Rzumate Conferinta Oradea Oct 2017

A IX-a Conferin Naional de BRONHOLOGIE
The 9th National Conference of

BRONHOLOGY
A III-a Conferin Naional de CANCER PULMONAR

The 3rd National Conference of
LUNG CANCER
A II-a Conferin de
BOLI PULMONARE RARE
The 2nd Conference of
RARE LUNG DISEASES
Prima Conferin Naional de TRANSPLANT PULMONAR

The 1st National Conference of
LUNG TRANPLANTATION
11 14 OCTOMBRIE 2017
Oradea
CARTE DE REZUMATE
ABSTRACT BOOK
ISBN 978-973-0-25568-3
PREZENTRI ORALE
ORAL PRESENTATIONS
CURS 1/COURSE 1:
APORTUL ULTRASONOGRAFIEI PULMONARE N
DIAGNOSTICUL BOLILOR PULMONARE RARE
THE IMPORTANCE OF LUNG ULTRASOUND IN THE
DIAGNOSIS OF RARE LUNG DISEASES
APORTUL ULTRASONOGRAFIEI TORACICE IN DIAGNOSTICUL PNEUMONIILOR
PERIBRONSIECTAZICE IN BOLILE PULMONARE RARE
LAVINIA DAVIDESCU
Guidelines do not currently recommend the use of lung ultrasound as an alternative to chest
X-ray or chest computerized tomography scan for the diagnosis of pneumonia. The limitation of
chest x-ray in the emergency unit like the patient condition, time factor and the quality of the
interpretation which is variable is well known.
Lung ultrasound imaging for the detection of pneumonia is highly accurate, carries no risk
of irradiation, quickly performed, easily repeated and with a high sensitivity of 93,4% and a
specificity of 97%.
The main sonographic changes seen in pneumonia are: consolidation with air
bronchogram, fluid bronchogram, reverberation at the margins, abscess formation, regular
vascularization Consolidation and dynamic air bronchograms have the highest specificity for
pneumonia.
Being a non-invasive technique surely is a big advantage, recommending lung ultrasound,

in particular in the diagnosis of pneumonia in children, pregnant women and for the monitoring of
pulmonary lesions.
Conclusion
Pulmonary ultrasound method in the diagnosis of pneumonia is an rapid, safe and accurate
tool for diagnosis of pneumonia, which could replace even the Chest X-ray, especially in
pneumonia in children, pregnant woman and for lung lesions follow-up.
CURSUL 2/COURSE 2:
IMAGISTICA N CANCERUL BRONHOPULMONAR
LUNG CANCER IMAGING
APORTUL ULTRASONOGRAFIEI N PLEUREZIILE PARANEOPLAZICE
LAVINIA DAVIDESCU1, KISS EMESE2
1
Facultatea de Medicina si Farmacie, Oradea
2
Clinica Davidescu
Revarsatul pleural este frecvent intalnita atat in manifestarea clinica a bolilor maligne cat si a celor
benigne. Ultrasonografia pleurala este adesea efectuata pentru identificarea zonei anatomice
potrivite toracocentezei diagnostice sau terapeutice, dar in acelasi timp si diagnosticului diferential
cu : insuficiena cardiac, pleurezia parapneumonica, empiemul, embolia pulmonar, bolile
inflamatorii i afeciunile maligne.
Utilizarea ultrasonografiei pentru orice procedur pleural face parte din ghidurile oficiale i a
primit o recomandare puternic n ghidul British Thoracic Society din 2010.
Astfel intr-un studiu care a implicat 54 de pacieni cu revrsat pleural, ultrasonografic au fost
evidentiate modificari tipice asociate cu boli maligne: prezena ngroarii nodulare a diafragmei ,
n toate cazurile (15 din 15). Prin ecografia transtoracic s-a diagnosticat corect malignitatea la 26
din 33 pacieni (sensibilitate 73%, specificitate de 100%) i boala benigna la 19 din 19 pacienti.
Pleura ingrosata de peste 1 cm, pleura nodulara i ngroarea diafragmatica peste 7 mm au fost
foarte sugestive pentru etiologia neoplazica.
Ecografia transtoracica este util n diferenierea caracterului malign de cel benign la pacienii care
se prezint cu suspiciune de revarsat pleural malign. Prin urmare, poate fi util nu numai n
ghidarea toracocentezi i biopsiei, dar, de asemenea, ca manopera ce completeaza calea de
diagnostic.
THORACIC ULTRASOUND IN THE DIAGNOSIS OF MALIGNANT PLEURAL
EFFUSION
LAVINIA DAVIDESCU1, KISS EMESE2
1
Faculty of Medicine and Pharmacy, Oradea
2
Health Clinic Davidescu
Pleural effusion is a highly common clinical presentation in malignant and benign diseases. Pleural
ultrasound is often used to identify the most appropriate anatomical location to perform a
diagnostic or therapeutic thoracentesis, but at the same time also the differential diagnosis : heart
failure, parapneumonic effusion, empyema, pulmonary emboli, inflammatory disease and
malignancies.
The use of ultrasound for any pleural procedure is part of official guidelines and was given a
strong recommendation in the 2010 British Thoracic Society guideline .
In a study involving 54 patients with pleural effusion , typical findings on ultrasound have been
associated with malignancy: the presence of nodular thickening of the diaphragm was in all cases
(15 of 15). Transthoracic ultrasound correctly diagnosed malignancy in 26 of 33 patients
(sensitivity 73%, specificity 100%) and benign disease in 19 of 19 patients. Pleural thickening
above 1 cm, pleural nodularity and diaphragmatic thickening above 7 mm were highly suggestive
of malignant disease.
Transthoracic ultrasound (TUS) is useful in differentiating malignant from benign nature in

patients presenting with suspected malignant pleural effusion. TUS therefore may be useful, not
only in guiding thoracocentesis and biopsy, but also may become an important adjunct in the
diagnostic pathway to aid diagnosis.
CURSUL 3/COURSE 3:
CARE SUNT IMPLICAIILE CLINICE ALE
STADIALIZRII TNM 8?
WHAT ARE THE CLINICAL IMPLICATIONS OF THE
8TH EDITION OF TNM STAGING?
REALITY VERSUS THEORY IN LUNG CANCER MANAGEMENT
NATALIA MOTAS, MIHNEA DAVIDESCU, TEODOR HORVAT
Clinic of Thoracic Surgery, Institute of Oncology Bucharest, Romania

[email protected]
The paper presents objectively the way lung cancer is diagnosed, staged and treated in
Romania; each step is presented and compared with the recommendations from the existing guides.
The paper presents the surgeons point of view.
The main conclusion is: even if not all the diagnostic tools are widely available and even
not all the technical novelties in surgery are present, the appropriate surgical treatment is available
and it is applied for our patients, considering the international guides.
THE FAVORABLE PROGNOSTIC SIGNIFICANCE OF ATELECTASIS IN PATIENTS
WITH ADVANCED NON-SMALL CELL LUNG CANCER: RESULTS OF A
PROSPECTIVE OBSERVATIONAL STUDY
MIRCEA DEDIU
SANADOR Clinical Hospital Bucharest
Purpose: For lung cancer, the TNM staging system included atelectasis (At) as a negative
prognostic factor, within the T category. However, according to our clinical experience, we
observed the opposite. The aim of the study was to evaluate the influence of At on patient outcome
for unresectable stage III and IV non-small cell lung cancer (NSCLC).
Patients and methods:We prospectively evaluated the patient survival data, in correlation with
the presence, At(+), or absence, At(), of At. A distinct analysis according to stage was preplanned.
Univariate and multivariate analysis were performed to refine the prognostic significance of At.
Results: We evaluated 1352 consecutively treated patients, during 19972004. Sixty-eight patients
(5%)
were identified with At, of which 46/592 (8%) were in stage III, and 22/760 (3%) were in stage
IV. The
survival data were significantly better for patients At(+) vs. At(); median overall survival (OS):
21 months
(95% confidence interval [CI], 12.3729.63) vs. 10 months (95% CI, 9.2510.75) (p < 0.001), and
median
progression free survival (PFS):17 months (95% CI, 11.7122.29) vs. 7 months (95% CI, 6.48
7.52) (p < 0.001).
The most consistent difference, favoring patients At(+), was noted for patients in stage III, with
OS: 24
months (95% CI, 18.6529.35) vs. 14 months (95% CI, 12.4315.57) (p < 0.001), and PFS: 19
months (95%CI, 12.1125.89) vs. 8 months (95% CI, 6.899.02) (p < 0.001). In stage IV, we noted
a non-significant trend toward improved survival in patients At(+); OS: 16 months (95% CI, 4.49
27.51) vs. 9 months (95% CI, 8.519.49) (p = 0.21), and PFS: 8 months (95% CI, 5.8010.20) vs.
6 months (95% CI, 5.366.64) (p = 0.12). The multivariate analysis showed that At, stage and
ECOG performance status were independent predictors for survival.
Conclusion: At predicts a better survival in patients with advanced NSCLC. The prognostic value
is more
stringent for stage III patients. The 2016 revised edition of the TMN staging system withdrew At
from the non-sized base negative predictors, which is in line with our results.
LUNG CANCER UNEXPECTED LANDMARKS OF PREVENTION
RUXANDRA ULMEANU1,2,3, MD, PHD, FCCP; RAMONA NEDELCU2, MD ; ANDREEA

VLADAU2,3, MD, PHDS
1
President of Romanian Society of Pneumology;
2
National Institute of Pneumology Marius Nasta, Bucharest;
3
Faculty of Medicine University of Medicine and Pharmacy Oradea;
[email protected]
Lung cancer, already ranked first in the world in mobility and mortality data, can also be seen
under other aspects that influence the onset and evolution of the disease.
Inflammation is a triggering factor in the transformation and initiation of tumor progression in

cancer.
Non-steroidal anti-inflammatory treatment (NSAID) lowers lung cancer rates by 48% and
decreases the incidence of lung cancer associated with smoking by 26%, predominantly in men.
Aspirin reduces the risk of lung cancer in the Asian population, but increases the risk of small cell
lung cancer in Caucasian women.
Inhaled corticosteroids reduce the risk of lung cancer in patients with COPD.
Anti-inflammatory medication reduces the risk of lung cancer in histo-pathological subtypes and
requires extensive studies to outline a prevention algorithm depending on the genetic profile.
The study of pleiotropic associations by which a gene influences 2 or more phenotypic expressions
concludes COPD as an independent risk factor for lung cancer, and the association of COPD-
emphysema-smoking with high risk through the existence of multiple locus-susceptible genetic
variants.
Depending on the genetic profile associated with lung cancer, retrospective studies demonstrate
the susceptibility of adenocarcinoma in young, even children, exposed to passive smoking with
ALK translocations, young non-smoking predominantly women with EGFR mutations, young
smokers with ROS1 mutations.
Understanding the genome and epigenetic transformations involved in lung cancer determines the
course of therapy and can outline a prophylactic genetic testing algorithm for lung cancer risk.
Key words: broncho-pulmonary cancer, risk, anti-inflammatory, genome.

CANCERUL BRONHO-PULMONAR REPERE NEASTEPTATE ALE PREVENTIEI
RUXANDRA ULMEANU1,2,3, MD, PHD, FCCP; RAMONA NEDELCU2, MD ; ANDREEA
VLADAU2,3, MD, PHDS
1
Presedintele Societatii Romane de Pneumologie;
2
Institutul National de Pneumologie Marius Nasta, Bucuresti;
3
Facultatea de Medicina Universitatea de Medicina si Farmacie Oradea; [email protected]
Cancerul bronho-pulmonar, deja pe primul loc in lume in datele despre mobiditate si mortalitate,
poate fi privit si sub alte aspecte care influenteaza aparitia si evolutia bolii.
Inflamatia este un factor declansator al transformarii si initierii progresiei tumorale in cancer.
Tratamentul cu antiinflamatoare nesteroidiene (AINS) scade rata motalitatii prin cancer pulmonar
cu 48%, si scade cu 26% rata incidentei cancerului pulmonar asociat fumatului, predominant la
barbati.
Aspirina scade riscul de cancer pulmonar in populatia asiatica, dar creste riscul de cancer pulmonar
cu celule mici la femei caucaziene.
Corticosteroizii inhalatori scad riscul de cancer pulmonar la pacientii cu BPOC.
Medicatia anitiinflamatoare scade riscul de cancer pulmonar in subtipuri histopatologice si

necesita studii ample pentru a contura un algoritm de preventie in functie de profilul genetic.
Studiul asocierilor pleiotropice prin care o gena influenteaza 2 sau mai multe expresii fenotipice
concluzioneaza BPOC ca factor de risc independent pentru cancer pulmonar, iar asocierea BPOC-
emfizem-fumat cu risc crescut prin existenta multiplelor variante genetice locus-susceptibile.
In functie de profilul genetic asociat cancerului pulmonar, studiile retrospective demonstreaza

susceptibilitatea adenocarcinomului la tineri, chiar copii, expusi fumatului pasiv cu translocatii
ALK, tineri nefumatori predominant femei cu mutatii EGFR, tineri fumatori cu mutatii ROS1.
Intelegerea genomului si transformarilor epigenetice implicate in cancerul pulmonar determina

cursul terapiei si poate contura un algoritm de testare genetica profilactica a riscului de cancer
pulmonar.
Cuvinte cheie: cancer bronho-pulmonar, risc, antiinflamatoare, genom.
SIMPOZION MAJOR
DE LA PREVENIE LA SCREENING
MAJOR SYMPOSIUM
FROM PREVENTION TO SCREENING
WHAT ARE THE PARTICULARITIES OF LUNG CANCER IN WOMEN AND IN NON-
SMOKERS?
ANTIGONA TROFOR1, IONELA-ALINA GROSU2, CRISTINA CHIRILA3, IOANA

POROSNICU3
1
Grigore T. Popa University of Medicine and Pharmacy-Pulmonary Diseases Dept., Iasi,
Romania
2
Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania (Ph.D. Student)
3
Clinical Hospital of Pulmonary Diseases Iasi, Romania
Lung cancer is the leading cause of cancer-related mortality worldwide. If in the past this
disease was commonly associated with the male gender, an increase in its incidence among females
has been reported over the last years. Although lung cancer is frequently associated with tobacco
smoke, approximately 25% of all lung cancer is detected in never smokers and because of the
smoking prevention programs available now worldwide, its incidence is expected to increase.
Lung cancer in never smokers is now recognized as a distinct disease subset and from the
molecular point of view lung cancer in women should be considered a specific subset too. The risk
of lung cancer is greater in female never smokers than in male never smokers. There are gender
and smoking habit related differences in epidemiology, etiology, histology, genetic pathways and
disease outcomes. Unlike smokers in whom smoking is a major etiologic factor, in non-smokers
certain mutations seem to be the cause of cancer development. Although lung cancer mortality rate
has decreased among men, in women the mortality rate has dramatically increased. Lung cancer
in never smokers is more frequent in women and from the histological point of view
adenocarcinomas predominate. Furthermore, adenocarcinoma is significantly associated with
poorer survival. Because currently only few particularities of the lung cancer in never smokers and
in women are known further research should be made.
SIMPOZION MAJOR:
IMAGISTI - MICROBIOM - GENETIC -
BIOMARKERI N CANCERUL PULMONAR
MAJOR SYMPOSIUM
IMAGING - MICROBIOME - GENETICS - BIOMARKERS
IN PULMONARY CANCER
EVALUAREA CT A LEZIUNILOR PULMONARE NEOPLAZICE INCIPIENTE:
NODULI SOLIZI VERSUS STICL MATA
DIANA MANOLESCU, UNIVERSITATEA DE MEDICINA SI FARMACIE VICTOR

BABES, TIMISOARA
The imaging evaluation of a solitary pulmonary nodule is complex. Management decisions are
based on clinical history, size and appearance of the nodule, and feasibility of obtaining a tissue
diagnosis.
The most reliable imaging features are those that are indicative of benignancy, such as a benign
pattern of calcification and periodic follow-up with computed tomography for 2 years showing no
growth.
A solitary pulmonary nodule (SPN) is a round or oval opacity smaller than 3 cm in diameter that
is completely surrounded by pulmonary parenchyma and is not associated with lymphadenopathy,
atelectasis, or pneumonia.
Computed tomography (CT) features that are important to consider when determining the
likelihood of malignancy of an SPN are reviewed, including: nodule size, location, internal
attenuation characteristics (calcification, fat), margins, cavitation. An important CT features is the
nodule attenuation: solid, part-solid and non-solid.
Approximately 34% of nonsolid nodules are due to malignancy, while 40% to 50% of partly solid
nodules smaller than 1.5 cm in diameter are cancerous, and the risk of cancer increases with
increasing nodule size.
In using the various imaging and diagnostic modalities, one should strive to not only identify small
malignant tumorswhere resection results in high survival ratesbut also spare patients with
benign disease from undergoing unnecessary surgery.
Evaluarea imagistic a unui nodul pulmonar solitar este complex. Management se bazeaz pe
istoricul clinic, dimensiunea, aspectul nodulului i fezabilitatea obinerii unui diagnostic bioptic.
Arii de calcificare si un aspect stationar la monitorizarea tomografica periodica timp de 2 ani, sunt
caracteristici imagistice care indic benignitatea.
Nodul pulmonar solitar (SPN) este o opacitate rotund sau oval mai mic de 3 cm, care este
complet nconjurat de parenchim pulmonar i care nu se asociat cu adenopatii, atelectazie sau
pneumonie.
Caracteristicile tomografice (CT) care sunt importante pentru a determina probabilitatea
malignitii unui SPN includ: dimensiunea nodulului, localizarea, densitatea, marginile, cavitaia.
O caracteristic important CT este atenuarea nodulului: solid, parial solid i non-solid.
Aproximativ 34% dintre nodulii non-solizi sunt maligni, n timp ce 40% pn la 50% dintre nodulii
parial solizi mai mici de 1,5 cm n diametru sunt canceroi. Riscul de cancer este direct
proportional cu creterea in dimensiunii a nodulului.
Diagnostic imagistic este important atat in identificarea tumori maligne mici, n care rezecia
chirurgicala are ca rezultat rate nalte de supravieuire, cat i in identificarea pacieniilor cu tumora
benigna, evitand o intervenie chirurgicala inutila.
WHAT IS THE PLACE OF LIQUID BIOPSY (VERSUS SOLID BIOPSY) IN LUNG
CANCER DIAGNOSIS AND MANAGEMENT?
GABRIELA JIMBOREAN, ALPAR CSIPOR, EDITH S. IANOSI
University of medicine and Pharmacy, Tg. Mures
Liquid biopsy is a sampling and determination of a nonsolid tissue biopsy (from blood, or other
body liquid cerebrospinal or pleural liquid, urine, saliva, etc.) as a diagnosis/monitoring for
cancer. Analysis from liquid biopsy include detection of tumoral cells, circulating tumoral nucleic
acids (DNA or mRNA), tumor specific genes-alteration/mutations, exozomes, tumors biomarkers
(proteins/antigens released by the tumoral cells, antibodies against tumoral cells). Liquid biopsy
do not replace yet traditional tissue-based biopsies but could be an early diagnosis technique,
minimally invasive, confortable method for assessment of evolution under treatment, prognosis,
disease relapses, development of acquired resistance under cytostatic. The great advantages or the
liquid biopsies are that they are innocuous, non invasive, repeatable and they can detect very
small quantities of biomarker. It can be used for the primary or secondary tumor detection
(metastasis) and for treatment outcome and prognosis. Liquid biopsy could often eliminate the
complication or contraindication for the surgical biopsy. The sensitivity of the methods becomes
higher and higher along with the new discoveries and intensive researches in the field and will
enter soon into the clinical routine. The liquid biopsy could coexist with the traditional tissue-
based biopsies and indication will be individualized to the patient and type of the tumor. It will
improve detection of tumor phenotypes and rare genetically presentation. Liquid biopsies will
become in time cheap, significantly less costly than the surgical biopsies with important
diminishing of the discomfort and sides effects of the traditional biopsies. In the same time it will
improve the several diagnosis aspects and will allow early treatment beginning.
SIMPOZION MAJOR:
BRONGOLOGIE I
MAJOR SYMPOSIUM
BRONCHOLOGY I
ROLUL BRONHOSCOPIEI IN AUTOFLUORESCENTA IN DIAGNOSTICUL
PRECOCE AL CANCERULUI PULMONAR CENTRAL
AMULIU ARAMA
Spitalul de Pneumologie, Departamentul de Endoscopie bronsica, Iasi, Romania
Cancerul pulmonar este cel mai frecvent cancer, ca incidenta si mortalitate, iar cheia pentru
imbunatatirea supravietuirii in cancerul pulmonar este de a detecta boala ntr-un stadiu precoce.
Speranta ameliorarii depistarii leziunilor intr-un stadiu precoce este legata de aparitia noilor
tehnici: Bronhoscopia in autofluorescenta , Narrow band imaging, Microscopia confocala, etc
Bronhoscopia in Autofluorescenta este o tehnica de bioendoscopie care utilizeaza proprietatile de

fluorescenta si de absorbtie ale tesuturilor bronsice, expus unei lumini monocrome cu o anumita
lungime de unda (numita lumina de excitatie), pentru detectarea leziunilor bronsice preinvazive
si invazive precoce, la pacientii selectionati.
Lucrarea prezinta principiile autofluorescentei bronsice, principalele indicatii, exigentele si

limitele tehnicii
Bronhoscopia in Autofluorescenta este un instrument valoros in detectarea leziunilor bronsice

preinvazive si invazive precoce, la pacientii selectionati, pe baza unui risc foarte inalt, in
determinarea extinderii tumorilor bronho-pulmonare centrale, in detectarea cancerelor mici
sincrone sau metacrone, in ghidare biopsie bronhoscopice si ghidarea tratamentul endobronsic
minim invaziv
MANAGEMENT OF MAJOR COMPLICATIONS DURING BRONCHOSCOPY
ARIADNA PETRONELA FILDAN
Faculty of Medicine, Department of Internal Medicine, "Ovidius" University of Constanta,

Clinical Hospital of Pulmonology Constanta, Romania
email: [email protected]
Bronchoscopy is a widely used method carried out by pulmonologists but also many other
specialists, for diagnosis, therapeutics, and palliation. The procedure is generally safe and
effective, but as any minimally invasive/invasive procedure, there are numerous potential
complications that can occur. Basic precautions should be taken and a comprehensive patient
evaluation should be performed before the procedure. Complications may occur during
examination preparation, through the procedure itself or after the procedure. These complications
depend on procedure characteristics (e.g. flexible versus rigid bronchoscopy, type of anesthesia
and accessory techniques), patient characteristics (e.g. age, comorbidities) and technical factors
(e.g. operator expertise). Mechanical complications of bronchoscopy are primarily related to
airway manipulations or bleeding. Systemic complications arise from the procedure itself,
medication administration (primarily sedation), or patient comorbidities.
In this lecture, we will review the complications related to diagnostic and therapeutic
bronchoscopy as well as their management strategies, in hope of making practitioners who are
operators of these tools, and those who consult others for interventions, aware of potential
problems, and pitfalls in order to enhance patient safety and comfort.
MALIGNANT TRACHEAL TUMOURS
DOINA-ECATERINA TOFOLEAN, ARIADNA PETRONELA FILDAN, ADELINA

ANTON
Clinical Hospital of Constanta, Pneumology, Constanta, Romania
Primary malignant tracheal tumours are rare, accounting less than 1% of all malignancies and
consist of a heterogeneous group of benign and malignant tumours. Most primary cervical tracheal
tumours are malignant: adenoid cystic carcinoma, squamous cell carcinoma, adenocarcinoma,
mucoepidermoid carcinoma, carcinoid tumor, sarcoma, oat cell carcinoma, out of which squamous
cell carcinoma is the most common malignant form. These tumours are more common in male
smokers, with a peak of incidence in the sixth decade of life. Since there are general obstructive
symptoms as presenting features and no specific changes are seen on chest radiography, tracheal
carcinoma is frequently misdiagnosed, leading to misdiagnosis of chronic pulmonary disease.
Management of tracheal tumours include computed tomography, interventional endoscopy,
surgery, radiotherapy. Surgery, followed by adjuvant radiotherapy is the treatment of choice Thus,
in patients with unexplained symptoms, early thoracic computed tomography and bronchoscopic
examination can provide an appropriate diagnosis.
TUMORI TRAHEALE MALIGNE
DOINA-ECATERINA TOFOLEAN, ARIADNA PETRONELA FILDAN, ADELINA

ANTON
Patologia maligna traheala constituie o raritate in practica clinica, acest tip de tumori reprezentand
mai putin de 1 % din totatiltatea neoplasmelor si cuprinde un grup heterogen de tumori benigne si
maligne. Tumorile maligne traheale cuprind: carcinomul scuamos, carcinomul adenoid cistic,
carcinomul mucoepidermoid, adenocarcinomul, tumori carcinoide, carcinom bronhogenic
nonscuamos, sarcoame, adenom pleomorfic, carcinomul scuamos fiind principalul tip histologic.
Aceste tumori sunt mai frecvente in cazul barbatilor fumatori, cu un varf de incidenta in a sasea
decada de viata. Intrucat nu exista simptome specifice iar radiografia pulmonara nu prezinta
modificari caracteristice in cazul afectarii traheale, aceste tumori sunt diagnosticate tardiv sau
eronat. Managementul tumorilor traheale include computer tomografie, bronhoscopie, chirurgie,
radioterapie. Tratamentul de electie pentru acesti bolnavi este cel chirurgical, urmat de radioterapie
adjuvanta. De aceea, in cazul pacientilor cu simptome persistente neexplicate de o alta patologie,
evaluarea computer tomografia toracica timpurie si examinarea bronhoscopia conduc la un
diagnostic corect.
SIMPOZION MAJOR
BRONHOLOGIE II
MAJOR SYMPOSIUM
BRONCHOLOGY II
THE BEGINNINGS OF INTERVENTIONAL BRONCHOSCOPY AT THE FLORESCA
EMERGENCY HOSPITAL IN BUCHAREST
LIVIU VERINCEANU
Floreasca Emergency Hospital, Pneumology Department, Bucharest, Romania
Despite a major activity in the field of emergency medicine, bronchology had no

representation at the Floresca Hospital.
Back in 2015 BRONCHOSCOPY started at a modest level, within the framework of the internal
medicine service, under the protective wing of the digestive endoscopy laboratory.
With a minimal endowment (an Olympus exera 2 bronchscope) we began to do initially

bronchoscopy with diagnostic visa, then more and more with the interventional visa.
A turning point was represented by the fire in the Collective Club, when the importance of
bronchoscopy in the big burns, especially those who inhaled hot gases, smoke, toxic / corrosive
vapors, became obvious.
There was an episode that we could name the "Bad chance of persi-STENT asthma", an episode
that led to the installation of the first tracheobronchial stent in a patient with pulmonary neoplasm
with tracheal subtotal stenosis, left primitive stenosis and total obstruction of the primitive right.
Then, slowly, we started to mount stents in Y in J to perform double stents (tracheal and
esophageal in collaboration with gastroenterology colleagues), argon-plasma tumor
thermocoagulations, Cryobiopsis, transbronchial biopsies, foreign body extractions, stent
repositioning, tracheal dilatation and stenting, etc.
This paper aims to present some of the more special cases we have faced.
TRANSBRONCHIAL PERIPHERAL BIOPSIES ACCESSIBLE DIAGNOSTIC TOOL
IN ONCOLOGICAL PATIENT
NATALIA MOTAS1, MADALIN TETU2, FLORINA VASILESCU3, MIHNEA

DAVIDESCU1, VERONICA MANOLACHE1, ALIN BURLACU1, TEODOR HORVAT1
1
Clinic of Thoracic Surgery, Institute of Oncology Bucharest, Romania
2
Laboratory of Bronchoscopy, Institute of Oncology Bucharest, Romania
3
OncoTeam, Pathology Department, Monza Hospital Bucharest, Romania
[email protected]
Bronchoscopy is mandatory in patients with lung tumors. Beside the mucosal or tumoral
biopsy, a lot of technical procedures are available for cytology and histology diagnosis, as well as
staging. Among these, the transbronchial peripheral biopsy is possible at first endobronchial
examination, it requests no supplementary instruments and has a low complication rate.
In addition, in oncological patients with lung interstitial diseases, the transbronchial
peripheral biopsy is of real use.
Between January 2015 and June 2017 we performed transbronchial peripheral biopsies in
64 patients, in the Clinic of Thoracic Surgery, Institute of Oncology Bucharest. In patients with
lung tumor(s) we used no method of real-time guidance we used the CT-scan images for
orientation. Pathological diagnosis was made in 33 patients.
The diagnostic yield of our transbronchial peripheral biopsies is 51.56%, a very good value
considering the lack of real-time guidance.
THE IMPORTANCE OF BRONCHOSCOPY FOR THE VENTILATION OF THE
THORACIC SURGICAL PATIENT
GENOVEVA CADAR1, MIHAI ALEXE2, CIPRIAN BOLCA3
1
Institute of Pneumoftiziology " Marius Nasta", Departament of Anesthesia and Intensive Care,
Bucharest, Romnia
2
Institute of Pneumoftiziology " Marius Nasta", Departament of Bronchology, Bucharest, Romania
3
Institute of Pneumoftiziology " Marius Nasta", Thoracic Surgery Clinique, Bucharest, Romnia
Thoracic surgery is practically imposibil in the absence of bronchoscopy, either fiberoptic and/or
rigid bronchoscopy. Bronchoscopy is important in the hole perioperative management of the
thoracic surgical patient, but, obviously, the role in the ventilation is vital.
Fiberoptic bronchoscopy is indispensabile in case of difficult intubation, like in any other surgery,
but also for the correct positioning of the double lumen tube (especially in the right side or in case
of modified anatomy of the respiratory tract) and the correct positioning of bronchial blockers. It
is also absolutely necessary intraoperatively, in case of poor oxigenation, to establish the cause
and eventually to treat an obstruction and to reposition the tube in case of displacement.
Rigid bronchoscopy can also be usefull in special cases, like tight tracheal stenosis, to dilate the
trachea before intervention; in very difficult tracheal stenosis the rigid bronchoscope can even be
used for jet-ventilation untill a classical airway can be established.
As a concluzionat, tight colaboration between the anaesthesiologist and the bronchoscopist is

absolutely mandatory in the field of thoracic surgery, becouse the airway is frequently directy
implicated in the surgical process.
POSTINTUBATION TRACHEOESOPHAGEAL FISTULA WHAT SHOULD BE
DONE?
CIPRIAN BOLCA, IOAN CORDOS
Thoracic Surgery Division, Marius Nasta Institute of Pneumology, Bucharest
Introduction
Postintubation tracheoesophageal fistula is a severe complication occurring under certain

conditions in patients that require prolonged mechanical ventilation.
Material and methods
This presentation focuses on a sample of 15 patients with postintubation tracheoesophageal fistula,

operated in our department between 2005 and 2017. The anterior approach with tracheal resection
was performed in 13 of these patients, while other surgical technique was preferred in two atypical
cases. Three of these patients were subject to surgery while still on the ventilator, in order to help
weaning them from mechanical ventilation. Two patients were operated following a relapse of the
fistula, after attempts of closing it in other surgical units.
Results
Two patients (of those who were still on mechanical ventilation) died from intubation-related
complications that persisted after tracheal resection (anastomotic dehiscence with mediastinitis
and tracheoarterial fistula in the brachiocephalic arterial trunk). The 13 remaining patients
improved, with their airways restored and having regained normal deglutition.
Conclusions
The surgical approach of this pathology is successful in surgical units that are specialised in
tracheal and oesophageal surgery. Adequately timing the surgery is crucial for a good outcome.
SIMPOZION MAJOR:
TRANSPLANTUL PULMONAR
MAJOR SYMPOSIUM:
LUNG TRANSPLANT
LIMITS IN ADDRESSING PATIENTS FOR LUNG TRANSPLANTATION
CRISTIAN COJOCARU, ANDREI TUDOR CERNOMAZ
Gr. T. Popa University of Medicine and Pharmacy Iasi, Romania

Pulmonology
Lung transplantation is a medical and surgical intervention widely used but still not performed in
Romania. Although it is a new chance for life, transplanted patients are vulnerable and therapy
dependent.
Objective: highlighting pre-transplant management particularities in patients with chronic

respiratory diseases and future perspectives.
There are scientific guidelines in patient management for lung transplantation. However, out of
the guidelines we are confronting with severe restrictions from the health system, economical and
psychological acceptance from patients. Those limitations are less measurable and unpredictable,
so they could generate mistrust and confusion.
Conclusion: lung transplantation is a complex technique with a low rate of success in our country.
Pre-transplant management is under great pressure from mass media which could generate big
misunderstanding from the people. Discovering all the negative influences in the health system
can raise the trust in doctors.
Key words: lung transplantation, limitation, management

INCLUDEREA PACIENTULUI NTR-UN PROGRAM DE REABILITARE
PULMONAR PRE-TRANSPLANT
EMANUELA TUDORACHE, CRISTIAN OANCEA
Programele de reabilitare pulmonar (PRP) joac un rol esenial n transplantul pulmonar,

att prin optimizarea funciei fizice nainte de intervenia chirgical ct i prin facilitarea
recuperrii post-transplant. n ciuda faptului c aceste PRP sunt folosite n majoritatea centrelor
de transplant, pn la ora actual nu exist un ghid internaional de reabilitare pulmonar la aceast
categorie de pacieni. Interveniile medicale i chirurgicale n transplantul pulmonar au evoluat de-
a lungul timpului, astfel nct astzi se poate vorbi de transplant i n cazul persoanelor n vrst
sau a celor cu multiple comorbiditi i limitri funcionale.
Datorit faptului c mecanismele de limitare funcional pre-transplant sunt
multifactoriale, evaluarea acestor pacieni utilizeaz o baterie larg de teste ale capacitii de efort,
ale funciei musculare, ale gradului de mobilitate i ale nivelului de activitate fizic. Dup o
evaluare preliminar complex, realizat de ctre o echip interdisciplinar, se stabilete un PRP
individualizat care cuprinde obligatoriu tehnici de conservare a energiei, exerciii de for ct i
de anduran i exerciii de cretere a amplianei toraco-pulmonare. Toate acestea sunt premizele
unui prognostic mai bun i implicit a unor costuri mai reduse pentru sistemul de sntate.
BROCHOSCOPIC MONITORING AFTER LUNG TRANSPLANTATION
ARIADNA PETRONELA FILDAN, RUXANDRA ULMEANU

Oradea University, Faculty of Medicine and Pharmacy, Marius Nasta National Institute of
Pulmonology, Bucharest, Romania
Surveillance bronchoscopy in the care of lung transplant recipients remains a matter of

current debate. Although fiberoptic bronchoscopy facilitates early detection of acute pulmonary
allograft rejection or infection after lung transplantation, definitive evidence for a positive impact
on survival is yet to be demonstrated. Benefits of transbronchial lung biopsies include the
possibility of an early detection of specific histological features (especially acute cellular rejection
or lymphocytic bronchiolitis), which have been associated with higher risk of chronic lung
allograft rejection, and, also, the possibility of a longitudinal insight into immunological events in
the allograft, which can assist long-term management. Bronchoalveolar lavage is an important
method for the assessment of infection in immunosuppressed hosts. It helps to detect bacterial,
viral, fungal, and protozoal infections with high sensitivity and specificity. In addition, the
visualization of the anastomosis, performed at every fiberoptic bronchoscopy after lung transplant,
is of utmost importance for an early detection of anastomotic defects or possible dehiscence. The
large airway monitoring facilitates prompt attention to developing strictures and thereby prevents
downstream post-obstructive bronchiectasis. This lecture reviews the evidence for and against the
utility of performing surveillance bronchoscopy postlung transplantation, discuss the pro and con
arguments and how the application of this procedure can be customized in the individual patient.
SIMPOZION MAJOR
CAZURI CLINICE DE TRANSPLANT PULMONAR
MAJOR SYMPOSIUM
CLINICAL CASES - LUNG TRANSPLANT
HIPERTENSIUNEA ARTERIALA PULMONARA SI TRANSPLANTUL PULMONAR
NICOLETA BERTICI
Universitatea de Medicina si Farnacie Victor Babes Departamentul XIII Pneumologie,

Timisoara, Romania
[email protected]
Obiective: Evaluarea rolului si rezultatelor transplantul pulmonar la pacientii cu hipertensiune

arteriala pulmonara (PAH)
Metode: Analiza retrospectiva pe 10 ani a evolutiei pacientilor cu PAH aflati in programul national
de tratament, cu urmarirea indicatiei si a rezultatelor transplantului pulmonar.
Rezultate: Pe parcursul a 10 ani de derulare a PN de tratament a PAH (2008 - 2017) au fost tratati
in total 74 de pacienti. Am constatat decesul a 35 dintre acesti pacienti (47,29%). Au avut indicatie
de evaluare pentru transplant pulmonar 52 de pacienti (70,27), dar au ajuns sa fie evaluati intr-un
centru de referinta doar 7 pacienti (reprezentand 13,46 din cei 52 care aveau indicatie). Dintre
acestia doar 3 pacienti au fost inclusi pe lista de transplant (restul nu si-au completat investigatiile
sau au renuntat). O singura pacienta a ajuns sa fie transplantata la 8 luni de la punerea pe lista, dar
evolutia a fost nefavorabila, cu multiple complicatii postranspalnt si deces dupa un an. Al 2-lea
pacient a asteptat disperat 16 luni donatorul, dupa care a survenit decesul. Cea de-a 3-a pacienta
a prezentat o complicatie severa in 2016 (un abces cerebral, vindecat actualmente) si dupa 2 ani a
fost scoasa de pe lista de asteptare (a renuntat).
Concluziii: Indicatia teoretica de transplant o are un procent foarte mare de pacienti cu PAH, dar
conditiile practice (posibilitatile de adresare, costurile, suportul psihosocial, donatorii) sunt
dezastruoase iar rezultatele sunt modeste, discutabile.
THE IMPORTANCE OF LUNG TRANSPLANT IN A PATIENTS LIFE WITH
PULMONARY ARTERIAL HYPERTENSION
NICOLETA BERTICI
University of Medicine and Pharmacy Victor Babes , Department of Pneumology, Timisoara,

Romania
[email protected]
Introduction: Evaluating the role and results of lung transplantation in patients with pulmonary
arterial hypertension (PAH).
Method: 10-year retrospective analysis of the evolution of patients with PAH in the local national
treatment program, following the indication and results of lung transplantation.
Results: During the 10 years of PAH treatment registry (2008-2017), a total of 74 patients were
under treatment. 52 patients (70.2%) had indication for lung transplant evaluation, but only 7
patients (13.4% of those 52) were evaluated in a reference center. Only 3 patients were included
on the transplant list (the rest did not complete their investigations or gave up). Only one patient
was transplanted 10 months after listing, but the evolution was unfavorable, with multiple post-
transplant complications and death after one year. The second patient desperately waited for the
donor, however after 16 months death occurred. The third patient presented a severe complication
in 2016 (a brain abscess, currently cured) and after 2 years was removed from the waiting list.
Unfortunately 35 of patients (47.29%) have died.
Conclusions: The theoretical indication for lung transplantation has a very high percentage of
patients with PAH, but the practical conditions (addressing possibilities, costs, psychosocial
support, donors) are disastrous and the results are modest.
COMPLICAIE RAR A TRANSPLANTULUI PULMONAR
RARE COMPLICATION AFTER LUNG TRANSPLANTATION
TUDOR CONSTANTINESCU
UMF Carol Davila, Institutul Marius Nasta, Bucuresti
Double-lung transplantation represents a modern but complex therapeutical approach, addressed

to almost any end-stage pulmonary disease.
After recovering from the procedure, the patients usually are at risk for developing graft rejection
or various infectious complications due to complex and life-long immune-suppression. We present
the case of a male patient, transplanted in 2013 for idiopathic pulmonary fibrosis that developed
severe bilateral lung edema. The complex medical workup revealed a very rare complication of
lung transplantation that benefited from a curable treatment.
ALVEOLAR PROTEINOSIS INDICATION OR COMPLICATION OF LUNG
TRANSPLANT?
ELENA DANTES1, CLAUDIA LUCIA TOMA2
1
Faculty of Medicine, "Ovidius" University Constanta, Clinical Hospital of Pulmonology
Constanta, Romania, [email protected]
2UMF "Carol Davila", Department of Pneumology, Institute of Pneumophtisology Marius Nasta,
Bucharest, [email protected]
Pulmonary alveolar proteinosis (PAP) is characterized by abnormal accumulation of surfactant

within alveoli and terminal bronchioles. Granulocyte-macrophage colony stimulating factor
(GM-CSF) has an important role in the differentiation of alveolar macrophages, causing impaired
surfactant clearance in the most frequent forms as autoimmune PAP. The conventional treatments
are represented by whole-lung lavage and administering of inhale GM-CSF therapy. We present
the case of female, 45 years old, non smoker; diagnosed with PAP in May 2010 who received
bilateral sequential lung transplant three years later, due to a progressive dyspnea and deterioration
of lung function despite the traditional treatment. After 4 years and 5 months, the patient is stable,
in a good clinical condition and with a high quality of life. The evolution complicated with
pulmonary fibrosis and respiratory failure could be a bad prognosis factor and an indication for
the lung transplant in patients with PAP. Also, the cases reported in the literature underline that
PAP is both indication and a rare, possible complication of the lung transplant.
RARE DISEASES AS INDICATION FOR LUNG TRANSPLANTATION
CLAUDIA LUCIA TOMA1, ELENA DANTE2, STEFAN DUMITRACHE-RUJINSKI1,

MIRON ALEXANDRU BOGDAN1
1
Carol Davila University of Medicine and Pharmacy and Marius Nasta Institute of
Pneumology, Bucharest, Romania. [email protected]
2
Constanta, Romania, [email protected]
Advanced chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis,
emphysema due to alpha-1 antitrypsin deficiency, and pulmonary arterial hypertension are the
most common indications for lung transplantation, accounting for almost 85% of all procedures
performed worldwide. The remaining 15% consist of a variety of diagnoses of end-stage lung
disease such as: lymphangioleiomyomatosis, pulmonary Langerhans' cell histiocytosis,
sarcoidosis, alveolar proteinosis, etc.
We present our experience with patients with rare diseases which were transplanted in Vienna and
monitored both in Vienna and Bucharest.
RISK OF TUBERCULOSIS AFTER LUNG TRANSPLANTATION
ADRIANA SOCACI, VOICU TUDORACHE
Clinical Hospital of Infectious Diseases and Pneumology, Dr. Victor Babes, Timisoara,
Romania
Lung transplantation has become an accepted treatment for end-stage pulmonary parenchymal and
vascular diseases. Bacterial infections comprise approximately half of all infectious complications.
Infection with M. tuberculosis may occur due to reactivation, occult disease in the remaining native
lung after single lung transplantation, transmission by transplantation, or nosocomial infection.
Lung transplant recipients are at increased risk for infectious complications compared to other
solid organ transplant (SOT) recipients due to the direct contact between the pathogens and the
graft in an immunosuppressed patient. Other factors include: the loss of effective lymphatic
drainage, and the decrease of mechanical defense due to reduced mucociliary clearance and
decreased cough. Tuberculosis (TB) is a serious opportunistic infection reported in lung transplant
recipients. Its incidence ranges between 6.5% and 10%. Incidences among transplant recipients
varythe variation depends primarily on geographic location, and incidences range from 1% in
Europe and North America to 2%15% in Africa, the Middle East, and Asiabut are generally
greater than those in the general population. Rates also vary depending on the type of organ
transplant performed as well as on local screening practices and immunosuppression protocols.
The rates and risk of TB in transplant recipients are highly dependent upon the key features, such
as the frequency of TB in the recipient and donor population, the organ transplanted (highest in
lung transplant recipients), the type and intensity of recipient screening for TB, and the use of prior
or current anti-TB drug intake, preventively or curatively. The clinical manifestations of TB are
subtle and the diagnosis is difficult, which might lead to treatment delays, multiple repetition of
tests might be needed. The risk of TB is highest in the first year post-transplant, during the time of
maximal immunosuppression. Meticulous postoperative surveillance, however, is still crucial for
the management of lung transplant patients with respect to early detection and treatment of
rejection and infection. However, improved methods for screening organ donors and recipients
need to be identified, and alternative therapies that have lower toxicity profiles are needed for
transplant recipients.
KEYWORDS: lung transplantation, bacterial infections, tuberculosis

SIMPOZION MAJOR:
ABORDUL PACIENILOR CU FIBROZ PULMONAR

IDIOPATIC N PRACTICA CLINIC
MAJOR SYMPOSIUM:
THE APPROACH OF PATIENTS WITH IDIOPATIC

PULMONARY FIBROSIS IN CLINICAL PRACTICE
QUALITY OF LIFE IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS
DANIEL TRAILA, VOICU TUDORACHE
Clinical Hospital of Pneumophtysiology and Infectious Diseases Victor Babes, Pneumology,

Timisoara, Romania
Idiopathic pulmonary fibrosis (IPF), the most common form of idiopathic interstitial
pneumonias, is a fatal disease with a mean survival time of 24 years from the time of diagnosis.
Though the disease course may vary among patients and many patients experience periods of
relative stability, disease progression and worsening of symptoms are inevitable for the majority
of patients. The most common symptoms are dry cough, dyspnoea and fatigue. IPF patients are
susceptible to anxiety and depression. The combination of poor prognosis, uncertainty of disease
course and severe symptom burden heavily impacts quality of life (QOL) both for patients and
family members.
Management of IPF requires regular evaluations and implementation of both
pharmacological and nonpharmacological treatments. Antifibrotic therapies have a disease
modifying effect and slow down decline in lung function. Lung transplantation remains the only
curative treatment for the small minority of patients who are eligible for this major intervention.
Patients should be encouraged to attend a pulmonary rehabilitation maintenance programme,
which has been shown to improve dyspnoea, QOL, physical activity and body composition.
Patients with IPF may have subclinical or overt comorbid conditions including pulmonary
hypertension, gastroesophageal reflux, obstructive sleep apnea, obesity, and emphysema.
Identification and treatment of comorbidities may improve QOL and potentially influences
prognosis.
A synchronized comprehensive management strategy is vital to match IPF patients needs

throughout the disease course. A model for continuous care in IPF includes assessing patients
needs, backing patients by giving cinformation and support, delivering comfort care by focusing
on treating symptoms and taking into account comorbidities, striving to prolong life by disease
modification, helping and preparing patients and their caregivers for the eventual end-of-life events
that are likely to occur.
PARTICULARITI ALE REABILITRII PULMONARE N MANAGMENTUL
BOLILOR INTERSTIIALE PULMONARE
EMANUELA TUDORACHE, MONICA MARC, CRISTIAN OANCEA
Pneumopatiile interstiiale difuze (PID) i n mod special fibroza pulmonar idiopatic

reprezint un grup heterogen de peste 200 de entiti, care n majoritatea cazurilor prezint o
deteriorare accelerat a funciei pulmonare, un raspuns modest la tratamentul clasic i au un
prognostic rezervat pe termen lung. Datorit faptului c multe din terapiile farmacologice non-
specifice se dovedesc a fi insuficiente pentru ncetinirea ritmului de progresie al bolii, iar terapiile
specifice sunt adesea controversate i costisitoare, reabilitarea pulmonar (RP) trebuie s fac parte
obligatoriu din tratamentul integrativ al acestor complexe patologii.
Dup o evaluare preliminar realizat de ctre o echip multidisciplinar, se stabilete un
program de RP individualizat. Aceste programe se desfoar n centre specializate, sub
ndrumarea unor cadre medicale competente. Acestea vor prescrie tipul de exerciii necesare,
ritmul i nivelul de efort, combinnd diferite tehnici tehnici de conservare a energiei, exerciii de
rezisten i for a membrelor superioare i inferioare precum i exerciii de cretere a amplianei
toraco-pulmonare. Puinele studii disponibile la ora actual, au demonstrat c programele de RP
duc la creterea toleranei la efort, scderea gradului de dispnee i la mbuntirea calitii vieii
pacienilor cu PID. Pe lang diagnosticarea precoce, terapia farmacologic si RP, pacienii trebuie
consiliai n vederea renunrii la fumat, dietei alimentare, vaccinrii antigripale i
antipneumococice, oxigenoterapiei de lung durat i acolo unde este cazul, referire pentru
transplant pulmonar.
ECOGRAFIA PULMONARA SI PLAMANUL FIBROTIC - UTILITATE SI CORELATII
IMAGISTICE
DIANA MANOLESCU, VOICU TUDORACHE
Universtitatea de Medicina si Farmacie Victor BabesTimisoara
Obiectiv si metoda: HRCT este metoda imagistica de electie in diagnosticul pneumopatiilor

interstitiale difuze (PID) prin aprecierea patternului si a extensiei leziunilor pulmonare. Opacitati
reticulare cu distributie subpleurala, cu predominanta bazala ce asociaza leziuni chistice aerice de
tip honey-combing si bronsiectazii de tractiune, reprezinta modelul imagistic de pneumonie
interstitiala usuala (UIP), ce suprapune o fibroza pulmonara idiopatica (FPI).
Ecografia este o metoda de diagnostic non-invaziva, non-iradianta, ce apreciaza orice modificare
de densitate pulmonara. Multiple linii B (coada de cometa) si o ingrosare a liniei pleurale sunt
elementele de morfologie ecografica caracteristice unui sindrom interstitial fibros.
Au fost evaluati 23 de pacienti cu diagnostic de FPI realizat prin consens multidisciplinar.
Modificarile HRCT (opacitati in sticla mata, reticulatia, honey-combing, bronsiectazii) s-au
comparat cu cele ecografice (numarul de linii B si grosimea liniei pleurale). S-a apreciat: FVC,
TLC, DLCO.
Rezultate: toti pacientii au prezentat multiple linii B distribuite bilateral, cu o distanta medie intre
ele de 6,7mm, caracteristica unui sindrom interstitial. Gradul de severitate a fibrozei se coreleaza
direct cu numarul total de linii B, cu grosimea liniei pleurale si cu o scadere a DLCO si FCV.
Concluzie: ecografia pulmonara este o metoda utila in screeningul si monitorizarea fibrozei
pulmonare.
LUNG ULTRASOUND - A RELIABLE TOOL IN ILD ASSESSMENT
DIANA MANOLESCU1, VOICU TUDORACHE2
1
Radiology Department of University of Medicine and Pharmacy Timisoara, Romania
2
Pulmonology Department of University of Medicine and Pharmacy Timisoara, Romania
Objective: This study evaluated the sonographic features of interstitial syndrome and compare
them with the findings of chest high-resolution computed tomography (HRCT) and pulmonary
function tests (PFTs).
Materials & methods: High-resolution computed tomography (HRCT) is the method of choice
in assessment of the extent and the pattern of pulmonary fibrosis. Sub-pleural reticulation in a
basal predominance with honeycombing and bronchiectasis are HRCT findings of IPF.
Lung sonography is a non-invasive, non-radiation technique, very sensitive to detect any
alterations in the lung parenchymal density. Diffuse sub-pleural abnormalities as those occur in
IPF are characterized by the presence of multiple B-lines and thickening of pleura line.
Twenty three patients with a multidisciplinary consensus IPF diagnosis underwent lung ultrasound
(LUS) to assess the fibrotic index based on the evidence of B-lines and the characterization of the
pleura line. These findings were compared with HRCT features (ground glass, reticulation and
honey-combing) and with PFT: forced vital capacity (FVC), total lung capacity (TLC), diffusion
capacity for carbon monoxide (DLCO).
Results: All patients had diffuse bilateral B-lines. The main distance between two adjacent B lines
was 6.7mm suggestive for a predominant reticular pattern. Number of total B-lines correlated
directly with the severity of fibrosis on HRCT and inverse correlated with FVC, DLCO. A
fragmented, irregular, blurred pleura line are the features of severe fibrosis.
Conclusion: ultrasound fibrotic index is correlated with HRCT fibrotic index, when the severity
of the IPF is in counted. Therefore LUS is a non-radiation imagine technique reliable in IPF
screening and monitoring.
SIMPOZION MAJOR
PROTOCOALE DE TRATAMENT N FIBROZE DIFUZE
IDIOPATICE
SESIUNE INTERACTIV, CAZURI CLINICE
MAJOR SYMPOSIUM
TREATMENT PROTOCOLS IN IPF
INTERACTIVE SESSION, CLINICAL CASES
ASPECTE HCRT CARACTERISTICE UIP
DIANA MANOLESCU, CRISTIAN OANCEA
Universitatea de Medicina si Farmacie Victor Babes, Timisoara
Introducere: Fibroza pulmonar interstiiala, entitate clinic sau sindrom, cauz sau efect secundar n
multiple afeciuni pulmonare, a constituit i constituie subiectul a numeroase cercetri clinice i
experimentale. Morfopatologic se caracterizeaza printr-un ansamblu de leziuni elementare asociate in
diferite grade de severitate si care constituie un substrat polimorf pentru diagnosticul si interpretarea
computer tomografic. Identificarea corect a modelelor imagistice HRCT sugestive pentru o patologie
interstiial fibrozant este necesar pentru stabilirea prognosticului si a strategiei terapeutice.
Scop: Lucrarea de fata isi propune sa prezinte criterile imagistice de diagnostic plecand de elementele
anatomice ale lobului secundar, la caracterizarea tomografica a modelului de pneumopatie interstitiala
uzuala (UIP), cu cele trei grade (cert, posibil sau neconcludent). Limitele diagnosticului imagistic sunt
legate in special de tehnica de achizitie, prin lipsa de randomizare a acesteia, O alta sursa de controverse
este legata de diagnoza modificarilor de tip honeycombing -criteriu de UIP definit, cu variatii inter
si intraobservatori , respectiv a formelor imagistice atipice dar cu pattern definit histologic de UIP ce
necesita o evaluare multidisciplinara.
Concluzii: HRCT este metoda gold-standard in diagnosticul pneumopatiilor interstitiale fibrozante.
In ultimii ani, studiile bazate pe corelatiile radio-histologice, indica necesitatea revizuirii ghidurilor
(ATS/ERS/JRS/ALAT din 2011), cu reorganizarea in special a criteriilor imagistice de pattern definit/
posibil de UIP si validarea unor criterii, pentru stadiul incipient de fibroza care pot prezenta beneficiu
terapeutic.
Objective: Interstitial pulmonary fibrosis, clinical entity or syndrome, cause or side effect in multiple
pulmonary disorders has been the subject of numerous clinical and experimental research.
Radiologically and histopathologically, IPF is characterized by specific pattern called usual interstitial
pneumonia (UIP), however, this pattern is not fully typical in all cases, and, moreover, it could be seen
in other ILDs, e.g. chronic hypersensitivity pneumonitis, asbestosis, autoimmune connective tissue
diseases and many others as well. The correct identification of HRCT imaging models suggestive of a
fibrous interstitial pathology is necessary for establishing the prognosis and therapeutic strategy.
Aim: To present the diagnostic imaging criteria starting from the anatomical elements of the secondary
lobe in the tomographic characterization of the usual interstitial pneumonia (UIP) with the three degrees
(defined, possible or inconsistent). The limits of imaging diagnosis are mainly related to the acquisition
technique, due to its lack of randomization. Another source of controversy is related to the diagnosis of
honeycombing- defined UIP criteria with inter and intra-observator variations, respectively of the
atypical imaging forms with histologically defined pattern of UIP requiring a multidisciplinary
assessment.
Conclusions: HRCT is the "gold-standard" method in the diagnosis of IPF. In recent years, studies
based on radio-histological correlations indicate the need to revise the ATS / ERS / JRS / ALAT 2011
guidelines, especially of defined / possible UIP pattern criteria and validating criteria for the early stage
of fibrosis that may have therapeutic benefit.
MONITORIZAREA FIBROZEI PULMONARE IDIOPATICE SUB MEDICAIA
ANTIFIBROTIC
LAVINIA DAVIDESCU
Recent, in Romania, s-a aprobat Protocolul terapeutic de prescriptie a medicatiei

antifibrotice in Fibroza Pulmonara Idiopatica, dar utilizarea lui de catre medicii pneumolog, cat si
supravegherea si monitorizarea tratamentului antifibrotic sunt putin cunoscute.
Alegerea medicaiei antifibrotice se va face inand cont de forma de boal, criteriile de
excludere i contraindicaiile fiecrui produs. Monitorizarea tratamentului este obligaia medicului
pneumolog currant. Monitorizarea tratamentului presupune clinica, urmarind ameliorarea
simptomelor, aparitia eventualelor efecte adverse, precum si i biologica (transaminaze,
bilirubina, fosfataza alcalin) cel puin o dat pe lun n primele 6 luni apoi minim o dat la trei
luni.
Monitorizarea funcionala respiratorie se recomanda cel puin de trei ori pe an (minim
spirometrie i DLco) iar imagistic cel puin o dat pe an prin examen CT (de nalt rezoluie cu
seciuni subiri sub 3 mm).
Prezentam cazul unui pacient in varsta de 61ani, diagnosticat cu FPI din 2016, la care s-a
instituit medicatie antifibrotica de 4 luni, fiind monitorizat atent de catre clinica noastra.
MONITORING OF IDIOPATHIC PULMONARY FIBROSIS UNDER ANTIFIBROTIC
MEDICATION
LAVINIA DAVIDESCU
Recently, in Romania, the Therapeutic Protocol for the prescription of antifibrotic medication in
Pulmonary Idiopathic Fibrosis was approved, but the use and monitoring of antifibrotic treatment
by pneumologists are not well known.
The choice of antifibrotic medication will be made taking into account the form of the disease, the
exclusion criteria and the contraindications of each product. Treatment monitoring is the
responsibility of the Pneumologist. Clinical treatment monitoring is recommended, aiming at
symptom relief, possible adverse effects as well as biological (transaminases, bilirubin, alkaline
phosphatase) at least once a month for the first 6 months and at least every three months.
Functional respiratory monitoring is recommended at least three times a year (minimum

spirometry and DLCO) and imaging at least once a year through a CT exam (high resolution with
thin sections below 3 mm).
We present the case of a patient aged 61 yearsold, diagnosed with IPF in 2016, with 4-month
antifibrotic medication being carefully monitored by our clinic.
SIMPOZION MAJOR:
PROVOCRI DIAGNOSTICE I INTERFERENE
DEFICIT DE ALF-1 ANTITRISPUNA-IPF-EMFIZEM
PULMONAR
MAJOR SYMPOSIUM
DIAGNOSTIC CHALLENGES AND DEFICIENCY
INTERFERENCES OF ALFA-1 ANTITRYPSIN-IPF-
PULMONARY EMPHYSEMA
DAAT IN ROMANIA: UNDE NE AFLAM?
RUXANDRA ULMEANU, ANA ZAHARIE, SABINA ANTONIU, LAVINIA DAVIDESCU,

OANA ARGHIR, EMANUELA TUDORACHE, DANIELA BOLDEANU
Deficitul de alfa-1 antitripsina (DAAT) este o patologie recent cautata si recent identificata in
Romania. Screeningul pentru DAAT a inceput in Romania in 2012 prin bunavointa si ajutorul
National Institute of Tuberculosis and Lung Diseases, Varsovia. Pe perioada ultimilor 5 ani, un
numar de 770 persoane au fost testate (455 barbati, varsta medie de 49.7316.53 ani, volumul
expirator maxim pe secunda, VEMS mediu 63.6126.33%), cu rezultate disponibile pentru 741
pacienti (restul probelor in lucru). S-au identificat 56 (7.55%) genotipuri anormale (altele 5 fiind
in curs de secventiere genica). S-au identificat 7 cazuri de deficit sever (4 ZZ, 1 PlowellZ, 1 IZ,
1SZ), dintre care 3 cazuri sunt copii. S-au pus datele registrului nationala de deficit de alfa-1
antitripsina si urmaririi pacientilor si se fac eforturi pentru includerea pacientilor in studii clinice
pentru administrarea terapiei de augmentare.
DAAT IN ROMANIA: WHERE ARE WE?
RUXANDRA ULMEANU, ANA ZAHARIE, SABINA ANTONIU, LAVINIA DAVIDESCU,

OANA ARGHIR, EMANUELA TUDORACHE, DANIELA BOLDEANU
Alpha-1 antitrypsin deficiency (AATD) is a pathology recently sought and recently identified in
Romania. The AATD screening started in Romania in 2012 with the goodwill and help of the
National Institute of Tuberculosis and Lung Diseases, Warsaw. Over the past 5 years, 770
individuals were tested (455 men, mean age 49.73 16.53 years, mean forced expiratory volum
in 1 second, FEV1 of 63.61 26.33%), with results available for 741 patients (the rest of the
samples are still under processing). A number of 56 (7.55%) of abnormal genotypes were
identified (another 5 being undergoing gene sequencing). Among them, 7 cases of severe
deficiency were identified (4 ZZ, 1 PlowellZ, 1 IZ, 1SZ), of which 3 were children. The national
registry of alpha-1 antitrypsin deficiency data and patient follow-up were made and efforts were
made to include patients in clinical trials for augmentation therapy.
RISK OF LUNG DISEASE IN PI MZ HETEROZYGOTES
LAVINIA DAVIDESCU
Severe alpha-1 antitrypsin (AAT) deficiency, caused by the inheritance of two deficiency
alleles at the Serpina 1 locus, is a proven genetic risk factor for chronic obstructive pulmonary
disease (COPD). There are more than 100 alleles causing AAT deficiency, but most common
alleles associated with severe AATD are PI-ZZ. Heterozygotes for the Z allele (most commonly
PI MZ) have lower serum levels of AAT than normal individuals (PI MM), but the risk of lung
disease in PI MZ individuals remains uncertain.
The risk of lung disease in PI-MZ is controversial in different studies. Some case-control
studies found that prevalence of PI-MZ is increased in COPD population. With an estimated six
million PI MZ individuals in the US and over 10 million in Europe, determination of the COPD
risk in PI MZ individuals may have broad public health implications.
The majority of the studies show a a lower FEV1 values in PI-MZ heterozygotes than in PI MM,
and implicitly a higher risk of COPD. However, it is important to examine the interaction between
PI MZ genotype and cigarette smoking to accurately quantify risk in both smokers and non-
smokers.
MONITORIZAREA FUNCIEI PULMONARE I A CALITII VIEII N DAAT
EMANUELA TUDORACHE, DIANA MANOLESCU, CRISTIAN OANCEA
Deficitul de alfa 1 antitripsin (DAAT) este o afeciune genetic rar, subdiagnosticat, a

crei manifestare respiratorie tipic include emfizemul pulmonar, broniectaziile i boala
pulmonar obstructiv cronic cu debut precoce (nainte de 45 de ani). Aceste forme sunt severe,
ritmate de perioade de exacerbare, cu un raspuns modest la tratamentul clasic i cu o deteriorare
accelerat a funciei pulmonare. O data diagnosticai aceti pacieni, trebuiesc urmrii n dinamic
prin diferite investigaii de laborator (determinare plasmatic cantitativ a A1AT, examenul sputei,
hemoleucogram, transaminaze, fosfataz alcalin, etc.), imagistice (radiografie sau tomografie
computerizat toracic) i funcionale (spirometrie, DLCO, pletismografie), dar i prin chestionare
de evaluare a calitii vieii. Declinul funcional i al calitii vieii depinde de o multitudine de
factori individuali, mai mult sau mai puin modificabili (genotip, tipul i severitatea expresiei
clinice, afectare extrapulmonar, comorbiditi, accesul la terapie de substituie, nivelul de
educaie i aderena la tratament, ect.), astfel nct prognosticul acestei patologii este foarte
variabil.
SIMPOZION MAJOR
DAAT I ALTE BOLI RARE CU DETERMINARE
PULMONAR
MAJOR SYMPOSIUM
AATD AND OTHER RARE DISORDERS WITH
PULMONARY DETERMINATIONS
FEATURES OF IMMUNOCYTOKINE REGULATION OF THE SPECIFIC
INFLAMMATORY PROCESS IN THE LUNGS
L.D. TODORIKO, I.V. IEREMENCHUK, .. SEMIANIV
HSEI "Bukovinian State Medical University", Chernivtsi, Ukraine
The results of research studies indicate that there occurs a disturbance of the molecular
mechanisms of regulating cellular death due to an increased activity of the genes of external
modulators of apoptosis in the focus of inflammation.
Methods: ELISA assessment of cytokines (CK) plasma concentrations, particularly interleukins
(IL) IL-6, IL-10, IL-18 was performed with the analyzer Sunrise. Was performed morphological
study of bronchial epitheliocytes. Antigens Bax, Bcl-2, PCNA- and TUNEL-positive
immunohistochemistry definition was also carried out.
The study included 63 patients with Tuberculosis (TB).
Results. Assessment of IL-6 plasma concentration in pulmonary TB patients revealed a significant
1.7 folds increase (p<0.01), and, respectively, a significant 1.2 folds decrease in the level of IL-10
and IL-18 (p<0.001). Pearson correlation analysis between pro- and anti-inflammatory CK showed
that in patients with TB there is a weak, negative correlation between the levels of IL-6 and IL-10
between IL-18 and IL-10 (r=-0.22, p<0,001, and r=-0.16, p<0.001, respectively).
Conclusions. Comprehensive assessment level of pro- and anti-inflammatory CK level in TB
patients showed a moderate endogenous intoxication, break down of the cellular component of the
immune reactivity and the development of MBT resistance. Activated apoptotic process with a
transition into an uncontrollable naturally cell death is characterized by prevalence and progression
of TB process, clinical manifestation and prognosis of the residual changes formation.
CARACTERISTICILE CONTROLULUI PRIN IMUNOCYTOKINE A PROCESULUI
INFLAMATOR PULMONAR SPECIFIC
L.D. TODORIKO, I.V. IEREMENCHUK, .. SEMIANIV
HSEI "Universitatea de Medicin Bucovinean de Stat, Cernui, Ucraina
Rezultatele studiilor de cercetare indic faptul c exist o tulburare a mecanismelor moleculare de

reglare a apoptozei celulare, cauzate de amplificarea activiti genicemodulate la
nivelul inflamaiei.
Metode: testele ELISA privind concentraiile plasmatice ale citokinelor (CK), n special
interleukine (IL) , IL-6, IL-10, IL-18, a fost efectuat cu analizatorul Sunrise. S-a efectuat studiul
morfologic al celulelor epiteliale bronice. S-a procedat, deasemenea, la definirea antigenilor Bax,
Bcl-2, PCNA- i TUNEL-pozitive nucleara, prin analiza imunohistochimic .
Studiul a inclus 63 de pacienti cu tuberculoza (TB).
Rezultate. Evaluarea concentraiei plasmatice a IL-6 la pacienii cu TB pulmonar a evideniat o
cretere semnificative de 1,7 ori (p <0,01), i, respectiv, o scdere semnificativa de 1.2 ori n
nivelul de IL-10 i IL-18 (p <0,001). Analiza de corelaie Pearson ntre pro- i anti-inflamatory
CK a artat c la pacienii cu TB exist o corelaie slab, negativ ntre nivelurile de IL-6 i IL-10
ntre IL-18 i IL-10 (r = -0.22, p <0,001 respectiv r = -0,16, p <0,001s).
Concluzii. Studiul privind evaluare a nivelului pro- i anti-inflamatory CK la pacienii cu TB a
demonstrat o intoxicaie endogen moderat, afectarea componentei celulare a reactivitii
imune i dezvoltarea rezistenei MBT. Activarea procesului apoptotic, cu tranziia catre o moarte
natural celulara necontrolat, este data de prevalena si progresia procesului TBC, a
manifestarilor clinice i prognosticului sechelar.
UPDATES IN THE NONSPECIFIC THERAPY OF THE ALPHA 1- ANTITRYPSIN
DEFICIENCY
DANA OLAR1, LUMINITA COTUNA1, LAVINIA DAVIDESCU2
1
VGWU Arad
2
Faculty Of Medicine and Pharmacy Oradea
The ALPHA 1-ANTITRIPSIN deficiency represents a codominant autosomal hereditary

condition, characterized by low levels of Alpha1-antitripsin levels in plasma and tissues;
The AAT deficit favors the imbalance of the pulmonary protease-antiprotease balance;
- proteases such as the neutrophilic elastase are no longer counteracted in their action on the
lungs, leading to pulmonary lesions and emphysema
The clinical signs of the AAT deficit: strongly associated with the ZZ type of deficit; necrosing
panniculitis and necrotizing vasculitis may occur;
There have also been described associations of the AAT deficit with bronchiectasis, pulmonary
thromboembolism, hepatic primitive neoplasm, proliferative membranous glomerulonephritis,
perforated diverticulitis. The serious pulmonary impairment, expressed as COPD and panacinar
pulmonary emphysema, may occur when the AAT serum level is below the protector threshold of
35% of the normal average value.
1. Prevention of the pulmonary emphysema is achieving by stopping smoking and removing the
pollutants from the environment;
- the control of the respiratory infections and of the bronchial hyper-reactivity is useful by the
reduction of the neutrophilic charge at pulmonary level
- the reduction of the exposure to respiratory irritants (second-hand smoking, smoke, dust) up to
changing the workplace is required in certain situations; the anti-pneumococcal and anti-flu
vaccination
2. The nonspecific therapy: -bronchodilator in most of the cases with DAAT and obstructive
pulmonary condition
-CSI in some cases of bronchial hyperactivity
-antibiotics in case of bronchitis and upper respiratory tracts infections (macrolides)
-oxygen therapy for those who desaturate during exercises
- oral corticoids: for those with asthmatic obvious component
- fighting depression (agonist of the serotonin receptors)
- respire rehabilitation
- Intensive nutritional support
CONCLUSIONS: though the augmentation therapy represents the gold-standard, the
nonspecific therapy also brings its substantial contribution in improving the quality of life for the
patients with alpha 1-antitrypsin deficit
TELOMERII - FACTORI DE PROGNOSTIC NEGATIV IN DAAT
BOLDEANU DANIELA1, RAJNOVEANU RUXANDRA2
1
Spitalul Clinic de Pneumoftiziologie Leon Daniello, Cluj Napoca
2
Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj Napoca, Disciplina de
Pneumoftiziologie
Deficitul de 1-antitripsina (AATD) este un defect genetic, ereditar rar care duce la niveluri
plasmatice scazute de 1-antitripsina, fapt care determina o crestere semnificativa a riscul pentru
dezvoltarea bronhopneumopatiei obtructive cronice (BPOC) si cirozei hepatice la cei afectati.
Telomerii sunt structuri proteice a ADN localizate la capetele cromozomilor, protejandu-I de

degradare si fuziune cap-la-cap.
Numeroase studii au aratat ca stresul oxidativ din cadrul bolilor ulmonare severe accentueaza
scurtarea telomerilor si s-a gasit a fi asociat cu riscul de emfizem la pacientii cu BPOC.
Procesulu de scurtare a telomerilor este caracterizat prin stres oxidativ si inflamatie cronica, cu
relevanta clinica, care impune cercetari suplimentari. Mai mult, in cadrul pacientilor cu AATD,
lungimea telomerilor ar fi in directa relatie cu fenotipul AATD, sugerand astfel ca lungimea
telomerilor ar putea fi folosita ca si biomarker al progresiei AATD si afectarea pulmonara si
hepatica.
Studii recente coreleaza existenta anumitor fenotipuri de AATD si scurtare exponentiala a

telomerilor cauzate in principal de stresul oxidativ. Aceste noi date pot fi folosite in stabilirea unor
biomarkeri de progresie a AATD.
DEFICITUL DE ALFA1 ANTITRPSINA SI TRANSPLANTUL PULMONAR
LAVINIA DAVIDESCU1, DANA OLAR2
1
2
UVVG Arad
Deficitul de alfa 1 antitripsina (DAAT) este o boala genetica autosomal dominanta, care
afecteaza plamanii si ficatul, determinand la varste tinere emfizem pulmonar si BPOC, respectiv
colestaza, ciroza hepatica si chiar neoplasm hepatic.
Pacientii la care boala progreseaza in ciuda tratamentului medicamentos, la care nu se poate
efectua reducerea volumelor pulmonare operator sau prin implantare de valva endobronsica, care
au un index BODE 5-7 si VEMS <25% si nu prezinta contraindicatii absolute pentru
transplant, intrunesc criterii de indrumare spre un centru de transplant.
Pacientii cu DAAT vor intra pe lista de asteptare pentru transplant pulmonar daca prezinta
hipertensiune pulmonara arteriala moderata/severa si au un indice BODE>7, VEMS<15-20% si
un istoric de trei sau mai multe exacerbari cu insuficienta respiratorie si hipercapnie in ultimul an.
DAAT este a patra indicatie de transplant pulmonar dublu dupa BPOC, fibroza chistica si
PID.
Transplantul pulmonar este o optiune terapeutica insotita permanent de riscul de rejet al
grefei si de reactile adverse ale medicatiei imunosupresoare.
Daca rejetul grefei este principala cauza de deces imediat post transplant, in primul an o
reprezinta infectiile, ca apoi bronsiolitele sunt insotite de cea mai mare rata de mortalitate la
pacientii transplantati pulmonar.
Supravietuirea dupa transplant pulmonar a pacientilor cu deficit de alfa 1 antitripsina este
comparabila cu cea a pacientilor cu BPOC transplantati pulmonar. In cazul deficitului de alfa 1
antitripsina calitatea vietii pacientilor creste dupa transplatul pulmonar, dar nu si supravietuirea.
ALPHA1 ANTITRYPSIN DEFICIENCY AND LUNG TRANSPLANTATION
LAVINIA DAVIDESCU1, DANA OLAR2
1
2
UVVG Arad
Alpha 1 antitrypsin deficiency (AATD) is a dominant autosomal genetic disease that

affects the lungs and the liver, causing early pulmonary emphysema and COPD, cholestasis, liver
cirrhosis and even liver cancer.
The patients with AATD meet the required criteria in order to be guided to a lung transplant
center, only if: disease progresses despite the medical treatment; lung volume reduction or
endobronchial valve implantation is not possible; they present a BODE index between 5 and 7,
and a FEV1 smaller than 25%; there are no absolute contraindications for lung transplant.
AATD patients will enter on the lung transplant waiting list if they have moderate / severe
arterial pulmonary hypertension, a BODE index> 7, FeV1 <15-20% and a history of three or more
exacerbations with respiratory failure and hypercapnia in the last year. AATD is the fourth
indication of bilateral lung transplantation after COPD, cystic fibrosis and idiopathic pulmonary
fibrosys.
Lung transplantation is a therapeutic option always accompanied by the risk of graft

rejection reaction and effects of immunosuppressive medication. The graft rejection is the leading
cause of death immediately after lung transplantation.In the first year after lung transplant, the
main cause of death are infections and bronchiolitis. Survival after lung transplantation to patients
with alpha-1 antitrypsin deficiency is comparable to that of patients with COPD lung transplant.
In the case of alpha 1 antitrypsin deficiency, the quality of life of patients increases after
lung transplantation, but not the survival.
CLINICAL USE OF ALPHA-1 PROTEINASE INHIBITOR IN THE MANAGEMENT OF
ADULT PATIENTS WITH SEVERE ALPHA-1 ANTITRYPSIN DEFICIENCY
KISS EMESE1, LAVINIA DAVIDESCU1,2
1
2
Alpha-1 antitrypsin (AAT) functions primarily to inhibit neutrophil elastase, and its deficiency
predisposes individuals to the development of chronic obstructive pulmonary disease (COPD).
The protective serum concentration is generally considered to be above a threshold of 11 M/L,
and therapeutic augmentation of AAT above this value is believed to retard the progression of
emphysema.
Several AAT preparations derived from plasma have been commercialized since approval by the
US Food and Drug Administration (FDA) in 1987. Biochemical efficacy has been demonstrated
by augmentation of pulmonary antiprotease activity, but demonstration of clinical efficacy in
randomized studies has been tough to demonstrate by the practical difficulties of performing
conventional studies in a rare disease with a relatively long natural history.
Computed tomography has been shown to be more specific and sensitive than Pulmonary Function
test parameters e.g Forced expiratory volume in 1 second(FEV1) in the determination of lung
density in emphysema. Studies consistently show a therapeutic reduction in the rate of lung density
decline under the above treatment.
Intravenous administration of AAT at a usual dose of 60 mg/kg/week was demonstrated to be safe

and well tolerated. International and national guidelines on the management of AAT deficiency
recommend sequential intravenous therapy to complete the optimal treatment in COPD patients
with severe Alpha-1 Antitrypsin Deficiency.
SIMPOZION MAJOR
BRONHOLOGIE III
MAJOR SYMPOSIUM
BRONCHOLOGY III
HOT IN CRYO AND HOT THERAPY
MRIOARA IMON, ANTONIA HRNGU
Clinica Pneumoftiziologie, Cluj-Napoca
Cryotechnology has been used in treating lung cancer for many years, now it is emerging to have a new
indication in diagnosing lung diseases. Cryoprobe transbronchial lung biopsy has been introduced into
clinical practice as a new technique, providing a larger biopsy specimen, potentially improving the
diagnostic yield of transbronchial biopsies in parenchymal lung diseases. Bronchoscopic lung cryobiopsies,
may fit into the diagnostic algorithm of PID. Cryobiopsy is safe, has a high diagnostic yield and has lower
complication and mortality rates compared to SLB.
Advanced lung cancer can cause a severe worsening of the quality of life due to CAO. We will present the
advantages and disadvantages of this ablative methods: electrocautery, laser, APC and some good practice
points for bronchologists. Choosing the endoscopic techniques that will be used depend on the tumor and
patient characteristics, expertise of the team and on the available facilities. The best therapeutic approach
is a combination of the treatment modalities. Bronchoscopic treatments should be used for selected cases
and should be individualized for each patient.
Conclusions Cryobiopsy might be considered the first diagnostic approach for obtaining tissue in ILDs. Hot
bronchoscopic therapy may be curative or palliative and increases the quality of life of the patients.
BENIGN ENDOBRONCHIAL PROLIFERATION PROCESSES - DIAGNOSIS AND
TREATMENT
GABRIELA JIMBOREAN, ALPAR CSIPOR, MIOARA SZATMARY, EDITH SIMONA

IANOSI
University of Medicine and Pharmacy, Tg. Mures
Benign tumors of the trachea and great bronchi are uncommon. The most frequent benign tumors
are: hamartoma, lypoma, condroma, leiomyoma, neurogenic tumors, squamous/glandular cells
papilloma, adenomas, fibro epithelial polyps, amyloid tumors. Depending on endobronchial and
vascular development they can induce airway obstruction and atelectasis, hemorrhages, recurrent
infection/suppuration. The main symptoms that drive the further investigation (chest X-ray, CT,
bronchoscopy) are chronic cough, stridor, wheezing, dyspnea, hemoptysis, recurrent bronchial or
pulmonary infections and chest pain. Firstly it must establish the benign character of the tumor by
biopsy/histological exam, the tumor size, location and extension (by CT/PET-CT), the presence of
extrabronchial growth and the functional status of the patient. Nowadays endoscopic resection
techniques for benign tumors are effective, safe, avoid surgery and general anesthesia complication
and could solve the cases with contraindication or patient refusal for surgery. The most used
minimally interventional bronchoscopy techniques are: Nd YAG Laser, microwave, argon plasma
coagulation, electrocautery, high radiofrequency snaring, dehydrated ethanol injection therapy,
cryotherapy, and forceps resection. The different maneuvers can be performed via flexible or rigid
bronchoscopy. Choosing the type of bronchoscope depends on tumor location, size and cardio
respiratory condition of the patient. The flexible bronchoscope may be used in small, easy
removable tumor, distal or superior lobe tumor location where the rigid device could not reach the
lesion (the blind zone). The rigid bronchoscope are preferred when there is a greater bleeding
risk and a need for rapid secretion aspiration, stenting, laser or thermal ablation, argon plasma
coagulation, large tissue removal. The two bronchoscopes can be used also simultaneously. The
tumor management will be individualized in each patient according to the tumor characteristic
presented above and upon the cardio - respiratory condition. Surgery should be considered in
patients with extra bronchial invasion, large size of the tumor, organized post obstructive
atelectasis or secondary suppuration.
SIMPOZION MAJOR
ENDOSCOPIA PULMONAR PROBLEME I SOLUII
N ANUL 2017
MAJOR SYMPOSIUM
LUNG ENDOSCOPY PROBLEMS AND SOLUTIONS IN
2017
BRONHOSCOPY UPDATE 2017
RUXANDRA ULMEANU1,2,3, MD, PHD, FCCP; ANDREEA VLADAU2,3, MD, PHDS
1
President of Romanian Society of Pneumology;
2
National Institute of Pneumology Marius Nasta, Bucharest;
3
Faculty of Medicine University of Medicine and Pharmacy Oradea;
[email protected]
Bronchoscopy, method of diagnosis in respiratory medicine, is continuously updated in terms of

technique and procedures in various respiratory pathologies.
In pulmonary tuberculosis, frequent pathology in our country, fluorescence in sputum exam is
diagnostic. However, up to 50% of cases may have negative smear at microscopy and cultures,
and alternative diagnostic methods are required.
The first option should be sputum induced, and the second option bronchial lavage performed by
bronchoscopy for non-responder.
Between the two procedures there is no significant difference in diagnostic sensitivity of Koch
bacillimicroscopy and cultures.
The presence and persistence of ground-glass opacities, which involves differential diagnosis
pulmonary tuberculosis-lung cancer, requires surgical intervention.
Preoperative bronchoscopy does not add extra data and routine bronchoscopy has limited value in
these cases.
Transbronchial lung cryo-biopsy, in a multidisciplinary team, with deep sedation, with the benefit
of lower costs, is recognized in recent studies as an effective method of diagnosis of pulmonary
interstitial lung disease similar to pulmonary biopsy by assisted video-thoracoscopy.
Complications of transbronchial cryo-biopsy are pneumothorax and moderate bleeding.

Peripheral lung lesions and solitary pulmonary nodule can be effectively approached by radial eco-
endoscopy (EBUS). Combining electromagnetic navigation (EMN) with EBUS modestly
improves diagnostic sensitivity.
The new "spyglass" technique complementing radial EBUS in distal lesions increases diagnostic
precision by detecting the place for biopsy and complications.
The nasal or oral approach in linear EBUS is the patient's and physician's options, being similar in
terms of comfort, complications, and the rate of diagnosis.
Re-biopsy through EBUS-TBNA or EBUS-Spyglass techniques increases effectiveness in the

detection of the non-small cell lung cancer (NSCLC) with EGFR mutation tyrosine-kinase-
resistant.
EBUS-TBNA is effective in staging lung cancer, including for mechanically ventilated patients,
and can approach left adrenal.
Advanced bronchoscopy techniques and associated combined procedures improve the cost-
effectiveness in diagnosis of respiratory diseases.
Key words: bronchoscopy, diagnosis, EBUS, respiratory pathology.

BRONHOSCOPIA UPDATE 2017
RUXANDRA ULMEANU1,2,3, MD, PHD, FCCP; ANDREEA VLADAU2,3, MD, PHDS
1
Presedintele Societatii Romane de Pneumologie;
2
Institutul National de Pneumologie Marius Nasta, Bucuresti;
3
Facultatea de Medicina Universitatea de Medicina si Farmacie Oradea;
[email protected]
Bronhoscopia, metoda de diagnostic in medicina respiratorie, este actulalizata continuu in ceea ce

priveste tehnica si procedurile in diverse patologii respiratorii.
In tuberculoza pulmonara, frecventa patologie in tara noastra, fluorescenta la examenul sputei este
diagnostica. Insa, pana la 50% din cazuri pot avea microscopie si culturi negative si se impun
metode alternative de diagnostic.
Prima optiune ar trebui sa fie sputa indusa, iar a doua optiune lavajul bronsic efectuat prin
bronhoscopie pentru non-responderi. Intre cele doua proceduri nu este o diferenta semnificativa
de sensibilitate diagnostica a microscopiei si culturilor bacilului Koch.
Prezenta si persistenta opacitatilor in sticla mata ce presupune diagnostic diferentierea

tuberculoza pulmonara-cancer pulmonar, impune interventia chirurgicala.
Bronhoscopia preoperatorie nu aduce date suplimentare si bronhoscopia de rutina are valoare

limitata in aceste cazuri.
Crio-biopsia pulmonara transbronsica, in echipa multidisciplinara, cu sedare profunda, cu

avantajul costurilor mai reduse, este recunoscuta in studii recente ca metoda eficienta de diagnostic
al bolilor interstitiale pulmonare similara cu biopsia pulmonara prin video-toracoscopie asistata.
Complicatiile crio-biopsiei transbronsice sunt pneumotoraxul si sangerarea moderata.
Leziunile pulmonare periferice si nodulul pulmonar solitar pot fi abordate eficient prin
ecoendoscopie (EBUS) radiala. Asocierea navigatiei electromagnetice (EMN) la EBUS
imbunatateste modest sensibitatea diagnostica.
Noua tehnica spyglass in completarea EBUS radial in leziunile distale creste precizia diagnostica
prin detectia locului pentru biopsie si a complicatiilor.
Abordul nazal sau oral in EBUS liniar sunt optiunile pacientului si medicului, fiind similare sub
aspectul comfortului, complicatiilor si ratei diagnosticului.
Re-biopsia prin tehnici EBUS-TBNA sau EBUS-spyglass creste eficienta in detectia profilului
genetic al cancerului pulmonar cu celule non-mici (NSCLC) cu mutatie EGFR rezistente la
tratamentul cu tirozin-kinaza.
EBUS-TBNA este eficienta in stadializarea cancerului pulmonar, inclusiv in cazul pacientilor

ventilati mecanic, si poate obtine punctie adrenala stanga.
Tehnicile avansate de bronhoscopie si procedurile asociate combinate imbunatatesc cost-eficienta

diagnosticului bolilor respiratorii.
Cuvinte cheie: bronhoscopia, diagnostic, EBUS, patologie respiratorie

BRONHOSCOPIA N SERVICIILE DE TERAPIE INTENSIV- PARTICULARITI
PENTRU ROMNIA
EMANUELA TUDORACHE, MONICA MARC, CRISTIAN OANCEA
Fibro-bronhoscopia (FB) a devenit un instrument indispensabil nu numai pentru

pneumologi, ci i pentru anesteziti pentru obinerea unei intubri corecte i pentru mbuntirea
ventilaiei i oxigenrii pacientului aflat n unitatea de terapie intensiv (TI). Pacienii aflai pe
secia de TI, susinui de ventilaia mecanic, prezint adesea patologii severe i comorbiditi
semnificative astfel nct FB are anumite particulariti pornind de la poziionarea pacientului, la
diametrul canalului de aspiraie i pn la componena echipei care efectueaz procedura. FB n
unitatea de TI este util n cazurile de intubare dificil, n tratamentul secreiilor bronice i a
hemoptiziilor masive, pentru diagnosticul etiologic al infeciilor legate de ventilator, pentru
biopsierea unor leziuni suspecte/formaiuni tumorale, n managemetul traheostomelor, fistulelor
sau a corpilor strini, ect. Aceast procedur mbuntete supravieuirea i calitatea vieii
pacienilor i reduce perioada de spitalizare i costurile pentru sistemul de sntate.
SIMPOZION MAJOR:
MANAGEMENTUL CANCERULUI PULMONAR
MAJOR SYMPOSIUM
MANAGEMENT OF LUNG CANCER

INTERACTIONS (PATHOGENESIS, DIAGNOSIS AND TREATMENT) BETWEEN
CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND LUNG CANCER
ADRIANA SOCACI
Clinical Hospital of Infectious Diseases and Pneumology, Dr. Victor Babes, Department of
pneumology, Timisoara, Romania
Chronic obstructive pulmonary disease (COPD) and lung cancer are leading causes of morbidity
and mortality in the worldwide that commonly coexist and present a number of medical challenges.
They share a common environmental risk factor in cigarette smoke exposure and a genetic
predisposition represented by the incidence of these diseases in only a fraction of smokers. Lung
cancer and COPD may be different aspects of the same disease, with the same underlying
predispositions,whether this is an underlying genetic predisposition, telomere shortening,
mitochondrial dysfunction or premature aging. In the majority of smokers, the burden of smoking
may be dealt with by the bodys defense mechanisms: anti-oxidants such as superoxide dismutases,
anti-proteases and DNA repair mechanisms. However, in the case of both diseases these fail,
leading to cancer if mutations occur or COPD if damage to the cell and proteins becomes too great.
Alternatively COPD could be a driving factor in lung cancer, by increasing oxidative stress and
the resulting DNA damage, chronic exposure to pro-inflammatory cytokines, repression of the
DNA repair mechanisms and increased cellular proliferation. Both lung cancer and COPD are
associated with cigarette smoking, which by generating reactive oxidant species, induces a chronic
inflammatory state in the lung. Lung cancer is one of the most common causes of death among
COPD patients, and continued cigarette smoking poses an additional lung cancer risk in patients
with preexisting COPD. The reasons for the different responses to a common inflammatory
response induced by smoking remain to be determined, but likely lie in genetic polymorphisms in
genes that regulate genome integrity in cancer and that regulate the immune response to tissue
destruction in COPD. Understanding the mechanisms that drive these processes in primary cells
from patients with these diseases along with better disease models is essential for the development
of new treatments. Current studies have shown a marked benefit of cancer screening in the COPD
population, although challenges remain, including the common underdiagnosis of COPD. COPD-
associated lung cancer presents distinct clinical features. Treatment for lung cancer coexisting with
COPD is challenging as COPD may increase postoperative morbidities and decrease survival. In
this review, we outline current progress in the understanding of the clinical association between
COPD and lung cancer, and suggest possible cancer prevention strategies in this patient
population.
KEYWORDS: chronic obstructive pulmonary disease, lung cancer, clinical association

IS IT POSSIBLE TO IMPROVE PROGNOSIS IN PULMONARY LUNG CANCER BY
ASSOCIATING MOLECULAR MARKERS WITH STAGING OF TNM?
ELENA DANTES

Constanta, Romania,
[email protected]
Survival in lung cancer is dependent on histologic subtype, anatomic tumor extension revealed by
the TNM stage, gender, age, performance status, comorbidities, genomics, environment and
treatment-related factors. Non-small cell lung cancer (NSCLC) accounts for 80-85% of all lung
cancers. Five years survival for extended tumor or IV-stage NSCLC disease is only 5-13%. In
recent years, important findings have been made on identifying genetic mutations and
standardizing molecular biomarkers that control tumor growth. The discovery of new therapeutic
classes and the establishment of treatment algorithms have led to increased survival even in
extensive forms of the disease. We are now in the era of personalized medicine for patients with
lung cancer, especially adenocarcinoma. Personalized medicine means that a standardized
biomarker is used to identify the presence of a disease-specific gene or genes profile that controls
the growth of cancer. The greatest advances could be obtained by giving drugs that target specific
mutations or oncogenic genetic drivers such as EGFR mutations and EML4-ALK translocations.
National protocols for these drugs are now available in Romania.
SIMPOZION MAJOR COMUN
CANCER PULMONAR BRONHOLOGIE
RADIOLOGIE
MAJOR JOINT SYMPOSIUM
LC BRONCHOLOGY RADIOLOGY
TENDINTE EVOLUTIVE ALE TIPURILOR HISTOPATOLOGICE DE CANCER
BRONHOPULMONAR DIAGNOSTICAT PRIN BRONHOSCOPIE
EMILIA CRISAN, RUXANDRA ULMEANU, MIHAI ALEXE, CAMELIA BADESCU,

IONELA ERHAN, ALINA CROITORU
Institutul de Pneumoftiziologie Marius Nasta, Bucuresti
In Romania, cancerul bronhopulmonar ocupa primul loc in randul cancerelor la barbat si locul
patru la femei. Aproximativ 25-30% din cancerele pulmonare sunt inoperabile in momentul
descoperirii, 10-17% avand tablou dramatic de obstructie centrala.
Scopul studiului a fost analiza evolutiei cancerului bronhopulmonar din punct de vedere al tipului
histopatologic prin compararea cu trendul evolutiv din ultimii 40 ani, date cu impact asupra
abordului terapeutic si al prognosticului.
A fost un studiu retrospectiv, observational, transversal pe pacienti consecutivi adresati

departamentului de Bronhologie al Institutului Marius Nasta in anul 2016 cu suspiciunea de cancer
bronhopulmonar. Datele obtinute in 2016 referitoare la evolutia tipurilor histopatologice de cancer
bronho-pulmonar au fost comparate cu cele obtinute in anii:1975; 1985; 2005.
Rezultatele studiului au aratat ca incidenta cancerului bronhopulmonar este in continuare mai mare
la barbati, cu tendinta la crestere usoara in randul sexului feminin. Biopsia bronsica a fost
principala metoda de confirmare histopatologica, cu predominenta aspectului endobronsic de tip
infiltrativ. In 12,5% din cazuri localizarea a fost traheala.
Se observa un trend ascendent al proportiei cancerelor diagnosticate endoscopic ce au ca principal
factor de risc fumatul (scuamos, cancer cu celula mica), cu scaderea minora a procentului de
adenocarcinom.
Cuvinte cheie: cancer bronho-pulmonar, endoscopie bronsica, tip histopatologic

THE EVOLUTION TRENDS OF HISTOPATHOLOGICAL TYPES OF
BRONCHOPULMONARY CANCER DIAGNOSED BY BRONCHOSCOPY
EMILIA CRISAN, RUXANDRA ULMEANU, MIHAI ALEXE, CAMELIA BADESCU,

IONELA ERHAN, ALINA CROITORU
Marius Nasta Institute of Pneumophtysiology, Bucharest
In Romania, the bronchopulmonary cancer occupies the first place among the cancers in males and
the fourth place in females. Approximately 25-30% of lung cancers are inoperable at the time of
discovery, 10-17% having a dramatic central obstruction panel.
The aim of the study was to analyze the evolution of bronchopulmonary cancer from the
histopathological type point of view by comparing it with the evolutionary trend of the last 40
years, data with impact on the therapeutic approach and the prognosis.
It was a retrospective, observational, transversal study on consecutive patients addressed to the
Bronchology Department of the Marius Nasta Institute in 2016 with suspicion of
bronchopulmonary cancer. Data obtained in 2016 on the evolution of histopathological types of
bronchopulmonary cancer were compared with those obtained in the years: 1975; 1985; 2005.
The results of the study showed that the incidence of bronchopulmonary cancer is still higher in
males, with a tendency towards mild growth among female sex. Bronchial biopsy was the main
method of histopathological confirmation, with predominance of infiltrative type on endobronchial
appearance. In 12.5% of cases, the location was tracheal.
We observed an upward trend in the proportion of endoscopically diagnosed cancers smoking

related (squamous cell, small cell cancer), with a minor decrease in adenocarcinoma.
Key words: broncho-pulmonary cancer, bronchial endoscopy, histopathological type

BRONCHOSCOPY WITH AUTOFLUORESCENCE, EXPERIENCE OF THE FIRST 91
CASES IN INSTITUTE OF PNEUMOLOGY "MARIUS NASTA"
RUXANDRA ULMEANU, ALEXANDRA DIACONU, VALENTIN COEI, CORINA

BORCEA, EMILIA CRIAN, MIHAI ALEXE, CORNELIA BDESCU, IOANA LEABU
Introduction. Autofluorescence (AF) bronchoscopy is a field of interest because lung neoplasms

are known to be the first cause of mortality by neoplasia, and prognosis is directly dependent on
disease status at the time of diagnosis. White light bronchoscopy (WL) is routinely used in the
diagnosis of lung neoplasms, but has a limited contribution for diagnosis of pre-invasive or micro-
invasive lesions. Bronchoscopy with AF has been developed as a solution to standard
bronchoscopy limitations because it has a higher sensitivity in the detection of these types of
lesions.
Purpose. Comparing the standard WL bronchoscopy with AF bronchoscopy for the detection of
lung cancer lesions and for establishing the limit for surgical resection.
Material and methods: longitudinal prospective study of 91 patients who have performed both
WL and AF bronchoscopy, between June 2015 and June 2017 at the "Marius Nasta" Institute of
Pneumology Bucharest. The results were compared with the final histopathological examination.
Results: The analysis of the general data identified 49 men (53.33%), an average age of
60.3111.52 years, 33 active (36.67%) active smokers, 29 former smokers (32.22%) with an
average number of 33.9118.34PY. Regarding the sensitivity and specificity of the examination
in AF and LA, it depended on the macroscopic aspect considered. The WL examination identified
correctly histopathologically confirmed (HP) tumors with a sensitivity and specificity of 71.43%
and 68.75% respectively. AF examination had a sensitivity and specificity of 85.71% and 68%
respectively. If both examinations were considered sensibility and specificity were 96.67% and
71.43%, respectively. Differences between the two lights were noted in 16 cases, of which 13 were
HP confirmed to be malignant. Of these, AF rated 11 cases better, and 7 of them were negative for
WL examination as an endoscopic suggestion for malignancy, while AF confirmed neoplasia.
Regarding the extension limit AF has obtained superior results compared to WL examination for
17 cases.
Discussion: In this study, bronchoscopy with AF is discretely superior to WL bronchoscopy.
Effectiveness of both depends on the of the examiner's experience and the macroscopic appearance
considered.
Conclusions: Performing AF bronchoscopy by an experienced examiner, endorsed by subtle

changes, brings additional advantages over standard bronchoscopy as a diagnosis tool for neoplasia
and for establishing the limit of resection.
Key words: white light bronchoscopy, autofluorescence bronchoscopy, pulmonary neoplasia

BRONHOSCOPIA CU AUTOFLUORESCEN, EXPERIENA PRIMELOR 91 DE
CAZURI N INSTITUTUL MARIUS NASTA
RUXANDRA ULMEANU, ALEXANDRA DIACONU, VALENTIN COEI, CORINA

BORCEA, EMILIA CRIAN, MIHAI ALEXE, CORNELIA BDESCU, IOANA LEABU
Introducere. Bronhoscopia cu autofluorescen (AF) reprezint un domeniu de interes, deoarece

neoplaziile pulmonare sunt cunoscute ca fiind prima cauz de mortalitate global prin neoplazie,
iar prognosticul este direct dependent de stadiul bolii la momentul diagnosticului. Bronhoscopia
cu lumin alba (LA) este utilizat de rutin n diagnosticul neoplaziilor pulmonare, ns aceasta
este limitat ca aport diagnostic n cazul leziunilor preinvazive sau microinvazive. Bronhoscopia
cu AF a fost dezvoltat ca o soluie la limitrile bronhoscopiei standard, deoarece prezint o
sensibilitate mai mare n detectarea acestor tipuri de leziuni.
Scopul acestui studiu este de a compara bronhoscopia standard n LA cu bronhoscopia cu AF
pentru evidenierea leziunilor canceroase pulmonare i stabilirea cu o mai mare acuratee a limitei
de rezecie chirugical.
Material i metode: studiu prospectiv, longitudinal, compus din 91 de pacieni la care s-au efectuat
la acelai moment bronhoscopie cu LA i AF n perioada iunie 2015- iunie 2017 n cadrul
Institutului de Pneumoftiziologie Marius Nasta Bucureti. Rezultate au fost comparate cu
examenul histopatologic final.
Rezultate:. Analiza datelor generale a identificat un numr de 49 brbai (53.33%), o vrst medie
60.3111.52 ani, 33 pacieni (36,67%) fumtori activi, 29 de foti fumtori (32,22%), cu un numr
mediu de 33.9118.34 PA. n ceea ce privete sensibilitatea i specificitatea examinrii n AF i
LA aceasta a depins de aspectul macroscopic considerat. Examinarea n LA a decelat aspectele
tumorale i infiltrative care au fost confirmate ulterior histopatologic (HP) cu o sensibilitate i
specificitate de 71,43% respectiv 68,75%, examinarea n AF cu o sensibilitate i specificitate de
85,71% respectiv 68,75%, iar ele dou metode combinate 96,67%, respectiv 71,43%. De
menionat c la examinarea ntre cele 2 lumini, s-au observat diferene n 16 cazuri din care 13 au
fost confirmate HP ca fiind maligne. Dintre acestea, AF a evaluat mai bine 11 cazuri, iar 7 dintre
ele au fost negative la examinarea n LA ca aspect endoscopic sugestiv pentru malignitate, n timp
ce AF a confirmat neoplazia . n ceea ce privete limita de extensie AF a reuit s obin rezultate
superioare fa de examinarea n LA pentru 17 cazuri.
Discuii: n studiul de fa bronhoscopia cu AF este discret superioar bronhoscopiei cu LA

Ambele depind ca eficien de experiena examinatorului i de aspectul macroscopic considerat.
Concluzii: Efectuarea bronhoscopiei cu AF de un examinator experimentat, avizat de modificrile

subtile aduce avantaje suplimentare fa de bronhoscopia standard ca aport diagnostic al
neoplaziilor i pentru stabilirea limitei de rezecie.
Cuvinte cheie: bronhoscopie n lumin alb, bronhoscopie cu autofluorescen, neoplazie

pulmonar
EBUS IN THE TARGET THERAPY ERA
MRIOARA IMON, LCRMIOARA TOMA, LAURA IACOBAN, TUDOR SIMU,

ANTONIA HARANGUS
Clinica Pneumoftiziologie, Cluj-Napoca

In patients with lung cancer mediastinal staging is important for : establish the treatment options
(surgical or multimodality treatment), estimate prognosis, provide a common language when
communicating about patients and enrolling them in clinical trials.Methods for diagnosis and
staging of lung cancer are: imaging methods, non-invasive (Contrast-enhanced chest CT, PET
scan), needle techniques- minimally invasive techniques (EBUS, EUS) and invasive methods-
surgical techniques-mediastinoscopy, VATS). Newer ultrasonographic endoscopic technology has
emerged as a sensitive and less invasive mediastinal sampling approach with sensitivity and
specificity of 92,3% and 100% respectively. EBUS-TBNA samples processed as histopathological
specimens for EGFR and ALK genotyping in primary lung adenocarcinoma have shown a high
clinical utility. The needle gauge did not affect genotyping efficacy. Using Rapid-Onsite
Evaluation in conjunction with EBUS is far superior for assessing adequacy for comprehensive
molecular testing and allows the most benefit to the patient by minimizing excessive procedures,
obtaining diagnostic and staging information and adequate material for molecular testing. We will
present the comparative aspects of this techniques and our experience with EBUS-TBNA.
Conclusions: EBUS-TBNA is a safe, cheaper and cost/effective novel bronchoscopic tool and it
will likely reshape the current strategy for diagnostic and staging of lung cancer. For the majority
of patients with lung cancer EBUS should be the first modality offered and performed.
SIMPOZION MAJOR:
ABORDRI TERAPEUTICE NOI N HIPERTENSIUNEA
ARTERIAL PULMONAR
MAJOR SYMPOSIUM:
NEW THERAPEUTIC APPROACHES IN PULMONARY
ARTERIAL HYPERTENSION
TRATAMENTUL MEDICAMENTOS AL HIPERTENSIUNII PULMONARE
POSTTROMBOEMBOLICE
MEDICAL TREATMENT OF CHRONIC THROMBOEMBOLIC PULMONARY
HYPERTENSION
TUDOR CONSTANTINESCU
UMF Carol Davila, Institutul Marius Nasta, Bucuresti
Chronic thromboembolic pulmonary hypertension (CTPH) represents a distinct group in the

pulmonary hypertension clinical classification, as a complication of venous thromboembolic
disease, persistent with long term anticoagulation therapy. The diagnosis relies on the confirmation
of precapillary pulmonary hypertension and complex imaging techniques, from the classical
conventional pulmonary angiography and ventilation / perfusion scintigraphy to the more modern
angioCT and angioMR.
Although the main therapeutical indication is the surgical procedure of pulmonary endarterectomy,
many patients cannot be operated due to predominance of distal disease or comorbidities. In this
patients the medical therapy is indicated with the introduction of specific pulmonary vasodilators
used in pulmonary arterial hypertension.
This lecture will present the recommended therapies, proved in randomized controlled trials and
also other off label medications.
TREATMENT OF PULMONARY HYPERTENSION DUE TO CHRONIC LUNG
DISEASES
CLAUDIA LUCIA TOMA
Pneumology, Bucharest, Romania
[email protected]
Patients with pulmonary hypertension (PH) due to chronic lung diseases (chronic
obstructive pulmonary disease or interstitial lung disease) or conditions that cause hypoxemia
(obstructive sleep apnea, alveolar hypoventilation disorders) are classified as having group 3 PH
(Nice classification 2013). PH associated with underlying lung disease and/or hypoxemia is
typically slowly progressive and is associated with increased morbidity and mortality
All patients with group 3 PH (like patients with group 1 pulmonary arterial hypertension),
should stop smoking, exercise as tolerated, receive vaccinations, and be treated with supportive
measures such as oxygen and diuretics. Disease-specific therapies (like bronchodilators in COPD)
are indicated to improve alveolar hypoxia which is thought to be the pathogenesis of PH.
Treatment of the lung disease (COPD, interstitial lung disease, sleep apnea) is indicated in
all patients with group 3 PH. Some treatments, like continuous positive airway pressure in
obstructive sleep apnea modestly reduce pulmonary artery pressures. For most patients with group
3 PH the treatment with PAH-directed therapy is not recommended because it has not been shown
to result in significant benefit and may be associated with significant adverse effects.
Patients with mild or moderate PH should be monitored every 6 months for signs or
symptoms of progression and those with severe PH should be referred to a specialized center and
encouraged to participate to a clinical trial. Patients with end-stage disease should be evaluated for
lung transplantation.
CONNEXIONS PULMONARY ARTERIAL HYPERTENSION OBSTRUCTIVE SLEEP
APNEA SYNDROME
DR. ZAHARIA DRAGOS-COSMIN, DR. STEFAN DUMITRACHE-RUJINSKI
UMF Carol Davila, Pneumophtisiology, Bucharest, Romania
Pulmonary hypertension (PH) in a disease characterized by increasing of blood pressure in the

pulmonary circulation, having multiple ethiologies (pulmonary circulation diseases, left heart
disease, lung/hypoxic diseases, etc). Among the hypoxic ethiologies, obstructive sleep apnea
(OSAS) syndrome is the most frequent, but usually generates mild forms of PH and responds to
CPAP therapy. Pulmonary arterial hypertension (PAH) is a very rare disease involving the
pulmonary circulation. There are cases of incidental association between this very rare disease
(PAH) and sleep apnea syndrome, wrongly suggesting PAH is secondary to OSAS. However, there
are also some polygraphic anomalies discovered in patients with PAH only, usually upper airway
resistance syndrome and snoring, most probably given by nazal mucosa conjestion due to
vasodilator drugs used in PAH. The presentation aims to discuss all this relationships between
these entities.
SIMPOZION MAJOR
NOUTI N LIMFANGIOMIOMATOZ
MAJOR SYMPOSIUM
UPDATES ABOUT LYMPHANGIOLEIOMYOMATOSIS
THE ROLE OF GENETIC TESTS IN DIAGNOSING
LYMPHANGIOLEYOMYOMATOSIS
DR. ZAHARIA DRAGOS-COSMIN, DR. STEFAN DUMITRACHE-RUJINSKI
UMF Carol Davila, Pneumophtisiology, Bucharest, Romania
Lymphangioleiomyomatosis (LAM) is a very rare disease with lung involvement characterized by

proliferation of abnormal smooth muscle cells. There are two forms of LAM, associated to
tuberous sclerosis complex (TSC, autosomal-dominant genetic disease) and sporadic (evolving
alone). The gold-standard for diagnosis confirmation is open lung biopsy and perirenal
angiomyolipomas.
However, in some cases, the severity of the disease or some other conditions contraindicate the
use of biopsies and therefore, other noninvasive techniques are desirable. The available blood
genetic and marker tests may have a role in diagnosing such patients.
TREATMENT OF LYMPHANGIOLEIOMYOMATOSIS
CLAUDIA LUCIA TOMA
[email protected]
Lymphangioleiomyomatosis (LAM) is a multisystem disease that affects mostly women and

primarily affects the lung. Referral to centers with expertise in this disorder is mostly advised
because of the complexity of the disorder. The management of the patients is based on use of
Sirolimus to slow progression of the disease, prevention and treatment of complications (mostly
recurrent pneumothorax) and supportive care (use of supplemental oxygen, avoidance of estrogen-
containing medications, bronchodilators, pulmonary rehabilitation).
For patients with LAM who have normal or mildly impaired lung function defined as FEV1 more
than 70% predicted, monitored observation with lung function assessments at three month intervals
is recommended. The treatment based on inhibition of mechanistic target of rapamycin (mTOR)
with Sirolimus is indicated for symptomatic patients with FEV1 under 70% predicted and evidence
of progressive disease and for those with chylothorax or chylous ascites. The drug has toxicities
and continuous exposure is required for durable benefit. Everolimus, which is approved for the
treatment of angiomyolipomas and central nervous system tumors related to tuberous sclerosis
complex, is a second line treatment in LAM. It was used in an open-label study in LAM, but is not
approved for the treatment of LAM. Lung transplantation is the option for patients with advanced
LAM.
SIMPOZION MAJOR:
ESCALADAREA VS. DEZESCALADAREA N BPOC
MAJOR SYMPOSIUM:
ESCALATION VS DE-ESCALATION IN COPD
MANAGEMENTUL PACIENTILOR CU BPOC CLASA DE RISC C I D-INTRE
ESCALADARE I DEZESCALADARE
LAVINIA DAVIDESCU
Noile ghiduri terapeutice GOLD 2017 pentru bronhopneumopatia obstructive cronica

(BPOC) inregistreaza modificari notabile. Clinicianul se confrunta cu o tendinta de individualizare
a schemei terapeutice in functie de fiecare pacient in parte. Elementul cheie in tratamentul BPOC
ramane bronhodilatatoarele inhalatorii ,alegerea lor tinand cont de controlul sau persistenta
simptomelor, grupul de risc, numarul de exacerbari si numarul de spitalizari.
In managementul cazului se introduce notiunea de escaladare a terapiei, primordial pentru
a controla si a reduce simptomele si nu in ultimul rand pentru a preveni exacerbarile. Astfel, in
managementul pacientilor grup C,optiunea terapeutica initiala este LAMA, cel mai frecvent se
face escaladare a terapiei de la un singur bronhodilatator la terapia duala LABA/LAMA , in
prezenta exacerbarilor si persistenta simptomelor.
Managementul pacientilor grup D implica initial bronhodilatatia duala LAMA/LABA, iar

in caz de exacerbari, escaladare la tripla terapie ICS/LABA/LAMA.
Optiunea dezescaladarii este de asemenea noua in GOLD 2017,permitind reducerea

medicatiei atunci cand simptomele sunt controlate si pacientul nu mai prezinta exacerbari. Datorita
evolutiei imprevizibile atat a unui pacient stabil cu BPOC clasa de risc C si D cat si a unui pacient
in exacerbare , sunt necesare strategii de stabilire a momentului optim de escaladare si
dezescaladare a terapiei .
MANAGEMENT OF PATIENTS WITH COPD RISK CLASS C AND D- BETWEEN
ESCALATION AND DES-ESCALATION
LAVINIA DAVIDESCU
New therapeutic guideline GOLD 2017 for chronic obstructive pulmonary disease (COPD)
recorded notable changes. The clinician faces a tendency to individualize the regimen according
to each individual patient. The key element in the treatment of COPD remains inhaled
bronchodilators, considering their choice by control of symptoms or persistent symptoms, risk
group, the number of exacerbations and number of hospitalizations.
The case management introduces the notion of escalating therapy, the primary one to
control and reduce symptoms and last but not least to prevent exacerbations. Thus, in the
management of group C patients, the initial therapeutic option is LAMA, the most common is the
escalation of therapy from a single bronchodilator to LABA / LAMA dual therapy in the presence
of exacerbations and the persistence of symptoms.
Group D patient management initially involves LAMA / LABA dual bronchodilation, and
in case of exacerbations, escalation to triple ICS / LABA / LAMA therapy. Des-escalation option
is also new in GOLD 2017 allowing reduction of medication when symptoms are controlled and
the patient no longer shows exacerbations. Due to unpredictability of evolution of a stable COPD
patient risk class C or D , new strategies are needed to determine the optimal timing of escalation
and des-escalation therapy.
SIMPOZION MAJOR
BOLI PULMONARE VARIA I
MAJOR SYMPOSIUM
LUNG DISEASES I
PARTICULARITATI EVOLUTIVE CORTICOTERAOIE LA PACIENTII CU
SARCOIDOZA
DIANA MANOLESCU
Universtitatea de Medicina si Farmacie Victor Babes Timisoara
Introducere: Boala granulomatoasa multisistemica de etiologie necunoscuta, sarcoidoza

afecteaza in general personele tinere si de varsta medie. Manifestarile clinice in sarcoidoza sunt
extrem de heterogene si se suprapun cu diverse afectiuni granulomatoase infectioase sau
noninfectioase. Desi afectarea pulmonara este prezenta la peste 90% din pacienti, afectarea
multisistemica este caracteristica bolii si orice organ poate fi interesat. Din punct de vedere
histologic, leziunea caracteristica este reprezentata de granulomul epitelioid necazeificat. Evolutia
bolii este imprevizibila, de la forme asimptomatice sau cu regresiune spontana pana la forme
cronice cu fibroza pulmonara sau extinderi extrapulmonare severe.
Scopul lucrarii: prezentarea unor cazuri cu raspuns atipic la tratamentul corticosteriodian
sistemic.
Material si metoda: am studiat un lot de 85 de pacienti aflati in evidenta noastra cu diagnosticul

de sarcoidoza din 2005 pana in prezent. Dintre pacientii aflati in baza noastra de date, un numar
de 48 au urmat tratament corticosteroidian. Toti pacientii au efectuat CT toracic la momentul
diagnosticului si ulterior pentru monitorizare. Confirmare histopatologica prin biopsie au avut un
numar de 66 pacienti si un numar de 22 au efectuat DLCo.
Rezultate si discutii: . Majoritatea pacientilor au urmat corticoterapia pe o perioada de un an si

jumatate si au avut un raspuns bun la tratament. Totusi au fost cateva cazuri care, in ciuda
tratamentului, nu au avut un raspuns clinic si/sau radiologic favorabil sau au prezentat recaderi la
intreruperea corticoterapiei.
Concluzii: corticoterapia sistemica ramane prima linie de tratament in sarcoidoza, desi nu exista
studii care sa ateste beneficiile pe termen lung in ceea ce priveste evolutia bolii cum ar fi preventia
fibrozei pulmonare.
Introduction: Sarcoidosis is a multisystemic granulomatous disease, of unknown origin and it
affects generally young and middle-aged people. The clinical manifestations of sarcoidosis are
extremly heterogenuous and they overlap various infectious or non-infectious granulomatous
diseases. Although pulmonary involvement is present in more 90% of cases, multisystemic
involvement is characteristic for this disease and any organ may be affected. Non-caseating
epithelioid granuloma is the histopathological finding. The course of the disease is unpredictible,
from asymptomatic or spotaneous regression to chronic with pulmonary fibrosis or severe
extrapulmonary involvement.
The aim: presentig a few cases with atypical response to sistemic corticotherapy.
Material and Method: We studied a group of 85 patients diagnosed with sarcoidosis from 2005
until present time. 48 patients from our data base followed corticotherapy. All patients had thoracic
CT-scan when they were first diagnosed and for follow-up. A number of 66 patients had
histopathological confirmation after biopsy and 22 patients had DLCo.
Results and discussions: Most of the patients had corticotherapy for a year and a half with a
favorable response. Still there were a few cases in wich, in spite of therapy, the clinic and/or
radiografic responses were poor or had relapses after corticoid suppression.
Conclusions: Systemic corticotherapy remains the first-line treatment in sarcoidosis, although,

until now, there are no studies to establish the long term benefits for outcome, like preventig
pulmonary fibrosis.
PREZENT SI VIITOR IN TUBERCULOZA DIN ROMANIA
GILDA POPESCU, DOMNICA CHIOTAN
Au trecut mai mult de 20 ani de cand OMS a declarat TB, urgenta mondiala de sanatate publica si
a inceput implementarea Programelor pentru Controlul TB.
Cu toate aceste masuri in 2016 la nivel global se inregistrau:
10.400.000 CN i Retratamente TB din care, 5.4 milioane cazuri incidente la brbai i 3.2
milioane la femei)
3,5 % din cazurile noi si 11% din retratamente sunt MDR/XDR TB (480.000 cazuri MDR
TB estimate si doar 111.000 pacienti aveau tratament anti-TB instituit).La nivel global se
remarca extinderea fenomenului chimiorezistentei TB ,cu concentrarea ateniei
internaionale asupra acestei problemei ce pune serioase obstacole n controlul TB n lume,
tulpinile rezistente fiind la fel de contagioase ca i cele sensibile.
Pentru Romnia, n comparaie cu 2002 anul maximei incidene , (142,9%000 de locuitori) , n
2016 valoarea indicatorului inregistra o scadere de 54,7% , iar numrul celor notificati a sczut de
la 30.985 la 12.836 pacienti.
Concordant cu scderea incidenei TB la adulti(64,5%000), incidena TB la copii a sczut cu
59,7% de la 48,1%000 n 2002 la 19,4%000 n 2006.
Ca expresie a atenurii valorii endemiei, rata mortalitii a sczut si ea cu 49% de la 10,8%000 n
2002 la 5,3%000 n 2015. Nimic din toate acestea nu ar fi fost posibil fr atingerea unei rate de
succes terapeutic de 85%, la cazurile TB chimiosensibila.
Progresele inregistrate n ceea ce privete diagnosticul rapid ,fenotipic si genotipic precum si in
terapia conditiei mentionate, s-au bazat pe finanare extern i ar trebui asumate de statul romn
pentru a fi sustenabile.
Concluzii:
In contextul actual legal, organizatoric i financiar, principala problema o reprezinta lipsei unei
rate nalte de succes terapeutic a cazurilor cu chimiorezistenta , echivalent cu rata de evoluie
spontan favorabil, n absena oricrui tratament etiologic.
Cauzele, in de absena unei abordri programatice a domeniului, de existena unui decalaj
diagnostic i terapeutic de dou generaii, absena finantarii i accesul la medicaia validat
internaional i, n consecin, imposibilitatea unui diagnostic precoce i a unei terapii acoperitoare
i continue.
SARCOIDOZA SI MULTIPLELE SALE CHIPURI CUM PROCEDAM
DR. ANTONELA DRAGOMIR1,2, DR. SILVIU DUMITRU1, PROF. DR. RUXANDRA

ULMEANU1,3
1
INP Marius Nasta Bucuresti
2
UMF Carol Davila Bucuresti
3
Universitatea Oradea
Sarcoidoza este afectiunea inflamatorie multisistemica caracterizata histopatologic prin

dezvoltarea unei inflamatii granulomatoase necazeificate. La 90% cazuri exista afectare
pulmonara, putand evolua spre fibroza progresiva.
Cauzele aparitiei sarcoidozei nu sunt cunoscute, unii oameni de stiinta considerand ca este o boala
a sistemului imun care apare la pacientii cu o predispozitie genetica, si declansata de anumiti
factori: bacterii, virusuri, substantechimice.
Prognosticul pe termen lung este dificil. Aproximativ 60% din pacienti intra in remisiune in 2-5
ani. Unii pot avea o evolutie cronica progresiva, cu afectare a mai multoro rgane, dar decesul se
inregistreaza la mai putin de 5% din cei bolnavi.
Tratamentulul (atunci cand boala nu are remisiune spontana) se face cu corticoizi sau cu alte
substante ce induc scaderea imunitatii (ciclofosfamida, methotrexate, azatioprina).
SARCOIDOSIS AND ITS MANY FACES HOW DO WE PROCEED
DR. ANTONELA DRAGOMIR1,2, DR. SILVIU DUMITRU1, PROF. DR. RUXANDRA

ULMEANU1,3
1
2
UMF Carol Davila Bucuresti
3
Universitatea Oradea
Sarcoidosis is a multisystem inflammatory illness caracterized by histopathological evidence of

noncaseating epithelioid cell granuloma. In 90% of cases the lungs are afected by a wide array of
injuries from minimal lessions to extensive pulmonary fibrosis.
The etiology of this disease is still unknown, but the scientific community has generated a few
hypothesis linking a genetic predisposition and exposure to bacteria, viruses, organic matter and
inorganic matter.
The prognostic of patients diagnosed with sarcoidosis is hard to foresee. About 60% of all patients
undergo remission in the next 2 to 5 years after diagnosis. Others will have a progressive chronic
evolution, with multiple organ dissemination, but the fatality rate is under 5%.
The treatment (when the disease does not spontaneously undergo remission) is based on
corticotherapy alongside other immunosuppressive drugs like cyclophosphamide, methotrexate
and azathioprine.
SIMPOZION MAJOR:
MUCOVISCIDOZA REALITI I SOLUII
MAJOR SYMPOSIUM:
MUCOVISCIDOSISFACTS & SOLUTIONS
SURVIVING TO CYSTIC FIBROSIS
CRISTIAN COJOCARU1, ADINA TURCANU1, ELENA COJOCARU2
Gr.T. Popa University of Medicine and Pharmacy Iasi, Romania

1
Department of Pneumology
2
Physiology
Nowadays, cystic fibrosis is changing, due to important progress in patients therapy and becomes
more and more an adult disease. In consequence, the medical care has changed and more
specialities are involved. Also, the impact on society is growing.
Objectives: recognition and highlighting of the patient`s particularities regarding cystic fibrosis,
the evolution and the modalities of adaptation to disease.
Even though we still expect new therapies for cystic fibrosis, the oxygen therapy, the prophylaxis
infection, mucolytic, kineto-therapy and psychological support are improving survival and life
quality. However, we recorded major difficulties such as: lack of chance for lung transplantation,
for oxygen therapy outside of the residential, or for modern therapies. Moreover, some of the
patients are not genetic counselled due to different causes. Depression, social and financial factors,
limited support from patients agencies increase the impact of the disease on patients and their
families.
Conclusions: Surviving with cystic fibrosis is nowadays a challenge and a great victory for patients
and health system. There is a big hope for increasing the quality of life and life expectancy
involving more and more patients.
Key words: cystic fibrosis, life quality, life expectancy

DIAGNOSTICUL FIBROZEI CHISTICE LA ADULT PARTICULARITI CLINICE
I DIFICULTI NTMPINATE
ANCA MACRI1, CRISTIAN POPA2, ANCUA CONSTANTIN1, MDLINA IONESCU1,

TEODORA BUTNARU1
1
Institutul de pneumologie "Marius Nasta", Secia 3, Bucureti, Romnia
2
Institutul de pneumologie "Marius Nasta", Secia 5, Bucureti, Romnia
Introducere: Fibroza chistic (FC) este cea mai frecvent afeciune genetic monogenic
autosomal recesiv a populaiei de origine caucazian, cu o evoluie cronic potenial letal
(afecteaz 1/2500 nou-nscui caucazieni, mai rar la rasa neagr i asiatici). Mutaiile n gena
CFTR sunt responsabile de afectarea transferului transmembranar al ionilor de Na+ si Cl-; se
cunosc > 1900 mutaii responsabile de boal, cu impact diferit asupra manifestrilor fenotipice ale
FC. Prognosticul FC este mult mbuntit n zilele noastre.
Situaia n 2016 n Romnia: 98 aduli din cei 410 pacieni cu FC nregistrai (23,4%), plus alte 29
cazuri ntre 16-18 ani.
Caracteristici ale cazurilor de FC la adult: de regul sunt forme fenotipice incomplete, generate de
mutaiile uoare ale genei; se aseamn cu alte afeciuni respiratorii cronice (astm, BPOC,
broniectazii non-FC, rinosinuzit cronic) subdiagnostic cert; e nevoie de sensibilizarea
pneumologilor asupra dg FC la adult; acceptarea dificil a diagnosticului, negarea bolii i a
terapiei; evoluia natural a bolii mai blnd; efectul interveniilor terapeutice mai puin evident;
sfatul genetic e ignorat frecvent.
Dificulti n ngrijirea pacienilor aduli cu FC: lipsa unei conduite medicale unitare; absena unui
centru dedicat acestor pacieni; lipsa mijloacelor necesare diagnosticului pozitiv; dificulti de
trecere din serviciile de pediatrie ctre cele de aduli; lipsa unor centre medicale specializate pentru
aduli; proceduri diagnostice accesibile numai n serviciile de pediatrie; costuri mari, legislaie
incoerent.
Cuvinte cheie: fibroz chistic, aduli

DIAGNOSIS OF CYSTIC FIBROSIS IN ADULTS - CLINICAL PARTICULARITIES
AND DIFFICULTIES ENCOUNTERED
ANCA MACRI, CRISTIAN POPA, ANCUTA CONSTANTIN, MDLINA IONESCU,

TEODORA BUTNARU
Introduction: Cystic fibrosis is the most common autosomal recessive monogenic genetic disorder
of the Caucasian population with a potentially lethal chronic evolution (affects 1/2500 Caucasian
newborns, rarer in the black and Asian). Mutations in the CFTR gene are responsible for affecting
the transmembrane transfer of Na + and Cl- ions; there are> 1900 mutations responsible for the
disease, with a different impact on the phenotypic manifestations of FC. The FC prognosis is much
improved nowadays.
The situation in 2016 in Romania: 98 adults out of 410 patients with CF registered (23.4%) plus a
further 29 cases between 16-18 years.
Characteristics of FC cases in adult: usually are incomplete phenotypic forms, generated by light
mutations of the gene; is similar to other chronic respiratory diseases (asthma, COPD, non-FC
bronchiectasis, chronic rhinosinusitis) certain underdiagnosis; it is necessary to sensitize
pneumologists to diagnose FC in adult; difficult acceptance of diagnosis, denial of disease and
therapy; the natural evolution of milder disease; less therapeutic effect of therapeutic interventions;
genetic counseling is often ignored.
Difficulties in caring for adult CF patients: lack of unitary medical conduct; the absence of a
dedicated center for these patients; lack of necessary means for positive diagnosis; difficulties in
switching from pediatric to adult services; lack of specialized medical centers for adults; diagnostic
procedures only available in pediatric services; high costs, incoherent legislation.
Keywords: cystic fibrosis, adults

DIAGNOSTICUL SI MONITORIZAREA STATUSULUI PULMONAR IN FIBROZA
CHISTICA (MUCOVISCIDOZA)
LIVIU L. POP1,2, IOANA M. CIUCA1,2
1
Departamentul de Pediatrie, Universitatea de Medicin si Farmacie " Victor Babes" Timisoara
2
Centrul National de Mucoviscidoz Timisoara
Introducere: Desi mucoviscidoza (fibroza chistica- FC) are un spectru larg de manifestari,
afectarea pulmonara este cea care dicteaza prognosticul vital al bolii. Diagnosticarea precoce a
complicatiilor pulmonare si stabilirea momentului interventional este esential pentru un prognostic
favorabil, de aici necesitatea existentei unor metode de evaluare pulmonara la copil este esentiala.
Prezentarea isi propune trecerea in revista a metodelor actuale de evaluare a functiei pulmonare la
copil si rolul lor in monitorizarea pulmonara.
Metode: Se vor prezenta modalitatile de diagnostic si monitorizare a statusului pulmonar, pe grupe
de varsta, recomandarile actuale, protocoale de diagnostic, indicatii si discutii legate de eficienta
modalitatilor de evaluare.
Rezultate: Modalitatile de evaluare a statusului pulmonar includ atat interpretarea functionala cat
si evaluarea morfologica pulmonara. Daca la adult, functia pulmonara poate fi facuta cu ajutorul
spirometriei , la copiii sub 6 ani, acest lucru este extrem de dificil . Metode ca pletismografia,
rezistenta specifica a cailor respiratorii, metoda oscilatiilor fortate, a respiratiei intrerupte sau
washout-ul genereaza parametri cu elocventa variabila, majoritatea metodelor fiind laborioase.
Concluzie: Determinarea unor parametri de baza, ca fluxurile exploratorii distale, si indicele de

clearance pulmonar in scopul evaluarii corecte a statusului pulmonar din fibroza chistica reprezinta
o necesitate, atat pentru depistarea precoce a bolii pulmonare si interventie terapeutica
subsecventa cat si pentru stabilirea indicatiei de transplant.
DIAGNOSIS AND MONITORING OF CYSTIC FIBROSIS LUNG DISEASE
LIVIU L. POP1,2, IOANA M. CIUCA1,2
1
Pediatric Department, University of Medicine and Pharmacy Victor Babes Timisoara
2
National Cystic Fibrosis Centre
Introduction: Although cystic fibrosis (CF) has a wide spectrum of manifestations, the respiratory
disease has the most important role on the prognosis of the disease; therefore early diagnosis of
pulmonary complications is essential. The presentation aim is to review the current methods
available for assessing the lung function in children and their role in monitoring the lung disease.
Methods: The data will be presented regarding the evaluation of pulmonary status, by age group,
with reliable current recommendations, diagnostic protocols, indications and discussions on
effective methods of evaluation.
Results: The methods of assessment of lung status include both functional interpretation and
morphological assessment of lung. If the adult lung function is evaluated by spirometry, in children
younger than 6 years methods are extremely laborious or insufficiently accurate. Methods like
plethysmography, specific airway resistance, forced oscillation method or multiple breath washout
generates parameters use now for the assessment of the lung function.
Conclusion: Determination of basic parameters like expiratory flows, lung clearance index in order
to assess the correct status of the CF childrens became a necessity, for early detection of lung
disease and therapeutic intervention subsequence and for establishing the transplant timing.
RESPIRATORY TRACT INFECTIONS IN PATIENTS WITH CYSTIC FIBROSIS
DANA-TEODORA ANTON-PDURARU1, CRISTIAN COJOCARU2
Gr.T.Popa University of Medicine and Pharmacy Iai, Romania

1
Department Mother and Child Health
2
Pulmonology
Email:[email protected]
Email:[email protected]
Cystic fibrosis (CF) is a disease that degrades the local defense mechanisms of the lower
respiratory tract. As a result, patients develop recurrent infections that progressively deteriorates
antiinfection defenses and represent the major cause of mortality. A hallmark of those infections
is the diversity of microorganisms isolated from broncho-alveolar lavage or sputum. The clinical
significance of isolates is different, the recognition of the role in altering of respiratory function
being important in guiding antibiotic therapy. Current data support pathogenicity in CF of S.
aureus, P. aeruginosa and B. cepacia complex, the latter two being considered "preterminal
bacteria". S. aureus was the most common cause of mortality and morbidity in preantibiotic era.
Today, life expectancy was improved with the introduction of antistaphylococcal antibiotics.
Hypermutation of P. aeruginosa - the most common species isolated from patients with CF, is the
essential factor in the development of multi-resistance to antibiotics. As P. aeruginosa,
B.cenocepacia is a virulent species that cause infections with poor prognosis. Microorganisms with
secondary role (H. influenzae, S. maltophilia, atypical Mycobacteria, Aspergillus spp) whose
clinical significance has not been clarified yet, require further studies.
Key words: cystic fibrosis, respiratory tract infections, microbial pathogens, clinical significance.
References:
1. Bhagirath A, Li A, Somayajula D, Dadashi M, Badr S, Duan K. Cystic fibrosis lung environment
and Pseudomonas aeruginosa infection. BMC Pulm Med. 2016; 16: 174. doi: 10.1186/s12890-
016-0339-5
2.Filkins L, OToole G. Cystic Fibrosis Lung Infections: Polymicrobial, Complex, and Hard to
Treat. PLOS Pathogens 11(12): e1005258.https://doi.org/10.1371/journal.ppat.1005258
3.Keravec M, Mounier J, Prestat E, Vallet S, Jansson JK, Burgaud G et al. Insights into the
respiratory tract microbiota of patients with cystic fibrosis during early Pseudomonas
aeruginosa colonization. SpringerPlus 2015;4:405. https://doi.org/10.1186/s40064-015-1207-0
SIMPOZION MAJOR:
ONCOLOGIE - CHIRURGIE TORACIC
MAJOR SYMPOSIUM:
ONCOLOGY THORACIC SURGERY
PROGRESSION IN GENETICS, MULTIMODAL TREATMENT AND PROGNOSIS OF
MESOTHELIOMA
EDITH SIMONA IANOSI, GABRIELA JIMBOREAN
University of Medicine and Pharmacy, Tg. Mure, Clinic of Pneumology, County Hospital Mure
Introduction
Researchers have actively sought biomarkers for mesothelioma(MPM) for more than 20 years.
Nowadays there arent biomarkers in clinical use for MPM. The early diagnosis of MPM remains
a challenge and the patients have a poor accessibility to biomarkers.
Results
Management of patients with MPM is difficult and controversial - heterogeneous disease, variable
clinical course. The majority of patients (80%) are diagnosed in stage III / IV, and they are not
candidates for surgical treatment. Systemic therapy is the only treatment option for most of these
patients, but poor performance status, and low sensitivity of this type of tumor to radio- and
chemotherapy cause a poor prognosis.
Conclusions
MPM remains a rare disease, it takes a multidisciplinary approach to make progress in its
management. Integration of preclinical studies in standard clinical practice is required to improve
survival and quality of life of these patients.
Keywords: progression, genetics, multimodal treatment of mesothelioma.

DOES SMOKING CESSATION IMPROVE SURVIVAL IN LUNG CANCER?
RUXANDRA RJNOVEANU,2, ANDRADA TECSI2, MONICA POP1,2, RUXANDRA

ULMEANU3
1
University of Medicine and Pharmacy Iuliu Hatieganu, Pneumology Department, Cluj-Napoca,
Romania
2
Pneumology Clinical Hospital, Cluj-Napoca, Romania
3
University of Medicine and Pharmacy, Pneumology Department, Oradea, Romania
The impact of smoking cessation on survival rates in lung cancer remains a complex issue. The
links between smoking and lung cancer are quite clear but less is known about the effect of
smoking cessation after lung cancer diagnosis. Smoking affects cancer treatment and outcome,
interfereing with the effects of some therapeutic or chemopreventive agents. Smoking not only
leads to lung cancer but also lowers the survival of those who undergo treatment of their cancer.
The current scientific data showed that quitting smoking in lung cancer patients shortly before or
after diagnosis may reduce the risk of cancer recurrence and death. Survival benefit is significantly
higher in tobacco quitters, despite the severity of the disease. Still, the focus of most of the studies
is represented by early-stages. Besides the cases having chemotherapy or other treatments, for the
surgical cases, quitting smoking also helps improve the bodys ability to heal and the response to
therapy. The risk of complications, such as pneumonia and respiratory failure is also lowered.
Increasing advocacy for tobacco control including patients with diagnosis of lung cancer should
become a standard of care for all patients. Future randomized and observational clinical trials are
needed in order to assess the complex impact of tobacco cessation on lung cancer patients survival.
Keywords: cessation, smoking, lung, cancer, survival.

SIMPOZION MAJOR:
CANCERUL PULMONAR: COMORBIDITI,
PROFILAXIE, MANAGEMENT
MAJOR SYMPOSIUM:
LUNG CANCER: COMORBIDITIES, PROPHYLAXIS,
MANAGEMENT
WHICH IS THE OPTIMAL ALGORITHM FOR MULTIPLE PULMONARY NODULES
MANAGEMENT?
CLAUDIA LUCIA TOMA
[email protected]
Multiple pulmonary nodules may be caused by malignant or benign diseases. Conventional chest
radiography raise the suspicion of multiple lung nodules, but high resolution computed
tomography (HRCT) is used to describe more accurate multiple pulmonary nodules. The etiology
of multiple pulmonary nodules can frequently be determined by a thorough history and physical
examination. However, a biopsy from one or more nodules is sometimes required for a confident
diagnosis.
Benign diseases that are known to cause multiple pulmonary nodules are infections (tuberculosis,
histoplasmosis), non-infectious inflammatory diseases (granulomatosis with polyangiitis formerly
called Wegener's granulomatosis, rheumatoid arthritis, sarcoidosis, and amyloidosis),
arteriovenous malformations, and pneumoconioses. If a benign cause is the most likely etiology,
multiple pulmonary nodules can be followed by serial HRCT scans and periodically reassessed.
In patients with known malignant tumors, multiple pulmonary nodules that are more than 1cm in
diameter are most commonly due to metastatic disease, while multiple pulmonary nodules that are
less than 5 mm in diameter and located near the visceral pleura are more likely benign lesions
(fibrotic scars, granulomas, or intrapulmonary lymph nodes). In the case of uncertainty about the
etiology of multiple pulmonary nodules or there is a high suspicion of malignancy based on clinical
or radiological data, a biopsy is needed. CT-guided transthoracic needle biopsy, transbronchial
needle or forceps biopsy, and surgical lung biopsy (video-assisted thoracoscopic surgery or open
thoracotomy) can be performed in order to establish the etiology.
WHY IS IT IMPORTANT TO IDENTIFY GENETIC MUTATIONS (EGFR, ALK, ROS1,
ETC.) IN PULMONARY CANCER?
DE CE ESTE IMPORTANT IDENTIFICAREA MUTAIILOR GENETICE (EGFR,
ALK, ROS1, ETC.) N CBP?
STEFAN DUMITRACHE-RUJINSKI
UMF Carol Davila, Institutul Marius Nasta, Bucuresti.
Lung cancer is one of the most common human cancers and represents a leading cancer-
related death worldwide.
Identifying genomic alterations in lung cancer may impact therapy and provide targeted
lung cancer personalized therapy. Personalized treatments utilize drugs specifically designed to
target particular gene mutations involved in uncontrolled cell proliferation, increased cell
angiogenesis and invasiveness.
New therapies with kinase receptor inhibitors (against EGFR: epidermal growth factor
receptor, ALK: rearranged anaplastic lymphoma kinase and ROS1) or antibodies (against EGFR
and against VEGF: vascular endothelial growth factor) can work synergistically with standard
chemotherapy and produce benefits in progression-free survival and overall response rates in lung
cancer.
CHALLENGES IN MANAGING OF N2 NON - SMALL CELL LUNG CANCER
ARIADNA PETRONELA FILDAN

Approximately 30% of patients who are newly diagnosed with nonsmall cell lung cancer
(NSCLC) will present with stage IIIA (N2) disease on the basis of metastasis to the mediastinal
lymph nodes. The optimal management of patients with stage IIIA (N2) NSCLC disease remains
widely debated among surgeons, pulmonologists, and oncologists. Despite advances in
chemotherapeutic regimens, methods of delivery for radiation, and less invasive surgical
techniques, survival for patients with stage IIIA (N2) malignancies remains poor.
For suspicious N2 disease, endoscopic needle techniques, such as endobronchial ultrasound and
transbronchial needle aspiration, oesophageal ultrasound and fine needle aspiration, or a
combination of both, are preferred to any surgical staging technique. In cases of suspicious nodes
and negative results using needle aspiration techniques, invasive surgical staging using
mediastinoscopy or video-assisted thoracic surgery should be performed. Restaging after induction
therapy remains a controversial topic. Today, neither CT, PET nor PET/CT scans, are accurate
enough to make final further therapeutic decisions for mediastinal nodal involvement. An invasive
technique providing cytohistological information is still recommended.
The aim of this lecture is to evaluate and update the role of noninvasive, minimally invasive and
invasive techniques in the staging and restaging of N2 non-small cell lung cancer and to review
the current literature in order to determine the optimal combination and timing of multimodality
treatment.
MASA ROTUND
BOLILE PULMONARE I RELAIA MEDIC-PACIENT
(SESIUNE MIXT CU ASOCIAIILE PACIENILOR)
PULMONARY DISEASES AND DOCTOR-PATIENT
RELATIONSHIP
(MIXED SESSION WITH PATIENT ASSOCIATIONS)
TRATAMENTUL PACIENILOR DIAGNOSTICAI RECENT CU TUBERCULOZ,
N FUNCIE DE POLIMORFISMUL GENEI GLUTATION - S-TRANSFERAZA
MARIUS DUMITRU
Asociaia Romana a Bolnavior de Tuberculoz (ARB TB)
Scopul studiului este de a mbunti protocolul de tratament la pacienii diagnosticai recent

cu tuberculoz pulmonar destructiv utilizand formule injectabile de izoniazid i rifampicin, in
functie de polimorfismul gluthathione -S- transferazei.
ADN-ul genomic a fost izolat din probele de snge ale pacienilor cu tuberculoz, folosind reactivi
"DNA-sorb-B". Situs-urile polimorfice GSTM1 i GSTT1 au fost amplificate prin multiplex
polymerase chain reaction.
Efectul negativ al genotipurilor G STM1-nul i GSTT1-nul asupra procesului de detoxifiere i

acumularea de metabolii n organism, responsabile pentru efectele toxice i
alergice ale organismului, au fost demonstate la pacientii cu TB. Cu toate acestea, la pacienii
din grupul 2 conversia sputei dupa 60 de doze a fost observat la 93, 6% din cazuri, iar la
pacienii din grupul 1 - n 74,4% din cazri, confirmnd eficiena cii injectabile de administrare a
medicamentelor anti-TB la pacientii cu genotipuri G STM1-null i GSTT1-null.
Concluzie. Genotipul G STM1-null i GSTT1-null nu a demonstrat un efect de ncredere asupra

eficienei tratamentului la pacienii cu NDTB pulmonar.
Mulumim echipei de cercetare de la Universitatea de Medicin Bucovinean de

Stat, Cernui, Ucraina, coordonatorului Todoriko Liliia, lui Semianiv Igor i Ieremenchuk Inga.
TREATMENT OF PATIENTS WITH NEWLY DIAGNOSED TUBERCULOSIS,
DEPENDING ON THE GLUTATHIONE-S-TRANSFERASE GENE POLYMORPHISM
MARIUS DUMITRU
Romanian TB Patients Association (ARB TB)
The aim is to improve the protocol of chemotherapy in patients with newly diagnosed destructive
pulmonary TB with injectable formulations of isoniazid and rifampicin, considering gluthathione-
S-transferase polymorphism.
Genomic DNA was isolated from the blood samples of patients with tuberculosis utilizing reagents
DNA-sorb-B. Polymorphic GSTM1 and GSTT1 sites were amplified by multiplex polymerase
chain reaction.
Negative effect of the GSTM1-null and GSTT1-null genotypes upon the process of detoxication
and accumulation of metabolites in the organism, which is responsible for toxic and allergic effects
of the body, was proven in TB patients. However, in patients of the 2nd group sputum conversation
after 60 doses was observed in 93,6% of cases, in patients of the 1st group in 74,4 %, confirming
the efficiency of the injectable route of administration of anti-TB drugs in patients with GSTM1-
null and GSTT1-null genotypes.
Conclusion. GSTM1-null and GSTT1-null genotype did not demonstrate a reliable effect upon
treatment efficiency in patients with pulmonary NDTB.
Thanks to the research team HSEI "Bukovinian State Medical University", Chernivtsi, Ukraine,
coordinator Todoriko Liliia, Semianiv Igor and Ieremenchuk Inga.
SIMPOZION MAJOR:
BOLI PULMONARE VARIA II
MAJOR SYMPOSIUM:
PULMONARY DISORDERS II
THERAPEUTIC TIMELINESS IN TORACICAL TUMORS AND VASCULAR
ABNORMALITIS
DR. CRIAN MARILENA1.2, DR. CLADOVAN CLAUDIA2, DR. SOCACI ADRIANA3,

DR. VRACI DIANA2, PROF. UNIV. ULMEANU RUXANDRA1
1
Facultatea de Medicin i Farmacie, Oradea,
2
Spitalul Clinic Municipal, Oradea
3
Spitalul Clinic de Pneumoftiziologie, Timioara
Introducers
Generalized vascular abnormality is parte of rare tumors and vascular abnormality group.
Characterized by lymphangiomas infiltrating tissues, viscera, chest, this entity with great
variability of localization and extension induces a significant impact on quality of life. The limited
therapeutic options, mostly conservative / palliative, result in a high mortality rate. Since
administration of Propanolol, corticosteroids, Alpha interferon, chemotherapy or Bevacizumab did
not result in the expected results, current studies focus on mTOR inhibitory antiangiogenic therapy.
From this point of view, Sirolimus therapy (Rapamycin) seems promising in stabilizing the disease
and prolonging survival.
Case presentation
The 17-year-old girl initially diagnosed in the infant's period with the abdominal Lamphangioma
later outlining the clinical picture of generalized (including thoracic) lymphangiomatosis with
adverse response to surgical conservative treatment and administration of steroids and Alpha-
interferon;
resulting in long-term development with multiple hospitalizations for complications and
impairment of quality of life, including school drop-out. Administration of Sirolimus is under
discussion.
Conclusion
Off-label administration of Sirolimus in patients with lymphatic vascular abnormalities (including
children) may be a therapeutic solution in terms of prolonging survival and improving the quality
of life.
ACTUALITATI TERAPEUTICE IN TUMORI SI MALFORMATII VASCULARE
TORACICE
DR. CRIAN MARILENA1.2 , DR. CLADOVAN CLAUDIA2, DR. SOCACI ADRIANA3,

DR. VRACI DIANA2, PROF. UNIV. ULMEANU RUXANDRA1
1
Facultatea de Medicin i Farmacie, Oradea,
2
Spitalul Clinic Municipal, Oradea
3
Spitalul Clinic de Pneumoftiziologie, Timioara
Introducere
Limfangiomatoza generalizata face parte din grupul tumorilor si malformatiilor vasculare rare.
Caracterizata prin prezenta multiplelor limfangioame care infiltreaza tesuturile, viscerele, toracele
aceasta entitate cu mare variabilitate a localizarii si extinderii induce un important impact asupra
calitatii vietii.
Optiunile terapeutice limitate, de cele mai multe ori conservative/paleative au ca si consecinta o
rata inalta a mortalitatii. Deoarece administrarea de Propanolol, corticosteroizi, Alfa interferon,
chimioterapie sau Bevacizumab nu a dus la rezultatele scontate, studiile actuale se concentreaza
pe terapia antiangiogenetica cu efect inhibitor mTOR. In acest sens terapia cu Sirolimus
(Rapamycin) pare a fi promitatoare in stabilizarea bolii si prelungirea supravietuirii.
Prezentare de caz
Fetita in varsta de 17 ani si jumatate, diagnosticata initial in perioada de sugar cu Lamfangiom
abdominal conturand ulterior tabloul clinic de Limfangiomatoza generalizata (inclusiv toracic) cu
raspuns nefavorabil la tratamentul conservativ chirurgical si administrare de steroizi si Alfa-
interferon; consecinta fiind evolutie indelungata cu multiple spitalizari pentru complicatii si
afectarea calitatii vietii, inclusiv abandon scolar. Se pune in discutie administrare off-label de
Sirolimus.
Concluzia
Administrarea off-label de Sirolimus la pacientii cu anomalii vasculare limfatice (inclusiv copii)
poate reprezenta o solutie terapeutica in cea ce priveste prelungirea supravietuirii si imbunatatirea
calitatii vietii.
ABORDAREA ENDOSCOPIC A TUMORILOR TRAHEALE
CAMELIA PESCARU, EMANUELA TUDORACHE, CRISTIAN OANCEA
Universitatea de Medicin si Farmacie Victor Babe, Timioara

Timisoara, Romania,
[email protected]
Introducere: Incidena tumorilor traheale maligne este sczut , aproximativ 0,1 la 100000
persoane/an, Carcinomul cu celule scuamoase si carcinomul chistic adenoid sunt responsabile de
2/3 din tumorile traheale primare la adult. Restul de tumori variaz foarte mult si include att
tumori maligne ct si benigne. Fumatul este frecvent asociat ca factor de risc. In unele studii 40%
din pacienti au anterior, concomitant sau dezvolta ulterior un carcinom de orofaringe, laringe sau
plmn.Tumorile traheale sunt de trei ori mai frecvente la barbat dect la femei. Incidena maxim
apare ntre decada 5 si 6 de viat. Pacienii cu tumor traheala malign au prognostic nefavorabil,
supravieuirea raportat la 5 si 10 ani fiind ntre 5 si 15% respective 6-7% pentru toate tipurile de
carcinom tracheal.
Scop: prezentarea unui caz clinic particular al unui pacient in varsta de 65 ani care s-a prezentat
pentru hemoptizie in cantitate minima, diagnosticat cu cu tumor traheal primar.
Particularitatea cazului este ca pacientul are o tumora traheal rar si comorbiditi cardiace
care schimb abordarea terapeutic.
ENDOSCOPIC APPROACH OF TRACHEAL TUMORS
Introduction:The incidence of primary tracheal malignancies is low, approximately 0.1 in every

100,000 persons per year, squamous cell carcinomas and adenoid cystic carcinomas accounting
for about 2/3 of adult primary tracheal tumors.The remaining tumors are widely varied and include
both malignant and benign histotypes. Smoking is a commonly associated risk factor. In some
studies, 40% of patients had prior, concurrent, or later carcinoma of oropharynx, larynx, or
lung.Tracheal tumors are three times more common in males than in females. Peak incidence
occurs in the fifth and sixth decades of life. Patients with tracheal malignancies show an
unfavorable prognosis, with reported 5- and 10-year survival rates of 5% to 15% and 6% to 7%,
respectively, for all types of tracheal carcinoma.
Aim: presentation of a clinical case of a patient aged 65 years who were presented for hemoptysis
in minimum quantity diagnosed with primitive trachel tumor
The particularity of the case: The patient has a rare tumor and cardiovascular comorbidity who
change therapeutic approach.
EXPERIENTA A PESTE 1000 FIBROBRONHOSCOPII LA SPITALUL DE
PNEUMOFTIZIOLOGIE IZVORU, JUDETUL GIURGIU
DR. ANA GUSE, .DR. MIHAELA SIMION, DR. PATRICIA STEGARU, DR. FLORIN
DASCALU
Cuvinte cheie: bronhologie, biopsie bronsica, tuberculoza, neoplasm pulmonar.
Introducere: Spitalul de pneumoftziologie Izvoru, avand in structura 125 paturi, este situat la circa
40 km de Bucuresti, pe DN 61 Giurgiu-Gaiesti si ofera servicii medicale celor 280.000 locuitori ai
judetului Giurgiu dar si celor din judetele Dambovita si Ialomita de unde provin circa 30% din
pacienti.
Material si metoda: Dotat cu un fibrobronhoscop flexibil achizitionat in 2007, cu camera video
si monitor atasate,compartimentul de bronhologie al spitalului, desi autorizat sa functioneze din
iunie 2010 el este practic functional din mai 2011 iar din iunie 2015 s-au prelevat si biopsii
bronsice, pe langa aspiratele bronsice si citologii, care se trimit pentru prelucrare si interpretare la
Institutul M.Nasta , Serviciul de A natomie Patologica. In intervalul martie 2011-iunie 2017 au
fost efectuate circa 1000 FB exploratorii si diagnostice, un numar de 835 de aspirate bronsice
pentru examen Bk, 142 pentru citologie si au fost prelevate 93 biopsii bronsice.
Rezultate: In urma investigatiilor efectuate s-au diagnosticat 51 tuberculoze pulmonare(rata de
confirmare 6,1%), 3 tuberculoze bronsice, s-au confirmat 66 neoplasme bronhopulmonare ( rata
de confirmare 76%) 2 corpi straini traheobronsici. S-au descoperit 4 tumori laringiene si
amigdaliene.
Restul pacientilor au prezentat afectiuni inflamatorii acute si cronice: bronsita hipertrofica,
mucopurulenta, modificari de dinamica bronsica, diskinezii bronsice, modificari de pereti bronsici
de tip bronsiectatic sau cicatriceal, depuneri antracotice, stenoze, anomalii congenitale
traheobronhopulmonare, etc.
Complicatii: minore(0,5 - 2 pacienti cu subfebra la 6-8 ore de la momentul investigatiei, 3 pacienti
cu spute hemoptoice remise dupa 24 ore), majore -1 (0,1%- deces prin AVC dupa biopsie bronsica
in cursul manevrei -2016).
Concluzii: Avand in vedere activitatea compartimentului de bronhologie al Spitalului Izvoru, rata
buna de confirmarea a biopsiilor bronsice, procentul mic al complicatiilor aparute secundar
manevrelor efectuate, concluzionam ca se poate face bronhologie diagnostica de buna calitate si
la nivelul unui spital mic, cu dotare modesta, pentru degrevarea serviciilor de bronhologie
consacrate avand drept rezultat scaderea costurilor investigatiilor efectuate de catre spital si
cresterea calitatii serviciilor medicale oferite, cu conditia cooperarii cu un serviciu de anatomie
patologica accesibil si cu experienta in patologia respiratorie.
INCIDENTS AND COMLICATIONS OF BRONHOSCOPY ALWAYS IN THE NEWS
MADALINA BURECU, CAMELIA BADESCU, MIHAI ALEXE, EMILIA CRISAN,

CONSTANTIN MARICA, RUXANDRA ULMEANU
Marius Nasta Pneumology Institute, Bucharest, Romania
Flexible bronchoscopy was introduced in 1968 and today it is an essential procedure in respiratory
medicine. Bronchoscopy is generally considered safe, but diagnostic sampling could lead to
immediate complications as intrabronchial bleeding, bronchospasm, haemodynamic variations, or
even death. Also, the patient discomfort could be immediately, during the procedure, or days after
such as fever, sore throat, cough or reactions to the medication used in pre or anesthesia.
However, the severe complications are rare. Pneumotorax requiring intervention was reported in
0-2,1% of patients who had undergone TBB. Mortality rate was low. The willingness to repeat
bronchoscopy was well above 50%. Other complications reported was: hypoxemia (0,7- 76%),
bleeding (2,5-89%).
To conclude, bronchoscopy is a safe procedure in terms of serious complications as death,

pneumotorax or bleeding, but it is difficult to conclude regarding the frequency of these
complications, the variation in definitions can have several reasons, but it is likely due to the
clinicians and researchers perception of what can be considered significant complications or
serious adverse events.
Patients should be informed about the risk of complications and about the discomfort that could
appear. To provide this information we need a prospective study on clear definitions of the serious
complications; also, this study have to identify the high-risk procedures related to the outcomes
and the steps that should be followed in these conditions.
PREZENTRI E-POSTERE
E-POSTERS PRESENTATIONS
SESIUNE E POSTERE 1: CANCER PULMONAR I
BRONHOLOGIE
E POSTER SESSION 1: LC AND BRONCHOLOGY
LUNG CANCER-PART OF MULTIPLE PRIMARY MALIGNANT NEOPLASM
CORINA BUDIN1, ALEXANDRA COMES2, GABRIEL GRIGORESCU2, CORINA

MARGINEAN2, TODEA ADINA DOINA3
1
Clinical County Hospital Mures, Dpt. of Pneumology. Drd UMF Iuliu Hatieganu Cluj Napoca.
Targu Mures, Romania.
2
Clinical County Hospital Mures, Dpt. of Pneumology, Targu Mures, Romania
3
UMF Iuliu Hatieganu Cluj Napoca.
[email protected]
Key words: multiple primary malignant neoplasms, neoplasms,lung cancer
Objective : to better describe and diagnose lung cancer as part of multiple primary malignant
neoplasms and to better differentiate from secondary lung tumours.
Warren and Gates have described that if the interval is under 6 months it is accepted as
synchronous multiple primary malignant neoplasms(MPMN) , and if the interval is over 6 months,
then it is accepted as metachronous MPMN .
Patients and methods: After an analysis of the results from the literature, we tried to adapt the
results obtained in the current practice of our department.
We selected 3 patients with diagnoses relevant to the subject approached in the last year in the
Pneumology Department of Targu Mures, following their evolution under treatment.
Two men and a woman were selected, who associated lung cancer with breast cancer, colon cancer
and bladder cancer.
The case of the woman was a synchronous lung cancer with breast cancer, and the two of the men
were cases of metacrone pulmonary cancer with colon cancer and urinary bladder.
Results: The incidence of MPMN ranged from 0.7% to 11.7% in the literature. Quite different
values reported in the literature studies on the prevalence of MPMN.
Conclusions: The first treatment taken for primary tumor, shared risk factors such as genetic
predispositions, smoking, and alcohol are among the other accused factors for multiple primary
malignant neoplasms.
References:
1. Etiz D, Metcalfe E, Akcay M. Multiple primary malignant neoplasms: A 10-year experience

at a single institution from Turkey. J Can Res Ther 2017;13:16-20.
2. Lv M, Zhang X, Shen Y, Wang F, Yang J, Wang B, Chen Z, Li P, Zhang X, Li S, Yang J.
Clinical analysis and prognosis of synchronous and metachronous multiple primary
malignant tumors. Medicine (Baltimore). 2017 Apr;96(17).
ENDOBRONCHIAL EVALUATION LUNG METASTASES- SEMINOMA CASE
REPORT
LEVENTE BIRO, ALEXANDRA MURAR, CORINA BUDIN
Mures County Clinical Hospital, Targu Mures,Romania

[email protected]
Introduction: Invasive testicular cancer develops from carcinoma in situ (CIS) / testicular
intraepithelial neoplasia (TIN), these histological types of testicular tissue is often found in non-
malignant waste. The incidence of testicular cancer in Europe is increasing, doubling every 20
years. Aim : highlighting the need for immediate multidisciplinary approach, a case of seminoma
with lung metastases in a young patient in order of therapeutic conduct. Material and methods:
Patient aged 33 years, smoker, presents with marked fatigue, cough, mucous production, average
effort dyspnea, symptoms that starts approximately one month. Objective examination reveals an
influenced status, pulmonary crackles bilaterally, slightly enlarged right testis in volume. Chest
radiograph performed urgency raises suspicion of lung metastases. Results: CT supports the
suspect of metastasis, so endobronchial approach reveals a lung formation, histopathological
confirmation of seminoma metastases. . Laboratory result before the urological intervention shows
AFP = 11.05, beta-hCG = 20,47mUi / L, LDH = 754Ui / L. Right radical orchiectomy is
subsequently performed pT1N3M1a - Stage IIIB. Repeating tests after the 4th round of
chemotherapy (BEP), laboratory results show a normalization of AFP 6.04 ng / mL, beta-hCG
<0.1 M / L, LDH = 276Ui / L. Endobronchial reevaluation shows open lumen, with
histopathological confirmation as fibrotic tissue. Conclusion: The multidisciplinary approach was
essential in order to establish structure and etiology. Considering the changes, the estimated
prognosis and the advanced stage , the therapy can be summed as a success.
Keywords: seminoma, lung, metastases

1.Shanmugalingam, T., Soultati, A., Chowdhury, S., Rudman, S., & Van Hemelrijck, M. (2013).
Global incidence and outcome of testicular cancer. Clinical Epidemiology, 5, 417427.
http://doi.org/10.2147/CLEP.S34430
2.J. Oldenburg, S. D. Foss, J. Nuver, A. Heidenreich, H-J Schmoll, C. Bokemeyer, A. Horwich,

J. Beyer, V. Kataja, on behalf of the ESMO Guidelines Working Group; Testicular seminoma and
non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann
Oncol 2013; 24 (suppl_6): vi125-vi132. doi: 10.1093/annonc/mdt304
3 Xu, J., Zhao, J., Geng, S., Wang, Q., Wang, P., Zhang, C. ... Ji, Y. (2016). Primary seminoma
arising in the middle mediastinum: A case report. Oncology Letters, 12, 348-350.
https://doi.org/10.3892/ol.2016.4575
THE DIAGNOSIS OF PERIPHERIC BRONCHO-PULMONARY NEOPLASM A
CONTINUOUS CHALLENGE
CORINA MARGINEAN1, CORINA BUDIN1, GABRIEL GRIGORESCU1, VIRGIL
MARGINEAN2, PETRU-EMIL MUNTEAN1
1
Mures County Clinical Hospital, Pneumology Department, Targu Mures, Romania
2
Mures County Clinical Hospital IBCVT, Targu Mures, Romania
Introduction The pulmonary cancer represents a major problem of public health worldwide (1,8
million of new cases and 1,6 million deaths; 1 out of 8 men diagnosed and 1 aut of 51 women
diagnosed with pulmonary cancer) and national (2013 8890 of new cases and 8790 deaths).
The pulmonary cancer knows an alarming growth in the last decades situated on the second place
as a disease after cardiovascular diseases. An extremely serious particularity is related to late
detection of neoplasia less than 1/3 ( one third) of cases are found at diagnosis in a useful
therapeutical stage, 55% reperesent secondary determination, 30% advanced locoregional disease
and only 15% in localized stage. The rank of survival at 5 years for all stages is of 15%.
The method 2 cases of peripheric broncho-pulmonary neoplasm will be presented, at male gender
patients, smokers, detected in the fourth stage of disease, with brain secondary determinations and
neurologic symptoms which dominate the clinical image. The classical investigations
bronchoscopy and biopsy have not succeeded in establishing the HP diagnosis being necessary
complex methods for determining a diagnosis.
Discussions Establishing the HP diagnosis in case of peripheric pulmonary tumors is difficult

to be done being necessary invasive methods transthoracic aspiration on needle CT guided or
ultrasound in special at tumors which exceed 2 cm. Also it is imposed for accurate staging the
effectuation of skull CT together with thoracic and abdominal CT. Giving up smoking (which
causes 71% of deaths due to pulmonary cancer), reducing the urban pollution, avoiding the
exposure at chemical and carcinogen substances, changing the lifestyle can lead to the decrease of
pulmonary cancer incidence.
RISK OF MALIGNITY IN PULMONARY NODULES
DOINA PIRIU1, PETRONELA ARIADNA FILDAN2
1
Medstar General Hospital, Constanta, Romania
2
Clincal Pneumology Hospital, Ovidius University Constanta, , Romania
Backgrounde: Lung cancer is one of the diseases with a major impact on the population, being
the first place in the world statistics with a high mortality rate.
Materials/Methods: We retrospectively analyzed a group of 106 patients investigated between
September 2013 and June 2017 at Medstar General Hospital Constanta, patients who presented
solitary pulmonary nodules to determine the probability of malignancy of the pulmonary nodules
and then correlated the score obtained with the results of the pulmonary nodule biopsy.
All patients completed a screening questionnaire that included the following categories: age,
gender, family history of lung cancer, smoking history, presence of pulmonary emphysema, lung
nodule size, nodule type, lung nodule location, number of nodules, spiculiformity.
The probability of malignancy of the pulmonary nodules was calculated using the Brock
University Cancer Prediction Equation formula.
Results: Of the 106 patients studied, 47 showed malignant nodules proved by
anatomopathological examination. The type of neopalm was: adenocarcinoma - 33, squamous cell
carcinoma- 8, microcellular carcinoma- 6. Out of the 106 patients studied 78 were smokers or
exsmokers, 15 were non-smokers, 30 showed family history of lung cancer,lung nodule
dimensions were between 15-20 mm, the spiculiform character was present in 74 of the patients,
and the average malignity score was 64.36%.
Conclusions: Predictive scores based on characteristics of patient and lung nodule can be used to
accurately estimate the likelihood that the CT scan detected nodule is malignant and should be
used more widely in clinical practice.
Bibliography:
1. McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules
detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9.
doi:10.1056/NEJMoa1214726
2. Risk of malignancy in pulmonary nodules -Lung Cancer. 2015 Jul;89(1):27-30. doi:

10.1016/j.lungcan.2015.03.018. Epub 2015 Mar 28
EPIDERMOID CARCINOMA OF THE ESOPAGUS WITH TRACHEAL INVATION
AND CEREBRAL METASTASIS
LIVIU VERINCEANU1, CAMELIA DIACONU2
1
Floreasca Emergency Hospital, Pneumology Department, Bucharest, Romania
2
Dr Denus Geambulat
- The intimate report between esophagus and trachea often leads to interference between
respiratory and digestive pathology. The occurrence of a respiratory insufficiency on the
background of a chemo and radiopharmaceutical esophageal cancer is a serious, life-threatening
complication, having as substrate the compression of the tumor and the tracheal invasion.
- Cancer of the esophagus is the 7th cause of global mortality and the 8th neoplasm as incidence.
In African-Americans it is the fourth cause of mortality. Esophageal cancer has a very aggressive
evolution, being the most "lethal" digestive cancer after the pancreatic
- Overall survival at 5 years in the 2000s is about 10%
Stenting the trachea after a tracheal expansion or resection of tumor may be a palliative gesture
designed to prolong the life of the patient, possibly give the chance to a new chemo / radiotherapy.
On certain occasions, tracheal stenosis can provide the respiratory pathway before mounting an
esophageal stent enabling the patient to resume feeding. In the presence of a tracheobronchial
fistula, tracheal stenosis can ensure airway sealing of digestive secretions and food. Paralysis of
vocal cords is an indicator of severe prognosis ... Even if the patient has both the airway and the
digestive tract, control of swallowing has been lost! There will be alternative feeding pathways
(central venous catheter, gastrostoma).
LUNG TRANSPLANTATION - GENERAL ASPECTS AND INDICATIONS
GABRIELA JIMBOREAN, EDITH SIMONA IANOSI
University of Medicine and Pharmacy Tg. Mures
Pulmonary transplantation (PT) is a special therapy for advanced lung diseases that have exhausted
other less invasive methods, diseases with a dramatic impact on the quality of life and patients
survival. PT indications have been developed through international consensus and include
advanced pulmonary disorders or pulmonary vascular diseases that are untreatable or have a
reduced life expectancy at 1-2 years, the failure of previous treatments of chronic respiratory
disease, severe functional impairment with marked disability in patients without significant
associated diseases, capable of respiratory rehabilitation and with a satisfactory emotional/social
status. Among the conditions included in the above criteria we mention: very severe COPD (BODE
index 7-10, cor pulmonale despite O2 treatment, FEV1 <20% without reversibility, DLCO <20%),
cystic fibrosis, diffuse bronchiectasis (FEV1 <30%, exacerbations requiring ICU hospitalization,
recurrent hemoptysis), idiopathic pulmonary fibrosis ("honeycomb" pattern with fibrosis score 2,
DLCO 35%, severe stress hypoxemia - SaO2 88%), primary pulmonary hypertension (class III-
IV NYHA), silicosis, sarcoidosis, lymphangioleiomyomatosis (LAM), Langerhans histiocytosis.
Conditions that contraindicate lung transplantation are chronic renal/hepatic/cardiac diseases with
manifest failure, simultaneous presence of a malignant tumor, severe fungal or bacterial/viral
chronic infections (HIV-AIDS, hepatitis B, C), noncompliant patients, malnutrition, chronic
alcoholism and drug consumption, severe psychosis, advanced neuromuscular diseases. Although
age is not an absolute contraindication the recommendation of PT is age-related: 60 year/old -
bilateral lung transplantation, 65 year/old - single lung transplantation. Preliminary
investigations for PT are numerous and must be strictly respected for correct selection of the
eligible candidates, prevention of post-transplant complications: detailed clinical examination,
complex respiratory functional tests (spirometry, DLCO plethysmography, gasometry and stress
tests), HRCT, cardiac functional tests (ECG, echocardiography, angiography at 45 year/old),
liver and kidney analysis, colonoscopy (over 50 year/old), psychiatric exam tricus, bacteriological
sputum explorations, bronchoscopy, serological and haematological tests for the detection of viral
or fungal infections. Preparing the pre-transplant examinations as well as complex case
management and long-term follow-up is the aptitude of a multidisciplinary team: pneumologist,
cardiothoracic surgeon, cardiologist, cardiopulmonary rehabilitation specialist, infectious disease
specialist, immunologist, nutritionist, social worker.
SESIUNE E POSTERE 2: CANCER PULMONAR I
BRONHOLOGIE
E POSTER SESSION 2: LC AND BRONCHOLOGY
ROLUL REABILITARII RESPIRATORII IN CANCERUL PULMONAR
ALINA CROITORU, DANIELA JIPA, CIPRIAN BOLCA, IRINA PELE, MIRON

BOGDAN
Universitatea de Medicina si Farmacie Carol Davila, Institutul de Pneumoftiziologie Marius Nasta,

Bucuresti
Reabilitarea respiratorie face parte din arsenalul terapeutic modern al bolilor pulmonare,
complementar terapiei medicamentoase. Scopul principal este ameliorarea independentei
functionale i autonomizarea rapid a pacientului. Programele de reabilitare se pot desfaura in
sistem intraspitalicesc, ambulator sau la domiciliu.
Unul dintre domeniile de interes ale reabilitrii respiratorii este cancerul pulmonar. Se
poate efectua asociat chirurgiei (preoperator, postoperator) si / sau asociat chimioterapiei. Durata
programelor de reabilitare este de 4-8 saptamani, mai redusa preoperator datorita timpului de
asteptare chirurgical. Principalele componente sunt: drenajul bronsic, antrenamentul muschilor
respiratori, educarea respiratiei, educarea tusei, spirometria incitativa, antreanamentul la efort. O
atentie deosebita la acest tip de pacienti trebuie acordata consilierii psihologice.
Studiile efectuate in reabilitarea din chirurgia cancerului pulmonar au pus in evidenta
efecte pozitive in ceea ce priveste capacitatea de efort, forta musculara, scaderea complicatiilor
postoperatorii si reducerea duratei spitalizarii.
La pacientii la care s-a efectuat reabilitare respiratorie si chimioterapie s-a obtinut o
crestere a capacitatii de efort.
Cuvinte cheie: reabilitare respiratorie, cancer pulmonar, exercitiu

THE ROLE OF RESPIRATORY REHABILITATION IN LUNG CANCER
ALINA CROITORU, DANIELA JIPA, CIPRIAN BOLCA, IRINA PELE, MIRON

BOGDAN
Carol Davila University of Medicine and Pharmacy, Marius Nasta Institute of Pneumophtysiology
Bucharest
Respiratory rehabilitation is part of the modern therapeutic arsenal of pulmonary diseases,

complementary to drug therapy. The primary goal is to improve functional independence and to
make the patient be autonomous quickly. Rehabilitation programs can be run in-hospital,
outpatient or home-based.
One of the areas of interest in respiratory rehabilitation is lung cancer. It can be associated
with surgery (preoperative, postoperative) and/or associated with chemotherapy. Duration of
rehabilitation programs is 4-8 weeks, less in preoperative rehabilitation due to surgical waiting
time.The main components are: bronchial drainage, respiratory muscles training, breathing and
coughing education, incentive spirometry, exercise training. Particular attention should be paid to
this kind of patients for psychological counseling.
Studies with rehabilitation in lung cancer surgery have highlighted positive effects in terms
of exercise capacity, muscle strength, postoperative complications, and reduced hospitalization
duration.
Respiratory rehabilitation associated to chemotherapy has increased exercise capacity.
Key words: respiratory rehabilitation, thoracic surgery, exercise

THE HIGH QUALITY OF THE INTERDISCIPLINARY COOPERATION- THE KEY OF
THE EFFICIENT BRONCHOSCOPY EVALUATION
CRINU NUTA
County Hospital Slatina, Department of Pneumology, Adomedica Medical Centre, Slatina,

Romania,
[email protected]
Bronchoschopy is an important diagnostic feature, not only in broncho-pulmonary cancer, but also
in other pulmonary diseases. Endobronchial visualisation shows us only the area of big aerial tubes
which means aproximatelly 290 cm2, because the optic fiber goes only through the subdivisions
of the fourth generation. The rest of respiratory area, meaning 1 400 000 cm2, is located in the
fine aerial ways and it is represented by the endobronchial mucous and the alveolar walls as far as
the 24 th generation.
Bronchoalveolar lavage, directed by the torax computer tomography, is an important part of the
diagnostic with biological arguments from the citopatologist.
Professionals from internal medicine, otorhinolaryngology, infectious diseases, anesthesiology

and intensive therapy, endocrinology, hemathology, oncology frequently recommend
endobronchial endoscopy as well as pneumologists. Cooperation of all these professionals is the
key of the efficient endobronchial evaluation.
This paper tries to identify the interdisciplinary disfunctionalities in diagnostic, possible

incomplete diagnostics and the medical responsibility of each professional from recommendation
to final diagnostic and therapy.
DOES THE SCREENING IN LUNG CANCER IS JUSTIFIED?
GABRIELA JIMBOREAN, ALPAR CSIPOR, EDITH SIMONA IANOSI
Lung cancer (LC) largely qualifies as a subject for early screening because of several reasons: the
disease is a long-term in a latent / incipient stage in which it most often has no symptoms; disease
is an important health problem with high prevalence and mortality; the population risk factors can
be easily identified; there are proven techniques (accessible and specific) to have an impact on
early detection of LC. The main risk factors for LC are: heavy smoking (over 20packs/years), age
over 50, history of previous neoplasia, chronic pulmonary inflammation (COPD, emphysema,
chronic bronchitis, tuberculosis, pneumonia, exposure to secondhand smoking), obstructive
ventilatory dysfunction, occupational exposure to substances with carcinogenic risk (asbestos,
metals/radioactive products). There are currently many screening investigations to help improve
early diagnosis and decrease mortality in LC by early treatment (autofluorescence bronchoscopy,
low-dose CT, endobronchial ultrasound, tumor biomarkers). Bronchoscopy with autofluorescence
allows detection of complex dysplasia/early lesions or in situ LC and allows targeted biopsy. Low
- dose CT (performed once/year in high risk individuals) demonstrated 20% mortality reducing in
LC and was an important adjunct method in smoking cessation program. The drawbacks of low -
dose CT are: radiation risk, lack of large accessibility in poor geographic areas, risk of emotional
stress caused by screening pressure. The most useful tumor markers are: liquid biopsy - circulating
tumor DNA, microRNAs, antitumoral antibodies, promoters of hypermethylation detection,
chromosomal aneusomy. Currently, there is no standardized screening methodology in LC but
surely in the near future consensus data will be published on LC screening guidelines and
methodology. At present, investigations for early detection of LC are carried out in
multidisciplinary excellence centers.
COMPLICATION OF THE LUNG TRANSPLANTATION
GABRIELA JIMBOREAN, ALPAR CSIPOR, MIOARA SZATMARY, EDITH SIMONA

IANOSI
Complications of lung transplantation are common. They may be early (occurring between 0 - 30
days or tardive between 30 days - 1 year or more). Survival after lung transplantation decreases
with the time of intervention - from 70% in the first year to 30% after 10 years. Median survival
was estimated at approximately 4.6 years in single lung transplantation and at 6.6 years in the
double one. Early complications are: reperfusion pulmonary edema and ARDS, acute rejection
(20-25%), bronchial anesthesia dehiscence, hemorrhages (pleural, pulmonary, mediastinal), heart
failure, infection, pulmonary thromboembolism. Late complications are: chronic rejection,
pleuropulmonary infections, pulmonary thromboembolism, neoplasms, lymphoproliferative
syndromes, intolerance and adverse effects on long - term immunosuppressive medication
(osteoporosis, diabetes, muscles hypotrophy after corticoids; renal failure, neurological
complications, hypercholesterolemia after tacrolimus, digestive intolerance after most cytostatics,
frequent opportunistic infections). Prophylaxis of complications involves careful clinical
supervision and periodic investigation by key investigations: bronchoscopy with bronchoalveolar
lavage and / or transbronchial pulmonary biopsy at 2,3 months with bacteriological / cytological /
biochemical examination, respiratory functional tests, markers determination (antibodies or
antigens) of opportunistic infections (Cytomegalic virus, Epstein Barr virus, Toxoplasma,
Pneumocystis jiroveci, pseudomonas, Aspergillus, etc.), biological samples (blood glucose,
nitrogen, blood analysis, bone densitometry), thoracic echography or thoracic CT, exaled NO.
Despite multiple complications, lung transplantation increases quality of life, global survival,
family, social or professional reinsertion.
AN ENDOBRONCHIAL EVALUATION OF THE RESPONSE TO THE TREATMENT OF
PULMONARY ADENOCARCINOMA A SERIES OF CLINICAL CASES
IRINA IONELA STOIA DJESKA, STELIAN EUGEN STOIA DJESKA
Spitalul Clinic de Boli Infecioase i Pneumoftiziologie "Dr. V. Babe", Timioara, Romania,

[email protected]
[email protected]
Introduction: Bronchoscopy plays a critical part during the process of reaching a diagnosis and
coming up with a therapeutic strategy as far as lung adenocarcinoma is concerned. Nevertheless, even
so, post-therapeutic assessments and checking for potential relapses are done almost exclusively by
using imaging means.
The aim of this article is to estimate the usefulness of post-chemotherapy endobronchial monitoring
of pulmonary adenocarcinoma.
Material and methods: After chemotherapy for pulmonary adenocarcinoma, eight patients were re-
evaluated bronchoscopically. The residual endobronchial lesions were analysed, namely the presence,
the aspect, the distribution and the extension along the bronchial tree.
Results: In our study, we have observed the persistence of some initial endobronchial lesions
depending on the localization and the evolutionary stage of the disease at the time of diagnosis. The
peripheral resorption detected via medical imaging has been frequently associated with proliferative
endobronchial aspects. It matched the initial endobronchial metastasis, but only the
anatomopathological examination determined the activity degree of this residual aspect. The diffuse
infiltrative aspect of bronchial wall implied a severe prognostic.
Conclusion: Bronchoscopy is the first step for an optimal characterization of the post-therapeutic lung
adenocarcinoma. The evidence of certain endobronchial lesions, of a proliferative type, incongruous
with the imaging involution should be taken into consideration in the selection of patients for
pulmonary resection.
Keywords: adenocarcima, , endobronchial lessions, postchemotherapy evaluation

References:
1. The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic,
Clinical and Radiologic Advances Since the 2004 Classification.Travis WD1, Brambilla E,
Nicholson AG et al.
2. Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International
Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory
Society classification. Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K,
Yatabe Y, Ishikawa Y, Wistuba I, Flieder DB et al
3. The new IASLC-ATS-ERS lung adenocarcinoma classification: what the surgeon should
know..Eguchi T1, Kadota K2, Park BJ3, Travis WD4, Jones DR3, Adusumilli PS5.
PROCEDURILE IN BRONHOLOGIE MOFT SAU NECESITATE?!
MOLDOVAN IOAN
Spitalul Militar de Urgenta Cluj-Napoca
Bronhoscopia este o procedur minim invaziv, dar cu toate acestea nu este lipsita de
riscuri(minore/majore).
Apreciem ca fiind utila o dezbatere pro/contra legata de felul in care o procedura poate rigidiza
sau poate optimiza aceasta investigatie, in functie de modul in care fiecare serviciu de bronhologie
concepe aceasta procedura.
Existenta unei proceduri de examinare inadecvate sau a uneia atent conceputa poate influenta
rezultatul final.
Prevenirea complicatiilor sau managementul acestora daca au apartut, reprezinta o alta situatie care
poate fi optimizata atunci cand exista o procedura clara si documentata.
Practic dorim sa prezentam un management al riscurilor posibile, pornind de la identificarea

acestora si dezvoltarea unei strategii de raspuns la factorii de risc in vederea unui control optim al
acestora. Sunt riscuri ce tin de factorul uman, de tehnica folosita, de pacientul examinat, de
logistica avuta la dispozitie si de ce nu de supravegherea pacientului dupa bronhoscopie in
vederea consolidarii lucrului bine facut.
Trebuie avuta in vedere si nevoia de updatare(daca apar caracteristici noi la fibrobronhoscoapele

moderne) dar si optimizarea procedurii de fibrobronhoscopie atunci cand se identifica o cale de
imbunatatire a examinarii sau de limitare maxima a riscurilor.
SESIUNE E POSTERE 3: BOLI PULMONARE RARE,
TRANSPLANT PULMONAR
E POSTER SESSION 3: RARE LUNG DISEASES, LUNG
TRANSPLANT
ROMANIAN REGISTRY FOR INTERSTITIAL LUNG DISEASES (REGIS):
INCLUSION OF PATIENTS IN 3 YEARS
IRINA STRAMBU1, DANIEL TRIL2, TEODOR SALMEN3, ELENA DANTE4, ANCA

MACRI1, MILENA MAN5
1
Marius Nasta National Institute of Pneumology, Bucharest, Romania
2
Victor Babes Hospital, Pneunology Department, Timisoara, Romania
3
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
4
Palazu Hospital, Pneumology Department, Constanta, Romania
5
Leon Daniello Pneumology Hospital, Cluj-Napoca, Romania
REGIS was developed by the Working Group within the Romanian Society of Pneumology. The
inclusion of patients was performed voluntarily by designated physicians in 4 centers.
In 3 years, 104 patients with interstitial lung diseases (ILD) were registered. The investigations
performed for diagnosis were: chest X-ray (100%), CT scan (99.04%), spirometry (95.19%),
DLCO (80.77%), broncho-alveolar lavage (49.04%), biopsy (40.38%), serum biomarkers:
angiotensin-converting enzyme (32.39%), autoantibodies (16.35%).
The diagnosis were: idiopathic pulmonary fibrosis (IPF) 26 pts (25%), sarcoidosis 25 pts (24.04%),
collagen disease associated ILD 13 pts (12.5%), hypersensitivity pneumonitis 12 pts (11.54%),
eosinophilic pneumonia 3 pts (2.88%), NSIP and undefined ILD each 7 pts (6.73%), drug induced
ILD and cryptogenic organizing pneumonia and polyangeitis granulomatosis each 2 pts (1.92%),
one case each: bronchiolitis related ILD, lymphangioleyomyomatosis, Langerhans hystiocitosis,
and alveolar proteinosis.
The 26 IPF patients were most male (69.23%) and smokers (65,38%), mean age 63. Disease was
mostly severe, with a mean FVC of 60.26% predicted and mean DLCO 42.89% predicted. All had
UIP pattern on HRCT. In 4 patients (15.38%) lung biopsy was performed.
The 24 sarcoidosis patients had mean age 40.52, 19 (76%) were nonsmokers, 88% had mediastino-
pulmonary involvement. Mean FVC was 94,08% predicted, mean DLCO 78.06%. In 20 pts (80%)
biopsy was performed.
In Romania, ILDs are generaly underdiagnosed and underreported. Diagnosis is made in advanced
stages of disease. In dedicated centers, all needed investigations are available.
MANAGING IDIOPATHIC PULMONARY FIBROSIS: MULTIDISCIPLINARY
ASPECTS
ALICE CRISTINA PAVEL1, EMANUELA ANDREEA PASCARIU1, CRISTIAN

COJOCARU1,2
1
Clinical Hospital of Pneumology, 1st Pneumology Unit, Iasi, Romania
2
Gr. T. Popa University of Medicine and Pharmacy, Pneumology Department, Iasi, Romania
Background: Idiopathic pulmonary fibrosis (IPF) is a progressive condition that, according to

current guidelines, requires a multidisciplinary approach. Diagnostic and therapeutic interventions
reflect the complexity of the biological changes present in this disease and the need for identifying
new criteria for assessing evolution.
Purpose: To highlight the clinical and the biological features in IPF and to assess the need for a
multidisciplinary approach.
Results: Current guidelines document the diagnosis of IPF on the basis of computer-tomographic
and / or histological criteria. There is a need for clinician radiologist pathologist close
collaboration, as well as the assistance of the thoracic surgeon and eventually the specialist in
functional respiratory exploration or the bronchologist. Of course, we can add to the above team a
psychologist, kineto-therapist, cardiologist, etc. But as the care team of these patients expands,
there may be a risk of non-intervention or communication impairment. In current practice, given
the local particularities and the additional risks generated by the health insurance system, we find
a relatively small proportion of diagnosed and treated cases.
Conclusion: IPF may have various clinical and biological aspects, making it difficult to establish
the diagnosis under the assumption of a clear responsibility for diagnostic and therapeutic
interventions, which is why the multidisciplinary approach should be promoted, accepted and
stimulated by decision-makers.
Keywords: idiopathic pulmonary fibrosis, multidisciplinary approach, management

References:
Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic

Society/European Respiratory Society statement: update of the international
multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir
Crit Care Med 2013; 188: 73348.
Chung JH, Lynch DA. The value of a multidisciplinary approach to the diagnosis of
the usual interstitial pneumonitis and idiopathic pulmonary fibrosis: radiology,
pathology and clinical correlation. AJR Am J Roentgenol. 2016 Mar; 206(3): 463-71.
Yagihashi K, Huckleberry J, Colby TV, et al. Radiologicpathologic discordance in
biopsy-proven usual interstitial pneumonia. Eur Respir J. 2016 Apr; 47(4): 1189-97.
WHAT WE KNOW ABOUT SWYER-JAMES-MACLEOD SYNDROME?
A CASE REPORT AND REVIEW OF THE LITERATURE
RAMONA NEDELCU, ANA MARIA SASU, ANCA MACRI, RUXANDRA ULMEANU
Introduction: Swyer-James-MacLeod Syndrome (SJMS) is a rare entity characterized by

hypoplasia and/or agenesis of the pulmonary arteries. It is currently recognized as one of several
causes of unilateral translucent lung. Usually left side of unknown reasons is commonly involved
however bilateral involved can also be seen. SJMS is now considered a post-infectious
manifestation of childhood bronchiolitis obliterans. The treatment includes the early control of
lung infections as well as influenza and pneumococcal vaccinations. The clear indications for
surgical management have not been well established.
Case presentation: A 23 year-old men, non-smoker, was admitted to our hospital with productive
cough, shortness of breath, insidious progression of dyspnea and central cyanosis. The onset of
symptoms typically occurs during infancy or early childhood in association with frequent
respiratory infections, including two episodes of pulmonary tuberculosis. Lung function test
revealed a severe obstructive pattern (FEV1=27% predicted) with significant air trapping and
decreased diffusion (DLCO=58.3% predicted). Chest X-ray showed hyperlucency on the lower
part of the right hemithorax and deviation to the right of the mediastinal structures. Bronchoscopy
- no endobronchial lesion was identified. This case highlights the significance of taking a careful
history, the application of computed tomography and scintigraphy in confirming the diagnosis of
SJMS and in eliminating other diseases.
Thorax computed tomography (CT) revealed bronchiectatic changes, hyperlucency and

diminished vascularity in the right lower and middle lobe with hyperinflation of the left pulmonary
parenchyma. Pulmonary ventilation-perfusion scintigraphy shows marked decrease in ventilation,
vascular flow and perfusion in the affected regions. An echocradiogram depicted normal chamber
dimensions with preserved systolic and diastolic function with evidence of pulmonary
hypertension.
In this case with advanced disease and respiratory failure long-term oxygen therapy is required.
Conclusion: Typically, this disorder is diagnosed in childhood after evaluation for recurrent
respiratory infections, but sometimes an indolent course means diagnosis is not made until
adulthood. The main reason for our reporting this case was related to the fact that few cases have
been reported worldwide of adults presenting with SJMS.
Key words: Swyer-James syndrome, High resolution computed tomography, Perfusion scan.
References
1. Kanwal Fatima Khalil and Waseem Saeed, Swyer-James-MacLeod Syndrome, Journal of the
College of Physicians and Surgeons Pakistan 2008, Vol. 18 (3): 190-192
2. Sager et al. : Swyer james (MacLeods) syndrome, Journal of Research in Medical Sciences,
Sep 2014.
3. A. Sulaiman et al. : Interactive CardioVascular and Thoracic Surgery 8 (2009) 482484
4. Marchevsky et al. : Swyer-James (MacLeod) Syndrome, Arch Pathol Lab MedVol 129, May
2005.
CASE REPORT- COMPLICATIONS OF CORTICOTHERAPY IN THE TREATMENT
OF SARCOIDOSIS
ILEANA SAMUILA2, LAVINIA DAVIDESCU1,2, SHEIRA NUNKOO3
1
2
Hospital New Medics, Oradea
3
Sarcoidosis is a relatively rare disease of unknownaetiology. It is a systemic inflammatory disease

with a predilection for the respiratory system, but it can affect the eyes, skin, liver, heart and central
nervous system. In most cases, systemic therapy is not necessary, the disease regressing
spontaneously. Oral corticosteroids are considered the first line of treatment for sarcoidosis. It is
well known that systemic corticosteroid therapy can be associated with multiple complications.
Prolonged corticotherapycomplications include osteoporosis, myopathy, avascular
necrosis, hyperglycemia, diabetes mellitus, hypertension,obesity, memory deficit, or even
psychosis. We present the case of a 45 years-old woman, known with hypertension, with complains
of dyspnea, dry cough, fatigue.Chest radiography and computer tomography reveals mediastinal
lymph nodes and lung infiltrations in lower lobes. The histopathological examination of the
mediastinal lymph nodes describes numerous epithelioid and giganto-epithelioid granulomas.
Based on clinical, imagistic and histopathological data, the diagnosis of stage II pulmonary
sarcoidosis is established.
After two months of corticotherapy the patient presents a favorable clinical and imagistic
evolutionof thepulmonary lesions. During the corticotherapy the patient develops cushingoid face,
increase of blood pressure and cortico-induced diabetes (insulin-dependent diabetes). The
particularity of this case consists of the occurrence of insulin-dependent diabetes mellitus as a
complication of corticotherapy of a patient of normal BMI with sarcoidosis, without a past history
of diabetes.
Key words: sarcoidosis, corticotherapy, complications.

COMPLICATIILE CORTICOTERAPIEI IN TRATAMENTUL SARCOIDOZEI-CAZ
CLINIC
ILEANA SAMUILA2, LAVINIA DAVIDESCU1,2, SHEIRA NUNKOO3
1
2
Spital New Medics, Oradea
3
Clinica Davidescu
Sarcoidozaeste o boala relative rara de etiologie necunoscuta. Este o boala inflamatorie

sistemica cu predilectie pentru sistemul respirator, dar poate afecta ochii, pielea, ficatul, inima si
sistemul nervos central.
In majoritatea cazurilor nu este necesar un tratament sistemic, boala involuand spontan.
Terapia cu corticosteroizi orali este considerata prima linie de tratament in sarcoidoza.
Este bine cunoscut faptul ca tratamentul sistemic cu corticosteroizi se poate insoti de

multiple complicatii. Complicatiile corticoterapiei de lunga durata sunt osteoporoza, miopatie,
necroza avasculara, hiperglicemie, diabetzaharat, hipertensiune, obezitate, tulburari de memorie si
chiar psihoza.
Prezentam cazul unei paciente in varsta de 45 ani, cunoscuta hipertensiva, care se prezinta
pentru dispnee, tuse seaca, fatigabilitate. Radiografia pulmonara si CT torace deceleaza adenopatii
mediastinale si infiltrate pulmonare lobii inferiori bilaterali. Examenul histopatologic din
ganglionii mediastinali descrie numeroase granuloame epiteloide si gigant-epiteloide. Pe baza
datelor clinice, imagistice si histopatologice se stabileste diagnosticul de sarcoidoza pulmonara
stadiul II.
La doua luni de corticoterapie evolutia pacientei este favorabila din punct de vedere clinic
si imagistic cu regresia leziunilor pulmonare si a adenopatiilor mediastinale. Pe perioada
corticoterapiei pacienta prezinta facies cushingoid, cresterea valorilor tensionale si diabet zaharat
insulinonecesitant.
Particularitatea cazului consta in aparita diabetului zaharat ca si complicatie a
corticoterapiei la o pacienta cu sarcoidoza, normopoderala si fara ancededente heredocolaterale
semnificative.
Cuvinte cheie: sarcoidoza, complicatii corticoterapie.

RISK FACTORS FOR PULMONARY DECLINE IN CYSTIC FIBROSIS CHILDREN
IOANA M. CIUCA1,2, CRISTIAN OANCEA2,3, MIHAELA DEDIU1, MONICA MARC3,

LIVIU L. POP1,2, VOICU TUDORACHE3
1
Departament of Pediatrics, UMF Victor Babes, Timisoara, Romania
2
National Cystic Fibrosis Centre Timisoara, Romania
3
Department of Pulmonology, UMF Victor Babes, Timisoara, Romania
Email: [email protected]
Key words: cystic fibrosis, children, lung disease

Background: Pulmonary inflammation is a major cause of decline in lung function in patients
with cystic fibrosis and acute exacerbations may occur therefore slowing evolution of lung disease
is a primary aim of CF therapy may precede the onset of chronic infection.
Methods: An observational, cross-sectional transversal study including fifty seven patients
evaluated the influence of factors potentially influent on the pulmonary function in CF patients.
The correlation of specific parameters like age, gender, nutritional status, CF related diabetes
(CFRD), CF associated liver disease (CFLD), with the lung function expressed by FEV1 were
studied. Multiple linear regression analysis was performed using FEV1 as a dependent variable
and the following variables of interest: age, age-at-diagnosis, BMI, sex, pancreatic insufficiency,
microbial infection, CFLD, CFRD as independent variables.
Results: The correlation of the lung function, expressed by FEV1, was positive with BMI, every
increase with a unit of BMI associated an increase of the FEV1 percentage with a mean value of
5.447 (95% CI 1.892; 9.002). The mean value of FEV1 % decreased with 1.474 (95% CI -2.868;
-0.080) for every increase unit increase in the patients age. With a stepwise multiple regression we
obtained a significant model (p<0.001) in which the variability of FEV1 is expressed by sex (=-
0.297, p=0.059), BMI (=0.498, p=0.004) and age (=-0.332, p=0.039) in proportion of
approximately 45% (R-square=0.435).
Conclusions: The most important negative influence on the pulmonary status in our CF patients
had the age, female sex and the MRSA colonization, while the positive effect of enhanced BMI on
the lung function was registered, as expected.
Bibliography:
1.Kerem E, Viviani L, Zolin Aet all . ECFS Patient Registry Steering Group. Factors associated
with FEV1 decline in cystic fibrosis: analysis of the data of the ECFS Patient Registry. Eur Respir
J. Jan 2014, 43 (1) 125-133
2.Kozlowska W.J- Lung Function from Infancy to the Preschool Years after Clinical Diagnosis of
Cystic Fibrosis, American Journal of Respiratory and Critical Care Medicine, Vol. 178,
No. 1 (2008), pp. 42-49
3.Tiddens, H. A.W.M., Donaldson, S. H., Rosenfeld, M. and Par, P. D. (2010), Cystic fibrosis
lung disease starts in the small airways: Can we treat it more effectively?. Pediatr. Pulmonol.,
45: 107117
ACROMEGALIA SI SINDROMUL DE APNEE IN SOMN-CAZ CLINIC
ALINA BOTA-SZIBER1, LAVINIA DAVIDESCU1,2
1
Clinica Davidescu
2
Introducere: Acromegalia este o afeciune endocrin ce are ca substrat producia excesiv,

persistent i autonom de hormon de cretere, debutat dup nchiderea cartilajelor de cretere.
Prevalena bolii este de aproximativ 5 cazuri la 100000 de locuitori.
n majoritatea cazurilor, acromegalia are ca i cauz adenomul hipofizar secretant de GH iar boala
se caracterizeaz prin creterea n dimensiuni a oaselor late i scurte, hipertrofia esuturilor moi,
visceromegalie. Cel mai frecvent, acromegalia asociaz tulburri cardiovasculare, pulmonare,
digestive, metabolice, manifestri articulare, neuromusculare i psihice.
Prezentm cazul unui pacient n vrst de 39 ani, diagnosticat cu acromegalie, adenom hipofizar
secretant de GH, operat i aflat sub tratament cu analogi de somatostatin. Asociat, pacientul
prezint insuficien hipofizar pe linie tirotrop, corticotrop i gonadotrop, pentru care urmeaz
tratament substitutiv.
Pacientul a fost diagnosticat in Clinica noastra cu sindrom de apnee n somn obstrctiv sever, cu
index AHI =32/h de somn ,SaO2 medie nocturna 92%, minim nocturn 52%, index desaturri=
56/h de somn. S-a recomandat terapie CPAP nocturn, ; presiune medie necesara pe parcursul
nopii 10cm H2O n REM n supin. cu o mbuntire evident a strii generale.
Sindromul de apnee n somn este una dintre cele mai frecvente complicaii la pacienii cu
acromegalie, iar acetia necesit evaluare pneumologic periodic.
ACROMEGALY ASSOCIATED WITH SLEEP APNEA -CLINICAL CASE
ALINA BOTA-SZIBER1, LAVINIA DAVIDESCU1,2
1
2
Introduction: Acromegaly is an endocrine disease that occurs due to excessive, persistent and
autonomous production of growth hormone, in adults.
The prevalence of this disease is about 5 cases per 1000000 population.
In the majority of cases, the cause of acromegaly is a GH secreting pituitary tumor and the main
consequences are the growth of short and wide bones, soft tissue hypertrophy, visceromegaly. The
most frequent complications are cardiovascular, pulmonary, digestive, metabolic, articular, neuro-
muscular and psychiatric manifestations.
We present the case of a 39-year-old male, diagnosed with acromegaly, GH secreting pituitary
tumor. It has been surgically removed and he follows treatment with somatostatin analogs. The
patient is also diagnosed with TSH, FSH/LH and ACTH deficiency, for which he is also treated.
The patient was diagnosed with sleep apnea, severe obstructive form, AHI index 32/h of sleep,
mean nocturnal SaO2 value 92%, minimum nocturnal SaO2 52%, desaturation index 56/h of
sleeps. Nocturnal CPAP therapy was recommended, with a pressure support of 10 cmH2O, with
very good results.
Sleep apnea syndrome is one of the most frequent complications of acromegaly, and patients
diagnosed with this disease need periodical sleep evaluation and therapy if needed.
AN OCASIONAL SURPRISE IN A RARE DISEASE
MIHAELA DEDIU1, IOANA M. CIUCA1,2, ANDREEA FICA1, GABRIELA DUTA1,

MONICA MARC3, CRISTIAN OANCEA2,3, LIVIU L. POP1,2, VOICU TUDORACHE3
1
Department of Pediatrics, Clinical County Hospital "Pius Brinzeu" Timisoara
2
National Cystic Fibrosis Centre, Timisoara, Romania
3
Key words : children, fever, rare disease

Background: Hyperthermia is one of the most frequent causes of a child presentation to the
paediatrician. Children with known chronic pneumopathies are likely to develop acute infectious
exacerbations, like others. The aim paper presents the case of 9 years old boy with cystic fibrosis
with hemoptysis and hyperthermia and haemoptysis.
Methods: Patient was diagnosed with cystic fibrosis in infancy with f 508 del homozygous
genotype and is known with Staphylococcus aureus chronic pulmonary infection. He was on
chronic ciprofloxacin treatment and started to have fever.
Results: The initial supposition was a new exacerbation with Staphyloccocus or a new emergent
pathogen, like Pseudomonas aeruginosa. Therefore, he was admitted in the cystic fibrosis
department and started the i.v. treatment with meropenem; unfortunately he continued to have
fever and investigations revealed a minor inflammatory syndrome. Sputum samples were taken
and during the evolution he continues to be febrile and developed mucosal candidiasis. After 4
days of meronem, we noticed the presence of white granular oral lesions, the IgM for measles was
detected positive and exanthema appeared after 7 days.
Conclusion: Not every fever or hemoptysis in a child with cystic fibrosis signifies an exacerbation.
During a viral epidemic trend we have to think of child exposure risk, especially in patients with
chronic pathologies.
Bibliography:
1.Lee TWR, Brownlee KG, Convay SP, Denton M, Littlewood JM. Evaluation of a new definition
of chronic P. aeruginosa infection in cystic fibrosis. J Cyst Fibros. 2003;2:2934
2.Tiddens HAWM, Donaldson SH, Rosenfeld M, et al. Cystic fibrosis lung disease starts in the
small airways: can we treat it more effectively? Pediatr Pulmonol 2010; 45: 107117
3.F. Ratjen, G. Comes, K. Paul, H.G. Posselt, T.O. Wagner, K. Harms Effect of continuous
antistaphylococcal therapy on the rate of P. aeruginosa acquisition in patients with cystic fibrosis,
Pediatr Pulmonol, 31 (1) (2001), pp. 1316
HOW USEFUL IS LUNG ULTRASOUND IN CYSTIC FIBROSIS
IOANA M. CIUCA1,2, CRISTIAN OANCEA2,3, MONICA MARC3, LIVIU L. POP1,2,

VOICU TUDORACHE3
1
Departament of Pediatrics, UMF Victor Babes, Timisoara, Romania
2
National Cystic Fibrosis Centre Timisoara, Romania
3
Key words: cystic fibrosis, lung ultrasound, children

Objectives: Considering the recurrent exacerbation of children with CF and frequent need for
radiation exposure, lung ultrasound (LUS) might be a useful tool for evaluation of pulmonary
changes.
Methods: A prospective observational study included 82 CF patients (age between 4 months-24
years) monitored in our center for two years period. Ultrasound was performed every 6 months,
using a convex 3-5 MHz probe and supplementary exam when patients were admitted for
exacerbations. Specific US marks were used for normal lung and detection of consolidation,
interstitial syndrome, pleural effusion, emphysema. CT was used as a gold standard for evaluation
of pulmonary structural changes and performed after LUS examinations.
Results: Typical LUS signs for consolidation were found in 8.5% of the patients, in 2 of them with
pleural effusion; in this patients a good correlation between US and CT findings was noted (r=0.
79, p< 0.001). The main feature found in LUS were alveoli-interstitial lines, specific for interstitial-
alveolar syndrome (42.6%). Lesions were age-dependent, with more severe lesions in older
patients. LUS detected saccular bronchiectasis in almost all patients confirmed by CT, however
tubular bronchiectasis escaped LUS, showing a low US/CT correlation ( r=0.14, p< 0.9).
Emphysema was detected also easily by M mode examination in 32.8% of patients, predominantly
infants.
Conclusion: Lung ultrasound is a reliable method for detection of substantial lung alterations in
children with CF while for incipient bronchiectasis, CT remain superior. US could be use for
rapid and safe evaluation in CF pulmonary exacerbations.
Bibliography:
1.D.Lichtenstein:Lung Ultrasound (in the Critically Ill) Superior to CT: the Example of Lung
Sliding Korean Journal of Critical Care Medicine 2017; 32(1): 1-8
2.I.M.Ciuca, L.L.Pop. Lung ultrasound in CF children's exacerbation one center experience,
Journal of Cystic Fibrosis Volume 14, Supplement 1, June 2015, S95
3.Daniel Lichtenstein- Novel approaches to ultrasonography of the lung and pleural space: where
are we now? Breathe (Sheff). 2017 Jun; 13(2): 100111.
PULMONARY LYMPHANGITIC CARCINOMATOSIS AND PARANEOPLASTIC
LEUKEMOID REACTION DUE TO METASTATIC GASTRIC CANCER: CASE
REPORT
CRISTINA CLRAU1, MIMI NIU2 , MIHAI OLTEANU2, RAMONA CIOBOATA2
1
Victor Babe Clinical Hospital, Craiova
2
University of Medicine and Pharmacy, Craiova
Background: Pulmonary lymphangitic carcinomatosis (PLC) represents 6-8 % of the lung

metastasis. Neoplastic cells infiltrate the pleural, peribronchial and perivascular lymphatics or the
adjacent interstitia causing thickening of the bronchovascular bundles and septa. The primary
tumours most commonly associated with PLC are: breast (33%), stomach (29%), lungs (17%),
pancreas (4%) and prostate (3%)
Case presentation: We present a case of a 56 year old male with persistent cough, loss of appetite
(especially for meat) and significant weight loss. Initial chest X-ray suggested interstitial lung
disease that should be differentiated between pneumoconiosis, lymphangitic carcinomatosis or
military tuberculosis. Also to be noted that he never smoked, never was exposed to significant
respiratory irritants and he has a medical history of gastric ulcer. His initial CBC showed
leukocytosis so he started treatment with broad spectrum of antibiotics for 10 days but his WBC
doubled. Patient presented no fever, but he accused moderate gastric pain and constipation. His
oxygen saturation was 96-98% during admission. His sputum exam and tests for M. tuberculosis
were negative. Abdominal Thoracic CT scan revealed thickening of septa associated with a
nodular pattern especially in lower fields of both lung areas suggestive for lymphangitic
carcinomatosis. Abdominal ultrasound raised the suspicion for gastric tumor that was later
confirmed with gastroscopy. Gastric biopsy result is not available to this moment. Lung biopsy
was refused.
Discussions: Gold standard for PLC diagnosis is transbronchial biopsy but patient refused. PLC
presented with non-specific respiratory symptoms as a manifestation of disseminated gastric
cancer is rather rare and needs histopathological confirmation. Mechanism of simultaneous
paraneoplastic leukemoid reactions is caused by cytokine production by tumor cells or metastatic
cells and was sometimes associated with solid tumors (eg. carcinoma of the lung, undifferentiated
carcinoma. Patients with PLC have a poor prognosis with <50% survival rate at 3 months but some
of the patients responded well to platinum based therapy.
Key words: lymphangitic carcinomatosis, transbronchial biopsy, paraneoplastic leukemoid

reactions
1. Bruce DM, Heys SD, Eremin O. Lymphangitis carcinomatosa: a literature review. J R Coll
Surg Edinb 1996; 41: 713.
2. Piessen G, Messager M, Leteurtre E, Jean-Pierre T, Mariette C. Signet ring cell histology
is an independent predictor of poor prognosis in gastric adenocarcinoma regardless of
tumoral
clinical presentation. Ann Surg. 2009;250(6):878-887.
3. Dennstedt FE, Greenberg SD, Kim HS, et al. Pulmonary lymphangitic carcinomatosis
from occult stomach carcinoma in young adults: an unusual cause of dyspnea. Chest 1983;
84: 787788.
4. Thomas A, Lenox R. Pulmonary lymphangitic carcinomatosis as a primary manifestation
of colon cancer in a young adult. CMAJ 2008; 179: 338340.
5. Kikuchi N, Shiozawa T, Ishii Y, Satoh H, Noguchi M, Ohtusuka M. A patient with
pulmonary lymphangitic carcinomatosis successfully treated with TS-1 and cisplatin
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6. Riley LK, Rupert J, Evaluation of Patients with Leukocytosis. Am Fam Physician. 2015
Dec 1;92(11):1004-11.

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A IX-a Conferin Naional de BRONHOLOGIE

The 9th National Conference of

A III-a Conferin Naional de CANCER PULMONAR

Prima Conferin Naional de TRANSPLANT PULMONAR

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LAVINIA DAVIDESCU1, KISS EMESE2

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Inflamatia este un factor declansator al transformarii si initierii progresiei tumorale in cancer.

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