Background: Pulmonary tuberculosis (TB) is a chronic disease, with slow evolution and slow recove... more Background: Pulmonary tuberculosis (TB) is a chronic disease, with slow evolution and slow recovery with specific treatment. Some of the cases have differential diagnosis doubt over a long period of time. Material and methods: We present a series of 6 patients (5 females), mean age 43.1 years (range 27-70 years), with various respiratory symptoms and opacities on chest radiography, who needed multiple diagnosis procedures over a long period of time before the diagnosis of TB. Results: Mean delay of diagnosis was 19.1 month (range 5-24 months). Symptoms consist of: cough (6), dyspnea (4), and low grade fever (2). Chest X-ray showed: pulmonary micronodular pattern (4), consolidation (1), and pseudotumor (1). CT-scan showed “tree in bud” pattern in patients with micronodules on chest radiography. One patient monitored several times with CT-scan and bronchoalveolar lavage was diagnosed with TB after 2 years, when cavities appeared on CT-scan and sputum smear became positive for acid fas...
Post-intubation tracheal stenosis represents a severe complication in patients with hypercapnic r... more Post-intubation tracheal stenosis represents a severe complication in patients with hypercapnic respiratory failure due to COPD. We present a series of iatrogenic tracheal stenoses in COPD patients addressed to the Bronchology Department during 5 years. There were 13 patients (10 males, 46% over 60 years-old), COPD stage III-IV GOLD, who suffered a severe exacerbation that required oro-tracheal intubation; 8 needed tracheotomy.Tracheal stenoses developed after a mean period of 24 days (7-42) and were clinically significant. Bronchoscopy revealed tracheal stenosis with diameter less than 5 mm. 8 were located in proximal trachea and 5 in medial trachea, with length more than 2 cm in 7 cases and less than 2 cm in other 6. Initially, all were treated with interventional bronchoscopy (dilatation, granuloma resection) but the results were instable in time, requiring other methods: prosthetics (8 cases) or surgery (5 cases). In the patients treated by prosthesis, the stent was removed in 3 cases after 1,5-2 years, the rest remained chronic carriers of prostheses. The patients treated by surgery had significant complications: 1 death by mediastinis, 3 stenosis relapse on the anastomosis line (finally resolved with interventional bronchoscopy). Only one case was successfully solved after surgery. In conclusion, interventional bronchoscopy had a higher success rate (37%) than surgical therapy (20%), also solving the cases complicated post-surgery with reoccurrence of stenosis. While for different etiologies of tracheal stenosis, surgical resection is the first choice of treatment, in patients suffering from COPD, interventional bronchoscopy remains the only way to solve it.
This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exac... more This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exacerbation which required oro-tracheal intubation. The tracheal stenosis occurred on average after 24 days of intubation and were clinically severe. Treatment algorithm first included bronchoscopic interventional techniques with an immediate success rate of 37%, but the results were unstable in time, requiring tracheal stenting. The surgical approach, which generally is the first choice in the treatment of tracheal stenosis, had discouraging results in these patients, with a low rate of success (20%) and an increased incidence of restenosis. The only solution for those postoperative complications was, again, interventional bronchoscopy. In conclusion, while for various other etiologies of tracheal stenosis the surgical resection is the first choice of treatment, in COPD patients interventional bronchoscopy often remains the only way of solving.
Mediastinal cysts (MC) mainly have an embryonic origin, are benign and frequently discovered than... more Mediastinal cysts (MC) mainly have an embryonic origin, are benign and frequently discovered thanks to tomodensitometry, sometimes by magnetic resonance imaging. Rarely symptomatic, excepted in cases of very large cysts, they are mainly pleuropericardic cysts (PPC) that represent 30% of MC Surgery is commonly performed by videothoracoscopy or by video-assisted mini-thoracotomy, mainly for PPC We report the case of a 62-year-old woman, smoker (30 packs years), who is hospitalized in Constanta Pneumology Hospital in June 2011 for slight shortness of breath, sweating, pain in the left hemi thorax, minor hemoptysis, recurrent. In her medical history, there are to be noticed a blood transfusion after hysterectomy for uterine fibroma (1995), arterial hypertension (2006). After admission, X-ray exam of the chest shows cardiomegaly and a few lung nodular lesions in the right upper lobe. An initial differential diagnosis includes congestive heart failure, dilated cardiomyopathy, valvular hea...
Between November 2001-April 2010, 107 tracheal resections were performed in our department for di... more Between November 2001-April 2010, 107 tracheal resections were performed in our department for different types of tracheal stenosis: iatrogenic or tumoral, benign or malignant. We present the diagnosis and treatment principles that we used, along with our results. We operated on 74 (69.15%) iatrogenic postintubation tracheal stenosis, 6 (5.6%) of them complicated with tracheo-esophageal fistula, 6 (5.6%) benign tumors, 11 (10.28%) primary malignant and 16 (14.97%) secondary malignant ones, with a 3.8% total mortality. Tracheal resection and reconstruction is the only curative treatment for all types of tracheal stenosis. Interventional endoscopy is of a major importance in the assessment and treatment of tracheal stenosis. We believe that each patient diagnosed with a tracheal stenosis should be referred to a tertiary center with multidisciplinary experience in the treatment of tracheal stenosis.
Chirurgia toracică video-asistată CTVA (VATS) este, la ora actuală, practicată în întreaga lume p... more Chirurgia toracică video-asistată CTVA (VATS) este, la ora actuală, practicată în întreaga lume pentru aproape toate patologiile tratabile prin chirurgie toracică deschisă (toracotomie). Ca parte din chirurgia toracică miniminvazivă (MITS), CTVA sau VATS oferă atât pacienţilor cât şi medicilor rezultate excelente şi satisfacţii profesionale pe măsură. Acest articol prezintă VATS sub aspectele sale de clasificare, indicaţii şi contraindicaţii, instrumente, incizii şi abord, incidente şi conversie, curbă de învăţare şi training. Ne dorim ca aceste informaţii să fie de folos tuturor colegilor, rezidenţi sau medici cu experienţă chirurgicală toracică, pentru a putea începe şi continua în siguranţă VATS ca standard chirurgical toracic. chirurgie toracică video-asistată (CTVA-VATS), chirurgie toracică minim-invazivă (MITS), tehnică chirurgicală toracică, cancer pulmonary, metodă de învăţare CTVA-VATS, training în CTVA-VATS
INTRODUCTION: Pulmonary tuberculosis is an ancient contagious disease which remains a public heal... more INTRODUCTION: Pulmonary tuberculosis is an ancient contagious disease which remains a public health issue due to a large reservoir of latent infection (1). CASE PRESENTATION: We present a case of unique clinical presentation of tuberculosis in a patient with COPD. A 70 years old engineer, ex-smoker (55PA), with a history of tuberculosis (1967), systemic hypertension (since 2002), COPD (since 2006), who was admitted in 2009 for high fever, dyspnea, cough and muco-purulent sputum production. Physical examination revealed an underweight (BMI= 16,4 kg/m2) and febrile patient (38.2C), with cough, purulent sputum, pale skin, diaphoresis, dyspnea with orthopnea position, normal breath sounds bilateral with no pulmonary rales. The lab tests showed a mild leukocytosis with inflammatory syndrome (WBC 13.000/μL, ESR 74mm/h). Chest X-ray revealed a patchy condensation in the right upper lobe. Given the results of the investigations, community acquired pneumonia was suspected and antibiotic treatment was started while waiting for the culture results. Repeated cultures from sputum and bronchoalveolar lavage were negative for bacteries, including M. tuberculosis. The patient's clinical status worsened and the leukocytosis and inflammatory syndrome worsen (WBC-24.400/ μL, ESR-112mm/h, Fibrinogen-896mg/dL, CRP-171mg/L). The HRCT-scan revealed the persistence of the patchy condensation in the right upper lobe-figure 1. Bronchiolitis obliterans organizing pneumonia was suspected and corticotherapy was added. Patient's clinical status worsened again, with the persistence of negative repeated cultures for non-specific
Bronchial resection and anastomosis represents an alternative to the pneumonectomy in patients wi... more Bronchial resection and anastomosis represents an alternative to the pneumonectomy in patients with severe impairment of pulmonary function and/or other diseases which make such radical surgery too risky. The authors present two clinical cases of right upper lobe lung cancer (a squamous-cell carcinoma and an adenocarcinoma) admitted in the Thoracic Surgery Department of the National Institute of Pulmonology "Marius Nasta" from Jan-March 2001, in which they could not perform pneumonectomy because of unacceptable high risks. In both patients a right upper lobectomy with "sleeve" resection was done, with the anastomosis of right main bronchus to the intermediary one. The clinical, bronchoscopic and functional results were excellent. The literature review also shows very good results of this technique in the surgical treatment of lung cancer. For these reasons, the authors recommend this procedure in all the cases in which it can be technically applied; more than tha...
Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies ... more Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies in the world, an important number of such patients can necessitate, at a certain moment, a thoracic surgical intervention, especially pulmonary resections for pulmonary carcinoma. In these cases, the removing of a certain volume of pulmonary tissue from a patient who already has a respiratory malfunction necessitates a judicious preoperative evaluation to establish the correct indication, risk factors and postoperative prognosis (at least regarding the pulmonary function). Although the preoperative evaluation for pulmonary resections has been studied for many years, a parameter has not been found yet, simple or combined, to accurately predict the outcome. The majority of the candidates for pulmonary resections can be operated without previous complicated tests like CPET (cardio-pulmonary exercise testing) and regional pulmonary function, which are expensive and sometimes non accessible. ...
Tracheal stenosis is a disorder which is very difficult to diagnose in its early stages. Most cas... more Tracheal stenosis is a disorder which is very difficult to diagnose in its early stages. Most cases are reffered to the hospital with an obstruction of at least 50% of the tracheal lumen, when dyspnea is already symptomatic. The cases with obstructive phenomena of over 70% represent immediately endoscopic emergencies, due to the risk of decompensation by adding the obstruction secondary to tracheo-bronchial secretions and bleeding. Initial management of a compromised central airway by endoscopic technique allows to obtain optimal conditions for the curative treatment. The main cause is malignancy and the for treatment are used endoscopic techniques with palliative visa. After restoring the permeability of the affected airways, stenting is mandatory to keep them open. Among the first stents invented, there was Montgomery type in 1965. Besides the silicon stent, there are the newest type, metallic or hybrid, which try to compensate disadvantages of silicone type, but with significant ...
This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exac... more This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exacerbation which required oro-tracheal intubation. The tracheal stenosis occurred on average after 24 days of intubation and were clinically severe. Treatment algorithm first included bronchoscopic interventional techniques with an immediate success rate of 37%, but the results were unstable in time, requiring tracheal stenting. The surgical approach, which generally is the first choice in the treatment of tracheal stenosis, had discouraging results in these patients, with a low rate of success (20%) and an increased incidence of restenosis. The only solution for those postoperative complications was, again, interventional bronchoscopy. In conclusion, while for various other etiologies of tracheal stenosis the surgical resection is the first choice of treatment, in COPD patients interventional bronchoscopy often remains the only way of solving.
Mediastinal cysts (MC) mainly have an embryonic origin, are benign and frequently discovered than... more Mediastinal cysts (MC) mainly have an embryonic origin, are benign and frequently discovered thanks to tomodensitometry, sometimes by magnetic resonance imaging. Rarely symptomatic, excepted in cases of very large cysts, they are mainly pleuropericardic cysts (PPC) that represent 30% of MC Surgery is commonly performed by videothoracoscopy or by video-assisted mini-thoracotomy, mainly for PPC We report the case of a 62-year-old woman, smoker (30 packs years), who is hospitalized in Constanta Pneumology Hospital in June 2011 for slight shortness of breath, sweating, pain in the left hemi thorax, minor hemoptysis, recurrent. In her medical history, there are to be noticed a blood transfusion after hysterectomy for uterine fibroma (1995), arterial hypertension (2006). After admission, X-ray exam of the chest shows cardiomegaly and a few lung nodular lesions in the right upper lobe. An initial differential diagnosis includes congestive heart failure, dilated cardiomyopathy, valvular hea...
Pulmonary inflammatory pseudotumor (PIP) is a rare condition of unknown etiology. It is still a m... more Pulmonary inflammatory pseudotumor (PIP) is a rare condition of unknown etiology. It is still a matter of debate if it represents an inflammatory lesion characterized by uncontrolled cell growth or a true neoplasm. Although mostly benign, these tumors are diagnosis and therapeutic challenges. Preoperative diagnosis can rarely be established. The treatment of choice is surgical resection which has both diagnostic and therapeutic value. We report the case of a 63-year-old male presented with clinical and imagistic picture suggestive of malignancy in the thorax. Lobectomy was performed with histological diagnosis of PIP. No evidence of tumor recurrence.
Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies ... more Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies in the world, an important number of such patients can necessitate, at a certain moment, a thoracic surgical intervention, especially pulmonary resections for pulmonary carcinoma. In these cases, the removing of a certain volume of pulmonary tissue from a patient who already has a respiratory malfunction necessitates a judicious preoperative evaluation to establish the correct indication, risk factors and postoperative prognosis (at least regarding the pulmonary function). Although the preoperative evaluation for pulmonary resections has been studied for many years, a parameter has not been found yet, simple or combined, to accurately predict the outcome. The majority of the candidates for pulmonary resections can be operated without previous complicated tests like CPET (cardio-pulmonary exercise testing) and regional pulmonary function, which are expensive and sometimes non accessible. ...
Barrett esophagus is a rare medical entity. We present the case of a 56 years female patient admi... more Barrett esophagus is a rare medical entity. We present the case of a 56 years female patient admitted in our clinic for surgical treatment of a complication of a rigid stenosis of the lower esophagus. The situation is particular by the presence of two digestive strictures due to the same cause: gastric acid aggression. The steps of therapy of Barrett esophagus are reviewed, as well as the surgical options for choosing the best digestive segment able to replace the resected esophagus. The excellent immediate and long-term postoperative evolution allow us to believe that the surgical solution we used was the most appropriate and that the resected stomach can be successfully employed as a substitute for the esophagus after the resection of its lower half.
ABSTRACT Tuberculosis Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, Ma... more ABSTRACT Tuberculosis Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Pulmonary tuberculosis is an ancient contagious disease which remains a public health issue due to a large reservoir of latent infection (1). We present a case of unique clinical presentation of tuberculosis in a patient with COPD. A 70 years old engineer, ex-smoker (55PA), with a history of tuberculosis (1967), systemic hypertension (since 2002), COPD (since 2006), who was admitted in 2009 for high fever, dyspnea, cough and muco-purulent sputum production. Physical examination revealed an underweight (BMI= 16,4 kg/m2) and febrile patient (38.2C), with cough, purulent sputum, pale skin, diaphoresis, dyspnea with orthopnea position, normal breath sounds bilateral with no pulmonary rales. The lab tests showed a mild leukocytosis with inflammatory syndrome (WBC 13.000/μL, ESR 74mm/h). Chest X-ray revealed a patchy condensation in the right upper lobe. Given the results of the investigations, community acquired pneumonia was suspected and antibiotic treatment was started while waiting for the culture results. Repeated cultures from sputum and bronchoalveolar lavage were negative for bacteries, including M. tuberculosis. The patient's clinical status worsened and the leukocytosis and inflammatory syndrome worsen (WBC -24.400/ μL, ESR-112mm/h, Fibrinogen - 896mg/dL, CRP- 171mg/L). The HRCT-scan revealed the persistence of the patchy condensation in the right upper lobe-figure 1. Bronchiolitis obliterans organizing pneumonia was suspected and corticotherapy was added. Patient's clinical status worsened again, with the persistence of negative repeated cultures for non-specific bacteria and an exploratory thoracotomy with biopsy was performed. The pathological examination from the right upper and medium lobes showed extensive parenchymatous lesions with necrosis and granulomatous inflammatory infiltrates and fibous-exudative alveolitis, suggestive for pulmonary tuberculosis. The cultures for M. Tuberculosis came positive after 2 months. Treatment for tuberculosis was started immediately, with good outcome. Although a relationship between TB and COPD is likely, unfortunately it can not be assumed (2). So, we should always treat tuberculosis as a life-threatening infectious disease which remains a major global health issue, especially due to dormant bacteria.Reference #1: WHO 2010. Global tuberculosis control-surveillance, planning, financing. Geneva, Switzerland: WHO.Reference #2: Allwood BW, Myer L, Bateman ED A Systematic Review of the Association between Pulmonary Tuberculosis and the Development of ChronicAirflow Obstruction in Adults. Respiration. 2013 May 3DISCLOSURE: The following authors have nothing to disclose: Bianca Paraschiv, Claudia Lucia Toma, Stefan Dumitrache-Rujinski, Liliana Grigoriu, Ionela Nicoleta Belaconi, Codin Saon, Miron Alexandru BogdanNo Product/Research Disclosure Information.
Between November 2001-April 2010, 107 tracheal resections were performed in our department for di... more Between November 2001-April 2010, 107 tracheal resections were performed in our department for different types of tracheal stenosis: iatrogenic or tumoral, benign or malignant. We present the diagnosis and treatment principles that we used, along with our results. We operated on 74 (69.15%) iatrogenic postintubation tracheal stenosis, 6 (5.6%) of them complicated with tracheo-esophageal fistula, 6 (5.6%) benign tumors, 11 (10.28%) primary malignant and 16 (14.97%) secondary malignant ones, with a 3.8% total mortality. Tracheal resection and reconstruction is the only curative treatment for all types of tracheal stenosis. Interventional endoscopy is of a major importance in the assessment and treatment of tracheal stenosis. We believe that each patient diagnosed with a tracheal stenosis should be referred to a tertiary center with multidisciplinary experience in the treatment of tracheal stenosis.
Background: Pulmonary tuberculosis (TB) is a chronic disease, with slow evolution and slow recove... more Background: Pulmonary tuberculosis (TB) is a chronic disease, with slow evolution and slow recovery with specific treatment. Some of the cases have differential diagnosis doubt over a long period of time. Material and methods: We present a series of 6 patients (5 females), mean age 43.1 years (range 27-70 years), with various respiratory symptoms and opacities on chest radiography, who needed multiple diagnosis procedures over a long period of time before the diagnosis of TB. Results: Mean delay of diagnosis was 19.1 month (range 5-24 months). Symptoms consist of: cough (6), dyspnea (4), and low grade fever (2). Chest X-ray showed: pulmonary micronodular pattern (4), consolidation (1), and pseudotumor (1). CT-scan showed “tree in bud” pattern in patients with micronodules on chest radiography. One patient monitored several times with CT-scan and bronchoalveolar lavage was diagnosed with TB after 2 years, when cavities appeared on CT-scan and sputum smear became positive for acid fas...
Post-intubation tracheal stenosis represents a severe complication in patients with hypercapnic r... more Post-intubation tracheal stenosis represents a severe complication in patients with hypercapnic respiratory failure due to COPD. We present a series of iatrogenic tracheal stenoses in COPD patients addressed to the Bronchology Department during 5 years. There were 13 patients (10 males, 46% over 60 years-old), COPD stage III-IV GOLD, who suffered a severe exacerbation that required oro-tracheal intubation; 8 needed tracheotomy.Tracheal stenoses developed after a mean period of 24 days (7-42) and were clinically significant. Bronchoscopy revealed tracheal stenosis with diameter less than 5 mm. 8 were located in proximal trachea and 5 in medial trachea, with length more than 2 cm in 7 cases and less than 2 cm in other 6. Initially, all were treated with interventional bronchoscopy (dilatation, granuloma resection) but the results were instable in time, requiring other methods: prosthetics (8 cases) or surgery (5 cases). In the patients treated by prosthesis, the stent was removed in 3 cases after 1,5-2 years, the rest remained chronic carriers of prostheses. The patients treated by surgery had significant complications: 1 death by mediastinis, 3 stenosis relapse on the anastomosis line (finally resolved with interventional bronchoscopy). Only one case was successfully solved after surgery. In conclusion, interventional bronchoscopy had a higher success rate (37%) than surgical therapy (20%), also solving the cases complicated post-surgery with reoccurrence of stenosis. While for different etiologies of tracheal stenosis, surgical resection is the first choice of treatment, in patients suffering from COPD, interventional bronchoscopy remains the only way to solve it.
This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exac... more This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exacerbation which required oro-tracheal intubation. The tracheal stenosis occurred on average after 24 days of intubation and were clinically severe. Treatment algorithm first included bronchoscopic interventional techniques with an immediate success rate of 37%, but the results were unstable in time, requiring tracheal stenting. The surgical approach, which generally is the first choice in the treatment of tracheal stenosis, had discouraging results in these patients, with a low rate of success (20%) and an increased incidence of restenosis. The only solution for those postoperative complications was, again, interventional bronchoscopy. In conclusion, while for various other etiologies of tracheal stenosis the surgical resection is the first choice of treatment, in COPD patients interventional bronchoscopy often remains the only way of solving.
Mediastinal cysts (MC) mainly have an embryonic origin, are benign and frequently discovered than... more Mediastinal cysts (MC) mainly have an embryonic origin, are benign and frequently discovered thanks to tomodensitometry, sometimes by magnetic resonance imaging. Rarely symptomatic, excepted in cases of very large cysts, they are mainly pleuropericardic cysts (PPC) that represent 30% of MC Surgery is commonly performed by videothoracoscopy or by video-assisted mini-thoracotomy, mainly for PPC We report the case of a 62-year-old woman, smoker (30 packs years), who is hospitalized in Constanta Pneumology Hospital in June 2011 for slight shortness of breath, sweating, pain in the left hemi thorax, minor hemoptysis, recurrent. In her medical history, there are to be noticed a blood transfusion after hysterectomy for uterine fibroma (1995), arterial hypertension (2006). After admission, X-ray exam of the chest shows cardiomegaly and a few lung nodular lesions in the right upper lobe. An initial differential diagnosis includes congestive heart failure, dilated cardiomyopathy, valvular hea...
Between November 2001-April 2010, 107 tracheal resections were performed in our department for di... more Between November 2001-April 2010, 107 tracheal resections were performed in our department for different types of tracheal stenosis: iatrogenic or tumoral, benign or malignant. We present the diagnosis and treatment principles that we used, along with our results. We operated on 74 (69.15%) iatrogenic postintubation tracheal stenosis, 6 (5.6%) of them complicated with tracheo-esophageal fistula, 6 (5.6%) benign tumors, 11 (10.28%) primary malignant and 16 (14.97%) secondary malignant ones, with a 3.8% total mortality. Tracheal resection and reconstruction is the only curative treatment for all types of tracheal stenosis. Interventional endoscopy is of a major importance in the assessment and treatment of tracheal stenosis. We believe that each patient diagnosed with a tracheal stenosis should be referred to a tertiary center with multidisciplinary experience in the treatment of tracheal stenosis.
Chirurgia toracică video-asistată CTVA (VATS) este, la ora actuală, practicată în întreaga lume p... more Chirurgia toracică video-asistată CTVA (VATS) este, la ora actuală, practicată în întreaga lume pentru aproape toate patologiile tratabile prin chirurgie toracică deschisă (toracotomie). Ca parte din chirurgia toracică miniminvazivă (MITS), CTVA sau VATS oferă atât pacienţilor cât şi medicilor rezultate excelente şi satisfacţii profesionale pe măsură. Acest articol prezintă VATS sub aspectele sale de clasificare, indicaţii şi contraindicaţii, instrumente, incizii şi abord, incidente şi conversie, curbă de învăţare şi training. Ne dorim ca aceste informaţii să fie de folos tuturor colegilor, rezidenţi sau medici cu experienţă chirurgicală toracică, pentru a putea începe şi continua în siguranţă VATS ca standard chirurgical toracic. chirurgie toracică video-asistată (CTVA-VATS), chirurgie toracică minim-invazivă (MITS), tehnică chirurgicală toracică, cancer pulmonary, metodă de învăţare CTVA-VATS, training în CTVA-VATS
INTRODUCTION: Pulmonary tuberculosis is an ancient contagious disease which remains a public heal... more INTRODUCTION: Pulmonary tuberculosis is an ancient contagious disease which remains a public health issue due to a large reservoir of latent infection (1). CASE PRESENTATION: We present a case of unique clinical presentation of tuberculosis in a patient with COPD. A 70 years old engineer, ex-smoker (55PA), with a history of tuberculosis (1967), systemic hypertension (since 2002), COPD (since 2006), who was admitted in 2009 for high fever, dyspnea, cough and muco-purulent sputum production. Physical examination revealed an underweight (BMI= 16,4 kg/m2) and febrile patient (38.2C), with cough, purulent sputum, pale skin, diaphoresis, dyspnea with orthopnea position, normal breath sounds bilateral with no pulmonary rales. The lab tests showed a mild leukocytosis with inflammatory syndrome (WBC 13.000/μL, ESR 74mm/h). Chest X-ray revealed a patchy condensation in the right upper lobe. Given the results of the investigations, community acquired pneumonia was suspected and antibiotic treatment was started while waiting for the culture results. Repeated cultures from sputum and bronchoalveolar lavage were negative for bacteries, including M. tuberculosis. The patient's clinical status worsened and the leukocytosis and inflammatory syndrome worsen (WBC-24.400/ μL, ESR-112mm/h, Fibrinogen-896mg/dL, CRP-171mg/L). The HRCT-scan revealed the persistence of the patchy condensation in the right upper lobe-figure 1. Bronchiolitis obliterans organizing pneumonia was suspected and corticotherapy was added. Patient's clinical status worsened again, with the persistence of negative repeated cultures for non-specific
Bronchial resection and anastomosis represents an alternative to the pneumonectomy in patients wi... more Bronchial resection and anastomosis represents an alternative to the pneumonectomy in patients with severe impairment of pulmonary function and/or other diseases which make such radical surgery too risky. The authors present two clinical cases of right upper lobe lung cancer (a squamous-cell carcinoma and an adenocarcinoma) admitted in the Thoracic Surgery Department of the National Institute of Pulmonology "Marius Nasta" from Jan-March 2001, in which they could not perform pneumonectomy because of unacceptable high risks. In both patients a right upper lobectomy with "sleeve" resection was done, with the anastomosis of right main bronchus to the intermediary one. The clinical, bronchoscopic and functional results were excellent. The literature review also shows very good results of this technique in the surgical treatment of lung cancer. For these reasons, the authors recommend this procedure in all the cases in which it can be technically applied; more than tha...
Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies ... more Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies in the world, an important number of such patients can necessitate, at a certain moment, a thoracic surgical intervention, especially pulmonary resections for pulmonary carcinoma. In these cases, the removing of a certain volume of pulmonary tissue from a patient who already has a respiratory malfunction necessitates a judicious preoperative evaluation to establish the correct indication, risk factors and postoperative prognosis (at least regarding the pulmonary function). Although the preoperative evaluation for pulmonary resections has been studied for many years, a parameter has not been found yet, simple or combined, to accurately predict the outcome. The majority of the candidates for pulmonary resections can be operated without previous complicated tests like CPET (cardio-pulmonary exercise testing) and regional pulmonary function, which are expensive and sometimes non accessible. ...
Tracheal stenosis is a disorder which is very difficult to diagnose in its early stages. Most cas... more Tracheal stenosis is a disorder which is very difficult to diagnose in its early stages. Most cases are reffered to the hospital with an obstruction of at least 50% of the tracheal lumen, when dyspnea is already symptomatic. The cases with obstructive phenomena of over 70% represent immediately endoscopic emergencies, due to the risk of decompensation by adding the obstruction secondary to tracheo-bronchial secretions and bleeding. Initial management of a compromised central airway by endoscopic technique allows to obtain optimal conditions for the curative treatment. The main cause is malignancy and the for treatment are used endoscopic techniques with palliative visa. After restoring the permeability of the affected airways, stenting is mandatory to keep them open. Among the first stents invented, there was Montgomery type in 1965. Besides the silicon stent, there are the newest type, metallic or hybrid, which try to compensate disadvantages of silicone type, but with significant ...
This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exac... more This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exacerbation which required oro-tracheal intubation. The tracheal stenosis occurred on average after 24 days of intubation and were clinically severe. Treatment algorithm first included bronchoscopic interventional techniques with an immediate success rate of 37%, but the results were unstable in time, requiring tracheal stenting. The surgical approach, which generally is the first choice in the treatment of tracheal stenosis, had discouraging results in these patients, with a low rate of success (20%) and an increased incidence of restenosis. The only solution for those postoperative complications was, again, interventional bronchoscopy. In conclusion, while for various other etiologies of tracheal stenosis the surgical resection is the first choice of treatment, in COPD patients interventional bronchoscopy often remains the only way of solving.
Mediastinal cysts (MC) mainly have an embryonic origin, are benign and frequently discovered than... more Mediastinal cysts (MC) mainly have an embryonic origin, are benign and frequently discovered thanks to tomodensitometry, sometimes by magnetic resonance imaging. Rarely symptomatic, excepted in cases of very large cysts, they are mainly pleuropericardic cysts (PPC) that represent 30% of MC Surgery is commonly performed by videothoracoscopy or by video-assisted mini-thoracotomy, mainly for PPC We report the case of a 62-year-old woman, smoker (30 packs years), who is hospitalized in Constanta Pneumology Hospital in June 2011 for slight shortness of breath, sweating, pain in the left hemi thorax, minor hemoptysis, recurrent. In her medical history, there are to be noticed a blood transfusion after hysterectomy for uterine fibroma (1995), arterial hypertension (2006). After admission, X-ray exam of the chest shows cardiomegaly and a few lung nodular lesions in the right upper lobe. An initial differential diagnosis includes congestive heart failure, dilated cardiomyopathy, valvular hea...
Pulmonary inflammatory pseudotumor (PIP) is a rare condition of unknown etiology. It is still a m... more Pulmonary inflammatory pseudotumor (PIP) is a rare condition of unknown etiology. It is still a matter of debate if it represents an inflammatory lesion characterized by uncontrolled cell growth or a true neoplasm. Although mostly benign, these tumors are diagnosis and therapeutic challenges. Preoperative diagnosis can rarely be established. The treatment of choice is surgical resection which has both diagnostic and therapeutic value. We report the case of a 63-year-old male presented with clinical and imagistic picture suggestive of malignancy in the thorax. Lobectomy was performed with histological diagnosis of PIP. No evidence of tumor recurrence.
Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies ... more Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies in the world, an important number of such patients can necessitate, at a certain moment, a thoracic surgical intervention, especially pulmonary resections for pulmonary carcinoma. In these cases, the removing of a certain volume of pulmonary tissue from a patient who already has a respiratory malfunction necessitates a judicious preoperative evaluation to establish the correct indication, risk factors and postoperative prognosis (at least regarding the pulmonary function). Although the preoperative evaluation for pulmonary resections has been studied for many years, a parameter has not been found yet, simple or combined, to accurately predict the outcome. The majority of the candidates for pulmonary resections can be operated without previous complicated tests like CPET (cardio-pulmonary exercise testing) and regional pulmonary function, which are expensive and sometimes non accessible. ...
Barrett esophagus is a rare medical entity. We present the case of a 56 years female patient admi... more Barrett esophagus is a rare medical entity. We present the case of a 56 years female patient admitted in our clinic for surgical treatment of a complication of a rigid stenosis of the lower esophagus. The situation is particular by the presence of two digestive strictures due to the same cause: gastric acid aggression. The steps of therapy of Barrett esophagus are reviewed, as well as the surgical options for choosing the best digestive segment able to replace the resected esophagus. The excellent immediate and long-term postoperative evolution allow us to believe that the surgical solution we used was the most appropriate and that the resected stomach can be successfully employed as a substitute for the esophagus after the resection of its lower half.
ABSTRACT Tuberculosis Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, Ma... more ABSTRACT Tuberculosis Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Pulmonary tuberculosis is an ancient contagious disease which remains a public health issue due to a large reservoir of latent infection (1). We present a case of unique clinical presentation of tuberculosis in a patient with COPD. A 70 years old engineer, ex-smoker (55PA), with a history of tuberculosis (1967), systemic hypertension (since 2002), COPD (since 2006), who was admitted in 2009 for high fever, dyspnea, cough and muco-purulent sputum production. Physical examination revealed an underweight (BMI= 16,4 kg/m2) and febrile patient (38.2C), with cough, purulent sputum, pale skin, diaphoresis, dyspnea with orthopnea position, normal breath sounds bilateral with no pulmonary rales. The lab tests showed a mild leukocytosis with inflammatory syndrome (WBC 13.000/μL, ESR 74mm/h). Chest X-ray revealed a patchy condensation in the right upper lobe. Given the results of the investigations, community acquired pneumonia was suspected and antibiotic treatment was started while waiting for the culture results. Repeated cultures from sputum and bronchoalveolar lavage were negative for bacteries, including M. tuberculosis. The patient's clinical status worsened and the leukocytosis and inflammatory syndrome worsen (WBC -24.400/ μL, ESR-112mm/h, Fibrinogen - 896mg/dL, CRP- 171mg/L). The HRCT-scan revealed the persistence of the patchy condensation in the right upper lobe-figure 1. Bronchiolitis obliterans organizing pneumonia was suspected and corticotherapy was added. Patient's clinical status worsened again, with the persistence of negative repeated cultures for non-specific bacteria and an exploratory thoracotomy with biopsy was performed. The pathological examination from the right upper and medium lobes showed extensive parenchymatous lesions with necrosis and granulomatous inflammatory infiltrates and fibous-exudative alveolitis, suggestive for pulmonary tuberculosis. The cultures for M. Tuberculosis came positive after 2 months. Treatment for tuberculosis was started immediately, with good outcome. Although a relationship between TB and COPD is likely, unfortunately it can not be assumed (2). So, we should always treat tuberculosis as a life-threatening infectious disease which remains a major global health issue, especially due to dormant bacteria.Reference #1: WHO 2010. Global tuberculosis control-surveillance, planning, financing. Geneva, Switzerland: WHO.Reference #2: Allwood BW, Myer L, Bateman ED A Systematic Review of the Association between Pulmonary Tuberculosis and the Development of ChronicAirflow Obstruction in Adults. Respiration. 2013 May 3DISCLOSURE: The following authors have nothing to disclose: Bianca Paraschiv, Claudia Lucia Toma, Stefan Dumitrache-Rujinski, Liliana Grigoriu, Ionela Nicoleta Belaconi, Codin Saon, Miron Alexandru BogdanNo Product/Research Disclosure Information.
Between November 2001-April 2010, 107 tracheal resections were performed in our department for di... more Between November 2001-April 2010, 107 tracheal resections were performed in our department for different types of tracheal stenosis: iatrogenic or tumoral, benign or malignant. We present the diagnosis and treatment principles that we used, along with our results. We operated on 74 (69.15%) iatrogenic postintubation tracheal stenosis, 6 (5.6%) of them complicated with tracheo-esophageal fistula, 6 (5.6%) benign tumors, 11 (10.28%) primary malignant and 16 (14.97%) secondary malignant ones, with a 3.8% total mortality. Tracheal resection and reconstruction is the only curative treatment for all types of tracheal stenosis. Interventional endoscopy is of a major importance in the assessment and treatment of tracheal stenosis. We believe that each patient diagnosed with a tracheal stenosis should be referred to a tertiary center with multidisciplinary experience in the treatment of tracheal stenosis.
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