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Ian Millar

Monash University, Epidemiology and Preventive Medicine, Faculty Member

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Viacheslav Kuleshov

Stockholm University

University of Hawaii

Universidade do Algarve

Dr Virendra Kumar Verma

Savitribai Phule Pune University

Massimo Mazzotti

University of California, Berkeley

Jean-Marc Olivier

University of Toulouse

The Scottish Association for Marine Science

Francesca Pasotti

Ghent University

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Evry University

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Papers by Ian Millar

Hyperbaric Oxygen in Lower Limb Trauma (HOLLT); protocol for a randomised controlled trial

BMJ open, Jan 11, 2015

Open fractures with significant soft tissue injury are associated with high rates of complication... more Open fractures with significant soft tissue injury are associated with high rates of complications, such as non-union, infection, chronic pain and disability. Complications often require further inpatient care, and in many cases, multiple operations and prolonged rehabilitation. Use of hyperbaric oxygen therapy as an adjunct to standard orthopaedic trauma care has the potential to reduce the complications of musculoskeletal injury and thus improve outcomes. Two previous randomised trials have suggested some positive effect, but neither functional measures nor long-term outcomes were reported. An international, multicentre, randomised, open-label, clinical trial. Patients with trauma with an acute open fracture of the tibia with severe soft tissue injury (Gustilo grade 3) and high risk of injury-related complications were recruited from participating major trauma hospitals with hyperbaric facilities. Patients were enrolled with the expectation of commencing 12 sessions of hyperbaric ...

Performance of the Atom 235 Syringe Infusion Pump under Hyperbaric Conditions

Anaesthesia and Intensive Care, 1998

Inotrope-dependent patients may become haemodynamically unstable during treatment in the hyperbar... more Inotrope-dependent patients may become haemodynamically unstable during treatment in the hyperbaric chamber. One possible cause is altered performance of infusion devices. We tested six Atom 235 syringe infusion pumps under hyperbaric conditions of 2.8 atmospheres absolute in a multiplace chamber using a gravimetric method. There was a small but significant reduction in infused volume during a thirty-minute period including compression time. We concluded that altered inotrope delivery may explain at least some of the haemodynamic instability sometimes seen, although a physiologic effect of hyperbaric treatment cannot be excluded.

Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial

The Medical Journal of Australia, Mar 1, 1999

Introduction-Methods-Results-Discussion-Conclusion-References-Authors' details Make a comment-Reg... more

A pleural vacuum relief device for pleural drain unit use in the hyperbaric environment

Diving and Hyperbaric Medicine, Sep 30, 2017

Introduction: When a standard water-seal pleural drain unit (PDU) is used under hyperbaric condit... more Introduction: When a standard water-seal pleural drain unit (PDU) is used under hyperbaric conditions there are scenarios where excessive negative intrapleural pressure (IPP) and/or fluid reflux can be induced, risking significant morbidity. We developed and tested a pleural vacuum relief (PVR) device which automatically manages these risks, whilst allowing more rapid hyperbaric pressure change rates. Methods: The custom-made PVR device consists of a one-way pressure relief valve connected in line with a sterile micro filter selected for its specific flow capacity. The PVR device is designed for connection to the patient side sampling port of a PDU system, allowing inflow of ambient air whenever negative pressure is present, creating a small, controlled air leak which prevents excessive negative pressure. The hyperbaric performance of a Pleur-Evac A-6000 intercostal drain was assessed with and without this added device by measuring simulated IPP with an electronic pressure monitor connected at the patient end of the PDU. IPP readings were taken at 10, 15, 20 and 30 cmH 2 O of suction (set on the drain unit) at compression rates of 10, 30, 60, 80, 90 and 180 kPa•min-1 to a pressure of 280 kPa. Results: At any compression rate of > 10 kPa•min-1 , the negative IPP generated by the Pleur-Evac A-6000 alone was excessive and resulted in back flow through the PDU water seal. By adding the PVR device, the generated negative IPP remains within a clinically acceptable range, allowing compression rates of at least 30 kPa•min-1 with suction settings up to-20 cmH 2 O during all phases of hyperbaric treatment. Conclusions: The PDU PVR device we have developed works well, minimising attendant workload and automatically avoiding the excessive negative IPPs that can otherwise occur. This device should only be used with suction.

A pleural vacuum relief device for pleural drain unit use in the hyperbaric environment

Diving and Hyperbaric Medicine Journal, 2017

Introduction: When a standard water-seal pleural drain unit (PDU) is used under hyperbaric condit... more Introduction: When a standard water-seal pleural drain unit (PDU) is used under hyperbaric conditions there are scenarios where excessive negative intrapleural pressure (IPP) and/or fluid reflux can be induced, risking significant morbidity. We developed and tested a pleural vacuum relief (PVR) device which automatically manages these risks, whilst allowing more rapid hyperbaric pressure change rates. Methods: The custom-made PVR device consists of a one-way pressure relief valve connected in line with a sterile micro filter selected for its specific flow capacity. The PVR device is designed for connection to the patient side sampling port of a PDU system, allowing inflow of ambient air whenever negative pressure is present, creating a small, controlled air leak which prevents excessive negative pressure. The hyperbaric performance of a Pleur-Evac A-6000 intercostal drain was assessed with and without this added device by measuring simulated IPP with an electronic pressure monitor connected at the patient end of the PDU. IPP readings were taken at 10, 15, 20 and 30 cmH 2 O of suction (set on the drain unit) at compression rates of 10, 30, 60, 80, 90 and 180 kPa•min-1 to a pressure of 280 kPa. Results: At any compression rate of > 10 kPa•min-1 , the negative IPP generated by the Pleur-Evac A-6000 alone was excessive and resulted in back flow through the PDU water seal. By adding the PVR device, the generated negative IPP remains within a clinically acceptable range, allowing compression rates of at least 30 kPa•min-1 with suction settings up to-20 cmH 2 O during all phases of hyperbaric treatment. Conclusions: The PDU PVR device we have developed works well, minimising attendant workload and automatically avoiding the excessive negative IPPs that can otherwise occur. This device should only be used with suction.

Hyperbaric Oxygen Reduces Severity and Improves Survival in Acute Pancreatitis

Pancreas, 2005

The aggressiveness of pancreatic cancer due to complex genetic abnormalities and de novo chemo-ra... more The aggressiveness of pancreatic cancer due to complex genetic abnormalities and de novo chemo-radio resistance ultimately results in poor patients survival. Thus there is an urgent need to develop rational and more effective therapeutic agents for the treatment of pancreatic cancer with better outcome. Among the few basic differences in the cellular milieu of normal and malignant cells is their ability to cope with oxidative stress due to an imbalance in the levels of antioxidant enzymes. Multiple stress sensor proteins such as cyclooxygenases (COX) and lipoxygenases (LOX) as well as the redox sensitive transcription factors such as NF-kB are up-regulated in cancer cells conferring resistance to apoptosis. Hence, targeted cellular delivery of drugs with potential to modulate cellular redox status in cancer cells may lead to inactivation of such stress sensor proteins leading to induction of apoptosis in tumor cells selectively. In the present work we describe the structural design and characterization of novel, synthetic analogs of well-established NF-kB modulator isoflavone, genistein and the selective COX-2 inhibitor, viz. nimesulide, along with their copper conjugates. Here we report that the copper conjugates of genistein analog as well as the modified COX-2 inhibitor show a dose dependent growth inhibition in both COX-positive and COX-negative pancreatic cell lines with substantially lowered IC 50 values (3-4 mM) than the parent ligands. The inclusion of copper conjugates was prompted by their excellent SOD mimetic properties leading to generation of intracellular hydrogen peroxide acting as a trigger to redox sensitive proteins and subsequent induction of apoptosis in cancer cells. Further, we tested the copper complexes in vivo in SCID mice bearing orthotopically implanted pancreatic cancer cells. Our findings show that the copper complex of genistein analog greatly reduces the tumor weight in treated mice relative to control as well as inhibits the NF-kB activation. Our results provide evidence in support of the potential use of novel genistein analogs as well as modified COX-2 inhibitors and their metal complexes (small molecule) for the treatment of pancreatic cancer in the future.

Compressed breathing air - the potential for evil from within

Diving and hyperbaric medicine, 2008

Human underwater activities rely on an adequate supply of breathable compressed gas, usually air,... more Human underwater activities rely on an adequate supply of breathable compressed gas, usually air, free from contaminants that could cause incapacitation underwater or post-dive or longer-term health effects. Potentially fatal but well-known hazards are hypoxia secondary to steel cylinder corrosion and carbon monoxide (CO) poisoning due to contaminated intake air. Another phenomenon may be behind some previously unexplained episodes of underwater incapacitation and perhaps death: low-level CO poisoning and/or the effects of gaseous contaminants generated within the compressor, including toluene and other volatile compounds. Many low molecular weight volatile contaminants are anaesthetic and will be potentiated by pressure and nitrogen narcosis. In sub-anaesthetic doses, impaired judgement, lowered seizure threshold and sensitisation of the heart to arrhythmias may occur. Toxic compounds can be volatilised from some compressor oils, especially mineral oils, in overheated compressors, ...

Oxygen toxicity in recreational and technical diving

Diving and hyperbaric medicine, 2008

It is increasingly common for recreational scuba divers to use breathing mixtures enriched with a... more It is increasingly common for recreational scuba divers to use breathing mixtures enriched with additional oxygen ('nitrox' or 'enriched air nitrogen') and for technical divers to be exposed to elevated partial pressures of oxygen for prolonged periods of time. The National Oceanic and Atmospheric Administration oxygen exposure limits have traditionally been used by the recreational diving industry and technical diving communities. Review of the original research into oxygen toxicity brings into question the validity of these limits and would suggest revised limits with a maximum partial pressure of oxygen of 162 kPa (1.6 Ata) and 142 kPa (1.4 Ata) at depth and the use of the repetitive air excursion (REPEX) limits for single and repetitive exposures. Suitable conservatism in case of the need for recompression therapy is recommended.

Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning

New England Journal of Medicine, 2003

September 5 issue 1 contained a description of clinical material from one patient that was also i... more September 5 issue 1 contained a description of clinical material from one patient that was also included in an article on a series of patients that was published shortly thereafter in Stroke. 2 Although asked, we failed to inform the editors of each journal of the other publication. We apologize for not providing this information.

Hyperbaric Oxygen Therapy Reduces Severity and Improves Survival in Severe Acute Pancreatitis

Journal of Gastrointestinal Surgery, 2007

Severe acute pancreatitis is characterized by pancreatic necrosis, resulting in local and systemi... more Severe acute pancreatitis is characterized by pancreatic necrosis, resulting in local and systemic inflammation. Hyperbaric oxygen (HBO) therapy modulates inflammation, but has not been extensively studied in pancreatitis. This study investigates the effects of HBO in a rat model of severe acute pancreatitis. Sixty-four rats were induced with severe pancreatitis using 4% sodium taurocholate and randomized to HBO treatment or control. HBO was commenced 6 h after induction (100% oxygen at 2.5 atmospheres for 90 min) and continued every 12 h for a maximum of eight treatment episodes. Surviving animals were killed at 7 days. Severity of pancreatitis was graded macroscopically and microscopically. Lung edema was calculated using wet and dry lung weights. Macroscopic and microscopic severity scores (mean ± SE) of HBO-treated animals with pancreatitis (8.3±0.7; 9.6±0.4) were lower than those of controls (10.5±0.5; 11.1±0.4) (p=0.02 and p=0.03, respectively). The HBO-treated group had reduced pancreatic necrosis compared to controls (40±4% vs. 54± 4%; p=0.003). There was no difference in pulmonary edema between the groups. Median survival in the HBO-treatment group was 51 h, compared to 26 h in controls. Day-7 survival was significantly improved in the HBO-treated animals compared to controls (40% vs. 27%; p=0.04). HBO therapy reduces overall severity, decreases the extent of necrosis, and improves survival in severe acute pancreatitis.

Hyperbaric oxygen therapy for severe acute pancreatitis

Journal of Gastroenterology and Hepatology, 2007

Despite improvements in the supportive management of severe acute pancreatitis over the last deca... more Despite improvements in the supportive management of severe acute pancreatitis over the last decade, the morbidity and mortality rate remains high. The main feature of this condition is pancreatic necrosis leading to sepsis, with both localized and systemic inflammatory response syndromes. Early pathophysiological changes of the pancreas include alterations in microcirculation, ischemia reperfusion injury, and leukocyte and cytokine activation. The efficacy of hyperbaric oxygen (HBO) therapy in improving these pathophysiological disturbances is documented for various conditions. However, its effect in the treatment of severe acute pancreatitis is undetermined. This report documents the case of a 56-year-old woman presenting with severe acute pancreatitis treated by HBO therapy. The severity of disease was based on an Acute Physiology and Chronic Health Evaluation (APACHE II) illness grading score of 11 and a Baltazar based computed tomography severity index (CTSI) score of 9. Administration of 100% oxygen was commenced within 72 h of presentation at a pressure of 2.5 atmospheres for 90 min and given twice daily for a total of 5 days. Therapy was well tolerated with improvements in APACHE II and CTSI grading scores. HBO therapy for severe acute pancreatitis appeared to be safe and may have a role in improving treatment outcomes. Further study is required.

Two unusual presentations of probable decompression sickness after deep mixed-gas recreational diving

Diving and hyperbaric medicine, 2008

We present two unusual presentations of decompression sickness manifesting at previous injury sit... more We present two unusual presentations of decompression sickness manifesting at previous injury sites after deep mixed-gas recreational diving. While previous injury is often cited as a predisposing factor in decompression illness, formal case reports of this phenomenon are rare in the diving literature.

Hyperbaric Oxygen Reduces Severity and Improves Survival in Acute Pancreatitis

by Ian Millar and Christopher Christophi

Pancreas, 2005

ABSTRACT

Composition and evolution of the Ancestral South Sandwich Arc: Implications for the flow of deep ocean water and mantle through the Drake Passage Gateway

Global and Planetary Change, 2014

Where a licence is displayed above, please note the terms and conditions of the licence govern yo... more Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

Hyperbaric oxygen therapy in the treatment of skin ulcers due to calcific uraemic arteriolopathy: experience from an Australian hyperbaric unit

Diving and hyperbaric medicine, 2008

Calcific uraemic arteriolopathy (CUA), also known as 'calciphylaxis', is a syndrome of is... more Calcific uraemic arteriolopathy (CUA), also known as 'calciphylaxis', is a syndrome of ischaemic necrotic ulcers occurring in uraemic patients with end-stage renal failure. It is a debilitating condition with a high morbidity and mortality. Hyperbaric oxygen (HBO) has been used to treat such wounds for many years but evidence of its efficacy is limited. We aimed to study the efficacy of HBO on the healing of problem ulcers secondary to CUA. A retrospective case review of all patients with chronic skin ulcers secondary to CUA treated at the Alfred Hospital Hyperbaric Unit from July 1997 to March 2006 (n = 20). HBO was beneficial in eleven (55%) patients, with six of these (30%) experiencing complete resolution of their ulcers on completion of their treatment. Advancing age was identified as a predictor of a positive outcome (P = 0.02). There was no statistical correlation between the number of HBO treatments and ulcer healing. HBO can benefit patients with chronic non-healing...

Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial

The Medical journal of Australia, 1999

To assess neurological sequelae in patients with all grades of carbon monoxide (CO) poisoning aft... more To assess neurological sequelae in patients with all grades of carbon monoxide (CO) poisoning after treatment with hyperbaric oxygen (HBO) and normobaric oxygen (NBO). Randomised controlled double-blind trial, including an extended series of neuropsychological tests and sham treatments in a multiplace hyperbaric chamber for patients treated with NBO. The multiplace hyperbaric chamber at the Alfred Hospital, a university-attached quarternary referral centre in Melbourne providing the only hyperbaric service in the State of Victoria. All patients referred with CO poisoning between 1 September 1993 and 30 December 1995, irrespective of severity of poisoning. Pregnant women, children, burns victims and those refusing consent were excluded. Daily 100-minute treatments with 100% oxygen in a hyperbaric chamber--60 minutes at 2.8 atmospheres absolute for the HBO group and at 1.0 atmosphere absolute for the NBO group--for three days (or for six days for patients who were clinically abnormal ...

Sma-Pirarubicin Combined with Hyperbaric Oxygen Therapy for the Treatment of Colorectal Tumour Liver Metastases

[abstract] SMA-PIRARUBICIN COMBINED WITH HYPERBARIC OXYGEN THERAPY FOR THE TREATMENT OF COLORECTAL TUMOUR LIVER METASTASES

Abstracts-Abstracts of Papers Submitted to the 36th Annual Meeting of the American Pancreatic Association, November 3-4-HYPERBARIC OXYGEN REDUCES SEVERITY AND IMPROVES SURVIVAL IN ACUTE

Hyperbaric oxygen therapy in the to calcific uraemic arteriolopathy: treatment of skin ulcers due experience from an Australian hyperbaric unit

Hyperbaric Oxygen in Lower Limb Trauma (HOLLT); protocol for a randomised controlled trial

BMJ open, Jan 11, 2015

Open fractures with significant soft tissue injury are associated with high rates of complication... more Open fractures with significant soft tissue injury are associated with high rates of complications, such as non-union, infection, chronic pain and disability. Complications often require further inpatient care, and in many cases, multiple operations and prolonged rehabilitation. Use of hyperbaric oxygen therapy as an adjunct to standard orthopaedic trauma care has the potential to reduce the complications of musculoskeletal injury and thus improve outcomes. Two previous randomised trials have suggested some positive effect, but neither functional measures nor long-term outcomes were reported. An international, multicentre, randomised, open-label, clinical trial. Patients with trauma with an acute open fracture of the tibia with severe soft tissue injury (Gustilo grade 3) and high risk of injury-related complications were recruited from participating major trauma hospitals with hyperbaric facilities. Patients were enrolled with the expectation of commencing 12 sessions of hyperbaric ...

Performance of the Atom 235 Syringe Infusion Pump under Hyperbaric Conditions

Anaesthesia and Intensive Care, 1998

Inotrope-dependent patients may become haemodynamically unstable during treatment in the hyperbar... more Inotrope-dependent patients may become haemodynamically unstable during treatment in the hyperbaric chamber. One possible cause is altered performance of infusion devices. We tested six Atom 235 syringe infusion pumps under hyperbaric conditions of 2.8 atmospheres absolute in a multiplace chamber using a gravimetric method. There was a small but significant reduction in infused volume during a thirty-minute period including compression time. We concluded that altered inotrope delivery may explain at least some of the haemodynamic instability sometimes seen, although a physiologic effect of hyperbaric treatment cannot be excluded.

Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial

The Medical Journal of Australia, Mar 1, 1999

Introduction-Methods-Results-Discussion-Conclusion-References-Authors' details Make a comment-Reg... more

A pleural vacuum relief device for pleural drain unit use in the hyperbaric environment

Diving and Hyperbaric Medicine, Sep 30, 2017

Introduction: When a standard water-seal pleural drain unit (PDU) is used under hyperbaric condit... more Introduction: When a standard water-seal pleural drain unit (PDU) is used under hyperbaric conditions there are scenarios where excessive negative intrapleural pressure (IPP) and/or fluid reflux can be induced, risking significant morbidity. We developed and tested a pleural vacuum relief (PVR) device which automatically manages these risks, whilst allowing more rapid hyperbaric pressure change rates. Methods: The custom-made PVR device consists of a one-way pressure relief valve connected in line with a sterile micro filter selected for its specific flow capacity. The PVR device is designed for connection to the patient side sampling port of a PDU system, allowing inflow of ambient air whenever negative pressure is present, creating a small, controlled air leak which prevents excessive negative pressure. The hyperbaric performance of a Pleur-Evac A-6000 intercostal drain was assessed with and without this added device by measuring simulated IPP with an electronic pressure monitor connected at the patient end of the PDU. IPP readings were taken at 10, 15, 20 and 30 cmH 2 O of suction (set on the drain unit) at compression rates of 10, 30, 60, 80, 90 and 180 kPa•min-1 to a pressure of 280 kPa. Results: At any compression rate of > 10 kPa•min-1 , the negative IPP generated by the Pleur-Evac A-6000 alone was excessive and resulted in back flow through the PDU water seal. By adding the PVR device, the generated negative IPP remains within a clinically acceptable range, allowing compression rates of at least 30 kPa•min-1 with suction settings up to-20 cmH 2 O during all phases of hyperbaric treatment. Conclusions: The PDU PVR device we have developed works well, minimising attendant workload and automatically avoiding the excessive negative IPPs that can otherwise occur. This device should only be used with suction.

A pleural vacuum relief device for pleural drain unit use in the hyperbaric environment

Diving and Hyperbaric Medicine Journal, 2017

Introduction: When a standard water-seal pleural drain unit (PDU) is used under hyperbaric condit... more Introduction: When a standard water-seal pleural drain unit (PDU) is used under hyperbaric conditions there are scenarios where excessive negative intrapleural pressure (IPP) and/or fluid reflux can be induced, risking significant morbidity. We developed and tested a pleural vacuum relief (PVR) device which automatically manages these risks, whilst allowing more rapid hyperbaric pressure change rates. Methods: The custom-made PVR device consists of a one-way pressure relief valve connected in line with a sterile micro filter selected for its specific flow capacity. The PVR device is designed for connection to the patient side sampling port of a PDU system, allowing inflow of ambient air whenever negative pressure is present, creating a small, controlled air leak which prevents excessive negative pressure. The hyperbaric performance of a Pleur-Evac A-6000 intercostal drain was assessed with and without this added device by measuring simulated IPP with an electronic pressure monitor connected at the patient end of the PDU. IPP readings were taken at 10, 15, 20 and 30 cmH 2 O of suction (set on the drain unit) at compression rates of 10, 30, 60, 80, 90 and 180 kPa•min-1 to a pressure of 280 kPa. Results: At any compression rate of > 10 kPa•min-1 , the negative IPP generated by the Pleur-Evac A-6000 alone was excessive and resulted in back flow through the PDU water seal. By adding the PVR device, the generated negative IPP remains within a clinically acceptable range, allowing compression rates of at least 30 kPa•min-1 with suction settings up to-20 cmH 2 O during all phases of hyperbaric treatment. Conclusions: The PDU PVR device we have developed works well, minimising attendant workload and automatically avoiding the excessive negative IPPs that can otherwise occur. This device should only be used with suction.

Hyperbaric Oxygen Reduces Severity and Improves Survival in Acute Pancreatitis

Pancreas, 2005

The aggressiveness of pancreatic cancer due to complex genetic abnormalities and de novo chemo-ra... more The aggressiveness of pancreatic cancer due to complex genetic abnormalities and de novo chemo-radio resistance ultimately results in poor patients survival. Thus there is an urgent need to develop rational and more effective therapeutic agents for the treatment of pancreatic cancer with better outcome. Among the few basic differences in the cellular milieu of normal and malignant cells is their ability to cope with oxidative stress due to an imbalance in the levels of antioxidant enzymes. Multiple stress sensor proteins such as cyclooxygenases (COX) and lipoxygenases (LOX) as well as the redox sensitive transcription factors such as NF-kB are up-regulated in cancer cells conferring resistance to apoptosis. Hence, targeted cellular delivery of drugs with potential to modulate cellular redox status in cancer cells may lead to inactivation of such stress sensor proteins leading to induction of apoptosis in tumor cells selectively. In the present work we describe the structural design and characterization of novel, synthetic analogs of well-established NF-kB modulator isoflavone, genistein and the selective COX-2 inhibitor, viz. nimesulide, along with their copper conjugates. Here we report that the copper conjugates of genistein analog as well as the modified COX-2 inhibitor show a dose dependent growth inhibition in both COX-positive and COX-negative pancreatic cell lines with substantially lowered IC 50 values (3-4 mM) than the parent ligands. The inclusion of copper conjugates was prompted by their excellent SOD mimetic properties leading to generation of intracellular hydrogen peroxide acting as a trigger to redox sensitive proteins and subsequent induction of apoptosis in cancer cells. Further, we tested the copper complexes in vivo in SCID mice bearing orthotopically implanted pancreatic cancer cells. Our findings show that the copper complex of genistein analog greatly reduces the tumor weight in treated mice relative to control as well as inhibits the NF-kB activation. Our results provide evidence in support of the potential use of novel genistein analogs as well as modified COX-2 inhibitors and their metal complexes (small molecule) for the treatment of pancreatic cancer in the future.

Compressed breathing air - the potential for evil from within

Diving and hyperbaric medicine, 2008

Human underwater activities rely on an adequate supply of breathable compressed gas, usually air,... more Human underwater activities rely on an adequate supply of breathable compressed gas, usually air, free from contaminants that could cause incapacitation underwater or post-dive or longer-term health effects. Potentially fatal but well-known hazards are hypoxia secondary to steel cylinder corrosion and carbon monoxide (CO) poisoning due to contaminated intake air. Another phenomenon may be behind some previously unexplained episodes of underwater incapacitation and perhaps death: low-level CO poisoning and/or the effects of gaseous contaminants generated within the compressor, including toluene and other volatile compounds. Many low molecular weight volatile contaminants are anaesthetic and will be potentiated by pressure and nitrogen narcosis. In sub-anaesthetic doses, impaired judgement, lowered seizure threshold and sensitisation of the heart to arrhythmias may occur. Toxic compounds can be volatilised from some compressor oils, especially mineral oils, in overheated compressors, ...

Oxygen toxicity in recreational and technical diving

Diving and hyperbaric medicine, 2008

It is increasingly common for recreational scuba divers to use breathing mixtures enriched with a... more It is increasingly common for recreational scuba divers to use breathing mixtures enriched with additional oxygen ('nitrox' or 'enriched air nitrogen') and for technical divers to be exposed to elevated partial pressures of oxygen for prolonged periods of time. The National Oceanic and Atmospheric Administration oxygen exposure limits have traditionally been used by the recreational diving industry and technical diving communities. Review of the original research into oxygen toxicity brings into question the validity of these limits and would suggest revised limits with a maximum partial pressure of oxygen of 162 kPa (1.6 Ata) and 142 kPa (1.4 Ata) at depth and the use of the repetitive air excursion (REPEX) limits for single and repetitive exposures. Suitable conservatism in case of the need for recompression therapy is recommended.

Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning

New England Journal of Medicine, 2003

September 5 issue 1 contained a description of clinical material from one patient that was also i... more September 5 issue 1 contained a description of clinical material from one patient that was also included in an article on a series of patients that was published shortly thereafter in Stroke. 2 Although asked, we failed to inform the editors of each journal of the other publication. We apologize for not providing this information.

Hyperbaric Oxygen Therapy Reduces Severity and Improves Survival in Severe Acute Pancreatitis

Journal of Gastrointestinal Surgery, 2007

Severe acute pancreatitis is characterized by pancreatic necrosis, resulting in local and systemi... more Severe acute pancreatitis is characterized by pancreatic necrosis, resulting in local and systemic inflammation. Hyperbaric oxygen (HBO) therapy modulates inflammation, but has not been extensively studied in pancreatitis. This study investigates the effects of HBO in a rat model of severe acute pancreatitis. Sixty-four rats were induced with severe pancreatitis using 4% sodium taurocholate and randomized to HBO treatment or control. HBO was commenced 6 h after induction (100% oxygen at 2.5 atmospheres for 90 min) and continued every 12 h for a maximum of eight treatment episodes. Surviving animals were killed at 7 days. Severity of pancreatitis was graded macroscopically and microscopically. Lung edema was calculated using wet and dry lung weights. Macroscopic and microscopic severity scores (mean ± SE) of HBO-treated animals with pancreatitis (8.3±0.7; 9.6±0.4) were lower than those of controls (10.5±0.5; 11.1±0.4) (p=0.02 and p=0.03, respectively). The HBO-treated group had reduced pancreatic necrosis compared to controls (40±4% vs. 54± 4%; p=0.003). There was no difference in pulmonary edema between the groups. Median survival in the HBO-treatment group was 51 h, compared to 26 h in controls. Day-7 survival was significantly improved in the HBO-treated animals compared to controls (40% vs. 27%; p=0.04). HBO therapy reduces overall severity, decreases the extent of necrosis, and improves survival in severe acute pancreatitis.

Hyperbaric oxygen therapy for severe acute pancreatitis

Journal of Gastroenterology and Hepatology, 2007

Despite improvements in the supportive management of severe acute pancreatitis over the last deca... more Despite improvements in the supportive management of severe acute pancreatitis over the last decade, the morbidity and mortality rate remains high. The main feature of this condition is pancreatic necrosis leading to sepsis, with both localized and systemic inflammatory response syndromes. Early pathophysiological changes of the pancreas include alterations in microcirculation, ischemia reperfusion injury, and leukocyte and cytokine activation. The efficacy of hyperbaric oxygen (HBO) therapy in improving these pathophysiological disturbances is documented for various conditions. However, its effect in the treatment of severe acute pancreatitis is undetermined. This report documents the case of a 56-year-old woman presenting with severe acute pancreatitis treated by HBO therapy. The severity of disease was based on an Acute Physiology and Chronic Health Evaluation (APACHE II) illness grading score of 11 and a Baltazar based computed tomography severity index (CTSI) score of 9. Administration of 100% oxygen was commenced within 72 h of presentation at a pressure of 2.5 atmospheres for 90 min and given twice daily for a total of 5 days. Therapy was well tolerated with improvements in APACHE II and CTSI grading scores. HBO therapy for severe acute pancreatitis appeared to be safe and may have a role in improving treatment outcomes. Further study is required.

Two unusual presentations of probable decompression sickness after deep mixed-gas recreational diving

Diving and hyperbaric medicine, 2008

We present two unusual presentations of decompression sickness manifesting at previous injury sit... more We present two unusual presentations of decompression sickness manifesting at previous injury sites after deep mixed-gas recreational diving. While previous injury is often cited as a predisposing factor in decompression illness, formal case reports of this phenomenon are rare in the diving literature.

Hyperbaric Oxygen Reduces Severity and Improves Survival in Acute Pancreatitis

by Ian Millar and Christopher Christophi

Pancreas, 2005

ABSTRACT

Composition and evolution of the Ancestral South Sandwich Arc: Implications for the flow of deep ocean water and mantle through the Drake Passage Gateway

Global and Planetary Change, 2014

Where a licence is displayed above, please note the terms and conditions of the licence govern yo... more Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

Hyperbaric oxygen therapy in the treatment of skin ulcers due to calcific uraemic arteriolopathy: experience from an Australian hyperbaric unit

Diving and hyperbaric medicine, 2008

Calcific uraemic arteriolopathy (CUA), also known as 'calciphylaxis', is a syndrome of is... more Calcific uraemic arteriolopathy (CUA), also known as 'calciphylaxis', is a syndrome of ischaemic necrotic ulcers occurring in uraemic patients with end-stage renal failure. It is a debilitating condition with a high morbidity and mortality. Hyperbaric oxygen (HBO) has been used to treat such wounds for many years but evidence of its efficacy is limited. We aimed to study the efficacy of HBO on the healing of problem ulcers secondary to CUA. A retrospective case review of all patients with chronic skin ulcers secondary to CUA treated at the Alfred Hospital Hyperbaric Unit from July 1997 to March 2006 (n = 20). HBO was beneficial in eleven (55%) patients, with six of these (30%) experiencing complete resolution of their ulcers on completion of their treatment. Advancing age was identified as a predictor of a positive outcome (P = 0.02). There was no statistical correlation between the number of HBO treatments and ulcer healing. HBO can benefit patients with chronic non-healing...

Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial

The Medical journal of Australia, 1999

To assess neurological sequelae in patients with all grades of carbon monoxide (CO) poisoning aft... more To assess neurological sequelae in patients with all grades of carbon monoxide (CO) poisoning after treatment with hyperbaric oxygen (HBO) and normobaric oxygen (NBO). Randomised controlled double-blind trial, including an extended series of neuropsychological tests and sham treatments in a multiplace hyperbaric chamber for patients treated with NBO. The multiplace hyperbaric chamber at the Alfred Hospital, a university-attached quarternary referral centre in Melbourne providing the only hyperbaric service in the State of Victoria. All patients referred with CO poisoning between 1 September 1993 and 30 December 1995, irrespective of severity of poisoning. Pregnant women, children, burns victims and those refusing consent were excluded. Daily 100-minute treatments with 100% oxygen in a hyperbaric chamber--60 minutes at 2.8 atmospheres absolute for the HBO group and at 1.0 atmosphere absolute for the NBO group--for three days (or for six days for patients who were clinically abnormal ...

Sma-Pirarubicin Combined with Hyperbaric Oxygen Therapy for the Treatment of Colorectal Tumour Liver Metastases

[abstract] SMA-PIRARUBICIN COMBINED WITH HYPERBARIC OXYGEN THERAPY FOR THE TREATMENT OF COLORECTAL TUMOUR LIVER METASTASES

Abstracts-Abstracts of Papers Submitted to the 36th Annual Meeting of the American Pancreatic Association, November 3-4-HYPERBARIC OXYGEN REDUCES SEVERITY AND IMPROVES SURVIVAL IN ACUTE

Hyperbaric oxygen therapy in the to calcific uraemic arteriolopathy: treatment of skin ulcers due experience from an Australian hyperbaric unit