Difference between revisions of "Marx3"

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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">'''The addition of hyperbaric oxygen therapy bracketed around hemi-mandibular reconstruction in an irradiated field improved the success rate of surgery.''' </span>
 
  
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Bottom Line:''' </span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">'''The addition of hyperbaric oxygen therapy bracketed around hemi-mandibular reconstruction in an irradiated field improved the success rate of surgery.'''</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. The addition of hyperbaric oxygen to the surgical management of jaw reconstruction improved the success rate of the operation as defined by continuity, alveolar bone height, osseous bulk, facial form and elimination of soft tissue deficiency. </span>
 
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. There was a trend to lower complication rates that did not reach statistical significance. </span>
 
  
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital </span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Bottom Line:''' </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. The addition of hyperbaric oxygen to the surgical management of jaw reconstruction improved the success rate of the operation as defined by continuity, alveolar bone height, osseous bulk, facial form and elimination of soft tissue deficiency. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. There was a trend to lower complication rates that did not reach statistical significance.</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Sydney; Tuesday, 13 April 1999 </span>
 
  
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Scenario:''' A patient presented for a hemi-mandibular jaw reconstruction following radiotherapy and surgery. We wondered if the addition of hyperbaric oxygen would improve outcome. </span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Sydney; Tuesday, 13 April 1999</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Question:''' In patients requiring reconstructive surgery to the mandible in a field with previous surgery and radiotherapy for carcinoma of the oropharynx, does the addition of hyperbaric oxygen before and after reconstruction result in any improvement in outcome or complication rate. </span>
 
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' Oropharynx carcinoma, reconstructive surgery. </span>
 
  
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:''' </span>
+
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Scenario:''' A patient presented for a hemi-mandibular jaw reconstruction following radiotherapy and surgery. We wondered if the addition of hyperbaric oxygen would improve outcome. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Question:''' In patients requiring reconstructive surgery to the mandible in a field with previous surgery and radiotherapy for carcinoma of the oropharynx, does the addition of hyperbaric oxygen before and after reconstruction result in any improvement in outcome or complication rate. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' Oropharynx carcinoma, reconstructive surgery.</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Non-blinded randomised controlled trial without intention-to-treat. Little detail given. Patients requiring hemi-mandibular jaw reconstruction in a tissue bed previously irradiated with at least 6,400 cGy. </span>
 
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Control group''' (N = 52; 52 analysed): Standard surgical technique </span>
 
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Experimental group''' (N = 52; 52 analysed): As above but 20 hyperbaric treatments before and 10 after surgery (dose not stated in report). </span>
 
  
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:''' </span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:''' </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Non-blinded randomised controlled trial without intention-to-treat. Little detail given. Patients requiring hemi-mandibular jaw reconstruction in a tissue bed previously irradiated with at least 6,400 cGy. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Control group''' (N = 52; 52 analysed): Standard surgical technique </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Experimental group''' (N = 52; 52 analysed): As above but 20 hyperbaric treatments before and 10 after surgery (dose not stated in report).</span>
  
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{|
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:'''</span><br/> &nbsp;
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Outcome''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Time to Outcome''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Control group''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''HBO group''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Relative risk reduction''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Absolute risk reduction''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''NNT''' </span></span>
+
 
 +
{| class="Table" style="border:solid windowtext 1.0pt"
 
|-
 
|-
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Success''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">unknown </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.654 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.923 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-41% </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-0.27 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-4 </span></span>  
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| style="width:71.85pt; border:solid windowtext 1.0pt" width="99" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Outcome</span></span>'''</span></p>  
 +
| style="width:61.15pt; border:solid windowtext 1.0pt" width="84" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Time to Outcome</span></span>'''</span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Control group</span></span>'''</span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">HBO group</span></span>'''</span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Relative risk reduction</span></span>'''</span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Absolute risk reduction</span></span>'''</span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT</span></span>'''</span></p>  
 
|-
 
|-
−
| <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''95% CI:''' </span></span> ||  ||  ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-64% to -18% </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-0.42 to -0.12 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-8 to -2 </span></span>  
+
| style="width:71.85pt; border:solid windowtext 1.0pt" width="99" |
 +
<span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Success</span></span>'''</span>
 +
 
 +
| style="width:61.15pt; border:solid windowtext 1.0pt" width="84" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">unknown</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.65</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.92</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">41%</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.27</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">4</span></span></span></p>  
 
|-
 
|-
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Complication''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">unknown </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.212 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.096 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">55% </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.12 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">9 </span></span>  
+
| colspan="4" style="border:solid windowtext 1.0pt" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI:</span></span>'''</span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">18% to 64%</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.12 to 0.42</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">2 to 8</span></span></span></p>  
 
|-
 
|-
−
| <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''95% CI:''' </span></span> ||  ||  ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-10% to 100% </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">-0.02 to 0.25 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">NNT'''4 to INF NNH'''48 to INF </span></span>  
+
| style="width:71.85pt; border:solid windowtext 1.0pt" width="99" |
 +
<span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">Complication</span></span>'''</span>
 +
 
 +
| style="width:61.15pt; border:solid windowtext 1.0pt" width="84" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">unknown</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.21</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.10</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">55%</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.12</span></span></span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">9</span></span></span></p>  
 
|-
 
|-
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| colspan="4" style="border:solid windowtext 1.0pt" | <p align="right" style="margin-bottom:.0001pt; text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI:</span></span>'''</span></p>
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| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">-10% to 100%</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">-0.02 to 0.25</span></span></span></p>
 +
| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">NNT 4 to INF NNH 48 to INF</span></span></span></p>
 
|}
 
|}
  
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Comments:''' </span>
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<br/> <span style="font-family: Arial, Helvetica, sans-serif; font-size: 120%;">'''Comments:''' </span> <span style="font-family: Arial, Helvetica, sans-serif; font-size: 120%;">1. Very brief report in a textbook. No details of methods employed. </span> <span style="font-family: Arial, Helvetica, sans-serif; font-size: 120%;">2. Other work from this author strongly suggests a regime of oxygen at 2.4ATA daily five times each week for 20 treatments pre-op and ten post-operatively.</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Very brief report in a textbook. No details of methods employed. </span>
 
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. Other work from this author strongly suggests a regime of oxygen at 2.4ATA daily five times each week for 20 treatments pre-op and ten post-operatively. </span>
 
  
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Expiry date:''' December 2019</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Expiry date:''' December 2019</span>
  
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''References:''' </span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''References:''' </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Marx RE. Clinical applications of hyperbaric oxygen. In: Hyperbaric Medicine Practice, 2nd edition, Kindwall EP (ed).Best, Arizona 1999; 683-687.</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Marx RE. Clinical applications of hyperbaric oxygen. In: Hyperbaric Medicine Practice, 2nd edition, Kindwall EP (ed).Best, Arizona 1999; 683-687. </span>
 
  
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[[File:sumhorsa.gif|center]]
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[[File:Sumhorsa.gif|center|Sumhorsa.gif]]
  
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<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Radiation tissue injury  | BACK]]'''</span>
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<span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Radiation_tissue_injury|BACK]]'''</span>

Latest revision as of 02:08, 8 July 2019

The addition of hyperbaric oxygen therapy bracketed around hemi-mandibular reconstruction in an irradiated field improved the success rate of surgery.

Clinical Bottom Line: 1. The addition of hyperbaric oxygen to the surgical management of jaw reconstruction improved the success rate of the operation as defined by continuity, alveolar bone height, osseous bulk, facial form and elimination of soft tissue deficiency. 2. There was a trend to lower complication rates that did not reach statistical significance.

Appraised by: Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital Sydney; Tuesday, 13 April 1999

Clinical Scenario: A patient presented for a hemi-mandibular jaw reconstruction following radiotherapy and surgery. We wondered if the addition of hyperbaric oxygen would improve outcome. Three-part Question: In patients requiring reconstructive surgery to the mandible in a field with previous surgery and radiotherapy for carcinoma of the oropharynx, does the addition of hyperbaric oxygen before and after reconstruction result in any improvement in outcome or complication rate. Search Terms: Oropharynx carcinoma, reconstructive surgery.

The Study: Non-blinded randomised controlled trial without intention-to-treat. Little detail given. Patients requiring hemi-mandibular jaw reconstruction in a tissue bed previously irradiated with at least 6,400 cGy. Control group (N = 52; 52 analysed): Standard surgical technique Experimental group (N = 52; 52 analysed): As above but 20 hyperbaric treatments before and 10 after surgery (dose not stated in report).

The Evidence:
 

Outcome

Time to Outcome

Control group

HBO group

Relative risk reduction

Absolute risk reduction

NNT

Success

unknown

0.65

0.92

41%

0.27

4

95% CI:

18% to 64%

0.12 to 0.42

2 to 8

Complication

unknown

0.21

0.10

55%

0.12

9

95% CI:

-10% to 100%

-0.02 to 0.25

NNT 4 to INF NNH 48 to INF


Comments: 1. Very brief report in a textbook. No details of methods employed. 2. Other work from this author strongly suggests a regime of oxygen at 2.4ATA daily five times each week for 20 treatments pre-op and ten post-operatively.

Expiry date: December 2019

References: 1. Marx RE. Clinical applications of hyperbaric oxygen. In: Hyperbaric Medicine Practice, 2nd edition, Kindwall EP (ed).Best, Arizona 1999; 683-687.

Sumhorsa.gif

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