Persistent Left Superior Vena Cava - Accidental Finding.

BACKGROUND/AIM: The presence of the superior left vena cava represents a rare anomaly of the thoracic venous system. CASE REPORT: An asymptomatic case of this type of anomaly, discovered as an accident during investigations for a different pathology (superior left pulmonary lobe tumor), is presented. A 56-year-old, heavy smoker was admitted in our clinic with a tumoral mass in the left superior pulmonary lobe discovered during a routine chest x-ray. Physical and clinical examination was normal. However, transthoracic echography noted a coronary sinus enlargement, which led to the suspicion of a thoracic venous anomaly. Contrast chest computed tomography pointed out a venous anomaly at the level of the left hemithorax originating from the cervical region, crossing the aortic arch and draining in the coronary sinus. During the examination, contrast substance was not detected in the right superior vena cava, either early or late during the computed tomography. During surgery the presence of a persistent left superior vena cava was observed, coming from the cervical region, crossing lateral to the aortic arch and draining in the coronary sinus. CONCLUSION: The presence of an enlarged coronary sinus should warn the surgeon about the possibility of a thoracic venous anomaly. Identifying a persistent left superior vena cava is important due to its clinical implications, especially during certain procedures such as mounting central venous lines, cardiac cannulation or implantation of cardiac stimulators.

[Iatrogenic tracheal stenosis in patients with COPD: a medico-surgical challenge]. / Stenoza traheala iatrogena la pacientul cu BPOC: o provocare medico-chirurgicala.

This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exacerbation which required oro-tracheal intubation. The tracheal stenosis occurred on average after 24 days of intubation and were clinically severe. Treatment algorithm first included bronchoscopic interventional techniques with an immediate success rate of 37%, but the results were unstable in time, requiring tracheal stenting. The surgical approach, which generally is the first choice in the treatment of tracheal stenosis, had discouraging results in these patients, with a low rate of success (20%) and an increased incidence of restenosis. The only solution for those postoperative complications was, again, interventional bronchoscopy. In conclusion, while for various other etiologies of tracheal stenosis the surgical resection is the first choice of treatment, in COPD patients interventional bronchoscopy often remains the only way of solving.

[The role of smoking in changing essential parameters in body homeostasis]. / Rolul fumatului in modificarea unor parametri esentiali in homeostazia organismului.

Smoking, one of the avoidable causes of mortality, is considered a major risk factor for cardiovascular diseases, chronic obstructive pulmonary diseases, and bronchopulmonary cancer. Many studies suggest that nicotine induces vasoconstriction, not only in coronary arteries but also in peripheral vessels, hypertension, pro-atherogenic effects, due to increase of platelet activation and fatty acids concentration, alterations of endothelial-cell shapes, as well as endothelial-cell proliferation. The main affected vascular biochemical parameters are: endothelin-1, cholesterol, triglycerides, lipoproteins, C-reactive protein, nitric oxide, fibrinogen, and uric acid. Cigarette smoke induces inflammation in respiratory epithelium, through local irritation due to release of oxidants, aldehydes, acids, ammonium; impaired ciliar function, and retention of mucus and toxins, followed by infection; carcinogenesis due to oncogene-expression induced by oxidants, aromatic hydrocarbons, and nitrosamines. These effects are induced by alterations of endothelin-1, nitric oxide, IL1, IL6, TNF, and the CYP Enzyme System. Saliva is the first biological fluid encountered by the cigarette smoke. In vitro and in vivo salivary exposure to cigarette smoke has been shown to determine changes of concentrations of lactate dehydrogenase, amylase, and uric acid, in saliva--important factors of the antioxidant salivary system. Such changes may promote occurrence of upper digestive cancers.

[Unilateral salpingian and ovarian TB, a rare form of extrapulmonary TB]. / Salpingo--ovarita bacilara unilaterala, forma, rara de tuberculoza extrapulmonara.

TB salpingitis and ovarian TB is a rare association of extrapulmonary tuberculosis, especially when the lesions are not associated with lung involvement. The correct therapy leads to the sterilization of the tuberculosis foci, although the risk of scars and adhesions is high, causing local functional disorders.

[Tuberculosis in Romania between 2006-2008]. / Tuberculoza in România intre anii 2006-2008.

The high level of TB incidence places Romania among first places in Europe and on the first place in European Union; in the last years a slowly, but hopefully descending trend can be observed (from 114.2 per hundred thousand in 2006 to 109.8 per hundred thousand in 2007 and 108 per hundred thousand in 2008). TB incidence in children has also decreased from 31.6 per hundred thousand in 2006 to 30.8 per hundred thousand in 2007 and 28.5 per hundred thousand in 2008. TB mortality decreased to 7.8 per hundred thousand in 2006 and 7.4 per hundred thousand in 2007. Every year, 800 cases with MDR TB are notified in Romania. The results obtained in the cohort of new patients with pulmonary SS(+) tuberculosis: the success rate reached in 2003 was 79.5% and 83.9% in 2006. The success rate was greater in pulmonary patients confirmed by culture: 82% in 2003 and 85.5% in 2006. In conclusion, the results of NTP implementation in Romania, reflected by the evolution of the principal epidemio-metrical indicators (decrease of the global incidence, TB incidence at children, TB mortality and increase of therapeutical successes) confirms the TB control activities efficacy.

[Multidrug resistant tuberculosis in Romania in the last years (2004-2007)--an extremely important social phenomenon]. / Tuberculoza multidrog rezistenta în România în ultimii ani (2004-2007)--un fenomen social de maxima importanta.

The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug resistant (MDR-TB) strains, has become a significant public health problem in a number of countries and an obstacle to effective global TB control. In many other countries, the extent of drug resistance is unknown and the management of the patients with MDR-TB is inadequate. In countries where drug resistance has been identified, specific measures need to be taken within TB control programmes to address the problem through appropriate management of patients and adoption of strategies to prevent the propagation and dissemination of drug resistant TB, including MDR-TB. In Romania there are two centers for the management of MDR-TB cases: one in Bucharest at The National Pneumology Institute "Marius Nasta" and the other at Bisericani (Neamt district). The comparative analysis of MDR-TB cases and under treatment evolution was done, in the two excellence centers Bucharest and Bisericani from 2004 to 2007. This is a retrospective study of MDR-TB patients enrolled in Romania between 2004-2007. All patients evaluated were managed under The National Tuberculosis Programme approved protocols and had the opportunity to receive more than 24 months of treatment. In addition, follow-up data on successfully treated patients were collected at the beginning of 2007. This study is based on an MDR register, and a software collecting information on MDR-TB cases. In order to be accepted in one of the two MDR centers, patients need to fulfill certain criteria to improve the treatment results. A total number of 305 MDR-TB patients were registered at the beginning of 2007 in Bucharest MDR center; this study used a number of 170 MDR-TB patients from Bucharest who fulfilled the study's criteria in oppose to the 294 MDR-TB patients from Bisericani. 184 patients from the first cohort of DOTS-Plus project were evaluated until the end of the study: 55 were completed treatment and 54 cured, which means 59,23% succes rate. The conversion rate of culture at 4 months (for the first cohort) in MDR excellence centers was: Bucharest--72,5% and Bisericani--64%.

[Hyperthermic intrapleural chemotherapy--another modality for the treatment of malignant pleural neoplasia]. / Termochimioterapia intrapleurala--o alta posibilitate de abordare terapeutica a pleureziilor neoplazice.

The high frequency and the severity of malignant pleurisies, despite their etiology, make the problem to be of great importance. At national level, the problem of neoplastic pleurisies was and still remains a medico-surgical problem with socio-economic implications, especially in the situation when cancer represents a major health problem for the national health system. Treatments are mostly palliative aiming to relieve dyspnea and thoracic pain. The increasing incidence of malignant pleurisies enforce a better knowledge of pathogenic mechanisms that led to a new therapeutic approach with promising results--cytoreductive surgery combined with intraoperative hyperthermic intrathoracic chemotherapy. Recent studies about compared results of different types of treatments, function of survival period and side-effects, demonstrate the advantages of association between surgical treatment with the intrapleural administration of hyperthermic chemotherapy, which may have control on pleurisy and pleural involvement. It is considered that hyperthermia represents a hope in increasing the quality of patient's life with radiotherapy and chemotherapy, as well as surgical treatment, resistant neoplastic pleurisy. It is necessary to be made in accordance with classical oncological treatments.