Podcasts about mediastinal

CardioNerds Co-Founder Dr. Daniel Ambinder, Episode Chair Dr. Dinu Balanescu, and FIT Lead Dr. Natalie Tapaskar discuss advanced heart failure in CardioOncology with expert Dr. Richard Cheng. Audio editing by CardioNerds Academy Intern, Dr. Akiva Rosenzveig. In this episode, we discuss the spectrum of advanced heart failure in patients with a history of cancer. We dissect cancer therapy-related cardiac dysfunction (CTRCD) cases and the imaging and biomarker tools available for risk stratification and disease monitoring. We delve into the data on the use of guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT) in these patients. We discuss the risk of prior radiation and chemotherapy during cardiac surgery. Finally, we learn about the post-transplant risk of rejection, recurrent malignancy, and de-novo malignancies, as well as treatment strategies we can employ for these patients. This episode is supported by a grant from Pfizer Inc. This CardioNerds Cardio-Oncology series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Giselle Suero Abreu, Dr. Dinu Balanescu, and Dr. Teodora Donisan.  CardioNerds Cardio-Oncology PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Advanced Heart Failure in CardioOncology Use the HFA-ICOS risk tool to understand the baseline risk of developing cancer therapy-related cardiac dysfunction (CTRCD). Key factors are type of cancer therapy, baseline CV risk factors, and age. A relative change in global longitudinal strain of more than 15% from baseline is a marker of early cardiac dysfunction and predicts the subsequent risk for systolic dysfunction in patients undergoing cardiotoxic chemotherapy. Statins may be useful in prevention of cardiovascular dysfunction in patients receiving anthracycline chemotherapy. There is limited data on the 4 pillars of GDMT in prevention of CTRCD, but should be started early once CRTCD is suspected or diagnosed! Mediastinal radiation causes adhesions and scarring which increase the risk of bleeding during cardiac surgery, lead to longer operative times, and can lead to RV failure and poor wound healing. Patients with a pre-transplant history of malignancy have a higher risk of mortality due to post-transplant malignancy. And patients with active cancer should not be considered for heart transplant. Post-transplant malignancy risk can be mitigated by utilizing an mTOR based, CNI free immunosuppression regimen. Show notes - Advanced Heart Failure in CardioOncology How do cardio-oncology and advanced heart failure intersect? There are 3 basic populations of patients to consider:Patients with advanced heart failure who develop cancer.Patients with pre-existing chemotherapy and radiation exposure for cancer treatment who later develop advanced heart failureHeart transplant recipients who, in the long term are at very high risk of developing cancer Cardio-oncologists must consider risk assessment and mitigation, long-term prognosis, and treatment strategies for each of these unique populations. How can we assess the risk of developing cardiovascular disease during cancer treatment (CTRCD)? There are many proposed risk tools. However, the majority are not well-validated. One of the most used tools is the HFA-ICOS risk tool.1You can select the planned cancer therapy for the patient (anthracyclines, HER-2, VEGF, RAF/MEK inhibitors, Kinase inhibitors, multiple myeloma therapies) and then calculate their risk of developing CV disease during cancer treatment based on baseline variables:1) previous history of CV disease,2) biomarkers – troponin and NT-proBNP3)age,4) CV risk factors -HTN, DM,

In today's episode, we are exploring a multitude of respiratory diseases, including Obstructive Lung Disease, Restrictive Lung Disease, Upper Respiratory Infections, Acute Respiratory Distress Syndrome, Pulmonary Embolisms, Mediastinal masses, Bronchospasm, & Tension Hemothorax and how they affect our anesthetic care. We're examining the difference between obstructive and restrictive lung disease and how we should manage our patients accordingly. We'll talk about some of the various reasons that procedures should be rescheduled and the optimal timeframe for such rescheduling. Support the showTo access all of our content, download the CORE Anesthesia App available here on the App Store and here on Google Play. Want to connect? Check out our instagram or email us at info@coreanesthesia.com

Maddy presents a case to Jack, Sharmin, and Ann Marie of a patient who is found to have a mediastinal mass on imaging. Mediastinal Mass Schema   Download CPSolvers App here RLRCPSOLVERS  

11/11/2022 | Mediastinal Masses

In this episode, our team provides a comprehensive review of the differential diagnosis for mediastinal masses, their workup, and biopsy considerations. Listen as we dive deeper into the perioperative planning and operative approach for resection of these masses with special considerations for patients with thymoma.  Learning Objectives: -Discuss the differential diagnosis of a mediastinal mass -Review the workup of a mediastinal mass -Outline indications for biopsy and describe the various approaches -Describe the operative techniques for thymectomy, pearls & potential pitfalls   Hosts:  Megan Lenihan MD, Kelly Daus MD, Peter White MD, and Brian Louie MD Referenced Material https://pubmed.ncbi.nlm.nih.gov/21847052/ Detterbeck FC, Nicholson AG, Kondo K, Van Schil P, Moran C. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011 Jul;6(7 Suppl 3):S1710-6. doi: 10.1097/JTO.0b013e31821e8cff. PMID: 21847052. https://pubmed.ncbi.nlm.nih.gov/33468329/ Ahmad U. The eighth edition TNM stage classification for thymic tumors: What do I need to know? J Thorac Cardiovasc Surg. 2021 Apr;161(4):1524-1529. doi: 10.1016/j.jtcvs.2020.10.131. Epub 2020 Nov 13. PMID: 33468329. https://pubmed.ncbi.nlm.nih.gov/34695605/ Marx A, et al. The 2021 WHO Classification of Tumors of the Thymus and Mediastinum: What Is New in Thymic Epithelial, Germ Cell, and Mesenchymal Tumors? J Thorac Oncol. 2022 Feb;17(2):200-213. doi: 10.1016/j.jtho.2021.10.010. Epub 2021 Oct 22. PMID: 34695605. https://pubmed.ncbi.nlm.nih.gov/22882218/ Meriggioli MN, Sanders DB. Muscle autoantibodies in myasthenia gravis: beyond diagnosis? Expert Rev Clin Immunol. 2012 Jul;8(5):427-38. doi: 10.1586/eci.12.34. PMID: 22882218; PMCID: PMC3505488. https://pubmed.ncbi.nlm.nih.gov/34339670/ Raja SM, Guptill JT, McConnell A, Al-Khalidi HR, Hartwig MG, Klapper JA. Perioperative Outcomes of Thymectomy in Myasthenia Gravis: A Thoracic Surgery Database Analysis. Ann Thorac Surg. 2022 Mar;113(3):904-910. doi: 10.1016/j.athoracsur.2021.06.071. Epub 2021 Jul 30. PMID: 34339670. Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed general surgery procedures. If you are a PGY4/5 general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com, for more information on how you could be compensated up to $400 for recording and submitting those videos. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other clinical challenge episodes here: https://behindtheknife.org/podcast-series/clinical-challenges/

CHEST September 2022, Volume 162, Issue 3 Nicholas P.J. Romatowski, MD, joins CHEST Podcast Moderator, Dominique Pepper MD, to discuss whether a 19-gauge needle offers greater diagnostic yield and sensitivity vs the 21G and 22G EBUS needles for a diagnosis of sarcoidosis, lymphoma, or mediastinal lymphadenopathy not yet diagnosed? DOI: https://doi.org/10.1016/j.chest.2022.03.041

How do we think about treatment of lung cancer? Recap on staging (see Episode 025) * Pro-tip: Highly recommend that you “forget” about the actual staging and focus more on the individual T, N, and M status * Tumor size:**T1a

This podcast presents an approach to mediastinal masses in pediatric patients. The listener will learn the key points in the history, physical exam, and initial investigations, as well as the differential diagnosis. Distinguishing features and management of the most common causes of mediastinal masses in children is also highlighted. This podcast was created by Kieryn Houlder, a fourth year medical student at the University of Alberta, with the help of Dr. Beverly Wilson, a pediatric oncologist at the Stollery Children's Hospital in Edmonton, Alberta.

Join moderators Divya Patel, DO, and Vineesha Arelli, MD, and journal CHEST® authors Marc Fortin, MD, and Pascalin Roy, MD, as they discuss the article, "A Prediction Model to Optimize Invasive Mediastinal Staging Procedures for Non-Small Cell Lung Cancer in Patients With a Radiologically Normal Mediastinum: The Quebec Prediction Model," which was published in the December 2021 issue. DOI: https://doi.org/10.1016/j.chest.2021.05.062

Herkese merhabalar... ''Yılın bu son gününde böyle başlıklı yazı olur mu ?'' diye sorduğunuzu duyar gibiyim. Haklısınız. Yazı sırası bana gelmişken paylaşımım ne olmalı sorusuna yanıt bulmamda, her zamanki gibi nöbetimde karşılaştığım boğaz ağrısı şikayeti ile başvuran bir vaka yardımcı oldu ve ben de bu yazıyı kaleme aldım. İyi okumalar... Mediastinit Nedir? Mediasten, basit anlamda sternumun arkasında, torasik vertebraların önünde olan alan olarak tanımlanabilir. Kalp, büyük damarlar, trakea, özefagus, timus, lenf nodları bu alanda bulunmaktadır. Bu alanda yer alan bağ dokusu veya yapıların inflamasyonu ve/veya enfeksiyonu mediastinit olarak tanımlanmaktadır. Bu yapıların sahip olduğu hayati önemm nedeni ile mediastinit, çoğu vakanın yoğun bakımda yatış ve tedavisini gerektirecek şekilde yüksek morbidite ve mortaliteye sahiptir. Mediastinit, çok sayıda nedenden kaynaklanabilir. Karşımıza çıkan en sık üç neden şu şekilede sıralanabilir (1): Sternotomi sonrası derin sternal yara enfeksiyonu (DSYE)Özefagus perforasyonuOrofarengeal apseye sekonder gelişebilen desandan nekrotizan mediastinit (DNM) Derin Sternal Yara Enfeksiyonu (DSYE) Sternotomi sonrası derin bir yara enfeksiyonuna sekonder olarak mediastenin enfekte olması ile meydana gerlen süreç olarak tanımlanabilir. CDC bu durumu: Ateş mevcudiyetiGöğüs ağrısı veAşağıdaki nedenlerden herhangi birine bağlı sternal instabilite olarak  tanımlamaktadır:Operasyon yara yerinden pürülan akıntı,Görüntüleme çalışmalarında mediastinal genişleme,Mediastinal sıvı veya dokulardan alınan  kültürlerde mikroorganizmaların saptanması,Medisatinal doku örneklerinde  mediastinitin histopatolojik kanıtlarının görülmesi. (2,3) DSYE'nin sınıflandırılması, enfeksiyöz sürecin derinlik ve yayılımını temel alır ve bu sınıflandırma, enfeksiyonun ciddiyeti ile koreledir: Tip I: Sadece deri ve subkütanöz dokuları kapsar.Tip II: Sternum veya kotları sürece dahil eder.Tip III: Sternum veya kaburgalarda kemik kaybı görülmektedir.Tip IV: Mediastenin kendisi etkilenmiştir (4). Yapılan çoklu merkezli kohort  çalışmaları ve meta analizlerde DSYE, kardiyak cerrahi sürecine giden hastaların %0.5 -%2.2'sini etkilerken, %14'lük bir mortalite ile ilişkilidir (5). DSYE için risk faktörleri hasta veya prosedür ile ilişkili olabilir: DSYE Oluşumu için Hasta ile İlişkili Risk Faktörleri İleri yaşObezitePre-operatif kreatinin değerlerinde yükseklikPeriferal avsküler hastalıkDMDiyabetik olmayan hastalarda hiperglisemiStaphylococcus aureus ile operasyon öncesi kolonizasyonKOAHSigara  kullanımıKalp yetmezliği veKadın cinsiyet. Bir acil tıp uzmanı gözü ile belirtmekte fayda görüyorum ki, erken perkütanöz trakeostomi daha yüksek risk oluşturmak ile birlikte derin sternal yara enfeksiyonları için trakostomi de bir risk faktörü olarak değerlendirilmektedir (6,7). Özefageal Perforasyon Özefageal kolonizasyon, özefageal duvar bütünlüğünde meydana gelen bir bozukluk sonrası mediastinit ile sonuçlanabilir. Bu duruma: Özefageal doku bozuklukları,Endoskopi ve endoskopi sırasında uygulanan pnomotik dilatasyonlar, sitriktürr dilatasyonları gibi tanısal prosedürler,Travmatik perforasyonlar,Malign perforasyonlar,Cerrahi anastomoz başarısızlığı,Boerhaave's sendromu gibi spontan rüptürler neden olabilir. Özefageal perforasyonlar nadir görülür ancak mortaliteleri %20'ye varabilir. Vakaların %20'ye yakını sadece otopside tanı almaktadır (8). Desendan Nekrotizan Mediastinit (DNM) Kulaklardan, burundan, boğazdan kaynak alan ve konnektif doku düzlemleri aracılığı ile aşağı doğru mediastene yayılım gösteren ciddi bir enfeksiyon olarak tanımlanabilir. Ciddi bir orofarengeal enfeksiyona eşlik eden, mediastiniti düşündüren radyolojik bulguların eşlik etmesi olarak ifade edilebilir. Sınıflandırılması Tip I: LokalizeTip IIa: Diffüz, alt anterior mediastinuma uzanım gösterir.Tip IIb: Diffüz, hem anterior hem de posterior alt mediastinuma uzanım gösterir. DNM,

This podcast will discuss data from a phase II trial evaluating the dose-adjusted EOPCH-R chemo-immunotherapy regimen for the treatment of primary mediastinal B-cell lymphoma in children.   TRANSCRIPT [MUSIC PLAYING] LISA GIULINO-ROTH: This JCO podcast provides observations and commentary on the JCO article "Dose-Adjusted Rituximab Therapy in Children and Adolescents with Primary Mediastinal B-cell Lymphoma, a Multicenter Phase II Trial" by Burke et al. My name is Lisa Giulino-Roth, and I am a pediatric oncologist at Weill Cornell Medical College in New York. My oncology specialty is lymphoma in children, adolescents, and young adults. I have no relevant disclosures. Primary mediastinal B-cell lymphoma, or PMBCL, is an aggressive non-Hodgkin lymphoma derived from thymic B-cells. While previously classified as a subtype of diffuse large B-cell lymphoma, PMBCL is now recognized as a distinct clinical and pathologic entity. Unlike diffuse large B-cell lymphoma, PMBCL has a peak incidence among adolescents and young adults and is more common in females. PMBCL also shares many molecular characteristics with Hodgkin lymphoma, including alterations in JAK-STAT pathway signaling and amplification of the 9p24.1 locus, leading to upregulation of PD-L1. Adults with PMBCL have historically been treated on regimens designed for diffuse large B-cell lymphoma, which in the US was most commonly R-CHOP and radiation therapy. More recently, adult patients have been treated with a dose-adjusted EPOCH-R regimen, which is composed of dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab. This radiation-free approach is of interest, given this young and predominantly female population who are at risk for significant long-term toxicity from chest radiation. In a single center NCI-led study by Dunleavy and colleagues, dose-adjusted EPOCH-R was administered for six to eight cycles without radiation therapy and resulted in excellent outcomes with a five-year event free survival of 93% and overall survival of 97% among 51 adult patients. Pediatric patients with PMBCL have historically been treated on regimens designed for mature B non-Hodgkin lymphoma, which in pediatrics is most commonly Burkitt lymphoma or diffuse large B-cell lymphoma. These dose intensive multi-agent regimens include doxorubicin, high dose methotrexate, and intrathecal chemotherapy without radiation. Outcomes for children with PMBCL treated on these regimens are inferior to pediatric patients with diffuse large B-cell lymphoma treated on the same protocol. Children with PMBCL have a five-year event-free survival ranging from 65% to 75% in different international series. Given the excellent outcomes observed with dose-adjusted EPOCH-R in the adult NCI trial, an international phase II trial of this approach was conducted by two cooperative groups, The European Intergroup for Childhood Non-Hodgkin Lymphoma and the Children's Oncology Group. This single arm trial enrolled patients age 18 and under with primary mediastinal B-cell lymphoma. All patients were treated with six cycles of dose-adjusted EPOCH-R without radiation. The primary endpoint was event-free survival with events defined as any of the following-- viable cells in any residual mass after six cycles of treatment, relapse, progressive disease, secondary malignancy, or death from any cause. The four-year event-free survival from this trial would be compared with the event-free survival from historic controls, which was estimated at 67%. A total of 46 pediatric patients were enrolled between 2012 and 2016. All patients received six cycles of dose-adjusted EPOCH-R without RT. At a median follow-up of 59 months, there were 14 events, including four patients with viable cells in the residual mass at the completion of therapy, eight progressions or relapses, and two secondary malignancies, including one case of Hodgkin lymphoma and one case of acute promyelocytic leukemia. The event-free survival of the entire cohort at four years was disappointing at 69.6% with a 95% confidence interval of 55.2% to 80.9%. This was not statistically different than historic controls treated on pediatric mature B and HL regimens. Overall survival at four years was 84.8% with a 95% confidence interval of 71.8% to 92.4%. The authors acknowledge several limitations in the current study and challenges when comparing this study to the NCI trial. Not all patients adhered to the dose escalation rules, and 29% should have received a higher dose level in at least one course of treatment. Among the 10 cases of local relapse or primary refractory disease, five were noted to have a failure to dose escalate, including one patient with a clinical complication that precluded dose escalation. Comparing this trial to the NCI trial is challenging due to several important differences. Adults in the NCI trial were treated with six or eight cycles of dose-adjusted EPOCH-R based on the response between cycles 4 and 6. In pediatrics, eight cycles was not deemed appropriate, given the potential for greater than 600 milligrams per meter squared of cumulative doxorubicin exposure and concern for significant long-term cardiac toxicity at this exposure level. In addition, the NCI trial did not consider residual viable cells or secondary malignancy as an event, both of which were defined as events in the current pediatric trial. In a reanalysis of the pediatric data using the NCI event definitions, there was only a modest change in event-free survival with a four-year event-free survival of 73.9%. So where does this leave dose-adjusted EPOCH-R and the management of pediatric patients with PMBCL? In my opinion, there's no single superior regimen to treat pediatric PMBCL. Outcomes are similar across regimens. However, the toxicities are different. Dose-adjusted EPOCH-R offers significantly less short-term toxicity, but the potential for a higher cumulative doxorubicin dose compared to pediatric mature B and HL regimens. Regardless of the chemotherapy backbone, it is clear that for children with PMBCL, outcomes remain suboptimal, and further studies are needed to advance treatment. Given the rare nature of PMBCL and the peak incidence in the AYA population, combined pediatric and adult trials may allow us to evaluate novel agents and advance outcomes. Both children and adults with PMBCL may benefit from the incorporation of novel agents. Retrospective multicenter data from adults treated with dose-adjusted EPOCH-R have also failed to reproduce the excellent outcomes observed in the NCI trial. In two large retrospective series, adults with PMBCL treated with dose-adjusted EPOCH-R had a two- and three-year progression-free survival of 85% and 87% respectively. To advance outcomes in PMBCL across age groups, our team at the Children's Oncology Group in collaboration with Alliance and the National Clinical Trials Network is conducting a randomized phase III trial of the checkpoint inhibitor nivolumab in combination with chemo immunotherapy for adult and pediatric patients with PMBCL. Checkpoint inhibitors, including pembrolizumab and nivolumab, have demonstrated efficacy and PMBCL in the relapsed setting. And pembrolizumab is FDA approved for children and adults with relapsed PMBCL after two or more lines of therapy. However, these agents have not been evaluated in the upfront setting. In this trial, the treating physician will choose between R-CHOP and dose-adjusted EPOCH-R as the chemotherapy backbone. And patients will then be randomized to standard of care with six cycles of chemo immunotherapy alone or six cycles of nivolumab plus chemo immunotherapy. We are optimistic that this will define the role for checkpoint inhibition in the upfront management of PMBCL and work towards improved outcomes for both adult and pediatric patients. This concludes this JCO podcast. Thank you for listening. [MUSIC PLAYING] SPEAKER: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. For more original research, editorials, and review articles, please visit us online at jco.org. This production is copyrighted to the American Society of Clinical Oncology. Thank you for listening.

This episode you meet Rachel from Vancouver Island, BC.  She is currently going through her cancer journey as we speak and will actually be having a scan in October shortly after this episode will air.  Rachel shares her Cancer Story with Stage II primary mediastinal b-cell lymphoma (Non-Hodgkins Lymphoma).  She speaks about how she was diagnosed, cancer treatment during a pandemic and being a patient instead of being a nurse.  Rachel also shares the struggles of sharing her diagnosis with friends and family as well as the decision to not tell her children right away.  We talk more about 3 major turning points in her life as well as the grieving process and the kindness of others.  To learn more about Rachel and Blood Cancer Awareness month and her Blog, please visit the link below: blog: Reflections of PMBCL IG. @reflectionsofPMBCL https://www.lls.org/article/september-blood-cancer-awareness-month https://www.llscanada.org/news/marking-blood-cancer-awareness-month --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/mycancerstorypodcast/support

Welcome to Pediatric Anesthesia's 'Featured Article of the Month' podcast. In this podcast, we discuss the article 'Pediatric mediastinal mass algorithm: A quality improvement initiative to reduce time from presentation to biopsy', published in the August 2021 issue of Pediatric Anesthesia. We hope you enjoy.

Review of middle and posterior mediastinal masses for radiology board exams.  Download the free study guide on this episode at www.theradiologyreview.com. 

Expanded upon the 4 T's of the anterior mediastinum.

Middle and posterior mediastinal masses (one is found in both!)

Review of anterior mediastinal masses for radiology board review. Download the free study guide on this topic at www.theradiologyreview.com. 

Thanks again James! You did a great job tackling this rare and high risk case - the anterior mediastinal mass.Please check out these great articlesManagement of the patient with a large anterior mediastinal mass: recurring myths. Peter Slinger and Cengiz Karsli, Current Opinion in Anesthesiology 2007, 20:1–3 and Anesthetic management of patients with an anterior mediastinal mass: Continuing Professional Development Can J Anesth/J Can Anesth (2011) 58:853–867Please rate, post a review and subscribe! Disclaimer: The information contained in this podcast is for medical practitioner education only. It is not and will not be relevant for the general public. This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such. The medical information is provided “as is” without any representations or warranties, express or implied. The presenter makes no representations or warranties in relation to the medical information on this episode.  You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant. You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode. The information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia. The information presented here does not represent the views of any hospital or ANZCA.

Today's episode is dedicated to the acute management of anterior mediastinal mass in the PICU. Join us as we discuss the patient case, symptoms, and treatment. We are delighted to be joined by Dr. Lisa Lima and Dr. Tom Austin.  Dr. Tom Austin is the Director of General Pediatric Anesthesiology at Children's Healthcare of Atlanta-Egleston. He is also an Associate Professor of Anesthesiology and Pediatrics at Emory University School of Medicine. Dr. Lisa Lima is a Fourth Year Advanced Technology Fellow in the Division of Critical Care at Children's Healthcare of Atlanta. She's also the Senior Associate in the Department of Pediatrics at Emory University School of Medicine. She's one of the only pediatric-trained ECMO Fellows in the country.  Show Highlights: Our case, symptoms, and diagnosis: A 17-year-old female has facial swelling and shortness of breath. She recently went to her primary care physician and received a steroid burst and Benadryl for the facial swelling. On the day of admission, her mother noticed that the patient had a deep voice and a “funny” inspiratory sound. The patient presented to the ER and was noted to have a widened mediastinum on a chest x-ray, bringing up concern for an anterior mediastinal mass. Key presentation features for mediastinal masses What defines a widened mediastinum? Important differentials to consider with mediastinal masses: Take the patient's history and presentation into context, like if there was a high-impact motor vehicle collision, history of congestive heart failure, lupus, transplant, leukemia, or lymphoma Pay attention to the Four T's: thymoma, teratoma, ATLL(lymphoma), and thyroid masses Key principles that might put pediatric patients with mediastinal masses at risk for anesthetic agents Important pathophysiologic issues for patients with mediastinal mass include compressed trachea, blocked access to lungs, and right ventricular failure; these effects can be magnified under general anesthesia Why we need to have great appreciation of the risk of cardiovascular collapse in patients in a tenuous physiological state General management strategies for those patients who are unable to lie flat or may not tolerate a diagnostic scan: patient history, personal physical exam, determining a rescue position Key considerations for the patient in the PICU: Keep the patient spontaneously breathing Have adequate access with large-bore IVs in sites with no anatomic compression Have a rescue position Have a backup plan for rapid deterioration Communicate with others on the patient care team Why the Chamberlain procedure is used to obtain a tissue biopsy when there isn't another primary biopsy site Key anesthesia principles for patients needing intrathoracic biopsies: Have clear role assignments in the multidisciplinary team approach Keep the patient spontaneously breathing Manage the patient's pain Employ liberal use of local anesthetics Avoid intubation if possible If necessary, use fiber optic intubation Keep large-bore IVs in extremities Why it's important to stress interdisciplinary involvement early in management Key factors to consider in patients headed to the OR about airway compression and vascular compression Takeaway clinical pearls regarding anterior mediastinal masses: Remember the Four T's The pathophysiology of local compression Emphasize a streamlined multidisciplinary approach with important considerations for contingency planning

Direto ao Ponto SBPT - Temas em evidência na área respiratória para atualização dos profissionais de saúde. Veja nesta edição: entrevista com a Dra. Viviane Figueiredo, Médica broncoscopista do InCor-HCFMUSP, do ICESP/Faculdade de Medicina da Universidade de São Paulo e do Hospital Sírio Libanês de São Paulo, Doutora em Pneumologia pela Faculdade de Medicina da Universidade de São Paulo e Master Bronchoscopy Instructor pela World Association for Bronchology and Interventional Pulmonology

Student Yasmin Valji discusses Mediastinal Masses. After listening to this episode, learners will be able to: -Describe the anatomy of the mediastinum -List the differential differential diagnosis of mediastinal masses -Describe the clinical presentation of an anterior mediastinal mass -Develop an approach to work up and treatment of mediastinal masses

Commentary by Drs. Julia Grapsa, Christopher Allen, Tiffany Patterson, and Simon Redwood

Thoracic - Mediastinal Staging (Mujtaba Mubashir & Monisha Sudarshan)). by TSRA

Episode 12: Got the Hiccups! The sun rises over the San Joaquin Valley, California, today is May 15, 2020. It’s 85 degrees today, Bakersfield is finally warming up! Some people are excited, but some may not be so thrilled, because Bakersfield’s heat in mid-summer is no joke. Would COVID 19 fade out with these warmer temperatures? We don’t know, but that’s our hope. Our program director, Carol Stewart, had a double celebration last week because of her birthday on “Cinco de Mayo” (which is May 5th), and also as a mother of three children, three dogs and hundreds of “adopted” children residents and medical students. Happy Birthday, Dr Stewart, thanks for your example of dedication, wisdom, and good sense humor; and Happy Mother’s Day to all our mother listeners. ______________________ Welcome to Rio Bravo qWeek, the podcast of the Rio Bravo Family Medicine Residency Program, recorded weekly from Bakersfield, California, the land where growing is happening everywhere. The Rio Bravo Family Medicine Residency Program trains residents and students to prevent illnesses and bring health and hope to our community. Our mission: To Seek, Teach and Serve. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care to patients throughout Kern and Fresno counties since 1971. “When one teaches, two learn” —Robert Heinlein Teaching is the best way to know that you know something. Dear residents, what knowledge is the most important for you? Go and learn those things good enough to be able to teach them. Remember, when one teaches, two learn. Today we are here to learn from Dr Yunior Martinez. He is on the last weeks of his training, and I’m happy for having him here today, in front of our microphones. Dr Martinez is one of our chief residents, welcome, Dr Martinez. 1. Question number 1: Who are you? My name is Yunior Martinez Duenas, PGY-3 at Rio Bravo Family Medicine Residency Program also one of the chief resident for the past 2 years. I am from Cuba, came to America in 2012 after working 5 years as a family physician in Venezuela. I am married, and a father of 2 teens and a dog. 2. Question number 2: What did you learn this week? I was in the hospital for the last 4 weeks, an interesting case arrived at our ER. He was a 45 year old Male complaining of HICCUPS for 3 days. The patient was being discharge after improvement of his symptoms, treated with Reglan®, however, his vital signs were significant for tachycardia, and fever as the patient was heading out the door. So, labs were performed including a swab for COVID-19. The patient was admitted because his oxygen saturation was also going down to the low 90s. Next day the COVID-19 test came back as POSITIVE. After 10 days in our service and appropriate treatment, which included azithromycin, hydroxychloroquine and finally convalescent plasma, patient was discharged fully recovered. The take home message: Hiccups is usually benign and self-limited, but it may be persistent and a sign of serious underlying illness. Hiccups affect almost everyone during their lifetime. Also known as a “hiccough”, from the Latin singult, meaning gasp or SOB. While brief hiccups episodes lasting less than 48 hours are common, little is known about the overall incidence and prevalence of prolonged hiccups in the general population. However, among patients with advanced cancer, 1 to 9 percent had persistent or intractable hiccups. Also, hiccups has a higher prevalence in people who are taller and male, mostly elders. No racial, geographic or socioeconomic variation in hiccups has been documented. Definition of hiccups A hiccup occurs due to an involuntary, intermittent, spasmodic contraction of the diaphragm and intercostal muscles causing a sudden inspiration that ends with abrupt closure of the glottis, generating the “hic” sound. Transient vs Persistent Hiccups The pathogenesis of hiccups lasting more than 48 hours is uncertain. Transient hiccups (usually due to gastric distention) is cause by excessive laughter or tickling, aerophagia, tobacco abuse, overindulgence in food or alcohol, GERD, change in gastric temperature due to movement into hot or cold environment, and ingestion of hot or cold foods. Recurrent or persistent hiccups lasting over 48 hours are caused by: 1. Reflex stimulation due to alcohol abuse, anxiety disorder. 2. Neurological disorders such as encephalitis, meningitis, vertebrobasilar ischemia, intracranial hemorrhage, intracranial tumor, uremia, dementia, cardiac pacemaker stimulating diaphragm. 3. Mediastinal disorders: aortic dissection, phrenic nerve trauma, TB, malignant neoplasm, pulmonary fibrosis, sarcoidosis, adherent pericardium, MI, pneumonia with pleural irritation (our patient hiccups’ etiology). 4. Abdominal disorders: diaphragmatic hernia, GERD, subphrenic abscess and peritonitis, liver disease, pancreatitis, post OP, splenic infarct. 5. Medications: steroids, benzodiazepines, chemotherapy, dopamine agonists 6. Related to tympanic membrane foreign body, anesthesia, also psychogenic and idiopathic. Workup In order to rule out any serious etiology, you should order a serum creatinine, liver chemistry test, CXR, CT or MRI of the head, Chest and abdomen, Echocardiography and upper endoscopy. Tailor your work up after examining Treatment 1. For transient hiccups, folk remedies include: breath holding, tongue traction, breathing into a paper bag, suddenly frightened, gargling ice water, drinking water for a side glass and occlude ears; Stimulate pharyngeal mucosa, swallow a teaspoon of vinegar, pickle juice or dry granulated sugar; Stimulate Gag reflex with tongue depressor (avoid it if recent food intake due to aspiration risk). 2. For intractable hiccups: • First line are central agents: o Chlorpromazine which is the best studied of all agents used for hiccups. Monitor for hypotension, QT prolongation. o Gabapentin or baclofen for up to 7-10 days o Other Agents: Diphenylhydantoin, Haldol, Orphenadrine, Ketamine • Peripheral agents: Reglan is the most effective. Other agents include quinidine, atropine, amphetamine, and amyl nitrate. 3. Question number 3: Why is that knowledge important for you and your patients? Hiccups can decrease quality of life by interrupting eating, drinking, sleeping, and conversation; exacerbate pain; cause insomnia, fatigue, and mental stress; or adversely affect mood. When prolonged, hiccups can have serious adverse health impacts including malnutrition, weight loss, and dehydration. Hiccups may have other sequelae; for example, a case report described a patient with pharyngitis who developed hiccups and bouts of convulsive syncope. 4. Question number 4: How did you get that knowledge? I learned it from my patients. Every patient is a learning opportunity and I take the time everyday to review an interesting topic, usually related to my patients. I also learn from our faculty, after discussion of every case in the clinic or the hospital. 5. Question number 5: Where did that knowledge come from? The sources I use are: Up to date, FP notebook, Quick medical Diagnosis and Treatment. See details in our website. ________________________ Speaking Medical (Medical word of the Week): EXOSTOSIS by Dr Golriz Asefi Exostosis refers to benign bone growth on top of normal bone. Another name for exostosis is bone spur. Depending on the location and shape of the exostosis, it may cause chronic pain ranging from mild to severe, and even disabling. When needed, treatment of exostosis is surgical. This week I saw a patient with buccal exostosis or tori. Buccal exostosis needs to be monitored by a dentist annually and treated if it causes pain, inflammation or for cosmetic reasons. Another location for exostosis is the external auditory canal, which commonly occurs in individuals who are repeatedly exposed to cold water. Exostosis may need surgical removal if it occludes the EAC and interferes with hearing. ________________________ Espanish Por Favor (Spanish Word of the Week): DOLOR by Dr Anuradha Rao Hi, guys, this is Dr Rao with our section Espanish Por Favor. Today we are going to talk about the word Dolor. Knowing this word can be very useful in performing your history and physical exam. Dolor means pain or ache in Spanish. This the most common complaint among Spanish-speaking patients. Dolor is easy to use because you can add an anatomical location to the phrase “Dolor de” and find out where the pain is. For example: Dolor de cabeza is headache, Dolor de cuerpo is body ache, Dolor de estómago is stomachache, and so on. Now you know the Spanish word of the week, dolor, see you next week! ______________________ For your Sanity This week, we just want you to breath. Inhale and exhale slowly for one minute. Repeat this exercise as frequently as you want. [Ocean waves] ______________________ Now we conclude our episode 12, “Got the Hiccups!”, remember that hiccups should last no longer than 48 hours. If hiccups are persistent or recurrent, think about other conditions such as neurologic disorder, intraabdominal problems and infections… including the feared COVID-19. If there is a Spanish word you need to know, it is dolor, which means pain. Just add a body part to “dolor de” and voilà, you are set to start your H&P. This week we didn’t have a joke for you, but breathing exercises are also good for your sanity. See you next week. This is the end of Rio Bravo qWeek. We say good bye from Bakersfield, a special place in the beautiful Central Valley of California, United States, a land where growing is happening everywhere. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. Our podcast team for this week was Hector Arreaza, Yunior Martinez, Anuradha Rao, and Golriz Asefi, Audio edition: Suraj Amrutia. See you soon! References 1) Hiccups, Anthony J Lembo, MDD, UpToDate, https://www.uptodate.com/contents/hiccups?search=hiccups%20treatment§ionRank=1&usage_type=default&anchor=H12&source=machineLearning&selectedTitle=1~150&display_rank=1#H12, accessed May 11, 2020. 2) Hiccups, Quick Medical Diagnosis & Treatment App, McGraw Hill Education. 3) Hiccup, Family Practice Notebook, https://fpnotebook.com/GI/Sx/Hcp.htm, accessed on May 10, 2020. 4) Medical Student Conducts History & Physical with Spanish-Speaking Patient Using Only the Word ‘Dolor’, by Dr Pablo Pistola, January 2016, https://gomerblog.com/2016/01/spanish-speaking-patient/

Show Notes Differentiating bronchiolitis from asthma and reactive airway disease in young children can be challenging, and a rapidly changing clinical presentation can confound accurate assessment of the severity of the illness. This episode reviews risk factors for apnea and severe bronchiolitis; discusses treatments/therapies and provides evidence-based recommendations for the management of pediatric patients with bronchiolitis. Show More v Pathophysiology Bronchiolar narrowing and obstruction is caused by: Increased mucus secretion Cell death and sloughing Peri-bronchiolar lymphocytic infiltrate Submucosal edema Smooth muscle constriction seems to have a limited role, perhaps explaining the lack of response to bronchodilators. Median duration of illness is 12 days in children 2 yo.3 Late fall epidemic peaking Nov-March, in the US.4 Human Metapneumovirus (HMPV) accounts for 3-19% 5,6 Similar seasonal variation to RSV. Parainfluenza, influenza, adenoviruses, coronaviruses, rhinoviruses, and enteroviruses are other causes.4-6 Rhinoviruses have been shown to play a larger role in Asthma.7 Presentation The American Academy of Pediatrics defines it as any of the following in infants: 1 Rhinitis Tachypnea Wheezing Cough Crackles Use of accessory muscles Nasal flaring Differential Diagnosis Emergent Causes Infection: pneumonia, chlamydia, pertussis Foreign body: aspirated or esophageal Cardiac anomaly: congestive heart failure, vascular ring Allergic reaction Bronchopulmonary dysplasia exacerbation Non-acute Causes Congenital anomaly: tracheoesophageal fistula, bronchogenic cyst, laryngotracheomalacia Gastroesophageal reflux disease Mediastinal mass Cystic fibrosis Clinical Pearls Vomiting, wheezing, and coughing associated with feeding; consider GERD. Wheezing associated with position changes; consider tracheomalacia or great vessel anomalies. Wheezing exacerbated by flexion of neck and relieved by neck hyperextension; consider vascular ring. Multiple respiratory tract infections and failure to thrive; consider cystic fibrosis or immunodeficiency. Wheezing with heart murmur, cardiomegaly, cyanosis, exertion or sweating with feeding; consider cardiac disease. Sudden onset of wheezing and choking; consider foreign body. Risk Factors for Severe Bronchiolitis Age < 6-12 weeks11-13 Prematurity < 35-37 weeks’ gestation11-13 Underlying respiratory illness such as bronchopulmonary dysplasia1 Significant congenital heart disease; immune deficiency including HIV, organ or bone marrow transplants, or congenital immune deficiencies14,15 Altered mental status (impending respiratory failure) Dehydration due to inability to tolerate oral fluids Ill appearance12 Oxygen saturation level ≤ 90%1 Respiratory rate: > 70 breaths/min or higher than normal rate for patient age1,12 Increased work of breathing: moderate to severe retractions and/or accessory muscle use1 Nasal flaring Grunting Risk Factors for Apnea Full-term birth and < 1 month of age16,17 Preterm birth (< 37 weeks’ gestation) and age < 2 months post birth11-13,17 History of apnea of prematurity Emergency department presentation with apnea17 Apnea witnessed by a caregiver17 Diagnostic Testing Xray Radiographs increase the likely hood of a physician giving antibiotics, even if the X-ray is negative.18-20 Routine radiography is discouraged, but may be helpful when severe disease requires further evaluation or exclusion of foreign body. Viral testing is not necessary for the diagnosis but may help when searching for the cause of fever in young infants. 2016 ACEP fever guidelines note that positive viral testing can impact further workup of fever for a serious bacterial infection (SBI).21 In infants 90% Clinicians may choose not to use continuous pulse oximetry (weak recommendation due to low-level evidence and reasoning)1 Fluids IV or NG administration of fluids to combat dehydration, until respiratory distress and tachypnea resolve. Suctioning Routine use of “deep” suctioning may not be beneficial and may be harmful.1 Nasal suction should be used to help infants with respiratory distress, poor feeding or sleeping. Bronchodilators1,25,26 Generally nor recommended for routine use. May trial in infants with: Severe bronchiolitis (these were excluded in the studies). History of prior wheezing. Family history of atopy/asthma in an older infant. Anticholinergic Agents (ipratropium bromide) No evidence for improvement in bronchiolitis.31-34 Corticosteroids AAP1, Cochrane Review27, and PECARN28 study all recommend against, finding no evidence for improvement. One small study (70 patients) found a benefit utilising 1 mg/kg oral dexamethasone followed by 0.6 mg/kg daily for 5 days. However, the study limited by size and increased prevalence of family history of atopy. Recommendations remain against use in first time wheezers with bronchiolitis. Racemic Epinephrine Not recommended1. Further study needed. Racemic Epinephrine + Oral Dexamethasone Pediatric Emergency Research Canada trial at 8 Canadian pediatric EDs involving 800 infants aged 6 weeks to 12 months with bronchiolitis found that the epinephrine-dexamethasone group had a lower admission rate over 7 days than the placebo group (17.1% vs 26.4%). This was not statistically significant. Further study needed. 30 Hypertonic Saline AAP guidelines do not recommend use in the ED but note clinicians may utilize it in the inpatient setting. 1 Cochrane reviews in 2013 and 2017 found some inpatient benefit, but a conflicting publication found it may worsen cough.35-37 High Flow Nasal Cannula (HFNC) Several small pediatric ICU studies show a benefit in severe cases. No large ED randomized trials exist, to date. Study protocols included weight based or age based flow rates. Nasal CPAP Shows benefit in pediatric ICU settings. Evidence vs HFNC is limited. Disposition Consider admission if any of the following are present: Risk for apnea Risk for severe bronchiolitis Respiratory distress, particularly if it interferes with feeding Hypoxia (oxygen saturation ≤ 90%) Decreased feeding and/or dehydration An unreliable caregiver (ie, unable to ensure patient care and appropriate 24-hour follow-up) All patients with severe bronchiolitis should be admitted.

Show Notes Differentiating bronchiolitis from asthma and reactive airway disease in young children can be challenging, and a rapidly changing clinical presentation can confound accurate assessment of the severity of the illness. This episode reviews risk factors for apnea and severe bronchiolitis; discusses treatments/therapies and provides evidence-based recommendations for the management of pediatric patients with bronchiolitis. Show More v Pathophysiology Bronchiolar narrowing and obstruction is caused by: Increased mucus secretion Cell death and sloughing Peri-bronchiolar lymphocytic infiltrate Submucosal edema Smooth muscle constriction seems to have a limited role, perhaps explaining the lack of response to bronchodilators. Median duration of illness is 12 days in children 2 yo.3 Late fall epidemic peaking Nov-March, in the US.4 Human Metapneumovirus (HMPV) accounts for 3-19% 5,6 Similar seasonal variation to RSV. Parainfluenza, influenza, adenoviruses, coronaviruses, rhinoviruses, and enteroviruses are other causes.4-6 Rhinoviruses have been shown to play a larger role in Asthma.7 Presentation The American Academy of Pediatrics defines it as any of the following in infants: 1 Rhinitis Tachypnea Wheezing Cough Crackles Use of accessory muscles Nasal flaring Differential Diagnosis Emergent Causes Infection: pneumonia, chlamydia, pertussis Foreign body: aspirated or esophageal Cardiac anomaly: congestive heart failure, vascular ring Allergic reaction Bronchopulmonary dysplasia exacerbation Non-acute Causes Congenital anomaly: tracheoesophageal fistula, bronchogenic cyst, laryngotracheomalacia Gastroesophageal reflux disease Mediastinal mass Cystic fibrosis Clinical Pearls Vomiting, wheezing, and coughing associated with feeding; consider GERD. Wheezing associated with position changes; consider tracheomalacia or great vessel anomalies. Wheezing exacerbated by flexion of neck and relieved by neck hyperextension; consider vascular ring. Multiple respiratory tract infections and failure to thrive; consider cystic fibrosis or immunodeficiency. Wheezing with heart murmur, cardiomegaly, cyanosis, exertion or sweating with feeding; consider cardiac disease. Sudden onset of wheezing and choking; consider foreign body. Risk Factors for Severe Bronchiolitis Age < 6-12 weeks11-13 Prematurity < 35-37 weeks' gestation11-13 Underlying respiratory illness such as bronchopulmonary dysplasia1 Significant congenital heart disease; immune deficiency including HIV, organ or bone marrow transplants, or congenital immune deficiencies14,15 Altered mental status (impending respiratory failure) Dehydration due to inability to tolerate oral fluids Ill appearance12 Oxygen saturation level ≤ 90%1 Respiratory rate: > 70 breaths/min or higher than normal rate for patient age1,12 Increased work of breathing: moderate to severe retractions and/or accessory muscle use1 Nasal flaring Grunting Risk Factors for Apnea Full-term birth and < 1 month of age16,17 Preterm birth (< 37 weeks' gestation) and age < 2 months post birth11-13,17 History of apnea of prematurity Emergency department presentation with apnea17 Apnea witnessed by a caregiver17 Diagnostic Testing Xray Radiographs increase the likely hood of a physician giving antibiotics, even if the X-ray is negative.18-20 Routine radiography is discouraged, but may be helpful when severe disease requires further evaluation or exclusion of foreign body. Viral testing is not necessary for the diagnosis but may help when searching for the cause of fever in young infants. 2016 ACEP fever guidelines note that positive viral testing can impact further workup ...

Dr. Venu Menon, Director of the Cardiovascular Fellowship Program and Section Head, Clinical Cardiology talks with Eoin Donnellen MD, a third year cardiovascular fellow about the impact of radiation induced aortic stenosis on treatment. Dr. Donnellen first describes a paper looking at Aortic Valve Replacement in patients who had had mediastinal radiation vs. those who did not have radiation . His second study looked at outcomes of TAVR in patients with mediastinal radiation associated aortic stenosis. Drs. Menon and Donnellen discuss the findings of both studies and the clinical implications

TSRA Podcast: Thoracic - Anterior Mediastinal Tumors (Panos Vardas & Ken Kesler) by TSRA

Dr. David Harpole, Duke University Medical Center, defines the concept of mediastinal node sterilization and its use after neoadjuvant therapy.

Dr. David Harpole, Duke University Medical Center, defines the concept of mediastinal node sterilization and its use after neoadjuvant therapy.

Dr. David Harpole, Duke University Medical Center, defines the concept of mediastinal node sterilization and its use after neoadjuvant therapy.

Dr. Mark Socinski, University of Pittsburgh Medical Center, describes the primary treatment options for stage IIIA NSCLC, including chemoradiation and surgery, and discusses trial evidence for each approach.

Dr. Mark Socinski, University of Pittsburgh Medical Center, describes the primary treatment options for stage IIIA NSCLC, including chemoradiation and surgery, and discusses trial evidence for each approach.

Dr. Mark Socinski, University of Pittsburgh Medical Center, describes the primary treatment options for stage IIIA NSCLC, including chemoradiation and surgery, and discusses trial evidence for each approach.

Dr. Mark Socinski, University of Pittsburgh Medical Center, describes the different types of stage III (locally advanced) NSCLC, and states which of these types tend to be resectable.

Dr. Mark Socinski, University of Pittsburgh Medical Center, describes the different types of stage III (locally advanced) NSCLC, and states which of these types tend to be resectable.

Dr. Mark Socinski, University of Pittsburgh Medical Center, describes the different types of stage III (locally advanced) NSCLC, and states which of these types tend to be resectable.

 In this episode, Thoracic Surgeon Dr. Simon Turner discusses Mediastinal Masses. Imagine that you’ve ordered a chest x-ray on a patient of yours with shortness of breath. When you look at the x-ray the lungs look normal, but you notice to your surprise that the mediastinum looks quite abnormal. You speak with a radiologist who confirms your suspicions that your patient has a widened mediastinum and a probable mediastinal mass. What is the differential diagnosis of this x-ray finding and what should be done about it? Because mediastinal masses are not infrequently found incidentally on chest x-rays, every physician should have some basic knowledge about these lesions. The objectives include the: Anatomy of the mediastinum Differential diagnosis of mediastinal masses Approach to work-up and treatment of these legions

Where is the Mediastinum? What tumors can you find in that region?

Interview with Maurizio Martelli, from Italy. Maurizio Martelli discusses the topic 'Primary mediastinal lymphoma'.The interview is led by Shaun McCann, Chair of EHATol Unit, Member of EHA Education Committee.

Interview with Maurizio Martelli, from Italy. Maurizio Martelli discusses the topic 'Primary mediastinal lymphoma'.The interview is led by Shaun McCann, Chair of EHATol Unit, Member of EHA Education Committee.

This podcast reviews the current role of PET and radiotherapy in PMBL.

Dr. Erik Folch and Dr. Colleen L. Channick join CHEST Podcast Editor, D. Kyle Hogarth, MD, FCCP, for a discussion on whether 50 supervised ultrasound-guided transbronchial needle aspiration procedures are needed to declare competency to assess lung cancer stage. Dr. Folch argues for, noting that although the procedure is safe, the risk of upstaging or downstaging is high in those without more extensive experience. Dr. Channick makes the case that the number 50 is arbitrary and that requiring such a large number of supervised procedures might exclude competent clinicians, thereby denying many patients with lung cancer a vital, non-surgical staging tool

Fri, 1 Jan 1988 12:00:00 +0100 https://epub.ub.uni-muenchen.de/9336/1/9336.pdf Richter, J. A.; Jochum, Marianne; Spannagl, Michael; Blümel, G.; Sternberger, A.; Wendt, P.; Baranky, A.; Dietrich, W.