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Organizator Societatea Romn de Chirurgie Toracic 1994

Presedinte Congresului - Prof. Dr. Ioan Cordo

Comitet de organizare:
Dr. Ciprian Bolca
Dr. Cezar Mota
Dr. Radu Matache
Dr. Radu Brnzea
Dr. Mihai Dumitrescu
Dr. Andrei Bobocea
Dr. Olga Dnil
Dr. Adrian Istrate
Dr. Adrian Iordache
Comitet tiinific
Prof. Dr. Adrian Aldea
Prof. Dr. Alexandru Boianu
Prof. Dr. Ioan Cordo
Prof. Dr. Teodor Horvat
Prof. Dr. Alexandru Nicodin
Prof. Dr. Zeno Popovici
Dr. Cristina Grigorescu
Dr. Dan Nicolau
Dr. Claudiu Nistor
Dr. Cristian Paleru

Nu ne lsm prad...
Nu ne lsm prad unei stri sociale fr precedent i ncercm s dm un bun exemplu,
exemplul unor oameni de bun credin a cror scop declarat sau nu (nu trmbiat!) este acela
de a-i pune viaa n slujba vindecrii sau alinrii suferinei semenilor lor.
Nu ne lsm prad neajunsurilor de tot felul i purcedem la organizarea Celei de-a 9
Conferine Naionale de Chirurgie Toracic cu participare internaional, la jumtatea lunii
octombrie a acestui an ntr-un splendid peisaj montan, n vremea n care lumina molatec a
toamnei va aurii crestele Bucegilor i ale Pietrei Craiului. ntlnirea cu bucurie a
participanilor va avea loc n dup amiaza zilei de joi, 13 octombrie, iar desprirea, cu regret,
la mijlocul zilei de smbt 15 octombrie. Dar ca s nu v supunem la grea ncercare
rbdarea, va anunm locul Conferinei ca fiind noul hotel montan de la Cheile Grditei, la
circa patru sute de metri mai sus de acela n care s-a desfurat Cea de-a 7-a Conferin din
2009.
Fr ndoial alturi de noi vor fi i prieteni apropiai din lumea chirurgiei toracice mondiale
care ne vor mprti din experiena lor. Tema conferinei se va axa mai mult pe tehnici
chirurgicale novatoare sau mai puin uzuale precum i pe promovarea Ghidului de diagnostic
i tratament al cancerului bronho-pulmonar. Sigur spiritul nostru tiinific va fi mult mai bogat
n urma acestor conferine i lucrri i ca de obicei vom aprecia cum se cuvine i programul
social.
Nu ne lsm prad uneltirilor acelora care ncearc s vre dihonia n nu foarte numeroasa
noastr societate i invitm la Conferina noastr pe toi truditorii cu suflet curat, pe toi aceia
care lupt necondiionat pentru bine pacientului: chirurgi toracici, anesteziti, pneumologi,
bronhologi, exploraioniti de toate felurile, anatomo-patologi, toi care ar putea s ne aduc o
ct de mic noutate n activitatea noastr fr preget. Invitm n mod special colegii
pneumologi care, dup spusele profesorului G. Massard, au o mare responsabilitate n
alegerea chirurgului care s le opereze pacientul.
Dorim o ct mai mare participare a membrilor Societii nostre deoarece este an de alegeri, an
n care, n mod cu totul democratic i deschis, vechea conducere va face un bilan al celor doi
ani trecui prednd tafeta noii conduceri pentru a consolida ceea ce s-a realizat, ceas de bilan
i...critici. Firete, n spirit colegial.
Nu ne lsm prad altor preocupri tentante i ne notm n calendar perioada 13-15 octombrie
cnd v ateptm cu nerbdare la Cheile Grditei pentru o ntlnire ntre nvingtori...
Preedintele Societii Romne de Chirurgie Toracic (care-i asum ntreaga rspundere
pentru cele scrise mai sus):
Prof. Dr. Ioan Cordo

THURSDAY, OCTOBER 13, 2011


16.00 General assembly of the Romanian Society of Thoracic Surgery 1994
18.30 - 19.30 Opening ceremony
19.30 Welcome reception

FRIDAY, OCTOBER 14, 2011


09.00 11.00 - Conferences - Session I
Chairmen: Eric Frechette; Cristian Paleru
9.00 9.30
Teodor Horvat
Extramucosal myotomy of upper esophageal sphincter
9.30 10.00
Lex Maat
Lung transplantation: surgical issues, organization and logistic problems
10.00 10.30
Ioan Cordo
Tracheobronchial stenosis challenging cases
10.30 11.00
Rick Paul
TNM 7: What went wrong? Which way forward?
11.00 11.30 Coffee break
11.30 13.30 - Conferences - Session II
Chairmen: Rick Paul; Lex Maat
11.30 12.00
Mariano Garcia Yuste
Results of standard pulmonary resection vs. conservatory (sublobar & bronchoplastic)
pulmonary resection in the treatment of carcinoid tumours
12.00 12.30
Eric Frechette
VATS lobectomy as treatment of NSCLC.
12.30 13.00
Dragan Subotic

Lung resection in COPD patients: where is the lower limit?


13.00 13.30
Jos Belda-Sanchis
Is thoracoscopic surgery justified to treat lung metastases?
13.30 15.30 Lunch break
15.30 17.30 - Presentations - Session I
Chairmen: Mariano Garcia Yuste, Teodor Horvat
15.30 15.40
Bleeding from an adrenal metastasis as an atypical clinical onset of a stage iv lung cancer
Boianu Petre Vlah-Horea1, Boianu Alexandru-Mihail1, Porav Daniel2, Boianu Ana-Maria
Voichia3
1
-Clinica Chirurgie IV UMF Trgu-Mure
2
-Clinica Urologie UMF Trgu-Mure
3
-Clinica Medical IV UMF Trgu-Mure
15.40 15.50
Uniportal thoracoscopy for pleural effusions
Natalia Mota, Cezar Mota, Mihnea Davidescu, Ovidiu Rus, Elena Moise, Andreea tefan,
David Achim, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
15.50 16.00
Mediastinal ectopic parathyroid adenoma case report
A.C.Nicodin1, O.N.Burlacu1, Codruta Lazureanu2, Mihaela Vlad3
1
Thoracic Surgery Department, City Hospital Timisoara
2
Anatompathology Department , City Hospital Timisoara
3
Endocrinology Department, County Hospital Timisoara
16.00 16.10
Sleeve resection with full pulmonary preservation for posttraumatic main bronchial stenosis
Radu Matache, Ciprian Bolca, Andrei Cristian Bobocea, Olga Danaila, Ion Jentimir, Ioan
Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
16.10 16.20
A complex surgical system for solid sternal reconstruction: thoratex mesh, stratos system and
kryptonite bone cement
*Claudiu Nistor, *Adrian Ciuche, *Daniel Pantile, **Teodor Horvat
* Emergency University Military Central Hospital Dr. Carol Davila, Bucharest
** Institute of Oncology "Prof. Dr. Alexandru Trestioreanu, Bucharest

16.20 16.30
The importance of histopathological factors in setting the long term prognosis for non-small
cell lung cancer
Suciu B.1, Bud V.1, Copotoiu C.1, Brnzaniuc Klara2, Copotoiu Ruxandra3, Fodor D.1,
Butiurca V.4
Surgical Clinic no. 1, Mure County Emergency Hospital
Anatomy Department, University of Medicine and Pharmacy, Tg.Mure
ICU Clinic, Mure County Emergency Hospital
Student, University of Medicine and Pharmacy, Tg.Mure
16.30 16.40
Cervical video-assisted mediastinoscopic approach of the left main bronchus - a series of six
cases
Cristian Paleru, Olga Danaila, Ciprian Bolca, Radu Matache, Mihai Dumitrescu, Adrian
Istrate, Ruxandra Ulmeanu, Ioan Cordos
Marius Nasta National Institute of Pneumology, Bucharest, Romania
1 - Thoracic Surgery Department
2 - Bronchoscopy Department
16.40 16.50
Extra-musculo-periosteal plombage thoracoplasty with balls still working after 46 years
Boianu Petre Vlah-Horea, Boianu Alexandru-Mihail
Discipline Surgery 4, University of Medicine and Pharmacy from Targu-Mures
16.50 17.00
Thoracic parietal hemangioma
Cezar Mota, Ovidiu Rus, David Achim, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
17.00 17.10
Unusual case of leyomiofibromatosis with multiple locations the truth beyond the
appearances case report
Adrian Istrate, Cristian Paleru, Mihai Dumitrescu, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
17.10 17.20
Videothoracoscopic thimectomy in nonthymomatous patients with myasthenia gravis
Cristina Grigorescu*, Trufa Denis*, Iosep Gabriel**
*Clinic of Thoracic Surgery. University of Medicine Gr.T.Popa Iasi
** ICU , Hospital of Pneumology Iasi
17.20 17.30
Hydatid cyst of anterior mediastinum
Cezar Mota, Natalia Mota, Mihnea Davidescu, Elena Moise, Ovidiu Rus, Daniel Banciu,
David Achim, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest

Gala dinner 20.00

SATURDAY, OCTOBER 15, 2011


08.30 11.00 - Conferences - Session III
Chairmen: Jos Belda-Sanchis, Alexandru Boianu
8.30 9.00
Irina Strmbu
The accuracy of imprint cytology for rapid intra operative diagnosis in lung cancer
9.00 9.30
Cristina Grigorescu
Neuroendocrine tumors of the lung
9.30 10.00
Lex Maat
Surgery in malignant pleural mesothelioma: sense or nonsense
10.00 10.30
Cristian Paleru
Mediastinal approach of postpneumonectomy left bronchial stump fistula
10.30 11.00
Alexandru Nicodin
European thoracic surgery database
11.00 11.30 Coffee break
11.30 13.00 - Presentations Session II
Chairmen: Dragan Subotic, Ioan Cordo
11.30 11.40
Emergency pulmonary resections - pulmonary tumor torn in pleura
Ovidiu
Rus,
Natalia
Mota,
Elena
Moise,
Teodor
Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
11.40 11.50
Management of intrathoracic esophageal ruptures a single centers experience
C.P.Tunea, V.T.Voiculescu, O.N.Burlacu, G.V.Cozma, I.Miron, I.A.Petrache, M.Butas, A.C.
Nicodin
Thoracic Surgery Department, Municipal Hospital, Timisoara
11.50 12.00
Surgical management of tracheal invasion by thyroid carcinoma single center experience
Andrei Cristian Bobocea, Ciprian Bolca, Olga Danaila, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest

12.00 12.10
Classical technique versus nuss in the treatment of failed surgery for pectus excavatum
G.V.Cozma, I.A.Petrache, O.N.Burlacu, A.C.Nicodin
Thoracic Surgery Department, Municipal Hospital, Timisoara
12.10 12.20
Our experience in the anterior surgical approach of c7-t1 spine
*Adrian Ciuche, *Claudiu Nistor, *Marian Mitrica, **Teodor Horvat
*Emergency University Military Central Hospital Dr. Carol Davila, Bucharest
** Institute of Oncology "Prof. Dr. Alexandru Trestioreanu, Bucharest
12.20 12.30
Postesophagectomy benign gastric tube to tracheobronchial tree fistulas. Presentation of two
cases, literature review, classification and treatment protocol
Bolca Ciprian*, Eric Frechette**
*1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
** Thoracic Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de
Quebec (IUCPQ), Quebec City, Canada
12.30 12.40
Serial resection for double tracheal stenosis post oro-tracheal intubation
Codin Saon, Liliana Caracuda, Felix Dobritoiu, Ioan Cordos, Genoveva Cadar, Emilia Crisan
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
12.40 12.50
Our experience in the surgery of the chest wall tumors
A.C.Nicodin, I.Miron, O.Sirbu, G.V.Cozma, O.N.Burlacu, I.A.Petrache, A.C.Nicola,
C.Mogoi.
Thoracic Surgery Department, Municipal Hospital, Timisoara
12.50 13.00
Ectopic thymomas with lateral paracardiac development
Boianu Alexandru-Mihail, Boianu Petre Vlah-Horea, Urcan Marius, Chiujdea Drago,
Lucaciu Oana, Hogea Timur, Batog Olivia, Pvloiu Valerian
Discipline Surgery 4, University of Medicine and Pharmacy from Targu-Mures

Poster session
1. Rare mediastinal masses: bronchogenic cyst and castleman's disease
Andrei Cristian Bobocea, Radu Matache, Ion Jentimir, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
2. Pericardial drainage in malignant effusions - early results

Cezar Mota, Natalia Mota, Mihnea Davidescu, Ovidiu Rus, Elena Moise, Andreea tefan,
David Achim, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
3. Triple tracheo-bronchial lesion post-mediastinoscopy and ebus
Natalia Mota, Cezar Mota, Ovidiu Rus, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
4. Malignant pleural pseudomesothelioma
Mihnea Davidescu, Elena Moise, Ovidiu Rus, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
5. Bullous dystrophy of the middle lobe
Corina Bluoss, David Achim, Elena Moise, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
6. Ianusian aspect of tyroid pathology
Elena Moise, Cezar Motas, Ovidiu Rus, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
7. Giant pleural tumor case report
Radu Matache, Andrei Cristian Bobocea, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
8. The role of the geroulanos procedure in the treatment of lung hydatic cyst today
G.V.Cozma, O.N.Burlacu, V.T.Voiculescu, C.P.Tunea, I.Miron, I.A.Petrache, M.Butas, A.C.
Nicodin
Thoracic Surgery Department, Municipal Hospital, Timisoara
9. Role of muscle flaps in the treatment of unresectable abscesses
Boianu Petre Vlah-Horea, Boianu Alexandru-Mihail, Gliga Mirela, Ionic Sebastian,
Chiujdea Drago, Lucaciu Oana, Hogea Timur, Batog Olivia
Discipline Surgery 4, University of Medicine and Pharmacy from Targu-Mures
10. Reversal of the flow in the thoracic drainage system rare postoperative accident
Boianu Alexandru-Mihail, Boianu Petre Vlah-Horea, Lucaciu Oana, Chiujdea Drago
Discipline Surgery 4, University of Medicine and Pharmacy from Targu-Mures
13.00 13.30
Traian Oancea award, for the best presentation during the conference
Closing remarks

JOI, 13 OCTOMBRIE 2011


16.00 - Adunarea Generala a Membrilor Societatii Romane de Chirurgie Toracica 1994
18.30 - 19.30 - Ceremonia de deschidere
19.30 - Cocktail-ul de deschidere

VINERI, 14 OCTOMBRIE 2011


09.00 11.00 - Conferine - Sesiunea I
Moderatori: Eric Frechette; Cristian Paleru
9.00 9.30
Teodor Horvat
Miotomia extramucoas a sfincterului esofagian superior
9.30 10.00
Lex Maat
Lung transplantation: surgical issues, organization and logistic problems
10.00 10.30
Ioan Cordo
Stenozele traheo-bronice cazuri dificile
10.30 11.00
Rick Paul
TNM 7: What went wrong? Which way forward?
11.00 11.30 Pauz de cafea
11.30 13.30 - Conferine - Sesiunea II
Moderatori: Rick Paul; Lex Maat
11.30 12.00
Mariano Garcia Yuste
Results of standard pulmonary resection vs. conservatory (sublobar & bronchoplastic)
pulmonary resection in the treatment of carcinoid tumours
12.00 12.30
Eric Frechette
VATS lobectomy as treatment of NSCLC.
12.30 13.00
Dragan Subotic

Lung resection in COPD patients: where is the lower limit?


13.00 13.30
Jos Belda-Sanchis
Is thoracoscopic surgery justified to treat lung metastases?
13.30 15.30 Pauz de prnz
15.30 17.30 - Lucrri - Sesiunea I
Moderatori: Mariano Garcia Yuste, Teodor Horvat
15.30 15.40
Hemoragia din metastaz suprarenalian modalitate atipic de debut clinic al unui cancer
pulmonar stadiul IV
Boianu Petre Vlah-Horea1, Boianu Alexandru-Mihail1, Porav Daniel2, Boianu Ana-Maria
Voichia3
1
-Clinica Chirurgie IV UMF Trgu-Mure, Romnia
2
-Clinica Urologie UMF Trgu-Mure, Romnia
3
-Clinica Medical IV UMF Trgu-Mure, Romnia
15.40 15.50
Toracoscopia uniportal n pleurezii
Natalia Mota, Cezar Mota, Mihnea Davidescu, Ovidiu Rus, Elena Moise, Andreea tefan,
David Achim, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
15.50 16.00
Adenom paratiroidian ectopic cu localizare mediastinala prezentare de caz
A.C.Nicodin1, O.N.Burlacu1, Codruta Lazureanu2, Mihaela Vlad3
1
Clinica de Chirurgie Toracica, Spitalul Municipal Timisoara
2
Departamentul de Anatomie patologica, Spitalul Municipal Timisoara
3
Clinica de Endocrinologie, Spitalul Judetean Timisoara
16.00 16.10
Rezectie-bronhoanastomoza de bronsie primitiva cu prezervare pulmonara totala pentru
stenoza posttraumatica
Radu Matache, Ciprian Bolca, Andrei Cristian Bobocea, Olga Danaila, Ion Jentimir, Ioan
Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
16.10 16.20
Sistem chirurgical complex pentru reconstrucia solid sternal: plas thoratex, lam stratos
i ciment kryptonite
*Claudiu Nistor, *Adrian Ciuche, *Daniel Pantile, **Teodor Horvat
* Spitalul Universitar de Urgen Militar Central Dr. Carol Davila, Bucureti
** Institutul Oncologic "Prof. Dr. Alexandru Trestioreanu, Bucureti

16.20 16.30
Importana factorilor histopatologici n stabilirea prognosticului pacienilor operai pentru
cancer pulmonar fr celule mici
Suciu B.1, Bud V.1, Copotoiu C.1, Brnzaniuc Klara2, Copotoiu Ruxandra3, Fodor D.1,
Butiurca V.4
Clinica Chirurgie I, Spitalul Clinic Judeean de Urgen Mure
Disciplina de Anatomie, Universitatea de Medicin i Farmacie Tg. Mure
Clinica ATI, Spitalul Clinic Judeean de Urgen Mure
Student, Universitatea de Medicin i Farmacie Tg. Mure
16.30 16.40
Abordul cervical videomediastinoscopic al broniei primitive stngi - o serie de 6 cazuri
Cristian Paleru, Olga Danaila, Ciprian Bolca, Radu Matache, Mihai Dumitrescu, Adrian
Istrate, Ruxandra Ulmeanu, Ioan Cordos
Institutul National de Pneumologie Marius Nasta, Bucuresti
1 Clinica I Chirurgie Toracica
2 Departamentul Bronhologie
16.40 16.50
Plombaj extra-musculo-periostal cu bile funcional dup 46 de ani
Boianu Petre Vlah-Horea, Boianu Alexandru-Mihail
Disciplina Chirurgie 4, Universitatea de Medicin i Farmacie din Trgu-Mure, Romnia
16.50 17.00
Hemangiom parietal toracic
Cezar Mota, Ovidiu Rus, David Achim, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
17.00 17.10
Leiomiofibromatoza cu multiple localizari adevarul dincolo de aparente prezentare de caz
Adrian Istrate, Cristian Paleru, Mihai Dumitrescu, Ioan Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
17.10 17.20
Timectomia videotoracoscopica in hiperplazia timica cu miastenie gravis
Cristina Grigorescu*, Trufa Denis*, Iosep Gabriel**
*Clinica de Chirurgie Toracica Iasi, UMF Gr.T.Popa Iasi
** Sectia de ATI, Spital clinic de Pneumoftiziologie Iasi
17.20 17.30
Chistul hidatic al mediastinului anterior
Cezar Mota, Natalia Mota, Mihnea Davidescu, Elena Moise, Ovidiu Rus, Daniel Banciu,
David Achim, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti

Gala dinner 20.00

SMBT, 15 OCTOMBRIE 2011


08.30 11.00 - Conferine - Sesiunea III
Moderatori: Jos Belda-Sanchis, Alexandru Boianu
8.30 9.00
Irina Strmbu
Valoarea amprentei tumorale in diagnosticul rapid intraoperator in cancerul pulmonar
9.00 9.30
Cristina Grigorescu
Neuroendocrine tumors of the lung
9.30 10.00
Lex Maat
Surgery in malignant pleural mesothelioma: sense or nonsense
10.00 10.30
Cristian Paleru
Abordul mediastinal al fistulei de bont bronsic postpneumonectomie stanga
10.30 11.00
Alexandru Nicodin
European thoracic surgery database
11.00 11.30 Pauz de cafea
11.30 13.00 - Lucrri Sesiunea II
Moderatori: Dragan Subotic, Ioan Cordo
11.30 11.40
Rezectii pulmonare in urgenta - tumora pulmonara rupta in pleura
Ovidiu Rus, Natalia Mota, Elena Moise, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
11.40 11.50
Managementul rupturilor esofagiene intratoracice experienta unui singur centru
C.P.Tunea, V.T.Voiculescu, O.N.Burlacu, G.V.Cozma, I.Miron, I.A.Petrache, M.Butas, A.C.
Nicodin
Clinica de Chirurgie Toracic, Spitalul Municipal, Timioara
11.50 12.00
Managementul chirurgical al carcinomului tiroidian cu invazie traheala - experienta unui
singur centru
Andrei Cristian Bobocea, Ciprian Bolca, Olga Danaila, Ioan Cordos

Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti


12.00 12.10
Sternocondroplastia clasica versus tehnica nuss in pectus excavatum recidivat
G.V.Cozma, I.A.Petrache, O.N.Burlacu, A.C.Nicodin
Clinica de Chirurgie Toracic, Spitalul Municipal, Timioara
12.10 12.20
Experiena noastr n abordul chirurgical anterior al vertebrelor c7-t1
*Adrian Ciuche, *Claudiu Nistor, *Marian Mitric, **Teodor Horvat
*Spitalul Universitar de Urgen Militar Central Dr. Carol Davila, Bucureti
** Institutul Oncologic "Prof. Dr. Alexandru Trestioreanu, Bucureti
12.20 12.30
Fistula benign postesofagectomie ntre tubul gastric i arborele traheobronic: prezentare a
dou cazuri, studiu literaturii, clasificare i protocol terapeutic
Bolca Ciprian*, Eric Frechette**
*Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
**Clinica de Chirurgie Toracic, Institutul Universitar de Cardiologie i Pneumologie
(IUCPQ), Quebec, Canada
12.30 12.40
Rezectie etajata, seriata, pentru dubla stenoza traheala severa post intubatie oro-traheala
Codin Saon, Liliana Caracuda, Felix Dobritoiu, Ioan Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
12.40 12.50
Experienta noastra in chirurgia tumorilor parietale toracice
A.C.Nicodin, I.Miron, O.Sirbu, G.V.Cozma, O.N.Burlacu, I.A.Petrache, A.C.Nicola,
C.Mogoi.
Clinica de Chirurgie Toracic, Spitalul Municipal, Timioara
12.50 13.00
Timoamele ectopice cu dezvoltare lateral - paracardiac
Boianu Alexandru-Mihail, Boianu Petre Vlah-Horea, Urcan Marius, Chiujdea Drago,
Lucaciu Oana, Hogea Timur, Batog Olivia, Pvloiu Valerian
Disciplina Chirurgie 4, Universitatea de Medicin i Farmacie din Trgu-Mure, Romnia

Sesiunea postere
1. Tumori mediastinale rare: chist bronhogenetic si boala castleman mediastinala
Andrei Cristian Bobocea, Radu Matache, Ion Jentimir, Ioan Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
2. Drenajul pericardic n revrsatele maligne rezultate precoce
Cezar Mota, Natalia Mota, Mihnea Davidescu, Ovidiu Rus, Elena Moise, Andreea tefan,
David Achim, Teodor Horvat

Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu


Bucureti
3. Tripl leziune traheo-bronic post-mediastinoscopie i ebus
Natalia Mota, Cezar Mota, Ovidiu Rus, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Bucureti
4. Pseudomezoteliom pleural malign
Mihnea Davidescu, Elena Moise, Ovidiu Rus, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
5. Distrofia buloas de lob mediu
Corina Bluoss, David Achim, Elena Moise, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
6. Aspect ianusian de patologie tiroidian
Elena Moise, Cezar Motas, Ovidiu Rus, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
7. Tumora fibroasa solitara pleurala giganta prezentare de caz
Radu Matache, Andrei Cristian Bobocea, Ioan Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
8. Rolul actual al procedeului geroulanos in tratamentul chirurgical al chistului hidatic
pulmonar
G.V.Cozma, O.N.Burlacu, V.T.Voiculescu, C.P.Tunea, I.Miron, I.A.Petrache, M.Butas, A.C.
Nicodin
Clinica de Chirurgie Toracic, Spitalul Municipal, Timioara
9. Rolul lambourilor musculare n tratamentul abceselor pulmonare nerezecabile
Boianu Petre Vlah-Horea, Boianu Alexandru-Mihail, Gliga Mirela, Ionic Sebastian,
Chiujdea Drago, Lucaciu Oana, Hogea Timur, Batog Olivia
Disciplina Chirurgie 4, Universitatea de Medicin i Farmacie din Trgu-Mure
10. Inversarea fluxului n sistemul de drenaj toracic accident postoperator rar
Boianu Alexandru-Mihail, Boianu Petre Vlah-Horea, Lucaciu Oana, Chiujdea Drago
Disciplina Chirurgie 4, Universitatea de Medicin i Farmacie din Trgu-Mure

13.00 13.30
Decernarea premiului Traian Oancea pentru cea mai bun prezentare n cadrul
sesiunilor de lucrri
nchiderea conferinei

ABSTRACTS
CONFERENCES
Miotomia extramucoas a sfincterului esofagian superior
Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Bucureti
Se prezint un subiect mai puin cunoscut n literatura medical din Romnia
miotomia extramucoas a sfincterului esofagian superior.
Sunt trecute n revist date de anatomie chirurgical i aspecte de fiziologie i fiziopatologie
ale sfincterului esofagian superior. Sunt aduse n discuie maladiile care pot afecta
funcionarea normal a complexului faringe-sfincter-esofag cervical, care n principal pot fi
boli neurologice centrale i/sau periferice, afeciuni musculare congenitale sau ctigate,
maladii intrinseci ale muchiului cricofaringian etc.
Se prezint indicaiile i contraindicaiile chirurgicale ale miotomiei extramucoase faringocrico-esofagiene, date de tehnic chirurgical, operaii asociate, complicaii postoperatorii.
Rezultate postoperatorii i re-miotomii extramucoase sunt trecute n revist.
Extramucosal myotomy of upper esophageal sphincter
Teodor Horvat
Thoracic Surgery Clinic, Institute of Oncology, Bucharest
A less known subject in romanian medical literature is presented extramucosal myotomy of
the upper esophageal sphincter.
This paper presents surgical anatomy data, physiologic and physiopathologic aspects of the
upper esophageal sphincter. The maladies which affect the normal function of the pharinxsphincter-esophagus are also presented, meaning neurological diseases (central and/or
peripheral), muscular diseases (congenital or aquired), intrinsec conditions of cricopharyngeal
muscle etc.
Surgical indications and contraindications of the pharingo-crico-esophageal extramucosal
myotomy are presented and also surgical techniques, associated procedures and postoperatory
complications. Postoperatory results and extramucosal re-myotomy are reviewed.

Lungtransplantation: surgical issues


APWM (Lex) Maat
Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
In this presentation, both aspects of the donor operation and the implantation will be
discussed.
Since most donation procedures are multi-organ procedures, operation starts with a midline
sterno-laparotomy which is usually made by the abdominal team. On arrival of the lung

donation team a broncoscopy is performed in the OR and the lungs are visually inspected and
palpated by the donor surgeon. When the lung(s) are accepted for donation, the implant team
is called to proceed with the acceptor operation. The main pulmonary artery is canulated to
deliver antegrade pulmoplegia and the left atrial appendage is opened to allow for drainage.
After pulmoplegia, the lungs are harvested n bloc and on a side table retrograde pulmoplegia
is given into the pulmonary veins to wash out any clots.
The lungs are then packed in 3 sterile plastic bags and stored in a cooler box on melting ice.
In the near future we expect that continuous perfusion and ventilation of donor lungs will
become standard practice in order to minimize ischemia time.
During the donation procedure, the implantation team has already started with the acceptor
operation. For bilateral lungtransplantation we position the patient on a special v-shaped
pillow with both arms in a low position to make a clam shell incision. For unilateral
lungtransplantation we use a standard postero-lateral thoracotomy. Extirpation of the
diseased lungs can be extremely difficult due to severe adhesions and hilar lymphadenopathy.
When a patient can not tolerate single lung ventilation, extra corporeal circulation is needed.
The technique of implantation is described with special attention for the bronchial
anastomosis and several tips and tricks are discussed for the anastomosis of the pulmonary
veins.
Lungtransplantation: organization and logistic problems
APWM (Lex) Maat
Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
Organ donation procedures can be performed in the setting of a heart beating procedure or a
non heartbeating procedure. In heartbeating procedures the donor is braindead and the
procedure can be planned and performed in an semi-elective setting. In a heartbeating donor,
often the heart is also donated. Cardiac surgeon and lung surgeon have to work carefull
together in order to harvest both organs in an optimal way for implantation. In non
heartbeating donation the donor has severe braindamage and can not survive but the donor is
non brain dead. With the explant teams ready in the OR, ventilation is stopped; after
ventilation stop the EKG has to be flat within 1 hour. After cardiac arrest, there is a 5 minute
no touch time and then the donor is rushed to the OR. A midline sternotomy/laparotomy is
performed, clamping of descending aorta, perfusion of abdominal organs and lungs and after
perfusion organ harvest. In these procedures, the heart is not donated but is extirpated in order
to allow for easy access to both lungs. When in non-heartbeating donation the heart does not
stop in the hour after ventilation stop, the procedure is cancelled and the patient will not
donate any organs.
Lung donation is in most cases part a multi organ donation. It means different teams from
different hospitals have to be taken to the donor hospital and meet together in the OR. To
organize this is often very challenging. Most of these teams have never met before, never
worked together and often speak different languages and this can lead to problems.
From an experience of more then 25 years with heart- and lungtransplantion, we present
several unexpected and difficult situations we and other teams came accross.

Stenozele traheo-bronice cazuri dificile


Ioan Cordo
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
Soluionarea chirurgical a stenozelor traheo-bronice a reprezentat ntotdeauna o provocare
pentru chirurgul toracic. Hermes Grillo a sesizat dificultatea interveniilor chirurgicale care
vizau extremitile conductului aerian principal: jonciunea laringo-traheal i carina.
Majoritatea stenozelor traheo-bronice pot fi rezolvate chirurgical respectnd principiile
operatorii enunate n tratatele de specialitate: diagnostic precis, intervenie minuioas,
folosirea manevrelor de relaxare traheal, evitarea devascularizrii capetelor de anastomozat,
buna colaborare a pacientului n perioada postoperatorie imediat.
Marile excepii pot beneficia de metode mult mai sofisticate de plastie traheal cu grefoane
musculocutanate cu pedicul vascular, transplant de trahee conservat i populat cu celule
proprii, gref traheal din segment aortic sau n cel mai nefericit caz stentarea conductului
aerian.
ntre aceste dou extreme se situeaz cazurile dificile, mai puin pomenite sau detaliate n
tratate i articole de specialite, situaii operatorii care trebuie soluionate ad hoc. Ele pot fi
dificile din mai multe puncte de vedere: al diagnosticului, al topografiei, al interveniei
chirurgicale ca atare i al evoluiei postoperatorii.
Stenozele traheobronice pot fi de natur benign sau malign, primitive sau secundare.
Ca leziuni benigne am considerat cazuri dificile: reinterveniile de rezecie traheal pentru
restenozare sau chiar ruptur a anastomozei care a depit momentul critic, vital, prin
canularea captului distal, captul proximal vindecndu-se prin obstrucie complet (patru
cazuri) i stenoza postraumatic a broniei primitive stngi (dou cazuri). Un alt caz de
stenoz benign a aprut la o pacient laringectomizat cu traheostom terminal definitiv.
Ca leziuni maligne primitive discutm un caz de carcinom adenoid chistic situat la jonciunea
dintre treimea medie i inferioar a traheei mult extins n afara conductului aerian.
Leziunile maligne secundare cele extinse de la tiroid (trei cazuri) i o determinare secundar
de Mycosis fungoides.
Cu totul excepionale au fost dou situaii de confuzie diagnostic care au condus la o
intervenie de rezecie traheo-bronho-pulmonar (lobectomie superioar) cu reconstrucia
arborelui traheobronic. Din fericire evoluia postoperatorie a fost simpl.
Am dorit s prezentm cteva cazuri particulare ca precedent pentru viitoarele cazuri
dificile intenionnd s sugerm anumite soluii care nou ni s-au prut pertinente i
fezabile, dovada fiind fcut de rezultatele bune imediate i la distan a majoritii pacienilor
operai.
Tracheobronchial stenosis challenging cases
Ioan Cordo
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
The subject of tracheobronchial stenosis has always been a challenging one for thoracic
surgeons. Hermes Grillo was among the first to notice the challenges of surgical procedures
involving the extremities of the main respiratory duct: the laryngotracheal junction and the
carina.

Most cases of tracheobronchial stenosis can be solved by simply following the guidelines
mentioned in the medical literature: establishing a precise diagnosis, performing a carefully
planned procedure, applying tracheal relaxation inducing methods, avoiding the disruption of
blood supply to the ends chosen for anastomosis, and making sure the patient respects the
recovery program following surgery.
The most difficult cases can benefit from (1) sophisticated plastic and reconstructive surgery
procedures in which richly vascularized musculocutaneous flaps are used, (2) transplants with
tracheal tissue grown from the patients own stem cells, (3) tracheal graft from the aortic
segment, and with less extent (4) tracheal stents.
In between these categories, we find the challenging cases, less mentioned in the medical
literature and studies, cases in which ad hoc solutions must be found. The challenges lie in (1)
establishing a correct diagnosis, (2) determining the topography of the region, (3) anticipating
and managing postoperative events and in (4) the surgical act itself.
Tracheobronchial stenoses are of benign or malignant origin, the latter being either primary or
secondary.
Among the cases listed in the benign section, we consider the following to be the most
challenging: resection for recurrent stenosis or even rupture, following a late anastomosis in
which the proximal end healed by complete obstruction (four cases) or post-traumatic
stenosis of the primitive left bronchia occured (two cases). Another case of benign stenosis
was encountered in a patient with permanent terminal tracheostomy following a total
laryngectomy.
From the primary malignant section, we wish to mention a case of adenoid cystic carcinoma
(ACC) at the junction of the second and third segments of the trachea, which had extended to
the tissue surrounding the trachea.
From the secondary malignant section, the cases worth mentioning are those involving the
thyroid (three cases) and a metastasis with Mycosis fungoides (granuloma fungoides).
In two unusual cases, diagnostic confusion led to a tracheobronchial pulmonary resection
(upper pulmonary lobe resection) followed by tracheobronchial reconstructive surgery.
Despite the post-operative risks, the recovery period was uneventful.
In this presentation we wished to draw attention to some particular cases which could serve as
a stepping stone to other challenging cases and at the same time offer solutions which we
consider to be relevant and viable, given the good long term results we obtained in most of the
patients we operated on.

TNM 7: What went wrong? Which way forward?


M.A. Paul
VU University Medical Center, Amsterdam, Netherlands
The NSCLC staging system defines specific stages of the disease, which makes it possible to
compare treatment strategies and, to a certain extent, define prognosis. The TNM system has
been greatly successful and all over the world doctors now have a common language .
Until recently the system was based on a rather limited number of, mainly surgical, cases
from North American data-bases. Unresectable tumors were classified T4, even if they were
small and could be treated well by an other modality(radiotherapy). Very large tumors,
confined to a lobe, were classified T2, because they were easily resectable.
A good classification system does not only predict respectability but also prognosis.
Prognosis is correlated with anatomical extension, but not exclusively. Biological factors also

play a major role and much research is carried out to unravel these mysteries. So far without
much result
The new edition of the TNM system has greatly expanded our knowledge. It is based on a
large data set, over 80.000 cases, from all over the world, and also includes cases with best
palliative care.
However, because the system has to be applicable to every country in the world it is still
based on anatomical criteria. Tumour behavior has still to come.
Two things have to be kept in mind when using the 7th edition. First of all there is an
increasing number of subsets, which automatically occurs when one has a large number of
data. But in surgical practice this can be confusing. Second, the groups were not defined by
resectability but by prognosis. Which means that tumor types are grouped together, which
may be very different. For example, stage IIIA contains patients with T4N0, but also patients
with N2 disease. The 7th TNM edition did not look into treatment, these data were considered
not reliable enough.
But surgeons need criteria for treatment. Prognosis and treatment approaches are not the
same and both are not static. Better imaging may lead to stage migration and better treatments
lead to a better prognosis.
Therefore we need biological criteria. Recently it was proposed to classify tumors according
to their clinical presentation (1). The growth pattern may very well reflect the biological
behavior
Four types of growth pattern have been postulated: 1) Direct local invasion, 2) Spread to
lymphnodes, 3) additional foci in the lung, and 4) (early)distant metastases. This emphasis on
clinical presentation can be used beside the new TNM system and may help the surgeon in
making treatment decisions. And help him in the discussion with non-surgical to prevent
undertreatment in some patients.
Literature:
1. Anatomy, biology and Concepts, pertaining to Lung Cancer Stage Classification.
Detterbeck FC, Tanoue LT, Boffa DJ.
JTO 2009; 4: 437 -443.

Results of standard pulmonary resection vs. conservatory (sublobar & bronchoplastic)


pulmonary resection in the treatment of carcinoid tumours
Mariano Garcia Yuste
Professor of Surgery
Head of the Thoracic Surgery Department
University Clinic Hospital. Valladolid, Spain
The aim of this presentation is to answer different questions to determine the repercussion of
the surgical procedure in the prognosis of the lung carcinoid tumours.
From 1980 to 2008 we gained our experience in 1082 patients treated surgically. Among these
patients 923 (85.3%) had a lung carcinoid tumor; 796 (73.6%) were patients with typical
carcinoid (TC) and 127 (11.7%) with atypical carcinoid (AC). At the beginning, 389 of these
patients were collected retrospectively (345 TC; 44 AC) and from 1999 the other 535 (451
TC; 84 AC) were studied prospectively. Mediastinal sampling or nodal mediastinal dissection
were systematically performed in the prospective group. All the patients were pathologically
codified following the standards of the 2009 TNM lung cancer staging.

Surgical procedures performed in both typical versus atypical carcinoids were: standard
resections 598 (75%) /106 (83,4%) (lobectomy 427/71, bilobectomy 88/13 and
pneumonectomy 83/22), 114 sublobar procedures (14,3%)/15 (11,8%) and 84 bronchoplastic
procedures (11%)/6 (4,7%), respectively.
In patients with TC, 22 of 796 (2.8%) presented metastases. Additionally, 10 (1.3%)
presented local recurrence -3 of them associated with distant metastases- and another 7 only
local recurrence. The characteristics of the different factors for patients with and without
metastases were as follows: Demographics: male, 63.6% and 44.4% (p=0.074), mean age
43.317.3 and 49.0316.1 years (p=0.651), size of primary tumour 33.419.15 and 24.913.5
mms (p=0.031), respectively.
When considering patients with AC, 27 of 127 patients (21.3%) presented metastases 5 of
which were associated to local recurrence. Additionally, 4 patients presented isolated local
recurrence. The behaviour of the factors analyzed as concerns TC with and without
metastases in these tumours was the following: Demographics: male, 63.9% and 52%
(p=0.310), mean age 60.18.6 and 52.917.8 years (p=0.000), size of primary tumour
35.617.3 and 31.415.7 mms (p=0.627), respectively.
According to 2009 TNM stage classification the results in percentage of T, N, and M factors
and tumour stage in both the TC and AC patients group are described in Table Ia.
Comparisons for the described parameters between patients with or without metastases are
defined in Table I.
Table I. A)TNM 2009 Classification. B) Comparisons for the described parameters between
patients with or without metastases.

T1a
T1b
T2a
T2b
T3
T4

All
patients
248
105
375
31
28
9

Typical
Carcinoid
With
metastases
7
2
7
2
3
1

N0
N1
N2
N3

734
40
22
0

Atypical carcinoid
With
metastases
2
3
17
1
1
3

2.8
1.9
1.8
6.4
10.7
11.1

All
patients
20
16
66
11
9
5

16
5
1
0

2.1
12.5
4.5
0

84
18
24
1

14
5
8
0

16.7
27.8
33.4
0

M0 791
M1a 1
M1b 4

21
0
1

2.6
0
25

121
0
6

22
0
5

18.2
0
83.4

Ia
Ib
IIa
IIb
IIIa
IIIb

6
5
6
2
2
0

1.9
1.4
9.7
6.9
6.7
0

29
40
19
6
24
3

3
5
5
1
7
1

10.3
12.5
26.3
16.7
21.2
33.3

326
344
62
29
30
0

10.0
18.8
25.8
9.1
11.1
12

IV

B
T factor
N Factor
M factor
Stage

20

Typical Carcinoids
0.036
0.000
0.018
0.000

83.3

Atypical Carcinoids
0.136
0.275
0.000
0.004

The influence of surgical procedure and nodal involvement in the presence of metastases and
overall survival was analyzed considering central vs. peripheral location in these tumours.
(Table II)
Table II
Central
Location
Typical
carcinoid

Atypical
carcinoid

P
Standard Bronchoplastic Others Metastases Overall Local
resection resection
survival recurrence
N0 400
77
24
0.691
0.129
0.004
N+ 37

0.386

0.709

0.202

N0 39

0.585

0.723

N+ 27

0.481

0.145

0.893

Standard Sublobar
resection resection
142
89

0.975

0.447

0.375

19

0.773

0.900

0.950

N0 30

13

0.45

0.599

0.018

N+ 11

0.763

0.727

0.345

Peripheral
location
Typical
N0
carcinoid
N+

Atypical
carcinoid

Conclusion
Our results allow us to conclude the conditions in which the conservative resection of
parenchyma in carcinoid tumours is advisable. In central typical carcinoid the use of lungsparing bronchoplastic techniques demands the intraoperative pathologic verification of the
existence of an adequate surgical margin 5mm by frozen section avoiding local recurrence.
In peripheral atypical carcinoids the increase in the local recurrence probability after a limited
resection makes it not advisable.
References
1. Travis WD, Rush W, Flieder DB, Falk R, Fleming M, Gal A, et al. Survival analysis
of 200 pulmonary neuroendocrine tumors with clarification of criteria for atypical

carcinoid and its separation from typical carcinoid. Am J Surg Pathol 1998; 22:93444.
2. Stamatis G, Freitag L, Greschuchna D. Limited and radical resection for tracheal and
bronchopulmonary carcinoid tumour. Report on 227 cases. Eur J Cardiothorac Surg
1990; 4: 527-532.
3. Thomas CH F, Tazelaar HD, Jett JR. Typical and atypical pulmonary carcinoids.
Outcome in patients presenting with regional limph node involvement.Chest 2001;
119:11431150.
4. Filosso PL, Rena O, Donati G, Casadio C, Ruffini E, Papalia E, Oliaro A, Maggi G.
Bronchial carcinoid tumors: surgical management and long-term outcome. J Thorac
Cardiovasc Surg 2002; 123: 303-309.
5. Cardillo G, Sera F, Di Martino M, Graziano P, Giunti R, Carbone L, Facciolo F,
Martelli M. Bronchial carcinoid tumors: nodal status and long-term survival after
resection. Ann Thorac Surg 2004; 77: 1781-1785.
6. Asamura H, Kameya T, Matsuno Y, et al. Neuroendocrine neoplasms of the lung: a
prognostic spectrum. J Clin Oncol 2006; 24:7076.
7. Garca-Yuste M, Matilla JM, Cueto A, Rodrguez Paniagua JM, et al. Typical and
atypical carcinoid: analysis of the experience of the Spanish multicenter study of
neuroendocrine tumors of the lung. Eur J Cardiothorac Surg 2007;31:192-197.
8. Rea F, Rizzardi G, Zuin A, et al.Outcome and surgical strategy in bronchial carcinoid
tumors:single institution experience with 252 patients. Eur J Cardiothorac Surg
2007:31:186-191.
9. Garca-Yuste M, Matilla JM, Gonzalez-Aragoneses F. Neuroendocrine lung tumors.
Current Opinin Oncology 2008; 20:148154.
10. Bertino EM, Confer PD, Colonna JE, Ross P, Otterson GA. Pulmonary
neuroendocrine. Carcinoid tumors. Cancer 2009; 1: 4434-4441.
11. Davini F, Gonfiotti A, Comin C, Caldarella A, Mannini F, Janni A. Typical and
atypical carcinoid tumors: 20-year experience with 89 patients. J Cardiovasc Surg
2009; 50: 807-811.
12. Detterbeck FC. Management of carcinoid tumors. Ann Thorac Surg 2010; 89: 9981005.

VATS lobectomy as treatment of NSCLC.


Eric Frechette
Thoracic Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de
Quebec (IUCPQ), Quebec City, Canada
Since the first reports of VATS lobectomy in the 1990s, the technique as gone through
different refinements, has gained wide world-wide acceptance, and is now considered by
many as a standard of care in the treatment for stage I NSCLC. When compared to open
lobectomy, the technique has been reported to have the same oncological results and many
benefits in term of postoperative pain, perioperative outcomes, length of stay, biological
impact and costs in a North-American setting. Although there is variability in the technique
between surgeons, the procedure is safe, can be easily learned, and is performed every year in
a growing proportion of cases. Lymph-node sampling or dissection can (and should) be
included. Locally advanced tumors have been resected through VATS with concomitant
chest-wall resection, pneumonectomy, or sleeve resection, but the benefit of performing

theses more extensive resections remains unclear. In many countries, the cost of the additional
staplers necessary to perform the technique may limit its development, but alternative
solutions exist. The knowledge of some simple intraoperative details and concepts will help
surgical teams to switch from open to VATS lobectomy. So although multiinstitutional trial of
open versus VATS lobectomy will probably never take place, the best available evidence
strongly suggests that VATS lobectomy is the treatment of choice for stage I NSCLC.

Lung resection in COPD patients: where is the lower limit?


Dragan Subotic
Clinic for thoracic surgery, Clinical center of Serbia, Belgrade
Currently, the preoperative lung function assessment is focused to the prediction of
postoperative ventilatory function and to the estimate of cardiorespiratory reserve. It is now
established that predicted postoperative FEV1 (ppoFEV1) is accurate in predicting FEV1 36 months after surgery, but in the same time it is likely to overestimate the FEV1 in the initial
post-operative days, when, in fact, most complications occur. It was recently demonstrated
that, on the first post-operative day after lobectomy, for example, the measured FEV1 may be
30% lower than predicted.
The smaller postoperative loss in FEV1 in COPD vs. non-COPD patients has been reported
with increasing frequency, but without clear suggestion of the lower limit. Results of several
reports showing that the lung function can be better preserved after upper lobectomy in COPD
patients, can be counterweighted by recent findings that the observed postoperative loss in
FEV1 may exceed the predicted loss after upper lobectomies in COPD patients. It means that
COPD strongly influences FEV1 at both the early and late terms after upper lobectomy, so that
the exact way of it's influence to the early postoperative lung function preservation still has
not been fully elucidated.
In patients undergoing pneumonectomy, the ppoFEV1 can underestimate the actual poFEV1
by an average of 500 ml. The smaller loss in FEV1 and greater decrease of hyperinflation
after pneumonectomy in COPD vs. non-COPD patients means that prediction of the
postoperative lung function in candidates for pneumonectomy with limited lung function, can
be done in a similar way than in COPD patients undergoing a lobectomy: COPD patients are
likely to do a little bit better postoperatively than predicted. Furthermore, it was convincingly
demonstrated that, in patients with preserved phrenic nerve and normal diaphragm motion, the
postoperative FEV1 was significantly better than in patients with either immobile diaphragm
or with paradoxical diaphragm motion.
Having in mind that many COPD patients have also the increased cardiac risk, the current
review addresses several points that influence the preoperative selection in this challenging
patient population.

Is thoracoscopic surgery justified to treat lung metastases?


Jos Belda-Sanchis
Hospital Universitari Mutua de Terrassa, Barcelona, Spain
The advent of new and specific technology in earliest 90s leaded to an increase in interest in
videoassisted thoracoscopy surgery (VATS) as a diagnostic and therapeutic tool in all fields
of the thoracic surgery. At that time, many surgeons changed the traditional open approach to
pulmonary resection of colorectal metastases for less invasive thoracoscopic techniques. Still
now, there are many areas of controversy concerning the capability of VATS in detecting and
removing all the lung metastases.
For the moment, there are not randomized controlled trials comparing VATS to the open
approach for the curative pulmonary metastasectomy. In 1999 the CALGB planned a
prospective randomized trial comparing the treatment of pulmonary metastases by VATS vs
open surgery but the study was closed early due to the slow accrual (1). There are two
systematic reviews of published series which evaluate the current status of the surgical
treatment of colorectal lung metastases (2,3). Many others studies specifically review the
results of pulmonary metastasectomy by means of open and VATS approach in terms of
safety and long term survival.
Many case series and cohort studies have pointed out the main controversial aspects regarding
thoracoscopic pulmonary metastasectomy.
1st. Does VATS approach allow the identification and resection of pulmonary metastases
equal than open approach? VATS metastasectomy is based on the preoperative images, in
the ability (or inability) to adequately explore the entire lung using the thoracoscope, in the
palpation with the surgeons finger of the most external part of the lung or in the marking of
the pulmonary node with a spiral type harpoon. Validity of the old and new CT scans is
questionable for guiding pulmonary resection of pulmonary metastases with a sensitivity
ranging from 75% to 82% (4). Non-detected pulmonary metastases on preoperative CT scan
or FDG PET scan but discovered during bimanual palpation at thoracotomy range from 15%
to 42% (5,6,7,8). According these results, an open approach allows for more complete
resection of malignant metastases. At the moment, the clinical relevance in terms of prognosis
and survival of the disagreement between the number of preoperative detected nodules and
pathologically confirmed metastases is unknown.
2nd What is the meaning of complete resection of lung metastases? It is well known that
a complete resection is an independent prognostic factor of survival after pulmonary
metastasectomy for colorectal cancer (2,9, 10). Nevertheless, the term incomplete resection
is used in the majority of studies for describing an unresectable disease due to the local
extension (the disease involves vital structures, mediastinal lymph nodes or the patient can not
afford the magnitude of the resection). Probably this meaning is not equivalent to
radiologically undetectable nodules that could remain into the lung after a VATS resection.
There is not evidence that such undetectable non-resected nodules confer a worse prognosis.
Such small nodules undetected at the time of the thoracoscopy will grow and they will be
diagnosed as new metastases. Many studies have shown that repeated metastasectomy is
associated to a 5-years survival equal than first metastasectomy (11,12,13,14).
3rd VATS for selected patients? As Dr. Cerfolio state in their study published in the
European Journal of Cardio-thoracic Surgery in 2009, the optimal surgical approach to
pulmonary metastases may be patient-dependent rather than surgeon-dependent. There are
few studies of case series which addressed to this topic (15,16,17,18). In these studies, the
selective use of VATS metastasectomy is associated with a long term outcome (5 years
survival, disease free survival) that is comparable with that after resection by thoracotomy.

These authors recommend a VATS resection for patients with small nodules, fewer nodules or
single pulmonary metastases and lesions located in the outer third of the lung (15-20).
1. Kohman LJ. Cancer and Leukemia Group B Surgery Committee. Clin Cancer Res
2006; 12 (11 suppl):3622s-7.
2. Pfannschidt J, Dienemann H, Hoffmann. Surgical resection of pulmonary metastases
from colorectal cancer: A systematic review of published series. Ann Thorac Surg
2007;84:324-38.
3. Yano T, Shoji F, Maehara Y. Surg Today 2009;39:91-7.
4. Margaritora S, Porziella V, DAndrilli A, Cesario A, Galetta D, Macis G, et al.
Pulmonary metastases: can accurate radiological evaluation avoid thoracotomic
approach? Eur J Cardiothorac Surg 2002;21:11114
5. McCormack PM, ATS 1993. Accuracy of lung imaging in metastases with
implications for the role of thoracoscopy. Estudio retrospectivo.
6. McCormack PM, Bains MS, Begg CB, Burt ME, Downey RJ, Panicek DM, et al. Role
of video-assisted thoracic surgery in the treatment of pulmonary metastases: Results of
a prospective trial. Ann Thorac Surg 1996;62:2136.
7. Ludwig C, Cerinza J, Passlick B, Stoelben E. Comparison of the number of pre-,
intra- and postoperative lung metastases. Eur J Cardio-thorac Surg 2008;32:470-72.
8. Cerfolio RJ, McCarty T, Bryant A. Non-imaged pulmonary nodules discovered during
thoracotomy for metastasectomy by lung palpation. Eur J Cardio-thorac Surg
2009;35:786-91.
9. The International Registry of Lung Metastases. Long-term results of lung
metastasectomy: Prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg
1997;113:3749.
10. Watanabe K, Nagai K, Kobayashi A, Sugito M, Saito N. Factors influencing survival
after complete resection of pulmonary metastases from colorectal cancer. Br J Surg
2009;96:1058-65.
11. Saito Y, Omiya H, Kohno K, Kobayashi T, Itoi K, Teramachi M, et al. Pulmonary
metastasectomy for 165 patients with colorectal carcinoma: a prognostic assessment. J
Thorac Cardiovasc Surg 2002;124:100713.
12. Pfannschmidt J, Muley T, Hoffmann H, Dienemann H. Prognostic factors and survival
after complete resection of pulmonary metastases from colorectal carcinoma:
Experiences in 167 patients. J Thorac Cardiovasc Surg 2003;126:732-9.
13. Ogata Y, Matano K, Hayashi A, Takamori S, Miwa K, Sasatomi T, et al. Repeat
pulmonary resection for isolated recurrent lung metastases yields results comparable
to those after fi rst pulmonary resection in colorectal cancer. World J Surg
2005;29:3638.
14. Welter S, Jacobs J, Krbek T, Krebs B, Stamatis G. Long-term survival after repeated
resection of pulmonary metastases from colorectal cancer. Ann Thorac Surg
2007;84:20310.
15. Rotolo N, De Monte L, Imperatori A, Dominioni L. Pulmonary resections of single
metastases from colorectal cancer. Surgical Oncology 2007;16:S141-S144.
16. Nakajima J, Murakawa T, Fukami T, Takamoto S: Is thoracoscopic surgery justified to
treat pulmonary metastasis from colorectal cancer? Interact Cardiovasc Thorac Surg
2008, 7:212-216. discussion 216217.
17. Carballo M, Maish MS, Jaroszewski DE, Carmack E Holmes CE. Video-assisted
thoracic surgery (VATS) as a safe alternative for the resection of pulmonary
metastases: a retrospective cohort study. Journal of Cardiothoracic Surgery 2009;
4:13.

18. Mutsaerts EL, Zoetmulder FA, Meijer S, Baas P, Hart AA, Rutgers EJ. Long-term
survival of thoracoscopic metastasectomy vs metastasectomy by thoracotomy in
patients with a solitary pulmonary lesion. Eur J Surg Oncol 2002;28:864868.
19. Lin JC, Wiechmann RJ, Szwerc MF, Hazelrigg SR, Ferson PF, Naunheim KS et al.
Diagnostic and therapeutic video-assisted thoracic surgery resection of pulmonary
metastases. Surgery 1999;126 (4):636-41.
20. Nakas A, Klimatsidas MN, Entwisle J, Martin-Ucar AE, Waller DA. Video-assisted
versus open pulmonary metastasectomy: the surgeons finger or the radiologists eye?
Eur J Cardio-thorac Surg 2009; 36: 469-474.

Aportul amprentei tumorale n diagnosticul cancerului pulmonar primitiv i metastatic


Irina Strambu
Pneumology Department, Marius Nasta National Institute of Pneumology, Bucharest
Amprenta tumoral reprezint o alternativ simpl, rapid i cu cost sczut la seciunile din
material ngheat pentru stabilirea intraoperatorie a diagnosticului histologic de cancer
pulmonar. Cu toate acestea, exist puine studii care s evalueze valoarea amprentei tumorale
i ganglionare.
n acest studiu prospectiv am evaluat concordana diagnostic ntre malignitatea identificat
prin amprenta citologic a tumorii i cea prin examen histopatologic la parafin cu scopul de a
stabili valoarea amprentei tisulare ca metod rapid de diagnostic histologic n cancerul
pulmonar. Ca obiectiv secundar, studiul i-a propus s analizeze acurateea identificrii tipului
histologic prin metoda amprentei.
Au fost analizate 107 produse prelevate intraoperator n serviciul de chirurgie toracic, din
care s-a realizat amprenta pe lam, fixat, colorat i examinat imediat, ca i includerea la
parafin i examen histopatologic. X produse au fost excluse, Y examinate, dn care Z maligne
i W benigne la examenul histopatologic.
Am calculat o sensibilitate a amprentei de 97,4%. Aceasta nseamna c testul confirm boala
la majoritatea bolnavilor. Specificitatea a fost ns de doar 65%, cu o proporie important de
fals pozitivi (7 cazuri din 20).
Rezultatele confirm utilitatea acestei metode ca adjuvant sau alternativ la procedeul
extemporaneu cu seciuni ngheate, n evaluarea patologic a leziunilor neoplazice pulmonare
sau mediastinale, fiind ns necesare studii suplimentare pe cazuri benigne i selecia mai
riguroas a cazurilor Metoda prezint multe avantaje: este un procedeu simplu, mai ieftin i
mai rapid dect seciunile nghetate, dar pentru interpretare necesit un citolog cu experien.

Neuroendocrine tumors of the lung


Cristina Grigorescu
Clinic of Thoracic Surgery, University of Medicine Gr.T.Popa Iasi
Neuroendocrine tumors of the lung represent a broad spectrum of morphologic types that
share specific morphologic, immunohistochemical, ultrastructural, and molecular
characteristics. The classification of neuroendocrine lung tumors has changed over the last

decades and currently four categories are distinguished: typical carcinoid tumor, atypical
carcinoid tumor, large cell neuroendocrine carcinoma and small cell carcinoma. Because of
differences in clinical behavior, therapy, and prognosis, a reliable histological diagnosis, as
well as clinical and pathological staging system are essential for an appropriate medical
proceedings. The most effective treatment of bronchial carcinoids and large cell
neuroendocrine carcinoma in an early stage is complete surgical resection, whereas
chemotherapy remains the primary treatment for small cell carcinoma.Increased knowledge
about pulmonary neuroendocrine tumors biology and the genetic characteristics, imply that
carcinoid tumors appear to have a different etiology and pathogenesis than large cell
neuroendocrine and small cell carcinoma. In practice, it could be easiest to conceptualize this
group of pulmonary tumors as a spectrum of malignancy ranging from the low grade typical
carcinoid to the highly malignant large cell neuroendocrine and small cell carcinoma. Typical
carcinoid tumors associated with a fairly benign behavior should be classified as low-grade
neuroendocrine tumor/carcinoma (G1) and atypical carcinoid tumors as intermediate-grade
tumor/carcinoma (G2). Whereas, large cell neuroendocrine and small cell carcinoma should
be grouped together under the designation of high-grade neuroendocrine tumor/carcinoma
(G3).No medical therapy exists for the primary treatment of neuroendocrine tumor of the
lung. Chemotherapeutic agents and radiation therapy have been used in the treatment of
metastatic disease but have met with virtually no success. A response rate of 30-35% has been
reported using a combination of 5-fluorouracil and streptozotocin. Symptomatic relief of
carcinoid syndrome from metastatic disease has been achieved by administration of
octreotide.

Surgery in malignant pleural mesothelioma: sense or nonsense


APWM (Lex) Maat
Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
Malignant pleural mesothelioma is a cancer rising from the mesothelial cells in the visceral
and parietal pleura. In The Netherlands between 400 and 500 patients die tearly due to
mesothelioma.
There is a close relationship between exposure to asbestos and development of mesothelioma.
Untill the introduction of Pemetrexed, there was a general therapeutic nihilism amongst most
physicians dealing with mesothelioma patients. The last 10 years however, many paper have
been published on surgery in malignant pleural mesothelioma, claiming that surgery in the
setting of multi-modality treatment is the treatment of choise. Till the summer of 2011
however, there have not been performed randomized controlled studies on surgery in
mesothelioma. The proponents of surgery in mesothelioma have been severely criticised on
their opinions and this led to heated discussions both in journals and during scientific
meetings. It is very well possible that success claimed by surgeons can be attributed to patient
selection, timing of diagnosis and natural behaviour of the disease. The different operations
(pleuro-pneumonectomy and pleurectomy-decortication) will be explained. The contents of
the criticism will be discussed. We will also shed light on the problems we encountered in
our own Rotterdam MPM study and will discuss the MARS study and finally will talk about
possible future ways.

Mediastinal approach of postpneumonectomy left bronchial stump fistula


Cristian Paleru
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
Left main bronchial stump fistula remains a severe complication of left pneumonectomy.
Mediastinal approach methods use a noncontaminated operatory field with an almost normal
anatomy. Classical method of transsternal transpericardial approach, developed in the 60s is
nowadays in competition with minimally invasive surgery, especially with transcervical
approach, first described by Azorin in 1996.
Both these methods are being used in our department; this presentation tries to show when
should we use one or the other, advantages and limitations of each of those two techniques.
When possible, transcervical approach gained ground for reasons of reduction of the operating
time and hospital stay and reduction of mortality and morbidity related to transsternal
approach.

European thoracic surgery database


Alexandru Nicodin, Iris Miron, Ioan Petrache
Clinica de Chirurgie Toracica Timisoara
Introducere:
Datorita patologiei chirurgicale toracice, in special a cancerului bronho-pulmonar, care
ramane in continuare o piatra grea de incercare atat pentru pacienti cat si pentru medici,
incercarea de a intelege aceasta patologie a facut ca nevoia de a efectua studii pe loturi mari
de pacienti sa fie din ce in ce mai mare. Societatea Europeana de Chirurgie Toracica pune la
dispozitia noastra o modalitate usoara in vederea realizarii acestui deziderat.
Scop:
Lucrarea de fata isi propune sa familiarizeze chirurgul toracic cu baza de date europeana
propusa de ESTS (ESTS Registry) in incercarea de a contribui activ in dezvoltarea acestui
proiect pentru care colaboreaza in prezent alte 190 de tari si societatea similara din Statele
Unite (STS) si sa prezinte experienta Clinicii de Chirurgie Toracica din Timisoara in ceea ce
priveste folosirea acestei aplicatii, care, in conditiile in care sunt inscrise cat mai multe unitati
romanesti, poate servi pe post de baza de date nationala (o baza nationala de date realizata
independent costa foarte mult si necesita resurse pe care nu le avem).
De asemenea baza de date ESTS reprezinta calea catre accederea clinicilor de chirurgie
toracica in randul clinicilor cu acreditare europeana prin Programul European de Calitate
Institutionala.
Concluzii:
Baza de date europeana reprezinta nu numai o modalitate gratuita si facila in centralizarea
datelor pentru interventiile chirurgicale toracice si atingerea scopului realizarii de studii pe
loturi mari de pacienti, dar si o modalitate de autoevaluare a performantei clinicilor de
chirurgie toracica in vederea obtinerii certificarii in cadrul Programului European de Calitate
Institutionala.

European thoracic surgery database


Alexandru Nicodin, Iris Miron, Ioan Petrache
Thoracic Surgery Department, Municipal Hospital, Timisoara
Introduction:
Due to the surgical pathology of the thorax, especially lung cancer, that poses still big
problems both for the patient and for the doctor, the attempt to understand this pathology lead
to the increasing need to develop studies on a larger number of patients. The European
Thoracic Surgery Society allows us easy access in achieving this goal.
Purpose:
This presentations purpose is to familiarize the thoracic surgeon with the ESTS database
(ESTS Registry) in the attempt to actively contribute to the development of this project for
which other 190 countries collaborate today, along with the similar American society(STS)
and to present our experience of using this application, which can be used as a national
thoracic surgery database if there are o lot of clinics in Romania that contribute, taking into
account that an independent national database would cost too much and would require
resources out of our reach.
Also, the ESTS database is the way to achieve European accreditation through the European
Institutional Quality certification program.
Conclusions:
The european database represents not only a free and fast way to centralize the data from the
surgical procedures in order to achieve studies on large number of patients, but also a way for
the auto-evaluation of performance of the thoracic surgery departments, especially in they
apply for the European Institutional Quality certification program.

ORAL PRESENTATIONS
BLEEDING FROM AN ADRENAL METASTASIS AS AN ATYPICAL CLINICAL
ONSET OF A STAGE IV LUNG CANCER
Boianu Petre Vlah-Horea1, Boianu Alexandru-Mihail1, Porav Daniel2, Boianu Ana-Maria
Voichia3
1
-Clinica Chirurgie IV UMF Trgu-Mure
2
-Clinica Urologie UMF Trgu-Mure
3
-Clinica Medical IV UMF Trgu-Mure
Introduction. We present a particular clinical onset of a lung cancer.
Material and method. We report a 46 years old male, with a history of 2 episodes of acute
pancreatitis and a laparoscopic cholecystectomy, whose actual disease started sudden with
intense pain in the left lumbar area. The patient presented to the Urology Clinic where the
diagnostic of renal colic was excluded (no pielo-caliceal dilatations) and the patient was
referred to the general surgery emergency department with the suspicion of acute abdomen.
Ultrasound showed a left adrenal mass and emergeny CT scan showed a 6 cm diameter
suppurated right pulmonary tumor and a left adrenal mass with a 7 cm diameter and
periglandular hemorrhagic infiltration, with no other secondary lesions. For pain control we
used opioides, followed by placement of an epidural catheter. We started with the thoracic
lesion, performing a non-anatomic resection of segment 6 Fowler, and after 10 days we
performed a left adrenalectomy through a left subcostal incision.
Results. The Immediate postoperative course was favourable, with complete resolution of the
lumbar pain after the left adrenalectomy. Pathologic examination showed in both specimens
adenoscuamous pulmonary carcinoma, the adrenal mass being a metastasis with diffuse
intraglandular bleeding. At 21 months after surgery, the patient has no abdominal or thoracic
complaints and has no signs of tumoral recurrence.
Conclusions. The case is interesting due to the sudden and atypical clinical onset of the lung
cancer due to the bleeding from the adrenal metastasis, due to the pain management problems
and the presence of secondary pulmonary suppuration which required to start the surgical
approach with the thoracic lesion.

UNIPORTAL THORACOSCOPY FOR PLEURAL EFFUSIONS


Natalia Mota, Cezar Mota, Mihnea Davidescu, Ovidiu Rus, Elena Moise, Andreea tefan,
David Achim, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
Introduction: Uniportal VATS has demonstrated a large application in the diagnosis and
treatment of different intrathoracic conditions.
Material and method: Between January 2010 and June 2011 (18 months) we performed 56
uniportal thoracic endoscopies for pleural effusions, representing 78.8% of all thoracoscopic
procedures (no minithoracotomy). There were 34 female and 22 male with mean age of
61.3311.38 years.
A 5-mm, 0-degree thoracoscope was used. Double-lumen intubation and separrated-lung
ventilation was used in 29 cases, single-lumen intubation was preffered in 25 cases and

spontaneous ventilation with local and intravenous analgesia was appropriate in 2 selected
cases.
Results:
Pleural biopsies were performed in all cases; when possible, intraoperatory talc
poudrage was added. A malignant diagnosis was made in 46 cases and chronical
inflammation in 10 cases. In 6 cases of unknown previous malignancy a pleural neoplasy was
diagnosed.
Conclusion: Uniportal thoracoscopy is a safe and effective diagnostic and therapeutical
procedure in pleural effusions. Double-lumen intubation anesthesia is reccomended but for
pleural biopsy and chemical pleurodhesis a single-lumen intubation can be safely used.

MEDIASTINAL ECTOPIC PARATHYROID ADENOMA CASE REPORT


A.C.Nicodin1, O.N.Burlacu1, Codruta Lazureanu2, Mihaela Vlad3
1
Thoracic Surgery Department, City Hospital Timisoara
2
Anatompathology Department , City Hospital Timisoara
3
Endocrinology Department, County Hospital Timisoara
Introduction.
Incidence of ectopic parathyroid glands in individuals is approximately 6%, the most common
location being the thymic capsule or the superior mediastinum.
Case.
We present the case of 21-years-old female with a recent history of osteoclastoma affecting
the maxillary bone and the mandible, together with increased values of the parathyroid
hormone (over 20 times the normal value), total calcium and alkaline phosphatase and
decreased serum phosphorus. A cervico-mediastinal MRI was performed with the disclosure
of a well delimited 5/5.5/2 cm tumoral mass in the antero-superior part of the mediastinum, as
well as multiple cystic bone tumors affecting the maxillary bone, mandible, clavicle, humeral
head and scapula - osteitis fibrosa cystica in context of the primary hyperparathyroidism.
In September 2010 thymectomy was performed through a right antero-lateral thoracotomy.
Intraoperatively we found a hemorhagic superior and anterior mediastinal mass, very adherent
to the ascending aorta. During the dissection of the tumor a lot of blood loss was encounterred
with the enlargement of the tumor. In order to removed the mass, we used human fibrinoid
haemostatic agents, as a tactical approach. Two chest drains were inserted.
Results.
At the site of the thymic capsullae a nodule was identified, formed mainly by parathyroidian
cells, without any sign of malignacy. The final anatomo-pathological result was ectopic
parathyroidian adenoma. Posoperative the evolution of tha patient was favorable, with the
decrease of serum values of PTH from 1392.4 pg/ml peroperatory down to 4 pg/ml the next
day. The patient received further tratment in the Endocrinolgy Clinic for re-establishing the
ionic and hormanal equilibrium.
Conclusion.
After surgical removal of the mediastinal mass, imagistically suspected and
histopathologically confirmed as ectopic parathyroid tissue, the syndrome of primary
hyperparathyroidism was resolved.

SLEEVE RESECTION WITH FULL PULMONARY PRESERVATION FOR


POSTTRAUMATIC MAIN BRONCHIAL STENOSIS
Radu Matache, Ciprian Bolca, Andrei Cristian Bobocea, Olga Danaila, Ion Jentimir, Ioan
Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
Introduction
Tracheobronchial disruption is one of the most severe injuries caused by blunt chest trauma.
A high index of clinical suspicion and accurate interpretation of radiological findings are
necessary for prompt surgical intervention.
Cases report
We present five patients operated in our department with main bronchial stenosis after blunt
chest trauma. All patients are young males and were diagnosed with pneumothorax and
discrete pneumomediastinum. They all received chest drains for the affected hemithorax.
In four cases radiologic aspect was complete lung atelectasis, persistent pneumothorax and
bronchoscopy revealed main bronchial stenosis. In one case, main bronchus rupture was
diagnosed at admission and stenosis was later confirmed as pneumonia evolved under
antibiotherapy.
After thoracotomy lung parenchyma seemed normal and we resected only the stricture in all
patients. Control bronchoscopy reveals main bronchus widely patent with untraceable suture
line.
Discussion
Blunt tracheobronchial trauma is usually lethal, more than 75% of patients dying before
hospital admission.
Traumatic main bronchus rupture is an effect of chest wall compression generating traction
forces as lungs are fixed at carinal level, but mobile in the pleural cavity, and sudden increase
in intraluminal pressure.
Sleeve resection of the stenosed segment is the treatment of choice, restores full lung function
and gives best long-term results.
Management of delayed presentations is challenging. Surgical intervention even many years
after initial trauma gives excellent results.
Conclusion
Rupture of main bronchus is a rare complication of blunt chest trauma. Flexible bronchoscopy
is recommended for all patients with chest trauma and pneumothorax or pneumomediastinum
for early diagnosis of tracheobronchial injuries.
Posttraumatic bronchial stenosis can present months, even years after the initial incident. Late
presentation doesnt impair the postsurgical evolution as subjacent lung parenchyma is
frequently in good shape despite long-time atelectasis. Conservative sleeve resection with
end-to-end anastomosis is the key of successful in these cases.

A COMPLEX SURGICAL SYSTEM FOR SOLID STERNAL RECONSTRUCTION:


THORATEX MESH, STRATOS SYSTEM AND KRYPTONITE BONE CEMENT
*Claudiu Nistor, *Adrian Ciuche, *Daniel Pantile, **Teodor Horvat
* Emergency University Military Central Hospital Dr. Carol Davila, Bucharest
** Institute of Oncology "Prof. Dr. Alexandru Trestioreanu, Bucharest

Introduction: The paper presents 2 cases admitted in the thoracic surgery department with
malignant sternal tumors: a 49 years old female with manubrial secondary tumor (tubulopapilary adenocarcinoma) after a right breast cancer (right Halsted mastectomy with pre and
postoperative chemo and radiotherapy) and a 45 years old male with a primary
chondrosarcoma of the sternal body.
The authors reveal the modality of sternal resection and reconstruction in approaching of
these cases through very illustrative preoperative, intraoperative and postoperative images.
Material and method: In both cases, after radical resection of the tumors, the rigid
reinforcement of the sternum was achieved with thoratex mesh reinforced with STRATOS
system and Kryptonite bone cement. The soft reconstruction was made with widely mobilized
pectoralis major muscle flaps (humeralis, sterno-costal and clavicular insertions transected)
shifted to the midline for loose closure.
Results: The complete removal of the tumors and very good chest wall stability was achieved
in both cases. In the second case, the kryptonite bone cement mixed with healthy
osteochondral fragments is useful both for the rigid sternal reconstruction and for creation of a
neosternum (porous structure was favorable for osseointegration and bone regeneration).
Conclusions: Large sternal defects after resection for malignant sternal tumors are safely
reconstructed with this complex surgical system combined with pectoral major muscular
flaps.

THE IMPORTANCE OF HISTOPATHOLOGICAL FACTORS IN SETTING THE LONG


TERM PROGNOSIS FOR NON-SMALL CELL LUNG CANCER
Suciu B.1, Bud V.1, Copotoiu C.1, Brnzaniuc Klara2, Copotoiu Ruxandra3, Fodor D.1,
Butiurca V.4
Surgical Clinic no. 1, Mure County Emergency Hospital
Anatomy Department, University of Medicine and Pharmacy, Tg.Mure
ICU Clinic, Mure County Emergency Hospital
Student, University of Medicine and Pharmacy, Tg.Mure
Introduction
In the last decades, the rate of pulmonary cancer has risen alarmingly. Pulmonary cancer
represents the main cause of death in women and in men in the United States of America,
100.000 new cases being registered annually in men and 50000 new cases in women. The
purpose of our study is to evaluate the importance of histopatological factors in the long term
outcome of patients operated for lung cancer.
Material and methods
In order to write the present paper, we realized a retrospective observational study on a period
of 6 years. We used the casuistry of the Surgical Clinic No.1,Mure County Emergency
Hospital. We studied all the patients papers who were admitted in Surgical Clinic No.1 from
the 1st of January 2005 till 31 December 2010. Further, we based our research on 197 patients
that were admitted in Surgical Clinic No.1 for bronchopulmonary tumors.
Results
We studied 197 patients admitted with malignant bronchopulmonary pathology in Surgical
Clinic No.1, Mure County Emergency Hospital from 01.01.2006 till 31.12.2010. We tried to
study was the importance of the T descriptor (tumor) from the TNM staging for establishing
the long term prognostic. The value of p was 0.1676 so we didnt obtain any value of

statistical importance. We also took into consideration the value of N from the TNM staging
as a prediction factor for long term survival in the patients that underwent surgical
intervention for pulmonary cancer. The p parameter was 0.0152 so we can say that we
obtained a direct connection between the stages of adenopathy and long term survival rate
Conclusions
Long time survival rate of the patients depends on the histological type of the tumor. Long
term survival prediction rate is better if the patients are over 60 years, compared with the
patients that are under 60 years. The N descriptor can be considered an important prediction
factor, while the T descriptors value is useless. The existence of Ns descriptor in more
stages of the TNM complex shows the limits of it and encourages for further improvements.
Key words : lung, cancer, prognosis, descriptor

CERVICAL VIDEO-ASSISTED MEDIASTINOSCOPIC APPROACH OF THE LEFT


MAIN BRONCHUS - A SERIES OF SIX CASES
Cristian Paleru, Olga Danaila, Ciprian Bolca, Radu Matache, Mihai Dumitrescu, Adrian
Istrate, Ruxandra Ulmeanu, Ioan Cordos
1 - 1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
2 - Bronchoscopy Department, Marius Nasta National Institute of Pneumology, Bucharest
Introduction
Bronchial stump fistula (BSF) after pneumonectomy remains a feared complication. Only 8
cases involving cervical video-assisted mediastinoscopy for closure of the bronchial stump
fistula (BSF) following pneumonectomy were reported worldwide.
Materials and Methods
The authors present a series of 6 patients who underwent cervical video-assisted
mediastinoscopy for closure of the left main bronchus (LMB) between December 2009 and
July 2011. Mean age was 44.2 years (2 females and 4 males). 2 patients underwent the
procedure for closure of the postpneumonectomy BSF and 4 prior to pneumonectomy in
tuberculous destroyed lung. The follow up ranged from 7 weeks to 20 months.
Results
Mean operating time was 85 minutes. Mediastinal drainage was performed in 1 case. Only
one stapling failure was recorded. The patients were discharged on the 3rd day following
surgery. No relapses during the follow-up period. 1 patient died 7 weeks after surgery as a
consequence of a cardiac event.
Conclusions
Cervical video-assisted mediastinoscopy is a viable alternative to thoracothomy and transsternal approach of the left main bronchus. Its main indications are postpneumonectomy BSF,
airway sealing and bronchial resection in patients with permanent damaged lungs. This
procedure especially addresses the LMB because of the anatomical considerations. A high
level of expertise in mediastinoscopy and special surgical instruments are required. In order to
assure the success of the procedure the cases must be carefully selected, one of the main
conditions being a bronchial stump of at least 1.5cm in length.

EXTRA-MUSCULO-PERIOSTEAL PLOMBAGE THORACOPLASTY WITH BALLS


STILL WORKING AFTER 46 YEARS
Boianu Petre Vlah-Horea, Boianu Alexandru-Mihail
Discipline Surgery 4, University of Medicine and Pharmacy from Targu-Mures
Introduction. Plombage thoracoplasty was extremely popular in the 1940-50's due to it'
simplicity and esthetic advantage; it was abandoned due to some specific complications and to
the good results achieved after the introduction of modern tuberculostatic treatment.
Material and method. We report an 81-years old patient who underwent at the age of 35 years
(46 years ago) an extramusculo-periosteal plambage with balls for a fibro-cavitary left upper
lobe tuberculosis.
Results. The patient had an excellent postoperative evolution, with negative cultures for
Mycobacterium tuberculosis, no respiratory symptoms and a complete social reinsertion
(general practitioner until the age of 70 years); he was admitted to our unit for an enteromesenteric infarction and died on postoperative day 8 (after segmentary enterectomy) due to a
myocardial infarction.
Conclusions. The case is interesting due to the imagistic aspects and the excellent evolution
after a procedure with which the actual generation of surgeons is not familiar. The actual
recrudescence of tuberculosis may bring into attention procedures that were considered
abandoned at a certain time.

THORACIC PARIETAL HEMANGIOMA


Cezar Mota, Ovidiu Rus, David Achim, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
Introduction
Thoracic parietal angioma is a very rare condition. The positive and differential diagnosis is
difficult and the surgical resection can be technical challenging.
Material and method
A 56 years old male patient is admitted with a left posterior chest wall tumor developped
along 1 year period. The tumor is well delimited, developped along the inferior 2/3 of the
paravertebral muscles. CT-scan compleetly described the tumor and MRI pointed-out its rich
vascularisation.
Results
Intraoperatory description is an angiomatous mass, approx.20cm long, located under the
superficial sheat of left paravertebral muscles. The complete resection of the tumor is
performed toghether with muscular fibers adherent to it. The histologic result is cavernous
angioma. Postoperatory recovery is uneventfull.
Conclusions
The rare angiomatous tumors have to be considerred in any case of thoracic parietal tumor.

UNUSUAL CASE OF LEYOMIOFIBROMATOSIS WITH MULTIPLE LOCATIONS


THE TRUTH BEYOND THE APPEARANCES CASE REPORT
Adrian Istrate, Cristian Paleru, Mihai Dumitrescu, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
Introduction: Leyomiofibromatosis constitutes an unusual cause of respiratory and/or
digestive disturbances, her main localization being genital.
Material and methods: We present a puzzling case of a 22 years woman with multiple
localization of leyomiofibromas, which few symptoms (recurrent respiratory infections, slow
weight loss, dry cough, recent dysphagia to solids) remains undiagnosed and untreated for a
long period. Previous surgery (bilateral cataract, thyreoglossal cyst) have become important in
the process of elaborating an accurate diagnostic.
Results: Following the investigations, the patient was submitted to surgery (extended
resection of an posterior mediastinal tumor, which includes the esophagus, the esophageal
sphincter and the stomach fundus, and moving the liver, the right lung and the inferior vena
cava; biopsy of the bronchial and tracheal nodules; replacement with gastric tube of the
esophagus) trough thoracic-abdominal-cervical approach. In the 10th postoperative day, it
develops a cervical anastomotic fistula, which under conservative treatment is solved. The
pathology results confirm leyomiofibromatosis. The follow-up at 30 days indicates no signs of
relapse.
Conclusion: Our case report may provide important insight into a rare, but significant
pathology with multiple implications, which undiagnosed leads to a high associated
morbidity. This case requires further investigations who may elucidate the etiology and the
possible association with an other pathologic entity.

VIDEOTHORACOSCOPIC THIMECTOMY IN NONTHYMOMATOUS PATIENTS


WITH MYASTHENIA GRAVIS
Cristina Grigorescu*, Trufa Denis*, Iosep Gabriel**
*Clinic of Thoracic Surgery. University of Medicine Gr.T.Popa Iasi
** ICU , Hospital of Pneumology Iasi
Myasthenia gravis(MG) is an autoimmune disease in which autoantibodies to different
antigens of the neuromuscular junction cause the typical weakness and fatigability.
Thymectomy is recommended as an option for nonthymomatous patients with generalized
MG, in particular those with acetylcholine antibodies and younger than 60 years, to increase
the likelihood of remission or improvement.
In last decade, variations in videothoracoscopic techniques have been developed, with
unilateral or bilateral acces to the mediastinum.
In our experience with 19 patients between 2008-2011, the use of thoracoscopic thymectomy
in nonthymomatous MG was comparable to that the classical transsternal approach; complete
stable remission was 95% at 2 years of follow-up.
Compared with transsternal surgery videothoracoscopic thymectomy is associated with less
morbidity and negligible esthetic sequelae.

HYDATID CYST OF ANTERIOR MEDIASTINUM


Cezar Mota, Natalia Mota, Mihnea Davidescu, Elena Moise, Ovidiu Rus, Daniel Banciu,
David Achim, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
Introduction
Echinococcosis is endemic in Romania. Hydatid cyst can develop in any segment or organ,
but the most frequent locations are liver and lung. Mediastinal hydatid lesions are extremly
rare and a only a few cases exists in the medical literature.
Material and method
The objective is to evaluate clinical, imagistical and surgical aspects of this rare lesion.
Between 1994 and 2011 there were 3 patients diagnosed and surgical trated for hydatid cyst of
mediastinum. The patients were 2 men and 1 woman with ages of 20, 37 and 52 years. All
hydatid cysts were located in anterior mediastinum, all were solitary lesions, no other hydatid
dereminations.
Results
In 1 case the positive diagnosis was made preoperatory, in the other 2 the diagnosis was
intraoperatory. The approach was through thoracotomy: right axillary, right anterolateral and
left axillary. One cyst was complicate (non-viable tymyc hydatid cyst) and 2 chysts were
viable there were inactivated with alcohol, evacuated and followed by pericystectomy. first
case was treated by ideal cystrctomy.
There was 1 postoperatory complication: gaseous cerebral embolism remitted after medical
treatment.
Conclusions
Although very rare, anterior mediastinal hydatid cysts must be considered in every patient
with anterior mediastinal mass. Complete surgical excision is the treatment of choice because
provides complete cure.

EMERGENCY PULMONARY RESECTIONS - PULMONARY TUMOR TORN IN


PLEURA
Ovidiu Rus, Natalia Mota, Elena Moise, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest

Introduction
The parafluide density tumors are often a problem of therapeutic management. Late
presentation of a patient to the doctor may generate complications, such as rupture of the
tumor content into the pleural space.
Method
The case of 52 years old patient, admited for chest pain and minimum haemoptysis for
approximately
2
months,
is
presented.
Chest CT scan, performed before admission, shows a bulky tumor, round-oval (10 / 5,5 / 4
cm), with parafluid structure, relatively homogeneous, well defined, in lower lob of right
lung
without
other
associated
pathological
lesions.
The patient condition is deteriorating after admission with main symptoms such as increased
chest pain and dyspneea. CT exam confirms fluids accumulated in the pleural space.

Results
The right thing in this case was decided to be an emergency surgery. We have discovered
during the intervention liquid in the pleural cavity, about 1000ml, and also a relatively welldemarcated tumor with a 5 cm diameter, with a hard consistency, presenting on mediastinal
face of the right lung a fistula that had a tumoral content with purulent aspect. It was
performed a right lower lobectomy with lymphadenectomy and pleuro-pulmonary Williams
decortication.
Cystic formation proved to be a mesenchymal tumor with large areas of necrosis, and after the
IHC tests, the diagnosis of synovial sarcoma was put.
Conclusions
This case draws attention to a rare, possible evolution, in lung tumors.

MANAGEMENT OF INTRATHORACIC ESOPHAGEAL RUPTURES A SINGLE


CENTERS EXPERIENCE
C.P.Tunea, V.T.Voiculescu, O.N.Burlacu, G.V.Cozma, I.Miron, I.A.Petrache, M.Butas, A.C.
Nicodin
Thoracic Surgery Department, Municipal Hospital, Timisoara
Introduction:
We are presenting our experience in the management of esophageal ruptures, emphasizing
various etiology and the attempt of a single and aggresive treatment.
Materials and Methods:
We studied the esophageal perforations treated between 2002 and 2011 in our Thoracic
Surgery Clinic; there were 10 cases (2 women and 8 men, ages between 29 and 69 years);
there were 5 foreign bodies, 1 postsurgical procedure, 1 stented neoplasm, 3 Boerhave
syndrome; 1 followed conservatory treatment, 4 first intention suture and 5 pleural drain and
alimentary tract derivation; the interval between the perforation and treatment was between 12
hours and 4 days; we used alimentary tract derivation only for the stenosis(postcaustic and
neoplasic).
Results:
There was only 1 death (stented esophageal neoplasm); the hospitalisation was between 17
and 35 days(Boerhave Syndrome); the case that was treated conservatory (cervicomediastinitis anfter swallowing of a fish bone)was cured without any sequels; serial surgical
procedures were done only for the Boerhave syndrome.
Conclusions:
The diagnosis was based on clinics; contrast substance ingestion confirmed only the
topography of the lesion; first intention suture is the safer method for the treatment no matter
the time span from the perforation; pleural drain and alimentary tract derivation are only for
final cases.

SURGICAL MANAGEMENT OF TRACHEAL INVASION BY THYROID CARCINOMA


SINGLE CENTER EXPERIENCE
Andrei Cristian Bobocea, Ciprian Bolca, Olga Danaila, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
Introduction
Well-differentiated thyroid cancer usually progresses slowly and rarely invades other tissues.
Airway invasion by thyroid carcinoma is an uncommon but important clinical problem.
The surgical management of airway invasion is controversial. There are studies suggesting
that tangential shave excision might be adequate, despite a marked risk of local recurrence.
Circumferential sleeve resection of the trachea is safe and lowers this risk.
Materials and methods
We performed thyroidectomy and tracheal resection in 7 patients between January 2007 and
December 2010. All patients were admitted in emergency with severe dyspnea. The
bronchoscopic examination was very important to assess the exact involvement of the trachea
and the CT scan was performed in order to eliminate the distant spread of malignancy.
We performed en-bloc resection of the thyroid gland with 3 to 5 tracheal rings and in one case
with the anterior part of the cricoid cartilage. Local limphadenectomy was performed in all
cases.
Results
There were 3 nondifferentiated thyroid carcinomas (NDTC) and 4 well differentiated thyroid
carcinomas (WDTC). There was no postoperative mortality. In one case (NDTC) we
encountered an anastomotic fistula which required a definitive tracheostomy. The survival
was 6, 9 and 14 month for the patients with NDTC, one case with WDTC lived for 13 months,
the other three patients are alive and with no sign of local or distant disease at 9, 16 and 25
month after surgery.
Conclusions
There is still doubt whether a shave excision that may leave microscopic disease at the site, or
a complete resection that includes removal of a portion of these structures is the better
approach.
Tracheal resection and reconstruction for thyroid carcinomas with airway invasion might
provide long-lasting palliation and might even be curative in a significant number of patients
suffering from this disease.

CLASSICAL TECHNIQUE VERSUS NUSS IN THE TREATMENT OF FAILED


SURGERY FOR PECTUS EXCAVATUM
G.V.Cozma, I.A.Petrache, O.N.Burlacu, A.C.Nicodin
Thoracic Surgery Department, Municipal Hospital, Timisoara
Introduction:
The aparition of minimal invasive pectus repair (Nuss) allowed the succesful replacement of
the classical technique(Ravitch) for a certain cathegory of the patients. There are situations
when the Nuss technique can be used even after the use of the classical technique. Our day to
day practice we encountered also reversed situations when the minimal invasive is not optimal
and we were forced to use the classical technique for the resolving of the rebound of pectus.

Matherial and methods:


Our experience totals a number of 37 cases on a ten year period(2001 2011), from which 19
were resolved through minimally invasive technique and the rest thorough classical technique.
Unfortunately we encountered cases with recurrence of the diformity. We present two cases
operated in our service with pectus excavatum. A female patient operated through Ravitch
procedure when she was 5 years old that was admitted after 15 years and resolved by Nuss
correction. The other patient, a young man operated two years ago by using minamal invasive
procedure was readmitted in our department with the rebound of pectus after the Lorentz
blade migrated. He was resolved by Ravitch technique.
Results:
In both situations the reintervention using complementary procedure was succesfully
accomplished, the sternal defect was optimally resolved.
Conclusions:
Although there are controversies in the choosing of the repair procedure, wether we talk about
Nuss or classical technique, in the cases with recurrent pectus excavatum after Nuss the
correction is done better by classical procedure, and in the recurrency after classical technique
Nuss can be the right solution

OUR EXPERIENCE IN THE ANTERIOR SURGICAL APPROACH OF C7-T1 SPINE


*Adrian Ciuche, *Claudiu Nistor, *Marian Mitrica, **Teodor Horvat
*Emergency University Military Central Hospital Dr. Carol Davila, Bucharest
** Institute of Oncology "Prof. Dr. Alexandru Trestioreanu, Bucharest
Introduction: The paper presents three cases of traumatic injury with compression fracture of
C7-T1 spine. The authors reveal the surgical modality of approaching of these cases through
illustrative preoperative, intraoperative and postoperative images.
Material and method: Cervicothoracic CT scan and RM reveals the existence of compression
fracture T1 spine in the first case and C7 in the second and in the third case. In all cases, the
corporeal fragments of spine caused compression of the cervicothoracic spinal cord. The
surgery procedure was removing T1 versus C7 vertebral body and discectomy above and
below the involved vertebra. Vertebral reconstruction was performed with autogenous iliac
bone graft (anteriorly fixation using locking plate) in the first and third case and using titan
implant in the second one. Anterior surgical exposure of C7-T1 spine was performed through
a combined right oblique neck and upper sternotomy incision.
Results: Decompression of the spinal cord has been achieved in all cases through the
complete removal of the herniated corporeal fragments. In the third case we performed a
reintervention through the same anterior approach for the plate extraction (poor fixation and
migration to the spinal roots). Postoperative clinical results were satisfactory with
ameliorating the sensitive function and preserving the motor function.
Conclusions: Anterior surgical procedures of C7-T1 spine has represented a milestone both
for the neurosurgeon (difficult resection and reconstruction beyond great mediastinal vessels),
and for thoracic surgeon (cervicothoracic dissection with mobilization of the right thyroidian
lobe without laryngeal nerve injury and protecting innominate artery).

POSTESOPHAGECTOMY BENIGN GASTRIC TUBE TO TRACHEOBRONCHIAL


TREE FISTULAS. PRESENTATION OF TWO CASES, LITERATURE REVIEW,
CLASSIFICATION AND TREATMENT PROTOCOL
Bolca Ciprian*, Eric Frechette**
*1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
** Thoracic Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de
Quebec (IUCPQ), Quebec City, Canada
Background
Benign fistula formation between the airway and the gastric tube after esophageal resection is
a very rare and potentially fatal complication requiring immediate management. As the
literature consists mainly in case reports, there is no agreement on the treatment for this rare
condition.
Material and methods
We present two cases of such fistulas succesfully treated in our department. The management
was different for these two cases, as was the clinical appearance and predisposing factors.
One case was treated by means of imediate surgery and the other by conservative mesures.
Texbooks and published articles offer limitead information on this subject. A Medline search
allowed us to identify 42 reported cases in the literarure. After studing all these published
reports we tried to establish a clasification and a protocol treatment of this dreadful
complication.
Results
Closure of gastric tube to main airway fistula was succesfully achieved in both our patients.
By studing all reported cases, we observed a pattern in ethiological and favoring factors, time
of appearance and management, which allowed us to propose a simple clasification and a
treatment protocol.
Conclusions
A benign fistula between the neoesophagus and main airway is an uncommon and difficult to
treat complication. Symptomatology, size and site of the fistula and and the period of time
after initial surgery will dictate the management in order to restore the patients airway and
reestablish a contient digestive tract and swallowing ability, thus providing efective treatment
for this debilitating condition.

SERIAL RESECTION FOR DOUBLE TRACHEAL STENOSIS POST ORO-TRACHEAL


INTUBATION
Codin Saon, Liliana Caracuda, Felix Dobritoiu, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
This report presents the case of a female patient aged 26, diagnosed with double
postintubation tracheal stenosis (neck and lower chest), following a car crash resulting in
severe
cranio-thoracic
politrauma.
Surgery consisted in two sleeve tracheal resections performed in two stages. The second
resection was performed one month after the first surgical intervention.
Evolution was favorable after surgery. Bronchoscopic controls performed one month, 6

months, and one year after the last intervention, showed that the tracheal lumen caliber
remains unchanged.

OUR EXPERIENCE IN THE SURGERY OF THE CHEST WALL TUMORS


A.C.Nicodin, I.Miron, O.Sirbu, G.V.Cozma, O.N.Burlacu, I.A.Petrache, A.C.Nicola,
C.Mogoi.
Thoracic Surgery Department, Municipal Hospital, Timisoara
Introduction:
The tumoral pathology of the chest wall is extremely interesting and wide, and still today it
rises a great amount of problems related to the diagnosis and surgical treatement. That is why
the purpose of this article is to share our departments experience confronting this type of
pathology.
Material and method:
We analysed a series of 154 patients that underwent surgery in our department in ap 10 years
period(2001 2011), with ages between 21 and 74 years old. 43 of the patients had benign
pathology, the rest of 111 had primary, secondary or contiguous malignancies of the chest
wall. The surgical procedures applied were chest wall resection followed by reconstruction
with several types of synthetic materials such as Thoratex mesh, Spider Web suture or the
use of methylmetacrylate in 25.4% of the cases and chest wall resection without stabilisation.
In 74.6% of the patients. The mean hospital stay was 8 days.
Results:
In all the cases the perioperative mortality and morbidity was zero. The immediate
postoperative outcome off the patients was good in 150 cases, 3 cases developed wound
seroma that was managed with conservative treatment and one patient underwent a second
surgery with muscular flap after stabilisation with methylmetacrylate.
Conclusions:
The tumoral pathology of the chest wall still raises a series of problems of surgical treatment,
some cases are indeed a chalange for the surgeon, but the continuous developement of the
surgical techniques and of the meterials for reconstruction along with the developement of
experienced surgical teams lead to obtaining optimal results without complications that
require further surgical attention.

ECTOPIC THYMOMAS WITH LATERAL PARACARDIAC DEVELOPMENT


Boianu Alexandru-Mihail, Boianu Petre Vlah-Horea, Urcan Marius, Chiujdea Drago,
Lucaciu Oana, Hogea Timur, Batog Olivia, Pvloiu Valerian
Discipline Surgery 4, University of Medicine and Pharmacy from Targu-Mures
Introduction.Thymomas with atypical development remain a challenge, both as diagnostic and
treatment.
Material and method. During the last 15 years we had 4 cases referred to our unit with the
diagnosis of mediastinal / pulmonary tumor, in whom the preoperative imagistics showed
mediastinal tumors with lateral paracardiac development. Intraoperative we found tumors in
closed contact with the diaphragm, developed posterior to the phrenic nerve. In all the cases

we performed complete excision of the tumors using a lateral approach (postero-lateral


thoracotomy 2 cases, antero-lateral thoracotomy 2 cases). Frozen-section examination was
unconcludent in all the cases, the diagnosis being established by the definitive pathologic
examination.
Results. The access on the lesion was excellent in all the cases. All the 4 patients had a good
immediate and late postoperative evolution. We encountered no recurrence (follow-up 6
months 14 years).
Conclusions. In cases of intrathoracic tumors with paracardiac location the possibility of a
thymoma should be taken into consideration. The lateral approach offers a good exposure on
selected cases. We also emphasize the diagnostic difficulties in the conditions from our
country.
HEMORAGIA DIN METASTAZ SUPRARENALIAN MODALITATE ATIPIC DE
DEBUT CLINIC AL UNUI CANCER PULMONAR STADIUL IV
Boianu Petre Vlah-Horea1, Boianu Alexandru-Mihail1, Porav Daniel2, Boianu Ana-Maria
Voichia3
1
-Clinica Chirurgie IV UMF Trgu-Mure
2
-Clinica Urologie UMF Trgu-Mure
3
-Clinica Medical IV UMF Trgu-Mure
Introducere. Prezentm un debut clinic particular n cancerul pulmonar.
Material i metod. Prezentm cazul unui pacient de 46 de ani, avnd n antecedente 2
episoade de pancreatit acut i o colecistectomie laparoscopic, a crui boal actual a avut
un debut brusc cu dureri intense la nivelul lombei stngi. Pacientul s-a prezentat la Clinica de
Urologie unde s-a infirmat diagnosticul de colic renal (fr dilataii pielo-caliceale) i
pacientul a fost trimis pentru consult de chirurgie general cu suspiciunea de abdomen acut
chirurgical. Ecografia a artat o leziune n suprarenala stng, iar examenul CT de urgen a
artat o tumor pulmonar dreapt supurat de 6 cm diametru i o tumor suprarenalian
stng de 7 cm cu infiltrat hemoragic periglandular, fr alte leziuni secundare. Pentru
controlul durerii am folosit opioide, urmate de plasarea unui cateter peridural. Am nceput cu
leziunea toracic, efectund o rezecie atipic de segment 6 Fowler, urmat la 10 zile de
suprarenalectomie printr-o incizie subcostal stng.
Rezultate. Evoluia postoperatorie imediat a fost favorabil, cu dispariia complet a durerii
lombare dup suprarenalectomie. Examenl histopatologic a artat n ambele piese leziuni de
carcinom pulmonar adeno-scuamos, leziunea din suprarenal fiind o metastaz cu hemoragie
intraglandular difuz. La 21 de luni de la intervenia chirurgical pacientul nu prezint acuze
abdominale sau toracice i nici semne de recidiv tumoral.
Concluzii. Cazul este interesant datorit debutului clinic brusc i atipic al cancerului pulmonar
secundar hemoragiei din metastaza suprarenalian, problemelor de control a durerii i
prezenei supuraiei pulmonare care a impus abordarea tumorii pulmonare naintea celei
suprarenaliene.

TORACOSCOPIA UNIPORTAL N PLEUREZII


Natalia Mota, Cezar Mota, Mihnea Davidescu, Ovidiu Rus, Elena Moise, Andreea tefan,
David Achim, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
Introducere: Toracoscopia uniportal este utilizat n diagnosticul i tratamentul diferitelor
afeciuni intratoracice.
Material i metod: ntre ianuarie 2010 i iunie 2011 (18 luni) am efectuat 56 toracoscopii
uniportale pentru pleurezii, reprezentnd 78,8% din totalul procedurilor toracoscopice (fr
minitoracotomie). Pacienii au fost 34 de femei i 22 de brbai, cu vrsta medie de
61.3311.38 ani.
A fost utilizat un toracoscop de 5mm cu vedere la 0 grade. Intubaia selectiv a fost folosit la
29 de pacieni, cea neselectiv la 25 de cazuri iar n 2 cazuri selecionate s-a folosit anestezie
local potenat intravenos.
Rezultate: S-au efectuat biopsii pleurale n toate cazurile; unde a fost posibil, s-a efrectuat
talcaj pleural intraoperator. Diagnosticul histologic a fost malign n 46 de cazuri iar la 10
pacieni a fost de inflamaie cronic. n 6 cazuri fr neoplazii cunoscute preoperator a fost
afirmat diagnosticul de cancer pleural (primar sau secundar).
Concluzii: Toracoscopia uniportal reprezint o procedur de diagnostic i tratament sigur i
eficient n pleurezii. Este de preferat intubaia oro-traheal selectiv, ns pentru biopsii
pleurale i pleurodez chimic se poate utiliza n siguran i intubaia neselectiv.

ADENOM PARATIROIDIAN ECTOPIC CU LOCALIZARE MEDIASTINALA


PREZENTARE DE CAZ
A.C.Nicodin1, O.N.Burlacu1, Codruta Lazureanu2, Mihaela Vlad3
1
Clinica de Chirurgie Toracica, Spitalul Municipal Timisoara
2
Departamentul de Anatomie patologica, Spitalul Municipal Timisoara
3
Clinica de Endocrinologie, Spitalul Judetean Timisoara
Introducere:
Incidenta paratiroidei ectopice este de aproximativ 6%, cea mai intalnita localizare fiind
reprezentata de capsula timica din mediastinul superior.
Caz:
Prezentam cazul unei femei de 21 de ani cu un istoric recent de osteoclastom maxilar si
mandibular, asociat cu valori ridicate ale concentratiei parathormonului (peste 20 de ori
valoarea normala), corelata cu niveluri crescute ale calcemiei, fosfatazei alcaline, si scaderea
fosfatemiei serice. S-a efectuat un RMN cervico-mediastinal cu evidentierea unei formatiuni
de 5/5/2 cm la nivelul mediastinului anterosuperior precum si multiple tumori chistice osoase
afectand maxilarul, mandibula, clavicula, capul humeral si scapula osteita fibroasa chistica
in contextul hiperparatiroidismului primar. In septembrie 2010 a fost efectuata timectomie
prin toracotomie anterolaterala dreapta. Intraoperator a fost decelata o formatiune tumorala
mediastinala extrem de sangeranda la disectie, intim aderenta la aorta ascendenta. Disectia a
fost dificila dat fiind faptul ca formatiunea era extrem de sangeranda, a fost nevoie de
folosirea de material hemostatic din fibrina umana pentru a controla hemoragia. Masa

tumorala a fost excizata in intregime. Drenajul pleural a fost asigurat de prezenta a 2 tuburi de
dren pleurale.
Rezultate:
La nivelul capsulei timice a fost identificat un nodul format in principal din celule
paratiroidiene, fara forme microcelulare de malignitate;. Diagnosticul histopatologic final a
fost de adenom paratiroidian ectopic. Postoperator evolutia pacientei a fost favorabila cu
prabusirea valorilor PTH de la 1392.4 pg/ml preoperator la 4 pg/ml a doua zi dupa operatie.
Pacienta a fost urmarita in clinica de endocrinologie pentru reechilibrare electrolitica si
hormonala.
Concluzii:
Dupa suprimarea chirurgicala a formatiunii tumorale mediastinale, suspicionata imagistic si
confirmata histopatologic ca fiind paratiroida ectopica, sindromul hiperparatiroidian primar a
fost remis.

REZECTIE-BRONHOANASTOMOZA DE BRONSIE PRIMITIVA CU PREZERVARE


PULMONARA TOTALA PENTRU STENOZA POSTTRAUMATICA
Radu Matache, Ciprian Bolca, Andrei Cristian Bobocea, Olga Danaila, Ion Jentimir, Ioan
Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
Introducere
Rupturile traheo-bronsice sunt dintre cele mai grave consecinte ale traumatismelor toracice
inchise. Suspiciunea clinica si interpretarea imaginilor radiologice au prima importanta pentru
interventia chirurgicala.
Prezentare de cazuri
Cinci pacienti au fost operati in clinica noastra pentru stenoze posttraumatice de bronsie
primitiva. Toti pacientii erau barbati tineri diagnosticati cu pneumotorax total si
pneumomediastin redus. In fiecare caz a fost drenata cavitatea pleurala afectata.
In patru cazuri aspectul radiologic a fost de atelectazie pulmonara completa cu pneumotorax
persistent iar bronhoscopia a pus diagnosticul de stenoza de bronsie primitiva. Intr-un caz,
ruptura de bronsie primitiva a fost identificata la internare si stenoza este suspicionata datorita
unei pneumonii drepte in evolutie sub tratament antibiotic si este diagnosticata tot
bronhoscopic.
Dupa toracotomie parenchimul pulmonar pare normal si se practica doar rezectia zonei de
stenoza a primitivei cu bronhoanastomoza in toate cazurile. Bronhoscopia de control arata
primitiva libera cu sutura slab vizibila.
Discutii
Traumatismele traheo-bronsice sunt de regula letale, peste 75% dintre victime decedeaza pana
la momentul spitalizarii.
Ruptura bronsiei primitive in traumatismele toracice inchise reprezinta un efect cumulativ al
compresiei peretelui toracic, tractiunii aplicate asupra plamanilor, fixati la nivelul carenei, dar
liberi in cavitatea pleurala, cu cresterea brusca a presiunii intraluminale.
Rezectia zonei de stenoza cu bronhoanastomoza este tratamentul de electie si permite
pastrarea intregului parenchim pulmonar.
In tratamentul stenozelor tardive, interventia chirurgicala, chiar la cativa ani dupa
traumatismul initial, are prognostic favorabil.
Concluzii

Ruptura de bronsie primitiva este o complicatie rara a traumatismelor toracice. Bronhoscopia


este indicata la pacientii cu traumastime si pneumotorax sau pneumomediastin si este de
prima importanta in diagnosticul rapid al leziunilor posttraumatice ale cailor aeriene.
Diagnosticul stenozelor traheo-bronsice poate intarzia luni sau ani de zile. Totusi, aceasta nu
afecteaza evolutia perioperatorie, parenchimul pulmonar subiacent fiind relativ normal, in
ciuda atelectaziei prelungite. Rezectia cu bronhoasnastomoza este cheia succesului in aceste
cazuri.

SISTEM CHIRURGICAL COMPLEX PENTRU RECONSTRUCIA SOLID


STERNAL: PLAS THORATEX, LAM STRATOS I CIMENT KRYPTONITE
*Claudiu Nistor, *Adrian Ciuche, *Daniel Pantile, **Teodor Horvat
*Spitalul Universitar de Urgen Militar Central Dr. Carol Davila, Bucureti
** Institutul Oncologic "Prof. Dr. Alexandru Trestioreanu, Bucureti
Introducere: Lucrarea prezint 2 cazuri internate n secia de chirurgie toracic cu diagnosticul
de tumor sternal: o femeie de 49 de ani cu o tumor secundar (adenocarcinom tubulopapilar) de manubriu sternal dup un cancer mamar drept (mastectomie dreapt tip Halsted,
chimio i radioterapie pre i postoperatorie) i un brbat de 45 de ani cu o tumor primar
(condrosarcom) situat la nivelul corpului sternal.
Autorii redau modalitile de rezecie i reconstrucie sternal efectuate n aceste cazuri,
folosind imagini relevante preoperatorii, intra i postoperatorii.
Material i metod: n ambele cazuri, dup rezecia radical a formaiunilor tumorale, s-a
folosit pentru reconstrucia solid sternal un sistem complex ce a inclus pe lng plasa
armat Thoratex o lama din titan tip STRATOS i ciment osteoconductiv Kryptonite. Pentru
reconstrucia prilor moi s-au utilizat lambouri musculare pediculizate din marele pectoral
(pectoralul stng unic chirurgical n primul caz i ambii pectorali n cel de-al doilea caz),
complet mobilizate (prin secionarea inseriilor humerale, sterno-costale i claviculare) i
transpuse medial pentru a acoperii defectul parietal n ntregime.
Rezultate: n ambele cazuri s-a realizat att ndeprtarea n limite oncologice a tumorilor
sternale ct i o foarte bun reconstrucie solid a peretelui toracic anterior. n cel de-al doilea
caz, n cimentul kryptonite au fost incluse fragmente osteocondrale indemne, n vederea
realizrii unui neostern (structura poroas a cimentului este favorabil intergrii i regenerrii
osoase).
Concluzii: Defectele parietale mari care apar dup rezecia n limite oncologice a tumorilor
maligne sternale pot fi reconstruite ntr-o manier sigur utiliznd acest sistem complex
chirurgical combinat cu reconstrucia prilor moi prin transpoziie de lambouri musculare.

IMPORTANA FACTORILOR HISTOPATOLOGICI N STABILIREA


PROGNOSTICULUI PACIENILOR OPERAI PENTRU CANCER PULMONAR FR
CELULE MICI
Suciu B.1, Bud V.1, Copotoiu C.1, Brnzaniuc Klara2, Copotoiu Ruxandra3, Fodor D.1,
Butiurca V.4
Clinica Chirurgie I, Spitalul Clinic Judeean de Urgen Mure
Disciplina de Anatomie, Universitatea de Medicin i Farmacie Tg. Mure

Clinica ATI, Spitalul Clinic Judeean de Urgen Mure


Student, Universitatea de Medicin i Farmacie Tg. Mure
Introducere
n ultimele decenii incidena cancerului pulmonar a crescut alarmant. Cancerul pulmonar
reprezint principala cauz de deces la femei i la brbai, n Statele Unite ale Americii,
100.000 de noi cazuri fiind nregistrate anual la brbai i 50000 de cazuri noi la
femei.Scopul studiului nostru este acela de a evalua importana factorilor
histopatologici n stabilirea prognosticului pe termen lung de pacieni operai pentru cancer
pulmonar.
Material i metod
Scopul prezentei lucrri a fost acela de a realiza un studiu retrospectiv observational pe o
perioada de 6 ani. Am folosit cazuistica Clinicii Chirurgie nr.1, a Spitalului Clinic Judeean de
Urgen Mure, pe o perioad de 5 ani, ntre 1.01.2005 i 31.12.2010. Am inclus n studio 197
pacieni internai i operai pentru tumori bronho-pulmonare n clinica noastr.
Rezultate
Am studiat 197 de pacieni internai i operai n Clinica Chirurgie 1 a Spitalului Clinic
Judeean de Urgen Mure. Am ncercat s studiem importana descriptorului T (tumora) a
stadializrii TNM pentru stabilirea prognosticului pe termen lung. Valoarea p a
fost 0.1676 asa ca nu am obinut o valoare semnificativ din punct de vedere statistic. De
asemenea, am luat n considerare valoarea descriptorului N al clasificrii TNM ca un factor
de predicie pentru supravieuirepe termen lung la pacienii operai pentru cancer
pulmonar..Parametrul p a fost 0.0152 asa ca putem spune c am obinut o legtur direct,
semnificativ din punct de vedere statistic ntre valoarea descriptorului N i supravieuirea
acestor bolnavi la distan.
Concluzii
Supravieuirea acestor pacieni pe termen lung depinde n primul rnd de stadiul
histopatologic al tumorii.Rata de predictibilitate a descriptorilor clasificrii TNM este mai
bun la pacienii cu vrste peste 60 de ani, comparativ cu cei ale cror vrste sunt sub 60 de
ani. Rata de predictibilitate a descriptorului N al clasificrii TNM este mai bun dect cea a
desciptorului T. Existena n acelai stadiu a clasificrii TNM a unor pacieni cu valori diferite
ale descriptorului N, dovedete limitele clasificrii TNM i faptul c aceast clasificare este
perfectibil.
Cuvinte cheie : plmn, cancer, prognostic, descriptor

ABORDUL CERVICAL VIDEOMEDIASTINOSCOPIC AL BRONIEI PRIMITIVE


STNGI - O SERIE DE 6 CAZURI
Cristian Paleru, Olga Danaila, Ciprian Bolca, Radu Matache, Mihai Dumitrescu, Adrian
Istrate, Ruxandra Ulmeanu, Ioan Cordos
Institutul National de Pneumologie Marius Nasta, Bucuresti
1 Clinica I Chirurgie Toracica
2 Departamentul Bronhologie
Introducere
Fistula bontului bronic (FBB) post-pneumonectomie este o complicaie de temut a chirugiei
toracice. Din 1996, cnd Azorin a prezentat n premier nchiderea unui bont bronic

dehiscent post-pneumonectomie stng prin mediastinoscopie cervical, doar 8 cazuri


referitoare la acest abord au fost publicate.
Material i metod
Autorii prezint 6 cazuri de abord transcervical mediastinoscopic al BPS (bronia principal
stng), efectuate n perioada Decembrie 2009 - Iulie 2011 pentru diverse indicaii. Media de
vrst a fost 44.2 ani (2 femei / 4 brbai). 2 intervenii s-au efectuat pentru FBB postpneumonectomie stng, iar n 4 cazuri BPS a fost nchis ca prim pas nainte de
pneumonectomie. n situaiile cu pneumonectomie n 2 timpi, rezecia pulmonar s-a realizat
dup 3 - 4 sptmni. Pacienii au fost urmrii pe perioade de timp cuprinse ntre 7 sptmni
i 20 luni.
Rezultate
Timpul operator mediu a fost 85 minute. Mediastinul a fost drenat doar la primul pacient. Un
caz a necesitat ntrire prin sutur manual a bontului bronic datorit unei deficiene a
stapler-ului. Postoperator pacienii au avut evoluie simpl, cu mobilizare la 6 ore i externare
a treia zi de la operaie. Nu au survenit recidive ale fistulei. 1 pacient a decedat la 7 sptmni
din cauze cardiace.
Concluzii
Abordul cervical videomediastinoscopic al BPS reprezint o alternativ viabil pentru
toracotomie i abordul transsternal, fiind indicat n FBB post-pneumonectomie stng, n
nchiderea i cicatrizarea bronic la pacienii cu plmn distrus supurativ. Aceast procedur
se adreseaz BPS i necesit un bont de cel puin 1,5 cm lungime, instrumentar scump, o
echip chirurgical experimentat putnd fi aplicat doar n cazuri atent selecionate.

PLOMBAJ EXTRA-MUSCULO-PERIOSTAL CU BILE FUNCIONAL DUP 46 DE ANI


Boianu Petre Vlah-Horea, Boianu Alexandru-Mihail
Disciplina Chirurgie 4, Universitatea de Medicin i Farmacie din Trgu-Mure
Introducere. Plombajul cu bile a reprezentat o operaie extrem de popular n anii 1940-50
datorit simplitii i avantajului estetic; ea a fost abandonat att datorit unor complicaii
specifice, ct i datorit rezultatelor favorabile dup introducerea tratamentului tuberculostatic
modern.
Material i metod. Prezentm un pacient de 81 de ani la care s-a practicat un plombaj extramusculo-periostal cu bile la vrsta de 35 de ani (n urm cu 46 ani) pentru o tuberculoz fibrocavitar de lob superior stng.
Rezultate. Pacientul a avut o evoluie postoperatorie foarte bun, devenind BK negativ,
complet asimptomatic i cu o reinserie social complet (medic de familie pn la 70 de ani),
fiind internat de urgen n clinica noastr pentru un infarct entero-mezenteric i decednd n
ziua a 8-a postoperator (enterectomie segmentar) prin infarct miocardic.
Concluzii. Cazul este interesant prin imagistic i prin evoluia excelent dup o intervenie
cu care actuala generaie de chirurgi nu este familiarizat. Recrudescena actual a
tuberculozei poate aduce n actualitate operaii abandonate la un moment dat.

HEMANGIOM PARIETAL TORACIC


Cezar Mota, Ovidiu Rus, David Achim, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
Introducere
Hemangiomele parietale toracice reprezita un procent redus in cadrul leziunilor situate la
acest nivel. Diagnosticul pozitiv i cel diferenial este adeseori dificil, cura chirurgical a
acestora ridicnd o serie de probleme de tehnic.
Material i metod
Prezentm cazul unui pacient n vrst de 56 ani ce se interneaz n clinica noastr prezentnd
o formatiune tumorala de pererete toracic posterior stng aprut de circa 1 an. Aceasta
leziune era bine delimitata, ntinzndu-se pe 2/3 inferioare ale musculaturii paravertebrale
stngi. Examenul computer tomograf toracic certific i evaluarea RMN atrage atenia asupra
gradului mare de vascularizaie.
Rezultate
Intraoperator s-a descoperit la nivelul planului muscular paravertebral stng, o tumora cu
aspect angiomatos de aproximativ 20 cm dezvoltat sub teaca superficial a musculaturii. S-a
practicat rezecia formaiunii aflat n strns legtura cu stratul superficial ale masei
musculare, rezultatul histopatologic fiind de angiom cavernos. Evoluia postoperatorie a fost
simpl, pacientul fiind externat complet vindecat
Concluzii
Dei rare, aceste tumori angiomatoase trebuie luate n considerare n evaluarea uneui pacient
cu patologie tumoral parietal toracic.

LEIOMIOFIBROMATOZA CU MULTIPLE LOCALIZARI ADEVARUL DINCOLO DE


APARENTE PREZENTARE DE CAZ
Adrian Istrate, Cristian Paleru, Mihai Dumitrescu, Ioan Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
Introducere: Leiomiofibromatoza constituie o cauza neobisnuita de tulburri respiratorii i /
sau digestive, localizarea ei principala fiind genitala.
Material i metod: Va prezentam cazul unei femei de 22 de ani, cu multiple localizari ale
leiomiofibromatozei, a carei simptomatologie modesta (infecii respiratorii recurente, pierdere
lenta ponderala, tuse uscat, disfagie recent la solide) a rmas nediagnosticata si netratata
pentru o perioad lung de timp. Interventiile chirurgicale anterioare (chist tireoglos, cataract
bilateral) au devenit importante n procesul de elaborare al unui diagnostic precis.
Rezultate: n urma investigaiilor, pacienta a fost supusa interventiei chirurgicale (rezecia
extins a unei tumori mediastinale posterioare, care includea esofagul, sfincterul esofagian i
fornixul gastric, i care deplaseaz ficatul, plamanul drept si vena cava inferioara, biopsie din
nodulii bronici i traheali; nlocuirea cu tub gastric a esofagului) prin abord triplu toracoabdomino-cervical. n ziua a 10-a postoperator, se dezvolta o fistula anastomotic cervicala,
care, sub tratament conservator se remite. Rezultatele anatomopatologice confirma
leiomiofibromatoza. Urmarirea la 30 de zile nu indic recidiv.
Concluzii: Lucrarea de fata poate oferi o perspectiva importanta ntr-o patologie rar, dar
semnificativ cu implicaii multiple, care nediagnosticata, conduce la o morbiditate asociata

ridicata. Acest caz necesit investigaii suplimentare, care ar putea elucida etiologia si posibila
asociere cu alta entitate patologic.

TIMECTOMIA VIDEOTORACOSCOPICA IN HIPERPLAZIA TIMICA CU MIASTENIE


GRAVIS
Cristina Grigorescu*, Trufa Denis*, Iosep Gabriel**
*Clinica de Chirurgie Toracica Iasi, UMF Gr.T.Popa Iasi
** Sectia de ATI, Spital clinic de Pneumoftiziologie Iasi
Miastenia gravis (MG) este o afectiune autoimuna, in care autoanticorpii fata de antigenele
placii neuromusculare determina diferite forme de tuburari neuromusculare si oboseala.
Timectomia este recomandata ca optiune terapeutica pentru pacientii fara timom cu MG, in
special la cei cu Ac antireceptori-acetilcolina si sub 60 de ani, pentru a imbunatati
performanta musculara sau chiar remisie a bolii.
In ultima decada s-au dezvoltat tehnici videotoracoscopice cu acces uni- sau bilateral.
In experienta noastra pe 19 cazuri din 288-2011, timectomia videotoracoscopica cu abord pe
dreapta la pacientii cu MG si hiperplazie timica a fost comparabila cu abordul classic
transsternal, cu remisie completa de 95% la 2 ani, fiind asociata cu o morbiditate mai redusa
si sechele estetice neglijabile.

CHISTUL HIDATIC AL MEDIASTINULUI ANTERIOR


Cezar Mota, Natalia Mota, Mihnea Davidescu, Elena Moise, Ovidiu Rus, Daniel Banciu,
David Achim, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
Introducere
Boala hidatic este o problem actual n patologia ntlnit n Romnia. Dei aceste leziuni
se pot ntlni practic n orice organ sau segment anatomic, cel mai frecvente localizri sunt n
ficat i plmni. Leziunile cu topografie mediastinal sunt extrem de rare, fiind relativ putine
descrieri n literatura de specialitate.
Material i metod
Obiectivul acestui studiu este de a evalua aspectele clinice i imagistice i tratamentul
chirurgical al acestor leziuni rare. n intervalul 1994 2011 au fost diagnosticai i tratai
chirurgical 3 pacieni cu chiste hidatice mediastinale. Pacienii au fost 2 brbai i 1 femeie,
vrstele fiind de 20, 37 i respectiv 52 de ani. n toate cazurile leziunea a fost localizat n
mediastinul anterior,.Toate leziunile au fost solitare, neasociind i alte determinri.
Rezultate
ntr-un singur caz dignosticul a fost precizat preoperator, celelalte fiind descoperiri
intraoperatorii. La toi pacienii abordul a fost prin toracotomie, 1 toracotomie axilar dreapt,
1 toarcotomie anterolateral dreapt i la un caz a fost preferat toracotomia axilar stng.
Doar intr-un singur caz chistul era neviabil (chist hidatic timic) n celelalte 2 cazuri chistul era
viabil. n aceste ultime 2 situaii s-a practicat inactivarea cu alcool 90 urmat de evacuarea
lichidului hidatic i a cuticulei i perichistectomie. La cel de-al treilea caz s-a efectuat

chistectomie ideal. S-a nregistrat o singur complicaie postoperatorie: embolie gazoas


cerebral care s-a remis prin tratament medical.
Concluzii
Dei extrem de rar ntlnite n practic, leziunile hidatice mediastinale trebuie luate n
considerare n evaluarea unui pacient cu o leziune tumoral la nivelul mediastinului anterior.
Tratamentul de elecie este cel chirurgical, acesta fiind singurul ce asigur vindecarea
complet a acestor pacieni.

REZECTII PULMONARE IN URGENTA - TUMORA PULMONARA RUPTA IN


PLEURA
Ovidiu Rus, Natalia Mota, Elena Moise, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
Introducere
Formatiunile tumorale cu densitati parafluide reprezinta adeseori o problema de management
terapeutic. Prezentarea tardiva a pacientului la medic poate genera complicatii cu ruperea
continutului tumoral in spatiul pleural.
Metod
Prezentm cazul unei paciente n vrst de 52 de ani ce se interneaz n clinica noastr
prezentnd dureri toracice si hemoptizii minime de aproximativ 2 luni. Examenul CT toracic
efectuat anterior internarii prezinta o formatiune tumorala voluminoasa, rotund-ovalara
(10/5,5/4cm), cu structura parafluida, relativ omogena, bine delimitata, la nivelul lobului
inferior drept pulmonar, fara alte leziuni patologice asociate.
Starea pacientei se deterioreaza dupa internare, aceasta acuzand dureri toracice accentuate,
dispnee. Examenul CT efectuat confirma ruperea continutului lichidian in pleura
Rezultate
S-a decis intervenia chirurgical in urgenta, intraoperator descoperindu-se lichid in cavitatea
pleurala, aproximativ 1000ml, si formatiune tumorala relativ bine delimitata, cu diametru de
5 cm, dura la palpare, ce prezinta spre fata mediastinala pulmonara traiect fistulos prin care se
exteriorizeaza continut cu aspect purulent.
Se practica lobectomie inferioara dreapta cu limfadenectomie si decoticare pleuro-pulmonara
Williams
Formatiunea chistica s-a dovedit a fi o tumora mezenchimala cu zone intinse de necroza,
testele IHC punand diagnosticul de sarcom sinovial.
Concluzii
Acest caz atrage atenia asupra unei posibiliti evolutive rare, dar posibil, a unei tumori
pulmonare.

MANAGEMENTUL RUPTURILOR ESOFAGIENE INTRATORACICE EXPERIENTA


UNUI SINGUR CENTRU
C.P.Tunea, V.T.Voiculescu, O.N.Burlacu, G.V.Cozma, I.Miron, I.A.Petrache, M.Butas, A.C.
Nicodin
Clinica de Chirurgie Toracic, Spitalul Municipal, Timioara
Introducere:
Prezentam experienta noastra in managementul rupturilor esofagiene, tinand cont de etiologia
acestora si incercarea de a aplica un tratament chirurgical agresiv.
Material si metoda:
Am inclus in studiul nostru pacientii cu perforatii esofagiene tratati in clinica noastra intre
2002 si 2011; au fost 10 cazuri (2 femei si 8 barbati, cu varstele intre 29 si 69 de ani); in 5
cazuri etiologia a fost reprezentata de corpi straini, in 1 caz post interventie chirurgicala, 1 caz
cu neoplasm stentat, 3 cazuri cu sindrom Boerhave; 1 pacient a urmat tratament conservator, 4
au beneficiat de sutura de prima intentie si 5 au avut drenaje pleurale si gastrostoma;
intervalul intre perforatie si tratament a fost intre 12 ore si 4 zile ; am folosit gastrostoma de
alimentatie numai in 2 cazuri de stenoza(postcaustica si neoplazica).
Resultate:
Am inregistrat numai un caz de deces(neoplasm esofagian stentat); spiatalizarea a fost intre 17
si 35 de zile(Sindrom Boerhave); cazul care a fost tratat conservator(cervico-mediastinita
supa ingestia unui os de peste) a fost vindecat fara sechele; interventii chirurgicale seriate au
fost aplicate doar in cazurile cu sindrom Boerhave.
Concluzii:
Diagnosticul a fost in mare parte clinic; s-a utilizat substanta de contrast care a confirmat doar
topografia leziunii; sutura de prima intentie a fost metoda cea mai sigura indiferent de timpul
scurs de la perforatie; drenajuol pleural si gastrostoma au fost applicate doar la cazurile grave.

MANAGEMENTUL CHIRURGICAL AL CARCINOMULUI TIROIDIAN CU INVAZIE


TRAHEALA - EXPERIENTA UNUI SINGUR CENTRU
Andrei Cristian Bobocea, Ciprian Bolca, Olga Danaila, Ioan Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
Introducere
Carcinomul tiroidian bine diferentiat evolueaza lent si rareori invadeaza tesuturile
inconjuratoare. Invazia cailor aeriene data de un neoplasm tirodian este o problema clinica
neobisnuita si importanta.
Atitudinea chirurgicala in invazia traheala este inca subiect de discutie. Sunt studii care afirma
ca rezectia tangentiala este suficienta, in ciuda riscului crescut de recidiva tumorala. Pe de alta
parte, rezectia circumferentiala a traheei este o procedura sigura si scade acest risc.
Material si metoda
In clinica noastra s-au practicat 7 tiroidectomii cu rezectie traheala in perioada ianuarie 2007 decembrie 2010. Toti pacientii au fost internati in urgenta cu dispnee. Examenul bronhoscopic
a fost cel mai important in evaluarea exacta a invaziei traheale iar examinarea CT a fost
efectuata pentru a elimina posibilitatea existentei unor metastaze.

S-a efectuat rezectia in bloc a glandei tiroide impreuna cu 3-5 inele traheale, iar intr-un caz s-a
practicat si rezectia portiunii anterioare a cartilajului cricoid. Limfadenectomia locala a fost
facuta in toate cazurile.
Rezultate
Anatomopatologic s-au identificat 3 carcinoame tirodiene nediferentiate si 4 carcinoame
tirodiene bine diferentiate. Mortalitatea postoperatorie a fost nula. Intr-un singur caz de
carcinom tirodian nediferentiat a existat o fistula de anastomoza ce a necesitat traheostomie
definitiva. Supravietuirea la distanta a fost de 6, 9 si 14 luni in cazul pacientilor cu carcinom
tirodian nediferentiat, respectiv 13 luni la un pacient din lotul cu carcinom tirodian bine
diferentiat. Ceilalti trei pacienti supravietuiesc la 9, 16 si respectiv 25 de luni postoperator
fara semne de recurenta a bolii sau metastaze la distanta.
Concluzii
Exista controverse privind metoda chirurgicala optima: rezectia tangentiala cu tesut tumoral
microscopic restant sau rezectia completa tireo-traheala.
Rezectia traheala cu anastomoza in cazurile de carcinoame tiroidiene cu invazia cailor aeriene
aduce paliatie de lunga durata si poate fi curativa pentru un numar semnificativ de pacienti ce
sufera de aceasta boala.

STERNOCONDROPLASTIA CLASICA VERSUS TEHNICA NUSS IN PECTUS


EXCAVATUM RECIDIVAT
G.V.Cozma, I.A.Petrache, O.N.Burlacu, A.C.Nicodin
Clinica de Chirurgie Toracic, Spitalul Municipal, Timioara
Introducere:
Aparitia tehnicilor minim invazive de sternocondroplastie (Nuss) a permis inlocuirea cu
succes tehnicii chirurgicale clasice(Ravitch) pentru o anumita categorie de pacienti. Exista
situatii cand tehnica Nuss poate fi utilizata chiar si in cazul recidivelor dupa tehnica clasica. In
practica noastra am intalnit si situatii inverse in care tehnica minim invaziva nu este infailibila
fiind nevoiti sa apelam la tehnica Ravitch pentru corectarea malformatiei sternocondrale
recidivate dupa Nuss.
Material si metoda:
Cazuistica noastra numara 37 de cazuri de pectus excavatum pe o periaoda de 10 ani(2001 2011). Dintre acestea 19 au fost rezolvate prin tehnica minim invaziva, restul prin tehnica
clasica. Din pacate am intalnit si cazuri la care malformatia condrala a recidivat. Prezentam
doua cazuri operate in serviciul nostru cu pectus excavatum recidivat. O pacienta operata
initial la varsta de 5 ani prin tehnica Ravitch, s-a prezentat in serviciul nostru dupa 15 ani cu
recidiva malformatiei sternocondrale care a necesitat recorectare prin tehnica Nuss. Celalalt
pacient, un tanar operat in urma cu 2 ani prin tehnica minim invaziva a revenit in clinica cu
recidiva malformatiei dupa migrarea lamei Lorentz. A fost resolvat prin tehnica Ravitch.
Rezultate:
In ambele situatii reinterventia prin tehnica complementara a fost realizata cu succes, defectul
condrosternal fiind corectat optim.
Concluzii:
Desi exista controverse in alegerea tehnicii de sternocondroplastie, in pectusul excavatum
recidivat dupa tehnica Nuss corectarea se face mult mai bine prin tehnica clasica, in timp ce in
pectusul excavatum recidivat dupa tehnica clasica, tehnica Nuss reprezinta o buna optiune.

EXPERIENA NOASTR N ABORDUL CHIRURGICAL ANTERIOR AL


VERTEBRELOR C7-T1
*Adrian Ciuche, *Claudiu Nistor, *Marian Mitric, **Teodor Horvat
*Spitalul Universitar de Urgen Militar Central Dr. Carol Davila, Bucureti
** Institutul Oncologic "Prof. Dr. Alexandru Trestioreanu, Bucureti
Introducere: Lucrarea prezint 3 cazuri de traumatisme cervico-toracice soldate cu fractura
corpilor vertebrali C7 sau T1 asociat cu compresiune medular la acest nivel. Autorii expun
abordul chirurgical anterior al acestor cazuri folosind imagini relevante preoperatorii intra i
postoperatorii.
Material i metod: Explorrile imagistice au artat existena de fracturi associate cu
compresie medular la nivelul vertebrei T1 n primul caz i la vertebra C7 n ultimele dou
cazuri. Tehnica chirurgical a constat n ndeprtarea corpilor vertebrali C7 i respectiv T1
mpreun cu discurile vertebrale supra i subiacente. Reconstrucia vertebral s-a realizat cu
grefon autogen din osul iliac n primul i al treilea caz (fixat anterior cu plac de titan) i cu
implant vertebral de titan n cel de-al doilea caz. Abordul chirurgical anterior al corpilor
vertebrali C7 i T1 s-a realizat printr-o cervicotomie dreapt paralel cu marginea anterioar a
muchiului sternocleidomastoidian, combinat cu o sternotomie parial nalt.
Rezultate: Decompresia medular s-a realizat prin ndeprtarea fragmentelor vertebrale
herniate. n cel de-al treilea caz a fost necesar efectuarea unei reintervenii prin aceeai cale
de abord, pentru extragerea plcii metalice (migrate ctre rdcinile spinale datorit fixrii
ineficiente). Rezultatele postoperatorii au fost satisfctoare, cu ameliorarea funciei senzitive
i conservarea celei motorii.
Concluzii: Abordul chirurgical anterior al vertebrelor C7-T1 reprezint o piatr de ncercare
att pentru neurochirurg (dificultatea rezeciei i reconstruciei vertebrale avnd anterior
marile vase) ct i pentru chirurgul toracic (disecia la grania cervico-toracic cu mobilizarea
lobului drept tiroidian fr lezarea nervului laringeu recurent i cu mobilizarea i protejarea
trunchiului arterial brahiocefalic, posterior de care se efectueaz practic ntreaga intervenie
chirurgical).

FISTULA BENIGN POSTESOFAGECTOMIE NTRE TUBUL GASTRIC I


ARBORELE TRAHEOBRONIC: PREZENTARE A DOU CAZURI, STUDIU
LITERATURII, CLASIFICARE I PROTOCOL TERAPEUTIC
Bolca Ciprian*, Eric Frechette**
*Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
**Clinica de Chirurgie Toracic, Institutul Universitar de Cardiologie i Pneumologie
(IUCPQ), Quebec, Canada
Introducere
Fistula benign ntre arborele traheobronic i tubul gastric ascensionat n torace dup
esofagectomie este o complicaie foarte rar, cu potenial letal crescut, care necesit tratament
imediat i agresiv. n literatura de specialitate aceast aspect apare sub forma unor serii foarte
mici sau ca prezentri de caz. Nu exist nc un protocol de tratament bine stabilit.
Material i metod
Prezentm modalitatea de abordare a dou astfel de cazuri; managementul a fost diferit pentru
fiecare dintre ele, la fel ca i aspectul clinic i factorii predispozani. Unul a fost tratat agresiv,

prin intervenie chirurgical imediat i altul prin masuri conservatoare. Tratatele i articolele
de specialitate ofer informaii limitate privitor la aceast problem. O cutare n Medline a
permis indentificarea a 42 de cazuri prezentate n literatur. Dup studierea acestora, am
ncercat s stabilim o clasificare i un protocol de tratament general valabil pentru aceast
complicaie.
Rezultate
nchiderea traiectului fistulos a fost obinut n amndou cazurile prezentate. Prin studierea
literaturii s-a putut identifica un model n ceea ce privete etiologia i factorii favorizani,
timpul de la operaia iniial pn la apariia fistulei i modalitile de tratment, aspecte care
ne-au permis s propunem o clasificare i un protocol terapeutic.
Concluzii
Formarea unei fistule ntre neoesofag i calea aerian este o complicaie neobinuit i dificil
de tratat. Simptomatologia, dimensiunile i localizarea traiectului fistulos i durata de timp de
la intervenia iniial vor dicta modalitatea de tratament n vederea restabilirii continuitaii
digestive i a cii aeriene i deci, de a rezolva aceast complicaie sever

REZECTIE ETAJATA, SERIATA, PENTRU DUBLA STENOZA TRAHEALA SEVERA


POST INTUBATIE ORO-TRAHEALA
Codin Saon, Liliana Caracuda, Felix Dobritoiu, Ioan Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
Lucrarea prezinta cazul unei paciente in varsta de 26 ani, diagnosticata cu stenoza traheala
dubla, cervicala si toracica joasa, post IOT, ca urmare a unui accident rutier soldat cu
politraumatism cranio-toracic.
Interventia chirurgicala a constat in rezectie-anastomoza traheala efectuata in 2 timpi la
interval de o luna.
Evolutia post-operatorie a fost favorabila. Controalele bronhoscopice efectuate la o luna de la
ultima interventie, 6 luni, un an, au prezentat un lumen traheal cu calibru pastrat.

EXPERIENTA NOASTRA IN CHIRURGIA TUMORILOR PARIETALE TORACICE


A.C.Nicodin, I.Miron, O.Sirbu, G.V.Cozma, O.N.Burlacu, I.A.Petrache, A.C.Nicola,
C.Mogoi.
Clinica de Chirurgie Toracic, Spitalul Municipal, Timioara
Indroducere:
Patologia tumorala parietala toracica este extrem de interesanta si vasta, ridicand si astazi o
serie de probleme de abordare in ceea ce priveste diagnosticul si tratamentul chirurgical. De
aceea scopul lucrarii este de a prezenta experienta clinicii noastre in confruntarea cu o astfel
de patologie
Material si metoda:
Am analizat o serie de 154 pacienti operati in clinica noastra pe o perioada de 10 ani (2001
2011), cu varste cuprinse intre 21 si 74 de ani. 43 de cazuri au prezentat patologie tumorala
benigna si 111 pacietni au avut tumori maligne primare, secundare sau prin contiguitate.
Procedeele chirurgicale aplicate au fost rezectia parietala toracica insotita de reconstructie si

stabilizare folosind diverse materiale(plasa armata tip Thoratex, tehnica Spider-Web,


metilmetacrilat) in 25,4% din cazuri si rezectia parietala fara stabilizare in 74,6% din cazuri.
Durata medie de spitalizare a fost de 8 zile.
Rezultate:
In cazul tuturor pacientilor operati mortalitatea si morbiditatea perioperatorie a fost 0.
Evolutia postoperatorie imediata a fost favorabila in 150 de cazuri, 3 pacienti au prezentat
serom de plaga operatorie care a fost tratat conservator, iar un caz a beneficiat de
reconstructie cu lambou muscular in timpul 2 dupa stabilizare cu placa de metilmetacrilat.
Concluzii:
Patologia tumorala parietala toracica ridica inca unele probleme de tratament chirurgical,
unele cazuri fiind o adevarata provocare pentru chirurg, insa dezvoltarea continua a tehnicilor
chirurgicale si a materialelor de reconstructie precum si formarea unor echipe experimentate
de chirurgi toracici au dus la obtinerea de rezultate bune, fara aparitia de complicatii
perioperatorii care sa necesite interventii chirurgicale repetate.

TIMOAMELE ECTOPICE CU DEZVOLTARE LATERAL - PARACARDIAC


Boianu Alexandru-Mihail, Boianu Petre Vlah-Horea, Urcan Marius, Chiujdea Drago,
Lucaciu Oana, Hogea Timur, Batog Olivia, Pvloiu Valerian
Disciplina Chirurgie 4, Universitatea de Medicin i Farmacie din Trgu-Mure
Introducere. Timoamele cu dezvoltare atipic rmn o provocare, att ca diagnostic, ct i ca
tratament.
Material i metod. n ultimii 15 ani am avut 4 cazuri trimise n clinica noastr cu diagnosticul
de tumor mediastinal / pulmonar, la care imagistica preoperatorie a evideniat tumori
mediastinale cu dezvoltare lateral - paracardiac. Intraoperator s-au gsit tumori n contact
direct cu pericardul, cu dezvoltare posterior de nervul frenic. La toate cazurile s-a practicat
extirparea complet a tumorii prin abord lateral (toracotomie postero-lateral 2 cazuri,
toracotomie antero-lateral 2 cazuri). Examenul histo-patologic extemporaneu a fost
neconcludent n toate cele 4 cazuri, diagnosticul fiind pus prin examen histo-patologic
definitiv.
Rezultate. Accesul asupra leziunii a fost excelent n toate cele cazurile. Toi cei 4 pacieni au
avut o evoluie postoperatorie imediat i tardiv favorabil. Nu am ntlnit recidive la nici
unul din pacieni (urmrire 6 luni 14 ani).
Concluzii. n cazul tumorilor intratoracice cu localizare paracardiac trebuie avut n vedere i
posibilitatea unui timom. Abordul lateral ofer un acces bun pe cazuri selecionate. Subliniem
i dificultile de diagnostic n condiiile din ara noastr.

POSTERS
RARE MEDIASTINAL MASSES: BRONCHOGENIC CYST AND CASTLEMAN'S
DISEASE
Andrei Cristian Bobocea, Radu Matache, Ion Jentimir, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
Introduction
The differential diagnosis of mediastinal masses includes over 30 different diseases, most
frecquent lymphomas, substernal goiter, thymomas, or, rarely, Castlemans disease and
bronchogenetic cyst.
Castleman's disease is a rare lymphoproliferative disorder also called angiofollicular lymph
node hyperplasia.
Bronchogenic cysts, although relatively rare, represent the most common cystic lesion of the
mediastinum.
Cases report
A 45 year old male complaining of dyspnoea was presented with a mediastinal mass
mimicking a thymoma. By posterolateral thoracotomy the mass was completely excised.
Pathology examination of specimen showed Castleman's disease.
A 65 year old female was presented with a mediastinal mass compressing the trachea
diagnosed as bronchogenic cyst. Transcervical complete resection was performed with
remission of dyspnoea.
Discussions
The initial presentation of mediastinal masses may be respiratory distress and symptoms can
be life threatening when they produce airway compromise.
Castleman's disease is a lymphoid tumour with majority of lesions occurring within the chest.
The unicentric pattern is usually localized to the mediastinum or pulmonary hilum. Less
commonly sites include neck, pelvis, retroperitoneum and axilla.
The bronchogenetic cysts are usually found using prenatal ultrasonography and in early
childhood or adulthood by routine chest radiography. It is rarely diagnosed in elderly.
Extrathoracic cysts are found in the neck, abdomen, and retroperitoneal space. The
mediastinal cysts are mostly carinal and paratracheal; intrapulmonary cases were reported.
Mostly, the complete resection of the bronchogenic cyst was performed by thoracotomy.
Conclusions
Castleman's disease of the mediastinum is a rare clinical finding often diagnosed after onset of
non-specific thoracic symptoms such as dyspnoea, cough or chest-wall pain.
Bronchogenetic cysts are rare findings in elderly patients and produce symptoms when
altering airway dynamics.
Complete surgical removal of this type of mediastinal masses is usually curative alone. In
cases where subtotal excision has been performed, short-term recurrences were seldom
reported.

PERICARDIAL DRAINAGE IN MALIGNANT EFFUSIONS - EARLY RESULTS


Cezar Mota, Natalia Mota, Mihnea Davidescu, Ovidiu Rus, Elena Moise, Andreea tefan,
David Achim, Teodor Horvat

Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest


Introduction: Pericardial effusion in neoplasic patient could be a life-threatening
complication.
Material and method: Between March 2010 and August 2011 we performed 27 pericardial
drainages in 25 patients (14 male and 11 female) with pericardial effusion and known
malignancies: 18 of lung, 5 of breast, 1 of cervix and 1 of lip.
The pericardial drainage was performed in emergency in 11 cases (cardiac tamponade, 2 cases
with localised tamponade) and in urgency in 16 cases.
As procedures we performed: 17 paraxyphoidian approaches (62,96%), 5 thoracoscopic
pericardo-pleural windows (18,51%), 2 percutaneous catheter drainages (7,4%), 2 subxyphoid
approach with xyphoid resection (7,4%) and 1 open left pericardial fenestration (3,7%).
The 17 paraxyphoidian approaches were performed under local anestesia, in 10 an
intravenous analgesia was added for patients comfort. We performed 3 paraxiphoidian
pericardioscopies (17,64%).
Results: The mean quantity of pericardial liquid extracted in the operating room was 845ml.
Pericardial biopsy was performed in 25 cases in only 6 patients the histology was malignant
(24%). The cytology was malignant in 16 of 19 cases (84,21%).
The intraoperatory mortality was zero; immediate postoperatory mortality was 3,7% (1 death
at 9 hours after internal cardiac massage for cardiac arrest in tamponade)
In 14 cases the pericarditis was accompanied by pleural effusion: in 5 cases a thoracoscopic
pericardial fenestration was performed (under general anestesia) and in 9 cases patients
condition imposed local anestesia and chest tube insertion was performed.
We had a double recidive of 1 pericarditis after a paraxyphoidian drainage and a percutaneous
US-guided pericardiocentesis, which imposed an open left partial pericardiectomy for a
limited tamponade on the emerge of the great vessels.
Conclusions: Because of the possibility of pericardial biopsy, paraxyphoidian approach is a
usefull surgical tool in malignant pericardial effusions. In paraxyphoidian access,
pericardioscopy with zero degrees endoscope is not appropiate.

TRIPLE TRACHEO-BRONCHIAL LESION POST-MEDIASTINOSCOPY AND EBUS


Natalia Mota, Cezar Mota, Ovidiu Rus, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
Introduction: Purulent mediastinitis is a severe condition with a high mortality rate even in
treated patients.
Material and method: A 61-y-o female patient is admitted in emergency with suflant and
purulent cervical postoperatory wound, dispneea, cough and purulent sputum. She had a
Carlens mediastinoscopy 6 days before in another department for a mediastinal subcarenal
mass. Before that, an EBUS tumoral biopsy has been performed with incomplete diagnosis
(lymphoid cells). The patient also had insulin-therapy for diabetus and corticoid therapy for
paraneoplastic pemphygus.
Results:
Paraclinical investigations revealed pneumomediastinum with cervical
extension, distal tracheal cartilages broken and two endobronchial communications with
mediastinum surrounded by granulation tissue. The diagnosis was acute purulent mediastinitis
secondary to tracheo-bronchial rupture. The mediastinum was drained with a transcervical

silicone tube, small amounts of lavage and repeated tracheo-bronho-aspirations, along with
intensive care support. In spite of all efforts, after 18 days the patient died due to cardiorespiratory arrest. The hystologic result from previous mediastinoscopy was Hodgkin
lymphoma.
Conclusion: Unrecognised tracheo-bronchial iatrogenic injury can lead to catastrofic
consequences in matter of hospital expenses and cost of life.

MALIGNANT PLEURAL PSEUDOMESOTHELIOMA


Mihnea Davidescu, Elena Moise, Ovidiu Rus, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
Background
Tumors that can present with a pseudomesotheliomatous appeareance include lung tumors
(adenocarcinoma), malignant vascular tumours, synovial sarcoma, thymoma and malignant
lymphoma.
Malignant melanoma is an aggressive cancer which can quickly metastasise. Its annual
incidence has increased dramatically over the past few decades. Secondary determinations
apear most frequently in the lungs, liver, brain and bones. Isolated pleural involvement is very
rare.
Methods
We report the case of a 59 year old woman presenting with exertional dyspnea and dysphonia
starting three months prior. She was diagnosed with a left pleural effusion and managed
conservatively with multiple recurrences in spite of repeated thoracenteses. Radiological
appearance has evolved from large pleural effusion without pleural thickening to a thick
confluent pleural tumor and entrapment of the lung; evolution characteristic for a diffuse
malignant mesothelioma.
She had a history of a right abdominal malignant melanoma resected in June 2008, with
postoperative adjuvant therapy - interferon alfa.
Results
For histological confirmation an open pleural biopsy was performed. This revealed a tumoral,
dark brown, pleural thickening. Histological analysis confirmed the diagnosis of metastatic
malignant melanoma.
Conclusions
Although quite rare, pleural metastasis of malignant melanoma can mimic a diffuse malignant
mesothelioma and should be considered in the differential diagnosis especially in patients
with a history of malignant melanoma.
The prognosis of most of the pseudomesotheliomatous tumours is poor, similar to
mesotheliomas, but there are some exceptions such as malignant lymphomas and thymomas.
One should always obtain histological confirmation of a suspected diagnosis no matter how
suggestive the clinical and imagistical aspects are so that the right, aimed, treatement can be
performed.

BULLOUS DYSTROPHY OF THE MIDDLE LOBE


Corina Bluoss, David Achim, Elena Moise, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
Background: Bullous dystrophy is a rare variety of congenital malformation of lung found in
newborn.
Materials and Methods: The authors are presenting the clinical case of a 33-year-old female
patient, without significant past medical history, admitted in the clinic for hemoptysis,
persistent right hemithoracic pain, fever and dyspnea, symptoms with a sudden onset three
weeks before presentation. Under antibiotic treatment the symptoms resolve, but the
radiologic findings persist.
Results: Laboratory results show leukocytosis and increased fibrinogen.
Chest X-ray shows multiple cavities with hydroaeric levels situated in the lower third of the
right hemithorax.
Chest contrast-enhanced CT reveals cavities with hydroaeric levels in the middle lobe
(maximal dimensions of 9.2/11.7cm), with fluid and fluid-like contents.
Bronchoscopy visualizes mucopurulent secretions in the middle lobe bronchus and in the
basal segmental bronchi (Microbiological examination: Str. Pyogenes and Candida Albicans).
Intraoperatively emphysematous bulae of different sizes are observed, situated in the middle
lobe, one of which surpassed the fissure towards the superior lobe. Middle lobectomy and
wedge resection of the superior lobe are performed.
Postoperative evolution is favorable.
Conclusion: The particularity of the case stems from the adult age discovery of a congenital
malformation which had hemoptysis as a clinical debut.

IANUSIAN ASPECT OF TYROID PATHOLOGY


Elena Moise, Cezar Motas, Ovidiu Rus, Teodor Horvat
Thoracic Surgery Clinic, Alexandru.Trestioreanu National Institute of Oncology, Bucharest
Introduction
Thyroid nodules are relatively frequent structural anomalies, identified by palpation or by
ultrasonography of the thyroid.
Tuberculosis is an infectious, contagious disease, caused by Mycobacterium tuberculosis.
Tuberculosis usually affects the lungs, but can also present with extrapulmonary
manifestations: tuberculous meningitis, peritonitis, pericarditis, genito-urinary tuberculosis,
and tuberculosis of the bones and joints, gastrointestinal system, liver, and lymph nodes.
Method
We report the case of a 53 year old woman, presenting with a thyroid nodule, known and
monitored for 10 years. She was admitted in our clinic with dysphagia. Ultrasonographic
evaluation and cervical computer tomography lead to the diagnostic of left thyroid nodule,
with extension to the mediastinum. Histopathological exam from fine-needle aspiration:
chronic thyroiditis.
Rezults
The surgical procedure reveals left inflamed thyroid lobe, at the lower pole, a tumor, about 3
cm in diameter, hard, which extends into the mediastinum.

We performed a hemithyroidectomy and the excision of the cervicomediastinal tumour. The


histopathological exam result was: tuberculosis of the lymph nodes.
Conclusions
This case highlights a rare, but possible tuberculous organ involvement.
The patient was treated a long period of time for thyroid nodules, the correct diagnostic and
treatment were confirmed through the surgical procedure.

GIANT PLEURAL TUMOR CASE REPORT


Radu Matache, Andrei Cristian Bobocea, Ioan Cordos
1st Clinical Department of Thoracic Surgery, Marius Nasta National Institute of
Pneumology, Bucharest
Introduction
Solitary fibrous tumors of the pleura (previously called benign mesotheliomas) are rare
neoplasms. Although most are benign, malignant variants have been reported. Approximately
600 cases have been reported in the literature to date.
Case presentation
We report the case of a young woman with a giant solitary fibrous tumor of the pleura. Chest
CT showed large well-delineated heterogeneous mass occupying all the affected hemithorax.
The tumor was diagnosed three years prior to admission, was sensibly smaller, but the patient
refused surgery at that time.
Complete surgical excision was carried out by posterolateral thoracotomy. Tumor size was
32/25/15 cm and weighed 4500 g. Postoperative chest x-ray showed complete lung expansion
and recovery course was uneventful. The pathological diagnosis was benign localized fibrous
tumor of the pleura.
Discussions
Primary tumors of the pleura may be diffuse or solitary. Diffuse tumors are mesotheliomas:
associated with asbestos exposure and commonly fatal. Solitary fibrous tumors are rare
benign pleural neoplasms and unrelated to asbestos exposure or tobacco use. They derive
from fibroblastic stem cells but successive mutations may lead to malignancy. The tumors are
usually asymptomatic. Cough, chest pain or dyspnea occurs occasionally.
These tumors exceptionally grow to large sizes like this. There are very few cases cited with
such impressive dimensions.
Complete surgical resection is usually curative, but local recurrences have been reported.
Resection of the solitary fibrous pleural tumors is generally easy. Large tumors may be
difficult to resect because of extensive adhesions and highly vascular pedicle. The underlying
lung parenchyma can be fully preserved. High operative mortality is due to compression of
mediastinal structures leading to fatal cardiopulmonary complications.
Conclusions
Localized fibrous tumors are considered benign, but malignant cases have been reported.
Benign fibrous tumors of the pleura are unrelated to asbestos exposure. Complete en bloc
surgical resection is usually curative.

THE ROLE OF THE GEROULANOS PROCEDURE IN THE TREATMENT OF LUNG


HYDATIC CYST TODAY
G.V.Cozma, O.N.Burlacu, V.T.Voiculescu, C.P.Tunea, I.Miron, I.A.Petrache, M.Butas, A.C.
Nicodin
Thoracic Surgery Department, Municipal Hospital, Timisoara
Introduction :
Lung hydatidosis still represents an endemic problem in South-Eastern Europe, a real
challenge for the thoracic surgeon, concerning both the surgical technique and the optimal
recovery of the lung parenchyma.
Objectives :
The purpose of this article is to point out the advantages and relevance of the Geroulanos
technique in resolving the remaining cavity after the surgical treatment of the pulmonary
hydatid cyst.
Method :
Our experience consists in 93 surgical procedures for lung hydatidosis between 2001-2010, 33
of which were solved by using the Geroulanos technique (35,48%) after cystectomy. We
present statistics according to sex, age groups, affected hemithorax, surgical access and
surgical techniques.
Results :
All the cases had good outcome. The technique was clearly succesful in young patients (12
patients under 20 years old). The main advantages are the natural, step-by-step lung reexpansioning, wihtout artificially modifiying the lung architecture, thus avoiding
complications that occur after other techniques, with very good conservation of lung
parenchyma. In the cases with giant hydatic cysts, the Geroulanos technique allowed sparring
of lung parenchyma by avoiding extended lung resections. The main disadvantage of the
technique is a longer recovery that involves a prolonged evaluation of the patient and of the
drainage.
Conclusions :
Although the Geroulanos technique can be considered of historical interest, in selected
patients it can have optimal results, with both anatomical and functional lung conservation,
also avoiding some of the postoperative complications frequent in other techniques. The only
notable disadvantage is the prolonged recovery time.

ROLE OF MUSCLE FLAPS IN THE TREATMENT OF UNRESECTABLE ABSCESSES


Boianu Petre Vlah-Horea, Boianu Alexandru-Mihail, Gliga Mirela, Ionic Sebastian,
Chiujdea Drago, Lucaciu Oana, Hogea Timur, Batog Olivia
Discipline Surgery 4, University of Medicine and Pharmacy from Targu-Mures
Introduction. The treatment pulmonary abscesses still remains a challenge for actual thoracic
surgery. We report our experience in using muscle flaps for the filling of unresectable
pulmonary abscesses.
Material and method. During the last 9 years we have used different muscle flaps (intercostal,
serratus anterior and latissimus dorsi) in 14 patients with unresectable primary pulmonary
abscesses. Muscle transposition was used alone (3 cases) or during thoracomyoplasties for
lung abscesses complicated with empyema (11 cases). The objective of the procedure was

complete obliteration of the diseases space and closure-reinforcement of the bronchial fistula;
the choice of the flap was made according to the local anatomy. Preoperative preparation was
made by daily lavages with antibiotics and disinfectants, including transparietal punction
using ultrasound guidance.
Results. We have encountered no mortality and no major complications. Hospitalisation
ranged between 25 and 46 days. At late follow-up (6 month 9 years) we encountered no
recurrence and no major sequelae.
Conclusions. The use of muscle flaps is a valuable solution for unresectable pulmonary
abscesses if the preoperative preparation is an adequate one. Compared to the classic
techniques, the extensive mobilization of the flaps offers a good-quality biological material
with considerable volume.

REVERSAL OF THE FLOW IN THE THORACIC DRAINAGE SYSTEM RARE


POSTOPERATIVE ACCIDENT
Boianu Alexandru-Mihail, Boianu Petre Vlah-Horea, Lucaciu Oana, Chiujdea Drago
Discipline Surgery 4, University of Medicine and Pharmacy from Targu-Mures
Introduction. In thoracic surgery there are many possible accidents, including some with no
relationship with the activity of the medical stuff.
Material and method. We report a 22 years-old male who underwent a thoracotomy for a
closed thoracic trauma with fracture of ribs 4, 5, 6 and 7, with tube thoracostomy performed
in onether unit, with 4 pulmonary lesions rib cerclage, pulmonary suture and removal of the
clot and remnant hemothorax. On the 2nd postoperative day, during some unexpected
technical revisions at the central aspiration system, a reversal of the flow in the thoracic
drainage system ocurred, with introduction of air under positive pressure inside the chest of
the patient.
Results. The patient presented intense pain, dyspnea and extended subcutaneous emphysema.
A few minutes after this accident the thoracic drainage system was disconnected, followed by
passive (underwater) drainage, then by active aspiration under negative pressure using a
portable electric system; for the subcutaneous emphysema we placed subcutaneous needles.
The evolution was favourable, with reexpansion of the lung, resolution of the subcutaneous
emphysema, development of pneumonia on the operated lung with resolution under antibiotic
treatment and removal of the drains on postoperative day 10.
Conclusions. Any repairs at the central aspiration system must be announced, especially in the
units with patients under thoracic drainage. Some apparently minor technical incidents may
endanger the life of the patients.

TUMORI MEDIASTINALE RARE: CHIST BRONHOGENETIC SI BOALA


CASTLEMAN MEDIASTINALA
Andrei Cristian Bobocea, Radu Matache, Ion Jentimir, Ioan Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
Introducere
Diagnosticul diferential al tumorilor mediastinale cuprinde peste 30 de afectiuni, dintre care
cele mai frecvente sunt limfoamele, gusa mediastinala, timoamele, si, cele mai rare, boala
Castleman sau chistul bronhogenetic.
Boala Castleman este o maladie limfoproliferativa rara, denumita si hiperplazie limfonodulara angiofoliculara.
Chistul bronhogenetic, desi o patologie rara, reprezinta cea mai frecventa cauza de leziune
chistica de la nivelul mediastinului.
Prezentare de cazuri
Un barbat de 45 de ani cu dispnee se prezinta cu o tumora mediastinala ce sugera un timom.
Prin toracotomie posterolaterala tumora a fost excizata complet. Rezultatul anatomopatologic
al specimenului pune diagnosticul de boala Castleman.
femeie de 65 de ani se prezinta cu o tumora mediastinala ce comprima traheea, diagnosticata
drept chist bronhogenetic. Se rezeca in totalitate chistul transcervical cu remisia simptomelor
de dispnee.
Discutii
Primul simptom al tumorilor mediastinale este dispneea, odata cu compresia extrinseca a
cailor respiratorii.
Boala Castleman este un tip de tumora limfoida in principal localizata la nivelul toracelui.
Varianta unicentrica este focalizata la nivelul mediastinului sau a hilului pulmonar. Alte
localizari sunt gatul, pelvisul, retroperitoneul sau axila.
Chistul bronhogenetic este diagnosticat ecografic in perioada prenatala sau ocazional
radiologic in copilarie sau adolescenta. La pacientii in varsta, sunt de regula diagnostice rare.
Localizarile extratoracice includ gatul, abdomenul sau spatiul retroperitoneal. Chisturile
mediastinale sunt predominant subcarinale si paratraheale; cazuri intrapulmonare sunt citate.
Rezectia lor completa se realizeaza cel mai frecvent prin toracotomie.
Concluzii
Boala Castleman mediastinala este o entitate rara, diagnosticata cel mai frecvent dupa debutul
unor simptome toracice nespecifice: dispnee, tuse, durere.
Chistul mediastinal este identificat rar la pacienti in varsta cand acesta produce compresie
asupra cailor aeriene.
Rezectia chirurgicala completa este curativa pentru acest tip de tumori mediastinale. In
cazurile in care se practica o rezectie subtotala, recidive pe termen scurt au fost raportate.

DRENAJUL PERICARDIC N REVRSATELE MALIGNE REZULTATE PRECOCE


Cezar Mota, Natalia Mota, Mihnea Davidescu, Ovidiu Rus, Elena Moise, Andreea tefan,
David Achim, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
Introducere: Pericardita lichidian la pacienii neoplazici este o complicaie potenial letal.

Material i metod: ntre martie 2010 i august 2011 am efectuat 27 drenaje pericardice la 25
pacieni (14 brbai i 11 femei) cu pericardite lichidiene i neoplasme cunoscute: 18
pulmonare, 5 mamare, 1 de col uterin i 1 de buz.
Drenajul pericardic a fost efectuat n urgen imediat n 11 cazuri de tamponad cardiac (2
tamponade localizate) i n urgen amnat la 16 pacieni.
Procedee de drenaj: 17 aborduri paraxifoidiene (62,96%), 5 fenestrri pericardo-pleurale
toracoscopice (18,51%), 2 drenaje prin cateter percutan (7,4%), 2 aborduri subxifoidiene cu
rezecia xifoidului (7,4%) i 1 fenestrare pericardic prin toracotomie stng (3,7%).
Cele 17 drenaje paraxifoidiene au fost efectuate sub anestezie local, la care n 10 cazuri a fost
adugat analgezia i.v. pentru confortul pacientului. Am efectuat 3 pericardoscopii
paraxifoidiene (17,64%).
Rezultate: Cantitatea medie de lichid pericardic evacuat intraoperator a fost de 845ml. Am
efectuat biopsie pericardic n 25 cazuri n doar 6 cazuri histologia a fost malign (24%).
Citologia a fost malign n 16 din 19 cazuri (84,21%).
Mortalitatea intraoperatorie a fost zero; mortalitatea postoperatorie imediat a fost 3,7% (1
deces la 9h dup masaj cardiac intern pentru stop cardiac n tamponad).
n 14 cazuri, pericardita a fost asociat cu pleurezie: n 5 cazuri s-a efectuat fenestrare
pericardo-pleural prin toracoscopie (anestezie general) iar la 9 pacieni starea general a
impus doar anestezie local, pleurezia fiind drenat prin pleurotomie minim asociat.
Am avut 1 caz cu dubl recidiv a pericarditei neoplazice (dup drenaj paraxifoidian i
pericardocentez eco-ghidat) cu tamponad localizat la emergena marilor vase ce a impus
pericardectomie parial stng prin toracotomie.
Concluzii: Deoarece permite biopsierea facil a pericardului, abordul paraxifoidian este extrem
de util n drenajul pericarditelor maligne. Endoscopul cu vedere la 0 grade nu este potrivit
pentru pericardoscopie paraxifoidian.

TRIPL LEZIUNE TRAHEO-BRONIC POST-MEDIASTINOSCOPIE I EBUS


Natalia Mota, Cezar Mota, Ovidiu Rus, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Bucureti
Introducere: Mediastinita purulent reprezint o afeciune grav cu mortalitate mare chiar i n
cazul pacienilor corect tratai.
Material i metod: Pacient de 61 de ani este internat n urgen pentru dispnee, tuse,
expectoraie purulent i plag cervical inferioar suflant, cu secreii purulente. n urm cu 6
zile s-a practicat n afara tarii o mediastinoscopie Carlens pentru o tumor mediastinal
subcarenal. nainte de aceasta se practicase o biopsie transbronic ecoghidat cu rezultat
histologic incomplet (celule limfoide). Pacienta este sub insulino-terapie pentru diabet zaharat
i corticoterapie pentru pemfigus paraneoplazic.
Rezultate: Investigaiile paraclinice arat pneumomediastin cu extensie cervical, cartilaje
traheale distale rupte i dou soluii de continuitate traheo-bronice, comunicante cu
mediastinul i mrginite de esut de granulaie. Se confirm diagnosticul de mediastinit acut
purulent prin rupturi traheo-bronice. Se practic drenaj mediastinal transcervical cu tub
siliconat, lavaje repetate reduse cantitativ i aspiraii repetate traheo-bronice, alturi de terapie
intensiv specific. n ciuda tuturor eforturilor, dup 18 zile pacienta decedeaz n urma unui
stop cardio-respirator. Rezultatul histologic n urma mediatinoscopiei este de limfom Hodgkin.
Concluzii: Leziunile traheo-bronice iatrogene nerecunoscute pot avea consecine catastrofice
prin costuri ridicate medico-economice i decesul pacienilor.

PSEUDOMEZOTELIOM PLEURAL MALIGN


Mihnea Davidescu, Elena Moise, Ovidiu Rus, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
Introducere
Aspect pseudomezoteliomatos pot avea metastazele pleurale ale tumorilor pulmonare
(adenocarcinom), tumorilor vasculare maligne, sarcomului sinovial, timomului i limfomului
malign.
Melanomul malign este o tumor agresiv ce metastazeaz rapid cu inciden n cretere n
ultimile decade. Determinrile secundare apar cel mai frecvent la nivelul plmnilor, ficatului,
creierului i oaselor. Afectarea singular a pleurei este foarte rar.
Material i metod
Prezentm cazul unei paciente n vrst de 59 de ani ce s-a internat n clinica noastr
prezentnd dispnee la eforturi mici, disfonie cu debut n urm cu trei luni. A fost diagnosticat
cu pleurezie stnga i tratat conservator n teritoriu cu recidiva pleureziei n ciuda
toracocentezelor repetate. Aspectul radiologic a evoluat de la pleurezie mare, fr afectare
evident a pleurei, la pleurezie redus cantitativ cu seroas pleural mult ngroat i ncarcerea
plmnului; evoluie caracteristic unui mezoteliom malign difuz.
Din antecedentele personale sunt de menionat un melanom malign de flanc abdominal drept
operat n iunie 2008, imunotratat alfa interferon, HTA, arteriopatie cronic obliterant.
Rezultate
Pentru confirmarea diagnosticului se decide efectuarea unei biopsii pleurale incizionale. Se
evideniaz pleura ingroat tumoral de culoare brun nchis. Rezultatul examenului
histopatologic a fost de metastaz de melanom malign.
Concluzii
Dei foarte rar, melanomul malign poate fi o cauz de pseudo-mezoteliom intrnd n
diagnosticul diferenial al acestuia mai ales la pacieii cu antecedente de melanom malign.
Prognosticul pseudomezotelioamelor este de regul nefavorabil, asemntor cu cel al
mezotelioamelor, dar exist i unele excepii ca limfoamele sau timoamele maligne.
Trebuie ntodeauna obinut confirmarea histologic a unei suspiciuni diagnostice indiferent ct
de sugestive sunt aspectele clinice i imagistice, pentru a se putea efectua un tratament corect,
intit.

DISTROFIA BULOAS DE LOB MEDIU


Corina Bluoss, David Achim, Elena Moise, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
Introducere: Distrofia buloas este o malformaie congenital rar descoperit la nou-nscut.
Material i metod: Autorii prezint cazul unei paciente n vrst de 33 ani, fr APP
semnificative, internat n clinic pentru hemoptizii, junghi toracic drept persistent, febr i
dispnee de efort, simptomatologie ce a debutat brusc cu 3 sptamni anterior prezentrii. Sub
tratament antibiotic, simptomatologia clinic se remite, dar persist modificrile radiologice.
Rezultate:La analizele de laborator se constat leucocitoz i fibrinogen crescut.

Radiografia toracic evideniaz mai multe caviti cu nivele hidroaerice situate n treimea
inferioar a cmpului pulmonar drept.
CT torace cu substan de contrast relev caviti cu nivel hidroaeric la nivelul lobului
mediu(dimensiuni maxime 9.2/11.7cm), cu coninut fluid i parafluid.
Bronhoscopic se evideniaz secreii mucopurulente n lobara medie i bazalele drepte (examen
microbiologic: Str. Pyogenes i Candida albicans).
Intraoperator se constat bule de emfizem de diferite dimensiuni, localizate la nivelul lobului
mediu, una dintre ele depaind puin scizura la nivelul lobului superior. Se practic lobectomie
medie i rezecie atipic lob superior drept.
Evoluia postoperatorie este favorabil.
Concluzii: Particularitatea cazului este reprezentat de descoperirea la vrsta adult a unei
malformaii congenitale (distrofia buloas) care a debutat prin hemoptizie.

ASPECT IANUSIAN DE PATOLOGIE TIROIDIAN


Elena Moise, Cezar Motas, Ovidiu Rus, Teodor Horvat
Clinica de Chirurgie Toracic, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu
Bucureti
Introducere
Nodulii tiroidieni sunt anomalii structurale ale tiroidei, identificati fie prin palpare fie in cadrul
unei ecografii tiroidiene.
Tuberculoza este o boala infectioasa contagioasa, provocata de Mycobacterium tuberculosis.
Tuberculoza pulmonara este cel mai comun tip al bolii, dar sunt si localizari extrapulmonare:
meningita tbc, peritonita tbc, pericardita tbc, tbc miliara, renala, osoasa si articulara,
gastrointestinala, hepatica, ganglionara.
Metod
Prezentm cazul unei paciente n vrst de 53 de ani, cu nodul tiroidian stang in observatie de
10 ani, ce se interneaz n clinica noastr prezentnd disfagie. Investigatiile paraclinice prezinta
imagini compatibile cu nodul de pol inferior tiroidian stang, plonjant in mediastin. Examen Hp
prin punctie cu ac fin: tiroidita cronica.
Rezultate
S-a decis intervenia chirurgical, intraoperator constatandu-se lob stang tiroidian modificat
inflamator; la polul inferior formatiune tumorala dura la palpare, cu diametru de 3 cm, cu
extensie in mediastin.
Se practica hemitiroidectomie stanga si exicizia formatiunii tumorale. Examenul histopatologic
extemporaneu, confirmat ulterior la parafina: adenita TBC.
Concluzii
Acest caz atrage atenia asupra unei localizari rare, dar posibil, a tuberculozei.
Pacienta a fost o perioada indelungata tratata pentru nodul tiroidian, stabilindu-se cu ocazia
interventiei chirurgicale diagnosticul si ulterior tratamentul adecvat.

TUMORA FIBROASA SOLITARA PLEURALA GIGANTA PREZENTARE DE CAZ


Radu Matache, Andrei Cristian Bobocea, Ioan Cordos
Clinica 1 Chirurgie Toracic, Institutul Naional de Pneumologie Marius Nasta, Bucureti
Introducere
Tumorile pleurale fibroase solitare, numite in trecut si mezotelioame benigne, sunt neoplasme
rare. Desi majoritatea sunt benigne, malignizari au fost raportate in trecut. Aproximativ 600 de
cazuri au fost citate in literatura pana in prezent.
Prezentare de caz
Prezentam cazul unei femei tinere cu o tumora giganta pleurala fibroasa solitara. Examenul CT
toracic evidentiaza o masa tumorala heterogena bine delimitata ocupand intreg hemitoracele
stang. Tumora a fost diagnosticata in urma cu trei ani, avea dimensiuni mult mai mici, dar
pacienta a refuzat interventia chirurgicala.
S-a realizat excizia completa a tumorii prin toracotomie posterolaterala. Dimensiunile tumorii
au fost de 32/25/15 cm si a cantarit 4500 grame. Radiografia toracica postoperatorie a aratat
expansionare completa a parenchimului pulmonar stang. Cazul a avut o evolutie simpla.
Rezultatul anatomopatologic a fost de tumora pleurala fibroasa solitara.
Discutii
Tumorile primitive pleurale sunt difuze sau solitare. Tumorile difuze sunt mezotelioamele: se
asociaza cu expunerea la azbest si sunt fatale. Tumorile fibroase solitare sunt formatiuni rare,
benigne, fara relatie cu expunerea la azbest sau fumatul. Ele deriva din celule stem
fibroblastice, dar pot suferi mutatii succesive si pot maligniza. Sunt asimptomatice, iar tusea,
durerea sau dispneea apar rar.
Aceste de tumori ajung rareori la dimensiuni importante cum sunt cele ale cazului de fata. Sunt
doar cateva cazuri citate in literatura cu astfel de diametre impresionante.
Rezectia chirurgicala completa este de obicei curativa, dar au fost citate si recidive. Excizia
totala a unei formatiuni fibroase pleurale facila. Tumorile voluminoase sunt greu de manipulat,
pot avea aderente stranse sau un pedicul bine reprezentat. Parenchimul pulmonar subiacent
poate fi salvat in totalitate. Mortalitatea operatorie este data de compresia structurilor
mediastinale cu complicatii cardio-pulmonare fatale.
Concluzii
Tumorile pleurale fibroase solitare sunt benigne, desi cazuri maligne au fost citate. Ele nu sunt
legate de expunerea la azbest. Excizia chirurgicala completa este curativa.

ROLUL ACTUAL AL PROCEDEULUI GEROULANOS IN TRATAMENTUL


CHIRURGICAL AL CHISTULUI HIDATIC PULMONAR
G.V.Cozma, O.N.Burlacu, V.T.Voiculescu, C.P.Tunea, I.Miron, I.A.Petrache, M.Butas, A.C.
Nicodin
Clinica de Chirurgie Toracic, Spitalul Municipal, Timioara
Introducere
Chistul hidatic pulmonar constituie inca o problema endemica pentru sud-estul Europei, iar
pentru chirurgul toracic o provocare tehnica, de rezolvare si recuperare optima a
parenchimului pulmonar.
Obiective

Autorii doresc sa evidentieze avantajele si actualitatea procedeului Geroulanos pentru


rezolvarea cavitatii restante dupa tratarea hidatidei.
Metoda
In Clinica de Chirurgie din Timisoara s-au efectuat in perioada 2001-2010, 93 de interventii
chirurgicale pentru hidatidoza pulmonara. Dintre acestea in 33 de cazuri (35,48%), s-a utilizat
procedeul Geroulanos pentru rezolvarea cavitatii restante postchistectomie. Sunt prezentate
statistici in functie de sex, grupe de varsta, hemitoracele afectat, cai de acces utilizate.
Rezultate
Toate cazurile au evoluat favorabil. Procedeul a fost utilizat cu succes la tineri (12 pacienti
sub 20 ani). Avantajele principale ale tehnicii mentionate constau in expansionarea treptata si
naturala a parenchimului pulmonar, fara modificarea artificiala a arhitecturii
bronhopulmonare. In consecinta au putut fi evitate complicatiile survenite dupa alte procedee,
iar parenchimul pulmonar este conservat integral. In chistele de mari dimensiuni, procedeul
Geroulanos a permis evitarea unor rezectii pulmonare intinse. Dezavantajul principal al
tehnicii este reprezentat de perioada mai indelungata de recuperare care implica si o
monitorizare prelungita a pacientului si a tubului de dren.
Concluzii
Desi procedeul Geroulanos poate fi considerat de interes istoric, in cazuri selectionate, poate
da rezultate excelente, cu recuperare functionala si conservare maxima a parenchimului
pulmonar. Sunt evitate unele complicatii postoperatorii, intalnite dupa alte procedee. Singurul
dezavantaj notabil este timpul prelungit de vindecare.

ROLUL LAMBOURILOR MUSCULARE N TRATAMENTUL ABCESELOR


PULMONARE NEREZECABILE
Boianu Petre Vlah-Horea, Boianu Alexandru-Mihail, Gliga Mirela, Ionic Sebastian,
Chiujdea Drago, Lucaciu Oana, Hogea Timur, Batog Olivia
Disciplina Chirurgie 4, Universitatea de Medicin i Farmacie din Trgu-Mure
Introducere. Tratamentul abceselor pulmonare constituie o problem major pentru chirurgia
toracic actual. Prezentm experiena noastr n folosirea lambourilor musculare pentru
plombajul unor abcese pulmonare nerezecabile.
Material i metod. n ultimii 9 ani am folosit lambouri musculare (intercostal, dinat anterior
i mare dorsal) la 14 pacieni cu abcese pulmonare primare nerezecabile. Transpoziia
muscular a fost folosit ca singur gest terapeutic (3 cazuri) sau n cadrul unor
toracomioplastii pentru abcese complicate cu empiem (11 cazuri). Obiectivul interveniei a
fost obliterarea complet a spaiului patologic i sutura-asigurare a fistulei bronice iar
alegerea lamboului s-a fcut n funcie de anatoma local. Pregtirea preoperatorie s-a
efectuat prin lavaje zilnice cu antibiotice i dezinfectante, inclusiv prin puncie transtoracic
sub ghidaj ecografic.
Rezultate. Nu am nregistrat mortalitate postoperatorie i nici complicaii majore. Durata
spitalizrii a variat ntre 25 i 46 de zile. La urmrirea tardiv (6 luni 9 ani) nu am nregistrat
recidive i nici sechele majore.
Concluzii. Lambourile musculare constituie o soluie viabil n cazul abceselor pulmonare
nerezecabile cu condiia unei pregtiri preoperatorii adecvate. Fa de tehnicile clasice,
mobilizarea extensiv a lambourilor ofer un material biologic de bun calitate i volum
apreciabil.

INVERSAREA FLUXULUI N SISTEMUL DE DRENAJ TORACIC ACCIDENT


POSTOPERATOR RAR
Boianu Alexandru-Mihail, Boianu Petre Vlah-Horea, Lucaciu Oana, Chiujdea Drago
Disciplina Chirurgie 4, Universitatea de Medicin i Farmacie din Trgu-Mure
Introducere. n chirurgia toracic exist numeroase accidente posibile, unele fr legtur cu
activitatea personalului medical.
Material i metod. Prezenm cazul unui pacient de 22 de ani la care s-a efectuat toracotomie
pentru traumatism toracic nchis cu fractur C4-5-6-7 drenat la un spital orenesc cu 4
leziuni pulmonare pentru care s-a practicat cerclajul coastelor, pneumorafie, evacuarea
cheagului i a hemotoracelui restant. n ziua a 2-a postoperator, pe fondul unor reparaii
neanunate la sistemul central de aspiraie, s-a produs inversarea fluxului n sistemul de drenaj
toracic cu introducerea de aer sub presiune extrem n toracele pacientului.
Rezultate. Pacientul a prezentat durere atroce, dispnee i emfizem subcutanat extins. La
cteva minute de la accident s-a decuplat trusa de aspiraie, trecndu-se la drenaj pasiv (sub
ap) apoi la aspiraie negativ folosind o aspiraie electric portabil; pentru emfizemul
subcutanat s-au plasat ace. Evoluia ulterioar a fost favorabil, cu reexpansionarea
plmnului, resorbia lent a emfizemului subcutanat, apariia unor focare de pneumonie pe
plmnul operat care s-au remis sub tratament medicamentos i extragerea drenurilor n ziua a
10-a postoperator.
Concluzii. Reparaiile la sistemul central de aspiraie trebuiesc anunate prealabil, n special n
serviciile unde exist pacieni cu drenaj toracic. Incidente tehnice aparent minore pot pune n
pericol imediat viaa pacienilor.