Summary:Haemorrhagic cystitis is a common and often debilitating complication of chemotherapy for which treatment is frequently unsatisfactory. With over 80 cases reported of radiation-induced cystitis treated successfully with hyperbaric oxygen, attention is now turning to the treatment of chemotherapeutic agent-induced cystitis. We report a case of haemorrhagic cystitis occurring after autologous peripheral blood stem cell transplantation for multiple myeloma. The patient had received cyclophosphamide and busulfan and had BK and adenoviruria. The haemorrhage was refractory to multiple conventional treatments but resolved after a course of hyperbaric oxygen. Keywords: haemorrhagic cystitis; hyperbaric oxygen; cyclophosphamide; adenovirus; BK virus Hyperbaric oxygen was administered in a multiplace chamber. The treatment plan was based on that which would be used to treat radiation-induced cystitis.1,2 The patient received 100% oxygen for 80 min at an absolute pressure of 2.4 atmospheres. The total duration of each treatment was 99 min. One treatment per day was administered, 5 to 6 days per week. The end-point for treatment was resolution of haematuria. Case historyA 41-year-old man was diagnosed with multiple myeloma in August 1995 after presenting with sudden onset of backpain. Bone marrow examination showed 32% plasma cells and an IgG paraprotein of 30 g/l was present in the serum. On the 5th post-transplant day, the patient became febrile and developed dysuria. The urine was noted to be rosé in colour. He was started on anti-bacterial antibiotics and urine was sent for BK virus, adenovirus and CMV isolation. By the 8th post-transplant day, he had progressed to severe bladder spasms and gross haematuria. A clinical diagnosis of haemorrhagic cystitis was made.An indwelling catheter was inserted. Continuous bladder irrigation was commenced. Adenovirus was cultured from the urine on the 13th post-transplant day and PCR for BK virus was weakly positive. Engraftment occurred on the 14th post-transplant day. On the 15th day, alum (1% solution) washouts were commenced and were continued for 1 week. By the 22nd day, haemorrhage was still uncontrolled requiring the introduction of intravesical prostaglandin F2 alpha (PGF2 alpha) 200 g in 50 ml normal saline instilled for 1 h or as long as tolerated. This was repeated at 4 hourly intervals. PGF2 alpha was poorly tolerated by the patient due to extreme pain and was subsequently performed in the operating room under general anaesthesia. PGF2 alpha was continued for a further 5 days with no benefit. On the 24th day the patient underwent flexible cystoscopy which confirmed widespread mucosal ulceration consistent with haemorrhagic cystitis. From the 27th to the 37th day, the patient was treated with intravenous ribavirin (9 mg/kg intravenously 8 hourly) during which time his fever settled but haematuria continued. The patient underwent rigid cystoscopy, diathermy and instillation of silver nitrate on the 33rd day. Alum irrigation was recommenced following cessation of rib...

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.

Rates of global and regional sea‐level rise between ~1850 and 1950 were high compared to those in preceding centuries. The cause of this sea‐level acceleration remains uncertain, but it appears to be pronounced in a small set of relative sea‐level proxy records from the Southern Hemisphere. Here we generate three new proxy‐based relative sea‐level reconstructions for southeastern Australia to investigate spatial patterns and causes of historical sea‐level changes in the Tasman Sea. Palaeo sea‐level estimates were determined using salt‐marsh foraminifera as sea‐level indicators. Records are underpinned by chronologies based on accelerator mass spectrometry 14C, radiogenic lead (210Pb), stable lead isotopes and palynological analyses. Our reconstructions show that relative sea level rose by ~0.2–0.3 m over the last 200 years in southeastern Australia, and rates of sea‐level rise were especially high over the first half of the 20th century. Based on modelled estimates of the contributing components to sea‐level rise, we suggest that the episode of rapid sea‐level rise was driven by barystatic contributions, but sterodynamic contributions were dominant by the mid‐20th century. Significant spatial variability in relative sea level indicates that local to sub‐regional drivers of sea level are also prominent. Our reconstructions significantly enhance our understanding of the spatiotemporal pattern of early 20th century sea‐level rise in the region.

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