[Extended lymphadenectomy for left NSLC--case report]. / Limfadenectomie extinsa in cancerul non small cells stâng--prezentare de caz.

The paper brings up a topical issue in the surgical treatment of non small lung cancer, namely optimal lymphadenectomy for tracking left, considering the anatomical features of specific drainage. This can be achieved by various methods recently introduced in the classical arsenal left lung cancer diagnosis. It's presented in detail a case of extended lymphadenectomy for lung cancer non small left to right paratraheal approach without ligament arterial section. The method allowed a correct staging and reporting of the case more accurate prognosis. The immediate goal of the authors is to discuss on this surgical technique and for long term to achieve a lot with statistical significance in order to assess the value of this method.

[Pulmonary vein anomaly in a patient with pulmonary aspergillosis]. / Anomalie venoasa pulmonara la un pacient cu aspergilom pulmonar.

Vein pulmonary anomalies are seldom met. They have a prevalence of 0.4-0.7% of the cases (according to the American authors). The case under discussion is a 68-year-old patient, who was admitted in the hospital for hemoptysis in low quantity but recurrent, physical asteny, fever and weight loss. The onset had been two months before admission to the hospital. The thoracic X-ray shows opacity at the left apex with marked subcostal and costal intensity, with a homogenous area of 5/6 cm. The thoracic CT exam shows multiple bilateral fibronodular images and the left upper lobe shows a cavitary image with regular and thin walls; intracavitary there is an oval formation with mixed densities of approximate 3.5/4/4.5 cm, which suggests a lung aspergilloma. Surgery will be performed--left upper lobectomy associated with atypical resection from the left Fowler segment. During the surgery it is noticed that the left upper pulmonary vein is abnormaly in the left pulmonary hilum. It has a cranial trajectory, runs in parallel with the left phrenic nerve on the mediastinal surface of the left upper lobe then goes in the mediastinum and pours into the left vein branchocefalic trunk. The post-surgery recovery was slowly favourable with complete pulmonary re-expansion, but with the persistence of the aerial losses which imposed pleural drainage for a period of over 2 weeks.

[Superior vena cava syndrome--surgical solution--case report]. / Sindromul de vena cava superioara--varianta terapeutica.

The patient of 52-year-old smoker was admitted in emergency with headaches, dyspnea, oedema and cyanosis of the cephalic extremity and of the superior members. This signs and symptoms suggest a superior vena cava sindrom. Thoracic CT scan shows the thrombosis of the superior vena cava and a tumor localized in the Bariety's Lodge of about 30/40 mm witch is around the right lateral wall of the traheea.This tumor is also tangent to the superior the superior vena cava. The patient was operated by total median sternotomy. By this approach we performed a complete excision of the mediastinal tumor mass. After that we effected a longitudinal cavotomy, we took out the endoluminal clot and we sutured the superior vena cava. The histological diagnosis of the mediastinal tumor was adenocarcinoma tubular-papillary moderately differentiated. The evolution post operative period was favorable the superior vena cava sindrom was a complet remission. The thoracic CT scan control after 9 months later didn't show a local relapse and blood flow was normally throw the superior vena cava.

Localized Fibrous Tumor of the Pleura An Unusual Cause of Severe Hypoglycaemia. Case Report.

Localized fibrous tumors of the pleura are rare. If there are symptomatic, the symptoms are based on hormone production or size. Complete resection offers the best results. However, recurrence is reported in a significant number of patients. Usually no oncologic treatment is necessary.

Early and late effect of infliximab on circulating dendritic cells phenotype in rheumatoid arthritis patients.

The aim of this study was to analyze the phenotype of circulating dendritic cells (DCc) in rheumatoid arthritis (RA) patients before and after treatment with infliximab (at 24 h and 6 months) and the correlation between these changes and the clinical response to treatment. Sixteen patients with RA were recruited and clinical status was determined using the Disease Activity Score 28 (DAS28). All patients had active disease (mean DAS28 = 5.96) and were suitable for treatment with infliximab. Samples of peripheral venous blood were obtained before administration of the first dose of infliximab and again at 24 h and 6 months after treatment. DCc populations were analyzed by flow cytometry. At 24 h, there were no differences in the clinical status of the patients. However, we found a decrease in CD11c+ and, to a lesser extent, CD123+ DCc percentages. The expression of CD83, the most important activation marker for DC, was also shown to be decreased 24 h after infliximab therapy. After 6 months of treatment, all patients showed significant clinical improvement (mean DAS28 = 3.64, p < 0.001) and expression of the activation marker on DCc remained low. In conclusion, this study supports the role of tumor necrosis factor (TNF)-alpha blockade in preventing the maturation of DCc and in reducing the expression of their activation markers. Although the clinical response to infliximab was not observed after 24 h, DCc activation was strongly reduced by anti-TNF-alpha therapy. After 6 months of treatment, current data show a less active phenotype of DCc associated with clinical improvement in all patients in the study.

Highlights in the minimally invasive treatment of SUI in women.

OBJECTIVE: Treatment of stress urinary incontinence consists of a wide range of options, from conservative therapies like lifestyle changes, medication, pelvic floor muscles exercises, electro-stimulation, to minimally invasive procedures--injection of collagen, suburethral slings TVT/TOT and last but not least, invasive surgical treatment reserved for recurrent and complex cases. Among the latest minimally invasive procedures reported in literature, the injection of intra-and perisphincterian of autologous stem cell (mioblasts and/or mature fibroblasts grown and multiplied in the laboratory from biopsy samples taken from the pectoralis muscles). MATERIAL AND METHOD: On October 18, 2010, in 'Fundeni' Clinical Institute of Uronephrology and Renal Transplantation was performed the first stem cell implantation procedure in the urethral sphincter, in Romania. RESULTS: Assessment at 6 weeks, the quality of life questionnaires, micturition diary and clinical examination revealed a stunning decrease of urine loss from 6 pads/day at one per day, which significantly improved the patient's quality of life. CONCLUSIONS: Stem-cell-mioblasts therapy may represent in the future an every-day intervention in the urologist's armamentarium. The effectiveness of this treatment can change the course of therapy and last but not least, the accessibility to urological evaluation of patients with stress urinary incontinence. Clinical and urodynamic evaluations will continue and will be future scientific topics.

Minimally invasive treatment for female stress urinary incontinence - Romanian highlights.

RATIONALE: Stress urinary incontinence is still a "battlefield" for many minimally invasive therapies, but, unfortunately, few can restore the anatomical and functional background of this disorder. OBJECTIVE: Assessing the latest minimally invasive procedures of intra and perisphincterian injection of autologous stem cells. METHOD AND RESULT: The first stem cell implantation (myoblasts and /or mature fibroblasts grown and multiplied in the laboratory from biopsy samples taken from the pectoralis muscle) in the urethral sphincter was performed on October 18, 2010, in "Fundeni" Clinic of Urology and Renal Transplantation, in Romania. DISCUSSION: The follow-up at six weeks with the quality of life questionnaires, micturition diary and clinical examination revealed a decrease of urine loss from six pads/ day at one per day, which significantly improved the patient's quality of life according to visual analogue scale. Clinical and urodynamic evaluations will continue and will be future scientific topics.

Prognostic factors in retroperitoneal fibrosis.

UNLABELLED: The aim of this study is to evaluate effective prognostic factors in the evolution of patients with retroperitoneal fibrosis and to establish the validity of fractal analysis in determining the disease severity in these patients. MATERIAL AND METHODS: This study included 19 patients (M/F: 5/14) treated for idiopathic retroperitoneal fibrosis and bilateral obstructive renal failure between Jan 2004-Dec 2008. Patients were identified retrospectively, searching for patients diagnosed with IRF, after retroperitoneal biopsy or, in most cases the diagnosis rested on radiological findings, especially CT, with identification of a retroperitoneal mass, the absence of other demonstrable renal or ureteric disease or any other pathology that could explain the findings. CT was very useful in describing the retroperitoneal mass around the aorta and inferior vena cava, the extent of the lesion and for monitoring the response to surgical treatment during the follow-up. The data were evaluated about medical history, physical examination findings, laboratory tests (serum urea and creatinine, blood sugar, sodium, potassium, bicarbonate levels, serum pH, uric acid, haematocrit, white blood cell count), imaging methods (renal ultrasound, abdominal CT-scan, MRI). At admission all patients had active disease with obstructive renal failure and underwent bilateral ureteric stenting in order to normalize the BUN levels. After normalizing of BUN levels, ureterolysis and omental wrapping was performed. Postoperatively, ureteric stents were removed after 1 month and remission of renal disfunction was obtained in approximately 5 months (range 2-10 months). All patients were followed for at least 1 year. Patients were regularly checked every 3 months. RESULTS: Of the 19 patients, there were 5 men and 14 women. The median age at diagnosis of RF was 50 years (range 42-64 years). The most frequent presenting symptoms were back or abdominal pain, weakness, weight loss, oligoanuria, arterial hypertension and mild fever. The duration of symptoms before diagnosis ranged from 6 to 18 months. At presentation all patients had active disease, presenting renal dysfunction with a median serum creatinine of 5.18 mg/dl (range 1-15.4 mg/dl). Most of the patients had moderate bilateral hydronephrosis (2nd degree hydronephrosis). In our study, all patients had excellent prognosis, with full recovery of renal function in 78% of cases (15 patients). The fractal dimension of the fibrosis mass contour correlates with level of renal function impairment. Even more, the fractal dimension seems to slightly variate between CT evaluations (1.30 +/- 0.1), suggesting a non aggressive pattern of extension of the fibrotic mass characteristic for benign lesions. CONCLUSIONS: The imaging parameters did not predict the disease severity, except the increase in fractal dimension of fibrosis surface area. Efficacy of bilateral ureteric stenting in improving renal function is limited in most of the cases. Dispite the level of renal function impairment at admission, full recovery can be achieved after bilateral ureteric stenting/nephrostomy and ureterolisis.

Sensorimotor neuropathy in a patient with Marinesco-Sjögren syndrome.

A case of Marinesco-Sjögren syndrome, displaying the characteristic signs (ataxia, congenital cataract and mental retardation) is presented. Electrophysiological examination pointed to the presence of a sensorimotor peripheral neuropathy with an underlying mixed process of segmental demyelination and axonal degeneration (probably secondary). The sural nerve and gastrocnemius biopsy confirmed these data, showing that in this case the segmental demyelination process was accompanied by axonal degeneration.

The prognostic value of ventricular rupture in cerebral hemorrhage.

Analysis of 41 cerebral hemorrhage cases associated or not with intraparenchymatous hematoma and ventricular rupture shows the role played by these associated phenomena in the evaluation and prognosis of these patients. The death rate was 56.25% in simple cerebral hemorrhage, 100% in hemorrhage associated with hematoma, 30.76% in hemorrhage associated with ventricular rupture and 80% in hemorrhage associated with hematoma and ventricular rupture. The authors point out that the mere presence of ventricular rupture is not a really aggravating factor. A particular severity resulting from association of hemorrhage with hematoma seems to be due to the extension of the cerebral lesion produced by the two conditions associated.

The chronic inhibition of angiotensin-converting enzyme impairs postoperative renal function.

UNLABELLED: Postoperative renal impairment can increase postoperative mortality and morbidity. We sought to identify preoperative risk factors responsible for postoperative renal impairment in patients undergoing aortic surgery. This prospective study included 249 patients admitted for aortic surgery. Preoperative and postoperative glomerular filtration rates (GFRs) were assessed with pre- and postoperative creatinine clearance measurements. Postoperative renal impairment was defined as a 20% decrease in GFR between Day 0 (before surgery) and Day 7 +/-1 day (after surgery). Preoperative and intraoperative variables considered as potentially responsible for postoperative renal impairment were tested. Chronic treatment with angiotensin-converting enzyme inhibitors (ACEIs) was the only factor significantly associated with postoperative renal impairment (odds ratio [95% confidence interval] = 2.01 [1.05-3.83]). Chronic preoperative ACEI treatment is significantly associated with postoperative renal impairment. Inhibition of renal compensatory mechanisms caused by renin angiotensin system blockade might be responsible for the observed decrease in renal function in patients chronically treated with ACEIs undergoing aortic surgery. However, age and preoperative renal dysfunction were not associated with a postoperative decrease in GFR, but they were associated with a postoperative creatinine clearance <60 mL/min. IMPLICATIONS: The aim of this study was to identify preoperative risk factors responsible for postoperative renal impairment in vascular surgery. Chronic angiotensin-converting enzyme inhibitor treatment was the only factor significantly associated with postoperative renal impairment. Inhibition of renal compensatory mechanisms caused by renin angiotensin system blockade might be responsible for the observed decreased renal function.