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Treatment Of Radiation Injuries In Gynecological Neoplasms

Medical information reviewed by: BOGDAN VINTILA, Physical therapist

i.php?p=18. Terapia cu oxigen hiperabric

Discover the hyperbaric medicine center opened in our clinic. Centrokinetic has the top-performing hyperbaric chamber in Bucharest, with multiple medical and anti-aging uses. The Baroks chamber has 5 seats, and operates at a constant pressure of 2.5 atmospheres, being fully automated and having protocols for each condition, and can be used individually for each patient. 

Hyperbaric oxygen therapy - benefits

Patients who use the clinic's hyperbaric therapy services benefit from:

  • The only medically accredited hyperbaric therapy chamber in Bucharest, which operates at 2.5 atmospheres (those for aesthetic use go to 1 atmosphere and have no medical benefits).
  • A safe medical procedure, without irradiation, without pain, without other side effects. 
  • The specialized medical team consists of recovery doctors, orthopedists, rheumatologists, neurologists, and neurosurgeons, meaning a multidisciplinary team specialized in all diseases that can be treated with hyperbaric therapy. 
  • Premium conditions at a fair price. Our clinic is recognized for the conditions offered and for the care of each patient. But we do not need to pay exorbitant prices to have access to quality medical services. At Centrokinetic you can find an affordable and fair price. But note that we do not have a contract with the National Health Insurance House (we do not offer state reimbursed services)

Centrokinetic is keeping contact with prestigious clinics and universities in Belgium, the Netherlands, France, and Greece to constantly update treatments to provide patients with the best medical solutions.

Causes of gynecological cell lesions   

Gynecological cancers treated with a combination of external beam radiation and brachytherapy, especially cervical and vaginal cancers, can result in the apex of the vagina receiving a high dose of radiation. The tolerance of the lateral apical vagina can be as high as 140 Gy. The tolerance is less for the rest of the vagina and can result in complications. These radiation-related complications, which develop months or years after treatment with radiation, are known as late radiation tissue injury (LRTI) and are estimated to affect 5 to 15% of all long-term survivors who have received radiation. The estimated prevalence of LRTI is 2 to 4%5 for those undergoing pelvic radiotherapy. Radiation causes progressive endarteritis of the small blood vessels resulting in cellular hypoxia and damage to the fibroblasts. This inhibits the ability of the irradiated tissue to repair itself and can result in non-healing ulcers.

A radionecrotic wound gradually progresses to involve surrounding tissue and frequently results in vesicovaginal, colovaginal, and rectovaginal fistulae, as well as a range of symptoms from vaginitis, deep dyspareunia, frank hematuria, and radiation proctitis to frank ulceration and necrosis. This is a very painful and particularly debilitating condition and associated with a malodorous and serosanguinous discharge. Most patients become socially isolated and are at risk for depression, nutritional deficiency, and require repeated hospitalizations. Medical treatment typically involves topical wound care, and unfortunately, treatment failure is common. Surgical repairs of fistulae related to radiation necrosis are not only technically difficult, but even the use of skin and myocutaneous flaps have met with only limited success due to a compromised blood supply. However, hyperbaric oxygen therapy (HBOT) is a treatment modality that can repair radiation-induced vascular changes. 

Transcutaneous oxygen measurements four years after HBOT have revealed near-normal levels, implying that the angiogenesis is essentially permanent. HBOT is the first available treatment for delayed radiation injuries that is potentially disease-modifying and is associated with healing in ulcerated, necrotic tissues. In April 2005, the Undersea and Hyperbaric Medical Society approved HBOT as an effective treatment for delayed radiation injury. That same year, the Food and Drug Administration (U.S.) also approved hyperbaric oxygen therapy for the treatment of delayed radiation injury (soft tissue and bony necrosis). The mechanism by which HBOT is thought to treat radiation tissue injury is via the induction of neovascularization, thereby reversing tissue hypoxia. The stimulus for angiogenesis appears to be mediated through macrophages responding to the oxygen gradient between the damaged hypoxic cells and the normal tissue surrounding them.

i.php?p=14. Terapia hiperbara in tratame

Other biochemical pathways involved include stem cell mobilization from bone marrow and vasculogenesis, resulting in elevated vascular endothelial growth factor levels. The subacute and chronic phases of radiation wounds are particularly suited to this form of therapy. HBOT acts to stimulate collagen formation at the wound edges through elevation of local tissue oxygen tension. New microvasculature which is dependent on a collagen matrix is greatly enhanced in this setting and allows re-epithelization to occur. HBOT also stimulates fibroblast proliferation. Typically, the treatment protocol for HBOT in patients with radiation-induced pelvic soft tissue injury and in whom the lesion is likely to remain chronic or deteriorate further, often consists of once-daily treatments at 2.5 atmospheres absolute pressure (ATA) on a five-days-per-week basis for up to 40 treatments, depending upon the patient’s condition. Follow-up should be conducted at four weeks. For the treatment and prevention of osteoradionecrosis, a protocol by Marx, et al. consists of 20 HBOT sessions before surgery in a previously irradiated area and 10 sessions afterward.

What are the effects of oxygen therapy on the body?

  • Decreases inflammation
  • Increases the body's oxygen saturation by 20-30%
  • Increases the body's immunity
  • Increases blood circulation and stimulates the formation of new capillaries
  • Decreases toxins in the body
  • Stimulates the production of new blood cells
  • Increases healing rate


The study aims to provide recommendations on the use of hyperbaric oxygen therapy in tissue problems caused by radiation for soft tissue necrosis, cystitis, proctitis, bone necrosis, and other complications in women treated with radiation for gynecological cancer.

While the authors acknowledge the importance of preventing soft tissue disease, this guide does not address the prevention, but rather the treatment of radiation-induced tissue damage.


Relevant evidence for this topic was searched in the databases. Search terms include hyperbaric oxygen, therapy or hyperbaric oxygenation; pelvis or pelvis or gynecology; and radiation damage or proctitis or cystitis or lesions the only limitation being the English language. The search identified a total of 45 studies, four of which were clinical trials.

Target groups

Women who have late tissue damage caused by radiation, including soft tissue necrosis, cystitis, proctitis, osteonecrosis, and other complications, caused by radiation therapy for cervical cancer and malignancies.


HBOT is effective for tissue damage that has been treated with radiation, especially the head, neck, anus, and rectum. Based on the mechanism of action, there is an adequate basis for proposing that HBOT be largely effective in delaying tissue damage with radiation.

The main indication for the use of HBOT therapy among women with lesions caused by radiation treatment for gynecological malignancies is to treat the lesions.
There is evidence for symptomatic benefits for certain clinical settings after RT in cervical cancer: cystitis, soft tissue necrosis, or osteonecrosis. The small number of case series and the number of patients make it difficult to make specific recommendations; however, HBOT should be considered for women who do not achieve the desired results through classical treatment techniques.
In patients requiring surgical removal of necrosis, there is evidence to support the use of HBOT to reduce the complications of gynecologic oncological surgery by stimulating small vessel angiogenesis.
There is a study that analyzes systematic and controlled studies to determine the effect of HBOT compared to the effect of conventional treatment for healing and preventing late tissue wounds. The analysis concluded that for patients with tissue damage with radiation affecting the tissues of the head, neck, anus, and rectum, HBOT shows improved results. HBOT also appears to reduce the chance of osteoradionecrosis following tooth extraction in an irradiated field. 

The application of HBOT to selected patients and tissues may be justified. Further research is needed to establish the optimal selection and timing of therapy for any patient. An economic assessment should also be carried out. Tissue injuries with radiation are considered similar after treatments applied to the vagina or cervix, or elsewhere in the body. HBOT treatment in specific scenarios helps a lot to improve the general condition of the patient.

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There is an ongoing international study called "HORTIS", which uses a random sample, in which the results of HBOT and classical treatments are compared. The main objective of this study is to determine more precisely the degree of benefits of hyperbaric oxygen therapy in the treatment of radiation-induced lesions in several specific locations of the body. The study has eight components. Seven involve the evaluation of established radionecrosis in the mandible, larynx, skin, bladder, rectum, colon, and female pelvis. The eighth will investigate the potential of hyperbaric oxygen therapy to prevent late radiation injury to the tissue. This study will also generate more accurate benchmarking data on complications associated with hyperbaric exposure, including incidence and degree of morbidity. Recently the results for HORTIS IV20 indicate very favorable results two years after HBOT treatment. Patients were treated with either hyperbaric oxygen at 2.0 absolute atmospheres or air at 1.1 absolute atmospheres. Those treated with HBOT had almost twice as rapid improvement in symptoms (eg, pain, frequency, bleeding, ulceration, etc.). ) using the SOMA-SLOW score. The response rate was also significantly higher for HBOT. Sidik and colleagues conducted a parallel, prospective study to assess the influence of HBOT on side effects and quality of life in 32 patients who suffered from pelvic radiation. The use of the LENT SOMA and Karnofsky scales shows that patients who underwent HBOT treatments had significantly fewer side effects and a significantly better quality of life after surgery.

Several studies have shown positive therapeutic effects of HBOT for delaying radiation damage to the pelvic tissues. Willams and colleagues examined the therapeutic effects of HBOT on radiation-induced soft tissue necrosis in patients who had previously received treatment for malignancies. Fourteen patients whose necrotic wounds failed to heal after three months of conventional treatment underwent HBOT therapy. All patients with vaginal radiation necrosis or rectovaginal fistulas were completely cured with HBOT; there was only one treatment failure. In 1996, Feldmeier and partners described the use of HBOT in 44 patients (19 of whom were treated for cervical cancer) with delayed pelvic and abdominal lesions. Of the 41 evaluable patients, 26 (63%) were cured and six out of eight patients with fistulas recorded their closure, while 3 patients required surgery. The overall response rate is 81% in patients receiving at least 20 treatments. 

More recently, Fink et al. (2006) performed a retrospective analysis of 14 gynecologic cancer patients with delayed radiation-induced lesions who were treated with HBOT between 1997 and 2003. At least 20 sessions of inhalation of 100% pure oxygen, at 2.4 ATA for 90 minutes over 70% of patients healed or improved their condition by over 50%. The results suggest that HBOT should be considered in patients with radiation-induced lesions who do not respond to other treatments.

Several studies suggest that HBOT may improve the patient's quality of life with radiation-induced toxicity following treatment for pelvic malignancy. Safra et al. (2008) also reported the positive impact of HBOT on the side effects induced by persistent radiation: 13 women (mean age 60.3 years) with cystitis or proctitis, vaginal ulcers and fistulas, and long-lasting skin lesions. they received HBOT treatments (100% oxygen, at 2 absolute atmospheres, for 90 minutes, once a day) in a multiplace room for an average of 27 sessions. 

The National Cancer Institute's Common Toxicity Classification System (CTC) decreased from an average of 3.3 ± 0.75 before HBOT to 0.3 ± 0.63 after HBOT. Rectal bleeding stopped in five of six patients; proctitis and dysuria were resolved in six of the seven cystitis patients; macroscopic hematuria stopped for seven out of seven patients; scar complications were resolved in two out of two patients, and none reported side effects associated with HBOT. Jones et al. (2006) also reported that in patients with radiation-induced proctitis refractory to standard therapy, HBOT resulted in complete resolution of rectal bleeding in four patients and relief of symptoms in three others.

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Complete remission of pain occurred in three patients and complete remission of diarrhea in one of the five patients, while amelioration occurred in three other patients; only two patients did not respond to HBOT. Finally, a recent study by Rud et al. (2009) investigated the possible pain-reducing effect of hyperbaric oxygen therapy (HBOT) in 16 patients with tissue damage after radiation treatment in gynecologic cancer. . Patients received HBOT for 21 consecutive days and were followed for 6 months after treatment.

Although HBOT did not have a significant effect on pain, its effect on tissue damage caused 50% of patients to report a beneficial effect of treatment.

In 2005, Chong and colleagues demonstrated in a retrospective study that for patients with radiation-induced hemorrhagic cystitis (pelvis) who received HBOT at 2.36 atmospheres absolute pressure, 90 minutes a day, for 33 sessions, the effects were was of total or partial resolution of hematuria in 80% of cases (48 out of 60 analyzed); however, this effect was increased in 96% of patients when treatment was initiated within six months of onset. Moreover, clot formation decreased in patients who received HBOT 6 months after onset.

Response rates were 81%, 83%, and 78% for patients who underwent external beam, primary, or adjuvant pelvic radiotherapy. In another retrospective study, Bui et al. (2004) analyzed the side effects of radiation on the pelvis and the effects of HBOT on the disease, finding that the severity of symptoms was improved after treatment with HBOT; 50% of patients reported improvement in tissue necrosis / mucosal side effects; the incidence of recurrence in these patients was 22%.

Following the interest of the Alberta College of Physicians and Surgeons, Hailey in 2003 prepared a paper that provides evidence of the effectiveness of hyperbaric oxygen therapy (HBOT) for several clinical applications. Regarding soft tissue radionecrosis, there was insufficient evidence to support this claim, as no controlled studies have been identified. However, the case study suggests evidence of the benefits of this therapy. Furthermore, a summary of an article by the U.S. Agency for Research and Quality of Care (AHRQ) states that the results suggest that HBOT may be beneficial when used as adjunctive therapy for this condition.

The British Columbia Cancer Agency (BCCA) recommends hyperbaric oxygen therapy as an option for some patients suffering from delayed radiation damage due to its apparent ability to increase blood supply to irradiated tissue and cause healing of necrotic areas. In 2006, the Scottish Intercollegiate Guideline Network recommended, based on certain studies, that hyperbaric oxygen facilities be available for patients with head and neck cancer.

Regarding the potential risks and side effects associated with the use of HBOT, it is recommended that all patients be evaluated by a physician specializing in hyperbaric therapies. Patients with the following medical conditions should be treated with caution: middle or inner ear disorders, congenital heart disease, claustrophobia, spherocytosis, diabetes, seizures, lung problems, asthma, upper respiratory tract infections, chronic obstructive pulmonary disease, eustachian tube dysfunction, high fever, cataracts, pregnancy or the use of a pacemaker. Also, the following are absolute contraindications to the use of HBOT: untreated pneumothorax and concomitant use of bleomycin, cisplatin, disulfiram, doxorubicin, and sulfamylon.

The use of hyperbaric oxygen therapy is considered safe when the room is properly installed, according to regulations, and complies with existing regulations. Operators and attendants should be properly trained in the technical function of the hyperbaric chamber, but should also be able to handle any serious complications that may be encountered in patients.

By applying these principles, serious risks are rare, and more common side effects are mild and easy to manage. The clinical condition (ie pain caused by cystitis, proctitis, bone necrosis, soft tissue necrosis, etc.) for which HBOT is considered a therapeutic option should be quantified and clinical endpoints determined on a case-by-case basis before initiating HBOT treatment. In general, after 20-25 HBOT treatments, it is recommended that a clinical evaluation be performed to reassess the patient's condition and determine if improvements have been made. If no significant progress has been made, there should be a reevaluation to determine if HBOT is an appropriate treatment option.


Centrokinetic is the place where you will find clear answers and solutions for your motricity problems. The clinic is dedicated to osteoarticular diseases and is divided into the following specialized departments:

  • Orthopedics , a department composed of an extremely experienced team of orthopedic doctors, led by Dr. Andrei Ioan Bogdan, primary care physician in orthopedics-traumatology, with surgical activity at Medlife Orthopedic Hospital, specialized in sports traumatology and ankle and foot surgery. .
  • Pediatric orthopedics , where children's sports conditions are treated (ligament and meniscus injuries), spinal deformities (scoliosis, kyphosis, hyperlordosis) and those of the feet (hallux valgus, hallux rigidus, equine larynx, flat valgus, hollow foot).
  • Neurology , which has an ultra-performing department, where consultations, electroencephalograms (EEG) and electromyography (EMG) are performed. 
  • Medical recovery  for adults and  children , department specialized in the recovery of performance athletes, in spinal disorders, in the recovery of children with neurological and traumatic diseases. Our experience is extremely rich, treating over 5000 performance athletes.
  • Medical imaging , the clinic being equipped with ultrasound and MRI, high-performance devices dedicated to musculoskeletal disorders, and complemented by an experienced team of radiologists: Dr. Sorin Ghiea and Dr. Cosmin Pantu, specialized in musculoskeletal imaging.
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Hyperbaric oxygen therapy in intestinal pneumatosis

Cystoid or cystic intestinal pneumatosis (intestinal emphysema) is a symptom that can occur in many gastrointestinal diseases. Hyperbaric oxygen therapy can be a successful treatment of cystoid intestinal pneumatosis and granulomatosis with polyangiitis.


Hyperbaric oxygen therapy in cell damage caused by radiation in gynecological cancers

Gynecological cancers treated with a combination of external beam radiation and brachytherapy, especially cervical and vaginal cancers, can result in the apex of the vagina receiving a high dose of radiation. Hyperbaric oxygen therapy has positive effects on the radiated tissues, especially the head, neck, anus, and rectum.


Hyperbaric oxygen therapy in post-radiotherapy CNS injury

Hyperbaric oxygen therapy involves the use of so-called levels of oxygen under pressure to increase the level of oxygen in the blood. The use of hyperbaric oxygen therapy involves oxygen treatment for soft tissue radionecrosis. Read this article and find out more.


Hyperbaric oxygenation vs normobaric oxygenation in CO poisoning

Prolonged CO exposure is responsible for more than half of fatal poisonings and is also one of the leading causes of poisoning in Western countries. We aimed to compare the effectiveness of therapy with hyperbaric oxygen (HBO) versus normobaric oxygen (NBO) in the setting of carbon monoxide poisoning (COP).


Hyperbaric oxygen therapy in diabetic foot

Hyperbaric oxygen therapy may be effective for Wagner's grade 3 and 4 diabetic foot ulcers and need to study the real problems with patients seeking treatment and demonstrates the need to study the real problems with patients seeking treatment. The results show that it is important to follow the treatment in order for the HBOT to be efficient.


The role of hyperbaric oxygen therapy in sports medicine

Hyperbaric oxygen is used in sports medicine to reduce hypoxia and edema and is also effective in treating stroke injuries and acute traumatic peripheral ischemia. When used clinically, hyperbaric oxygen should be considered as an adjuvant therapy used as early as possible after the diagnosis of the lesions.


Hyperbaric oxygen therapy in muscle injuries

Muscle stretches are the most common muscle injuries suffered during performance sports. Rapid recovery from muscle injury is crucial for elite athletes who regularly are exposed to training and increased competition. Hyperbaric oxygen therapy is a safe and effective method, being a non-invasive treatment


Hyperbaric oxygen therapy in sports injuries

Hyperbaric therapies are methods used to treat disease or injury using pressures higher than the local atmospheric pressure inside a hyperbaric chamber. The long-term effects are neovascularization (angiogenesis in hypoxic soft tissues), osteoneogenesis, and stimulation of collagen production by fibroblasts. This is beneficial for wound healing and recovery after irradiation.


Hyperbaric oxygen therapy in proctitis generated by radiation

Proctitis is the inflammation of the rectal mucosa causing pain, discharge, and other unusual symptoms. Pain can occur during bowel movements, it can be acute or chronic. Symptoms may vary, but the most common is tenesmus (the feeling of needing to go to the toilet), a sensation that persists even after using the toilet. This treatment should be offered to patients who fail to recover with conventional treatments for radiation-induced proctitis.


Hyperbaric oxygen therapy in refractory osteomyelitis

Osteomyelitis is an infection of the bone or marrow caused by bacteria or mycobacteria. Hyperbaric oxygen treatments can be considered an American Heart Association (AHA) Class II recommendation for the treatment of chronic, refractory osteomyelitis


Hyperbaric oxygen therapy in tinnitus

Hyperbaric oxygenation allows a controlled increase in oxygen pressure in the blood. This technique can be used in cases of tinnitus and sudden deafness, when certain changes in the inner ear and brain generate a lack of oxygen and, therefore, a limited intake of energy.


Hyperbaric oxygen therapy of ischemia and reperfusion injury

Hyperbaric oxygen therapy has been found to ameliorate the damaging effects of reperfusion by early modulation of inflammation, maintenance of metabolic function in downstream tissues, and reintroduction of oxidation scavengers.


Hyperbaric therapy in the treatment of second degree burns

HBOT has a beneficial effect on burn wound healing by reducing edema and ensuring there is adequate oxygen in microcirculation. It may speed up epithelialization and suppress unnecessary inflammation that could negatively affect normal wound healing. With further research, HBOT may become an adjuvant therapy to surgery.


Hyperbaric oxygen therapy

Hyperbaric therapy is a form of medical treatment that involves exposing the body to pure oxygen at a higher pressure than normal. There are about 45 diseases approved worldwide to be treated with hyperbaric oxygen.


Hyperbaric oxygen therapy in the management of patients with malignant otitis externa

Malignant otitis externa is a rapidly spreading bacterial infection that is aggressive and may be fatal if left untreated. Hyperbaric oxygen therapy (HBOT) is a medical treatment in which the entire body is placed in an airtight chamber at increased atmospheric pressure and has been proven to be effective for several different medical conditions.


Hyperbaric oxygen therapy in acute myocardial infarction

If left untreated, MI will lead to the progressive loss of viable cardiomyocytes, impaired heart function, and congestive heart failure. Oxygen cycling therapy serves as a very attractive option for the treatment of myocardial infarction, because it offers some of the greatest benefits while reducing treatment time and inconvenience to the subject.


Hyperbaric oxygen in ischemic ulcers

The present study has demonstrated that adjunct HBOT enhances the reduction of ulcer area and depth at 4 weeks in T2DM patients with ischaemic DFUs. HBOT is known to ensure hyperoxygenation of ischaemic tissue and restoration from hypoxia. Discover the hyperbaric medicine center open in our clinic. Centrokinetic has the top-performing hyperbaric chamber in Bucharest.


Hyperbaric therapy in femoral condylar osteonecrosis

Osteonecrosis of the knee (ONK) is a form of aseptic necrosis resulting from ischemia to subchondral bone tissue. Typically, treatment is invasive. Hyperbaric oxygen therapy (HBOT) may provide a noninvasive alternative by improving oxygenation and reperfusion of ischemic areas. This study evaluates the efficacy of HBOT in a series of ONK patients.


Hyperbaric therapy in femoral head necrosis

Femoral head necrosis (FHN), also called avascular necrosis, or femoral head osteonecrosis is a common multifactorial condition that affects patients of any age and can lead to substantial clinical morbidity. Hyperbaric oxygen therapy (HBO) is one of the proposed treatments. Indeed, tissue oxygen promotes angiogenesis that reduces edema. Read about the effectiveness of this treatment.


Hyperbaric oxygen therapy in central retinal artery occlusion

Central retinal artery occlusion (CRAO) is a devastating and common eye condition. It presents a sudden, unilateral, and painless loss of vision. Even when treated promptly, an acute obstruction of the central retinal artery usually leads to severe and permanent loss of vision.


Hyperbaric therapy in irradiated maxillofacial dental implant

There are numerous studies reported for the effectiveness of HBO in the treatment of osteoradionecrosis of various bone tissues. In addition to its usefulness in treating osteoradionecrosis, this therapy can prevent it. It also combats the negative effect of irradiation, stimulates osseointegration, and improves the survival rate of the implant.


Hyperbaric oxygen therapy in hear loss

The auditory function in the inner ear is maintained by the cochlea, which is known to have a high oxygen demand. Hyperbaric oxygen can increase the tension of oxygen in the perilymph and restore hearing in a significant number of patients with sudden hearing loss. Patients can be treated in a single-seater hyperbaric chamber or in a multiplace chamber.


Hyperbaric therapy in traumatic ischemia

Limb trauma, which leads to direct tissue damage, plus local hypoxic disorders caused by the resulting edema, causes acute peripheral ischemia. Surgical treatment and hyperbaric oxygen are not concurrent treatment modalities but are best used to complement each other in order to provide the best outcome for the patient.


Hyperbaric therapy in venous embolism

Small gas embolisms, as in this case, present serious risks, especially the complication of cerebral air embolism. To prevent neurological complications, it is necessary to urgently remove the air bubble. HBOT reduces the volume of the bubble, helps eliminate nitrogen, and improves the oxygenation of potentially hypoxic tissue. See the results of hyperbaric therapy in venous embolism.


Hyperbaric therapy in osteoradionecrosis

Osteoradionecrosis (ORN) is a common consequence of radiation provided to cancer patients. Currently, hyperbaric oxygen therapy (HBOT) has a major role in improving wound healing in patients with ORN.


Hyperbaric oxygen therapy in soft tissue radionecrosis

Discover the hyperbaric medicine center open in our clinic. Centrokinetic has the top-performing hyperbaric chamber in Bucharest, with multiple medical and anti-aging uses. The Baroks chamber has 5 seats, and operates at a constant pressure of 2.5 atmospheres, being fully automated and having protocols for each condition, and can be used individually for each patient.



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