[Mycobacterial mediastinal adenopathy]. / Adenopatie tuberculoasa mediastinala--dificultati de diagnostic.

Tuberculosis is a frequent cause of prolonged fever. Mediastinal lymph node enlargement is an uncommon feature of intrathoracic tuberculosis in adults. The authors present the case of a 64 year old man who developed prolonged fever and was admitted to Clinical Hospital of Infectious Diseases and Pneumophtisiology Dr. Victor Babes Timisoara during 06.04-15.04.2009. Diagnosis of mediastinal lymph node tuberculosis was established only after axillary thoracotomy and biopsy of tumoral mass, although the first results obtained after mediastinoscopy were negative. Dynamics of biological features, diagnostic pitfalls, differential diagnosis difficulties and peculiar aspects of evolution are presented. Mediastinal tuberculous adenopathy, without associated pulmonary involvement is a rare form of presentation among adults, generally evolving with sustained fever. Diagnosis of mediastinal tuberculosis is difficult due to non-specific clinical aspects and lack of characteristic radiographic features and so invasive diagnostic procedures gain importance (mediastinoscopy and biopsy).

The role of surgery in the management of pleuropulmonary tuberculosis - seven years' experience at a single institution.

Pleuropulmonary tuberculosis (TB) is a relatively frequent condition (the incidence of (TB) was 176/100,000 in our county in 2004) and some of these patients with TB are undergoing surgical interventions. The authors share their experience in surgical treatment of pleuropulmonary tuberculosis, based on minimal invasive techniques such as VATS and filling the residual cavities with muscle or skin-muscle grafts. The authors are retrospectively revising 144 patients between 1 January 2001 and 31 December 2007 who underwent surgical treatment for tuberculosis in this period. Two hundred and thirteen surgical procedures were performed for pleuropulmonary tuberculosis, representing 4% of all the procedures done in the department. For most of the patients the etiological diagnosis was not established until the operations, all the patients were sputum-negative. The diagnoses at the admittance were: pulmonary nodules or tumors (42 patients), pleural collections (46), pleural thickening and post-tuberculosis syndromes (46), fibrocavitary tuberculosis (6), and tuberculous pericarditis (4). Of all the procedures applied, 14 were pulmonary resections, 50 atypical (wedge) resections, 70 video-assisted thoracic surgery (VATS) procedures, and nine patients needed muscle or skin-musle flap for residual pleural cavities. Eleven patients (7.6%) had to undergo secondary surgery due to complications. No in-hospital mortality was registered. The mean hospitalisation period was 10.1+/-4.2 (S.D.) days.

[An improved approach in the diagnosis of mediastinal/pulmonary masses through the CT-guided transthoracic fine needle aspiration]. / O abordare eficientizata economic a diagnosticului formatiunilor mediastinopulmonare prin punctie transtoracica ghidata CT.

AIM: In our clinic we have gathered more than 750 cases of CT-guided transthoracic fine needle aspiration (FNA). This procedure is very useful for the diagnosis of mediastinal/pulmonary tumor masses. Because of the relatively high cost of this procedure, we tried to find out a less expensive but still reliable way to get the diagnosis for these tumors, and for this reason we figure out an original approach. METHODS: The study population consisted of 160 patients divided in two groups. To first group we applied the classic method using the conventional needles and the Papanicolaou stain. For the second group we used the spinal anesthetic needle and an original stain (blue--polychrome--tanine--Dragan). The chi2 test was used to match the results and complications between the two groups. RESULTS: This study prove that this original method is as reliable as the classic one but with a ten-fold reduction of costs: 1,198 euro versus 128 euro per 100 smears. CONCLUSIONS: Choosing of this original method for the diagnosis of mediastinal/pulmonary tumors through transthoracic FNA is justified by the low cost, simple technique and the same reliability as the classic method.