Romuald Olszański, Maciej Konarski and Piotr Siermontowski
The paper discusses the treatment results of ten patients with severe atopic dermatitis (AD) who did not respond to standard pharmacotherapy and underwent hyperbaric oxygen therapy (HBOT). Each patient was subject to 10 oxygen exposures at pO2 2.5 ATA (~ 250 kPa) with the duration time of 60 minutes. In the period of implementation of the hyperbaric procedures the general treatment plan was suspended for all patients while maintaining typical local treatment. Clinical evaluation was performed in the study group as well as determination of levels of immunoglobulins: IgA, IgG, IgM and IgE and C3 and C4 complement. All patients indicated clinical improvement and a decreased IgE immunoglobulin and complement C3 level upon the completion of the exposure cycle. Taking into account the authors’ own observations and data from literature, an overall improvement in the clinical status and a decrease in the level of immunoglobulin E and C3 complement following a cycle of exposures may be indicative of an immunomodulating HBOT effect on AD, whereas hyperbaric oxygenation may constitute a therapeutic option for some patients with AD, especially those exhibiting a poor response to standard treatment.
Romuald Olszański, Piotr Siermontowski and Zbigniew Dąbrowiecki
The article presents a dermatosis that occurs in tropical and subtropical countries. Though the definitive hosts of the cutaneous larva migrans parasite are animals, humans can become accidental hosts and they are infected when their skin comes into contact with damp soil, most frequently sand. The disease is only present in the epidermis where an itch is brought about by the mining activity of the larva. Sunbathers and divers who put on their gear on a beach, on account of the epidermis maceration caused by a prolonged exposure to water, are particularly susceptible to the penetrative activities of the larva. In Poland the cutaneous larva migrans is in most cases mistaken for nettle rash or eczema.
Romuald Olszański, Piotr Siermontowski, Dariusz Juszczak, Zbigniew Dąbrowiecki and Agnieszka Pedrycz
Cutaneous leishmaniasis in Poland is an imported disease mainly occurring in tourists who travelled to tropical countries. Cutaneous symptoms occur as late as between ten and twenty days following the return from the tropics. Lesions connected with cutaneous leishmaniasis were most commonly diagnosed by Polish doctors as furuncle, ecthyma or ulceration and ineffectively treated for several weeks with antibiotics.
The paper presents the case of leishmaniasis in a 30-year-old male with an ulceration of the left shank, ineffectively treated with antibiotics over a period of four months. The ulceration was healed completely only after leishmaniasis was diagnosed and following the application of a treatment based on antimony derivatives, followed by hyperbaric oxygenation performed in a hyperbaric chamber.
Maciej Jerzemowski, Zbigniew Dąbrowiecki, Romuald Olszański, Piotr Siermontowski and Janusz Jerzemowski
Research shows a potential threat from external environmental factors which might be the cause of upper and lower gastrointestinal diseases in tourists, or soldiers engaged in tropical peacekeeping missions. The research includes infections which due to their spread are also present in their home countries such as Helicobacter pylori infections, viral hepatitis as well as infections which might cause symptoms of upper and lower gastrointestinal tract diseases as a result of poor sanitary and unhygienic conditions. Contact with diseases typical of the tropical climate, especially during longer stays, increases the chances of bringing some tropical diseases back to Poland, which can be problematic for the domestic health care service.
Romuald Olszański, Zbigniew Dąbrowiecki, Dorota Niewiedział, Krzysztof Gadomski and Ewa Zieliński
Allergic rhinitis occurs in various regions of the world and affects from 10 to 40% of the population. The skin prick test is the “gold standard” for the detection of type I allergic diseases according to the Gella and Coombs classification, which is mediated by IgE. For our experiment, skin prick tests were performed on 60 divers aged between 30 and 40 years of age. The following tests for airborne allergens were used: tests for pollen from trees, grasses, cereals, weeds, proteins from house dust mites, animal hair and epidermis, and moulds. On the basis of an interview and a positive skin prick test allergic rhinitis was diagnosed in 17 divers.
Allergic rhinitis can cause health problems in divers and be the cause of diving accidents.
The application of the skin prick test during the health qualification in the Military Maritime Health Commission, would allow the exclusion of diver candidates suffering from allergies.
Piotr Siermontowski, Beata Janas and Romuald Olszański
This two-part article reviews the current legal situation of specialist staff performing hyperbaric procedures for purposes not related to diving. Numerous discrepancies between the applicable legal acts and the lack of legal regulations concerning procedures not financed from the state budget have been noted. The first significant problem consisted in the lack of a correlation between various Regulations of the Minister of Health concerning hyperbaric oxygenation, as well as inconsistencies with the programmes of medical specialisation effective in Poland. The second problem is the lack of determination requirements of medical personnel other than doctors and nurses in the documents of the Ministry of Health. It was also found that medical hyperbaric centres which do not apply for funding from the budget (National Health Fund), do not even meet the minimum requirements defined as to the qualifications of the staff working there. Moreover, there is a lack of knowledge of the requirements set out in legal acts other than those concerning medicine.
Michał Żychliński, Piotr Siermontowski and Romuald Olszański
Service on a submarine is the most stressful and psychologically challenging form of military service. It is characterised by specific living and sanitaryepidemiological conditions which are far from typical. This work is based on the analyses of reports formulated from research conducted by a working environment laboratory, and on the control protocols of the sanitary supervision and control team (WOMP) Gdynia, from the Kobben submersible vessels in the years 2014 and 2015. Military Centres of Preventive Medicine hold supervision over Military Units pursuant to generally applicable regulations in the civil environment and standardised NATO norms. Measurements concern the level of noise, mechanical vibrations, chemical agents, electromagnetic radiation, physiochemical and biological water and kitchenware tests. The objective of the research is to evaluate the service conditions on a submersible vessel with regard to sanitary-epidemiological aspects such as exposure to infectious and occupational diseases. In selected stations, the conducted measurements indicate an increased level of noise, electromagnetic radiation and excess quantities of bacteria colonies on kitchenware.
Kazimierz Ulewicz, Janusz Masłowski, Przemysław Michniewski, Brunon Kierznikowicz and Romuald Olszański
The authors conducted the preliminary clinical investigation on 16 multiple sclerosis (Sclerosis multiplex) patients of median disease duration 9.33 years and symptoms evaluated on Kurtzke’s scale. The patients underwent between 25 and 30 hyperbaric oxygen exposures at a pressure of 2 ata in intervals spread over a few days. The patients were qualified and classified to the treatment symptomatologically according to Fisher but the obtained results were evaluated according to the standardised Disability Status Scale by Kurtzke. During the investigations the authors carried out additional quantitative immunoglobulin and complement activity determination, lymphocyte T and B determinations as well as the usually applied clinical and laboratory investigations. Evident clinical improvement was observed in 14 patients, but in the case of one patient a deterioration was observed after 15 hyperbaric expositions (resulting in the hyperbaric oxygen treatment being stopped), whilst in another case no curative effect could be observed. By utilising the 50% haemolysis method, within the examined immunological parameters the authors observed an increase of complement fractions and its activity, white lymphocytes T and B examined qualitatively did not maintain the characteristic shift. The authors are still discussing the obtained results.
Romuald Olszański, Zbigniew Dąbrowiecki, Wojciech Marusza, Irina Netsvyetayeva, Dorota Niewiedział, Piotr Siermontowski and Ewa Zieliński
The most hazardous adverse reactions following hyaluronic acid injections in aesthetic medicine involve vascular complications, known as the Nicolau Syndrome. This article presents a vascular complication in the area of the upper part of the nasolabial fold following subcutaneous administration of 0.5 ml of hyaluronic acid. At the time of the injection, paling occurred, which was followed by livedo racemosa appearing an hour later. Upon the lapse of a week, an ulceration appeared. It was not until the tenth day after the hyaluronic acid injection that hyaluronidase was administered. After 15 hyperbaric oxygen exposures, the ulcer was completely healed
Zbigniew Dąbrowiecki, Małgorzata Dąbrowiecka, Romuald Olszański and Piotr Siermontowski
Pathogenic micro-organisms can easily transfer from the surface of a diver’s skin onto the surfaces of a protective suit. A long-term stay in a hyperbaric chamber during a saturation dive increases the risk of infection if in the chamber there is even a single carrier of disease-causing pathogens.
The conducted research has confirmed that the diving equipment located in Diving Centres is a place of many different bacteria and fungi, including pathogenic ones. The vast majority of microbes found on the surfaces of wetsuits, etc. are commensals (with some being opportunistic organisms). This fact allows us to realise that the surfaces of diving equipment are an excellent “transmission route” for various dermatoses and other diseases. In order to reduce the risk of infection the diving equipment used by various people should be subject to the process of decontamination. The authors recommend decontamination with the use of gaseous hydrogen peroxide which does not cause damage to equipment.