Tuberculous tracheobronchial stenosis: avoiding resection-when less is more.

A case of tracheobronchial stenosis due to tuberculosis in a young woman is presented. Compromised pulmonary function due to near-total obstruction of the proximal left main bronchus was diagnosed. Treatment options included surgical resection, endobronchial dilation or stenting, and argon photocoagulation. An approach was chosen to address symptoms without aggressive resection or commitment to stenting. She remains monitored and, while possibly committed to future intervention, no bridges have been burned with respect to more definitive and invasive therapies. We propose this "less is more" initial approach in all patients when possible. Reserving the more aggressive alternatives for high-risk surgical candidates and those that have been unresponsive to lesser procedures.

Ultrasonography in preclinical education: a pilot study.

CONTEXT: Ultrasonography is a valuable diagnostic tool in the clinical setting. Yet, medical students often have minimal familiarity with this technology. OBJECTIVE: To evaluate the ability of second-year medical students to use ultrasonography for identification of anatomic structures and pathologic conditions. DESIGN: A self-directed approach that reduced facilitator involvement, encouraging learning that mimicked the medical school's problem-based learning pathway program. METHODS: Five students were each given 10 hours of instruction in ultrasonographic techniques by three certified ultrasonographers in outpatient and hospital settings. Each student performed 40 hours of organ-specific ultrasonographic scans on another student in 2-hour sessions during 20 weeks. Images were archived for future evaluation and quality rating. Students took a 35-question posttraining examination with 10 contrived case scenarios. Questions were designed to test student knowledge in three categories: anatomic structure, technical skill, and clinical diagnosis. RESULTS: Posttraining examination results, expressed as the percent of correct answers for all five participants by category, were as follows: anatomic structure, 70%; technical skill, 70%; clinical diagnosis, 68%. Evaluations of the archived images, which were graded for proper anatomic identification and image clarity, yielded the following scores indicating "good" or "fair" quality for each anatomic region: abdominal, 80%; pelvic, 63%; cardiac, 73%. CONCLUSION: Second-year osteopathic medical students can attain a sufficient degree of proficiency in limited ultrasonographic technique.