Practices and perspectives on advanced diagnostic and interventional bronchoscopy among pediatric pulmonologists in the United States.

INTRODUCTION: Advanced diagnostic bronchoscopy includes endobronchial ultrasound (EBUS) guided transbronchial lung and lymph node biopsies, CT navigation and robotic bronchoscopy. Interventional bronchoscopy refers to procedures performed for therapeutic purposes such as balloon dilation of the airway, tissue debulking, cryotherapy, removal of foreign bodies and insertion of endobronchial valves [1]. For adult patients, these procedures are standard of care [2, 3]. Despite a lack of formalized training, there are numerous case reports and case series describing the use of advanced diagnostic and interventional bronchoscopy techniques in children. The safety and feasibility of EBUS-TBNA, cryotherapy techniques, endobronchial valves among other techniques have been demonstrated in these publications [1, 4-9]. METHODS: We sought to better understand the current practices and perspectives on interventional and advanced bronchoscopy among pediatric pulmonologists through surveys sent to pediatric teaching hospitals across the United States. RESULTS: We received 43 responses representing 28 programs from 25 states. The highest bronchoscopy procedure volume occurred in the 0-5 years age group. Among our respondents, 31% self-identified as a pediatric interventional/advanced bronchoscopist. 79% believe that advanced and interventional training is feasible in pediatric pulmonology and 77% believe it should be offered to pediatric pulmonary fellows. DISCUSSION: This is the first study to characterize current practices and perspectives regarding advanced diagnostic and interventional bronchoscopy procedures among pediatric pulmonologists in the United States. Pediatric interventional pulmonology (IP) is in its infancy and its beginnings echo those of the adult IP where only certain centers were performing these procedures.

A review of ductal stenting in hypoplastic left heart syndrome: bridge to transplantation and hybrid stage I palliation.

There is increasing interest in applying ductal stenting technology to high-risk patients with hypoplastic left heart syndrome (HLHS). In this review, we present the complete history and a comprehensive up-to-date analysis of all available data on the use of ductal stenting as part of various hybrid strategies for the combined medical and surgical management of HLHS.

Is there differential access to carotid endarterectomy based on gender?

The purpose of this study was to determine whether there was differential access to carotid endarterectomy (CEA) based on gender at our institution. In 1995, the year after ACAS results were published, 1774 carotid duplex studies were performed in our vascular laboratory in 765 men and 1009 women. The incidence of 50-99% carotid stenosis was 13% (n = 235) overall and did not differ between men (13.3%; 102/765) and women (13.2%; 133/1009). The frequency that patients subsequently underwent CEA was determined to assess whether men with significant carotid stenosis were more likely to undergo CEA than women. Attempts were made to contact patients with 50-99% stenosis directly. Data were available for 101 patients (41 men, 60 women) with 50-99% carotid stenosis diagnosed by carotid duplex. There was conflicting information regarding the possibility of gender bias in the selection of candidates for CEA: logistic regression analysis suggested that disease severity dictated surgical intervention, however, a significantly lower percentage of women with ICA/CCA peak systolic ratios > or =2.9 underwent CEA. This study cannot refute the possibility that gender bias existed in the selection of patients for CEA.

The history and development of cardiac transplantation.

The history of heart surgery, spanning only 100 years to date, has seen some of the most daring and persistent men and women in all of medical history. Many aspects of heart surgery, including such innovations as the heart-lung machine, aortic aneurysm surgery, and the correction of congenital heart defects, have provided future surgeons with an important lesson: diligent research can solve complex problems. The history and development of cardiac transplantation is particularly full of challenges that have been overcome, with the research phase alone spanning more than 90 years. During that time, essential contributions came from all over the world, including the United States, Russia, England, and South Africa. As is typical of medical advancement, individual contributions did not stand alone but added to the experience of those who had come before. Even so, the work of a few particular groups deserves special recognition. Most notable is the Stanford team, led by Dr. Norman Shumway, who continued to transplant human hearts when other institutions had abandoned hopes for the operation. Largely because of the commitment of that team, cardiac transplantation has become a standard option in the treatment of end-stage heart disease. Currently, only the availability of donor hearts limits the number of cardiac transplantations performed worldwide.