The Role of Lung Microbiome in Fibrotic Interstitial Lung Disease-A Systematic Review.

Interstitial Lung Disease (ILD) involves lung disorders marked by chronic inflammation and fibrosis. ILDs include pathologies like idiopathic pulmonary fibrosis (IPF), connective tissue disease-associated ILD (CTD-ILD), hypersensitivity pneumonitis (HP) or sarcoidosis. Existing data covers pathogenesis, diagnosis (especially using high-resolution computed tomography), and treatments like antifibrotic agents. Despite progress, ILD diagnosis and management remains challenging with significant morbidity and mortality. Recent focus is on Progressive Fibrosing ILD (PF-ILD), characterized by worsening symptoms and fibrosis on HRCT. Prevalence is around 30%, excluding IPF, with a poor prognosis. Early diagnosis is crucial for optimizing outcomes in PF-ILD individuals. The lung microbiome comprises all the microorganisms that are in the respiratory tract. Relatively recent research try to evaluate its role in respiratory disease. Healthy lungs have a diverse microbial community. An imbalance in bacterial composition, changes in bacterial metabolic activities, or changes in bacterial distribution within the lung termed dysbiosis is linked to conditions like COPD, asthma and ILDs. We conducted a systematic review of three important scientific data base using a focused search strategy to see how the lung microbiome is involved in the progression of ILDs. Results showed that some differences in the composition and quality of the lung microbiome exist in ILDs that show progressive fibrosing phenotype. The results seem to suggest that the lung microbiota could be involved in ILD progression, but more studies showing its exact pathophysiological mechanisms are needed.

Managing Severe Adverse Reactions to Biologicals in Severe Asthma.

BACKGROUND: The use of biological agents in the treatment of various inflammatory and malignancy conditions has expanded rapidly. However, these agents can induce hypersensitivity reactions, posing significant clinical challenges. METHODS: We conducted a retrospective study that included nine patients with severe asthma who experienced hypersensitivity reactions to biological agents (omalizumab, benralizumab and dupilumab). RESULTS: Hypersensitivity reactions to biologicals in severe asthma were observed in 9 of 68 patients treated. In five cases, treatment was stopped or changed to another available biological, and for four patients administered under close surveillance, titrated provocation or desensitization was applied. Successful desensitization was achieved in three of the patients, allowing them to continue therapy without adverse reactions. Improvements in asthma control were observed post-desensitization, leading to the reduced need for systemic steroid treatments and an increase in quality of life. CONCLUSIONS: This study highlights the importance of recognizing hypersensitivity reactions to biologicals to have an appropriate approach for patients with severe asthma. As an effective approach for patients experiencing hypersensitivity reactions to biological agents, desensitization allows treatment continuation.

COPD in Firefighters: A Specific Event-Related Condition Rather than a Common Occupational Respiratory Disorder.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Smoking remains the most important risk factor, but occupational exposures may play an essential role as well. Firefighters are among occupations regularly exposed to a variety of irritative inhalational products, and they may be expected to develop respiratory health problems because of such an occupational exposure. To better understand and characterize this relationship, we performed an extensive search of the scientific literature, and we identified two major research areas: firefighters exposed to wildland fire smoke and firefighters involved in the World Trade Centre disaster-related operations. Most of the studies did not report a significant increase in COPD diagnosis in firefighters. An accelerated rate of decline in lung function was seen, a short time after major exposure events. This is the reason for an increased rate of exacerbations observed in individuals already diagnosed with obstructive respiratory disorders. A limited number of studies not covering these specific circumstances of exposure were found. They reported long-term morbidity and mortality data, and the results are controversial. Major confounding factors for most of the studies were the "healthy worker effect" and the lack of useful data regarding smoking habits. Efforts should be made in the future to better characterize specific biomarkers for the progression of COPD; to establish exposure limits; and to implement preventive strategies like rotation of workers, smoking cessation programs, and long-term monitoring programs for respiratory disorders.

Increased Vascular Endothelial Growth Factor Serum Level and the Role of +936C/T Gene Polymorphism in Chronic Obstructive Pulmonary Disease.

Background and Objectives: Chronic obstructive pulmonary disease (COPD) represents a debilitating disease, with rising morbidity and mortality. Vascular endothelial growth factor (VEGF) plays a major role in angiogenesis, vascular permeability, and airway remodeling. The purpose of this study was to investigate the relationship between VEGF serum levels and VEGF +936 C/T gene polymorphism (rs3025039) with COPD, for the first time in a Romanian population. Materials and Methods: In total, 120 participants from Transylvania were included in this case-control study. Serum levels of VEGF were determined using an enzyme-linked immune-sorbent assay and rs3025039 was investigated by high molecular weight genomic deoxyribonucleic acid (DNA). Spirometric values, arterial blood gas analysis, and the Six Minute Walk Test (6MWT) outcome were also determined. Results: The serum level of VEGF was higher in the COPD group versus controls (p < 0.001), with a positive correlation with the 6MWT outcome. No significant difference was observed in the VEGF serum levels between VEGF +936C/T genotypes. There was no difference in the VEGF +936C/T genotype between COPD patients and healthy subjects (chi2 test p = 0.92, OR = 1.04, 95%CI = 0.41-2.62), but the presence of the T allele was significantly linked to the presence of COPD (chi2 test p = 0.02, OR = 2.36, 95%CI = 1.12-4.97). Conclusions: Higher VEGF serum levels were found in moderate and severe COPD and were positively correlated with the distance in the 6MWT. No significant difference was found between CC, CT, and TT genotypes of rs3025039 and the presence of COPD. The presence of the T allele was found to be linked to COPD and also to the degree of airway obstruction.

Alveolar proteinosis - an underdiagnosed condition in young people.

Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by an abnormal intra-alveolar accumulation of surfactant derived lipoproteinaceous compounds, leading to dyspnea and, in severe cases, to respiratory failure. The most common form of PAP is the auto-immune one. Secondary PAP has been recognized in myeloid leukemia, non-hematological neoplasms, lung infections or environmental exposure to noxious particles. Mutations in several genes (such as MARS, SFTPB, TTF1) are responsible for the alteration of surfactant production. Diagnosis tools include high-resolution computed tomography, bronchoalveolar lavage. Although over the past 20 years the pathophysiology of PAP has become more clear, the therapeutic strategies still need improvement. A national programme for patients with PAP might be useful in Romania.

Palliative Care Initiation in Chronic Obstructive Pulmonary Disease: Prognosis-Based, Symptoms-Based or Needs-Based?

The absence or late initiation of palliative care (PC) in chronic obstructive pulmonary disease (COPD) is multidimensional. To provide palliative care from the moment of COPD diagnosis remains utopic. Even the advanced forms or the end-of-life stages benefit late or never from these services. In this context, the research questions for the present systematic review were focused on the prognosis variables or multicomponent indices in COPD patients alongside the symptoms and unmet needs, which may be useful for the palliative care initiation. The aim was to help clinicians to identify not only the tools reliable to predict poor survival in COPD patients but also to identify the criteria for appropriateness for early palliative care onset. The search included systematic reviews and reviews published in English in the PUBMED database from Jan 1, 2015 to Jan 6, 2020. From a total of 202 findings, after applying filters, using additional sources, and eliminating duplicates, the search strategy screened 16 articles, out of which 10 were selected and included. A Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) flow diagram was constructed. The main domains identified as barriers in providing palliative care in COPD patients were complex: from the prognosis difficulties to the prognostic variables and scores proposed for initiating PC; from the troublesome symptoms or the unidimensional symptom tools to the unmet needs of COPD patients. The review concluded that none of the existing prognostic variables and multicomponent indices are reliable enough to exclusively predict poor survival in COPD patients and the decision to initiate PC should be rather based on the presence of refractory symptoms and patients' unmet needs and preferences. Despite the current advances, the ideal model to initiate palliative care from the moment COPD is diagnosed is a goal for clinicians trained in, and capable of providing palliative care in any COPD patient.

Fatal hypersensitivity pneumonitis after chemical occupational exposure.

Hypersensitivity pneumonitis (HP; extrinsic allergic alveolitis) is a rare non-immunoglobulin E (IgE)-mediated inflammatory lung disease caused by inhalation exposure (occupational, recreational or ordinary home exposure). A 36-year-old female patient, without significant medical history, is referred to an outpatient pulmonology clinic for dry cough, shortness of breath, fever, fatigue and weight loss. Chest high-resolution computed tomography (HRCT) was performed, and significant lung fibrosis (especially centrilobular and interlobular in bilateral "thick lines"), traction bronchiectasis and alveolitis in both superior lobes are described. Lung function tests showed severe restrictive dysfunction. Transfer factor of the lung for carbon monoxide (TLCO) being very low, the flexible bronchoscopy was contraindicated. Surgical lung biopsy was performed. Histopathological examination showed characteristic lesions of chronic bilateral hypersensitivity pneumonitis. The patient died four days after the surgical intervention due to post-operative complications. Exposure to various chemical substances can form bonds with human proteins molecules and induce an exaggerated immune response in susceptible individuals. A high index of suspicion of occupational exposure can determine an early diagnosis with a better outcome.

Assessment of the correlations between nicotine dependence, exhaled carbon monoxide levels and oral hygiene status: an observational study.

BACKGROUND AND AIM: Cigarette smoking has negative effects on general health, including oral health. The aim of our study was to assess the correlations between nicotine dependence, exhaled carbon monoxide levels and oral hygiene status. METHODS: Smoker and non-smoker participants were enrolled in this observational study. The Fagerström test was used to classify nicotine dependences: low (score: 0-3), medium (score: 4-6) or high (score: 7-10). The oral hygiene status was classified according to the oral hygiene indices of plaque, calculus and gingival inflammation. Lastly, the exhaled carbon monoxide levels were measured with a MicroSmokelyzer (Bedfont Scientific Ltd., Kent, United Kingdom). RESULTS: Sixty five participants (50 smokers in the study group and 15 non-smokers in the control group) were enrolled between 11th and 29th of January 2016. No statistical differences were observed between the study group and the control group in terms of age (mean age±SD 23.5±1.9 and 24.0±1.5, respectively) or gender (50% and 26.6%, respectively). A statistically significant difference was observed between the 2 groups in terms of plaque, (p=0.036), calculus (p=0.001) and gingival indices (p<0.001). A positive correlation was found between the exhaled levels of carbon monoxide and the general Fagerström score (r=0.97, p<0.001) or the Fagerström score in smokers (r=0.93, p<0.001); a negative correlation was observed between the exhaled carbon monoxide levels and the number of tooth brushings daily (r=-0.41, p=0.001). The plaque index was statistically significantly associated with the exhaled carbon monoxide levels (p=0.008), general Fagerström score (p=0.016) and number of tooth brushings daily (p<0.001). The calculus and gingival indices were statistically significantly associated with the exhaled carbon monoxide levels (p<0.001), general Fagerström score (p<0.001) and score in smoker participants (p=0.029 and p=0.001, respectively) as well as the number of tooth brushings daily (p<0.001). CONCLUSION: Our study found a significant association between the plaque, calculus and gingival indices and smoking. Moreover, nicotine dependence was significantly associated with the number of daily tooth brushings and the gingival index.

Opinions and practices regarding electronic cigarette use among Romanian high school students.

OBJECTIVE: The study assessed awareness, opinions, practices regarding electronic cigarettes (e-cigarettes) and factors associated with their use among Romanian high school students. METHODS: A cross-sectional study was conducted in 2013 in two major Romanian cities, distributing anonymous questionnaires to 342 high school students aged 16-18. RESULTS: 52.3% of the smokers, 29.2% of the ex-smokers and 7% of the never-smokers had tried e-cigarettes at least once in their life; 7.8% of the smokers and 4.6% of the ex-smokers had used e-cigarettes in the last month. Among smokers, e-cigarette use was associated with lower participation in school health education regarding e-cigarettes and with having parents using e-cigarettes.. Among ex-smokers and never-smokers, e-cigarette use was associated with intention to use e-cigarettes in the next year and with having friends who use e-cigarettes. CONCLUSION: Health education programmes and regulatory interventions addressing e-cigarettes are needed in Romania. More research is necessary on how to develop effective public health messages.

Tuberculous constrictive pericarditis complicated with tuberculous mediastinitis - case report.

Constrictive pericarditis is a rare and severe disease. A 37-year-old patient was admitted in the hospital for dyspnea, precordial pain, right-sided cardiac failure. Chest X-ray showed cardiac enlargement and an opacity suggestive for pleural effusion. Echocardiography revealed an adhesive-effusive-constrictive pericarditis, a very thickened pericardium and bilateral pleural effusion. After a pericardiectomy done to restore cardiac compensation and to identify etiological factors, a tuberculous pericarditis (TBP) was diagnosed. After surgery and starting anti-TB treatment, the patient presented altered clinical status, dyspnea, dry cough, fever and delayed callus formation at sternum level. Thoracic scan revealed mediastinal air collections, pericarditis and pleurisy. Thus, the TBP diagnosis was extended to mediastinal TB and anti-TB therapy was continued. After four months of treatment, another thoracic scan showed disappearance of the mediastinal air-leakage bubbles, multiple new micronodules in both lungs and lymph nodes of up to 15 mm; also increasing pericardial and pleural effusions. This case was interpreted as a TB treatment failure situation. A retreatment regimen was started, resulting in a slow favorable outcome. Pericardial TB is a rare condition, usually with delayed diagnosis and poor treatment benefits. Whenever possible, earlier diagnostic can contribute to better management of these cases.

Smoking cessation for free: outcomes of a study of three Romanian clinics.

In 2007, Romania implemented a national program for smoking cessation, providing medication and counseling, entirely for free. The present study focuses on the results of the program among participating smokers treated in three smoking cessation centers from three main cities of Romania: Iasi, Targu Mures and Cluj. Telephone interviews of 832 subjects from three databases of the Romanian cessation clinics of Iasi, Cluj and Targu Mures cities were conducted. These interviews were based on a standard Romanian guideline follow-up questionnaire. At 3 months follow up, abstinence was quite high (53.4%); at 12 months post quit date the study found 18.6% still abstinent subjects. More severely addicted smokers have quit with varenicline and the most difficult category of patients was represented by heavy smokers with respiratory co-morbidities. 61.5% of smokers and 97.2% of non-smokers were willing to receive relapse prevention counseling. Many subjects achieved a long duration partial abstinence (154 days ± 180 SD abstinence days). This is the first study in Romanian smoking cessation centers to analyze the long term impact of fully reimbursed smoking cessation, covering three months pharmacotherapy and counseling. Providing smoking cessation for free had a positive long term impact on program participants.

Lung response after subchronic glass fiber intratracheal instillation: an experimental study on rats.

The aim of the study was to identify the effects on the lung after subchronic glass fiber intratracheal instillation study on rats. We evaluated the toxicological effects on the lung: persistent inflammatory reaction, cell proliferation, and pulmonary fibrosis on histopathological examination. We performed a glass fiber intratracheal instillation study on total 32 Wistar rats. The animals were divided into four groups: three test groups exposed to different doses of glass fiber and one control group. One week after the end of the exposure period, all animals were euthanized. The histopathological examination of the lung performed in this study followed both distribution of the lesions through the multilevel biopsies that were taken and the inflammatory profile using both hematoxilin-eozin and Sirius red staining. The inflammatory lesions described for the first group were minimal/slight (grade I) and the total score was between 0 and 10 points (mean value = 3). For the second group, the inflammatory lesions were moderate/marked (grade II) with discrete collagen proliferation and discrete fibrosis and the total score ranged between 11 and 20 points (mean value = 11,250). For the third group, the described inflammatory lesions were massive with total score ranging between 21 and 30 points with collagen deposition, pulmonary and pleural fibrosis, and lung emphysema (mean value = 21,750) and no lesion in control group (with statistically significant difference P ≤ .001). This study of fiber glass intratracheal instillation of three different doses demonstrates that exposure to fiber glass is responsible for the development of persistent inflammatory response and a large range of hystopathological lesions which correlate to the administered dose.

Parental environmental tobacco smoking and the prevalence of respiratory diseases in primary school children.

INTRODUCTION: The inhaling tobacco smoke to which a child is exposed, in a home environmental area, could affect respiratory system. MATERIAL AND METHODS: The aim of the study consists in detecting the prevalence of respiratory diseases in home exposure to secondhand smoke among primary school children. A 6-month prospective case-control study based on questionnaire survey was carried out among school children of "Spiru Haret" Primary School, Medgidia, Romania, with absences for respiratory diseases, related to exposure to parental passive smoking, in their home environmental. 136 school children and their families informed, consented to complete the questionnaire and were surveyed for respiratory diseases and domestic environmental tobacco smoking, from the 1st of October, 2011 to the 31st March, 2012. The method consists in collecting data about any respiratory illness events, correlating them with the questionnaire --reports of parental smoking in home environmental. RESULTS: Participants were divided in 88 cases exposed to SHS (E) and 48 controls without exposure (NE). The most sick children with more than one episode of respiratory illness were among cases (n = 61/88; 69.31% vs 19/48; 39.58%; OR = 3.45; RR = 1.62; chi2 = 12.25; p < 0.0008). The most important source of parental passive smoking is the father (n = 67/88; 76.13%), being a single parent in most of the cases (n = 46/88; 57.95%). The prevalence of bronchial asthma was 0.34% in cases, being related with prenatal maternal smoking exposure (1.11%). CONCLUSION: The prevalence of respiratory diseases is higher among children with environmental parental tobacco exposure, in particular, smoking father.

Churg Strauss syndrome associated with montelukast--case report.

Churg-Strauss Syndrome (allergic granulomatous angiitis) is a rare systemic and pulmonary vasculitis. We report the case of a 62 years old female, non-smoker, with a 20 years history of moderate persistent asthma treated with Salmeterol/Fluticasone 50/500 microg bid for 5 years and supplemental Montelukast in the past 5 months. The patient was admitted in our hospital with fever, malaise, sensory deficits in the lower extremities, diffuse musculoskeletal and thoracic pain. Blood eosinophil was 38% of her total WBC, thoracic computed tomography evidenced ill-defined groundglass attenuation predominantly involving the lateral segment of the middle lobe. Pulmonary infiltrates with eosinophilia can be used to define eosinophilic lung diseases. We made the differential diagnosis of eosinophilic lung disease: acute or chronic eosinophilic pneumonias, allergic bronchopulmonary aspergillosis, Loffler syndrome, Churg-Strauss syndrome, bronchocentric granulomatousis, idiopathic hypereosinophilic syndromes. Bronchoalveolar lavage showed 14.6% eosinophils. Few days after hospital admission patient experienced nausea, vomiting and diarrhea. She underwent a digestive endoscopy, which showed eosinophilic enteritis according to colon biopsy. Nasal mucosa biopsy found granulomas. Anti-neutrophil cytoplasmatic antibody (ANCA) was positive at 1:20. She displayed more than four American College of Rheumatology (ACR) criteria for Churg-Strauss Syndrome (developed while she was receiving montelukast therapy). Discontinuation of Montelukast and association of oral prednisone (1 mg/kgc) induced rapid improvement of symptoms and rapid decrease of peripheric eosinophils (72 hours). This case report illustrates the importance of early diagnosis of Churg-Strauss syndrome and the possible pathogenic link between leukotriene receptor antagonist use and CSS development.

Surgical treatment to increase the success rate of multidrug-resistant tuberculosis.

OBJECTIVE: Mycobacterium tuberculosis infects more than one-third of the world's population and causes an estimated 2-3 million deaths annually. The medical treatment of multidrug-resistant tuberculosis (MDR-TB) can cure 50-75% of cases. The median prevalence of new MDR-TB cases is 1.1%, while that of previously treated cases is 7%. METHODS: We carried out a retrospective study on 45 patients with MDR-TB who underwent surgical resection at the Leon Daniello Hospital (Regional Surgery Department) between January 1995 and December 2005. The number of MDR-TB cases has continued to increase despite the implementation of MDR-TB treatment strategies. Drug susceptibility tests showed that all our patients were resistant to at least isoniazid (hydrazide) and rifampicin. Therefore, individual drug regimens including at least five antibiotics were prescribed. Surgery under general anaesthesia (double-lumen endotracheal intubation) was performed by a team of thoracic surgeons. The patients had received anti-tuberculosis (TB) treatment for at least 1 month preoperatively as well as postoperatively. RESULTS: We collected and analysed patients' demographic data, clinical characteristics, place of origin, radiological findings, smear and culture status before surgery, TB localization, primary or secondary drug resistance, surgical procedures, complications, bacteriological smear and culture status after surgical treatment. The indications for surgery include medical treatment failure in 39 patients, persistent cavitary lesions with possible relapses in 3 patients and massive haemoptysis in 3 patients. Lobectomy was carried out in 30 cases, segmentectomy in four cases and cavernoplasty (speleoplasty) in 11 cases. Four weeks postoperatively, there were 83% smear-negative and 17% smear-positive patients. Only minor complications were registered: three patients had wound infections, two had minor haemorrhages and one presented a minor pneumothorax. Operative mortality was zero. CONCLUSIONS: The absolute indications for the surgical treatment of MDR-TB include failure of medical therapy (due to persistent cavitary disease and lung or lobar destruction) and massive haemoptysis. Proper patient selection and the timing of operations are crucial to avoid relapses and to provide a definitive cure. Good cooperation between chest physicians and thoracic surgeons as well as patients' adherence to pre- and post-chemotherapy can increase the success rate of MDR-TB treatment.

[Why do doctors smoke?]. / De ce fumeaza doctorii?

Smoking prevalence is decreasing in developed countries in the last decades. Nevertheless, there is a constant increase of morbidity and mortality of smoking-related diseases (COPD, asthma, respiratory infections, cardiac diseases, cancer). Then why do doctors smoke? Because they experimented in adolescence and college and the addiction developed fast, while information about smoking risks arrived too late. Five hundred questionnaires were distributed to 100 doctors and 400 students between March-April 2009; 50% were returned from the doctors and 90.5% from the students. We analyzed comparative the smoking status (60% non-smoking doctors and 56.9% non-smoking students. Mean age was 25.05 for doctors and 24.2 for smoking students. Mean starting age was 17.13 years, 17.78 respectively. They were asked about major components of cigarettes, main diseases induced by smoking, the effects of nicotine addiction, known laws and projects, the need for introducing in the university curricula of anti-smoking modules. 20% of the doctors and 14.5% of the students had a smoking-related disease. 52% of doctors and 57% of students supported forbidding smokingin public spaces, 13.7% of doctors and 88.9% of students supported the increase of cigarettes price, and only 48% of doctors and 47% of students suggested the need of help for smoking cessation. We noticed there are flaws in knowledge of extra pulmonary diseases in students as well as doctors. Most respondents had lacking, non-systematic information and 96% of doctors and only 69.6% of students consider useful tabaccology lectures. For stopping epidemic morbidity and mortality due to smoking related diseases, there is need for involving all those working in health programmes. For this, medical schools should do better in preparing specialists. We also consider it is time that all medical specialties should consider smoking cessation a priority, while the pneumologists should sustain a systematic and routine activity against smoking.

Smoking during pregnancy--a challenge to practitioners.

Smoking during pregnancy is a common finding among women whose parents have been smokers, among those whose husbands are smokers, among women who smoked more than 10 cigarettes per day before they became pregnant, and women who started to smoke at an early age. Smoking while pregnant is dangerous to both mother and child. Smoking exposure risks such as infertility (both primary and secondary), bleeding during pregnancy, abruptio placentae, placenta praevia, premature rupture of membranes, premature birth, low birth weight newborns, sudden infant death syndrome are taken into consideration. Efficient smoking cessation interventions targeting pregnancy impose, as many women are not aware of dangers of tobacco exposure. Smoking cessation medical aid consists of immediate recommendation to stop smoking, counselling, behavioural therapy and self-helping educational materials.

[Evolution of pulmonary metastasis in osteosarcoma]. / Evolutia metastazelor pulmonare de osteosarcom.

Osteosarcomas are tumors with a high aggressivity which gives early and frequent pulmonary metastasis. These patients have a poor prognosis. The reveal of prognosis factors and early detection of pulmonary relapse would influence the outcome of these patients. We performed a retrospective study at Oncology Institute from Cluj, observing 35 patients with osteosarcomas and pulmonary metastasis at the onset or in evolution. We tried to quantify some prognosis factors. We observed the predominance of male sex (20), from urban area (25), with age between 11-20 years (16 cases), with primary tumors localized more frequently at the limbs. Pulmonary metastasis were shown without free interval from the onset (12 patients), or in the first years (17 cases), more frequently with multiples locations (26 cases). 28 patients were submitted to surgical treatment for cure of primary tumor, 18 chemotherapy, and pulmonary metastasis resection in 5 cases only. The outcome under treatment was favorable in 4 cases only, compared with other studies. Early detection of pulmonary metastasis and aggressive therapy with augmentation of resection criteria for pulmonary metastasis would improve the prognosis of this patients.

[Primary pleural-pulmonary non-Hodgkin lymphoma]. / Limfom non-Hodgkin primar pleuro-pulmonar.

Primary pleuro-pulmonary non-Hodgkin lymphomas are very rare tumors, possibly under diagnosed, with a very long, frequently asymptomatic evolution. The authors present the diagnostic difficulties of such pathology, in a particular case, which was diagnosed only by open biopsy and immunohistochemical analysis of tissue fragments. Chemotherapy and radiotherapy determined a favorable course of the disease.