Fiducial marker placement with electromagnetic navigation bronchoscopy: a subgroup analysis of the prospective, multicenter NAVIGATE study

Fiducial markers (FMs) help direct stereotactic body radiation therapy (SBRT) and localization for surgical resection in lung cancer management. We report the safety, accuracy, and practice patterns of FM placement utilizing electromagnetic navigation bronchoscopy (ENB). Methods: NAVIGATE is a global, prospective, multicenter, observational cohort study of ENB using the superDimension™ navigation system. This prospectively collected subgroup analysis presents the patient demographics, procedural characteristics, and 1-month outcomes in patients undergoing ENB-guided FM placement. Follow up through 24 months is ongoing. Results: Two-hundred fifty-eight patients from 21 centers in the United States were included. General anesthesia was used in 68.2%. Lesion location was confirmed by radial endobronchial ultrasound in 34.5% of procedures. The median ENB procedure time was 31.0 min. Concurrent lung lesion biopsy was conducted in 82.6% (213/258) of patients. A mean of 2.2 ± 1.7 FMs (median 1.0 FMs) were placed per patient and 99.2% were accurately positioned based on subjective operator assessment. Follow-up imaging showed that 94.1% (239/254) of markers remained in place. The procedure-related pneumothorax rate was 5.4% (14/258) overall and 3.1% (8/258) grade ⩾ 2 based on the Common Terminology Criteria for Adverse Events scale. The procedure-related grade ⩾ 4 respiratory failure rate was 1.6% (4/258). There were no bronchopulmonary hemorrhages. Conclusion: ENB is an accurate and versatile tool to place FMs for SBRT and localization for surgical resection with low complication rates. The ability to perform a biopsy safely in the same procedure can also increase efficiency. The impact of practice pattern variations on therapeutic effectiveness requires further study

Massive hemorrhage after inspection bronchoscopy for carcinoid tumor

Carcinoid tumor is a neuroendocrine tumor that can arise in the bronchial tree and can be hypervascular. Here we describe a case of bronchial carcinoid tumor in a 34-year-old previously healthy male who presented with hemoptysis and right lung mass. Inspection bronchoscopy revealed bronchus intermedius endobronchial lesion and was complicated by urgent intubation and placement of endobronchial blocker for massive hemorrhage. Subsequent angiography with embolization of the bronchial artery supplying the mass resulted in control of bleeding. While massive hemorrhage has been described with biopsy of bronchial carcinoid tumor, this case suggests that careful planning for inspection bronchoscopy is needed when carcinoid tumor is suspected. Keywords: Hemoptysis, Carcinoid tumor, Hemorrhag

Der Podcast als Lehr- und Lernmittel. Recht per Stimme

Serie de podcast jurídicos con un fin divulgativo. En los últimos tiempos se ha hecho patente la necesidad de explicar el Derecho de una manera más cercana, imparcial y accesible: el qué y el porqué de algunas las leyes, la función de los jueces, la explicación de ciertas penas, etc… Es necesario explicar el Derecho de manera que todos puedan entenderlo, empezando por nuestras y nuestros estudiantes, aunque no exclusivamente. Hemos optado por el formato podcast porque nos parece una manera actual, accesible e inclusiva de enseñar. Se trata de enseñar Derecho de una manera amena. Hay más proyectos de este tipo (por ejemplo: Café Jurídico: https://cafejuridico.es/; Tertulia jurídica: https://open.spotify.com/show/2B4wGYx5rVulH2BLvQhvOG?si=5f72b8b98ed147ab; Almacén de Derecho: https://almacendederecho.org/podcasts, entre otros), pero todos adolecen –desde nuestro punto vista- del mismo problema: Son demasiado teóricos y el lenguaje es demasiado técnico. Nuestro objetivo es acercar el mundo del derecho al público en general. A todas aquellas personas que son legas en Derecho pero que se interesan por los temas jurídicos de actualidad. Que quieren entender el porqué de lo que pasa, que tiene curiosidad por comprender todo lo que ocurre en el Parlamento o en los Juzgados, qué hace que se imponga una pena u otra, etc. Así, para poder hacer un producto de calidad y accesible a todo el mundo, en nuestro equipo contamos no solo con juristas y profesores de reconocido prestigio, sino también con periodistas, alumnos y alumnas de comunicación (grado y doctorado) y personas de la sociedad civil que actuarán como asesores temáticos. Creemos que es necesario que existan todos estos perfiles (junto con el de técnicos, obviamente) porque a veces desde la Academia perdemos la perspectiva social y es una “pata” esencial si queremos que el resultado de nuestro proyecto tenga realmente un carácter divulgativo. Se plantea una serie de podcasts. Cada podcast tendrá una duración de 20-30 minutos aproximadamente y los temas se programarán según criterios de actualidad, por lo que a priori no podemos determinar los temas de antemano. No queremos que se convierta en un repositorio de lecciones de Derecho en general, sino de píldoras que respondan a necesidades informativas/aclaratorias y divulgativas del momento. De ahí que los temas no pueden ser establecidos desde ahora mismo. No obstante, lo que sí ha quedado ya determinado es que los temas a tratar serán de los ámbitos del Derecho Constitucional, del Derecho penal y del Derecho de las nuevas tecnologías, puesto que desde un punto de vista informativo son los que más interés generan. (Se incluye en apartado Imágenes ejemplo de escaletas.)Universidad Complutense de MadridSección Deptal. de Derecho Constitucional (Ciencias de la Información)Fac. de Ciencias de la InformaciónFALSEsubmitte

Standardized Definitions of Bleeding After Transbronchial Lung Biopsy: A Delphi Consensus Statement From the Nashville Working Group.

BackgroundTransbronchial lung biopsies are commonly performed for a variety of indications. Although generally well tolerated, complications such as bleeding do occur. Description of bleeding severity is crucial both clinically and in research trials; to date, there is no validated scale that is widely accepted for this purpose. Can a simple, reproducible tool for categorizing the severity of bleeding after transbronchial biopsy be created?MethodsUsing the modified Delphi method, an international group of bronchoscopists sought to create a new scale tailored to assess bleeding severity among patients undergoing flexible bronchoscopy with transbronchial lung biopsies. Cessation criteria were specified a priori and included reaching > 80% consensus among the experts or three rounds, whichever occurred first.ResultsThirty-six expert bronchoscopists from eight countries, both in academic and community practice settings, participated in the creation of the scale. After the live meeting, two iterations were made. The second and final scale was vetted by all 36 participants, with a weighted average of 4.47/5; 53% were satisfied, and 47% were very satisfied. The panel reached a consensus and proposes the Nashville Bleeding Scale.ConclusionsThe use of a simplified airway bleeding scale that can be applied at bedside is an important, necessary tool for categorizing the severity of bleeding. Uniformity in reporting clinically significant airway bleeding during bronchoscopic procedures will improve the quality of the information derived and could lead to standardization of management. In addition to transbronchial biopsies, this scale could also be applied to other bronchoscopic procedures, such as endobronchial biopsy or endobronchial ultrasound-guided needle aspiration