[Clinical features and course of patients with tuberculosis requiring intensive care]. / Particularitatile clinico-evolutive ale pacientilor cu tuberculoza care au necesitat terapie intensiva.

BACKGROUND: To describe the characteristics of patients with tuberculosis (TB) requiring intensive care and to identify the risk factors for mortality. METHODS: We conducted a retrospective, cohort study, between January 2006 and December 2009. The patients with TB, admitted in Pneumology Clinic Hospital, Iasi, requiring advanced life support in intensive care unit (ICU), were included. We assessed different clinical parameters to identify the factors that predict in-hospital mortality. The primary outcome was the in-hospital mortality. RESULTS: During the study period, 27 patients with TB required intensive care. Of them, 16 (59.3%) had acute respiratory failure and 6 (22.2%) required mechanical ventilation. Eighteen (66.7%) patients died. Acute respiratory failure, acute hepatic failure and mechanical ventilation significantly correlate with a high in-hospital mortality rate. CONCLUSIONS: In this study we found a high mortality rate in TB patients requiring intensive care, identifying some risk factors.

[Unique monoblock lung right-left, unique pleural cavity]. / Plamân monobloc dreapta-stânga. Cavitate pleurala unica. Plamîn hipoplazic stâng. Caz clinic.

A 34-year-old female with WPW syndrome has been under surgical treatment in our clinic with left basal chronic pleural empyema. During the surgical intervention multiple anatomical anomalies were detected, like unique pleural cavity, monoblock lung left-right, hypoplasic left lung, no scissures on the left side, no left pulmonary arteria with an aberrant arteria for the left lung derived from the right pulmonary arteria, the same for the bronchis. The pleural-pulmonary shelling proceeded without incidents and it has been finalized with the drainage of the whole pleural cavity.

[Surgical treatment of lung hydatid cysts]. / Tratamentul chirurgical al chistului hidatic pulmonar.

UNLABELLED: Lungs represent the econd most common localization of hydatidosis, after liver. The current treatment for pulmonary hydatid cyst (PHC) is complete excision with maximum preservation of lung tissue. The authors emphasize the particularities of diagnosis and surgical treatment of PHC. MATERIAL AND METHOD: A clinical retrospective study was carried out on a series of 247 cases with PHC, admitted in the Thoracic Surgery Department of Pneumology Hospital of Iasi between 1999 and 2007. Data regarding the clinical picture, imagistical findings and surgical treatment were collected from the medical files and reviewed. RESULTS: There were 162 men and 85 women, aged between 11 and 78 years. Of these, 134 patients had uncomplicated cysts and 113 had complicated forms. The cysts were located in the right lung in 115 cases (46.5%), the left lung in 98 cases (39.5%) and bilaterally in 34 cases (14%). Liver cysts were associated in 28 cases (11.3%) cases. The surgical procedures employed were: Dor in 118(47.5%) cases, Posadas in 64 (26%) cases, Geroulanos in 5 cases and ideal cystectomy in 14 cases. Pulmonary resection was used in 46 cases (18.5%), including 16 wedge resections, 27 lobectomies and 3 pneumonectomies. Medical parasiticide (Albendazole, 800 mg per day) was used postoperatively. The outcome was fatal in one patient (0.41%), mainly due to associated pathology. In our series, the overall incidence of complications was 7.7%, these consisting of: anaphyfilaxis (3 cases), hemothorax (2 cases), pneumothorax (2 cases), prolonged air leak in 5 cases (including a bronchial stump insufficiency) and atelectasis (5 cases). CONCLUSION: Surgery is the mainstay of the treatment of PHC and the operative technique must be adapted to each individual case.

[Giant diaphragmatic hemangiopericytoma. A case report]. / Hemangiopericitom diafragmatic gigant. Prezentare de caz.

A 47-year-old man presented with dyspnea and pain in the right lower thorax. The thoracic radiography and the MRI exam were suggestive for a giant tumor located in the right supradiaphragmatic region. Surgical exploration revealed a diaphragmatic pediculated tumor, hyper-vascularised, weighting 4.8 Kg and measuring about 27 / 18 cm, that was removed with difficulty due to adherences and bleeding. The histopathologic examination showed multiple capillary and arteriolar vessels, included in masses of round and fusiform cells (pericytes), having multiple nuclear abnormalities.

[Thoracoscopic pleurodesis in malignant pleural effusions]. / Pleurodeza toracoscopica in pleureziile maligne.

We performed retrospectively study on 136 thoracoscopies done in our clinic in the period January 2000 and December 2004. We reviewed 136 thoracoscopies, 71 patients were male and 65 were female (mean age 58.4 years). Straw colored effusions were present in 78 cases (57%) and hemorrhagic in 58 cases (43%). The surgical procedure consist in diagnostic of thoracoscopy with drainage of pleural effusion, multiply pleural biopsy, pleurodesis and continuous pleural drainage. In our study, the talc powder (5g) was successfully as sclerosing agent. The primary tumor was: lung-63 (46%), breast-26 (19%), mesothelioma-21 (15.5%), stomach-3, ovarian-3, prostate-3, colon-2, lymphoma-1, leukemia-2, plasmocytoma-1 and unknown primary tumor in 11 cases (8%). Adverse effects included-chest pain-35 cases (25%), fever-20 cases (15%), empyema-6 cases (4.5%), prolonged air leak-5 cases (4%), pulmonary infection-2 cases, acute respiratory failure-1 case, malignant invasion of scar-1 patient. For statistical analysis, the success of talc pleurodesis was defined as the absence of pleural fluid on the follow-up chest radiographs. Pleurodesis was successful in 125 cases (92%) of the patients after 1 month-follow-up. Thoracoscopic talc pleurodesis is a safe, economical and effective treatment for malignant pleural effusion.

[Up-to-date indications for surgery in pleural and pulmonary tuberculosis]. / Indicatii actuale in chirurgia tuberculozei pleuro-pulmonare.

Tuberculosis is an "old disease" but still remains a threat in modern days life. Despite human and material efforts, despite the improvements in drug therapy, the treatment of tuberculosis continue to consume a great amount of health care worldwide. A certain percentage among the patients with pleuro-pulmonary tuberculosis represents failures of DOTS therapy. Among them, paraclinical investigations will select candidates eligible for thoracic surgery. In our study we are reviewing the main surgical options and we present our experience regarding surgery in pleuro-pulmonary tuberculosis--what to operate and when is the best moment.