Disseminated tuberculosis with gradual evolution and unusual localization.

We present a case of disseminated tuberculosis (pulmonary, skeletal and lymph nodes) accompanied by subcutaneous abscesses and with unusual localization, osteolytic lesions of the skull caused by Mycobacterium tuberculosis var. hominis. Although the patient was immunocompetent, the disease had a gradual and unexpected progression. In the malign forms of tuberculosis, treatment must be extended for a year or more.

[260 cases of tuberculosis death at the Institute of Pneumophysiology of Bucharest 1976-1985]. / Etude de 260 cas de tuberculose décédés à l'Institut de Pneumophtisiologie de Bucarest de 1976 à 1985.

The case notes of all deaths due to tuberculosis registered at the Institute of Pneumophysiology at Bucharest have been reviewed. Out of 273 patients registered, the diagnosis of tuberculosis was retrospectively confirmed 260 times on either bacteriology or histology and was not confirmed by analysis of the medical notes on 13 cases. Of the 260 cases (70% males) the ages range from 18 to 75. There was 95 new cases of tuberculosis, 68 were relapses and on 97 occasions it was chronic form. Resistant bacilli were isolated 79 times (63%). Intolérance to treatment was noted in 95 patients (36%) and an incomplete treatment occurred in 84 patients (32%). The death occurred before treatment could be instituted in 33 patients. Tuberculosis was multicavitatory in 192 cases (74%), was bilateral in 214 cases (82%). From the last admission on 140 patients whose bacteriology was available for studies 112 (80%) were positive on direct examination. Compared to another enquiry carried out in Bucarest between 1961 and 1968 on 350 deaths due to tuberculosis, it appeared that the patients in the more recent period were suffering from a more severe form of tuberculosis. The above facts witness the efforts made in Rumania to achieve an early diagnosis and treatment in the management of tuberculosis.

[Atypical pulmonary hydatid cyst]. / Kyste hydatique pulmonaire atypique.

An atypical form of a pulmonary hydatid cyst is described. This was a solitary super-infected pseudo-tumoral cyst and the membrane was incarcerated which has enabled us to propose as a description for this new morphological aspect of a cyst, with a filled margin of the proliferative membrane. We propose the term "Rosebud".

Cellular immune response in atypical tuberculosis diagnosed by PCR in paraffin embedded material.

The aim was to evaluate the cellular immune response in atypical tuberculosis and granulomatous inflammation consistent with tuberculosis (TBC), negative histochemically for acid-fast bacilli and analysed by PCR for Mycobacterium tuberculosis (MT) detection in paraffin-embedded tissue. Thirty six samples of differently localized atypical tuberculous lesions and granulomatous tuberculoid lesions negative for acid fast bacilli and 4 positive cases on Ziehl-Nielsen stain were analysed by PCR for MT detection and were tested immunohistochemically (IHC) for the cellular immune response in the granulomas and perigranulomatous tissue. The samples selected were: 7 pulmonary and 33 extrapulmonary specimens, especially lymph nodes. Histologically, the atypical tuberculous lesions contained supurative necrosis, defective granulomas and cellular polymorphism. The epithelioid cells showed frequent mitoses. The immunoprofile of cells was polymorphous. L26 positive small lymphocytes were found in nodular lymphoid aggregates surrounding granulomas. A significantly increased number of positive UCHL1 cells were found in 33 out of the 40 analysed cases, with a larger percentage of CD4 positive T cells (81.8% of cases). CD44 was positive in multinucleated giant cells (17.5% of cases), epithelioid cells (60% of cases) and lymphocytes (30% of cases). CD68 was localized in multinucleated giant cells and epithelioid cells, in a 4%, respectively 62.5% of cases. The PCR was performed in all 40 cases; the tissue samples were heterogeneous (lung, lymph nodes, lever, nasopharynx, etc.) and needed a good quality extraction of DNA. Performing a control PCR for Beta Globin tested the extraction; a good result was obtained in 31 cases (77.5%); from these, 19 cases had amplification for IS 6110. The cellular immune response in the atypical tuberculous lesions was similar in cases with and without acid-fast bacilli, but positive for PCR. In the most cases with negative PCR reaction, it was due to a deficient fixation of the material. The T lymphocytes were numerous in all types of tuberculous granulomas, with the prominence of CD4 positive subtype. The immunoprofile of the epithelioid cells, positive for CD44 and CD68, presenting frequently mitoses suggests an activate state in a possible relationship to the T-cell-mediated immune response in tuberculosis.

[A case of tumor-like pulmonary sarcoidosis]. / Sarcoidoza pulmonara--forma pseudotumorala.

We present the case of a female patient age 32, with no medical history, presenting with chest pain and asthenia. Chest X-ray and CT scan revealed multiple nodular shadows in both lungs, suggesting lung metastasis. Bronchoscopy and broncho-alveolar lavage didn't reveal any malignant cells. Clinical examination and lab examinations didn't find any primitive extra-pulmonary tumor. Open lung biopsy was performed, revealing sarcoidosis. Patient received oral steroids, with significant radiologic improvement after only 1 month.

[Sequential approach in a case of tracheal hemangioma: segmental tracheal resection after Nd-YAG laser application]. / Abord secvential intr-un caz de hemangiom traheal: rezectie traheala segmentara precedata de Nd-YAG laser.

Tracheal tumors of malignant or benign origin are very rare. The symptoms may mimic asthmatic crisis, dyspnea at rest or light efforts appear only when the tumor obstructs 60% of the tracheal diameter. We present the case of a 50 year old patient, ex-smoker with symptoms present 5 years before admittance with dyspnea and small hemoptysis. Diagnosis was based on bronchoscopic examination, CT scan and histological examination of the resection sample revealing a rare benign tracheal tumor: a hemangioma. The sequential treatment of the disease is presented: interventional endoscopy and surgical resection. The excellent postoperative evolution emphasized the diagnostic and therapeutic value of bronchoscopy as well as surgery in benign tracheal tumors.

Lymphoid interstitial pneumonia.

A case of lymphoid interstitial pneumonia in a 43-year-old woman is reported. Following a clinical evolution of two years, not influenced by the treatment applied, a pulmonary biopsy puncture was performed to determine the diagnosis. The histological examination furnished evidence of diffuse interstitial infiltration with adult lymphocytes and perivascular, juxtavascular and juxtabronchic cellular cuffs and nodules. Another fragment revealed large lymphoid nodules including reorganized pulmonary structures. Various aspects concerning the differential diagnosis of this pulmonary disease are discussed.

DNA content of macrophages in pulmonary granuloma induced in rats by complete Freund's adjuvant.

Pulmonary granulomas were induced in rats with complete Freund's adjuvant. Histologic and cytologic alterations and Feulgen-DNA amounts determined by a cytophotometric method were studied. Fourteen (hours after injection, the pulmonary interstitia were thickened by cell infiltration. After 3 days; small granulomatous nodules developed containing macrophages, epithelioid and giant cells. The Feulgen-DNA amounts increased significantly in the course of the first day and reached peak values on the 3rd day. Then they showed a tendency to decrease after the 7th day. The present results confirm the previously obtained data, revealing the stimulating effect of the complete Freund's adjuvant on cell metabolism, DNA synthesis included.

[New aspects of collagen formation]. / Noi aspecte privind formarea colagenului.

New data are presented concerning the process of synthesis and secretion of collagen. The stages are described of its elaboration and biochemical transformations of collagen molecules occurring in the cell and the alterations leading to collagen fibres building-up in the extracellular spaces. Electronic microscopy of fibrogenesis study, carried out during an experimental research on lung fibrosis, has shown new aspects not yet described in the literature. It is demonstrated that collagen fibres could be formed by assembling the tropocollagen molecules in the fibroblast cytoplasm, before the expulsion from the cell. This phenomenon could represent a new way not yet mentioned among the mechanisms of collagen synthesis. It is likely that this process take place in the framework of pathological process of fibrosis development.

[Idiopathic pulmonary hemosiderosis (case report)]. / Hemosideroza pulmonara idiopatica.

A case is presented, of idiopathic pulmonary hemosiderosis in a female aged 19 years. The clinical onset occurred at the age of 3 years and the evolution was characterized by subfever, dispnoea, coughing and cyanosis. Radiological examination revealed reticulation and uniform distribution of nodules in both lungs. Other laboratory investigations have revealed hypochromic anaemia, restrictive syndrome and reduction of the maximal ventilation rate with marked arterial hypoxemia. Pulmonary bioptic puncture was performed and the patient died three days after puncture. Histopathologic examination of the bioptic sample and of necroptic specimens revealed fibrotic interstitial nodules filled with siderophages. The small and the median arteries displayed fragmentation of the elastic fibers, and hyperelastosis. The changes oberved allowed to make an exact diagnosis of idiopathic pulmonary hemosiderosis.

[Acute fungal pneumopathy caused by Candida and Aspergillus (case report)]. / Pneumopatie acuta fungica cu Candida si Aspergillus (prezentare de caz).

A case is presented, of a patient with acute fungal pneumopathy. The evolution of the disease in this 63 years male was short and rapid, characterized by fever, dyspnea, thoracic pain, muco-purulent expectoration and intense coughing. In spite of the complex treatment applied the patient died with acute cardio-respiratory failure. The radiological examination revealed micro-nodular and nodular opacities extending predominantly in the left lung. Laboratory investigations included a microbiologic study for the Koch bacillus, which was negative. The post-mortem examination revealed multiple focuses with suppurative aspects on a diffuse background of hepatization. The microscopic examination evidenced the presence in the respective focuses of abundant colonies of Candida and Aspergillus, and a hematogenic invasion with Candida and allowed to determine a diagnosis of acute pneumopathy of fungal origin as a result of a double infection with Candida and Aspergillus strains.

[Pleural puncture biopsy--a diagnostic method in serofibrinous tuberculous pleurisy in children]. / Punctia biopsie pleurala--metoda de diagnostic in pleurezia serofibrinoasa tuberculoasa a copilului.

The biopsy of the parietal biopsy with the help of a needle has become an essential method of diagnosis in the adult patients with a pleural malady of an unknown etiology and may become a complementary paraclinical method in children. A sure diagnosis in the tubercular serofibrinous pleurisy with children is made by rendering evident the Koch bacillus on the direct test or in culture and by rendering evident the tubercular lesions on fragments of pleural biopsy puncture. The study is supported on the results obtained at the pleural biopsy puncture performed on a number of 6 children. In four cases out of six the histological test of the pleural fragment has rendered evident the presence of tubercular lymphoepithelioid nodulus with central necrosis, thus carrying the argument of certitude. The pleural biopsy puncture allows an early and sure diagnosis in over two-thirds of the pleurisies of a tubercular etiology.

[The problems of clinico-morphological diagnosis in a case of fatal hemoptysis]. / Probleme de diagnostic clinico-morfologic într-un caz de hemoptizie fatala.

28 children with bronchial asthma, between 6 and 18 years old, were followed by a varied period of time 3 months - 5 years. 7-8 functional tests were carried out. The cases were studied in different clinical phases: asymptomatic, manifest, crisis of bronchial asthma. The functional pulmonary investigation included: spirographic examination [vital capacity (VC), maximum expiratory volume per second (MEVS) the VC/MEVS ratio], plethysmographic examination (VGT, Raw), measurement of the maximum instantaneous expiratory flows on the flux-volume curve (MEF50). The average value, standard residual deviation and the variation coefficient were calculated for each parameter studied in different clinical moments. The results are presented on 3 groups: per total, symptomatic and asymptomatic. The analysis of the data found showed that the variation of the parameters measured during repeated functional examinations in children with bronchial asthma ranges within broad limits (2.9%-11.5%); the broadest variation was recorded for Raw followed by MEF50 and the slightest variation was that of the VC/MEVS ratio. This indicated the lower value of the information furnished by this ratio in children in appreciating the presence or severeness degree of the obstructive syndrome.

[Pleural puncture biopsy--a diagnostic method in tuberculous serofibrinous pleurisy in children]. / Punctia biopsie pleurala--metoda de diagnostic în pleurezia serofibrinoasa tuberculoasa a copilului.

The biopsy of the parietal pleura with a special needle has become an essential diagnosis method in the adult patients with pleural disease of unknown etiology, and might become a complementary paraclinical method for children also. The certitude diagnosis in tuberculous serous fibrinous pleurisy of the child is laid on evidencing Koch's bacillus at the direct examination or in culture, and on fragments of pleural biopsy puncture, in evidencing the lesions. The study is based on the results obtained in the pleural biopsy puncture made on 6 children. The histologic examination of the pleural fragment showed, in 4 cases of 6, the presence of tuberculous lymphoepithelioid nodules, with central caseous necrosis thus granting certitude to the diagnosis. The pleural biopsy puncture permits an early and certain diagnosis in more than 2/3 of the pleurisies of tuberculous etiology.

Cytophotometric study of the DNA content in experimental pulmonary granuloma.

Pulmonary granulomas were induced in rabbits with Freund's complete adjuvant. Histologic alterations, the mitotic index and Feulgen-DNA amounts determined by a cytophotometric method were studied. The mitotic index and DNA amounts increased significantly within the first hours and reached peak values on the 3rd day, then showed a tendency to decrease after the 7th day. After the 3rd day, a certain dissociation was noted between the mitotic index and Feulgen-DNA amount. The change in Feulgen-DNA content reflects the functional alterations that characterize pulmonary granuloma.

[Bilateral multifocal pulmonary leiomyomatosis]. / Leiomiomatoza pulmonara plurifocala bilaterala.

A case of diffuse primary pulmonary leiomyomatosis with a 24-years-old asymptomatic woman having a pulmonary radiological aspect of miliary dissemination 3 years after a myomectomy for sub-serous uterine fibroma. The diagnosis was established after a surgical pulmonary biopsy. The case presented certain peculiar features: a young woman; the inter-relation between pulmonary leiomyomatosis and the operated sub-serous uterine fibroma; the aggravating factor--the pregnancy; a confirmed probably hormonal cause (hyperestrogenemia); a progressive aggravating evolution.

Infection in vitro of the human pulmonary macrophage with Staphylococcus aureus (bacteriologic and ultrastructural observations).

Alveolar macrophages from exeresis fragments taken from patients operated for pulmonary cancer were infected in vitro with Staphylococcus aureus. Part of the investigation was carried out in the presence of an antibiotic (pyopen) introduced in the culture medium. Bacteriologic seeding from an extracellular medium and from lyzed cells showed a greater intracellular multiplication rate. In the presence of pyopen there was a decrease in the number of germs due to the inhibition of multiplication. Electron microscopy revealed reduced phagolysosomal fusion, aspects of bacterial multiplication and the coexistence of intact bacteria and bacteria presenting structural alterations. The results suggest the importance of cellular parasitism in the chronic evolution of infectious bronchopulmonary processes.

Histologic aspects in pleural diseases revealed by needle biopsy.

In 59 patients, 18 to 82 years old, with pleural exudates, a number of 78 needle biopsies were performed in view of establishing the etiologic diagnosis. The diagnosis was: pleural tuberculosis in 9 cases, acute or chronic non-tuberculous inflammation in 8 cases, postinfectious sequelae in 6 cases, secondary malignant neoplasia in 10 cases; 2 mesotheliomas, and in 24 cases the aspect was normal or the minimal alterations found were not conclusive. The proportion of confirmations was of 81% for tuberculosis and 37% for cancer. The method is recommended as being of particular value in establishing the etiologic diagnosis of pleural exudates.

[Influence of tobacco smoking on the development of experimental pulmonary tuberculosis]. / Influenta fumului de tutun asupra evolutiei tuberculozei pulmonare experimentale

The present investigation was designed to the study, in rabbits, of morphologic and enzymatic pulmonary alterations produced by tobacco smoke and the course of tuberculosis under these conditions. The histologic examination revealed muciparous hyperplasia and pavementing metaplasia of the bronchic epithelium, accompanied by interstitial cellular reactions, reticulin, fibrilogenesis, atelectasis, emphysema and marked debility of the animals. In the animals treated with tobacco smoke the tuberculous lesions were very extensive and had an exudative-necrotic character. Under the influence of chemotherapy, applied during three months, reorganization of the lesions was reduced in comparison to the controls and an intense bacteriological activity persisted.

[Anatomicoclinical study of fatal cases of pulmonary tuberculosis at the Institute of Phthisiology in 1976-1986 (a preliminary study)]. / Studiul anatomoclinic al cazurilor letale de tuberculoza pulmonara din Institutul de Ftiziologie în perioada 1976-1986 (studiu preliminar).

The paper reports on 95 cases of treated pulmonary and extrapulmonary tuberculosis, deceased during 10 years. In 46 of them necropsy was made. Anatomoclinical examination confirmed in 5 cases pulmonary tuberculosis and intravital neglected tuberculosis in 4 cases. Advanced forms of the disease were found at case-finding in 2/3 of the cases, this explaining the death before the treatment action. Only in 70.5% of cases the cause of death was tuberculosis, in the rest it was due to associated affection. In about half of the cases (47.4% the patients' age was over 60.