CHEST PAIN DUE TO A GIANT THYMOMA IN AN ADOLESCENT BOY.

Chest pain in children is a common referral for emergency examination, although it is believed that the underlying condition is not a serious event. The authors present the case of a 17 years old male with complaints of chest pain with a very recent onset, constant, experienced after physical effort. All medical history and physical examination findings were normal, the poster-anterior chest X-ray revealed a heterogenous opacity in the middle third of the right hemithorax confirmed on computerized tomography as a large solid anterior mediastinal mass with a diameter of 7.5/10.3 cm. By thorax surgery the mass was identified in the anterior and superior mediastinum and total resection was achieved for the tumor mass and thymus. Pathology examination showed poor small and medium epithelial cells proliferation and the tumor was classified as thymoma type 1B. Mediastinum is a rare location of space occupying processes in children. Also, there is a high rate of asymptomatic lesions in this area, considering that half of them are incidentally discovered for various chest X ray examinations. Many causes of chest pain in children are benign; nonetheless, some serious events do exist sometimes and pediatricians must pay attention to identify and manage those cases.

Giant Esophageal GIST: Diagnostic and Therapeutic Challenge - Case Report.

GIST are rare mesenchymal tumors of the digestive tract (less than 1% of the digestive tract neoplasia). Of these, less than 1% are found in the esophagus. Surgery is the main treatment of GIST and is supported by targeted therapy with tyrosine kinase inhibitors like imatinibmesylate. We present the case of a female patient of 51 years, admitted in our clinic for a bulky tumor in the posterior mediastinum, diagnosed after investigations performed for fatigue for the great efforts. Clinical examination was unspecific. Chest X-ray and thoraco-abdominal CT identified a widening of the mediastinum through a posterior mediastinal tumor mass, determining a deviation to the left of the thoracic esophagus without causing not abledysphagia or respiratory symptoms. It was decided surgery by thoracotomy in V right intercostal space and total excision of the tumor was performed. Histopathology examination confirmed the preoperative suspicion of esophageal GIST. Prognosis is reserved, the risk of relapse is very high given the fact that the tumor was extracted fragmented. Currently the patient is under treatment with imatinib mesylate and entered into clinical and imaging follow-up program, according to clinical guidelines.

Surgical treatment for pulmonary metastases in urogenital cancers.

INTRODUCTION: The malignant disease's ability to metastasize remains one of the major obstacles when treating patients with cancer. The indication of metastasectomy is currently limited to patients undergoing treatment of the primary tumor. Resections for lung metastases of high selected patients with urogenital cancer present minimal risks and can prolong survival. Prognostic factors that determine which patients will benefit from surgery are still unclear. MATERIAL AND RESULTS: This article presents a retrospective analysis of patients who underwent lung metastases resection between 2008 and 2013 in our clinic. Among 148 patients, 8 (5.41%) had lung metastases after urologic cancers (UC), 18 (12.16%) after genital cancers (GC), 13 (8.78%) after breast tumors and 109 (73.65%) had lung metastases from other type of tumors. The overall 6 months survival was 100% for UC, 94.44 for GC, 84.62% for BC and 87.16% for others. DISCUSSION AND CONCLUSION: The criteria for surgery proved to have a positive predictive value and what should be considered are the following: prolonged disease-free interval (DFI), unilateral disease, the absence of systemic pathologies, oncological margins resecability and less than 3 radioimagistic detectable metastases. A negative prognosis was observed in those with primary tumor in the cervix, at least 3 metastases and a tumor larger than 3 cm. To determine how to select surgical candidates for pulmonary metastasectomy more precisely, further analysis of prognostic factors is evident and the need for a prospective, randomized, multicenter study is clear.

Molecular characterization of Echinococcus granulosus in south-eastern Romania: evidence of G1-G3 and G6-G10 complexes in humans.

Clin Microbiol Infect ABSTRACT: Echinococcus granulosus is the aetiological agent of cystic echinococcosis (CE), which is a public health problem in many eastern European countries, particularly in Romania, where the infection causes a high number of human and animal cases. To shed light on the transmission patterns of the parasite, we performed a genotyping analysis on 60 cyst samples obtained from patients who live in south-eastern Romania and who underwent surgery for liver or lung CE. DNA was extracted from the endocysts or the cyst fluids, and fragments of cytochrome c oxidase subunit 1 and NADH dehydrogenase subunit 1 mitochondrial genes (cox1 and nd1, respectively) were amplified by PCR and sequenced. We found that most of the samples analysed (59/60) belonged to the G1-G3 complex (E. granulosus sensu stricto), which contains the most widespread and infective strains of the parasite. We also identified the first human patient infected by a non-G1-G3 genotype of E. granulosus in this country. As the DNA sequence of this cyst sample showed maximum homology with the G6-G10 complex (Echinococcus canadensis), this is, in all likelihood, a G7 genotype, which is often found in pigs and dogs in most countries of eastern and south-eastern Europe.

Giant fibrovascular esophageal polyp misdiagnosed as achalasia.

A 59 years old woman was admitted in our unit accusing longtime dysphagia and regurgitation. On admission, the patient was wearing a 3 month old definitive feeding gastrostomy tube. The contrast swallow, endoscopy and esophageal manometry established the diagnostic--achalasia. We removed the gastrostomy tube and we performed an open Heller myotomy. The postoperative period was uneventful and the patient was discharged one week later with affirmatively unimpaired deglutition. One month later, the patient was admitted via emergency with a giant fibrous tumor arising from her mouth after an episode of strong coughing and vomiting. The repeated endoscopy showed a giant esophageal polyp that was missed by the previous investigations, originating from pharingoesophageal junction. The esophageal polyp was resected by cervical approach with good postoperative outcome. The polyp's particular extreme dimensions (27 cm) prevented the acute asphyxia by blockage at the laryngeal level, possibly provoked by smaller tumors. As postoperative one month barium swallow showed a normal esophageal aspect, a final question remains--was achalasia real or an erroneous diagnosis was established the second time too?

Whole lung lavage for pulmonary alveolar proteinosis after surgery for spontaneous pneumothorax.

INTRODUCTION: Pulmonary alveolar proteinosis (PAP) is a relatively rare lung disorder, probably under diagnosed, characterized by the accumulation of lipoproteinaceosus material in the lung alveoli. The primary (acquired or idiopathic) form occurs in more than 90% of all cases. Whole lung lavage is considered the golden standard of treatment. In this report, we describe a rare case of pulmonary alveolar proteinosis with severe and incapacitating respiratory, in which whole lung lavage followed the thoracotomy for spontaneous pneumothorax. CASE PRESENTATION: A 34-year-old white male patient presented at the respiratory intensive care with severe respiratory failure, aggravated in the last two months, cough, night sweats and important weight loss and left spontaneous pneumothorax. The initial diagnosis of diffuse interstitial pneumopathy was revised to Pulmonary Alveolar Proteinosis after bronchoalveolar lavage. Active pleural drainage of the pneumothorax was unsuccessful and after two months, surgical suture of the lung was performed under general anaesthesia. One month later a whole left lung lavage was performed. The same procedure was also performed on the right lung. Eight months later the patient had a good exercise tolerance, normal arterial blood gas (ABG) values, and persistent ground-glass opacities in some of the pulmonary segments on CT scan. CONCLUSIONS: The most severe forms of pulmonary alveolar proteinosis, in which hypoxemia and cyanosis occur, have a high mortality risk during anaesthesia and whole lung lavage. When a rare complication like spontaneous pneumothorax occurs, the suturing of the pulmonary apical blebs seems to be the only viable solution, despite the high risk of dehiscence of the sutures due to the poor pulmonary tissue integrity at the time of the whole lung lavage and during postoperative care.

Minimally invasive surgery in cancer. Immunological response.

Minimally invasive surgery produced major changes in treating abdominal malignancies and early stage lung cancer. Laparoscopy and thoracoscopy are less traumatic than open surgery: allow faster recovery, shorter hospital stay, better cosmesis. Although these clinical benefits are important, prolonged disease-free interval, long-term survival with improved quality of life are most important endpoints for oncologic surgery. Major surgery causes significant alteration of immunological response, of particular importance in oncologic patients, as postoperative immunosuppression has been related to septic complications, lower survival rate, tumor spread and metastases. Clinical studies have shown laparoscopic surgery preserves better the patient's immunological function. Postoperative plasma peak concentrations of IL-6, IL-10, C-reactive protein (CRP) and TNF-alpha were lower after laparoscopic colonic resection. Prospective thoracoscopic VATS lobectomy trials found better preservation of lymphocyte T-cell function and quicker return of proliferative responses to normal, lower levels of CRP, thromboxane and prostacyclin. Immune function is influenced by the extent of surgical trauma. Minimally invasive surgery show reduced acute-phase responses compared with open procedures and better preservation of cellular immune mechanisms.

Albendazole associated to surgery or minimally invasive procedures for hydatid disease--how much and how long.

Cystic echinococcosis is parasitic disease due to the larval stage of the metacestode Echinococcus granulosus in the liver (80%), lungs, kidneys, spleen, myocardium etc. Humans are accidental intermediate hosts. Diagnosis is based on laboratory and imaging studies. Treatment is multimodal, surgical and medical. Risks for dangerous complications and relapses are quite common. Adequate follow-up is needed. Albendazole has a central role in the medical therapy of the disease.

[Surgical and anesthetic coordination during tracheal and carinal resections and reconstruction]. / Coordonarea timpilor operatori si anestezici în rezectiile cu reconstructie ale traheei si carinei.

A retrospective study of anesthetic and surgical techniques involved in 55 consecutive cases of tracheal and carinal resections completed from 2001 to 2007, is presented. The anesthetic maneuvers and surgical approach differed in relation with the site of the tracheal lesions (upper, middle, lower trachea or carinal), the degree of the obstruction, the emergency of the surgical intervention and the concomitant presence of the eso-tracheal fistula. Ventilatory support during anesthesia involved special equipment adapted to the particular techniques used in this type of surgery. Cross field intubation of trachea or a mainstem bronchus, and High Frequency Jet Ventilation-HFJV- have been frequently used. Perfect coordination of the anesthetic techniques with every surgical step is mandatory and for good long term results special anesthetic equipment and a good preoperative anesthetic and surgical assessment of the strategy is needed.

[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.

[Metachronous bronchial carcinoma--three years after right upper lobectomy. A case report]. / Carcinom pulmonar drept metacron--trei ani dupa lobectomie superioara dreapta. Prezentare de caz.

The emergence of a secondary pulmonary neoplasm at some time after the primary one raises diagnostic and therapeutic issues especially in patients with functional respiratory capacities at the limits of resectability. We present the case of a 53 years old patient which suffered a right upper lobectomy three years before for a moderately differentiated squamous carcinoma and in which a second cancer was discovered in the right main bronchus. Para-clinic explorations demonstrated the lack of local and systemic invasion of the second cancer. The optimal therapeutic way is presented and its result, discussing also the means for long term follow-up of the patients operated for non-small cell lung cancer.

[The indications of bronchial resection and anastomosis in lung cancer]. / Indicatii ale rezectiei bronhoanastomoza în neoplasmul bronhopulmonar.

Bronchial resection and anastomosis represents an alternative to the pneumonectomy in patients with severe impairment of pulmonary function and/or other diseases which make such radical surgery too risky. The authors present two clinical cases of right upper lobe lung cancer (a squamous-cell carcinoma and an adenocarcinoma) admitted in the Thoracic Surgery Department of the National Institute of Pulmonology "Marius Nasta" from Jan-March 2001, in which they could not perform pneumonectomy because of unacceptable high risks. In both patients a right upper lobectomy with "sleeve" resection was done, with the anastomosis of right main bronchus to the intermediary one. The clinical, bronchoscopic and functional results were excellent. The literature review also shows very good results of this technique in the surgical treatment of lung cancer. For these reasons, the authors recommend this procedure in all the cases in which it can be technically applied; more than that, the survival rate is similar with other more radical techniques, but without any complications.