[Gas gangrene and hyperbaric oxygenation--a lesson forgotten or never learned?]. / Plinska gangrena i hiperbaricna oksigenacija--zaboravljena ili nikad naucena lekcija?

Gas gangrene develops in devitalized hypoxic tissue. It spreads rapidly under strong influence of enzymes produced by the causing bacteria and often results in fatal outcome. It is of utmost importance to stop toxin production as soon as possible, which is most effectively achieved by early application of hyperbaric oxygenation (HBO2), as the first measure in a "trident" (HBO2, antibiotics, surgical measures). The paper reviews the most important data from microbiology, pathophysiology and epidemiology of gas gangrene, current clinical practice, scientific basis for application of HBO2 in the treatment of this disease, and data from the archives of the Naval Medical Institute of the Croatian Navy in Split (NMI). At the NMI, in the period from 1982 to 2000, HBO2 was administered in the treatment of 21 patients with gas gangrene, of average age 41.6 +/- 16.3 years. The average treatment consisted of 6.8 +/- 3.8 sessions. 13 (76%) patients were cured.

Gastric rupture in a diver due to rapid ascent.

A 37-year-old, experienced female diver developed gastric rupture due to rapid ascent from a depth of 37 meters. The incident was preceded by a heavy meal, intake of soda beverages, swallowing of air and water under water, and panic. Sharp abdominal pain was present immediately after surfacing and afterwards. Full abdominal distension developed within two hours after the ascent. No other diving-related pathology was found. Surgery was performed around three hours after the accident and revealed pneumoperitoneum, gastric rupture, gastric content in the abdomen cavity, and signs of acute peritonitis. On surgery, a 4-cm rupture of the lesser curvature was found and sutured. The patient was discharged eight days after the event.