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Pengobatan Hiperbarik Oksigen dibidang klinik

Pengobatan Hiperbarik Oksigen dibidang klinik. Suyanto Sidik RSAL Dr.Mintohardjo JKT E-mail: suyantosidik@indosat.net.id. Dr.dr.Suyanto Sidik SpPD KGEH SpKL RSAL Dr.Mintohardjo Jakarta. Jabatan : Ka Kelompok Ahli RSAL Dr.Mintohardjo Pendidikan :

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Pengobatan Hiperbarik Oksigen dibidang klinik

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  1. PengobatanHiperbarikOksigendibidangklinik SuyantoSidik RSAL Dr.Mintohardjo JKT E-mail: suyantosidik@indosat.net.id

  2. Dr.dr.Suyanto Sidik SpPD KGEH SpKLRSAL Dr.Mintohardjo Jakarta Jabatan : Ka KelompokAhli RSAL Dr.Mintohardjo Pendidikan: Dokter FK GadjahMadaYk 1979 Hyperbaric and under sea Australia 1983 AhliPenydalam FK UNAIR Sby 1992 Endoscopy-Gastro intestinal FKUI 1996 Doktor FKUI Jkt 2006 Konsultan Gastro-Hepatologi 2007 SpesialiKedokteranKelautan 2009

  3. HISTORY OF HYPERBARIC MEDICINE • 1900 Behnke US navy—DCS • 1956 Dr I Boerma cardio pulm surg. • 1963 Conggres I HBO ProefBoerema • 2002 Conggres XIV Cramer & ShefieldSanfransisco, USA • 2005 Conggres XV Barcelona Jordi de sola • 2008 Conggres XVI Becker & Cramer Beijing

  4. 1ST INTERNATIONAL CONGRESS ON HYPERBARIC OXYGENATION, 1963 Australia 9th 1987 Amsterdam 10th 1990 CHINA 11, 16th 1993, 2008 Italy 12th 1996 Japan 13th 1999 America 8,14th 1984, 2002 Spanyol 15th 2005 Beijing 16th 2008

  5. Contraindications • Absolute Pneumothorax Relative: Upper Resp Inf Seizure disorders Malignant disease Pregnancy

  6. HBO THERAPEUTIC PROCEDURE 2-3 ATA - 90 I Intermiten O2 a. Paul Bert Effectin CNS.  Nausea  Twitching  Convultion Prev O2 toxcicity • b. Lorrain Smith Effect in pulmonal • Cough • Dyspnea • Substernal pain 6

  7. INDICATION HBOT UHMS • Air or gas embolism 6 • CO poisoning 5 • Gas gangrene 8 • Crush injury 3 • DCS 7 • Enhancement of healing 1 • Anemia 12 • Intracranial absces 13 • Necrotizing soft tissue infections 9 • Osteomyelitis 4 • Delayed radiation injury 2 • Skin grafts & flaps 10 • Thermal burns 11

  8. Distribution of HBO chambers in the world HBO chambers in Japan, 2004 Hosps: 617 mono: 758 multi: 57 in Europe Textbook of HBO by Jain, 2004 in the world

  9. Specialties of HBO doctor in Japan 172 HBO doctors since 2000

  10. There are eight principal methods in which HBO is capable of affecting tissue:Pressure effects of oxygen Vasoconstrictive effects of oxygen. 100% oxygen concentration effects on the diffusion gradient. Hyperoxygenation of ischemic tissue. Down regulation of inflammatory cytokines. Up-regulation of growth factors. Leukocyte effects. Antibacterial effects.

  11. HBOT should be used to compliment conventional therapies and treatments. • HBOT is very cost effective. • HBOT is noninvasive. • HBOT is safe. • HBOT works well with other treatments.

  12. HBOT has five actions which have been used to combat clinical infection: 1.Tissue rendered hypoxic by infection is supported by oxygen. 2.Neutrophils are activated and rendered more efficient. 3.Machrophage activity is enhanced. 4.Bacterial growth is inhibited. 5.The effect of antibiotics is potentiated.

  13. O2 Nutrisi Edema Glucose Lipid Infeksi Trauma Chronic Hematology Disease Social economy Autoimmune Medicine Psychosocial Like a Like Diagnose Everyday Care RA Prinsip Wound Care

  14. HBO THERAPY • OXYGEN 100%, Pressure 2 – 3 ATA  Hyperbaric Chamber • Decompresion sickness tx • Tissue damage: wound healing, hipoksia • Fibroblast, synthesis collagen, ratio RNA/DNA,  leucocyte killing, angiogenesis  neovascularisation of the wound •  & mikrovasc blood flow, dens cap  iskhaemi – reperfussion •  NO 4- 5 X  HBOT 2-3 ATA - 2 hours • Healing of tissue damage

  15. ANGIOGENESIS NEOVASKULARISASI

  16. SMITH S. HYPERBARIC TEXT BOOK OF SURGERY PREOPERATIVE CARE, 2002

  17. eNOS nNOS iNOS FAD + FMD + L - ARGININE + n NADPH + O2 L - CITRULINE + NO + NADP BH4 NO VASOKONSTRIKSI O 2 CO NO VASODILATASI 2 NITRIT OKSID PRODUCTION SMITH S. HYPERBARIC TEXT BOOK OF SURGERY PREOPERATIVE CARE, 2002 24

  18. COLLAGENIZATION

  19. SMITH S. HYPERBARIC TEXT BOOK OF SURGERY PREOPERATIVE CARE, 2002

  20. STRESSOR OHB OHB & IMMUNOHUMORAL CD4+ TCR + APC MHC II Th1 CD4+ TCR Th2 CD4+ TCR - IFNƳ IL10 + + B CD8+ TCR - + + APC SP MHC I IgG

  21. OHB & IMMUNOSUPRESI STRESSOR OHB CD4+ TCR APC MHC II + IgG IgE - B IFN Ƴ IL 4 Th1 CD4+ TCR Th2 CD4+ TCR

  22. HBOT FOR ANTI-INFLAMATORY • Sumen G, Cimsit M, Eroglu L. HBOT reduces carrageenan-induced acute inflammation in rats. Eur J Pharmacoln2001: 431; 265-8. • Haapaniemi T, Nylander G, Sirsyo A et al. Hyperbaric oxygen reduces ischemia-induced skeletal muscle injury. Plast Reconstr Surg 1996: 97: 602-7. • Waisman d, Brod V, Wolf R et al.Effects hyperoxia on local and remote circulatory inflammatory response alter splanchnic ischemia and reperfusion. Am J Physiol Heart Circ Physiol 2003:285: H 643-52.

  23. Cured 24.4% Obvious effect 51.4% Improvement 16.2% No effect 8.1% Effective HBOT RA 91,9% 1.The repercusision of the joint is fast, the effect of analgesia is good. 2.The curative and obcious rate is high. 1995 Proceding ICHM-11thHBOT in treating RA in Europe and Asia Rui-Chang

  24. Mild poisoning  1 sesion Moderate poisoning  2 sesion

  25. TERGANTUNG : DOSIS FRAKSINASI LUAS TEKNIK RADIASI LASHNER GILINSKY GEJALA ESL : ~ ESA + LEBIH BERAT DIARE LENDIR + DARAH ESA : 50 – 70 % GEJALA ESA : SAKIT PERUT TENESMUS HEMATOCHEZIA ESL : 2,5 – 25 % RADIASI PELVIS KARSINOMA PROKTITIS RADIASI 33

  26. Treatment of Radiation Proctitis and Enteritis 34

  27. 35

  28. 1 AGREGASI TROMBOSIT MAKROFAG GRANULOSIT V A S O D I L A T A S I 5 VASOKONTR I KS I 4 1 OHBT EPITEL 2 3 SEL ENDOTEL 6 LISIS KOLAGEN SINTESIS KOLAGEN 7 8 PERBAIKAN STRUKTUR JARINGAN 9 PENYEMBUHAN LUKA KERANGKA TEORI Keterangan : - NOS = Nitric oxide syntethase - Lingkaran – lingkaran kuning menunjukan tempat-tempat kerja OHB 1.Vasokonstriksi. 2. Peningkatan kemampuan sel endotel 3. Peningkatan VEGF 4. Peningkatan reseptor epitel vaskular 5. Pengurangan inflamasi 6. Kolagen sintesis. 7. Kolagen lisis 8. Perbaikan struktur jaringan. 9. Penyembuhan luka 36

  29. Kontrol 01 02 X P R S Eksperimen 03 y 04 METODE DAN ALUR PENELITIAN Keterangan P = Seleksi Pasien Penelitian R = Randominasi S = Sampel Penelitian 01 = Pretes pok pasien tanpa perlakuan sbg kontrol 02 = Postes pok pasien tanpa perlakuan sbg kontrol 03 = Pretes pok pasien dgn perlakuan 04 = Postes pok pasien dgn perlakuan 37

  30. Data deskriptif variabel penelitian yg akan di analisis dpt dilihat pada tabel 7. Tabel 7. Variabel penelitian pada pemeriksaan pertama Keterangan : K ; karnofsky Lent : LENT-SOMA MVD : MICRO VASCULER DENSITY 38

  31. Ratio beda pemeriksaan sebelum perlakuan s/d bulan ke-6 setelah perlakuan yang dinyatakan dalam persen. Tabel 8. Keterangan : ΔK 21 = Perbedaan kualitas hidup seblm perlakuan & segera setelah perlakuan ΔK 31 = Perbedaan kualitas hidup seblm perlakuan & bulan ke-6 setelah perlakuan ΔLent 12 = Perbedaan efek samping seblm perlakuan & segera setelah perlakuan ΔLent 13 = Perbedaan efek samping seblm perlakuan & segera bulan ke-6 setelah perlakuan) 39

  32. HUBUNGAN OHBT DGN PREVALENSI PROKTITIS RADIASI Tabel 9. Hasil analisis statistik chi-square untuk kejadian proktitis radiasi pada kelompok OHBT dan kontrol pada bulan ke-6 perlakuan Keterangan : OHBT = Oksigen Hiperbarik Terapi 40

  33. Ratio beda pemeriksaan sebelum perlakuan dan setelah perlakuan yang dinyatakan dalam prosen. Keterangan : CD31 =Cluster define 31 OHB = Oksigen hiperbarik 41

  34. Hubungan korelasi efek samping dengan MVD pada OHB Tabel Korelasi ESA radiasi dengan MVD 12 pada OHB Keterangan : ESA Lent21 = Efek samping akut menurut LENT SOMA segera setelah perlakuan dibanding sebelum perlakuan MVD21 = Densitas vaskuler segera setelah perlakuan dibanding sebelum perlakuan 42

  35. Published Report of Hyperbaric Oxygen for Prevention of Mandibular Necrosis 43

  36. Published Report of Hyperbaric Oxygen as Treatment for Mandibular Necrosis 44

  37. Hyperbaric Oxygen as Treatment for Soft Tissue Radiation Injury of the Head and Neck 45

  38. Hyperbaric Oxygen as Treatment for Radiation Cystitis 46

  39. Hyperbaric Oxygen as Treatment for Radiation Injury of the Chest Wall and Breast 47

  40. Hyperbaric Oxygen as Treatment for Radiation Injuries of the Extremities 48

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