[Non-invasive ventilation in Romania -- results of an inquiry among lung physicians]. / Ventilatia non-invaziva în Romania -- rezultatele unui chestionar aplicat pneumologilor.

Non-invasive ventilation (VNI), although it is a validated strategy for many years with serious scientific studies, remains a matter of acceptance by Romanian colleagues. In this investigation on 140 valid questionnaires we found that VNI was used by 22.1% of lung physicians, with the highest percentage of those under 40 years (30.8%); the home ventilation was indicated by 35.7% of colleagues, but actually only very few of them (5.2%) have experience which enables them to assert that they have a current practice. The major part of indications are related to COPD, chronic hypercapnic respiratory failure. Shortages in this field are manifold: from lack of knowledge concerning the VNI benefits who generates uncertainty in guidance and monitoring, to zero home insurance coverage and shortage of equipment in hospitals and ambulatory services.

[Preoperative evaluation for pulmonary resections in COPD patients]. / Evaluarea preoperatorie a pacientilor cu BPOC în vederea interventiilor chirurgicale toracice de rezectie pulmonara.

Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies in the world, an important number of such patients can necessitate, at a certain moment, a thoracic surgical intervention, especially pulmonary resections for pulmonary carcinoma. In these cases, the removing of a certain volume of pulmonary tissue from a patient who already has a respiratory malfunction necessitates a judicious preoperative evaluation to establish the correct indication, risk factors and postoperative prognosis (at least regarding the pulmonary function). Although the preoperative evaluation for pulmonary resections has been studied for many years, a parameter has not been found yet, simple or combined, to accurately predict the outcome. The majority of the candidates for pulmonary resections can be operated without previous complicated tests like CPET (cardio-pulmonary exercise testing) and regional pulmonary function, which are expensive and sometimes non accessible. In the past years, CPET gained more and more field in the appreciation of the surgical risk; combined with the split measurement of the function of the two lungs, it can even predict the postoperative effort capacity. In the complex preoperative evaluation of the chronic pulmonary patients we must not forget other, not so obvious aspects, so that the patient could benefit by the optimum moment and health status for his or her operation, for the purpose of a better prognosis.

[Left bronchial resection with bronchial anastomosis in a patient with posttraumatic bronchial stenosis]. / Rezectia bronsica stânga cu bronhoanastomoza la un pacient cu stenoza bronsica posttraumatica.

We present the case of a 25 year old patient, who suffered a car accident two month before he came to our hospital. At that moment, he had multiple costal fractures and left haemothorax, resolved by surgical means. At the actual presentation: dullness in the inferior half of left hemithorax, abolished breath sounds at this level. Radiologic--left lung atelectasis, bronchoscopic examination revealed--complete stenosis of the main left bronchus, while computer tomography has shown complete obstruction of the main left bronchus, at 1.7-2 cm from the carina. Fibrosis after posttraumatic bronchial disruption was the cause of the stenosis. Surgical treatment was the choice, with segmental resection of the main left bronchus and reanastomosis; the permeability was maintained on a month after the surgical intervention.