Conference Spotlight lecture: Dr. Gulliermo Cueto Robledo

Dr. Cueto as our featured speaker today at the National Conference of the Mexican Society of Pulmonology and Thoracic Surgery talking about pulmonary embolism.

Cancun, Mexico

The highlighted speaker for the conference today is the dynamic Dr. Gullermo Cueto Robledo of the General Hospital of Mexico City.  Dr. Cueto presentation was “Diagnostic opportunities in Pulmonary Embolism.”

Dr. Cueto at the 2012 Congreso Nacional de Neumologia y Cirugia de Torax

It was a standing room only crowd for his presentation on the incidence, mortality, diagnosis and treatment of pulmonary embolism.

Dr. Cueto reviewed the incidence of pulmonary embolism which occurs approximately 909, 753 times a year in the United States, with an estimated 296,370 deaths directly attributed to this phenomenon (2005, Journal of Thromboembolism & Hematology).

In a recent study at the Institute of Cardiology in Mexico City by Sandoval, 22.4% of all autopsies showed evidence of pulmonary embolism.

While many of the risk factors are well-known cardiovascular disease risks (obesity, hypertension, diabetes, smoking, elevated cholesterol) as well as traditional risk factors such as cancer/ malignant processes, venous stasis/ immobility, recent surgery and airline (or other travel) greater than two hours – Dr. Cueto discussed how pulmonary embolism is often overlooked.  He reviewed the existing criteria for predicting embolism risk such as the Wells, Winky (Geneva) scores, as well as the shortfalls of each of these scores, which often rely on subjective criteria on the basis of the individual applying the criteria.  He also talked about a recent paper suggesting a strong correlation between ST changes in aVR and presence of a right BBB in addition to the traditional S1Q3T3 finding on electrocardiogram.

He states that the strength of the D-dimer is not in it’s diagnostic capability but in it’s prognostic ability, as the elevated values at specific thresholds can be used to correlation both the location and risk of mortality.

Despite the advent of multi-modality imaging studies the gold standard remains the V:Q scan which is the only diagnostic tool to clearly rule out the presence of pulmonary emboli, along with the advantages and disadvantages of traditional and helical CT scans in addition to MRA (magnetic resonance imaging with angiography.)  He reports that initial enthusiasm for MRA has dampened due to multiple limitations in use as well as poor picture quality in comparison to other modalities. The main limitations of the multi-detector helical CT scan remain the inaccessibility and unavailability of this modality at many facilities due to cost.

He also reviewed the recently published guidelines from the American College of Chest Physicians (Chest, 2012) include very specific recommendations including initiation of thrombolytic and anti-coagulant therapies prior to formal or radiographic diagnosis in patients at high risk despite their classification of evidence as 2C.  These changes come due to recent studies showing adverse outcomes with delayed onset of treatment, with a marked shift around the twenty hour mark after the onset of the initial thrombotic event.  As he mentioned previously, since the majority of patients may demonstrate either vague or absent symptomatology on the onset of massive pulmonary embolism, these guidelines attempt to streamline and advance treatment that may be otherwise delayed by diagnostic testing.


(2012).  Antithrombotic treatment of venous thromboembolism.  ACCP guidelines.  Chest, 2012, supplement, 141(2) e4195 – e4945.

(2009).  Air travel and risk of thromboembolismAnn Internal Medicine 151 – 180: 190.  Review of the literature showing an 18% increase for every two- hour interval of travel.

Conference coverage: Congreso Nacional de Neumologia y Cirugia de Torax


Cancun, Quintana Roo – Mexico

I’m here at the National conference for pulmonologists and thoracic surgeons this year to hopefully interview (and possible recruit some surgeons to the research project).

It’s already been an eventful day, with several excellent presentations this morning as attendees continue to arrive to the official beginning of the conference tomorrow morning.   Extensive discussions on the multi-drug resistant tuberculosis started today and will continue for the rest of the week in addition to offering aimed at multiple specialties including surgery, nursing, respiratory therapy, pulmonology and general internists.

One of the featured presenters is Dr. Richard Light, MD who almost seems like family to me at this point, since I’ve been reading much of his previous work while I write a new case presentation about dual port thoracoscopy.  He’s one of the many people I hope to catch up with for a few minutes over the next few days.

Wish me luck!  I’ll continue to post about updates over the next several days.

Sociedad Mexicana de Neumologia y Cirugia de Torax

Cirugia de heads south of the border for the upcoming Sociedad Mexicana de Neumologia y Cirugia de Torax congreso (conference) this April. It’s also a chance for surgeons to find out more about the high altitude project.

The title of this post is apt in more ways that one.  The Mexican Society of Pulmonologists and Thoracic Surgeons is meeting for their 2012 annual meeting this April, and yes, Cirugia de is going to be there.  We’re hoping to interview and talk to some of Mexico’s greatest innovators and researchers in thoracic surgery during our visit this year.

We will be also talking about the high altitude lung surgery project with interested and potential participants – including prospective timelines, data collection tools (and validity of measurements), and expected responsibilities/ duties of site participants.

This year’s conference is being held in Cancun, from April 9th thru April 13th, 2012.  Check back in April for more news and conference coverage.