[Aspects of the surgical treatment in plurivisceral echinococcosis--case report]. / Aspecte ale tratamentului chirurgical in echinococoza pluriviscerala---prezentare de caz.

Hydatid disease remains endemic in many parts of the world, most notably the Mediterranean region, Australia, New Zealand, the Middle East, and South America. Plurivisceral echinococcosis is defined as the concomitant or successive presence of hydatidosis in more than one internal organ. It has been noticed that the number of cases with multi-organ localizations and multiple cysts has increased in the last years. As the surgery of plurivisceral echinococcosis remains one of the challenges for the medical world, in this article we present our experience during 2000-2007 with this disease, followed by a case report of one of the most special cases of echinococcosis, discussing the principles of treatment, along with a new classification of this disease. Plurivisceral echinococcosis is associated with higher postoperative morbidity and mortality than uncomplicated cysts, related to organ involvement and surgical treatment. In the sequential approach we recommend resolving first surgically the complicated cysts or those at risk. In the thoracic and abdominal locations, the thoracic cysts will be approached first. The treatment methods will be as conservative as possible. Management of pulmonary and hepatic cysts (diaphragmatic side) simultaneously through the thoracic route is convenient and should be encouraged in patients because this prevents a second operation.

[Remediastinoscopy--current indications. A case report]. / Remediastinoscopia--indicatii actuale. Prezentare de caz.

Current indications for remediastinoscopy include an inadequate first procedure, recurrent and second primary lung cancer, lung cancer occurring after an unrelated disease such as lymphoma, and restaging after induction therapy. Nowadays, restaging is the most frequent indication for remediastinoscopy. We present the case of a 42 years old male with a mediastinoscopy performed in another surgical unit 4 months before being admitted in our department. The CT scan showed bulky mediastinal lymph node enlargement, in evolution compared with the prior one, and no other lesions in the lung parenchyma. As the histopathological examination from the first specimen was negative, a diagnosis was requested in order to allow a correct treatment. A remediastinoscopy was successfully performed and avoided a more invasive procedure.

[Tracheal stenosis--diagnostic and therapeutic principles, results]. / Stenozele traheale--principii de diagnostic si tratament, rezultate.

Between November 2001-April 2010, 107 tracheal resections were performed in our department for different types of tracheal stenosis: iatrogenic or tumoral, benign or malignant. We present the diagnosis and treatment principles that we used, along with our results. We operated on 74 (69.15%) iatrogenic postintubation tracheal stenosis, 6 (5.6%) of them complicated with tracheo-esophageal fistula, 6 (5.6%) benign tumors, 11 (10.28%) primary malignant and 16 (14.97%) secondary malignant ones, with a 3.8% total mortality. Tracheal resection and reconstruction is the only curative treatment for all types of tracheal stenosis. Interventional endoscopy is of a major importance in the assessment and treatment of tracheal stenosis. We believe that each patient diagnosed with a tracheal stenosis should be referred to a tertiary center with multidisciplinary experience in the treatment of tracheal stenosis.

[Thoracoscopic sympathectomy for arterial ischemia of the upper extremities: a case report]. / Simpatectomia toracoscopica în tratamentul ischemiei arteriale a membrului superior: prezentare de caz.

INTRODUCTION: Thoracoscopic surgery reduce the morbidity of sympathectomy. Major indications of video-assisted sympathectomy (VAT) include hyperhidrosis, Raynaud's disease, causalgia, and reflex sympathetic dystrophy. Because little information is available in the national and international literature VAT sympathectomy in the treatment of upper extremities ischemia, we decided to present our first case. CLINIC CASE: The 38 years old patient was hospitalized for left upper-extremity ischemia (Raynaud's syndrome). Thoracoscopic sympathectomy was performed with resection of the main trunk proximally immediately after the stellate ganglion and distally at the level of T4 and identification and resection of 2 collateral branches of the sympathetic chain T2-T3. RESULTS: The postoperative evolution demonstrated evident clinical benefit. The thermography performed postoperative showed hyperthermia and hyper-vascularization in the left hemithorax with a difference of temperature of 2 degrees C between the two sides of the thorax. COMMENT: Before the advent of VAT, thoracic sympathectomy was performed only in highly selected patients because of its invasiveness. Now VAT sympathectomy is considered in most cases as the last resort to prevent extensive and successive amputation. Because the procedure is minimally invasive, safe, and associated with a low rate of complications, it should be considered earlier in the natural course of this disease.