Argentine consensus recommendations for lung cancer screening programmes: a RAND/UCLA-modified Delphi study.

BACKGROUND: Lung cancer (LC) screening improves LC survival; the best screening method in terms of improving survival is low-dose CT (LDCT), outpacing chest X-ray and sputum cytology. METHODS: A consensus of experts in Argentina was carried out to review the literature and generate recommendations for LC screening programmes. A mixed-method study was used with three phases: (1) review of the literature; (2) modified Delphi consensus panel; and (3) development of the recommendations. The Evidence to Decision (EtD) framework was used to generate 13 evaluation criteria. Nineteen experts participated in four voting rounds. Consensus among participants was defined using the RAND/UCLA method. RESULTS: A total of 16 recommendations scored ≥7 points with no disagreement on any criteria. Screening for LC should be performed with LDCT annually in the population at high-risk, aged between 55 and 74 years, regardless of sex, without comorbidities with a risk of death higher than the risk of death from LC, smoking ≥30 pack-years or former smokers who quit smoking within 15 years. Screening will be considered positive when finding a solid nodule ≥6 mm in diameter (or ≥113 mm3) on baseline LDCT and 4 mm in diameter if a new nodule is identified on annual screening. A smoking cessation programme should be offered, and cardiovascular risk assessment should be performed. Institutions should have a multidisciplinary committee, have protocols for the management of symptomatic patients not included in the programme and distribute educational material. CONCLUSION: The recommendations provide a basis for minimum requirements from which local institutions can develop their own protocols adapted to their needs and resources.

ELCA-Tripsy: Combination of Laser and Lithotripsy for Severely Calcified Lesions.

Rotational atherectomy (RA) and intravascular lithotripsy (IVL) are complementary calcium-debulking techniques. RA ablates intimal calcium and makes a channel that permits crossing of the Shockwave balloon, which cannot be easily delivered through severe lesions. Shockwave IVL completes lesion preparation, cracking deep calcium. When RA is discouraged, excimer-laser coronary angioplasty (ELCA) in combination with IVL (ELCA-Tripsy) may be useful, as ELCA facilitates Shockwave balloon delivery without impairment of recently implanted stents. To the best of our knowledge, this is the first description of this technique.

Recomendaciones para la realización de intervenciones pulmonares durante la pandemia COVID-19 / Recommendations for performing interventions during the COVID-19 pandemic

Coronavirus infection (SARS-CoV-2), is a pandemic disease declared by the World Health Organization (WHO). This disease reports a high risk of contagion, especially by the transmission of aerosols in health care workers. In this scenario, aerosol exposure is increased in various procedures related to the airway, lungs, and pleural space. For this reason, it is important to have recommendations that reduce the risk of exposure and infection with COVID-19. In this document, a team of international specialists in interventional pulmonology elaborated a series of recommendations, based on the available evidence to define the risk stratification, diagnostic methods and technical considerations on procedures such as bronchoscopy, tracheostomy, and pleural procedures among others. As well as the precautions to reduce the risk of contagion when carrying out pulmonary interventions.

[Recommendations for performing interventions during the COVID-19 pandemic]. / Recomendaciones para la realización de intervenciones pulmonares durante la pandemia COVID-19.

Coronavirus infection (SARS-CoV-2), is a pandemic disease declared by the World Health Organization (WHO). This disease reports a high risk of contagion, especially by the transmission of aerosols in health care workers. In this scenario, aerosol exposure is increased in various procedures related to the airway, lungs, and pleural space. For this reason, it is important to have recommendations that reduce the risk of exposure and infection with COVID-19. In this document, a team of international specialists in interventional pulmonology elaborated a series of recommendations, based on the available evidence to define the risk stratification, diagnostic methods and technical considerations on procedures such as bronchoscopy, tracheostomy, and pleural procedures among others. As well as the precautions to reduce the risk of contagion when carrying out pulmonary interventions.

Tracheobronchial Tuberculosis Without Lung Involvement.

Endotracheal tuberculosis (ETTB) is an infrequent form of tuberculosis whose major feature is the infection of the tracheobronchial tree by Mycobacterium tuberculosis. This case presents a 73-year-old man admitted to our hospital with fatigue, weakness, dry cough and weight loss. His chest X-ray was normal but the high resolution computed tomography (HRCT) showed normal parenchyma images with mediastinal and hilar lymphadenopathy. There was inflammation of the tracheal wall and infiltrates in pavement epithelium; however, the tracheal biopsy for acid-fast bacilli was negative. He was finally diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the lymph nodes. Four drugs were prescribed and symptoms improved. EBUS-TBNA contributed to prompt diagnosis. The patient was treated and evolved without complications, such as tracheal stenosis.

Un paciente joven con una lesión endobronquial poco frecuente / A young patient with an injury uncommon endobronchial

Paciente masculino de 32 años, con diagnóstico de asma hace diez años, tratado con fluticasona/ salmeterol y salbutamol. Se encontraba parcialmente controlado y refería que en el último año había presentado varios episodios de expectoración hemoptoica autolimitados. El examen físico y la radiografía de tórax no revelaban hallazgos patológicos. La espirometría era normal. Se solicitó una tomografía de tórax que mostró una imagen endoluminal en bronquio intermedio, sin otra lesión acompañante

Estadificación mediastinal del carcinoma de pulmón: el aporte de los nuevos métodos endoscópicos / Mediastinal staging of lung cancer: the contribution of new endoscopic methods

La estadificación mediastinal en cáncer de pulmón en pacientes potencialmenteoperables constituye un paso crítico para determinar la estrategia terapéutica. De los métodos de estadificación la mediastinoscopia es el “gold estándar” con una sensibilidadde 80% y baja morbilidad. Sin embargo, no deja de ser un procedimiento quirúrgico. Métodos endoscópicos utilizando ultrasonografía como guía para la punción con aguja fina han emergido como métodos mínimamente invasivos ofreciéndose como alternativaa los métodos quirúrgicos. Con reconocida precisión diagnóstica y sensibilidad, estos métodos van ocupando un lugar en la estadificación mediastinal. Esta revisión abordaprincipios, aplicaciones clínicas y el papel de esta nueva tecnología en la estadificación del cáncer de pulmón.

Mediastinal staging of lung cancer in potentially operable patients is a critical step in determining the therapeutic strategy. Among the methods of staging, mediastinoscopy is the “gold standard” because it combines an 80% sensitivity with a low rate of complications.However it remains a surgical procedure. Methods using endoscopic ultrasound to guide fine needle aspiration emerged as minimally invasive procedures presenting an alternative to surgical methods. Because of their established diagnostic accuracyand sensitivity these methods are occupying a place in the mediastinal staging. This review deals with principles, clinical applications and the role of this new technologyin the staging of lun cancer.

Transition from a low: to a high-volume centre for bile duct repair: changes in technique and improved outcome.

BACKGROUND: Improvements in bile duct injury repairs have been shown in centres with specialized surgeons. The aim of the present study was to demonstrate the temporal change in the pattern of referral, technical variation associated with repair and long-term outcome of bile duct injuries at a tertiary referral centre in Mexico City. METHODS: A retrospective case note review was performed. Patients were divided into two groups: group I (GI) 1990 to 2004 and group II (GII) 2005-2008, and appropriate statistical analysis undertaken. RESULTS: Over a 20-year period, 312 patients with iatrogenic bile duct injuries required surgical treatment (GI = 169, GII = 140 patients). All injuries were reconstructed using a Roux-en-Y hepaticojejunostomy. The proportion of patients who had undergone a laparoscopic cholecystectomy increased from 24% to 36% (P = 0.017) over the two time periods. In the second time period there was an increase in segment IV and V partial resections (P = 0.020), a reduction in the use of transanastomotic stents (42% to 2%, P = 0.001) and an increase in the proportion of patients requiring a neoconfluence (2% to 11%, P = 0.003). In the second time period, the number of patients requiring a hepatectomy during repair (2% to 1%, P = 0.001), a portoenterostomy (16% to 9%, P = 0.060) or a double-barrel hepatico-jejunostomy (5% to 1%, P = 0.045) significantly decreased. During follow-up, patients in the second time period had a reduction in the incidence of post-operative cholangitis (11% to 6%, P = 0.310) and the frequency of post-operative anastomotic stenoses (13% to 5%, P = 0.010). Mortality remained low throughout the series but was absent in the second group. CONCLUSIONS: Changes in technique and growing experience of the multidisciplinary team improved operative and long-term results of bile duct injury repair.