Impact of hyperbaric oxygenation on oxidative stress in diabetic patients.

Taking into consideration that a high concentration of oxygen can express toxic effects due to production of reactive oxygen species (ROS), the aim of our investigation was to establish the influence of hyperbaric oxygenation on oxidative stress parameters and antioxidant enzymes in patients with diabetes mellitus (DM) type 2. Investigation included 50 patients with DM type 2 divided into two groups. The first group consisted of 25 patients, mean age 70 years, mean duration of illness 12 years and without manifest peripheral vascular complications (Wagner 0). The second group consisted of 25 patients, mean age 74 years, mean duration of illness 17 years and with manifest peripheral vascular complications (Wagner 1-5). All patients underwent the same therapeutic protocol, which included 10 hyperbaric oxygenation therapies, once a day for a duration of 60 minutes, with an average partial oxygen pressure of 1.7 atmospheres absolute (ATA). In blood samples the following parameters of redox balance were determined: levels of nitrites (NO2-), index of lipid peroxidation (TBARS), superoxide anion radical (O2-), hydrogen peroxide (H2O2) and antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT). Our results clearly show that hyperbaric oxygen (HBO2) therapy does not have a pro-oxidative effect. Additionally, it seems that this procedure strongly mobilized the antioxidant enzyme system, thus improving defense from oxidative damage. All significant data are marked as P ⟨0.05. Our results have shown that in terms of ROS production, HBO2 can be safe to use in patients suffering from DM type 2 with or without vascular complications.

[Effect of hyperbaric oxygen treatment on oxidative stress in patients having diabetes mellitus type 2].

INTRODUCTION: The aim of our study was to investigate the influence of breathing oxygen under high pressure on potential prooxidative activity in diabetic patients with serious vascular complications. MATERIAL AND METHODS: 24 patients with diabetes mellitus type 2, were divided into two groups, 12 patients each, by degree of peripheral vascular complications (by Wagner's scale). The group I was composed of 4 women and 8 men, their average age being 70 years, and average diabetes duration of 12 years, without clinically manifest peripheral vascular complication (Wagner 0). The group II was composed of 4 women and 8 men, their average age being 74 years, and average illness duration of 17 years, having peripheral vascular complications, classified by Wagner's scale 1-5. Blood samples for biochemical analysis were taken before the therapy, then on the 3rd, 5th, 7th and 10th day of hyperbaric oxygenation treatment. The values of superoxide anion radical (O2-), hydrogen peroxide (H2O2) and TBARS as a parameter of lipid peroxidation were measured during the HBOt. All examined patients were treated with the same therapy protocol (10 HBO treatments, under pressure of 1.7-2.2 bar, in duration of 60 minutes). The therapy was provided in monoplace oxygen hyperbaric chamber. RESULTS: The obtained results show no statistically significant increase in the values of O2-, H2O2, TBARS during the HBOt compared to the values before the HBOt. However, O2-, H2O2 were significantly reduced after HBOt. CONCLUSION: On the basis of these data, we can conclude that the use of oxygen under high pressure has no influence on the increased prooxidative activities in diabetic patients during and after HBOt, disregarding the degree of the present vascular damages.

[Evaluation of the therapeutic effect of hyperbaric oxygenation and erythropoietin in the treatment of chronic heart failure using myocardial perfusion scintigraphy G-SPECT].

BACKGROUND: The most important predictors of long-term survival in patients with cardiac ischemic disease are left ventricular ejection fraction, left ventricular volumes, infarction size, presence and extent of residual myocardial ischemia. One of the most important recent developments in single photon emission computed tomography (SPECT) myocardial perfusion imaging is the ability to acquire these studies in conjunction with electrocardiogram (ECG) gating (G-SPECT). The ability to asses radionuclide myocardial perfusion and function with ECG G-SPECT imaging has revolutionized this field of nuclear cardiology. Study with G-SPECT development algorithms permits to quantify measures of left ventricular (LV) volume, ejection fraction (LVEF) and even regional myocardial wall motion and thickening. The American Society of Nuclear Cardiology (ASNC) in its position paper from March 1999 recommends the routine incorporation of G-SPECT during cardiac perfusion scintigraphy. CASE REPORT: We presented a 70-year-old male with ischemic heart disease (dilatative, cardiomyopathy and absolute arrhythmia). He was few times hospitally treated by medicamentous therapy with no evidence of improvement. After hospital treatment, we included hyperbaric oxygenation (HBO) and erythropoietin injections. Hyperbaric oxygenation was carried out in a monoplace hyperbaric chamber, BLK S-303, by a graduated protocol for patients with severe heart insufficiency, totally 15 treatments. Recombinant erythropoietin beta (RecormonR F. Hoffmann-La Roche) was applied deeply subcutaneously, every second day from 2000 IU to totally 16000 IU. Before the therapy G-SPECT study was performed with 99m technetium-MIBI, and we obtained the functional parameters and perfusion of the left ventricle to follow-up the therapy effects. The study was performed by an ADAC-VERTEX PLUS-EPIC two-head gamma camera with dedicated quantitatively algorithm Auto-QUANT. The results of LVEF were 15%, with severity abnormal motion and wall thickening for all segments. Left ventricle end-diastolic volume was 393 ml (normal < 142 ml), and LV end-systolic volume was 334 ml (normal < 65 ml). Four months after the therapy G-SPECT showed improvement in any parameters; LVEF 25%, with improvement in wall motion (normalized wall motion in the anterior, lateral area, and proximal septum) and wall thickening, LV end-diastolic volume was 390 ml, LV end-systolic volume was 289 ml. CONCLUSION: Using G-SPECT method before and after the therapy with hyperbaric oxygenation and erythropoietin we obtained objective improvement and good therapy effects in the treatment of chronic heart insufficiency.

[The use of combined hyperbaric oxygenation and erythropoietin in the treatment of cardiac insufficiency].

INTRODUCTION: The aim of this research is to evaluate therapy efficiacy of hyperbaric oxgenation (HBO) with regenerative effects on human tissues and erythropoietin, as a nonspecific growth factor. MATERIAL AND METHODS: This study included a group of 9 patients with echocardiographically diagnosed cardiac insufficiency with ejection firaction (EF%) under 60%. HBO was used according to the protocol for patients with severe cardiac insufficiency (a total of 15 treatments). All patients also received subcutaneous erythropoietin, 2000 i.v., every other day. Control echocardiography was done 30-45 days after they finished their treatments. RESULTS: The average ejection fraction before treatment was 46%. After treatment, the average EF% was 57%, so it increased by 11%. All patients felt subjectively better, with improved capacity to physical efforts. DISCUSSION AND CONCLUSION: Ejection fraction of 30-40% is an indication for hyperbaric oxygenation therapy. The decision about the treatment is made by the physician based on his experience, general condition of the patient, frequency and severity of hypoxic episodes. If EF% is 30% or below, HBO is not recommended, because antioxidative defense mechanisms are exhausted under hyypoxia and the balance of the organism should not be changed. An increase in average EF% by 11% demonstrates that combined use of HBO and Erythropoietin gives good results.