UNLV Health and UMC Build the First Interventional Pulmonology Program in Nevada

UNLV Health’s Arthur Oliver Romero, MD, recently got an opportunity at UMC to use the advanced fellowship training in interventional pulmonology he received at the University of California San Francisco (UCSF). (UNLV Health is the new name of the multi-specialty group practice of the medical school – formerly known as UNLV Medicine.)

And he may well have saved a life.

Using the robotic-assisted ION platform designed by Intuitive Surgical that was recently acquired by University Medical Center (UMC) — the first and only hospital in the state with the groundbreaking program — Dr. Romero diagnosed a patient with early-stage lung cancer. Diagnostic tissue from the hard-to-reach lesion was collected through robotic bronchoscopy and this information was given to a surgeon. Less than two weeks later, the patient underwent surgery to remove the tumor.

“That patient’s lung cancer is now gone,” said Dr. Romero. “We got it out before there was any evidence of spread.”

The ION system provides new levels of precision, reach and stability when compared to manual biopsy techniques. The ION has an ultra-thin, easily controllable catheter that can bend 180 degrees in all directions.

Doctors can use the catheter to navigate through the lung to reach nodules in any airway segment. The robotic biopsy needle can also pass through very tight bends via the catheter to collect tissue in the peripheral lung, enabling a more precise biopsy and safer experience for patients.

Almost 1 in 4 cancer deaths are due to lung cancer, making it the leading cause of cancer death among both men and women.

Armed with better skills and broader experience dealing with the most complicated patients, Dr. Romero is now building the first interventional pulmonology (IP) program in Nevada. He is poised to help not only patients with lung cancer but other forms of advanced lung disease.

Angelica Honsberg, MD, the pulmonary critical care division chief for the Kirk Kerkorian School of Medicine who oversees the care of the sickest COVID-19 patients in UMC’s intensive care unit (ICU), says the new interventional pulmonology program at UMC will make a significant difference in lung disease care in Southern Nevada. She notes that Dr. Abhishek Kumar, another fellowship-trained interventional pulmonologist, recently joined the medical school and should prove to be a valuable addition to the new program.

“We’re taking a big step forward for the people of Nevada…People will be able to get world-class treatment right at home.”

“Historically,” she says, “there has been a gap in lung cancer care in our area, with many residents being diagnosed at an advanced stage of disease and not having consistent access to more advanced interventions. The new interventional pulmonology program, created through the joint efforts of the Kirk Kerkorian School of Medicine and UMC, offers Southern Nevada residents options for both lung cancer and severe emphysema treatment that they previously would have had to travel elsewhere to have. Our department is confident that being able to offer more options to Southern Nevadans will improve both quality of life and survival.”

Dr. Romero, who still must spend much of his time treating COVID-19 patients, is also performing tracheostomies to decrease patients’ time in the ICU. He is thankful for the partnership between UNLV Health and UMC. “Without UMC acquiring the most advanced equipment available, I would not be able to offer the best care to many of our lung cancer patients.”

Robotic bronchoscopy, which Dr. Romero uses for minimally invasive access to virtually any part of the lung, also allows for the delivery of dye markers to aid a surgeon on removing as little of the lung as possible. He’s also treating patients through rigid bronchoscopy, a therapeutic modality where a hollow metal tube is placed in the airway to facilitate the removal of airway tumors, relieve strictures and even placement of airway stents.

Soon, Dr. Romero says the new IP program will offer bronchoscopic lung volume reduction, which is for patients with severe emphysema. It involves the placement of valves in the airways with the purpose of collapsing the worst functioning lobe of the lung. This allows other healthier parts more room to expand with the goal of relieving the patient’s shortness of breath and exertional limitations.

In addition, Dr. Romero says other novel procedures being developed and soon to be offered are: medical pleuroscopy, where a camera is placed in the space between the lungs and the chest wall to evaluate and treat hard-to-diagnose cancer and infections; and lung cryobiopsy, where a catheter that can achieve extremely cold temperatures is used to freeze lung tissue that is extracted with the use of a bronchoscope. This allows for non-surgical biopsy of interstitial lung disease, which describes a large group of disorders, most of which cause progressive scarring of lung tissue.

“We’re taking a big step forward for the people of Nevada,” Dr. Romero says. “People will be able to get world-class treatment right at home.”

Photo: Dr. Arthur Romero, assistant professor of pulmonary and critical care medicine and UNLV Health physician, helps patients with advanced lung diseases through minimally invasive procedures. Courtesy of UNLV Health.

Researchers Focus on Diagnosing Destructive Brain Changes in Life

Well before popular media began reporting on chronic traumatic encephalopathy in professional athletes, Cleveland Clinic Lou Ruvo Center for Brain Health was working on Diagnose CTE, a study that aims to detect underlying changes in the brain during life.

Chronic traumatic encephalopathy (CTE) is the term for the brain changes neuropathologists can see in individuals who have been exposed to repetitive head trauma. Those with CTE have deposits of tau protein in the brain’s frontal lobes and basal ganglia, the regions that govern behavior, emotion and executive function.

Currently, CTE can be diagnosed only after death, which presents a challenge for physicians evaluating brain health in athletes in a clinical setting. Recently, a panel of experts developed clinical criteria based on the symptoms that people who had CTE at autopsy were known to experience during life. This constellation of symptoms in the living is known as traumatic encephalopathy syndrome (TES).

A road map for evaluating brain changes
Physician-scientists from the Lou Ruvo Center for Brain Health, in collaboration with Boston University, the Mayo Clinic and New York University, contributed to the 2021 publication in the peer-reviewed journal Neurology of these first consensus criteria on TES.

“Thanks to a group of researchers across multiple institutions, we can now diagnose and study people with behavioral and cognitive changes after repetitive head impact,” says Lou Ruvo Center for Brain Health neuropsychiatrist Aaron Ritter, MD. “Now we can look more closely at the biological changes that might be underlying CTE. This is a big step for the field, and will hopefully allow us to better understand brain trauma in living patients.”

Based on the newly established criteria, to be diagnosed with TES, an individual must have:

  • Significant exposure to repetitive head trauma (such as more than five seasons playing football or multiple blast injuries during military service), and
  • Progressive changes in memory, or
  • Behavioral dysregulation, such as explosive temper or irrational actions

An urgent public health issue
Researchers believe that repetitive injuries start a cascade of changes in the brain, leading to the slow, progressive destruction of brain tissue and associated changes in cognitive function, mood and behavior. When these changes become severe enough, they may lead to dementia.

Dr. Ritter says the TES consensus criteria will assist in differentiating CTE from similar disorders such as Alzheimer’s disease, as well as in clarifying the causes and specific risk and resilience factors for developing this neurodegenerative disease.

Researchers recognize CTE as a pending public health concern, given the prevalence of contact sports participation among today’s youth as well as the risk to soldiers exposed to blast injuries and to others who might experience repetitive head trauma, such as victims of domestic violence.

“Despite the excitement in the science community around consensus diagnostic criteria for TES, we still need further research,” says Dr. Ritter. “Ultimately, our goal, and the aim of the Diagnose CTE study, is to move CTE from being a purely pathological diagnosis to something we can see, treat or prevent during life, and to do everything we can to make sports as safe as possible.”

Photo: Lou Ruvo Center for Brain Health neuropsychiatrist Aaron Ritter, MD, Courtesy of Cleveland Clinic

Valley Hospital renovates its Emergency Department

Valley Hospital Medical Center announces the completion of renovation for its Emergency Department. The renovation project included replacing the department with all new flooring and adding sliding glass doors to patient open bays to enhance patient privacy. The renovation of this area also included the addition of new sinks and cabinetry.

Since 1972, healthcare professionals at Valley Hospital have provided quality patient care to all who enter the hospital’s doors. Valley Hospital is located in the center corridor in the heart of the Las Vegas Medical District (LVMD) and includes 306 acute care beds, including a 48-bed behavioral health unit and 16-bed rehab unit. As a teaching hospital with graduate medical education, a new pharmacy residency program and over 600 multidisciplinary clerkships and internships offered annually, Valley Hospital focuses on the use of evidence-based medicine and the importance of following clinical pathways that research has shown to be most effective.

Valley Hospital Medical Center is now an Advanced Comprehensive Stroke Center. In fact, it’s only the third hospital in Nevada to earn this designation. This new certification, from The Joint Commission, the American Heart Association and the American Stroke Association, recognizes the hospital’s ability to provide some of the highest and most advanced stroke treatment available to the community.

Photo: Valley Hospital’s renovated Emergency Department, Courtesy of Valley Hospital Medical Center

STEINBERG DIAGNOSTIC MEDICAL IMAGING (SDMI) WELCOMES NEW RADIOLOGIST

Steinberg Diagnostic Medical Imaging (SDMI) proudly welcomes a new radiologist to its practice, Dr. Tanner Jugler. Dr. Jugler joins the team with a sub-specialty in Neuroradiology.

SDMI interviewed Dr. Jugler to learn more:

WHY DID YOU CHOOSE RADIOLOGY?
During medical school I battled wanting to have sub-specialty training while also wanting to maintain a broad knowledge base of medicine. I was on a neurology rotation where I was able to work closely with the neuroradiologists and neurointerventionalists. I saw how radiology impacted the care of my patients and the benefits of additional specific training. It was then that I realized radiology was the perfect specialty to blend my desire for sub-specialty training while still securing broad medical knowledge. The ability to affect the care of each of our patients in a unique way is ultimately the reason why I chose radiology.

WHY DID YOU CHOOSE YOUR SUB-SPECIALTY?
Since medical school, I have always been interested in diseases of the neurological system, especially vascular diseases and stroke. Knowing that diagnoses and treatments are rapidly evolving in these areas made me want to be a part of these advances to help patients impacted by these diseases.

WHAT MADE YOU WANT TO JOIN THE SDMI FAMILY?
My wife was raised in Las Vegas and we have two boys and a girl on the way. We had lived away from family for so many years, we felt it was the perfect opportunity to be closer to family. When deciding on practices in the Las Vegas area, SDMI offered the best opportunity to continue broadening my career while delivering high quality care to all my patients.

HOW DO YOU SEE YOURSELF IMPACTING HEALTHCARE IN LAS VEGAS?
Medical education is growing in Las Vegas and with that comes innovation and opportunity. I see myself trying to attract new healthcare innovation to the Las Vegas area and somehow getting involved with medical education, all to continue to improve healthcare delivery in the city.

WHAT IS YOUR FAVORITE PART ABOUT BEING A DOCTOR?
Working in a team with the common goal to treat and heal people.

Photo: Dr. Tanner Jugler, Courtesy of SDMI