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Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is a common, acquired, non-neoplastic, vascular lesion that is often found on the skin and oral mucosa. The term "pyogenic granuloma" is a misnomer, as the lesion does not contain purulent material and is not a granuloma. Lesions have also been reported in the gastrointestinal tract and during pregnancy. PG is a smooth or lobulated, red lesion on a sessile or pedunculated base that varies in size from a few millimeters and rarely exceeds 2.5 cm. The etiology of PG remains unclear but they are thought to develop spontaneously or after local minor trauma where excess production of angiogenic growth factors have been implicated. Trachea PG lesion is rare and there is only 1 known report in the literature. Our case is unique, given the location of the lesion and our treatment using bronchoscopic cryosurgery.

Background Simulation training is widely accepted as an effective teaching tool, especially for dealing with high-risk situations. Objective We assessed whether standardized, simulation-based advanced cardiac life support (ACLS) training improved performance in managing simulated and actual cardiac arrests. Methods A total of 103 second- and third-year internal medicine residents were randomized to 2 groups. The first group underwent conventional ACLS training. The second group underwent two 2 1/2-hour sessions of standardized simulation ACLS teaching. The groups were assessed by evaluators blinded to their assignment during in-hospital monthly mock codes and actual inpatient code sheets at 3 large academic hospitals. Primary outcomes were time to initiation of cardiopulmonary resuscitation, time to administration of first epinephrine/vasopressin, time to delivery of first defibrillation, and adherence to American Heart Association guidelines. Results There were no differences in primary outcomes among the study arms and hospital sites. During 21 mock codes, the most common error was misidentification of the initial rhythm (67% [6 of 9] and 58% [7 of 12] control and simulation arms, respectively, P  =  .70). There were no differences in primary outcome among groups in 147 actual inpatient codes. Conclusions This blinded, randomized study found no effect on primary outcomes. A notable finding was the percentage of internal medicine residents who misidentified cardiac arrest rhythms.

Our single-center study shows that there was poor correlation between computed tomography and endobronchial ultrasound for the measurement of mediastinal and hilar lymph nodes. Malignant cells were recovered by ultrasound-guided needle aspiration from a substantial fraction of lymph nodes that were initially interpreted as normal in size. If these findings are confirmed, new criteria may be needed for lymph node measurement on computed tomography that will guide selection of lymph nodes for endobronchial ultrasound-transbronchial needle aspiration.

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