Browsing by Author "Guerrero, Jorge"

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    Convex Probe EBUS-guided Fiducial Placement for Malignant Central Lung Lesions
    (2018) Majid, Adnan; Palkar, Atul; Kheir, Fayez; Alape, Daniel; Fernández-Bussy, Sebastián; Aronovitz, Joseph; Guerrero, Jorge; Gangadharan, Sidhu; Kent, Michael; Whyte, Richard; Folch, Erik
    Background: Stereotactic body radiotherapy (SBRT) had become a therapeutic modality in patients with primary tumors, locally recurrent as well as oligometastasis involving the lung. Some modalities of SBRT require fiducial marker (FM) for dynamic tumor tracking. Previous studies have focused on evaluating bronchoscopic-guided FM placement for peripheral lung nodules. We describe the safety and feasibility of placing FM using real-time convex probe endobronchial ultrasound (CP-EBUS) for SBRT in patients with centrally located hilar/mediastinal masses or lymph nodes. Methods: This is a retrospective review of patients who were referred to Beth Israel Deaconess Medical Center’s multidisciplinary thoracic oncology program for FM placement to pursue SBRT. Results: Thirty-seven patients who underwent real-time CP-EBUS were included. Patients had a median age of 71 years [interquartile range (IQR), 59.5 to 80.5]. The median size of the lesion was 2.2 cm (IQR, 1.4 to 3.3 cm). The median distance from the central airway was 2.4 cm (IQR, 0 to 3.4 cm). A total of 51 FMs (median of 1 per patient) were deployed in 37 patients. At the time of SBRT planning, 46 (90.2%) were confirmed radiologically in 32 patients. Patients with unsuccessful fiducial deployment (n=5) underwent a second procedure using the same technique. Of those, 3 patients had a successful fiducial placement via bronchoscopy, 1 patient required FM placement by percutaneous computed tomography-guided approach and 1 patient required FM placement through EUS by gastroenterology. Conclusion: CP-EBUS-guided FM placement for patients with malignant lymph nodes and central parenchymal lung lesions appears to be safe and feasible
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    Tracheostomy tube placement: Early and late complications.
    (Journal of Bronchology & Interventional Pulmonology and Lippincott Williams & Wilkins, 2015) Fernández-Bussy, Sebastián; Mahajan, Bob; Folch, Erik; Caviedes, Iván; Guerrero, Jorge; Majid, Adnan
    Tracheostomy tube placement is a therapeutic procedure that has gained increased favor over the past decade. Upper airway obstructions, failure to liberate from the ventilator, and debilitating neurological conditions are only a few indications for tracheostomy tube placement. Tracheostomy tubes can be placed either surgically or percutaneously. A percutaneous approach offers fewer surgical site infections and postsurgical bleeding than a surgical approach. A surgical placement posses a lower risk of injury to the posterior tracheal wall and spontaneous decannulation is less common. Late complications of both approaches include stenosis, malacia, along with tracheoesophageal, tracheoinnominate, and tracheocutaneous fistulas. This review describes the indications and methods of placement of tracheostomy tubes along with early and late complications that may occur following placement.

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