[Our experience in the thoracoscopic surgery of the tuberculous pleural effusions]. / Experienta noastra în chirurgia toracoscopica a colectiilor pleurale tuberculoase.

Pleural tuberculosis (TB) is most often treated by a pneumologist. Some cases require operative interventions and may represent a challenge for the thoracic surgeon. There are two specific problems regarding TB pleural effusions: 15-25% of them remain undiagnosed using the conventional methods of diagnosis (imaging, thoracentesis, percutaneous pleural biopsies) and have a tendency for the rapid production of dense adherences and loculations. The authors present their experience in the diagnosis and the treatment of tuberculous pleurisy by means of mini-invasive surgical techniques. The period of study was January 2001-December 2006. In that period, the authors performed 400 video-assisted surgical operations, representing 9% of all the operations carried out in the clinic (3833). The surgical indications were for diagnosis (pleural, pericardial, lung or lymph node biopsy) and for treatment (pleurisy, pleuro-pericarditis, empyema). The contraindications for VATS were the usual ones. 56 cases were diagnosed with pleuro-pulmonary tuberculosis (14% of the VATS). For 43 patients the first approach was strictly thoracoscopic (VATS), while for the rest of 13 we started directly through a minithoracotomy with video assistance. We had 7 conversions to minithoracotomies with video assistance from those 43 aforementioned patients. Minithoracotomy with video assistance was preferred in 13 cases as a primary approach. We used two-port approach in 30 cases and the three-port triangular approach was useful for 6 patients. In 4 cases the bidigital technique was used in order to achieve greater room for exploration. We experienced only one minor intraoperative complication. Our results are comparable to those reported by other authors. The main idea of this paper is that the advantages of VATS in the pathology of the tuberculosis are undeniable.

[Bronchoscopy in thoracic trauma]. / Bronhoscopia în traumatologia toracica.

Thoracic trauma often bears difficult problems of diagnosis and treatment. This paper reports 87 procedures on 20 severe thoracic injured patients, who have also suffered multiple injuries, to whom was performed bronchoscopy. These cases were regarding gender, age, traumatic cause, associated injuries and dynamic endo-bronchial aspect. There are detailed technique used in bronchoscopy and bronchoscopic suction, additional diagnostic procedures, technical tips, incidents and are also reported close and follow up results in these cases. We discuss indications of bronchoscopy and broncho-aspiration in thoracic trauma from diagnostic and treatment point of view. Conclusions underline major role of bronchoscopy in the management of severe thoracic trauma.