ERIC P. KINDWALL, MD MEMORIAL LECTURE
ABOUT THE LECTURE:
Today’s radiotherapy schemes, particularly intensity modulated radiation therapy (IMRT), are often used as primary therapy for head and neck cancers. Used together with chemotherapy it has produced a higher incidence of radiation-induced complications. The wider fields, higher doses, and radio sensitizing chemotherapy has caused a more severe and wider spread of osteoradionecrosis (ORN), now even including the previously rare ORN of the maxilla as well as permanent mucositis, skin necrosis, dysphagia, and even some facial nerve palsies.
The role of HBO2 remains the same adjunct to surgical debridements but requires the full 30/10 HBO2 protocol to be conducted at the proven parameters at 2.4 ATA , 90 minutes on 100% O2 with air breaks and without interruption in the treatment sequence.
After resection or debridement of the necrotic bone, the resultant bony defect can be reconstructed today using tissue engineering in most cases as a single modality or together with a smaller amount of autogenous bone, thereby reducing the morbidity of treatment. Additionally, these bone grafting techniques produce a quality of normal viable bone suitable for dental implants to replace teeth lost in the ORN disease process, aiding the patient’s return to a more normal quality of life.
ABOUT DR. MARX:
Robert E. Marx, DDS, is Professor of Surgery and Chief of the Division of Oral and Maxillofacial Surgery at the University of Miami Miller School of Medicine as well as Chief of Surgery at Jackson South Community Hospital in Miami. He is well known as an educator, researcher, and innovative surgeon. Dr. Marx has pioneered new concepts and treatments for pathologies of the oral and maxillofacial area as well as new techniques in reconstructive surgery, including stem cell therapies.
His many prestigious awards, including the Harry S. Archer Award, the William J. Giles Award, the Paul Bert Award, the Donald B. Osbon Award, and the Daniel Laskin Award, attest to his accomplishments and commitment to the field of oral and maxillofacial surgery.
His textbook “Oral and Maxillofacial Pathology: A Rationale for Diagnosis and Treatment” has won the American Medical Writers Associations Prestigious Book of the Year Award. His other textbooks, “Platelet Rich Plasma: Dental and Craniofacial Applications,” “Tissue Engineering,” “Oral and Intravenous Bisphosphonates Induced Osteonecrosis” and an “Atlas of Bone Harvesting” have been best sellers. He is also a writer of fiction medical mystery novels. His first publication “Deadly Prescription” is currently an Amazon best seller.
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.
CHRISTIAN J. LAMBERTSEN MEMORIAL LECTURE
FRIDAY, JUNE 28: 1:00 pm - 2:00 pm
GUEST SPEAKER: SIMON MITCHELL, MBBS, PHD
LECTURE TITLE: Decompression Sickness As An Inflammatory Disease
ABOUT THE LECTURE:
It has long been considered that decompression sickness (DCS) is a disorder in which bubbles formed from dissolved gas in blood and / or tissue during or after ascent from a compressed-gas dive are the primary vectors of injury. The existence of such bubbles and their potential to cause or contribute to at least some of the manifestations of DCS have been proven. However, uncertainties remain. While the risk of developing symptoms of DCS correlates with numbers of venous bubbles detected using Doppler or echocardiography after diving, the correlation is not as strong as one might expect if bubbles were the only contributor to tissue injury. There are various potential explanations for this, including the possibility that a variably expressed secondary process of inflammation may contribute to the clinical picture. We have known for some time that intravascular bubbles, or the damage they may cause to vascular endothelium, appear to activate formed elements of blood and plasma proteins. Thus, bubbles may directly or indirectly activate platelets, leukocytes, the complement and kinin systems, and coagulation. There is some evidence that these activations contribute to development of some manifestations of DCS. More recently there has been intense interest in the role of proinflammatory intravascular microparticles (circulating fragments of formed elements of blood) in the pathophysiology of DCS. Microparticles may form during diving and increase after any dive, but perhaps moreso in divers exhibiting DCS symptoms. The relationship between bubble and microparticle formation is uncertain. There is some evidence that microparticles may produce harmful effects relevant to the pathophysiology of DCS, and there has been controversial speculation that microparticles may be a primary cause of some DCS manifestations. This presentation will review the pathophysiology of DCS with a particular focus on the potential role of inflammatory processes. Related unanswered questions and uncertainties will be identified.
ABOUT DR. MITCHELL:
Professor Simon Mitchell, MB ChB, PhD, DipAdvDHM, DipOccMed, FUHM, FANZCA.
Professor of Anesthesiology, School of Medicine, University of Auckland
Dr. Mitchell is a physician and scientist with specialist training in diving medicine and anesthesiology. He is widely published, with more than 150 papers or book chapters. He co-authored the 5th edition of “Diving and Subaquatic Medicine” and has two chapters on decompression illness in the most recent edition of Bennett and Elliott. He has twice been Vice President of the Undersea and Hyperbaric Medical Society and in 2010 received the society’s Behnke Award for contributions to the science of diving and hyperbaric medicine. In the past Simon was a naval diving medical officer and medical director of the Wesley Centre for Hyperbaric Medicine in Brisbane. He now works as a consultant anesthesiologist at Auckland City Hospital, and Professor in Anesthesiology at the University of Auckland. He provides on-call cover for diving and hyperbaric emergencies at the North Shore Hospital Hyperbaric Unit in Auckland. Simon is Editor-In-Chief of Diving and Hyperbaric Medicine Journal.
Simon’s diving career has included more than 6,000 dives spanning sport, scientific, commercial, and military diving. He has been a lead member of teams that were the first to dive and identify three deep wrecks of high historical significance in Australia and New Zealand. At the time of one of these dives (2002) the 600-foot depth represented the deepest wreck dive ever undertaken. He was elected to Fellowship of the Explorers Club of New York in 2006, and was the DAN Rolex Diver of the Year in 2015.
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.