CHRISTIAN J. LAMBERTSEN, MD, DSc (Hon) MEMORIAL LECTURE
THURSDAY, JUNE 29: 1:00 pm - 2:00 pm
GUEST SPEAKER: Tom Neuman, MD
LECTURE TITLE: “Arterial Gas Embolism”
ABOUT THE LECTURE: "Arterial Gas Embolism"
ABOUT DR. NEUMAN:
Dr. Neuman was trained as a diving medical officer, he retired from the Naval Reserve with the rank of Captain. He was president of the UHMS in 1989 and past editor-in-chief of the journal Undersea and Hyperbaric Medicine. He is the co-editor of the 5th Edition of Bennett and Elliott's Physiology and Medicine of achievement. Dr. Neuman was an advisor to the National Academies of Sciences to advise NASA on the medical problems associated with colonization of the moon and the trip to Mars. Dr. Neuman is an active diver, a PADI scuba instructor. He is board certified in Internal Medicine, Pulmonary Medicine, Emergency Medicine, Undersea and Hyperbaric Medicine and Preventive Medicine. Dr. Neuman received the Albert Behnke Award for outstanding scientific contributions to the field of Undersea Medicine. He also received the Stover-Link award for contributions to diving safety and the Merrill Spencer Award for lifetime achievement. Dr. Neuman was an advisor to the National Academies of Sciences on medical problems associated with colonization of the moon and the trip to Mars. He is an active diver and a PADI scuba instructor. He is board certified in Internal Medicine, Pulmonary Medicine, Emergency Medicine, Undersea and Hyperbaric Medicine and Preventive Medicine.
CHRISTIAN J. LAMBERTSEN, MD, DSc (Hon) MEMORIAL LECTURE
About Dr. Lambertsen:
Dr. Christian J. Lambertsen received a B.S. Degree from Rutgers University in 1938 and a M.D. Degree from the University of Pennsylvania in 1943. During his medical school period, he invented and first used forms of the initial U.S. self-contained closed-circuit oxygen rebreathing apparatus, for neutral buoyancy underwater swimming and diving. As a student, he aided the early Office of Strategic Services (O.S.S.) in establishing the first cadres of U.S. military operational combat swimmers. Dr. Lambertsen became a U.S. Army medical officer on graduation from medical school in early 1943, and immediately joined the O.S.S. Maritime Unit on active duty through its period of function in World War II. He joined the University of Pennsylvania Medical Faculty in 1946, and became Professor of Pharmacology in 1952. While a faculty member he combined diving research and further underwater rebreathing equipment developments for the Army and Navy. In 1967 he served as Founding President of the Undersea Medical Society (now Undersea and Hyperbaric Medical Society.) Dr. Lambertsen is recognized by the Naval Special Warfare community as "The Father of U.S. Combat Swimming.” His hand has touched every aspect of military and commercial diving. Dr. Lambertsen’s active contributions to diving began during WWII and became even more progressive in the post-war period through the evolutions of the U.S. Navy Deep Submergence and Naval Special Warfare developmental programs.
ERIC P. KINDWALL, MD MEMORIAL LECTURE
FRIDAY, JUNE 30: 1:00 pm - 2:00 pm
GUEST SPEAKER: John Feldmeier, DO
LECTURE TITLE: “Beams and Bars: Radiation oncology and hyperbaric medicine, an inseparable story, past, present and future”
ABOUT THE LECTURE:
On the occasion of the 50th Anniversary of the UHMS, this presentation will look to the past, present and future to discuss the historic and ongoing inextricable relationship between hyperbaric oxygen and radiation therapy. This relationship predates the founding of our society by at least 12 years, at which time a brave and inspired clinician and scientist named Churchill-Davidson first irradiated patients in a monoplace chamber at pressure. This brave study was based on firm and still-valid biologic principles established by Gray and Tomlinson a few years earlier: Namely, well-oxygenated tumors are as much as three times more sensitive to radiation cell kill than are hypoxic tumors. For a number of reasons, simultaneous radiation and hyperbaric oxygen are not clinically employed at this time even though retrospective reviews of these studies have shown statistically enhanced local tumor control.
For the latter decades of the last century and so far in the 21st century, the interaction between the two disciplines has been primarily the application of hyperbaric oxygen to treat or prevent delayed radiation injuries. The pioneering work of Robert Marx DDS, and his colleagues, initially at Wilford Hall USAF Medical Center and continuing to this day at the University of Miami, has established the rationale, designed a successful clinical protocol and reported the results in employing hyperbaric oxygen as an adjunct in the management and prevention of mandibular osteoradionecrosis. As the experience mounted and biologic principles were described, hyperbaric oxygen was applied to the treatment at many soft tissue and organ sites, including the rectum and bladder. We owe a debt of gratitude to Mr. Dick Clarke and the Baromedical Research Foundation for giving us a well-designed randomized controlled trial that supports HBO2 for delayed proctitis. The application of HBO2 has been so successful in radiation injury that at many centers it is the most common indication for treatment, and at several prominent centers, patients with radiation damage constitute more than 50% of those receiving treatment. Clinical dilemmas do arise when patients are found to have active malignancy or are undergoing chemotherapy. Recently some, especially our colleagues in Japan, have begun again to look at hyperbaric oxygen as a radiation sensitizer, employing and sequencing the two therapies in such a way that the dangers of explosive decompression and the resistance of staff to slowing throughput in a busy radiation center have been removed.
As for the future, there remains a wealth of unexplored and potentially even broader combined applications of the two therapies. A possible role for hyperbaric oxygen in hastening the resolution of severe acute consequences of cancer treatment has recently been reported. There is no reason not to consider and study hyperbaric oxygen as an enhancer of cytotoxic chemotherapeutic agents, many of which mimic radiation in their mechanism of action. Additional refinements of hyperbaric oxygen as a radiosensitizer show promise, including infused and implanted radioisotopes. In my mind, perhaps the most exciting potential future application would be the prophylactic application of hyperbaric oxygen in irradiated patients who are unknowingly at increased risk for complications due to inherent idiosyncratic sensitivities. In order to apply this concept to its full potential, reliable predictive biochemical or imaging assays will need to be developed so that intervention can take place before the expression of these serious consequences of treatment.
In summary, the fields of hyperbaric oxygen and radiation oncology have been closely related for more years than our society has existed. Previously, hyperbaric oxygen was investigated as the most powerful and safest radiation sensitizer. Currently, hyperbaric oxygen plays a key role in managing and preventing late complications. For the future, the studies of radiosensitization need to be revisited and refined to include cytotoxic drugs and novel ways to enhance radiation antitumor effect without the problems and dangers experienced nearly 60 years ago. The development of predictive assays for delayed radiation injury may allow intervention with hyperbaric oxygen even prior to the manifestation of those complications.
ABOUT DR. FELDMEIER:
A 1970 graduate of Duquesne University in Pittsburgh with a B.S. in Physics, Dr. Feldmeier initially served as a meteorologist in the USAF Weather Service until 1975. He received his D.O. degree from The Philadelphia College of Osteopathic Medicine in 1979 with USAF sponsorship and completed residency training in Radiation Oncology at the University of Texas Health Science Center at San Antonio, Texas in 1985. He received a fellowship certificate from the USAF Hyperbaric Medicine Fellowship Training Program at Brooks Air Force Base in San Antonio, Texas and was a staff physician there from 1980 to 1982. Dr. Feldmeier then served as the Chief of Radiation Oncology from 1985 to 1987 and ultimately simultaneously Chairman of the Hyperbaric Medicine Department at Wright-Patterson Air Force Base Medical Center in Dayton, Ohio. He returned to the University of Texas Health Science Center as faculty in 1987 and ultimately became Chief of Radiation Oncology there. He was also the Radiation Oncology Residency Program Director there before leaving to join the faculty at Wayne State University from 1992 until 1997. He became Division Chief and Clinical Chief of Radiation Oncology at Grace Hospital in Detroit, Michigan in 1993. In 1997 he joined the University of Toledo Medical Center (previously known as Medical College of Ohio) and served as Department Chairman of Radiation Oncology there until his retirement from that position in 2013. He was named Professor Emeritus upon his retirement.
Dr. Feldmeier has authored numerous publications in both radiation oncology and hyperbaric medicine. He has been the editor of the Undersea & Hyperbaric Medical Society (UHMS) Hyperbaric Oxygen Therapy Committee Report which provided the rationale for the UHMS Accepted Indications for HBO2. He served a review editor of the UHMS scientific journal, Undersea and Hyperbaric Medicine. He is a Fellow of Undersea and Hyperbaric Medicine and continues on the UHMS Board of Directors as Past- President of the UHMS. He currently co-chairs the UHMS Research Committee. He is a Fellow of the American College of Radiation Oncology. He has been recognized as one of “The Best Doctors in America” until his retirement beginning in 2007. He is a consultant to International ATMO. He is the only physician board certified in both Radiation Oncology and Undersea and Hyperbaric Medicine.
ERIC P. KINDWALL, MD MEMORIAL LECTURE
About Dr. Kindwall:
Dr. Kindwall is known by so many as the "Father of Hyperbaric Medicine.” Whether you knew him personally or simply by reputation, we have all benefited from his efforts, passion, wisdom, knowledge, energy and vision. Dr. Kindwall has played a great role in growing and shaping the specialty of Undersea and Hyperbaric Medicine. He was likewise instrumental in molding the UHMS into what it is today. Dr. Kindwall began diving in 1950. He cultivated his interest in the field and during the Vietnam War served as the Assistant Director of the U.S. Navy School of Submarine Medicine. He also was the Senior Officer responsible for the Diving Medicine Program. In 1969, after leaving the Navy, Dr. Kindwall became Chief of the Department of Hyperbaric Medicine at St. Luke’s Medical Center, Milwaukee, Wis. Shortly after the Undersea Medical Society was created in the mid-1960s, Dr. Kindwall identified the need for standardized education in the field. He created the UMS Education and Standards Committee to help elevate course content and ensure instructor competence. This committee later became our Education Committee. When the AMA initiated its Continuing Medical Education program, Dr. Kindwall persuaded the organization to recognize the UMS as a grantor of CME credits. In 1972, Dr. Kindwall felt that the Society’s members would benefit from improved communication. He created our first newsletter and was named editor. Dr. Kindwall chose the name Pressure because clinical hyperbaric medicine was rapidly developing. Even though the UHMS had not yet incorporated "Hyperbaric” into the Society’s name, he wanted a title for the newsletter that would encompass all who worked with increased atmospheric pressure. He stated: "The Society’s goal then, as it is now, is to serve all who deal with the effects of increased barometric pressure.” That same year, Dr. Kindwall recognized the need to have a relationship with Medicare to help provide insight on reputable clinical management. The UMS followed this lead, and a Medicare Panel was created. The recommendations were presented to the U.S. Public Health Service. The challenge was that no reliable hyperbaric medicine clinical guidelines were available that addressed appropriate applications of Hyperbaric Medicine. To remedy this deficit, the UMS Executive Committee created an Ad Hoc Committee on hyperbaric oxygen therapy. Dr. Kindwall was named Chair. The committee created the first Hyperbaric Oxygen Therapy Committee Report. Again, this text was published 10 years before the UHMS incorporated "Hyperbaric” into its name. The report was sent to HCFA and the Blues and became their source document for reimbursement. Dr. Kindwall updated the text two more times and thus was the Editor and Chair of the Committee and text for three of its 12 editions. Dr. Kindwall later worked to expand the available information on the specialty by creating one of the first complete texts on the field. He created Hyperbaric Medicine Practice in 1994 and later updated and revised his text two more times. The Society’s first journal, Hyperbaric Oxygen Review, has also has been influenced by Dr. Kindwall. His love for research and education was clear: He became the initial editor, creating a journal that at first consisted of review articles and one original contribution. Over the years,it has grown to one full of original research. Dr. Kindwall’s presence is felt in so many of the UHMS’ activities and initiatives. Much of what we all take for granted – what is just "there” and "available” – has his touch and influence. Some of us have been blessed to have had a closer impact by Dr. Kindwall’s life, but I think that I can easily say that each of us has been influenced in some way.