A Rare Thymic Tumor - Lipofibroadenoma - Always a Postoperative Surprise.

BACKGROUND/AIM: Thymic lipofibroadenoma is a benign growth of unknown etiology extremely rarely described in the literature, morphologically resembling lipofibroadenoma of the breast. The diagnosis is usually a postoperative surprise and is made by the anatomopathologist. Surgical resection is curative. CASE REPORT: The presented case is the first reported in a woman, to date. The patient was successfully submitted to surgery and complete resection of the giant intrathoracic tumor was performed. The histopathological and immunohistochemical studies came to demonstrated the presence of a thymic lipofibroadenoma while the postoperative outcomes were favorable. CONCLUSION: In cases presenting large intrathoracic tumors complete resection is able to provide a significant improvement of the general condition of the patient, as well as a chance for cure.

Interstitial lung diseases: an observational study in patients admitted in "Marius Nasta" Institute of Pulmonology Bucharest, Romania, in 2011.

Interstitial lung diseases (lLD) are a large group of rare diseases, with difficult diagnosis and management. Very little is known about prevalence, diagnosis and management of ILDs in Romania. This study aims to gather information on how ILDs are diagnosed and managed in Romania, focusing on a tertiary hospital with expertise and equipment needed for accurate diagnosis. We analyzed retrospectively the files of patients admitted with ILD in 2011 in "Marius Nasta" Institute of Pulmonology Bucharest. There were 178 eligible patient files with ILDs and 186 sarcoidosis cases. The ILD diagnosis were: 41 cases idiopathic pulmonary fibrosis (IPF), collagen disease associated ILD (29 cases), hypersensitivity pneumonia (19 cases), alveolar proteinosis (9 cases), cryptogenic organizing pneumonia (9 cases), undefined ILD (46 cases), other (25 cases). The investigations used for the diagnosis were: chest X-ray (100%), spirometry (157pts, 88.21%), diffusion capacity (127 pts, 71.43%, broncho-alveolar lavage (92 pts, 51.69%), CT scan (141 pts, 79.22%), lung biopsy (26 pts, 14.6%), similar to other European centers, but fewer lung biopsies are performed. There is need for a prospective registration of ILD cases in a national registry, for creating local guidelines for diagnosis of ILDs, to improve the suspicion of ILD and referring of patients to specialized centers. Diagnosis can be improved by a multidisciplinary approach of each case, involving the clinician, the radiologist, the pathologist and the thoracic surgeon.

[Medium-term strategy for the specific management of pneumology hospitals and wards after the decentralization of the sanitary system]. / Strategie pe termen mediu privind managementul specific al spitalelor si sectiilor de pneumologie dupa descentralizarea sistemului de sanatate.

Identifying and promoting new management techniques for the descentralized pneumology hospitals or wards was one of the most ambitious objectives of the project "Quality in the pneumology medical services through continuous medical education and organizational flexibility", financed by the Human Resourses Development Sectorial Operational Programme 2007-2013 (ID 58451). The "Medium term Strategy on the specific management of the pneumology hospitals or wards after the descentralization of the sanitary system" presented in the article was written by the project's experts and discussed with pneumology managers and local authorities representatives. This Strategy application depends on the colaboration of the pneumology hospitals with professional associations, and local and central authorities.

[Tuberculosis in Romania. Problems and solutions]. / Tuberculoza in România. Probleme si solutii.

UNLABELLED: The analysis of the Management Unit of the National TB Programme (NTP) database, together with the reports of the TB county managers, allowed to the authors to identify some weaknesses of TB control in Romania in the recent years and to propose the appropriate measures. PROBLEMS: The marked decrease in the reduction of TB cases reported annually from 2,761 in 2005-2006, to 145 in 2007-2008 and the stagnation of mortality rate: 7.5 per ten thousand in 2007 and 7.6 per ten thousand in 2008. Deficiencies in data recording and reporting through informatic system of the NTP. Lack of financial resources for system maintenance and upgrade. Deficiencies in monitoring and control of mycobacterium resistance to antituberculous drugs phenomenon at national level. Sensitivity testing only for a small percentage of culture confirmed new TB cases (21%). Higher percentage of MDR in new TB cases compared to the results of national survey of mycobacterium drug resistance 2003-2004. Lack of personnel: 16 TB dispensaries without any pulmonologist, vacancies for 259 doctors, 436 nurses and 433 auxiliary personnel. Important deficiencies in the NTP network's infrastructure and logistics countrywide. Discontinuities in the supply with first and second line antituberculous drugs resulting in interruption of treatments. Lack of an officially endorsed protocol for the diagnosis, treatment and monitoring of cases with TB/HIV co-infection. Solutions: Revitalization of monitoring-supervision activities of the NTP running countrywide, provision with necessary financial resources to perform the scheduled visits in counties. Providing maintenance and upgrade of the informatic system for data collection. Implementation of the necessary measures in order to attract and maintain the personnel in the NTP network. Conduct the national survey of mycobacterium susceptibility to first and second line antituberculous drugs and drug susceptibility testing of the most culture confirmed TB cases. Restore the centralized procurement of TB drugs. Finalization and official endorsement of the protocol for TB/HIV co-infection initiated in 2004.

[Clinical and epidemiological aspects of TB cases registered in persons aged > or =65 between 2002-2006, at the TB dispensary of sector 4, Bucharest]. / Aspecte clinico-epidemiologice ale cazurilor de tuberculoza înregistrate la persoanele de > or =65 ani în perioada 2002-2006 la dispensarul de pneumoftiziologie al sectorului 4, Bucuresti.

The study objectives were to find clinical and epidemiological aspects of TB cases registered between 2002-2006 in persons aged > or =65 years that belong to the TB Dispensary of the Sector 4-Bucharest. TB incidence in Romania at age group 265 years was in 2006 94% per hundred thousand (68.6% per hundred thousand in Sector 4-Bucharest). 153 new cases and 28 relapses were registered during 2002-2006, the highest percentage was between 68 and 78 years old. In 96.7% the tracking was passive and relatively delayed, with a 2.5 month mean from the onset of symptoms. The anatomical-radiological forms, caseous-extended and cavitary, represented 36% of the cases and the peripheral lymphatic node TB was the most frequent between the extrapulmonary forms--9.8%. The bacteriological confirmation was 81.7% in new TB cases. DOT strategy was applied in 76.8% of cases (139). The success rate of the therapy in the all cohort was 73.9% and the mortality was 20.4%. The introduction of a clinical surveillance system of the persons aged 65 years with a risk to develop the disease remain to be realised along with the application of the National Programme for TB Control 2007-2011.

[Multiple primary cancers with different localizations and histologic types. Clinical case]. / Neoplasme multiple cu localizari si tipuri histologice diferite. Caz clinic.

The authors describe the case of male patient of 46 years old, which was diagnosticated with 4 cancers of different localization and histopathological types in the course of 6 years. In chronological order these 4 neoplazias were: the Hodgkin's disease with mixed cellularity, the malign parieto-frontal right meningioma, a Grawitz renal tumor and a lung adenocarcinoma with bilateral lung and pleural metastasis. For both cerebral and renal tumors the patient was given a surgical treatment and for the Hodgkin's disease and lung cancer given chemotherapy and cobalt therapy.

[Mediastinal tuberculous lymphadenitis of adult]. / Tuberculoza ganglionara mediastinala la adult.

The authors report a case of primary tuberculosis with exclusively pulmonary hilar lymphadenitis and mediastinal lymphadenitis at an adult woman in which the non-invasive investigation headed to the diagnosis of sarcoidosis with a very large probability. The histopathological confirmation was made by mediastinoscopy.

[Multiple, paravertebral Pott's abscesses]. / Abcese pottice paravertebrale multiple.

The authors describe a case of vertebral tuberculosis with multiple localizations, high thoracical (T2-T6) and of the sacrum (S1-S4) at a young woman with nonspecific clinical symptoms and with CT examination suggestive of the diagnosis, where the diagnostical certainty was obtained by the bacteriological examination for bK of the pus (purulent liquid) extracted by CT guided fine needle biopsy performed in the posterior mediastinal tumor.