[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.

Disseminated tuberculosis with gradual evolution and unusual localization.

We present a case of disseminated tuberculosis (pulmonary, skeletal and lymph nodes) accompanied by subcutaneous abscesses and with unusual localization, osteolytic lesions of the skull caused by Mycobacterium tuberculosis var. hominis. Although the patient was immunocompetent, the disease had a gradual and unexpected progression. In the malign forms of tuberculosis, treatment must be extended for a year or more.

[Diagnostic difficulties--salvage diagnostic thoracotomies]. / Dificultati de diagnostic--toracotomii diagnostice salvatoare.

The authors are presenting the difficulties of diagnosis, in clearing up the etiology in two cases, where the acceptance of the exploring thoracotomy, influenced the prognostic and permitted to settle up the diagnosis. We are passing through, at this occasion, also the indications of this kind of operation.