Search Results (124)

Inflammatory bowel disease (IBD) management traditionally focuses on intestinal inflammation, yet extraintestinal manifestations can substantially impair patient quality of life. In this perspective, we emphasize the broad systemic impact of IBD—from highly prevalent conditions such as anemia, metabolic dysfunction-associated steatotic liver disease, or fatigue to rare but severe complications like interstitial lung disease and drug-induced glomerulonephritis. We review underlying mechanisms linking gut inflammation to distant organs, including immune dysregulation, microbial translocation, and metabolic derangements. Advances in diagnostics—such as biomarker panels, high-resolution imaging, and genomic/microbiome profiling—enable early detection and risk stratification. Emerging therapies, including targeted biologics (anti-TNF, anti-integrin, anti-IL-23), JAK and S1P modulators, precision nutrition, and microbiome modulation, offer new opportunities to address systemic inflammation. A multidisciplinary framework integrating gastroenterology with hepatology, hematology, neurology, nephrology, endocrinology, dermatology, pulmonology, and cardiology is essential to recognize hidden complications, facilitate timely intervention, and deliver personalized, comprehensive care for IBD. Full article

Background: The incidence of iatrogenic pneumothorax (IPTX) following transbronchial lung cryobiopsy (TBLCB) ranges from 1.4% to 20.2%. While chest X-ray (CXR) is the standard imaging modality to exclude IPTX, thoracic ultrasound (TUS) has demonstrated superior accuracy in detecting pneumothorax across various contexts. This study evaluates TUS as a reliable alternative to routine CXR for ruling out IPTX after TBLCB. Methods: A retrospective observational study included 51 patients undergoing ambulatory TBLCB. Pre- and post-TBLCB TUS were performed. CXR was reserved for cases where TUS findings were inconclusive (absence of sliding lung [SL] and seashore sign [SS] in any lung zones) or if patients exhibited symptoms or signs of IPTX. Results: TUS findings were concordant in 44 (86.1%) patients, of whom 42 (95.5%) did not require CXR. Two patients (4.5%) with symptomatic IPTX were identified and managed. Among the seven patients (13.7%) requiring CXR due to inconclusive TUS or symptoms, five (71.4%) were negative for IPTX, and two (28.6%) had asymptomatic IPTX. Conclusion: Our TUS protocol effectively ruled out clinically significant IPTX, eliminating routine CXR in 95.5% of patients. TUS is a safe alternative to CXR post-TBLCB, with CXR reserved for inconclusive TUS findings or symptomatic cases. Full article

The field of pediatric bronchoscopy is rapidly expanding and enables diagnostic tests and therapeutic maneuvers, benefiting many children suffering from respiratory disease. However, due to a paucity of pediatric providers trained in bronchoscopy, many institutions rely on adult interventionalists collaborating with pediatric care teams to complete these procedures. In this article, we address the adult interventionalist taking on these cases and offer insight into key differences in pediatric anatomy and physiology, unique challenges encountered in this population and explore the equipment available in pediatric sizes. We also consider the future of the field, including broadening pediatric training to enhance capacity to complete these necessary procedures. Full article

This article presents the report of the First International Congress of Preventive Medicine, organized by the Romanian Society of Preventive Medicine (SRMP) in March 2025, in Bucharest, Romania. The congress featured 11 discussion panels and workshops, bringing together over 85 experts from a wide range of medical disciplines, including oncology, vaccination, cardiology, endocrinology, gynecology, gastroenterology, surgery, family medicine, physical therapy, pulmonology, epidemiology, pediatrics, dentistry, pathology, ENT, genetics, pediatric cardiology, psychiatry, dermatology, plastic surgery, urology, infectious diseases, regenerative medicine, and other key stakeholders in preventive healthcare. The event served as a comprehensive platform for addressing critical public health challenges, with a focus on cancer prevention, anti-aging, oral health, genetics in preventive medicine, preventive cardiology and neurology, the correlation between craniofacial dysfunctions and posture, vaccination strategies, management of congenital malformations, neonatal screening, and the prevention of lifestyle-related diseases such as obesity and tobacco addiction. Furthermore, the congress highlighted the importance of interdisciplinary collaboration and evidence-based interventions in improving population health outcomes. It emphasized the urgent need for coordinated actions to address preventable diseases both at the national and international levels. Full article

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) represents the gold standard technique for the diagnosis and staging of lung carcinoma. However, its diagnostic yield may be limited for granulomatous pathologies or rare tumors requiring comprehensive histological and molecular analysis. Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) is an emerging technique that allows for the acquisition of larger histological samples with preserved tissue architecture. The primary objective of this prospective multicenter study was to evaluate the potential increase in diagnostic yield afforded by the addition of EBUS-TMC to EBUS-TBNA in patients selected by pre-test clinical–radiological criteria presenting with hilar–mediastinal lymphadenopathies without an obvious primary neoplastic lung lesion. Methods: The study prospectively enrolled 91 patients across two Italian interventional pulmonology units. Patients were selected based on a pre-defined clinical–radiological criterion aimed at excluding primary lung cancer suspects. For each patient, both EBUS-TBNA and EBUS-TMC were performed. Results: The overall diagnostic yield for the combined procedure was 84.6% (77/91 patients). EBUS-TMC achieved a diagnostic yield of 78.0%, which was significantly higher than EBUS-TBNA alone of 60.4%. The addition of EBUS-TMC resulted in a statistically significant increase in diagnostic yield of 17.6%. This increase was particularly pronounced for lymphoproliferative diseases. The safety profile of EBUS-TMC was favorable without major complications. The clinical–radiological criterion used to select patients for EBUS-TMC in addition to the standard of care of EBUS-TBNA, aiming at excluding primary lung cancer, was correct in 89.0% of the study population (81 out of 91 patients). Conclusions: EBUS-TMC is a safe and feasible technique that significantly enhances the diagnostic yield (17.6% absolute increase in diagnostic yield) in patients with hilar–mediastinal lymphadenopathies. The clinical–radiological criterion employed proved effective in pre-selecting patients who benefit most from cryobiopsy, thereby enabling a more rational allocation of healthcare resources. Full article

Hemorrhagic complications during pleural interventions—such as thoracentesis and chest tube insertion—remain a significant clinical concern, primarily due to inadvertent injury of the intercostal artery (ICA). The highly variable ICA anatomy is frequently not visualized on conventional imaging, limiting the reliability of landmark-based techniques. Color Doppler thoracic ultrasound (CDUS) has emerged as a non-invasive, real-time modality capable of identifying ICAs and their anatomical variants prior to pleural access. This narrative review synthesizes current evidence on CDUS-guided ICA screening, focusing on its technical principles, diagnostic performance, and clinical applicability. While feasibility and utility are supported by multiple observational studies, robust evidence demonstrating a reduction in bleeding complications is still lacking. Barriers to widespread implementation include heterogeneous scanning protocols, operator dependency, and the absence of standardized training. We discuss the anatomical rationale for pre-procedural vascular mapping and highlight emerging protocols aimed at standardizing ICA visualization. Although not yet incorporated into major clinical guidelines, CDUS represents a promising tool to enhance procedural safety. Emerging AI applications may further improve vessel detection by reducing operator dependency and enhancing reproducibility. High-quality prospective studies are essential to validate potential clinical benefits, optimize implementation strategies, and support integration into routine pleural practice. Full article

Background/Objectives: Patients with non-small cell lung cancer (NSCLC) being evaluated for stereotactic body radiation therapy (SBRT) are frequently staged non-invasively with positron emission tomography/computed tomography (PET/CT). Performing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in addition to PET/CT scanning may increase clinical certainty in lymph node staging, but the magnitude of added benefit of EBUS-TBNA over non-invasive staging methods is unclear. Methods: A single-center prospective cohort study involving patients with suspected or confirmed Stage I or IIa NSCLC referred for EBUS-TBNA prior to SBRT was performed. The primary outcome was concordance between PET/CT and EBUS-TBNA for nodal metastases. Secondary endpoints included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET/CT, and clinical outcomes based on staging results. Results: Among 115 patients, the concordance between PET/CT and EBUS-TBNA was 84.3% (95% CI: 0.76 0.90). EBUS-TBNA led to a stage shift in 15.7% of cases: 4 of 98 PET/CT N0 patients (4.1%) had nodal metastases, while 14 of 17 PET/CT N1 patients (82.4%) were downstaged to N0. PET/CT sensitivity was 42.9% (95% CI: 0.09–0.81), specificity 87% (95% CI: 0.79–0.93), PPV 17.6% (95% CI: 0.04–0.43), and NPV 95.9% (95% CI: 0.90–0.99). PET/CT-positive, EBUS-TBNA-negative patients had worse survival (HR 4.25, 95% CI: 1.24–14.53, p = 0.021) compared with double-negative patients. Conclusions: EBUS-TBNA improves staging accuracy over PET/CT in early-stage NSCLC, impacting SBRT candidacy. However, PET/CT-positive, EBUS-TBNA-negative patients had worse outcomes in comparison to double-negative patients, suggesting a need for additional therapy or surveillance in that population. Full article

Background: Between 2014 and 2024, Poland underwent a significant digital transformation in its healthcare sector, evolving from isolated initiatives to a cohesive national eHealth ecosystem. This review examines the development, clinical significance, and research trends in telemedicine in Poland, providing comparative insights from 1995 to 2015 and assessing the impact of the COVID-19 pandemic. Methods: A narrative review was conducted using the PubMed, Scopus, EMBASE, and Web of Science databases to identify peer-reviewed articles published between January 2014 and December 2024. A total of 1012 records were identified, and 212 articles were included after applying predefined inclusion criteria. These articles were categorized by medical specialty, study type, COVID-19 relevance, and clinical versus nonclinical focus. Gray literature and policy reports were examined only to provide a context for the findings. Results: Ninety-six publications were included in the clinical studies. The most common specialties are cardiology, psychiatry, geriatrics, general practice, and rehabilitation. In earlier years, survey-based and observational designs were predominant, whereas later years saw an increase in interventional trials and studies enabled by Artificial Intelligence (AI). The COVID-19 pandemic has had a significant impact on research activity, accelerating the adoption of digital technologies in previously underrepresented fields, such as pulmonology and palliative care, as well as in the routine use of modern Internet communication technologies for daily patient–doctor interactions. Discussion: Advancements in digital health (including eHealth and telemedicine) in Poland have been driven by policy reforms, technological advancements, and epidemiological events, such as COVID-19. Various fields have evolved from feasibility studies to clinical trials, and emerging specialties have focused on user experience and implementation. However, the adoption of AI and its interoperability remains underdeveloped, primarily because of regulatory and reimbursement challenges. Conclusions: Poland has made significant strides in institutionalizing digital health; however, ongoing innovation necessitates regulatory alignment, strategic funding, and enhanced collaboration between academia and industry. As the country aligns with the European Union (EU) initiatives, such as the European Health Data Space, it has the potential to lead to regional integration in digital health. Full article

This case report describes the acute and multidisciplinary management anesthesiologists performed for an intra-operative bronchobiliary fistula during a routine endoscopic retrograde cholangiopancreatography for a patient with intrahepatic cholangiocarcinoma. During the procedure, an unexpected rapid airway deterioration was encountered due to bile infiltration of the right bronchus and anesthesia circuit, necessitating (1) emergent extubation and reintubation with bronchoscopy, (2) extubation and reintubation with double-lumen endotracheal tube with right-bronchial blocker, and (3) transportation of the patient from endoscopy to interventional radiology for biliary drain placement. Overall, this case highlights a rare but serious consideration for patients with intrahepatic cholangiocarcinoma who may present with a bronchobiliary fistula and the steps taken to prevent total airway compromise and ensure rapid patient stabilization through coordination with advanced gastroenterology, interventional pulmonology, and interventional radiology. Full article

Predominantly antibody deficiencies (PADs) are the most prevalent types of inherited errors of immunity (IEI) and are characterized by a broad range of clinical manifestations, such as recurrent infections, autoimmunity, lymphoproliferation, atopy and malignancy. The aim of this study was to identify genetic defects associated with PADs in order to improve diagnosis and personalized care. Twenty patients (male/female: 12/8, median age of disease onset: 16.5 years, range: 1–50) were analyzed by next-generation sequencing (NGS) using a custom panel of 30 genes associated with PADs and their possible disease phenotype. The detected variants were classified according to the American College of Medical Genetics and Genomics (ACMG) guidelines and inheritance, and the penetrance patterns were evaluated by PCR–Sanger sequencing. Novel and rare mutations associated with the phenotype of common variable immunodeficiency (CVID) in genes encoding the transcription factors NFKB1, NFKB2 and IKZF1/IKAROS were identified. Alphafold3 protein structure prediction was utilized to perform a comprehensive visualization strategy and further delineate the mutation-bearing domains and elucidate their potential impact on protein function. This study highlights the value of genetic testing in PADs and will guide further research and improvement in diagnosis and treatment. Full article

Theoretical background: The study of psychological well-being in children and adolescents living with chronic illness is of particular relevance, as the physical and psychosocial aspects of the illness can have a significant impact on their quality of life. Previous research has highlighted that depression, nonproductive thoughts and various aspects of problematic internet use may be related to life satisfaction and ways of coping with illness. This study aims to examine how depression, nonproductive thoughts, and problematic internet use interact with illness perception and burden to affect psychological well-being and life satisfaction. Methods: A cross-sectional study was conducted with 207 chronically ill children aged 10–18 years. The children, aged between 10 and 18 years old, attended regular check-ups in different specialities (gastroenterology, pulmonology, onco-haematology, and paediatric rehabilitation). A cross-sectional study was carried out using psychological instruments to measure life satisfaction (SWLS), nonproductive thoughts (NPG-K), problematic internet use (PIU-Q), illness perception (PRISM) and illness burden (PRISM-D, IIRS), and depression (BDI-R). Spearman rank correlation analysis was used to explore the associations between variables. Results: Life satisfaction was negatively related to nonproductive thoughts (r = −0.28, p < 0.001), internet obsession (r = −0.20, p < 0.01), and internet neglect (r = −0.20, p = 0.004). Conversely, a positive correlation was found with the PRISM (r = 0.14, p = 0.042), suggesting that less dominance of illness detection is associated with higher life satisfaction. Depression and nonproductive thoughts showed a strong positive relationship (r = 0.49, p < 0.001), and depression and problematic internet use also showed significant correlations for the obsession, neglect and control subscales (r = 0.23–0.29, all p < 0.001). Cluster analysis identified three psychological profiles: ‘positive fighters’, ‘avoidant sufferers’, and ‘negative observers’, distinguished by differences in depression, nonproductive thoughts, illness burden, and well-being. Conclusions: The results suggest that the quality of life of children and adolescents with chronic illness is significantly affected by mental health factors, particularly depression, nonproductive thoughts and problematic internet use. Illness perception and illness-related distress also play a key role in shaping life satisfaction and overall psychosocial well-being. These findings underscore the need for targeted psychological interventions in pediatric chronic care to enhance well-being and promote adaptive coping and suggest that psychological interventions and targeted psychosocial support can significantly improve these children’s quality of life. Further research is needed to explore intervention options and to develop optimal support strategies. Full article

Introduction and case report: Angiosarcomas, rare soft tissue malignancies originating from endothelial cells, represent only 1–2% of all soft tissue sarcomas. Primary pleural angiosarcoma (PPA) is exceptionally rare, with only 43 reported cases since 1943. There are many diagnostic and therapeutic challenges due to the rarity of these tumors. We present the case of a 72-year-old man presenting with back pain, dyspnea and anemia. Conventional imaging revealed bilateral pleural effusion and a thickened parietal pleura, while contrast chest MR was able to identify pleural sites of contrast enhancement. Left chest tube placement evidenced a hemothorax, and the cytology result was negative. A thoracoscopic approach was chosen, allowing us to perform different parietal pleural biopsies. Radiological and pathological features led to the diagnosis of epithelioid PPA. Despite pleural drainage and blood transfusions, the patient died only 4 days after diagnosis. Objectives: To present a literature review, evaluating the disease epidemiology and the clinical, diagnostic and therapeutic features of PPA. Methods: We reviewed cases of PPA in the literature (1954–2024) by searching the PubMed database for the terms “pleural angiosarcoma” and “pleura + angiosarcoma”. Results: We found a total of 47 cases that were described between 1987 and 2024 with sufficient data to be included in our review. PPA was found to be a challenging diagnosis, found mostly in older Caucasian males. The cytology is mostly indeterminant, and an endoscopic approach is usually needed. Radical surgery is the most common treatment option, and chemotherapy and radiation therapy are also often used. However, the prognosis is poor. Conclusions: PPA is very rare, and complex cases such as this one showcase the importance of innovative approaches like MRI and emphasize the significance of multidisciplinary collaboration for optimal patient management. Bilateral spontaneous hemothorax, as seen in this case, is uncommon and poses additional challenges in disease management. Further research to advance the diagnostic capabilities and treatment efficacy is needed. Full article

The diagnostic evaluation of interstitial lung diseases (ILDs) remains challenging due to their heterogeneous etiologies and overlapping clinical and radiographic patterns. A confident diagnosis often necessitates histopathological sampling, particularly when high-resolution computed tomography and serologic assessments are inconclusive. While surgical lung biopsy (SLB) has long been considered the diagnostic gold standard, its invasiveness, associated morbidity, and limited feasibility in high-risk patients have driven the pursuit of less invasive alternatives. Here, we review the current applications, diagnostic yield, procedural techniques, and complications of several bronchoscopic modalities. Bronchoalveolar lavage (BAL) aids in characterizing inflammatory profiles and differentiating among conditions such as hypersensitivity pneumonitis, sarcoidosis, and eosinophilic pneumonia. Endobronchial biopsies (EBBs) and endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) are valuable in diagnosing granulomatous diseases with lymphadenopathy. Transbronchial lung biopsy (TBLB) is effective for peribronchial and centrilobular diseases but is limited by small sample size and tissue distortion. Transbronchial lung cryobiopsy (TBC) enables acquisition of larger, well-preserved parenchymal tissue samples from the peripheral lung. Over recent years, studies have demonstrated that TBC, when interpreted within a multidisciplinary discussion (MDD), achieves diagnostic concordance rates with SLB exceeding 75%, and up to 95% in cases where high diagnostic confidence is reached. When performed in experienced centers using standardized protocols, TBC is considered a viable first-line histopathologic tool in the diagnostic evaluation of ILD. Adequate training and standardization of the TBC procedure are needed to ensure low complication rates and a high yield. Full article

Background: Non-small cell lung cancer (NSCLC) accounts for a significant number of new lung cancer diagnoses each year, which, if identified early, may be surgically removed with curative intent. It is also the most common indication for a sublobar resection due to its equal efficacy in carefully selected patients. From the time of diagnosis to surgery, however, traditionally, there are three separate anesthesia-dependent events: (1) diagnostic bronchoscopy plus lymph node staging, (2) lung nodule marking, and (3) surgical resection. This study evaluated the viability of performing a pulmonary nodule marking and sublobar resection under a single-anesthesia-dependent event at a large community hospital. Methods: The study group was a single-center retrospective cohort of patients, scheduled for same-day marking and sublobar resection and admitted to a large community hospital between 6 January 2023 and 23 May 2023. Prior to arrival, patients had received cardiac surgical clearance, pulmonary function testing, and positron emission tomography to ensure their appropriateness for surgical intervention. Data regarding procedural time, anesthesia time, and hospital length of stay was collected retroactively though the electronic medical record. Results: A total of 12 patients with 16 pulmonary nodules were included. Results demonstrated a mean turnover time of 33 min between completing pulmonary fiducial marking and starting the sublobar resection. The estimated mean total time saved was 231 min. The average hospital length of stay was 1.83 days. Conclusions: Combining pulmonary fiducial marking and sublobar resection within a single-anesthesia-dependent event offers an opportunity to decrease total perioperative time and the time from diagnosis to curative intervention. Full article

Background: Thoracic ultrasound (TUS) has emerged as a viable alternative of computed tomography (CT) for pneumothorax diagnosis. Ultrasound elastography (USE), a technique assessing tissue elasticity, has recently been proposed as a novel tool for pneumothorax evaluation. Methods: This prospective, monocentric, observational study aimed to compare the diagnostic accuracy of static and dynamic USE with TUS in detecting iatrogenic pneumothorax after CT-guided transthoracic needle aspiration (TTNA). Results: Thirty-two patients were enrolled, with pneumothorax confirmed via CT in 40.63% of cases. The results showed that elastographic-mode images had significantly higher sensitivity (76.9% vs. 21.2%, p < 0.001) and improved positive and negative predictive values (67.8% vs. 52.4%, p-value 0.01, 82.6% vs. 61.7%, p-value < 0.001, respectively), compared to B-mode images. Concordance between expert and non-expert evaluators was also higher for elastographic images, suggesting improved interpretability. However, dynamic USE did not demonstrate a statistically significant advantage over B-mode videos. Conclusions: These findings suggest that USE may enhance static ultrasound-based pneumothorax detection and provide an objective imaging marker for reports. Further multicenter studies are needed to confirm these findings and explore the potential role of USE in other settings. Full article