piersantelli M, Pagliarani 7S, Benvenuti F, Canestrari F, et al. Oxidative stress and antioxidant status in patients undergoing prolonged exposure to hyperbaric oxygen. Clin Biochem. 2004;37:312-7.Madden LA, Chrismas BC, Mellor D, Vince RV, Midgley 8AW, McNaughton LR, et al. Endothelial function and stress response after simulated dives to 18 msw breathing air or oxygen. Aviat Space Environ Med. 2010;81:41-5.Vince RV, McNaughton LR, Taylor L, Midgley AW, Laden 9G, Madden LA. Release of VCAM-1 associated endothelial microparticles following simulated SCUBA dives. Eur J Appl Physiol. 2008;105:507-13.Wadsworth RM. Oxidative stress and the endothelium. 10 Exper Physiol. 2008;93:155-7.Butler BD, Little T, Cogan V, Powell M. Hyperbaric oxygen 11

Undersea Hyperb Med. 2006;33:407-17.Dujic E, Duplanc D, Marinovic-Terzic I, Bakovic D, Ivancev 12V, Valic Z, et al. Aerobic exercise before diving reduces venous gas bubble formation in humans. J Physiol. 2004;555:637-42.

13scuba diving. Exercise Sport Sci Rev. 2008;36:38-42.Blatteau JE, Gempp E, Balestra C, Mets T, Germonpré P. 14Predive sauna and venous gas bubbles upon decompression from 400 kPa. Aviat Space Environ Med. 2008;79:1100-5.Obad A, Valic Z, Palada I, Brubakk AO, Modun D, Dujic Z. 15Antioxidant pretreatment and reduced arterial endothelial dysfunction after diving. Aviat Space Environ Med.2007;78:1114-20.Obad A, Palada I, Valic Z, Ivancev V, Bakovic D, Brubakk 16AO, et al. The effects of acute oral antioxidants on diving-

induced alterations in human cardiovascular function. JPhysiol. 2007;578:859-70.Thomas SR, Witting PK, Drummond GR. Redox control of 17endothelial function and dysfunction: molecular mechanisms and therapeutic opportunities. Antiox Redox Signal.2008;10:1713-65.Angdin M, Settergren G, Starkopf J, Zilmer M, Zilmer K, 18Vaage J. Protective effect of antioxidants on pulmonary endothelial function after cardiopulmonary bypass. JCardiothorac Vasc Anesth. 2003;17:314-20.Pratico D. Antioxidants and endothelium protection. 19Atherosclerosis. 2005;181:215-24.Pablos MI, Reiter RJ, Chuang JR, Ortiz GG, Guerrero JM, 20Sewerynek E, et al. Acutely administered melatonin reduces oxidative damage in lung and brain induced by hyperbaric oxygen. J Appl Physiol. 1997;83:354-8.Goldfarb AH, McIntosh MK, Boyer BT, Fatouros J. Vitamin 21E effects on indexes of lipid peroxidation in muscle from dhea treated and exercised rats. J Appl Physiol. 1994;76:1630-5.Bader N, Bosy-Westphal A, Koch A, Rimbach G, Weirnann 22A, Poulson HE, et al. Effect of hyperbaric oxygen and vitamin C and E supplementation on biomarkers of oxidative stress in healthy men. Br. J Nutr. 2007;98:826-33.Madden LA, Vince RV, Sandstrom M, Taylor L, McNaughton 23L, Laden G. Microparticle associated vascular adhesion molecule-1 and tissue factor follow a circadian rhythm in healthy human subjects. Thromb Haemost 2008;99(5):909-15.Mak S, Egri Z, Tanna G, Colman R, Newton GE. Vitamin C 24prevents hyperoxia-mediated vasoconstriction and impairment of endothelium-dependent vasodilation. Am J Physiol-Heart Circulatory Physiol. 2002;282:H2414-21.Eskurza I, Monahan KD, Robinson JA, Seals DR. Effect of 25

with sedentary and physically active human ageing. J Physiol.2004;556:315-24.

Gokce N, Keaney JF, Frei B, Holbrook M, Olesiak M, 26Zachariah BJ, et al. Long-term ascorbic acid administration reverses endothelial vasomotor dysfunction in patients with coronary artery disease. Circulation. 1999;99:3234-40.Barak M, Katz Y. Microbubbles - pathophysiology and clinical 27implications. Chest. 2005;128:2918-32.Madden LA, Laden G. Gas bubbles may not be the underlying 28cause of decompression illness – the at-depth endothelial dysfunction hypothesis. Med Hypoth. 2009;72:389-92.

‘Sea legs’: sharpened Romberg test after three days on a live-aboard dive boatClinton R Gibbs, Katherine H Commons, Lawrence H Brown and Denise F Blake

Malignant otitis externa: experience with hyperbaric oxygen therapyAlex Saxby, Michael Barakate, Thomas Kertesz, Joanne James and Michael Bennett

Patient Age/sex Diabetes Cranial Pathogen Admission HBOT HBOT Outcome Follow up neuropathy (days) (number) problem (months)

1 75 M Yes No Bacteroides 53 29 Ongoing otorrhoea, 62 died of other disease2 79 M No No MRSA 32 30 Disease free, 90 P. aeruginosa, died of other disease3 72 M Yes VII P. aeruginosa, 36 30 Disease free, 51 Candida spp ongoing VII palsy

5 66 M Yes VII Negative cultures 59 40 Died of MOE 2 (2 months)6 65 F Yes VII P. aeruginosa, 71 37 Seizure, died of MOE 1 S. aureus (1 month) 7 84 M Yes VII Negative cultures 17 5 Pulmonary Disease free, 72 oedema VII palsy resolved8 78 M Yes XII P. aeruginosa 45 30 Disease free, 94 XII palsy resolved9 65 M Yes No Negative cultures 8 1 Claustrophobia Otorrhoea 80 and otalgia10 71 F No No Negative cultures o/p 30 Disease free, 26 died of other disease11 75 F No No P. aeruginosa 9+o/p 30 Disease free, 38 died of other disease12 84 M Yes VII P. aeruginosa, 43 29 Perforated Recurrence (11 m), 37 S. aureus TM VII palsy, died of other disease13 69 M Yes No S. epidermidis, 42 30 Disease free 43 S. apiospermum14 76 M Yes VII P. aeruginosa, o/p 30 Disease free, 49 Candida spp ongoing VII palsy15 71 M Yes VII (X) P. aeruginosa, 74 39 Recurrence (4 m), 6 Candida spp new X palsy, S. apiospermum died of MOE16 77 F Yes VII, IX, P. aeruginosa 39 30 Pulmonary Disease free, 77 XII oedema ongoing VII palsy, IX & XII resolved 17 77 M Yes VII MRSA, 93 38 Recurrence (5 weeks), 35 Corynebacterium, disease free, ongoing VII palsy

Year Author Patients Cure RateCase series 1982 Lucente17 3 NR1989 Shupak7 2 100 %1992 Davis6 16 100 %2004 Narozny10 8 88 %2010 Present study 17 70 %Case reports1982 Mader9 1 Cured1990 Schweitzer8 1 Cured1998 Bath18 1 Cured2000 Lancaster19 1 Died2005 Singh16 1 Cured

The database of randomised controlled trials in hyperbaric medicine maintained byDr Michael Bennett and colleagues at the Prince of Wales Hospital

Diving and Hyperbaric Medicine Unit is at:

<www.hboevidence.com>

Exceeding the limits - estimated tissue pressures among Western Australian recreational diversPeter Buzzacott, Terri Pikora, Jane Heyworth and Michael Rosenberg

Analyser position for end-tidal carbon dioxide monitoring in a rebreather circuitAlastair Ineson, Kaylene Henderson, David Teubner and Simon Mitchell

S100B and its relation to intravascular bubbles following decompressionMarianne B Havnes, Astrid Hjelde, Alf O Brubakk and Andreas Møllerløkken

Bubble grade0 1 2 3 4 5

Group II (400 kPa; n = 7) 4 3 0 0 0 0Group III (700 kPa; n = 11) 2 0 1 0 0 8

Severe hydrogen sulphide poisoning treated with 4-dimethylaminophenol and hyperbaric oxygenJoerg Lindenmann, Veronika Matzi, Nicole Neuboeck, Beatrice Ratzenhofer-Komenda, Alfred Maier and Freyja-Maria Smolle-Juettner

(

Patient Sex Age CPR Time to Time to Number Diagnosis Intubation ICU Hospital Outcome(yrs) DMAP HBOT HBOT (days) (days) (days)

1 F 39 Yes 90 100 2 VF, cerebral ischaemia & oedema 1 1 1 Deathpulmonary oedema, (day 2)malignant hyperthermia

2 F 40 No 60 100 6 Respiratory shock, pleural effusions 1 2 8 Fullrecovery

3 F 26 No 60 100 6 Respiratory & circulatory shock, 1 2 8 Fullcerebral oedema recovery

4 F 46 No 60 100 11 Respiratory & circulatory shock, 4 5 12 Fullpulmonary oedema, ARDS recovery

5 M 28 No 60 100 8 Respiratory & circulatory shock, 1 2 8 Full‘gas eye’ recovery

6 M 60 Yes 90 125 1 Cardio-respiratory arrest, AF, 7 7 7 Deathcerebral ischaemia & oedema (day 8)pulmonary oedema, ARDS,

Hyperbaric oxygen in the treatment of asphyxia in two newborn infantsAlberto Orozco-Gutierrez, Lucilina Rojas-Cerda, Rosa M Estrada and Cesar Gil-Rosales

Pre-HBOT Post-HBOT 1 Post-HBOT 2 Post-HBOT 3Case 1 CPK total (units) 3069 795 342 493

CK-MB (units) 58 35 29 41LDH (units) 1036 730 645 657

Case 2 CPK total (units) 2156 1230 539CK-MB (units) 77 43 30

CME ACTIVITY 2010/4HBOT AND MALIGNANT OTITIS EXTERNAMichael Bennett

Breathe easyJohn Parker

EXECUTIVE COMMITTEE (as of September 2010)

EUBS 37th ANNUAL SCIENTIFIC MEETING 201124–27 August 2011

Gdansk, PolandFirst Announcement

Hosts: The National Centre for Hyperbaric Medicine, GdyniaVenue: The Medical University of Gdansk

Main topics:

Contact the organising Committee at:

Visit our website: <www.EUBS2011.org>

Minutes of EUBS Executive Committee Meeting, 17 September 2010, Point Hotel, Istanbul

Minutes of EUBS General Assembly 2010Istanbul, 18 September 2010

Minutes of the SPUMS Executive Committee Meeting, 23 May 2010 at Berjaya Resort, Redang Island, Malaysia

22–27 May 2011

Venue: Hilton Resort and Spa, Tumon Bay, Guam

Call for Abstracts, Conference Information and Registration Forms

Themes:Medical aspects of military, occupational and recreational technical divingHead injury and diving workshop – review of clinical cases and guidelines

Management of acute diving injuries

The Head Injury and Diving Workshop will include medical risk assessment for diving

reviewed. Management of acute diving injuries will also be covered in the workshop forum.

Keynote speakers:David Doolette, PhD, US Navy Experimental Diving Unit, Panama City, USA

Simon Mitchell, PhD, FANZCA, The University of AucklandAndrew Fock, FANZCA, The Alfred Hospital, Melbourne

Abstracts:Abstracts for presentations should be submitted before 31 March 2011

If you wish to present a paper please contact:SPUMS ASM 2011 Convenor:

Dr Sarah LockleyE-mail: <spumssecretary@gmail.com> or <secretary@spums.org.au>

Mobile: +61-(0)4-3114-4817

Register via the SPUMS website <www.spums.org.au> or contact the Convenor for a Registration Brochure

Registrations not done via the website will incur a handling fee

The

website is atwww.spums.org.au

Members are encouraged to log in

TheDiving and Hyperbaric Medicine

website is atwww.dhmjournal.com

Readers are encouraged to log in

Important notice: New Continuing Professional Development Coordinator needed for 2011

International Congress on Hyperbaric Medicine

The 17th International Congress on Hyperbaric MedicineCape Town, South Africa

16–19 March 2011

Inter-university Diploma in Diving and Hyperbaric Medicine, France

The Hyperbaric Research Prize

German Society for Diving and Hyperbaric Medicine (GTUeM)

The Australia and New Zealand Hyperbaric Medicine Group

Introductory Course in Diving and Hyperbaric Medicine

Oxygen and Infection; European Committee for Hyperbaric Medicine (ECHM)

Conference Proceedings

(Short version, updated November 2010)

DIVER EMERGENCY SERVICES PHONE NUMBERS

The DES numbers (except UK) are generously supported by DAN

Printed by Snap, 166 Burwood Road, Hawthorn, Victoria 3122hawthorn@snap.com.au

Editorials

SPUMS notices & news

236 Instructions to authors(short version)

235 C o u r s e s , m e e t i n g s a n d advertising

229 Diploma of Diving and Hyperbaric Medicine requirements

230 Minutes of the SPUMS Executive Committee Meeting, 23 May 2010 at Berjaya Resort, Redang Island, Malaysia

232 South Pacif ic Underwater Medicine Society, 40th Annual

Hyperbaric Medicine234 International Congress on

Hyperbaric Medicine

Diving and Hyperbaric Medicine is indexed on SCIE and Embase/Scopus

181 The Editor’s offering182 HBOT for malignant otitis externa

Christian Heiden183 The EUBS President’s page

Diving and Hyperbaric Medicine Volume 40 No. 4 December 2010

223 EUBS Executive Committee224 EUBS 37th Annual Scientific

Meeting 2011224 Minutes of EUBS Executive

C o m m i t t e e M e e t i n g , 1 7 September 2010, at Point Hotel, Istanbul

227 Minutes of EUBS General Assembly 18 September 2010, Istanbul

EUBS notices & news

Continuing professional development

Original articles

Case reportsCourses and meetings

Instructions to authors

222 Breathe easyJohn Parker

213 Severe hydrogen sulphide poisoning treated with 4-dimethylaminophenol and hyperbaric oxygenJoerg Lindenmann, Veronika Matzi, Nicole Neuboeck, Beatrice Ratzenhofer-Komenda, Alfred Maier, Freyja-Maria Smolle-Juettner

218 Hyperbaric oxygen in the treatment of asphyxia in two newborn infantsAlberto Orozco-Gutierrez, Lucilina Rojas-Cerda, Rosa M Estrada and Cesar Gil-Rosales

184 Acute antioxidant pre-treatment attenuates endothelial microparticle release after decompressionBryna C R Chrismas, Adrian W Midgley, Lee Taylor, Rebecca V Vince, Gerard Laden, Leigh A Madden

189 ‘Sea legs’: sharpened Romberg test after three days on a live-aboard dive boatClinton R Gibbs, Katherine H Commons, Lawrence H Brown and Denise F Blake

195 Malignant otitis externa: experience with hyperbaric oxygen therapyAlex Saxby, Michael Barakate, Thomas Kertesz, Joanne James, Michael Bennett

201 Exceeding the limits - estimated tissue pressures among Western Australian recreational diversPeter Buzzacott, Terri Pikora, Jane Heyworth, Michael Rosenberg

206 Analyser position for end-tidal carbon dioxide monitoring in a rebreather circuitAlastair Ineson, Kaylene Henderson, David Teubner and Simon Mitchell

210 S100B and its relation to intravascular bubbles following decompressionMarianne B Havnes, Astrid Hjelde, Alf O Brubakk and Andreas Møllerløkken

221 CME Activity 2010/4HBOT and malignant otitis externaMichael Bennett

Poem