EMERGING INDICATIONS FOR HYPERBARIC OXYGEN THERAPY
NEW PEARLS OF WISDOM IN THE DIVING AND HYPERBARIC MEDICINE LITERATURE
CLINICAL AND METABOLIC ASPECTS IN BREATH-HOLD DIVING
EMERGING INDICATIONS FOR HYPERBARIC OXYGEN THERAPY PLENARY
8:00 AM - 10:00 AM
Enrico Camporesi, MD
"Hyperbaric Oxygen Therapy for Aseptic Necrosis of the Femoral Head andof the Femoral Condyli"
Osteonecrosis of the knee (ONK) is a form of aseptic necrosis resulting from ischemia to subchondral bone tissue. Typically, common surgical treatments are invasive and palliative or time-limited. Hyperbaric oxygen therapy (HBOT) may provide a non-invasive alternative by improving oxygenation and reperfusion of ischemic areas, both for distal femoral condyli, as recently described, or for a similar malady of the femoral head, previously published.
We recently described 37 ONK patients (29 male, 8 female; mean age ±1 SD: 54±14). 83.7% of patients presented with Aglietti stage I-II; 16.3% presented with Aglietti Stage III. Patients were treated with HBOT once a day, five days a week, at 2.5 ATA with 100% inspired oxygen by mask for an average of 67.9±15 sessions. Magnetic resonance imaging was performed before HBOT, within one year after completion of HBOT, and in 14 patients, 7 years after treatment. Oxford Knee Scores (OKS), an index of functionality, where 60 is normal, were recorded before HBOT and at the end of each HBOT treatment cycle.
After the 30 sessions of HBOT, 86% of patients experienced improvement in their OKS, 11% worsened, and 3% didn’t change. All patients improved in OKS after 50 sessions. MRI evaluation 1 year after HBOT completion showed that edema at the femoral condyle had resolved in all but one patient. MRI at 7 year after completing therapy were all normal. In conclusion, HBOT is beneficial in ONK. Patients experienced improvements in pain and mobility as demonstrated by improvement in OKS. Radiographic improvements were also seen upon post treatment follow-up. Aglietti Staging for the entire sample saw an aggregate decrease (p < 0.01) from 1.7 ± 0.7 to 0.3 ± 0.6.
Gerardo Bosco, MD
Shai Efrati, MD
- Basics pathophysiological cascade of non-recoverable brain injuries.
- The neuroplasticity effect of hyperbaric oxygen therapy
- Selecting the optimal candidate for the treatment
Clinical studies published in recent years present convincing evidences that hyperbaric oxygen therapy (HBOT) can be the coveted neurotherapeutic method for brain repair of neurological incidents like traumatic brain injury and stroke. This new understanding leads to a paradigm change in the way that we refer to chronic brain injuries; from now these should be thought of like other non-healing wounds in other parts of the body.
The classical candidate for HBOT is a patient with unrecovered brain injury where tissue hypoxia is the limiting factor for the regeneration process. In this patient, HBOT may induce neuroplasticity in the stunned regions where there is a brain anatomy/physiology mismatch (as for example PET/MRI).
In this lecture we will discuss the multi-faceted role HBOT can play in neurotherapeutics based on recent persuasive evidence demonstrating HBOT efficacy in brain repair as well as a new understanding of brain energy management and response to brain damage. We will also discuss how to select suitable candidates and how to choose the optimal HBOT protocol for the selected candidate.
NEW PEARLS OF WISDOM IN THE DIVING AND HYPERBARIC MEDICINE LITERATURE PLENARY
1:00 PM - 2:00 PM
CLINICAL AND METABOLIC ASPECTS IN BREATH-HOLD DIVING PLENARY
4:00 PM - 5:00 PM
Gerardo Bosco, MD
"Adaptive mechanisms in breath-hold divers"
Peter Lindholm, MD
"Pulmonary pathophysiology in deep breath-hold diving"
Deep breath-hold diving may expose the lungs to the limits of known human physiology. We will discuss barotrauma of descent with pulmonary edema, glossopharyngeal hyperinsufflation and arterial gas embolism.
Alessandro Marroni, MD
"Breaking news on breath-hold diving research"
Recent Data from Field Research on Pathophysiology of Breath Hold Diving, focusing particularly on Breath Hold Diving Induced Pulmonary Edema and Taravana. Epidemiology, Mechanisms, Pathogenetic Hypotheses and data on Genetic predisposing factors will be presented