| متن مقاله | Introduction hemorrhagic cystitis (HC) Hemorrhagic cystitis (HC) is an inflammatory hemorrhagic disease and condition that can be caused due to infectious (e. g. viruses) or non-infectious causes. This disease brings about different incidents of bleeding in mucosa parts of the urine bladder. In severity of HC and the results of the treatments, there are substantial obvious differences. Some patients only have microscopic bleedings and in some patients the symptoms appear in the lower parts of the urinary tracts. Due to the many different clinical observations of HC disease, different methods for treatment are used. Methods such as antivirus medicine types like vidarabine, oxygen or ozone therapy, <<>>, <<>>, cystoscopy and even cystectomy are utilized for treatment. Each of these methods can lead to the restoration of the patient’s health or certain side effects or complications. Hyperbaric (high-pressure) oxygen therapy is a non-invasive method in which pure oxygen in high pressure is used. This method is used for the treatment of the patients who have received <<>> (alloHSCT). The treatment of patients with this method shows and gives evidence that oxygen therapy (ozone therapy) (HBO) is a complete effective treatment method and that this method is a <<>> method with positive results of laboratory and clinical tests. As certain groups who are relatively severely in danger usually get HC, the aim of the presentation of this study was reporting a case of HC after alloHSCT with acute conditions and reached full recovery and restoration using hyperbaric oxygen therapy The Patient’s Introduction and Conditions A forty-year-old man, having acute myeloid leukemia (AML) received bone marrow transplantation (hematopoietic stem cell transplantation) in the month of Farvardin (March 21st to April 20th) in the year 1396 AH (2017) at Imam Reza Hospital in Kermanshah. The donor was the patient’s brother. After the transplantation, the patient was dismissed from the hospital with normal status. The result of the medical test chimerism in this patient was 95% which showed the highest transplantation matching. It is necessary to mention that despite the tutorials and training given to the patient and his family about the procedure and the process of the treatment and the necessity of on-time consumption of the medicine; unfortunately, neither the patient nor his family paid attention to on-time consumption of the medicine and the necessary dosage. On 22/03/1396 (June 12th, 2017), the patient referred to the hospital due to very severe hematuria. Among his other clinical symptoms were severe weakness, severe lethargy, fatigue and narcosis. Immediately, treatment actions by medical staff of the hospital were done. The first actions were urine test, blood test and the diagnostic ultrasonography of the kidneys and the urinary meatus and the urethra. Results of the full RBC urine test announced hemoglobin drop and platelets drop and the ultrasonography gave evidence against hydronephrosis. The second series of actions was urology consultation. Based on the consultant expert’s opinion, cystoscopy was prescribed for the patient. Therefore, pre-cystoscopy levels and stages including CT-scan of the abdomen and the pelvis, anesthesia consultation, VCUG and applying diagnosticsonography on the kidneys and the urinary meatus and the urethra, were all done. Operation room was reserved for June, 19th, 2017 (1396/03/29). At the operation room, entering the left ureter was done using the guidewide and the checking was done until the place of the renal pelvis. No stone, spatial lesion or hemorrhagic (bleeding) wound was seen; but the left ureter had edema and erythema. In the same way, the right ureter was also analyzed. No pathologic point was observed. Urinary bladder was washed. Due to the fact that there was no wound, formalin injection fulguration was not necessary. Three-way foley was embedded for the patient. Irrigation and clear stream/flow started. After the cystoscopy, the patient was transferred to the hospital unit/division. There was still hematuria. Patient’s urinary bladder was washed regularly and simultaneously, hemoglobin and platelets drop was compensated with injection of pexel products (PC) and platelets. Finally, because of the time length of the washing processes and due to the fact that bleeding did not stop, physician suggested ozone therapy for the patient. Ozone therapy for 5 sessions was done for the patient. After each session, urine test was obtained. On the last session, results of all the tests were normal. Ozone therapy inside the urinary bladder for curing hematuria was done for the first time in Iran. This method, blocking capillaries and very small vessels of the urinary bladder, stopped the bleeding. All the primary and routine treatment routes/paths was done for the patient; but the patient did not respond much significantly to the treatments. Despite all these, using ozone therapy, valuable results were achieved and the patient became stable. Discussion Hemorrhagic cystitis and the host’s reaction to the transplantation (graft-versus-host disease) (GVHD) is a complication and side effect of allogeneic hematopoietic stem cell transplant. Hemorrhagic cystitis is a common cause of mortality after allogenic transplant. The procedure of allogeneic hematopoietic stem cell transplant and the treatment of the increase in immunity system’s reaction for GVHD may be so long and time-consuming due to the defect, flaw and malfunction in the humoral and cell immunity system. GVHD can be either acute or chronic. In acute GVHD, it gets obvious within less than the first 100 days after the transplantation (often 30-40 days after the transplantation) and affects the skin, the liver and the digestion system. Chronic form of it occurs 100 days after the transplantation and is less severe than the acute form; though it affects joints, the mouth and the tear glands. As a cure and a control method for GVHD, medicine types such as methotrexate, cyclosporine and high dosages and quantities of corticosteroids are used. Taking these sorts of medicine can be likened to a two-bladed sword. If they are taken more than the certain dosage, they cause infections, etc; as they reduce the activity and the function of the immunity system. If they are taken less than the determined necessary dosage, this leads to GVHD. In this patient, due to the lack of attention to on-time consumption of the medicine, GVHD caused disorders in the urinary system of the patient. Also, for curing GVHD, mesenchymal stem cells of a third party are used which can cause suppression of the immunity system and stops the GVHD progression. Hemorrhagic cystitis is the inflammation and erythema of the urine bladder which leads to bleeding in the urine bladder. Clinical symptoms of this complication and condition are periodic hematuria, irritable abdominal pains, urinary tracts obstruction and urinary bladder tamponade. There are several different methods and ways for curing HC, such as the injection of hyaluronic acid and aluminum salt, chemotherapy, radiotherapy, ozone therapy, cystectomy, etc. As mentioned above, HC is a complication and side effect of allogenic transplant that is graded as mild, moderate and severe based on the severity, rate and level of hematuria and the patient’s pain. For mild HC, supportive treatment would respond, but it is possible that the patient needs other therapeutic methods such as antivirus medicine like vidarabine, oxygen or ozone therapy, washing the urine bladder, formalin therapy, cystoscopy and even cystectomy. Cystectomy is the invasive cure for HC which has less than 5% mortality or possibility of death. Among its side effects and complications are sexual malfunction and disorder and urine deflection (detour); although the patient’s quality of life is reported to be good. Ozone therapy treatment method was known for GH, 17 years ago. A retrospective study by Elzimaity showed that HC in matched unrelated donor (MUD) and unrelated cord blood (UCB) transplant occurs more than other cases of allogenic transplant. The occurrence of this condition in the under-twenty-six-year-old youth who receive this transplantation is much more than those of other ages. An overwhelming rate of the symptoms is detected and is obvious 30 days after the transplantation. Dellis et al. reported that HBO has significant effect in restoration and relief of the injuries caused by the ray radiation. Moreover, they reported years ago, the positive effect of HBO in curing HC which had been caused after pelvic radiotherapy. ???? et al. reported that 16 patients who had HC after AlloHSCT, benefitted from HBO and that HBO method reduced the hematuria. They also reported the significant obvious drop and reduce of BKviremia and viruria after HBO. In the present study, we also found out that HBO therapy was successful for this patient who suffered from HB with the clinical symptoms of very severe hematuria and abdominal pain. In the first stage and level of the treatment, several times of completely washing the urine bladder; treatment and curing using HBO was chosen for the last act which had valuable and worthy results. The patient’s bleeding stopped completely and the patient’s status and condition restored to normal. Conclusion With regards to surveying all the possible causes of cystitis hemorrhagic, especially the viral and infectious causes, with the diagnostic of GVHD condition, the patient received supplementary treatments. With utilizing ozone therapy, we managed to control hematuria and due to the patient’s sensitive critical conditions and his having ignored on-time consumption of the medicine, it is logical to say that it was natural that GVHD occurred as HC. After the patient’s referral to the hospital, different treatment methods were applied. After ozone therapy, the patient’s hematuria fully stopped and the patient returned to normal conditions. It was the first time in the Islamic Republic of Iran that ozone therapy was utilized for HC and fortunately, it has valuable worthy results. References 1. Tsuboi K, Kishi K, Ohmachi K, Yasuda Y, Shimizu T, Inoue H, et al. 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