Carte Rezumate 2012

Organizator
Societatea Romn de Chirurgie Toracic 1994

Preedintele Congresului - Prof. Dr. Ioan Cordo
Comitet de organizare:
Dr. Ciprian Bolca
Dr. Andrei Bobocea
Dr. Mihai Dumitrescu
Dr. Cezar Mota
Dr. Cristian Paleru
Comitet tiinific:
Prof. Dr. Alexandru Boianu
Prof. Dr. Ioan Cordo
Prof. Dr. Teodor Horvat
Prof. Dr. Alexandru Nicodin
Dr. Cristina Grigorescu
Dr. Cristian Paleru
Cultura, la dub!...sau n lumi paralele

Deunzi, cnd n timpul unui
protest mai mult sau mai puin panic,
jandarmii eliberau cu srg Piaa
Universitii ajutai de materiale de
specialitate: dube, bastoane etc. un
tinerel sfrijit ncerca s le explice, n
timp ce era ndemnat cu delicateea tipic forelor de ordine spre incinta
unui mijloc de transport, c nu face parte dintre protestatani ci este
reprezentantul unui site cultural. Ce, cultural... cultura la dub! a fost
rspunsul mai mult dect pertinent al jandarmului care fcea triajul...
i totui...n aceste vremuri n care cuvntul dat conteaz mai
puin dect n oricare perioad istoric, cnd profesionistii sunt acuzai
c nu sunt ndeajuns de vocali (cnd? n acelai timp n care ncearc si exercite profesia la cote maxime?), cnd argumentele logice cedeaz
prea lesne n faa tonului ridicat sau al unui bombardament telefonic,
cnd o strngere de mn echivaleaz de prea multe ori cu un cuit
nfipt n spate iar apartenena la un grup sau partid nu conteaz care
att timp ct traseismul este confundat cu abilitatea politic in loc de
instrucie, moralitate sau talent...n aceste vremuri, dup cum spuneam,
mai exist i profesioniti, oameni care n-au cedat tentaiei de a folosi
locul de minim rezisten, medici care n-au vzut n pacient un fel de
obiect al muncii ci un semen n suferin, n cutarea unui sprijin oferit
cu dezinteres, responsabilitate i compasiune, chirurgi ai vremurilor
actuale ba uneori cu un pas nainte, pentru acetia ne strduim s

organizm i-i invitm s participe la Cea de-a X-a Conferin
Naional de Chirurgie Toracic cu participare Internaional, care se va
desfura la Sala Parlamentului din Bucureti n perioada 4 6
octombrie 2012.
La Conferin sunt invitai nu numai chirurgii toracici, membri
ai Societii Romne de Chirurgie Toracic, ci toi profesionitii
implicai n managementul afeciunilor toraco-pulmonare, fie ele
benigne
sau
maligne:
pneumologi,
bronhologi,
exploraioniti,
anatomopatologi, oncologi, specialitii de anestezie i terapie intensiv,

fizioterapeui.
Vom avea ocazia s audiem conferine sunsinute de maetri ai
chirurgiei toracice, din ar i strintate (o parte dintre aceia care au
scris crile!), s ne prezentm activitatea, s mprtim din experiena
acumulat, s ne cunoatem mai bine i nu n ultimul rnd, s
planificm mersul viitor al specialitii noastre pentru a fi ntru totul
europeni.
Aadar, notai n agenda dumneavoastr data de 4 octombrie
cnd ne vom ntlni cu mare bucurie n lumea noastr pentru a tri
momente memorabile. Pn atunci v dorim mult sntate i spor n
toate succese profesionale nebnuite i idei inedite ntr-ale tiinei.
Preedintele Societii Romne de Chirurgie Toracic 1994
Prof. Dr. Ioan Cordo
PROGRAM
TIINIFIC
JOI, 4 OCTOMBRIE 2012

18.00 - Adunarea General a Membrilor Societii Romne de
Chirurgie Toracic 1994
19.00 - Ceremonia i Cocktail-ul de deschidere
VINERI, 5 OCTOMBRIE 2012

09.00 11.00 - Conferine - Sesiunea I
Moderatori: Alper Toker, Ioan Cordo
9.00 9.30
Alexandru Boianu
Staplerele n chirurgia toracic dezvoltare istoric i noi concepte
9.30 10.00
Marcin Zielinski
Comparison of Endobronchial Ultrasound (EBUS) and/or
Endoesophageal Ultrasound (EUS) with Transcervical Extended
Mediastinal Lymphadenectomy (TEMLA) for Staging and Restaging of
Non-Small Cell Lung Cancer (NSCLC)
10.00 10.30
Jos Belda-Sanchis
Surgical controversies in N2 lung cancer patients. Who is wrong and
who is rigth
10.30 11.00
Teodor Horvat
Hidrotoraxul hepatic
11.00 11.30 Pauz de cafea
11.30 13.30 - Conferine - Sesiunea II

Moderatori: Marcin Zielinski, Cristian Paleru
11.30 12.00
Philippe Dartevelle
TO BE ANNOUNCED
12.00 12.30
Philippe Dartevelle
TO BE ANNOUNCED
12.30 13.00
Ioan Cordo
Indicaiile chirurgicale n cancerul bronhopulmonar
13.00 13.30
Techno-meeting - MEDELA
13.30 15.30 Pauz de prnz
15.30 17.30 - Lucrri - Sesiunea I
Moderatori: Jos Belda-Sanchis, Teodor Horvat
15.30 15.40
Particularitati ale interventiiilor operatorii pe plamanul unic
chirurgical
Teodor Horvat, Cezar Mota, Natalia Mota, Corina Bluoss, Mihnea
Davidescu, Elena Moise, Ovidiu Rus
Clinica de Chirurgie Toracic, Institutul Oncologic Bucureti
15.40 15.50
Fistul eso-cavitar dreapt dup tuberculoz pulmonar bilateral
Eustaiu Memu1, Dnu Popovici1, Simona Cismaru2, Maria Mihrtescu3
1
Secia Chirurgie, 2Secia Anestezie-Terapie Intensiv, 3Secia

Pneumologie I, Spitalul Judeean de Urgen Drobeta-Turnu Severin
15.50 16.00
Chistul hidatic de dom hepatic abordarea chirurgului toracic
Clin unea, Ovidiu Burlacu, Gabriel Cozma, Voicu Voiculescu, Iris
Miron, Ioan Petrache, Alexandru Nicodin
Clinica de Chirurgie Toracic, Spitalul Municipal Timioara
16.00 16.10
Indicaii i rezultate ale toracotomiilor bilaterale n aceeai edin
operatorie
Boianu Alexandru-Mihail, Lucaciu Oana, Hogea Timur, Batog Olivia,
Giurgiu Ioana, Boianu Petre Vlah-Horea
Clinica Chirurgie IV, UMF Trgu-Mure
16.10 16.20
Hemangiopericitomul malign surpriza din "spatele" pneumoniei
Iulian Mihai Rdulescu, Mihaela Codrei, Adrian Mihail Iordache, Ioan
Cordo
Clinica de Chirurgie Toracic, Institutul Naional de Pneumologie
Marius Nasta, Bucureti
16.20 16.30
Importana autofluorescenei n evaluarea bronhoscopic a cancerului
bronho-pulmonar
Natalia Mota, Cezar Mota, Ovidiu Rus, Elena Moise, Teodor Horvat
16.30 16.40
Pectus carinatum pur (neasociat cu pectus excavatum)
rezolvat prin mirpc (minimally invasive repair of pectus carinatum)
Alin Demetrian1, Dan Ulmeanu1, Monalisa Enache2, Andreea-Lavinia Vnvu2
1
Clinica de Chirurgie Toracic, 2Clinica ATI, UMF Craiova
16.40 16.50
Reconstructie diafragmatica cu muschi latissimus dorsi in tumorile
pulmonare drepte cu invazie hepatica
Cristian Paleru1, Gabriel Mitulescu2, Adrian Istrate1, Ianos Pahomea2
1
Marius Nasta, Bucureti, 2Institutul Clinic Fundeni, Centrul de
Chirurgie Generala si Transplant Hepatic Dan Setlacec, Bucureti
16.50 17.00
Liposarcoamele mediastinului anterior
Cezar Mota, Natalia Mota, Ovidiu Rus, Elena Moise, Teodor Horvat
17.00 17.10
Aspecte clinice i imagistice la supravieuitorii de lung durat dup
toracoplastie cu plombaj pentru tuberculoz
Boianu Petre Vlah-Horea, Hogea Timur, Batog Olivia, Lucaciu Oana
Raluca, Giurgiu Ioana, Naftali Zoltan, Boianu Alexandu-Mihail
Disciplina Chirurgie IV, UMF Trgu-Mure
17.10 17.20
Sindromul Maffucci, entitate rara in chirurgia toracica
Felix Dobritoiu, Ioan Cordos, Codin Saon, Adrian Mihail Iordache,
Valerian Pavaloiu
17.20 17.30
Cervico - mediastinit acut descendent necrozant cu empiem
pleural bilateral i eroziune septic de ven jugular anterioar
dreapt i confluent venos jugulo-subclavicular pirogoff drept
Iris Miron, Ovidiu Burlacu, Ioan Petrache, Alexandru Nicodin
Gala dinner 19.00
SMBT, 6 OCTOMBRIE 2012

09.00 11.00 - Conferine - Sesiunea III
Moderatori: Teodor Horvat, Alexandru Boianu
9.00 9.30
Cristina Grigorescu
Actualiti medico-chirurgicale n LVRS (lung volume reduction
surgery)
9.30 10.00
Alper Toker
TO BE ANNOUNCED
10.00 10.30
Ion-Christian Chiricu
Actualiti n radioterapia 3D conformaional i cu intensitate
modulat n radioterapia cancerului broncho-pulmonar
10.30 11.00
Genoveva Cadar
Ventilaia unipulmonar n chirurgia toracic
11.30 13.00 - Lucrri Sesiunea II
Moderatori: Philippe Dartevelle, Ioan Cordo
11.30 11.40
Chirurgia timoamelor
11.40 11.50
Abordului transcervical minim invaziv al bronsiei primitive drepte.
Aspecte tehnice.
Cristian Paleru, Ioan Cordo, Olga Dnil, Mihai Dumitrescu, Adrian Istrate

11.50 12.00
Poate fi chirurgul toracic un bun bronhoscopist?
Voicu Voiculescu, Ioan Petrache, Ovidiu Burlacu, Clin unea, Gabriel
Cozma, Iris Miron, Alin Nicola, Alexandru Nicodin
12.00 12.10
Rezecii-reconstrucii parietale largi cu sistemul stratos
Mihnea Davidescu, Elena Moise, Ovidiu Rus, Teodor Horvat
12.10 12.20
Carcinoid tipic la un pacient tanar
Codin Saon, Valentin Soldea, Felix Dobritoiu
12.20 12.30
Chirurgia leziunilor TBC suprainfectate cu Aspergillus
Boianu Alexandru-Mihail, Boianu Petre Vlah-Horea, Lucaciu Oana
Raluca, Hogea Timur, Batog Olivia, Giurgiu Ioana
12.30 12.40
Miastenia Gravis dup timomectomie
12.40 12.50
Chirurgia toracoscopica uniportala
Gabriel Cozma, Ovidiu Burlacu, Ioan Petrache, Clin unea, Voicu
Voiculescu, Iris Miron, M. Butas, Alexandru Nicodin
Clinica de Chirurgie Toracic, Spitalul Municipal, Timioara
12.50 13.00
Toracomioplastia ca re-reinterveie
Boianu Petre Vlah-Horea, Boianu Alexandu-Mihail
SESIUNEA POSTERE
Chirurgia toracic miniinvaziv n tratamentul pleuro-pericarditelor
maligne
Claudiu Nistor1, Adrian Ciuche1, Cezar Mota2, Teodor Horvat2
1
Spitalul Universitar de Urgen Militar Central Dr. Carol Davila,
2
Pneumotorax spontan secundar la un pacient cu histiocitoz pulmonar
X i diabet insipid
Claudiu Nistor, Adrian Ciuche, Dragos Marin, Daniel Pantile
Spitalul Universitar de Urgen Militar Central Dr. Carol Davila
Chirurgia de reducie volumic ntr-un caz de emfizem pulmonar i
insuficien respiratorie acut
Adrian Ciuche, Claudiu Nistor, Dragos Marin, Daniel Pantile
Autofluorescena n chirurgia toracic debut romnesc la IOB
Natalia Mota, Cezar Mota, Mihnea Davidescu, Ovidiu Rus, Elena
Moise, Teodor Horvat
Chist hidatic pulmonar suprainfectat cu aspergillus

Raluca, Hogea Timur, Batog Olivia
Politraumatism cu volet costal, hemopneumotorax i emfizem
subcutanat rezolvat prin drenaj, puncii repetate i stabilizare
pneumatic intern
Boianu Alexandru-Mihail, Boianu Petre Vlah-Horea, Batog Olivia,
Giurgiu Ioana
Lipom intratoracic stng gigant (17x10x8 cm)
Boianu Petre Vlah-Horea, Cerghizan Anda, Lucaciu Oana Raluca,
Boianu Alexandu-Mihail
Un caz rar de tumora inflamatorie miofibroblastica cu localizare
mediastinala
Gabriel Cozma, Ovidiu Burlacu, Ioan Petrache, M. Marc, Voicu
Voiculescu, Clin Tunea, Iris Miron, Alexandru Nicodin
Corpuri straine intratoracice 11 ani de experienta
Iris Miron, Ovidiu Burlacu, Clin Tunea, Voicu Voiculescu, Gabriel
Cozma, Ioan Petrache, Alin Nicola
Peste 2000 de cazuri de traumatisme toracice 10 ani de experienta a
unui singur centru
Alexandru Nicodin, Ovidiu Burlacu, Voicu Voiculescu, Gabriel Cozma,
Clin Tunea
Caz rar de prezentare a unui hemangioendoteliom malign
Ovidiu Rus, Cezar Motas, Natalia Mota, Teodor Horvat
Cinci toracotomii succesive ipsilaterale (la acelasi pacient). Prezentare

de caz si consideratii.
Cristian Paleru, Ioan Cordos, Olga Danaila, Mihai Dumitrescu, Valerian
Cristian Pavaloiu
Punctia biopsie transtoracica cu ac - experienta clinicii I Chirurgie
Toracica a Institutului National de Pneumologie "Marius Nasta"
Olga Danaila, Cristian Paleru, Ciprian Bolca, Mihai Dumitrescu, Adrian
Istrate, Valerian Cristian Pavaloiu, Ioan Cordos
Tehnici de osteosinteza costala si fixare chirurgicala a voletului costal.
Studiu experimental comparativ.
Bogdan Popovici, Mircea Ciorba, Angela Goia, Dan Nicolau
Sectia de Chirurgie Toracica, Spitalul Clinic Leon Daniello Cluj Napoca
13.00 13.30
Decernarea premiului Traian Oancea pentru cea mai bun
prezentare n cadrul sesiunilor de lucrri
nchiderea conferinei
REZUMATE
CONFERINE
LUCRRI
POSTERE
VINERI, 5 OCTOMBRIE 2012

09.00 11.00 - Conferine - Sesiunea I
Moderatori: Alper Toker, Ioan Cordo
9.00 9.30
Alexandru Boianu
Staplerele n chirurgia toracic dezvoltare istoric i noi concepte
9.30 10.00
Marcin Zielinski
Introduction
The aim of his study is to compare the diagnostic yield of
endobronchial ultrasound (EBUS) and/or endoesophageal ultrasound
(EUS) with transcervical extended mediastinal lymphadenectomy
(TEMLA) for staging and restaging of non-small cell lung cancer
(NSCLC)
Methods
All consecutive patients undergoing primary staging and
repeated staging (restaging) after neodjuvant chemo- or chemoradiotherapy for NSCLC from 1.1.2006 to 31.12.2010 were included.
Staging was started with EBUS, EUS or EBUS combined with EUS
(CUS) with fine needle aspiration (FNA) biopsy and cytological study.
Results
Primary staging was performed in 617 patients: EBUS in 375
patients, EUS in 48 patients and combined EBUS/EUS in 194 patients.
TEMLA was performed in primary staging in 475 patients. There was
no mortality and morbidity after EBUS/EUS. Two patients died after
TEMLA and morbidity rate after TEMLA was 6.6% . There was a
significant difference between EBUS/EUS and TEMLA for sensitivity
(88.9% and 95.8%; p=0.00) and Negative Predictive Value (NPV)

(84.1% and 99.6%; p = 0.00) in favor of TEMLA. In the restaging
group endoscopic staging was performed in 52 patients and TEMLA in
99. There was a significant difference between EBUS/EUS and
TEMLA for sensitivity (79.2% and 96.6%, p = 0.00) and NPV (84.5%
and 98.6%; p = 0.00) in favor of TEMLA.
Conclusions
The results of this largest reported series comparing the
endoscopic and surgical primary staging and restaging of NSCLC
showed a significant higher diagnostic yield of TEMLA in comparison
of EBUS/EUS.
10.00 10.30
Jos Belda-Sanchis
who is rigth
The role of surgery for cN2-positive, stage IIIA nonsmall cell
lung cancer (NSCLC) has evolved over the last decades moving from
primary treatment to a relevant role in multimodality management
strategies.
The 5-year survival following primary surgery for N2 NSCLC
ranges between 7 to 34% with better survival for patients with only one
mediastinal level involved (similar to multistation N1 disease),
microscopic or unexpected N2 disease (1-5).
Data from randomized clinical trials (6-10) demonstrate that
preoperative chemotherapy increases the median survival in patients
with clinical-N2 non-small-cell lung cancer when comparing with
surgery alone, with 5-year survival of 36% vs 15% (p=0.056 by the log
rank test; p=0.048 by the BreslowGehanWilcoxon test; Roth Lung
Cancer 1998). Nevertheless, many patients in these studies were
assumed to have a N2 disease without pathological confirmation or do
not have a systematic nodal dissection to certify the result pathological
response due to the preoperative chemotherapy.
Recently, Albain et al (11), in a phase III randomized clinical
trial showed that chemotherapy plus radiotherapy with or without
resection are options for patients with stage IIIA(N2 pathologically
confirmed) non-small-cell lung cancer. But, in the analysis of overall

survival according to interim pathologic response data, N0 status
continued to predict improved outcome whether or not there was
residual primary tumor. Patients who were T0, N0 (pathological
complete response) had a median survival of 36.7 months and a 3-year
survival of 52%. Patients who were T0-1, N0 had a median survival of
36.7 months and a 3-year survival rate of 53%. The most relevant part
of the trial is that downstaging of N2 disease to N0 will occur in 46% to
48% of patients, and 3-year survival of this group is 53%. The results in
the surgery arm show the importance of nodal clearance on survival.
These findings demonstrate that not everybody should get surgery after
induction, even more, they point to the need to determine which patients
will have nodal downstaging by any method.
The LACE Collaborative Group and the NSCLC Meta-analyses
Collaborative Group recently published the results of three metaanalyses of individual patient data regarding the benefits of the adjuvant
chemotherapy, with or without postoperative radiotherapy, in operable
non-small-cell lung cancer (12,13). These meta-analyses show that the
addition of adjuvant chemotherapy after surgery for patients with
operable non-small-cell lung cancer significantly improves survival,
irrespective of whether chemotherapy was adjuvant to surgery alone or
adjuvant to surgery plus radiotherapy.
Whether a systematic lymph node dissection will improve long
terms survival is not clear. The question, is systematic lymph node
dissection superior to sampling in patients undergoing lung resection for
NSCLC? was analyzed in a recent review of the best evidence topic in
thoracic oncology. The results of the review show that in stage I
NSCLC there is a little difference but there is an increase in survival
when performing a systematic lymph node dissection in stage II to IIIA.
In addition systematic nodal dissection seems to be able to detect more
pN2 disease (14) and more pN2 multistation disease (15) without an
increase in mortality, morbidity or length of hospitalization but, yes,
with a longer median operative time: 15 minutes! (16,17). Even more,
taking into account the recent findings regarding the benefits of the
adjuvant treatment in patients with a pN1 or pN2 disease, incomplete or
inaccurate nodal staging could prevent some patients from receiving
postoperative chemotherapy or radiotherapy.
After analyzing prior information, some key points should be

put forward for discussion:
1. Should we consider patients with single zone, intracapsular
microscopic N2 disease for primary surgery? Probably yes.
2. Should we include patients in a multimodality treatment
without pathological confirmation of N2 disease?. Probably no.
3. Should we consider for surgery patients with persistent N2
disease after induction treatment? Probably no.
4. Should we consider routine systematic nodal dissection the
standard in order to obtain an accurate pathologic staging and
potentially higher cure rates when a complete resection can be
achieved? Yes.
References.
1.Andr F, Grunenwald D, Pignon J-P, et al. Survival of patients with Resected N2 NonSmallCell Lung Cancer: Evidence for a subclassification and implications. J Clin Oncol 2000;18:281-89.
2.Riquet M, Manac'h D, Saab M, Le Pimpec-Barthes F, Dujon A, Debesse B. Factors
determining survival in resected N2 lung cancer. Eur J Cardiothorac Surg. 1995;9:300-4.
3.Fontaine E, McShane J, Carr M, Shackcloth M, et al. Should we operate on microscopic N2
non-small cell lung cancer? Interactive CardioVascular and Thoracic Surgery 2011;12:95661
4.Cerfolio RJ and Bryant AS. Survival of Patients With Unsuspected N2 (Stage IIIA) NonsmallCell Lung Cancer. Ann Thorac Surg 2008;86:362-367
5.Marchevsky AM, Gupta R, Kusuanco D, Mirocha J, McKenna Jr RJ. The presence of isolated
tumor cells and micrometastases in the intrathoracic lymph nodes of patients with lung cancer is not
associated with decreased survival. Human Pathology 2010; 41: 153643
6.Pass HI, Pogrebniak HW, Steinberg SM et al. Randomized trial of neoadjuvant therapy for
lung cancer: interim analysis. Ann Thorac Surg 1992; 53: 9928.
7.Rosell R, Gomez-Condina J, Camps C, et al. A randomized trial comparing preoperative
chemotherapy plus surgery with surgery alone in patients with non- small-cell lung cancer. N Engl J Med
1994;330:1538.
8.Roth JA, Fossella F, Komaki R, et al. A randomized trial comparing perioperative
chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. J Natl
Cancer Inst 1994;86:67380.
9.Rosell R, Gmez-Codina J, Camps C, et al. Preresectional chemotherapy in stage IIIA nonsmall-cell lung cancer: a 7-year assessment of a randomized controlled trial. Lung Cancer 1999;47:714
10.Roth JA, Atkinson EN, Fossella F, et al. Long-term follow-up of patients enrolled in a
randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage
IIIA non-small-cell lung cancer Lung Cancer 21:1998;21:16
11.Kathy S Albain, R Suzanne Swann, Valerie W Rusch, et al. Radiotherapy plus chemotherapy
with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomized controlled
trial. Lancet 2009; 374: 37986.
12.NSCLC Meta-analyses Collaborative Group. Adjuvant chemotherapy, with or without
postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient
data. Lancet 2010; 375: 126777.
13.JP Pignon, Tribodet H, Scagliotti GV, et al. Lung Adjuvant Cisplatin Evaluation: A Pooled
Analysis by the LACE Collaborative Group. J Clin Oncol 2008; 26:3552-9.
14.Cerfolio RJ, Bryant AS, Minnich DJ. Complete Thoracic Mediastinal Lymphadenectomy
Leads to a Higher Rate of Pathologically Proven N2 Disease in Patients with Non-Small Cell Lung Cancer.
Ann Thorac Surg 2012;94:9026.
15.Hughes MJ, Chowdhry MF, Woolley SM, Walker WS. In patients undergoing lung resection
for non-small cell lung cancer, is lymph node dissection or sampling superior? Interactive CardioVascular
and Thoracic Surgery 2011;13: 311-5
16.Allen MS, Darling GE, Pechet TTV, et al. Morbidity and Mortality of Major Pulmonary
Resections in Patients With Early-Stage Lung Cancer: Initial Results of the Randomized, Prospective
ACOSOG Z0030 Trial. Ann Thorac Surg 2006;81:101320
17.Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node
sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less
than hilar) nonsmall cell carcinoma: Results of the American College of Surgery Oncology Group Z0030
Trial. J Thorac Cardiovasc Surg 2011;141:662-70)
10.30 11.00
Teodor Horvat
Hidrotoraxul hepatic
11.30 13.30 - Conferine - Sesiunea II
Moderatori: Marcin Zielinski, Cristian Paleru
11.30 12.00
Philippe Dartevelle
TO BE ANNOUNCED
12.00 12.30
Philippe Dartevelle
TO BE ANNOUNCED
12.30 13.00
Ioan Cordo
Indicaiile chirurgicale n cancerul bronhopulmonar
Intervenia chirurgical este prima opiune terapeutic n
neoplasmul bronho-pulmonar non-small, singura metod terapeutic
menit s ofere o cur radical a acestei afeciuni n stadiile precoce I,
II i III A.
Scopul prezentrii are n vedere adoptarea unei atitudini unitare
bazate pe evidene medicale, n stabilirea diagnosticului i terapiei
chirurgicale a pacienilor cu cancer bronho-pulmonar, indiferent de
medicul cruia i se adreseaz pacientul la apariia primelor semne i
simptome ale bolii.
Succesul terapeutic depinde crucial de explorarea preoperatorie
a pacientului candidat la intervenia chirurgical. El trebuie evaluat din
punct de vedere lezional examen clinic, imagistic (radiografie

standard, CT toracic, cap i abdomen superior, RMN), bronhoscopic
funcional i biologic general. Trebuie folosite toate metodele ce ne stau
la ndemn pentru a preciza diagnosticul de boal (diagnosticul
histopatologic !) i de stadiu a afeciunii.
Tratamentul este orientat dup ghidul terapeutic bazat pe
clasificarea TNM ediia a 7-a (Guidelines on the radical management of
patients with lung cancer - Eric Lim, David Baldwin, Michael Beckles,
et al, Thorax 2010 65:iii1 iii27).
Intervenia chirugical trebuie s fie adaptat fiecrui pacient, s
cuprind att ndeprtarea leziuni n condiiile unei securiti oncologice
segment, lob, bilob, pulmon ct i a teritoriului limfatic aferent.
Extirparea chirurgical poate fi precedat sau urmat de chimio i
radioterapie, n funcie de stadiul bolii.
Diagnosticul precoce, evaluarea responsabil n cadrul fiecrei
supraspecialiti, stadializarea corect, intervenia chirurgical complet
combinat cu o terapie oncologic adaptat fiecrui caz, vor concura n
mod real i evident la prelungirea supravieuirii pacienilor cu cancer
bronho-pulmonar non-small precum i la creterea calitii vieii
acestora.
15.30 17.30 - Lucrri - Sesiunea I
Moderatori: Jos Belda-Sanchis, Teodor Horvat
15.30 15.40
PARTICULARITATI ALE INTERVENTIIILOR OPERATORII
PE PLAMANUL UNIC CHIRURGICAL
Introducere
Chiar i dup o pneumonectomie att plmnul restant ct i
spaiul pleural corespunztor pot fi sediul unor afeciuni chirurgicale
Material i metod
Sunt studiai retrospectiv 12 pacieni la care s-a intervenit
chirurgical
pentru afeciuni toracice n spaiul pleuropulmonar
contralateral dup o pneumonectomie. n toate cazurile

pneumonectomia a fost efectuat pentru leziuni maligne.
S-au practicat 5 rezecii pulmonare atipice (2 lob superior stng,
2 lob superior drept i un din lobul inferior stng), 2 intervenii
toracoscopice (una pe stnga i alta pe dreapta), o decorticare
pleuropulmonar Williams i 4 pleurotomii minime.
Rezultate
n toate cele 5 rezecii pulmonare s-a dovedit postoperator
natura malign metastatic a leziunii pulmonare. Cele 2 toracoscopii au
fost adresate unor revrsate pleurale lichidiene ntr-un caz fiind
demonstrat etiologia malign metastatic, cellalt caz fiind al unei
leziuni TBC. Decorticarea pleuropulmonar a fost indicat de o pseudo
imagine nodular pulmonar n timp ce pleurotomiile au fost efectuate
pentru un empiem pleural, dou pleurezii secundare i un pneumotorax
stng debutat n prima zi postoperatorie dup o pneumonectomie
dreapt. S-a nregistrat doar o singur complicaie postoperatorie: o
bronhopneumonie aprut n cazul decorticrii pleuropulmonare care a
fost rezolvat sub tratament medical susinut. Mortalitatea
perioperatorie pe ntregul lot a fost nul recuperarea postoperatorie
imediat fiind complet.
Concluzii
O serie de afeciuni chirurgicale toracice trebuie luate n
considerare spre rezolvare chiar dac survin pe un plmn unic
chirurgical chiar dac pneumonectomia a fost dictat de leziuni
maligne.
15.40 15.50
FISTUL ESO-CAVITAR DREAPT DUP TUBERCULOZ
PULMONAR BILATERAL
1
Secia Chirurgie, 2Secia Anestezie-Terapie Intensiv, 3Secia

Pneumologie I, Spitalul Judeean de Urgen Drobeta-Turnu Severin
Introducere
Chirurgia tuberculozei pulmonare constituie nc o proporie
important a cazurilor operate n serviciile de chirurgie toracic din
multiple cauze.
Material i metod
Prezentm cazul unui brbat de 56 ani, cu multipli factori de risc
pentru evoluie nefavorabil a tuberculozei diagnosticate n 2010, care a
fost tratat i operat n Spitalul Judeean de Urgen Drobeta-Turnu
Severin pentru sechele fibrocavitare lob superior drept, fistul esocavitar i o formaiune tumoral de segment apical lob inferior drept.
Rezultate
S-a practicat lobectomie superioar dreapt, fistulectomie,
esorafie, rezecie atipic LID, gastrostom temporar de alimentaie.
Tumora din LID: hamartocondrom. Evoluie postoperatorie lent
favorabil, cu pierderi aeriene prelungite, colecie aeric rezidual
bazal dreapt. Externare n a 23-a zi postoperatorie, vindecat.
Concluzii
La pacienii cu tratamente prelungite, recidive, factori
economico-sociali precari, trebuie avute n vedere i complicaiile mai
rar citate ale tuberculozei, considerate uneori de interes istoric.
15.50 16.00
CHISTUL HIDATIC DE DOM HEPATIC ABORDAREA
CHIRURGULUI TORACIC
Obiective
Scopul studiului nostru a fost sa cuantificam eficacitatea
abordului transtoracic transdiafragmatic al chisturilor hidatice de dom
hepatic si sa determinam siguranta acesui abord.
Metoda
Prezentam experienta noastra bazata pe 11 pacienti (8 barbati/3
femei) tratati in clnica nostra intre 2005 si 2012. Chisturile hidatice
hepatice au fost abordate printr-o toracotomie dreapta cu frenotomie
urmata de inactivarea si evacuarea chistului principal si a chisturilor
fiice, tratamentul fistulelor biliare, drenajul cavitatii chistice, sutura
marginilor chistice, frenorafia si drenajul pleural.
Rezultate
Varsta pacientilor a fost cuprinsa in intervalul 14-71 de ani (45
+/-17 ani). Diagnosticul de chiste hidatice hepatice a fost stabilit in
toate cazurile prin computer tomografia etajului abdominal superior, 6
pacienti avand echinococoza multipla( 5 in plamanul drept si 4 in cel
stang) care au fost rezolvate simultan ( cele din plamanul drept si ficat)
sau in timpul doi (cel din plamanul stang). Durata medie de spitalizare a
fost 13.5 +/- 5.2 zile. Coeficientul Pearson intre varsta si zilele de
spitalizare a fost 0.06. Nu s-a inregistrat mortalitate intraspitaliceasca,
nici complicatii majore postoperatorii si nici recurenta bolii.
Concluzii
Toracotomia dreapta cu frenotomie asigura un abord excelent
pentru hidatidoza domului hepatic comparata cu laparotomia, fiind utila
mai ales in cazul prezentei simultane de chiste hidatice pulmonare
drepte, permitand rezolvarea acestora intr-un singur timp operator, cu
complicatii minime.
16.00 16.10
INDICAII I REZULTATE ALE TORACOTOMIILOR
BILATERALE N ACEEAI EDIN OPERATORIE
Introducere
Scopul lucrrii este evaluarea toracotomiei bilaterale n aceeai
edin operatorie pentru patologie toracic bilateral.
Material i metod
Acesta este un studiu retrospectiv efectuat pe un numr de 20 de
pacieni, internai n Clinica Chirurgie 4 UMF Trgu-Mure n perioada
01.01.1985-01.01.2012, la care s-a practicat toracotomie bilateral n
aceeai edin operatorie. Indicaiile acestui abord au fost: boala
hidatic (inclusiv o toracofrenotomie dreapt pentru asociere cu un chist
hidatic hepatic) 9 pacieni, traumatisme toracice 2 cazuri, metastaze
bilaterale 2 cazuri, empiem bilateral 2 cazuri, emfizem bilateral 2
cazuri, cancer pulmonar primar + metastaz controlateral 1 caz,
hidro-pneumotorax bilateral carcinomatoz pleural cu plmn

ncarcerat 1 caz, corpi strini metalici (tentativ de suicid) 1 caz.
Rezultate
Nu am nregistrat nici un deces postoperator. Un pacient cu
empiem bilateral a dezvoltat o cavitate rezidual ce a necesitat o
toracomioplastie. Nici unul dintre pacieni nu a necesitat ventilaie
mecanic postoperatorie. La alte 4 cazuri, a doua toracotomie a fost
amnat la solicitarea colegilor anesteziti (pacieni neinclui n acest
studiu).
Concluzii
Abordul bilateral n aceeai edin operatorie este fezabil cu
condiia existenei unei echipe antrenate n urmrirea i ngrijirea
bolnavilor operai pe torace. Principalul avantaj este cel funcional, prin
absena fixrii diafragmatice bilaterale ntruct paientul este forat s
respire n mod egal cu ambele diafragme. Alte avantaje sunt de ordin
estetic, psihologic i economic reducerea costurilor aproape la
jumtate.
16.10 16.20
HEMANGIOPERICITOMUL MALIGN SURPRIZA DIN
"SPATELE" PNEUMONIEI
Iulian Mihai Radulescu, Mihaela Codresi, Adrian Mihail Iordache, Ioan
Cordos
Introducere
Hemangiopericitomul este o tumora vasculara constituita din
capilare aranjate haotic, tapetate cu endoteliu si inconjurate de
mansoane din pericite proliferative. Este localizata mai frecvent in
piele, in tesuturile moi ale trunchiului si extremitatilor.
Hemangiopericitomul malign se caracterizeaza prin agresivitatea
pronuntata, metastazare vasculara precoce si recidiva locala.
Localizarea mediastinala este o situatie extrem de rar intalnita, fiind
citate mai putin de 20 de cazuri in literatura de specialitate.
Caz clinic
Pacient in varsta de 63 de ani, fiind investigat recent pentru un
AVC ischemic tranzitor, este descoperit la o radiografie cord-pulmon cu
opacitate cardiaca marita. Consultul cardiologic nu identifica o patologie
specifica si este indrumat catre serviciu pneumologie acuzand dispnee, tuse
cu expectoratie mucopurulenta, wheezing, durere toracica anterioara, stare
subfebrila diagnostic clinic: pneumonie. Investigat fibrobronhoscopic se
identifica tasare extrinseca asupra arborelui bronsic stang si importanta
supuratie retrostenotica. Sub tratament antibiotic simptomatologia se
remite partial. Examenul CT efectuat ulterior identifica o formatiune
tumorala in mediastinul anterior de cca 193/145mm, pacientul fiind trimis
catre serviciu chirurgie toracica unde se decide interventia chirurgicala.
Intraoperator se deceleaza o formatiune tumorala giganta, relativ bine
delimitata si se practica excizia formatiunii dupa detasarea acesteia de pe
plamanul stang, pericard, artera aorta, artera pulmonara, trunchiul
brahiocefalic venos stang, pleura mediastinala dreapta. Evolutia
postoperatorie este favorabila. Descriere histopatologica a piesei rezecate
hemangiopericitom malign.
Discutii
Acest caz ilustreaza dezvoltarea indelungata subclinica a unei
tumori maligne rare, localizata mediastinal, cu dificultati de diagnostic
diferential clinico-paraclinic, ce supune pacientul unor riscuri majore
intraoperator.
Concluzii
Hemangiopericitomul la acest pacient s-a dezvoltat intr-o perioada
lunga de timp fara a avea rasunet clinic. Descoperirea s-a facut dupa
numeroase investigatii si tratamente pentru patologii secundare prezentei
formatiunii mediastinale. Interventia chirurgicala a implicat riscuri majore
pentru pacient si mult efort din partea echipei operatorii.
16.20 16.30
IMPORTANA AUTOFLUORESCENEI
N EVALUAREA
BRONHOSCOPIC A CANCERULUI BRONHO-PULMONAR
Introducere
Bronhoscopia cu autofluorescen constituie o etap extrem de util
n depistarea, evaluarea i stadializarea cancerului bronho-pulmonar.
Material i metod
n clinica noastr au fost efectuate 42 de examinri traheobronhoscopice cu autofluorescen (din total 1126 bronhoscopii pn n
august 2012). Specificul Institutului Oncologic Bucureti face ca
principala indicaie s fie determinarea extensiei reale endoluminale a
cancerului bronho-pulmonar.
Rezultate
Sunt prezentate indicaiile, contraindicaiile metodei i
aplicabilitatea bronhoscopiei cu autofluorescen n cadrul pacienilor
notri - cazurile relevante din clinic n care bronhoscopia cu
autofluorescen a determinat atitudinea terapeutic ulterioar corect.
Concluzii
Bronhoscopia cu autofluorescen se dorete a fi n viitorul
apropiat un instrument obligatoriu n depistarea precoce a cancerului
bronho-pulmonar la pacienii cu risc i, de asemenea, un standard n
evaluarea preoperatorie a cancerului pulmonar rezecabil.
16.30 16.40
PECTUS CARINATUM PUR (NEASOCIAT CU PECTUS
EXCAVATUM) REZOLVAT PRIN MIRPC (MINIMALLY
INVASIVE REPAIR OF PECTUS CARINATUM)
1
Clinica de Chirurgie Toracic, 2Clinica ATI, UMF Craiova
Introducere
Pectus carinatum reprezint o malformaie a peretelui toracic ce
const n protruzia anterioar a sternului, ntlnit mult mai rar dect
malformaia opus, pectus excavatum. Spre deosebire de pacienii cu
pectus excavatum, cei care prezint pectus carinatum sunt adresai
chirurgului toracic cel mai frecvent din considerente estetice i nu
funcionale, indicaia chirurgical viznd de obicei asocierea dintre
pectus excavatum si pectus carinatum. Datorit implicaiilor psihologice
pentru pacient, cazurile de pectus carinatum pur (neasociat cu pectus
excavatum) pot beneficia de o rezolvare chirurgical minim invaziv.
Material i metod
Prezentm cazul unei tinere de 24 de ani, cu un pectus carinatum
important dar simetric, neasociat cu pectus excavatum, fr
simptomatologie cardiorespiratorie dar cu probleme psihosociale
importante pentru pacient, rezolvat prin tehnica minim invaziv

descris de Abramson (procedeul Nuss inversat) - MIRPC (Minimally
Invasive Repair of Pectus Carinatum).
Rezultate
Pentru reparaia malformaiei a fost utilizat o bar de titan
introdus sub control toracoscopic, plasat presternal, traversnd cele 2
caviti pleurale i fixat bilateral cu dou stabilizatoare. A fost
considerat necesar un drenaj pleural numai pe partea stng, suprimat n
prima zi postoperator. Evoluia a fost favorabil iar rezultatul estetic
considerat satisfctor de ctre pacient.
Concluzii
Dei indicaiile chirurgicale pentru pectus carinatum sunt mai
limitate dect cele pentru pectus excavatum, i bazate mai mult pe
considerente estetice dect funcionale, n malformaiile severe i cu
probleme psihosociale importante interveniile minim invazive precum
MIRPC (Minimally Invasive Repair of Pectus Carinatum) pot
reprezenta o soluie.
16.40 16.50
RECONSTRUCTIE
DIAFRAGMATICA
CU
MUSCHI
LATISSIMUS DORSI IN TUMORILE PULMONARE DREPTE
CU INVAZIE HEPATICA
1
Marius Nasta, Bucureti, 2Institutul Clinic Fundeni, Centrul de
Chirurgie Generala si Transplant Hepatic Dan Setlacec, Bucureti
Introducere
Patologia chirurgicala tumorala pulmonara cu invazie
transdiafragmatica ramane un capitol cu multe necunoscute si
dificultati, cu morbiditate impresionanta, cu evolutie anevoioasa, ceea
ce duce la individualizarea abordarii sale. Reconstructia diafragmului cu
material sintetic, in cazul unui defect partial, poate fi uneori suplinita cu
muschi proprii mari ai toracelui.
Material si metoda
Prezentam cazul unei paciente de 51 de ani, la care s-a stabilit
diagnosticul de tumora pulmonara lob inferior drept cu invazie de arcuri
costale VIII, IX, X, diafragm si de segment hepatic VII, la care s-a

practicat laparoscopie exploratorie si toracoscopie exploratorie dreapta, cu
stabilirea gradului de rezecabilitate, urmate de ablatia tumorii in bloc
(rezectie atipica lob inferior drept pulmonar, rezectie arcuri costale
posterioare VIII, IX, X, rezectie partiala de diafragm si hepatectomie
atipica segment VII) si reconstructie diafragm cu lambou de muschi
latissimus dorsi, prezervat la inceputul interventiei.
Rezultate
Evolutie postoperatorie favorabila lent, cu aspect normal
radiologic, fara pleurezie, fara tulburari de ventilatie, ceea ce permite
suprimare drenajului toracic la 4 zile p.o., dar cu aparitia unei fistule biliare
de la nivelul transei de hepatectomie care a necesitat ERCP cu coledocosfincterotomie larga retrograda si montare de stent coledocian de plastic in
ziua 15 p.o, ulterior si a unei reactii pancreatice, tratata conservator.
Pacienta se externeaza cu stare generala buna, cu drenaj peritoneal minim
si fara manifestari pleuropulmonare. Controalele ulterioare au permis
suprimarea drenajului abdominal si extragerea stentului coledocian, fara
complicatii. Diafragmul reconstruit s-a comportat normal.
Concluzii
Tinand seama de particularitatile anatomo-functionale ale
diafragmului, abordul multiplu toracic si abdominal al tumorilor din
aceasta arie, insotit uneori si de rezectii extinse parietale, necesita artificii
tehnice realizate ad-hoc si orientate catre imbunatatirea rezultatelor si a
evolutiei postoperatorii (utilizarea unui structuri specifice organismului,
asa cum sunt muschii mari parietali toracici, bine vascularizati, mai
rezistenti la infectii si drenaj bilios decat materialele sintetice).
16.50 17.00
LIPOSARCOAMELE MEDIASTINULUI ANTERIOR
Introducere
Liposarcoamele sunt leziuni maligne localizate rar n mediastin,
cel mai frecvent fiind situate n compartimentul posterior. Topografia
mediastinal anterioar este rar raportat n literatura de specialitate
Material i metod
Sunt analizate 2 cazuri de liposarcoame ale mediastinului
anterior, ntr-un caz fiind constat extensia cervical i n
compartimentul visceral a leziunii maligne. n ambele situaii s-a

practicat tumorectomia total, una din leziuni, gigant, a fost
caracterizat de 45/30/20 cm i aproximativ 8600g. Cealalt rezecie
tumoral a impus exereza unui segment din esofagul toracic.
Rezultate
n cazul exerezei esofagiene continuitatea digestiv a fost
restabilit 6 luni mai trziu fiind efectuat o esofagoplastie cu colon
plasat presternal. Doar n acest caz s-a efectuat radioterapie
complementar. Ambele formaiuni au recidivat, cea iradiat
postoperator la 10 ani n cellalt caz constatndu-se 2 recidive: la 4 ani
i respectiv la 6 ani de la prima intervenie. n acest ultim caz datorit
tarelor cardiace asociate s-a constatat decesul n ziua 4 postoperatorie.
Concluzii
Liposarcoamele sunt leziuni extrem de rar ntlnite n
mediastinul anterior. Dac sunt rezecate n totalitate i este asociat
tratament oncologic complementar supravieuirea poate fi bun.
17.00 17.10
ASPECTE CLINICE I IMAGISTICE LA SUPRAVIEUITORII
DE LUNG DURAT DUP TORACOPLASTIE CU PLOMBAJ
PENTRU TUBERCULOZ
Introducere
Toracoplastia cu plombaj a fost frecvent efectuat n anii 195060 pentru tuberculoz, fiind n prezent abandonat sau rareori efectuat.
Obiectivul prezentei lucrri este de a prezenta aspectele clinice i
imagistice ale unor suravieuiori de lung durat internai n Clinica
noastr.
Material i metod
n perioada 01.01.1990-01.01.2012 n Clinica Chirurgie IV
UMF Trgu-Mure au fost internai n total 5 pacieni avnd n
antecedente o toracoplastie cu plombaj efectuat pentru tuberculoz.
Materialul de plombaj a fost reprezentat de bile (2 cazuri), coast
autolog (2 cazuri) i ulei (un caz). Toate interveniile iniiale au fost
efectuate n alte uniti sau de ctre ali chirurgi din clinic, acest tip de
intervenie fiind abandonat de ctre echipa noastr.
Rezultate
2 pacieni au fost internai pentru complicaii legate de plombaj
recidiv i suprainfecie, necesitnd reintervenie (ndeprtarea
materialului de plombaj i toracomioplastie). Un pacient a fost internat
pentru un empiem contralateral iar 2 pacieni nu prezentau acuze
toracice. Materialul de plombaj a fost evident att pe radiografiile
toracice, ct i pe imaginile CT. La un an postoperator, nici unul dintre
pacienii operai nu prezenta semne de recidiv sau acuze toracice
semnificative. Un pacient a decedat pe perioada internrii, cauza
decesului neavnd legtur cu plombajul efectuat (infarct miocardic).
Concluzii
n practica medical actual putem ntlni supravieuitori pe
termen lung ai unor operaii considerate istorice cum este toracoplastia
cu plombaj, cu sau fr acuze legate de intervenia iniial.
Recrudescena tuberculozei poate readuce n actualitate acest tip de
intervenii ca o soluie pentru cazuri selectate.
17.10 17.20
SINDROMUL MAFFUCCI, ENTITATE RARA IN CHIRURGIA
TORACICA
Valerian Pavaloiu
Numit dupa profesorul italian de patologie Angelo Maffucci,
sindromul Maffucci, sau encondromatoza cu multiple hemangioame, a
fost descris pentru prima data in 1881 si este o afectiune congenitala
rara, caracterizata prin prezenta de encondroame, de regula localizate la
nivelul membrelor superioare, si multiple hemangioame si
limfangioame. De la prezentarea pentru prima data a acestei afectiuni si
pana in prezent au fost documentate doar aproximativ 200 de cazuri.
Se prezinta cazul unei paciente de 42 de ani, diagnosticata cu
sindrom Maffucci in adolescenta, multiplu operata in serviciul de
ortopedie pentru fracturi pe os patologic la nivelul membrelor de partea
dreapta, care se prezinta in clinica noastra prezentand o formatiune

tumorala parietala de 20 cm diametru, situata la nivelul hemitoracelui
drept, anterior, ce invadeaza arcurile costale II-V. Pe langa formatiunea
tumorala parietala, pacienta prezenta multiple tumori si deformari
osoase la nivelul membrelor de partea dreapta, precum si multiple
hemangioame si limfangioame. Fiind investigata pentru tumora maligna
de san, formatiunea tumorala parietala a fost diagnosticata ca fiind
osteocondrom gigant. Cresterea marcanta in dimensiuni intr-un timp
scurt, precum si riscul crescut de malignizare a impus rezectia
chirurgicala.
S-a practicat rezectia in bloc a formatiunii tumorale impreuna cu
arcurile costale II-V de partea dreapta si marginea dreapta a sternului,
reconstructia parietala realizandu-se cu ajutorul unor bare metalice de
titan fixate in stern si de capetele costale restante, precum si plasa de
polipropilena.
In ciuda raritatii sale si relativei benignitati, pacientii cu sindrom
Maffucci trebuie sa se prezinte in serviciul de chirurgie pentru rezectia
condroamelor, inaintea malignizarii acestora.
17.20 17.30
CERVICO - MEDIASTINIT ACUT DESCENDENT
NECROZANT CU EMPIEM PLEURAL BILATERAL I
EROZIUNE SEPTIC DE VEN JUGULAR ANTERIOAR
DREAPT
I
CONFLUENT
VENOS
JUGULOSUBCLAVICULAR PIROGOFF DREPT
Introducere
Autorii prezint o cervico-mediastinit acut descendent
necrozant consecutiv unui flegmon cervical anterior, asociat cu
multiple i grave complicaii, care a necesitat intervenii chirurgicale
seriate, n echip multidisciplinar, soldate nsa cu supravieuirea cu
sechele a pacientului.
Material i metod
Cazul este reprezentat de un pacient de 49 ani, cu o incizie
latero-cervical efectuat ntr-o clinic ORL pentru un flegmon
cervical, care se interneaz pentru disfagie, odinofagie, dispnee, dureri

cervico-toracice, febr. Examenul CT cervico - toracic relev un proces
voluminos heterodens ce include bule de aer la nivel submandibular ce
coboar n mediastinul anterior i mijlociu pn sub caren, pleurezie
bilateral. Se intervine succesiv de urgen i se practic pleurotomie
bilateral, cervicotomie transversal suprasternal cu mediastinotomie
anterioar i mijlocie, traheostomie tactic, lavaj cu ap oxigenat i
betadin, drenaj cu laniere de cauciuc.
Rezultate
Evoluia post-operatorie este grevat de apariia sngerrii
masive cervico-mediastinale drepte ce a impus hemostaz digital
provizorie la patul bolnavului i ulterior ligatura de ven jugular
anterioar dreapt, sterno-toracotomie anterioar dreapt ,,trap-door
cu sutura confluentului venos jugulo-subclavicular drept. Au urmat alte
complicaii ( hidro-pneumotorax apical drept restant, tromboza partial
venoas superficial de antebra drept, oc septic cu trombocitopenie
secundar, insuficien renal acut, granulom de fir parietal toracic
drept ) care au necesitat abordri specifice. Pacientul se externeaz cu o
supuraie parietal parasternal dreapt rezolvat n ambulator prin
debridare, antibioterapie i pansamente ndelungate.
Concluzii
Cervico-mediastinita este o boal grav, cu o mortalitate ridicat
i posibilitatea apariiei sngerrii acute masive mediastinale pe fond
septic, situaie ce impune intervenia rapid pentru salvarea vieii
bolnavului.
SMBT, 6 OCTOMBRIE 2012

09.00 11.00 - Conferine - Sesiunea III
Moderatori: Teodor Horvat, Alexandru Boianu
9.00 9.30
Cristina Grigorescu
Actualiti medico-chirurgicale n LVRS (lung volume reduction
surgery)
9.30 10.00
Alper Toker
TO BE ANNOUNCED
10.00 10.30
Actualiti n radioterapia 3D conformaional i cu intensitate
modulat n radioterapia cancerului broncho-pulmonar
Introducere
Progresele realizate n radioterapie fac posibil aplicarea unui
plan de radioterapie individualizat. Indicaia terapeutic este stabilit n
cadrul comisiei oncologice la care particip toi factorii implicai n
diagnosticul i primul act terapeutic efectuat. Consecintele modificarilor
clasificarii TNM ale cancerului broncho-pulmonar asupra indicatiilor
efectuarea unei radioterapiei externe vor fi discutate.
Materiale i metode
Dup stabilirea stadializarii TNM si a indicaiei terapeutice n
cadrul comisiei oncologice, cu recomandarea efecturii unei radioterapii
adjuvante sau neoadjuvante, pacientul este supus unei examinri CT n
poziia n care va fi efectuat radioterapia extern.
Rezultate
Volumele int delimitate sunt elaborate de ctre radioterapeut i
sunt bazate pe informaiile obinute prin examinare clinic, investigaii
imagistice (CT, IRM, PET/CT) i rezultatele examinrii
anatomopatologice a materialului tisular obinut prin biopsie sau
rezecie. Organele la risc, precum parenchimul pulmonar, miocardul,
maduva spinarii i esofagul sunt delimitate. Tumora primara si ariile
ganglionare mediastinale sunt delimitate in sectiunile axiale CT
efectuate si vor fi icluse in volumul de iradiat conform recomandarilor
actuale. Planul de iradiere realizat include dozele limit acceptate
pentru limitarea efectelor secundare la organele la risc, norme stabilite
n ghidurile terapeutice elaborate. Dozele aplicate n volumele int ce
includ zonele cu boal microscopic (CTV) sau macroscopic (GTV)
sunt cele stabilite n ghidurile terapeutice elaborate i variaz de la 50,4
Gy pn la 70 Gy sau mai mult, aplicate n fraciuni de 1,8 sau 2,0 Gy.
Iradierea se realizeaz printr-o tehnic 3D nalt conformaional sau
prin iradiere cu modularea intensitii (IMRT); n cadrul institutului
nostru folosim o variant a IMRT numit VMAT (volume modulated
arc therapy).
Concluzie
Prin aplicarea unei tehnici nalt 3D-conformaionale sau IMRT
de tip VMAT, este posibil aplicarea unui tratament radiologic de nalt
calitate, cu efecte secundare minore i control tumoral local maxim.
Protejarea parenchimului pulmonar si a organelor normale ca esofagul
si miocardul fac posibila reducerea maximala a efectelor secundare atit
de temute ca pneumonia radica si esofagita. Doze curative inalte de pina
la 70 Gy in fractiuni de 1,8 sau 2,0 Gy sunt aplicabile si imbunatatesc
controlul tumoral.
10.30 11.00
Genoveva Cadar
Ventilaia unipulmonar n chirurgia toracic
11.30 13.00 - Lucrri Sesiunea II

Moderatori: Philippe Dartevelle, Ioan Cordo
11.30 11.40
CHIRURGIA TIMOAMELOR
Clinica Chirurgie Toracic, Institutul Oncologic Bucureti
Introducere
Numeroase studii au demonstrat importana rezeciei tumorale n
cazul timoamelor. Un rol important l joac i tratamentul
complementar: radio i chimioterapia
Material i metod
Sunt studiai retrospectiv 50 de pacieni cu timom operai ntr-un
singur centru n intervalul octombrie 1994 octombrie 2009. Lotul
cuprinde 26 de brbai i 24 femei, distribuia pe stadiul Masaoka de
dezvoltare a tumorii fiind: 17 stadiul I, 9 stadiul IIa, 10 stadiul IIb, 9
stadiul III, 2 stadiul IVa i 3 stadiul IVb. Formele histologice conform
clasificrii OMS au fost: tipul A 11 cazuri, tipul AB 15 cazuri, tipul B1
11 cazuri, tipul B2 9 cazuri, tipul B3 2 cazuri i n 2 situaii au existat
forme mixte B2-B3. Miastenia gravis a fost asociat n 13 din timoame.
Rezultate
Sunt analizate datele de evoluie postoperatorie fiind comparat
supravieuirea acestor pacieni n funcie de tipul histologic, de stadiul
de dezvoltare, de tipul interveniei chirurgicale practicate i n funcie
de tratamentul complementar postoperator efectuat. Cu excepia unui
decees n ziua 4 postoperatorie (ARDS pe plmn unic), nu s-au
nregistrat complicaii notabile postoperator imediat. Din cele 13 cazuri
de miastenie, 5 s-au vindecat postoperator, 6 s-au ameliorat n timp ce
n 2 situaii s-a constatat agravarea simptomatologiei. Un pacient care
nu avea miastenie n momentul rezeciei a dezvoltat miastenia la 6 ani
de la rezecia tumoral. n 7 cazuri s-a constatat asocierea altor leziuni
maligne ntr-un caz fiind constatat asocierea chiar a 2 alte cancere.
Concluzii
Tipul interveniei chirurgicale, stadiul de dezvoltare Masaoka,
tipurile histologice i tratamentul complementar efectuat sunt principalii
factori care dicteaz supravieuirea pacienilor cu timom. n cazul
asocierii miasteniei se constat efectul benefic limitat al rezeciei

timomului. Pacienii cu timom au o predispoziie mai mare de a
dezvolta o a doua leziune malign.
11.40 11.50
ABORDULUI TRANSCERVICAL MINIM INVAZIV
BRONSIEI PRIMITIVE DREPTE. ASPECTE TEHNICE.
AL

Introducere
Va prezentam abordul transcervical minim invaziv al bronsiei
primitive drepte ca si tehnica operatorie. Aceasta tehnica este utila in
staplarea si sectionarea bronsiei primitive drepte in cazul pacientilor cu
tuberculoza pulmonara MDR pentru a evita diseminarea contralaterala
si fenomenul de spillage la nivelul cavitatii toracice drepte.
Materiale si metoda
Prin utilizarea ridicatorului suprasternal Cooper si adaptarea
indicatiilor Dr. Zielinski pentru TEMLA, se obtine acces la nivelul
mediastinului. Bronsia primitive dreapta este initial incercuita si apoi
staplata si sectionata. Timpul operator mediu a fost 70 min. Hemostaza
si aerostaza sunt timpi operatori importanti. Nu au fost observate
complicatii postoperatorii. O pneumonectomie dreapta simplificata a
fost efectuata 2 luni mai tarziu. In aceasta prezentare dorim sa va
prezentam aspectele acestei tehnici simple de abord a bronsiei primitive
drepte.
Rezultate
Procedura s-a desfasurat fara incidente si a fost bine tolerata,
obtinandu-se atelectazia plamanului drept. Pneumonectomia dreapta a
fost realizata doua luni mai tarziu. Nu au fost observate complicatii
postoperatorii si incidente dupa indepartarea plamanului.
Concluzii
Prin utilizarea unei proceduri minim invazive pentru a sectiona
bronsia primitiva dreapta oferim astfel pacientilor cu tuberculoza
pulmonara MDR si status clinic precar o sansa la vindecare. Riscul unei
fistule de bont bronsic postpneumonectomie este redus considerabil prin
staplarea bronsiei primitive drepte la nivelul mediastinului, anterior
pneumonectomiei. Raportam astfel success staplarii si sectionarii

bronsiei primitive drepte.
11.50 12.00
POATE
FI
CHIRURGUL
TORACIC
UN
BUN
BRONHOSCOPIST?
Obiective
Lucrarea are ca scop prezentarea experienei noastre n aplicarea
diagnostic i terapeutic a bronhoscopiei n sala de operaie sau n
ATI, n cadrul patologiei chirurgicale cu care ne-am confruntat.
Material i metod
Sunt analizate 1647 de proceduri, aplicate ntr-o perioad de 12
ani, la un numr de 1435 pacieni. Dintre acestea majoritatea au avut
viz terapeutica 58% proceduri iar 42% din proceduri au avut viz
diagnostic.
Rezultate
Procedurile terapeutice sunt defalcate n funcie de patologia
abordat i complicaiile pe care tenteaz s le rezolve. Pe primul loc se
afla traumatismele toracice iar dintre complicatiile in care s-a aplicat
bronhoscopia cu viza terapeutica cheagul endobronsic, ARDS si
bronhopneumonia au fost cele mai frecvente.
Dintre procedurile terapeutice bronhoaspiratia a fost cea mai
frecventa, pe ultimele locuri plasandu-se dezobstructia bronsica si
extragerea de corpi straini, datorita lipsei de instrumentar adecvat si a
lipsei de training. Unul din obiectivele de viitor ale clinicii este tocmai
cresterea marcata a acestor tipuri de inteventii.
n contextul patologiei i complicaiilor deosebit de grave
mortalitatea este de 6 %, interpretata ca un rezultat terapeutic
remarcabil, n care i bronhoscopia i aduce aportul.
Procedurile diagnostice s-au adresat in primul rand cancerului
bronhopulmonar iar procentul de eroare de extindere sau localizare
verificat intraoperator a fost de sub 3%. Biopsia a fost aplicat la 76%
din cazurile diagnosticate, cu rezultat anatomopatologic concordant cu
aspectul endoscopic n 78% din totalul biopsiilor, ceea ce a dus la

scaderea toracotomiilor cu biopsie.
Procedurile bronhoscopice per se nu au prezentat mortalitate iar
complicaiile au fost minore i ntr-un procent redus.
Concluzii
Chirurgul toracic cu antrenament in bronhologie, pe langa
atributiile sale specifice, poate aduce un aport major n susinerea
tratamentului chirurgical toracic. Rezultatele sale bune in bronhoscopie
se datoreaza antrenamentului sau principal in chirurgie si confruntarii
permanente intre imagistica, bronhoscopie si aspectul intraoperator.
Bronhoscopia poate fi aplicat fr nici o dificultate in clinica de
chirurgie toracica cu condiia unei dotri corespunztoare i a voinei de
a reui.
12.00 12.10
REZECII-RECONSTRUCII
PARIETALE
LARGI
SISTEMUL STRATOS
CU
Introducere
Rezeciile parietale sunt o component esenial n armamentul
terapeutic al mai multor afeciuni ale peretelui toracic. Reconstrucia
peretelui toracic dup rezecii parietale largi ridic o serie de probleme
aparte.
Prezentm folosirea unui sistem relativ nou de reconstrucie
parietal bazat pe un sistem de lame i clipuri ajustabil din titaniu:
Strasbourg Thoracic Osteosyntheses System STRATOS, MedXpert
GmbH, Germany.
Material i metod
Prezentm dou cazuri clinice de rezecii reconstrucii parietale
largi deosebite att prin etiologie, mrimea defectelor parietale ct i
prin metoda de reconstrucie: o pacient diagnosticat cu neoplasm
mamar drept i formaiune tumoral gigant de perete toracic anterior
drept (determinare secundar) i o pacient avnd n antecedente boala
Graves-Basedow, gua nodular (2005), diagnosticat cu carcinom
folicular tiroidian difereniat internat n clinica noastr cu o formaiune

tumoral presternal dur de mari dimensiuni.
Rezultate
n primul caz s-a practicat parietectomie toracic antero-lateral
dreapt cu rezecia superioare a sternului, a arcurilor costale 1-2-3;
rezecie atipic lob superior drept; mastectomie dreapt cu
limfadenectomie axilar; reconstrucie parietal cu sistem STRATOS,
plas Dual-Mesh i lambou de latissimus dorsi drept i pectoral mare
stng; gref de piele liber recoltat de pe abdomen.
n al doilea caz s-a practicat tiroidectomie total; rezecie
parietal toracic anterioar larg, cu excizia corpului sternal i a
cartilajelor costale 2,3,4, cu prezervarea jumatii superioare a
manubriului sternal i a apendicelui xifoid; parietoplastie cu dou bare
sistem STRATOS, plas Dual Mesh i lambouri de muchi pectorali.
Concluzii
Dup rezecii parietale largi reconstrucia cu sistemul
STRATOS este facil, sigur, oferind rezultate superioare fa de
materialele folosite n trecut. Permite reconstrucii dup defecte mai
ntinse ducnd la lrgirea indicaiilor operatorii.
12.10 12.20
CARCINOID TIPIC LA UN PACIENT TANAR
Se prezinta cazul unui pacient de 26 ani, tratat timp de trei ani
pentru astm bronsic, care se interneaza in serviciul nostru cu dispnee si
durere la nivelul hemitoracelui stang. Computerul tomograf si
bronhoscopia evidentiaza prezenta unei formatiuni tumorale
endobronsice, situata la nivelul bronsiei primitive stangi, distal, care
obstrua in totalitate lumenul bronsic. Plamanul stang era atelectaziat in
totalitate si colabat in baza iar cel drept herniat in hemitoracele stang.
Chiar daca istoricul pacientului si investigatiile paraclinice ar impinge
catre pneumonectomie, se decide ca primul pas al interventiei sa fie
sectionarea bronsiei primitive cu inspectarea arborelui bronhopulmonar
distal de formatiunea tumorala. Dupa indepartarea formatiunii tumorale
si evacuarea secretiilor bronsice, din plamanul atelectaziat, se practica

bronhoanastomoza capatului proximal al bronsiei primitive stangi cu cel
distal, in imediata vecinatate a bifurcatiei primitivei stangi. La
verificarea aerostazei se observa ca ambii lobi ai plamanului stang se
ventileaza si au aspect normal macroscopic. Controlul bronhoscopic
post-operator evidentiaza buna permeabilitate a ambelor bronsii lobare
stangi, iar probele functionale ventilatorii arata o imbunatatire a functiei
respiratorii.
La un pacient tanar, chiar daca evolutia afectiunii a fost
indelungata, secretiile aspirate intraoperator abundente, purulente si
chiar daca exista riscul de a practica pneumonectomia ulterior datorita
complicatiilor, merita tentata rezectia cu bronhoanastomoza.
12.20 12.30
CHIRURGIA LEZIUNILOR TBC SUPRAINFECTATE CU
ASPERGILLUS
Introducere
Obiectivul acestei lucrri este de a evalua rezultatele chirurgiei
pentru leziuni tuberculoase cronice suprainfectate cu aspergillus.
Material i metod
Am efectuat un studiu retrospectiv pe 33 de pacieni operai n
Clinica noastr ntre 01.01.1985-01.01.2011 pentru aspergilom
dezvoltat pe leziuni tuberculoase (active sau sechelare). Intervenia
chirurgical a constat n rezecie pulmonar n 26 de cazuri (lobectomie
5 cazuri, rezecie atipic 21, la 5 cazuri asociind i o aplatizareplicaturare a cavitii) i toracomioplastie la 7 cazuri. Toi pacienii au
fost trimii dup eecul tratamentului medical i au primit peroperator
terapie antifungic specific. Urmtorii parametri au fost evaluai:
mortalitate, morbiditate, reintervenii, spitalizare. Datele au fost
analizate cu programul GraphPad Prism.
Rezultate
Mortalitatea general a fost de 6% (2 pacieni). Am ntlnit 3
caviti reziduale supurate care au necesitat o reintervenie major
(fereastr pleural sau toracoplastie). La controalele efectuate la un an

postoperator (clinic, bacteriologie din sput, radiografie +/- CT toracic)
nu am ntlnit recidive, doi dintre pacieni decednd n urma unor cauze
fr legtur cu afeciunile toracice. Evaluarea comparativ rezecie
versus toracomioplastie nu a artat diferene semnificative n ceea ce
privete mortalitatea, incidena empiemului postoperator care s
necesite reintervenie sau a altor complicaii postoperatorii majore
(p>0,05 pentru toi parametrii studiai). Pacienii cu toracomioplastie au
necesitat spitalizri mai lungi (rezecie: spitalizri ntre 12-76, cu o
median de 18 zile vs toracomioplastie: spitalizri ntre 10-87, cu o
median de 42 de zile, p<0,05).
Concluzii
Tratamentul chirurgical al leziunilor TBC complicate cu
suprainfecie cu aspergillus rmne o provocare, implicnd o mortalitate
i morbiditate semnificativ. Pe cazuri selectate, att rezecia
pulmonar, ct i toracomioplastia, ofer rezultate bune.
12.30 12.40
MIASTENIA GRAVIS DUP TIMOMECTOMIE
Introducere
Este binecunoscut relaia dintre timoame i miastenia gravis:
10-15% din pacienii cu miastenia gravis au i un timom i ntre 3050% din pacienii cu timom pot prezenta miastenie.
Material i metod
Este prezentat cazul unui pacient care la vrsta de 36 de ani este
operat pentru timom fiind practicat timotimomectomie cu rezecia
peretelui anterior al trunchiului venos brahiocefalic stng i
reconstrucia acestuia cu petec de Goretex. De menionat c n acel
moment pacientul nu prezenta semnele clinice ale misteniei gravis,
timomul fiind o descoperire radiologic ntmpltoare. Postoperator
urmeaz tratamentul complementar (chimio i radioterapia), protocol
ncheiat dup 9 luni postoperator.
Rezultate
La 6 ani postoperator dezvolt miastenia gravis form
generalizat, simptomatologia fiind relativ brusc instalat. Urmeaz
tratament cortizonic i cu anticolinesterazice cu ameliorarea
simptomatologiei neuromusculare. Ultimul control CT toracic efectuat
la 10 ani de la rezecie, nu relev semne de recidiv tumoral sau alte
localizri ale leziunii maligne. n plus demonstreaz permeabilitatea
grefei vasculare.
Concluzii
Dei rar observat n practic, miastenia gravis poate apare i
trebuie luat n considerare i dup rezecia timusului tumoral.
12.40 12.50
CHIRURGIA TORACOSCOPICA UNIPORTALA
Introducere
Chirurgia toracoscopica uniportala reprezinta o alternativa
diagnostica si terapeutica pentru situatiile in care mijloacele de
investigare paraclinica sunt insuficiente pentru diagnostic sau cand
interventia chirurgicala clasica este excesiva pentru scopul diagnostic
propus, fie este contraindicata. Progresele tehnologice actuale permit
aplicarea acestei chirurgii miniinvazive pentru cazuri selectionate.
Material i metod
Studiul nostru este retrospectiv si cuprinde intervalul de timp
2001 2012. Au fost luate in calcul toate cazurile la care s-a intervenit
strict toracoscopic, dar si cele la care toracoscopia a reprezentat o etapa
intermediara pentru minitoracotomia video-asistata ulterioara, respectiv,
in cazuri izolate, toracotomia clasica.
Rezultate
In perioada mentionata s-au efectuat 312 video-toracoscopii, din
care 119 realizate pe un singur port, 85 pe doua porturi si 1 pe trei
porturi. In 107 situatii, toracoscopia uniportala a avut doar scop
explorator, fiind urmata de conversie la minitoracotomie, sau in cazuri
izolate de abord chirurgical clasic. Rezultatele histopatologice obtinute
dupa abordul toracoscopic uniportal a fost reprezentat de: 58 cazuri

TBC, 72 pleurezii inflamatorii nespecifice, 134 cazuri patologie
maligna. In celelelte situatii (47 de cazuri) abordul chirurgical
toracoscopic uniportal a permis rezolvarea unor colectii pleurale
posttraumatice, corectarea malformatiilor condrocostale (tehnica Nuss),
stabilirea diagnosticului de sarcoidoza, etc.
Concluzii
Chirurgia toracoscopica uniportala reprezinta o tehnica minim
invaziva cu numeroase avantaje in conditiile unor dezavantaje si riscuri
minime. Este o tehnica relativ facila pentru serviciile de chirurgie
toracica cu dotare adecvata. Poate fi realizata si in anestezie locala, insa
consideram ca trebuie realizata doar in sala de operatii.
12.50 13.00
TORACOMIOPLASTIA CA RE-REINTERVEIE
Introducere
Rolul interveniilor de toracomioplastie n tratamentul
empiemelor postoperatorii este controversat. Dificultatea major este
dat
de
secionarea
maselor
musculare
n
cursul
toracotomiei/toracotomiilor iniiale, avnd ca rezultat limitarea
volumului i a posibilitilor de mobilizare a lambourilor din vecintate.
Material i metod
n ultimii 8 ani am efectuat toracomioplastii la un numr de 7
pacieni avnd n antecedente cel puin 2 intervenii majore efectuate
prin toracotomie (fr a lua n considerare pleurotomia i fereastra
Eloesser). Indicaia a fost n toate cazurile prezena unui empiem
postoperator ce nu a putut fi controlat prin interveniile anterioare.
Intervenia a vizat obliterarea complet a cavitii i nchiderea
fistulelor bronice, cu nchiderea primar a noii plgi. S-au folosit
lambourile sau poriunile de lambouri musculare rmase intacte dup
toracotomiile anterioare (dinat anterior, mare dorsal, pectoral,
subscapular i intercostal).
Rezultate
La toi pacienii s-a obinut desfiinarea cavitii de empiem i
vindecarea per primam a plgii, cu spitalizri postoperatorii ntre 30 i
51 de zile, fr morbiditate major semnificativ. Un aspect interesant
este acela c 3 cazuri au fost diagnosticate cu tuberculoz pe baza
probelor recoltate n unitatea noastr, absena asocierii unui tratament
tuberculostatic corect putnd fi o explicaie pentru evoluia nefavorabil
a acestor pacieni.
Concluzii
Toracomioplastia poate fi o soluie definitiv i n cazul unor
complicaii postoperatorii cu caracter recidivant. Prin analiza atent a
anatomiei locale lambourile musculare pot fi folosite i dup mai multe
intervenii pe torace.
SESIUNE POSTERE
CHIRURGIA TORACIC MINIINVAZIV N TRATAMENTUL
PLEURO-PERICARDITELOR MALIGNE
Claudiu Nistor1 , Adrian Ciuche1, Cezar Mota2, Teodor Horvat2
1
Spitalul Universitar de Urgen Militar Central Dr. Carol Davila,
2
Institutul Oncologic Bucureti
Introducere
Pleuro-pericarditele maligne reprezint o complicaie comun
care poate surveni n cursul oricrei boli neoplazice.
Material i metod
Pentru perioada 01.01.1998 31.12.2008 s-a efectuat un studiu
retrospectiv. n aceast perioad 46 de bolnavi au fost diagnosticai i
tratai pentru pleuro-pericardite maligne n Clinica de Chirurgie
Toracic sub coordonarea Prof. Teodor Horvat (din SUUMC).
Rezultate
Un numr de 42 de pacieni au fost operai prin tehnici
chirurgicale miniinvazive: 36 de bolnavi prin chirurgie toracoscopic i
6 pacieni prin CTVA.
Cele mai frecvente cancere primitive, care au stat la originea

pleuro-pericarditelor maligne abordate miniinvaziv, pe statistica
noastr, au fost cancerele pulmonare (20 de cazuri).
Procedeul chirurgical de drenaj pericardic cel mai folosit a fost
fenestrarea pleuro-pericardic toracoscopic (34 de cazuri).
Metoda chirurgical cea mai folosit pentru mpiedicarea
recidivei revrsatului malign pleuro-pericardic a fost pleurodeza
postoperatorie cu bleomicin (22 de cazuri) urmat de talcajul pleural
toracoscopic (14 cazuri).
Concluzii
Chirurgia miniinvaziv joac un rol important n abordarea
cazurilor de pleuro-pericardite neoplazice datorit eficienei diagnostice
i terapeutice ridicate.
PNEUMOTORAX SPONTAN SECUNDAR LA UN PACIENT CU
HISTIOCITOZ PULMONAR X I DIABET INSIPID
Introducere
Lucrarea prezint cazul unui pacient de 37 de ani internat n
secia de chirurgie toracic pentru un pneumotorax stang recidivat. n
urm cu 9 ani pacientul a fost diagnosticat n sectia de pneumologie cu
histiocitoz X i diabet insipid cu ocazia unui episod de
pneumomediastin spontan.
Material i metod
Primul episod de pneumotorax spontan stng a fost rezolvat n
urm cu o lun prin drenaj pleural (pleurotomie minima stng). Pentru
rezolvarea celui de-al doilea episod de pneumothorax spontan stng am
utilizat chirurgia miniinvaziv prin intermediul creia s-a efectuat att
pleurodeza mecanic i chimic precum i confirmarea diagnosticului
de histiocitoz X prin biopsie pulmonar.
Rezultate
Rezultatele imediate postoperatorii au fost favorabile, cu
expansiune pulmonar complet i ameliorarea funciei respiratorii.
Concluzii
Chirurgia miniinvaziv toracic este tehnica de elecie n
abordarea acestui tip de maladii pleurale datorit avantajelor
diagnostice, terapeutice, cu mortalitate i morbiditate sczut, fa de
tehnicile chirurgicale clasice.
CHIRURGIA DE REDUCIE VOLUMIC NTR-UN CAZ DE
EMFIZEM PULMONAR I INSUFICIEN RESPIRATORIE
ACUT
Spitalul Universitar de Urgenta Militar Central Dr. Carol Davila
Introducere
Autorii prezint cazul unui brbat de 64 de ani, fost mare
fumtor, cunoscut cu BPOC i insuficien respiratorie cronic, care se
interneaz de urgen cu dispnee sever de repaus ( SO2 60% fr
oxigen i 80% cu oxigen pe masc).
Material i metod
Examenul radiologic standard arat existena unor zone de
hipertransparen toracic, localizate bazal bilateral, pe fondul unui
aspect radiologic ce sugereaz prezena unui emfizem pulmonar.
Examenul CT toracic nu poate stabili cu certitudine dac zonele bazale
de hipertransparen sunt date de prezena aerului n cavitatea pleural
sau de existena unor bule gigante de emfizem.
Se procedeaz la o abordare chirurgical secvenial:
pleurotomie minim dreapt cu obinerea expansiunii parenchimului
pulmonar i ameliorarea dispneei, pleurotomie minim stang, fr
expansiune pulmonar i fr pierderi aeriene, urmat de toracotomie
stang cu descoperirea i rezecarea a 3 bule gigante de emfizem, aflate
n tensiune, care produceau fenomene de compresie a parenchimului
pulmonar adiacent.
Rezultate
Ameliorarea simptomatologiei respiratorii i a tolerantei la efort
a fost constatat att dup efectuarea pleurotomiei minime drepte ct i
dup efectuarea interveniei chirurgicale de reducie volumic.
Concluzii
Cazul prezentat a ridicat nc de la nceput probleme de
diagnostic la un pacient cu insuficien respiratorie sever ce impunea
luarea unei decizii terapeutice de urgen. Pleurotomia minim a
constituit practic att o masur terapeutic salvatoare (pleurotomia
dreapt) ct i un mijloc de diagnostic pentru bulele gigante de emfizem
(cea stng). Chirurgia de reducie volumic a constituit un mijloc
terapeutic de completare i de mbuntire a situaiei respiratorii a
pacientului.
AUTOFLUORESCENA N CHIRURGIA TORACIC DEBUT
ROMNESC LA IOB
Introducere
Autofluorescena se bazeaz pe proprietatea esuturilor de a
emite lumin cu lungime de und diferit, dup stimulare cu lumin
avnd lungime de und specific.
Material i metod
Sunt prezentate primele imagini de autofluorescen
toracoscopic nregistrate att n IOB ct i n chirurgia toracic
romneasc.
Rezultate
Autofluorescena n chirurgia toracic are aplicabilitate n
evaluarea pleurei parietale i viscerale, a pericardului, n afeciuni
precum pleureziile maligne primare sau secundare, alte pleurezii
exudative, pericardite n suspiciunea de malignitate, pneumotorax
spontan etc.; metoda nltur reaciile adverse ale fluorescenei induse
medicamentos. Leziunile de tip inflamator dau rezultate fals pozitive.
Concluzii
Autofluorescena n chirurgia toracic (miniinvaziv) permite
identificarea leziunilor suspect maligne, biopsierea intit a acestora,
extensia leziunilor neoplazice i excizia n limite reale de sigura.
CHIST HIDATIC PULMONAR SUPRAINFECTAT CU

ASPERGILLUS
Raluca, Hogea Timur, Batog Olivia
Introducere
Att chistul hidatic pulmonar, ct i aspergilomul pulmonar sunt
relativ rare. Prezentm o asociere acestor dou afeciuni.
Material i metod
Prezentm o pacient de 28 de ani internat pentru febr,
dispnee i hemoptizie. Radiografia i examenul CT toracic arat o
leziune de 8 cm diametru situat n lobul superior stng, cu un aspect
plednd pentru chist hidatic pulmonar supurat. Intervenia chirurgical a
constat n chistectomie, perichistectomie i capitonajul cavitii restante.
Datorit aspectului macroscopic, s-a solicitat un examen micologic al
coninutului chistului, care a artat prezena Aspergillus spp. Pacienta a
rmas febril postoperator, fr o cauz evident.
Rezultate
Evoluia postoperatorie a fost favorabil, cu dispariia febrei
dup introducerea tratamentului antifungic specific (voriconazol) n
ziua a 5-a postoperator i externare n ziua 20 postoperator. La 3 ani de
la intervenia chirurgical pacienta nu prezint acuze toracice sau
sechele.
Concluzii
n chistele hidatice pulmonare supurate, examinarea micologic
permite detectarea unor infecii fungice i instituirea unei terapii
specifice, care previne complicaii ulterioare.
POLITRAUMATISM
CU
VOLET
COSTAL,
HEMOPNEUMOTORAX
I
EMFIZEM
SUBCUTANAT
REZOLVAT PRIN DRENAJ, PUNCII REPETATE I
STABILIZARE PNEUMATIC INTERN
Boianu Alexandru-Mihail1, Florean Lacrima2, Boianu Petre VlahHorea1, Batog Olivia1, Giurgiu Ioana1
1
Clinica Chirurgie IV, UMF Trgu-Mure,2Secia ATI, Spitalul Clinic
Judeean Mure
Introducere
Prezentm un caz de politraumatism cu probleme de diagnostic
i treatment.
Material i metod
Prezentm un pacient care a suferit un politraumatism prin
cdere de pe biciclet pe fondul unei stri avansate de ebrietate.
Examenul CT de urgen a evideniat fisur de os temporal drept,
colecie lichidiana la nivelul cavitii nazale i sinusului maxilar drept,
hematom epicranian stng, fractur medioclaviculara stng, multiple
fracturi costale la nivelul hemitoracelui stng, emfizem subcutanat
laterotoracic si laterocervical stng, pneumotorax stng i
pneumopericard. S-a efectuat de urgen pleurotomie i drenaj cu valv
Heimlich i intubaie oro-traheal (Odorheiul Secuiesc). Datorit
evoluiei nefavorabile instabilitate hemodinamic i accentuarea
emfizemului, pacientul este trimis cu SMURD n serviciul nostru. S-a
practicat cuplarea drenajului la aspiraie activ, drenajul emfizemului
subcutanat cu ace, puncii repetate i ventilaie mecanic prelungit
pentru 18 zile stabilizare pneumatic intern. Examinrile CT,
ecografice, bronhoscopice i RMN, exclud alte leziuni, cu excepia unei
tromboze de sinus carvernos fr indicaie de tratament chirurgical.
Traheostomia solicitat pentru ventilaie mecanic prelungit a fost
amnat pn cnd nu a mai fost necesar.
Rezultate
Evoluia a fost lent favorabil, att din punct de vedere
neurologic, ct i din punct de vedere respirator, permind extubarea
pacientului i externarea lui dup o spitalizare de 33 de zile. La
controlul efectuat la 3 luni, pacientul nu prezint sechele semnificative
cu excepia unui sindrom algic toracic.
Concluzii
Cazul este ilustrativ pentru dificultile de diagnostic al comei la
politraumatizai n contextul prelurii pacientului din alt unitate
(etilism, traumatism, com indus medicamentos) i pentru necesitatea
de a trata traumatismele toracice severe n centre cu dotare
corespunztoare i acces permanent la bronhoscopie, CT, RMN,
ecografie etc. Rezolvarea leziunii toracice s-a datorat n principal
stabilizrii pneumatice interne prin ventilaie mecanic prelungit.
LIPOM INTRATORACIC STNG GIGANT (17x10x8 cm)
Boianu Petre Vlah-Horea1, Cerghizan Anda2, Lucaciu Oana Raluca1,
Boianu Alexandu-Mihail1
1
Clinica Chirurgie IV, 2Clinica Medical III, UMF Trgu-Mure
Introducere
Prezentm un caz ce ilustreaz dificultile de rezolvare a unor
tumori intratoracice benigne de dimensiuni mari.
Material i metod
Prezentm un pacient de 70 de ani, cu patologie cardiac sever
ICC NYHA III, antecedente de AVC i carcinom nazo-palpebral
operat n urm cu 5 ani, internat la Cl. Medical pentru agravarea
dispneei. Radiografia arat o opacitate gigant la nivelul hemitoracelui
drept. Examenul CT evideniaz o tumor intratoracic de 17x10x8 cm,
bine delimitat, cu compresie i deviere traheal. Bronhoscopia si
endoscopia digestiva arat compresie extrinsec, dar far invazia
arborelui traheo-bronic, respectiv a esofagului. S-a intervenit
chirurgical printr-o toracotomie postero-lateral larg. Dup eliberarea
plmnului, s-a gsit o tumor extrapulmonar, cu 3 pedicoli vasculari
cu originea n vasele intercostale posterioare. S-a practicat excizia
complet a tumorii, planul de clivaj permind eliberarea de trahee,
esofag si aort.
Rezultate
Evoluia postoperatorie a fost extrem de dificil datorit unei
bronhopneumonii i a patologiei cardiace asociate, dar in cele din urm
favorabil, cu ameliorarea statusului respirator. Examenul
histopatologic a artat prezena unui lipom mixoid fuzocelular fr

atipii.
Concluzii
Cazul este interesant prin raritatea localizrii acestei tumori la
nivelul toracelui i dimensiunile mari.
UN
CAZ
RAR
DE
TUMORA
INFLAMATORIE
MIOFIBROBLASTICA CU LOCALIZARE MEDIASTINALA

Introducere
Tumora miofibroblastica inflamatorie (IMT) sau pseudotumora
inflamatorie este o tumora benigna rara compusa din celule tip spindle
care apare in locatii variate cum ar fi plamanul, pielea, sanul, tractul
gastrointestinal, pancreas, os, epididim, peritoneu. Localizarea
mediastinala este foarte rara. Prezentam cazul unei paciente de 16 ani
cu aceasta patologie.
Metoda
Pacientul a fost internat in clinica noastra cu istoric de toracalgii
la nivelul hemitoracelui drept, dispnee usoara si tuse iritativa.
Radiografia toracica a aratat o ascensionare marcata a hemidiafragmului
drept. Ecografia abdominala evidentiat prezenta de formatiuni
heterogene, polilobate cu dislocarea parenchimului hepatic si colectii
lichidiene intratumorale. Examinarea CT toracica a evidentiat o
formatiune giganta in hemitoracele drept cu efect de masa
supradiafragmatic asupra ficatului, mediastinului inferior si a
plamanului. S-a practicat toracotomie posterolaterala, descoperindu-se o
tumora giganta(14/13/12 cm) cu punct de plecare mediastinal. S-a
practicat ablatie tumorala totala.
Rezultate
Evolutia postoperatorie a fost favorabila, fara complicatii si
rexpansionare pulmonara completa. Durata de spitalizare a fost 7 zile.
Imunohistochimia a fost pozitiva pentru desmina, VIM, CD 34, CD 68,
Ki67, si a fost diagnosticata o tumora inflamatorie miofibroblastica. Nu

s-au evidentiat recurente tumorale la un an si la doi ani.
Concluzii
Tumora mediastinala mioinflamatorie reprezinta o patologie
extrem de rara. Poate pune o serie de probleme cum ar fi diagnosticul
preoperator, probleme de ordin tehnic legate de localizare. Daca ablatia
tumorala totala este posibila pacientii au un prognostic favorabil.
CORPURI STRAINE INTRATORACICE 11 ANI DE
EXPERIENTA
Introducere
Desi foarte rara, patologia corpurilor straine intratoracice , fie in
arborele bronsic, fie in cavitatea pleurala reprezinta o provocare si poate
pune o serie de probleme, in special daca pacientii in cauza sunt
debilitati.
Metoda
In 11 ani am internat 20 de cazuri cu diferite tipuri de corpi
straini, cu varste cuprinse in intre 16 si 75 de ani, cu rata barbati femei
de 17:3. Patologia a fost reprezentata de 13 plagi toracice cu retentie de
corp straini(sticla, lama de cutit, ace, gloante), 3 corpi straini in arborele
bronsic (1 ac de seringa, 2 pietre), 4 intraesofagieni(1 proteza dentara, 2
sarme de cupru, un os). S-a practicat toracotomie in 9 cazuri, drenaj
pleural in un caz, o bronhoscopie, explorarea plagilor, un singur caz cu
taratament chirurgical. Durata medie de spitalizare a fost de 11 zile.
Rezultate
In toate cazurile prognosticul pe termen lung a fost bun. Am
avut trei complicatii: pleurezie manageriata prin drenaj pleural intr-un
caz cu perforatie esofagiana, pneumonie de aspiratie si febra prelungita.
Concluzii
Corpurile straine intratoracice sunt cateodata o adevarata
provocare pentru chirurgul toracic si generalist, pentru bronholog si
pentru gastroenterolog. Toracotomia este solutia finala, chirurgia minim

invaziva este necesara in majoritatea cazurilor.
PESTE 2000 DE CAZURI DE TRAUMATISME TORACICE 10
ANI DE EXPERIENTA A UNUI SINGUR CENTRU
Clin Tunea
Obiective
Prezentam experianra clinicii noatre in diagnosticul si
tratamentul traumatismelor toracice, in literatura de specialitate aceasta
patologie fiind foarte controversata
Material si metoda
Studiul cuprinde 2156 de cazuri internate intr-o perioada de 10
ani (2002 2011). Pacientii au fost analizati in functie de sex, varsta,
agentul vulnerant, dar si in functie de asocierile lezionale traumatice, de
metodele de diagnostic si tratament chirurgical, durata de spitalizare si
evolutia sub tratament.
Rezultate
Spitalizarea datorita traumatismelor toracice reprezinta o medie
de 21 % din totalul internarilor. Cazurile de politrauma 35% au fost
abordate in echipe multidisciplinare. In ceea ce priveste metodele de
diagnostic, tomografia a fost folosita in 35% din cazuri, iar
bronhoscopia in 6%. Punchia ghidata cu ac fin a fost folosita pentru
diagnosticul diferential in contuziile pulmonare in 1.4% din cazuri. Cele
mai frecvente leziuni au fost fracturile costale, pleureziile
posttraumatice si contuziile pulmonare. Pleurotomia a fost cel mai
frecvent utilizata (47%) in timp ce toracotomia a fost folosita in 8% din
cazurile operate. Complicatiile au afectat 18% din cazuri. 76% din
pacientii care au necesitat peste 3 saptamani de spitalizare s-au
prezentat cu contuzie pulmonara intinsa. Rezultate nefavorabile au vost
observate la 4% din pacienti, in timp ce 2,6 % din pacienti au murit.
Concluzii
Traumatismul toracic reprezinta o incercare dificila, de multe ori
cu evolutie surprinzatoare. Diagnosticul si aplicarea celui mai bun
tratament chirurgical, de multe

multidisciplinare este obligatoriu.
ori
cu
ajutorul
echipelor
CAZ RAR DE PREZENTARE A UNUI HEMANGIOENDOTELIOM MALIGN

Ovidiu Rus, Cezar Motas, Natalia Mota, Teodor Horvat
Introducere
Hemangioendoteliomul malign este o tumora vasculara rara, cu
un tablou clinic nespecific, la care diagnosticul este de multe ori
intarziat ori confundat, limitand astfel posibilitatile terapeutice.
Metod
Prezentm cazul unui pacient n vrst de 42 de ani, cu
pericardita hemoragica operata in 2011, ce se interneaz n clinica
noastr cu diagnosticul de pleurezie dreapta de etiologie neprecizata.
Examenul CT efectuat anterior internarii prezinta multiple formatiuni
hepatice, noduli pulmonari drepti cu pleurezie dreapta in cantitate
medie.
Interventia chirurgicala este amanata datorita degradarii
hemoleucogramei cu trombocitopenie importanta si anemie, corectate
partial prin transfuzii si tratament medicamentos.
Rezultate
Se efectueaza toracoscopie dreapta: intraoperator se evacueaza
aprox 1200 ml lichid pleural cu aspect de sange vechi, fara leziuni
macroscopice ale pleurei parietale; la nivelul pleurei viscerale se
vizualizeaza leziuni nodulare cu aspect de determinari secundare. Se
decide extinderea interventiei cu practicarea unei minitoracotomii si
efectuarea unei rezectii atipice pulmonare de lob inferior drept.
Diagnostic IHC: hemangioendoteliom malign.
Evolutia postoperatorie este lent favorabila, cu reaparitia
trombocitopeniei, remisa partial sub tratament medicamentos.
Concluzii
Hemangioendoteliomul malign este o neoplazie rara, putin
cunoscuta; lipsa diagnosticului in timp util genereaza extinderea bolii,
cu asocierea complicatiilor (pleurezie neoplazica hemoragica), care

limiteaza speranta de viata.
CINCI TORACOTOMII SUCCESIVE IPSILATERALE (LA
ACELASI
PACIENT).
PREZENTARE
DE
CAZ
SI
CONSIDERATII.
Cristian Pavaloiu
Introducere
Toracotomiile recurente ipsilaterale greveaza actul operator si
evolutia prin modificarile parietale si intratoracice induse de disocierile
operatorii si fibroza succesiva. Dorim sa evidentiem un caz cu 5
toracotomii succesive prezentand
complicatiile si dificultatile
intraoperatorii ce pot apare in urma mai multor toracotomii pe acelasi
hemitorace la acelasi pacient.
Material si metoda
Pacienta CG in varsta de 42 de ani a fost diagnosticata in cursul
acestui an cu tumora pulmonara lob superior drept (Rx si CT) pentru
care s-a practicat rezectie atipica segment apical lob superior drept si
rezectie partiala arcuri costale laterale drepte C3-C4. In antecedentele
personale patologice se regasesc inca patru toracotomii drepte in decurs
de 11 ani pentru chist hidatic recidivant. Pentru obtinerea informatiilor
am folosit foaia de observatie a pacientului, protocolul operator,
buletinul histopatologic, buletinul computerului tomograf si biletele de
externare pentru fiecare din interventiile chirurgicale anterioare. S-au
efectuat per ansamblu 2 toracotomii postero-laterale de mari dimensiuni
si trei toracotomii laterale.
Rezultate
Intraoperator rigiditatea peretelui toracic, multiple aderente,
lipsa scizurilor, disparitia anatomiei muschilor dintat si latissim,
precaritatea examenului extemporaneu si plamanul friabil au grevat
actul operator, iar evolutia postoperatorie a fost intarziata de pierderi
aeriene prelungite, lipsa de expansiune a plamanului restant si nedecolat

complet ca si de sechelele dureroase mai vechi si postoperatorii imediat.
Concluzii
Toracotomiile iterative multiple depreciaza peretele si
parenchimul pulmonar punand prin cumulare o amprenta grea pe
evolutia postoperatorie, ceea ce face ca indicatia operatorie suucesiva sa
devina problematica implicand raspunderi din ce in ce mai mari care
trebuiesc anticipate de echipa operatorie / decizionala si comunicate
pacientului preoperator.
PUNCTIA BIOPSIE TRANSTORACICA CU AC - EXPERIENTA
CLINICII I CHIRURGIE TORACICA A INSTITUTULUI
NATIONAL DE PNEUMOLOGIE "MARIUS NASTA"
Olga Danaila, Cristian Paleru, Ciprian Bolca, Mihai Dumitrescu, Dana
Ivascu, Valerian Cristian Pavaloiu, Ioan Cordos
Introducere
Punctia biopsie transtoracica cu ac (PBTA) este o metoda sigura
si rapida utilizata pentru diagnosticul histopatologic al leziunilor
toracice inca din secolul al XIX-lea.
Material si metoda
Pe o perioada de 2 ani (mai 2010 - mai 2012) am efectuat in
clinica noastra PBTA la un numar de 42 pacienti (25 barbati si 17
femei, media de varsta 63 ani) pentru a evalua formatiuni
parenchimatoase pulmonare periferice, formatiuni ale peretelui toracic,
pleurale, mediastinale sau cervicale depistate la examenul computer
tomograf. Au fost exclusi pacientii cu diateze hemoragice incontrolabile
cat si cei necooperanti. In majoritatea cazurilor PBTA s-a efectuat in
conditii de ambulator, sub anestezie locala. In general am utilizat ace de
14 sau 16 gauge, sub control ecografic la 28 pacienti.
Rezultate
Pentru a obtine material bioptic suficient si reprezentativ a fost
necesara efectuarea manevrei in medie de 3 ori la un pacient. Dupa
prelucrarea probelor s-a obtinut diagnostic histopatologic specific in
83.3 % din cazuri, dintre care 27 (77.1%) au avut leziuni maligne. Cei 7
pacienti la care nu s-a putut obtine un diagnostic prin PBTA au fost
supusi interventiei chirurgicale de biopsie, iar 5 dintre ei au prezentat
leziuni maligne la examenul histopatologic. Doar in 4 cazuri PBTA a
fost complicata de aparitia pneumotoraxului ce a necesitat drenaj la 2
pacienti. Nu au survenit hemoragii majore si nici decese.
Concluzii
PBTA este o metoda minim invaziva sigura si eficienta in
stabilirea diagnosticului histopatologic a formatiunilor toracice, mai
ales in leziunile maligne. Doar in cazurile rare la care se obtine un
diagnostic specific de leziune benigna interventia chirurgicala poate fi
evitata. Acuratetea procedurii poate fi crescuta apeland la ghidaj
ecografic si un medic anatomopatolog experimentat.
TEHNICI DE OSTEOSINTEZA COSTALA SI FIXARE
CHIRURGICALA
A
VOLETULUI
COSTAL.
STUDIU
EXPERIMENTAL COMPARATIV.
Bogdan Popovici, Mircea Ciorba, Angela Goia, Dan Nicolau.
Sectia de Chirurgie Toracica, Spitalul Clinic Leon Daniello Cluj
Napoca
Introducere
Stabilizarea chirurgicala a voletelor costale are indicatii
restranse dar in practica au fost imaginate, practicate si publicate un
numar mare de tehnici chirugicale fara a se reusi standardizarea
tratamentului. Obiectivul acestui studiu a fost familiarizarea cu aceste
tehnici chirurgicale in conditii experimentale si compararea lor prin
prisma eficientei si randamentului.
Material si metoda
Studiul a fost efectuat in Centrul de Medicina Experimantala a
UMF Cluj Napoca pe porci la care s-au provocat volete costale.
Modelul experimental a constat in efectuarea a 4 tehnici chirurgicale
descrise in literatura, doua de osteosinteza costala si doua de fixare a
voletului costal. Au fost urmarite eficienta tehnicii, facilitatea, durata
interventiei, accesibilitatea si costurile materiale.
Rezultate
Toate metodele au permis o fixare eficienta a voletului costal.
Tehnicile de osteosinteza in focar sunt mai laborioase, mai scumpe, mai
putin accesibile si necesita dezvoltarea unor abilitati specifice; asigura o
osteosinteza mai buna. Tehnicile de fixare a voletului sunt facile tehnic,
ieftine, rapide, usor accesibile chirurgului toracic; asigura imobilizarea
voletului si ulterior osteosinteza definitiva.
Concluzii
Compararea metodelor demonstreaza ca nu se poate opta pentru
o tehnica standard. Tehnica optima este cea potrivita cu statusul
lezional, experienta chirurgicala si facilitatile materiale disponibile.
SCIENTIFIC
PROGRAMME
THURSDAY, OCTOBER 4, 2012

18.00 General assembly of the Romanian Society of Thoracic Surgery 1994
19.00 Opening ceremony and Welcome reception
FRIDAY, OCTOBER 5, 2012

09.00 11.00 - Conferences - Session I
Chaiermen: Alper Toker, Ioan Cordo
9.00 9.30
Alexandru Boianu
Surgical Staplers in Thoracic Surgery: Past and Future
9.30 10.00
Marcin Zielinski
10.00 10.30
Jos Belda-Sanchis
who is rigth
10.30 11.00
Teodor Horvat
Hepatic hydrothorax
11.00 11.30 Coffee break
11.30 13.30 - Conferences - Session II

Chairmen: Marcin Zielinski, Cristian Paleru
11.30 12.00
Philippe Dartevelle
TO BE ANNOUNCED
12.00 12.30
Philippe Dartevelle
TO BE ANNOUNCED
12.30 13.00
Ioan Cordo
Surgical Indications in Lung Cancer
13.00 13.30
Techno-meeting - MEDELA
13.30 15.30 Lunch break
15.30 17.30 - Scientific Session I
Chairmen: Jos Belda-Sanchis, Teodor Horvat
15.30 15.40
SPECIFIC FEATURES OF OPERATORY INTERVENTIONS ON
SINGLE SURGICAL LUNG
Thoracic Surgery Clinic, Institute of Oncology Bucharest
15.40 15.50
RIGHT ESOPHAGO-CAVITARY FISTULA AFTER BILATERAL
PULMONARY TUBERCULOSIS
1
Surgery Department, 2Intensive Care Department, 31st Pneumology

Department, Drobeta-Turnu Severin Emergency County Hospital
15.50 16.00
SURGICAL REPAIR OF THE LIVER DOME ECHINOCOCCOSIS
THE THORACIC SURGEONS WAY?
Thoracic Surgery Clinic, Timisoara Municipal Hospital
16.00 16.10
INDICATIONS AND RESULTS OF ONE-STAGE BILATERAL
THORACOTOMY APPROACH
Surgical Clinic IV, UMPh Trgu-Mure
16.10 16.20
MALIGNANT HEMANGIOPERICYTOMA THE "SURPRISE"
PNEUMONIA
Iulian Mihai Radulescu, Mihaela Codresi, Adrian Mihail Iordache,
Ioan Cordos
Thoracic Surgery Clinic, "Marius Nasta" Pneumology Institute,
Bucharest.
16.20 16.30
AUTOFLUORESCENCE BRONCHOSCOPY IN EVALUATION OF
LUNG CANCER
16.30 16.40
PURE PECTUS CARINATUM (NOT ASSOCIATED WITH PECTUS
EXCAVATUM) SOLVED BY MIRPC (MINIMALLY INVASIVE
REPAIR OF PECTUS CARINATUM)
1
Thoracic Surgery Clinic, 2Anesthesiology and Intensive Care Clinic,

UMF Craiova
16.40 16.50
DIAPHRAGM RECONSTRUCTION WITH LATISSIMUS DORSI IN
PULMONARY LUNG CANCER WITH HEPATIC INVASION
1
Bucharest, 2Fundeni Clinical Institute, Dan Setlacec General Surgery
and Hepatic Transplant Center.
16.50 17.00
LYPOSARCOMAS OF ANTERIOR MEDIASTINUM
17.00 17.10
CLINICAL AND IMAGISTIC ASPECTS IN LATE SURVIVORS
AFTER PLOMBAGE THORACOPLASTY FOR TUBERCULOSIS
Surgical Clinic IV UMPh Trgu-Mure
17.10 17.20
MAFFUCCI SYNDROME, RARE CONDITION IN THORACIC
SURGERY
Valerian Pavaloiu
Thoracic Surgery Clinic, "Marius Nasta" Pneumology Institute, Bucharest.
17.20 17.30
ACUTE NECROTIC DESCENDENT CERVICO-MEDIASTINITIS
WITH BILATERAL SECONDARY PLEURAL EMPIEMA AND
SEPTIC EROSION OF RIGHT ANTERIOR JUGULAR VEIN AND
RIGHT JUGULO SUBCLAVIAN VENOUS CONFLUENT
Gala dinner 19.00

SATURDAY, OCTOBER 6, 2012
09.00 11.00 - Conferences - Session III
Chairmen: Teodor Horvat, Alexandru Boianu
9.00 9.30
Cristina Grigorescu
Update reports in LVRS (lung volume reduction surgery)
9.30 10.00
Alper Toker
TO BE ANNOUNCED
10.00 10.30
3D Conformational and Intensity-Modulated Radiation Therapy in the
Treatment of Lung
10.30 11.00
Genoveva Cadar
One Lung Ventilation in Thoracic Surgery
11.00 11.30 Coffee break
11.30 13.00 - Scientific Session II

Chairmen: Philippe Dartevelle, Ioan Cordo
11.30 11.40
SURGERY OF THYMOMAS
11.40 11.50
TECHNICAL
ASPECTS
OF
MINIMALLY
INVASIVE
TRANSCERVICAL APPROACH OF RIGHT MAIN BRONCHUS
11.50 12.00
CAN
THE
THORACIC
SURGEON
BE
A
GOOD
BRONCHOSCOPIST?
12.00 12.10
LARGE PARIETAL RESECTIONS-RECONSTRUCTIONS WITH
THE STRATOS SYSTEM
12.10 12.20
TYPIC CARCINOID IN A YOUNG PATIENT
Bucharest.
12.20 12.30
SURGERY OF PULMONARY TUBERCULOUS LESIONS
OVERINFECTED WITH ASPERGILLUS
Surgical Clinic IV, University of Medicine and Pharmacy, Trgu-Mure
12.30 12.40
MIASTENIA GRAVIS AFTER THYMOMECTOMY
12.40 12.50
ONE PORT THORACOSCOPIC SURGERY
12.50 13.00
THORACOMYOPLASTY AS A RE-REDO PROCEDURE
POSTER SESSION
MINIMALLY INVASIVE THORACIC SURGERY IN MALIGNANT
PLEURO-PERICARDIAL EFFUSIONS
1
Emergency University Military Central Hospital Dr. Carol Davila,
2
Institute of Oncology Bucharest
SECONDARY SPONTANEOUS PNEUMOTHORAX IN A CASE OF
PULMONARY HISTIOCYTOSIS X AND DIABETES INSIPIDUS
Emergency University Military Central Hospital Dr. Carol Davila
VOLUME REDUCTION SURGERY IN A CASE OF PULMONARY

EMPHYSEMA AND ACUTE RESPIRATORY FAILURE
AUTOFLUORESCENCE IN THORACIC SURGERY ROMANIAN
DEBUT AT IOB
HYDATID PULMONARY CYST OVERINFECTED WITH
ASPERGILLUS
Alexandru-Mihail Boianu, Petre Vlah-Horea Boianu, Oana Raluca
Lucaciu, Timur Hogea, Olivia Batog
POLITRAUMA WITH CHEST FLAIL, HEMOPNEUMOTHORAX
AND SUBCUTANEOUS EMPHYSEMA SOLVED BY DRAINAGE,
REPEATED THORACENTHESIS AND INTERNAL PNEUMATIC
STABILISATION
1
Surgical Clinic IV, UMPh Trgu-Mure, 2ICU Mure County Hospital
GIANT INTRATHORACIC LEFT LIPOMA (17x10x8 cm)
1
Surgical Clinic IV, 2Internal Medicine Clinic III, UMPh Trgu-Mure
A RARE CASE OF MEDIASTINAL INFLAMMATORY
MYOFIBROBLASTIC TUMOR
INTRATHORACIC FOREIGN BODIES A 11 YEAR STATISTICS

Iris Miron, Ovidiu Burlacu, Clin Tunea, Voicu Voiculescu, Gabriel Cozma,
Ioan Petrache, Alin Nicola
OVER 2000 CASES OF THORACIC TRAUMA 10 YEARS
EXPERIENCE OF A SINGLE CLINICAL CENTRE
Alexandru Nicodin, Ovidiu Burlacu, Voicu Voiculescu, Gabriel Cozma, Clin
Tunea
PRESENTATION OF A RARE CASE OF
HEMANGIOENDOTHELIOMA
Ovidiu Rus, Cezar Motas, Natalia Mota, Teodor. Horvat
MALIGNANT
FIVE IPSILATERAL SUCCESSIVE THORACOTOMIES (AT THE SAME

PATIENT). CASE REPORT AND CONSIDERATIONS.
Cristian Pavaloiu
TRANSTHORACIC NEEDLE BIOPSY - THE EXPERIENCE OF 1st
THORACIC SURGERY CLINIC OF THE "MARIUS NASTA" NATIONAL
INSTITUTE OF PNEUMOLOGY
Olga Danaila, Cristian Paleru, Ciprian Bolca, Mihai Dumitrescu, Dana Ivascu,
Valerian Cristian Pavaloiu, Ioan Cordos
RIB FRACTURE FIXATION AND OPERATIVE STABILIZATION OF
FLAIL CHEST. EXPERIMENTAL AND COMPARATIVE STUDY
Department of Thoracic Surgery, Clinic Hospital Leon Daniello Cluj
Napoca
13.00 13.30
Traian Oancea award for the best presentation during the conference
Closing remarks
ABSTRACTS
CONFERENCES
ORAL
PRESENTATIONS
POSTERS
FRIDAY, 5 OCTOBER 2012

09.00 11.00 - Conferences - Session I
Chaiermen: Alper Toker, Ioan Cordo
9.00 9.30
Alexandru Boianu
Surgical Staplers in Thoracic Surgery: Past and Future
9.30 10.00
Marcin Zielinski
Introduction
The aim of his study is to compare the diagnostic yield of
endobronchial ultrasound (EBUS) and/or endoesophageal ultrasound
(EUS) with transcervical extended mediastinal lymphadenectomy
(TEMLA) for staging and restaging of non-small cell lung cancer
(NSCLC)
Methods
All consecutive patients undergoing primary staging and
repeated staging (restaging) after neodjuvant chemo- or chemoradiotherapy for NSCLC from 1.1.2006 to 31.12.2010 were included.
Staging was started with EBUS, EUS or EBUS combined with EUS
(CUS) with fine needle aspiration (FNA) biopsy and cytological study.
Results
Primary staging was performed in 617 patients: EBUS in 375
patients, EUS in 48 patients and combined EBUS/EUS in 194 patients.
TEMLA was performed in primary staging in 475 patients. There was
no mortality and morbidity after EBUS/EUS. Two patients died after
TEMLA and morbidity rate after TEMLA was 6.6% . There was a
significant difference between EBUS/EUS and TEMLA for sensitivity
(88.9% and 95.8%; p=0.00) and Negative Predictive Value (NPV)
(84.1% and 99.6%; p = 0.00) in favor of TEMLA. In the restaging

group endoscopic staging was performed in 52 patients and TEMLA in
99. There was a significant difference between EBUS/EUS and
TEMLA for sensitivity (79.2% and 96.6%, p = 0.00) and NPV (84.5%
and 98.6%; p = 0.00) in favor of TEMLA.
Conclusions
The results of this largest reported series comparing the
endoscopic and surgical primary staging and restaging of NSCLC
showed a significant higher diagnostic yield of TEMLA in comparison
of EBUS/EUS.
10.00 10.30
Jos Belda-Sanchis
who is rigth
The role of surgery for cN2-positive, stage IIIA nonsmall cell
lung cancer (NSCLC) has evolved over the last decades moving from
primary treatment to a relevant role in multimodality management
strategies.
The 5-year survival following primary surgery for N2 NSCLC
ranges between 7 to 34% with better survival for patients with only one
mediastinal level involved (similar to multistation N1 disease),
microscopic or unexpected N2 disease (1-5).
Data from randomized clinical trials (6-10) demonstrate that
preoperative chemotherapy increases the median survival in patients
with clinical-N2 non-small-cell lung cancer when comparing with
surgery alone, with 5-year survival of 36% vs 15% (p=0.056 by the log
rank test; p=0.048 by the BreslowGehanWilcoxon test; Roth Lung
Cancer 1998). Nevertheless, many patients in these studies were
assumed to have a N2 disease without pathological confirmation or do
not have a systematic nodal dissection to certify the result pathological
response due to the preoperative chemotherapy.
Recently, Albain et al (11), in a phase III randomized clinical
trial showed that chemotherapy plus radiotherapy with or without
resection are options for patients with stage IIIA(N2 pathologically
confirmed) non-small-cell lung cancer. But, in the analysis of overall
survival according to interim pathologic response data, N0 status

continued to predict improved outcome whether or not there was
residual primary tumor. Patients who were T0, N0 (pathological
complete response) had a median survival of 36.7 months and a 3-year
survival of 52%. Patients who were T0-1, N0 had a median survival of
36.7 months and a 3-year survival rate of 53%. The most relevant part
of the trial is that downstaging of N2 disease to N0 will occur in 46% to
48% of patients, and 3-year survival of this group is 53%. The results in
the surgery arm show the importance of nodal clearance on survival.
These findings demonstrate that not everybody should get surgery after
induction, even more, they point to the need to determine which patients
will have nodal downstaging by any method.
The LACE Collaborative Group and the NSCLC Meta-analyses
Collaborative Group recently published the results of three metaanalyses of individual patient data regarding the benefits of the adjuvant
chemotherapy, with or without postoperative radiotherapy, in operable
non-small-cell lung cancer (12,13). These meta-analyses show that the
addition of adjuvant chemotherapy after surgery for patients with
operable non-small-cell lung cancer significantly improves survival,
irrespective of whether chemotherapy was adjuvant to surgery alone or
adjuvant to surgery plus radiotherapy.
Whether a systematic lymph node dissection will improve long
terms survival is not clear. The question, is systematic lymph node
dissection superior to sampling in patients undergoing lung resection for
NSCLC? was analyzed in a recent review of the best evidence topic in
thoracic oncology. The results of the review show that in stage I
NSCLC there is a little difference but there is an increase in survival
when performing a systematic lymph node dissection in stage II to IIIA.
In addition systematic nodal dissection seems to be able to detect more
pN2 disease (14) and more pN2 multistation disease (15) without an
increase in mortality, morbidity or length of hospitalization but, yes,
with a longer median operative time: 15 minutes! (16,17). Even more,
taking into account the recent findings regarding the benefits of the
adjuvant treatment in patients with a pN1 or pN2 disease, incomplete or
inaccurate nodal staging could prevent some patients from receiving
postoperative chemotherapy or radiotherapy.
After analyzing prior information, some key points should be

put forward for discussion:
1. Should we consider patients with single zone, intracapsular
microscopic N2 disease for primary surgery? Probably yes.
2. Should we include patients in a multimodality treatment
without pathological confirmation of N2 disease?. Probably no.
3. Should we consider for surgery patients with persistent N2
disease after induction treatment? Probably no.
4. Should we consider routine systematic nodal dissection the
standard in order to obtain an accurate pathologic staging and
potentially higher cure rates when a complete resection can be
achieved? Yes.
References.
1.Andr F, Grunenwald D, Pignon J-P, et al. Survival of patients with Resected N2 NonSmallCell Lung Cancer: Evidence for a subclassification and implications. J Clin Oncol 2000;18:281-89.
2.Riquet M, Manac'h D, Saab M, Le Pimpec-Barthes F, Dujon A, Debesse B. Factors
determining survival in resected N2 lung cancer. Eur J Cardiothorac Surg. 1995;9:300-4.
3.Fontaine E, McShane J, Carr M, Shackcloth M, et al. Should we operate on microscopic N2
non-small cell lung cancer? Interactive CardioVascular and Thoracic Surgery 2011;12:95661
4.Cerfolio RJ and Bryant AS. Survival of Patients With Unsuspected N2 (Stage IIIA) NonsmallCell Lung Cancer. Ann Thorac Surg 2008;86:362-367
5.Marchevsky AM, Gupta R, Kusuanco D, Mirocha J, McKenna Jr RJ. The presence of isolated
tumor cells and micrometastases in the intrathoracic lymph nodes of patients with lung cancer is not
associated with decreased survival. Human Pathology 2010; 41: 153643
6.Pass HI, Pogrebniak HW, Steinberg SM et al. Randomized trial of neoadjuvant therapy for
lung cancer: interim analysis. Ann Thorac Surg 1992; 53: 9928.
7.Rosell R, Gomez-Condina J, Camps C, et al. A randomized trial comparing preoperative
chemotherapy plus surgery with surgery alone in patients with non- small-cell lung cancer. N Engl J Med
1994;330:1538.
8.Roth JA, Fossella F, Komaki R, et al. A randomized trial comparing perioperative
chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer. J Natl
Cancer Inst 1994;86:67380.
9.Rosell R, Gmez-Codina J, Camps C, et al. Preresectional chemotherapy in stage IIIA nonsmall-cell lung cancer: a 7-year assessment of a randomized controlled trial. Lung Cancer 1999;47:714
10.Roth JA, Atkinson EN, Fossella F, et al. Long-term follow-up of patients enrolled in a
randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage
IIIA non-small-cell lung cancer Lung Cancer 21:1998;21:16
11.Kathy S Albain, R Suzanne Swann, Valerie W Rusch, et al. Radiotherapy plus chemotherapy
with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomized controlled
trial. Lancet 2009; 374: 37986.
12.NSCLC Meta-analyses Collaborative Group. Adjuvant chemotherapy, with or without
postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient
data. Lancet 2010; 375: 126777.
13.JP Pignon, Tribodet H, Scagliotti GV, et al. Lung Adjuvant Cisplatin Evaluation: A Pooled
Analysis by the LACE Collaborative Group. J Clin Oncol 2008; 26:3552-9.
14.Cerfolio RJ, Bryant AS, Minnich DJ. Complete Thoracic Mediastinal Lymphadenectomy
Leads to a Higher Rate of Pathologically Proven N2 Disease in Patients with Non-Small Cell Lung Cancer.
Ann Thorac Surg 2012;94:9026.
15.Hughes MJ, Chowdhry MF, Woolley SM, Walker WS. In patients undergoing lung resection
for non-small cell lung cancer, is lymph node dissection or sampling superior? Interactive CardioVascular
and Thoracic Surgery 2011;13: 311-5
16.Allen MS, Darling GE, Pechet TTV, et al. Morbidity and Mortality of Major Pulmonary
Resections in Patients With Early-Stage Lung Cancer: Initial Results of the Randomized, Prospective
ACOSOG Z0030 Trial. Ann Thorac Surg 2006;81:101320
17.Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node
sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less
than hilar) nonsmall cell carcinoma: Results of the American College of Surgery Oncology Group Z0030
Trial. J Thorac Cardiovasc Surg 2011;141:662-70)
10.30 11.00
Teodor Horvat
Hepatic hydrothorax
11.30 13.30 - Conferences - Session II
Chairmen: Marcin Zielinski, Cristian Paleru
11.30 12.00
Philippe Dartevelle
TO BE ANNOUNCED
12.00 12.30
Philippe Dartevelle
TO BE ANNOUNCED
12.30 13.00
Ioan Cordo
Surgical Indications in Lung Cancer
Surgery is the patients first option for treating non-small cell
lung cancer and its the only radical method of treatment adressed to
early stages (I, II and IIIA).
Purpose is to adopt a multidisciplinary approach, only on
evidence based medicine, in establishing the diagnostic and appropriate
surgical treatment for patients with non-small cell lung cancer,
independent of the physician who examines the patient for the first
time.
Preoperative investigations are crucial for the success of surgical
treatment. The patient must undergo a series of clinical examinations
and investigations such as standard chest X-ray, CT examination of the
head, thorax and abdomen, MRI, bronchoscopy and specific tests

adressing the pulmonary function. All available methods should be used
for establishing an accurate diagnosis (histopathological) and stage.
Treatment revolves around the guidlines based on the TNM 7th
edition classification system.
The surgical procedure should be specific to each patient and
include an oncological resection of the lesion (segment, lobe, several
lobes, lung) as well as the removal of involved lymphatic stations.
Surgery can be preceded or followed by chemotherapy or radiotherapy,
depending on the stage.
Early diagnosis, a thorough evaluation, correct staging and a
complete resection accompanied by oncological treatment adapted to
each case, will ensure prolonged survival to patients with non-small cell
lung cancer as well as improving the quality of life in these patients.
15.30 17.30 Scientific Session I
Chairmen: Jos Belda-Sanchis, Teodor Horvat
15:30 15:40
SPECIFIC FEATURES OF OPERATORY INTERVENTIONS ON
SINGLE SURGICAL LUNG
Introduction
Even after pneumonectomy the remaining lung and pleural
space can be the site of certain surgical diseases.
Materials and methods
There retrospectively studied 12 patients who had surgical
interventions for thoracic disease in the contralateral pleuropulmonary
space after pneumonectomy. In all cases pneumonectomy was
performed for malignant lesions.
The surgical procedures were: 5 atypical lung resections (2 left
upper lobe, 2 lobes of the right upper lobe and lower left), 2
thoracoscopic interventions (one left and one right), a Williams

pleuropulmonary decortication and 4 chest tube insertions.
Results
In all 5 lung resection surgery the resected lesion proved to be
malignant, metastatic. The 2 thoracoscopies were performed for pleural
effusion, in a case the metastatic malignant etiology was demonstrated,
the other case was of TB etiyology. Pleuropulmonary decortication was
indicated for a pseudonodular lung image; chest tube insertions were
performed for a pleural empyema, two secondary pleural effusions and
a left pneumothorax started on the first postoperative day after right
pneumonectomy. There was only one postoperative complication: a
pleuropulmonary bronchopneumonia occurred in the decortication case
which was resolved by intensive medical treatment. Perioperative
mortality was zero, the immediate postoperative recovery was
complete.
Conclusions
A number of thoracic surgical diseases should be considered to
be solved even if they occur on a single surgical lung, even if
pneumonectomy was performed for malignant lesion.
15:40 15:50
RIGHT
ESOPHAGO-CAVITARY
FISTULA
BILATERAL PULMONARY TUBERCULOSIS
AFTER

1
Surgery Department, 2Intensive Care Department, 31st Pneumology

Department, Drobeta-Turnu Severin Emergency County Hospital
Introduction
Surgery of pulmonary tuberculosis (TB) accounts for an
important number of surgical interventions in Romanian thoracic
surgical units, due to various reasons.
Material and method
We present a case of a 56-yr old man, having multiple risk
factors for an unfavorable course of his 2010-diagnosed pulmonary TB,
who was treated and operated in Drobeta-Turnu Severin Emergency
County Hospital for right upper lobe (RUL) fibro-cavitary lesions,
esophago-cavitary fistula and a lung tumor of the right 6th segment.
Results
We performed a RUL lobectomy, fistulectomy, esophageal
repair, right lower lobe (RLL) wedge resection, temporary feeding
gastrostomy. RLL tumor: hamartoma. Postoperative course with minor
morbidity: prolonged air leaks, residual basal air collection. The patient
was discharged in the 23rd postoperative day, free from disease.
Conclusion
In cases with prolonged treatments, relapses, precarious social
and economic factors, it is advisable to remember even the rare cited
complications of TB, sometimes considered of historical interest.
15:50 16:00
SURGICAL
REPAIR
OF
THE
LIVER
DOME
ECHINOCOCCOSIS THE THORACIC SURGEONS WAY?
Objectives
The aim of our study was to assess the efficacy of the
transthoracictransdiaphragmatic approach of the liver hydatid cysts
and to determine his safety.
Methods
We present our experience based on 11 patients (8 male, 3
female) treated during 2005-2012. Hepatic cysts were approached
through a right axillary thoracotomy and phrenotomy followed
by evacuation of the main cyst and of the daughter cysts, treatment of
the billiary fistulaes, drainage of the cystic cavities, suture of the
margins of the cyst, and of the diaphragm and pleural drainage.
Results
The age ranged from 14 years to 71 years (45+/-17years); The
diagnosis of hepatic cysts was established in all the cases with upper
abdominal computed tomography, six patiens appearing with multiple
echinococcosis (5 right pulmonary and 1 right and left pulmonary)
resolved simultaneously (right pulmory and liver) and the remaining
one previously on the left; the mean postoperative stay was 13,5+/- 5,2
days. The Pearson coefficient age-postoperative days was 0,06. There

was no in-hospital mortality, no major postoperative complications and
no recurrences of the disease.
Conclusions
Right sided thoracotomy with frenotomy provides better access
to the liver dome cyst compared to the laparotomy, being useful
especially for the precence of right lung echinococcosis allowing the
surgical cure in one operative session, with minimal complications.
16:00 16:10
INDICATIONS AND RESULTS OF ONE-STAGE BILATERAL
THORACOTOMY APPROACH
Introduction
The aim of this study is the evaluation of the one-stage bilateral
thoracotomy approach for bilateral thoracic diseases.
Material and method
This is a retrospective study on 20 patients admitted to Surgical
Clinic 4 UMPh Tirgu-Mures between 01.01.1985-01.01.2012 in whom
we have performed one-stage bilateral thoracotomies. Indications for
this approach included: hydatid disease (one including a right
thoracophrenotomy to approach a hepatic hydatid cyst) 9 pts., thoracic
trauma 2 pts., bilateral metastases 2 pts., bilateral empyema 2 pts.,
bilateral blebs 2 pts., primary lung cancer + contralateral metastase
1 pt., bilateral hidro-pneumothorax - pleural carcinomatosis and trapped
lung 1 pt., bilateral metallic foreign bodies (suicide attempt) 1 pt.
Results
We encountered no mortality; one patient with bilateral
empyema developed a residual cavity that required a thoracomyoplasty
procedure. None of the patients required prolonged postoperative
mechanical ventilation. In other 4 cases where this approach was
planned, the second procedure was postponed at the request of our
anesthesia colleagues (patients not included in this study).
Conclusions
One-stage bilateral thoracotomy approach is feasible if there is a
team trained in the postoperative follow-up and care of the patients
operated on the chest. The major advantage of this approach is the
functional one, secondary to the lack of bilateral diaphragmatic fixation
since the patient is forced to breathe equally with both diaphragms.
Other advantages are esthetic, psychologic and echonomical reduction
of the costs to almost one half.
16:10 16:20
MALIGNANT HEMANGIOPERICYTOMA THE "SURPRISE"
PNEUMONIA
Iulian Mihai Radulescu, Mihaela Codresi, Adrian Mihail Iordache,
Ioan Cordos
Bucharest.
Introduction
Hemangiopericytoma is a vascular tumor made up of chaotic
arranged vascular capillaries surrounded by collars of proliferative
pericites. It is located more frequently into the skin, soft tissues of the
trunk and extremities. Malignant hemangiopericytoma is characterized
by aggressiveness, precocious vascular metastazis and local relapse.
Clinical case
63 years old male patient, recently investigated for ischemic
TIA, is found with enlarged heart opacity (heart-lung X-ray).
Cardiologic consultation does not identify a specific pathology and the
patient is referred to a pulmonology service accusing dyspnoea, cough
with mucopurulent expectoration, wheezing, chest pain, feverish state
clinical diagnosis: pneumonia. Fibrobronchoscopy reveals extrinsec
bronchial tree compaction on the left side and important retrostenotic
suppuration. Under antibiotic treatment the symptomes resolve
partially. CT scan perfomed subsequently identifies an anterior
mediastinal tumour of about 193/145 mm. The patient is referred to the
thoracic surgery department where surgery is decided. During the
operation a giant, relatively well defined tumour is found. Excision is
practiced after detaching it from the left lung, the pericardium, aorta,
pulmonary artery, the left brahiocefalic vein trunk, and the right
mediatinal
pleura.
Postoperative
evolution
is
favorable.
Histopathological description of the resected piece: malignant
hemangiopericytoma.
Discussions
This case illustrates the development of a long, subclinical, rare
mediastinal malignancy, clinical and laboratory differential diagnostic
difficulties, which subject the patient to major intraoperative risks.
Conclusions
In this case the hemangiopericytoma developed in a long time
without having clinical simptoms. The discovery was made after
numerous investigations and treatments for secondary diseases resulting
from the formations presence. The surgery intervention involved major
risks for the patient and a lot of team effort.
16:20 16:30
AUTOFLUORESCENCE BRONCHOSCOPY IN EVALUATION
OF LUNG CANCER
Introduction
Autofluorescence bronchoscopy represents a very useful step in
the detection, evaluation and staging of lung cancer.
Methods
42 autofluorescence bronchoscopies were performed in our
clinic (from 1126 bronchoscopies until August 2012). The main
indication is to deremine the the real endoluminal extension of lung
cancer and that is due to the specifics of the cases of Oncological
Institute.
Results
The indications, contraindications and the applicability of
autofluorescence in our patients are presented, in some relevant cases in
which autofluorescence bronchoscopy determined further therapeutical
management.
Conclusions
Bronchoscopy with autofluorescence wants to be in the near
future a mandatory instrument for the early detection of lung cancer in
patients at risk and also a standard in the preoperative evaluation of
lung cancer resections.
16:30 16:40
PURE PECTUS CARINATUM (NOT ASSOCIATED WITH
PECTUS EXCAVATUM) SOLVED BY MIRPC (MINIMALLY
INVASIVE REPAIR OF PECTUS CARINATUM)
1
Thoracic Surgery Clinic, 2Anesthesiology and Intensive Care Clinic,

UMF Craiova
Introduction
Pectus carinatum is a malformation of the chest wall which
consists in anterior protrusion of the sternum, occurring less frequently
than the opposite malformation, pectus excavatum. Unlike the patients
with pectus excavatum, those with pectus carinatum are most
commonly referred to the thoracic surgeon for aesthetic and not
functional reasons, usually the surgical indication regarding the
association of pectus carinatum and pectus excavatum. Due to
psychological implications for the patient, the cases of pure pectus
carinatum (not associated with pectus excavatum) can benefit from a
minimally invasive surgical repair.
We present the case of a young 24 year old woman with an
important but symmetrical pectus carinatum, not associated with pectus
excavatum, without cardiorespiratory symptoms but with significant
psychosocial problems for the patient, solved by the minimally invasive
technique described by Abramson (reversed Nuss procedure) - MIRPC
(Minimally invasive Repair of Pectus carinatum).
Results
To repair the malformation a titanium bar has been used inserted
under thoracoscopic control, placed presternal, crossing the two pleural
cavities and bilaterally fixed with two stabilizers. The pleural drainage
was considered necessary only on the left side, suppressed the first
postoperative day. The evolution was favorable and the aesthetic result
was satisfactory by the patient.
Conclusions
Although pectus carinatum surgical indications are more limited
than those for pectus excavatum, and based more on aesthetic than
functional considerations, in severe malformations with important
psychosocial issues minimally invasive interventions such as MIRPC
(Minimally Invasive Repair of Pectus carinatum) may represent a
solution.
16:40 16:50
DIAPHRAGM RECONSTRUCTION WITH LATISSIMUS
DORSI IN PULMONARY LUNG CANCER WITH HEPATIC
INVASION
1
Bucharest, 2Fundeni Clinical Institute, Dan Setlacec General Surgery
and Hepatic Transplant Center
Introduction
Diaphragm invading lung tumor surgical pathology remains a
chapter with with many unknowns and difficulties, with impressive
morbidity, with difficult evolution, leading to the individualization of its
approach. Diaphragmatic reconstruction with synthetic material, in case
of partial defect can sometimes be substituted with own large muscles
of the chest
We present the case of a patient of 51 years who was diagnosed
with right lower lobe lung tumor, with invasion of VIII, IX, X coastal
bodies, diaphragm and the 7th segment of the liver, who underwent
exploratory laparoscopy and right exploratory thoracoscopy, in order to
determine that the tumor can be surgically removed , followed by total
tumor ablation (atypical resection of the right lower lobe lung, posterior
resection of the VIII, IX, X rib bodies, partial resection of the
diaphragm and atypical hepatectomy in the 7th segment) and diaphragm
reconstruction with latissimus dorsi muscle flap, preserved earlier in the
same intervention.
Results
Slow favorable postoperative evolution, with normal radiologic
appearance, without pleural effusion, without ventilation disorders,
which allows suppression of the chest drainage 4 days after the surgery,
but with the appearance of a biliary fistula from the trance of
hepatectomy, requiring ERCP with sphincterotomy coledoco-wide
retrograde and plastic choledochal stenting in day 15 postoperative, and
then a pancreatic reaction, which was treated conservatively. The
patient was released in good general condition, with minimal peritoneal
drainage without pleural/pulmonary manifestations. Further controls
allow suppression abdominal drainage and choledochal stent extraction,
without complications. Reconstructed diaphragm behaved normally.
Conclusions
Given the anatomical and functional particularities of the
diaphragm, multiple approach - thoracic and abdominal tumors in this
area, sometimes accompanied by enlarged parietal resections, require
technical fireworks made for this and focused on improving outcomes
and postoperative evolution (using a structure specific organism, such
as large parietal thoracic muscles, well vascularized, more resistant to
infection than synthetic materials and bilious drainage).
16:50 17:00
LYPOSARCOMAS OF ANTERIOR MEDIASTINUM
Introduction
Lyposarcomas are malignant lesions rarely located in the
mediastinum, the most common being located in the posterior
compartment. Anterior mediastinal topography is rarely reported in the
literature.
There are reviewed 2 cases of anterior mediastinal luposarcoma,
in one case the visceral compartment and cervical extension were
found. In both cases complete tumorectomy was performed. One lesions
was giant - 45/30/20 cm and about 8600g. The other tumor required for
complete resection the excision of a segment of the thoracic esophagus.
Results
In the esophageal extirpation case, the digestive continuity was
restored six months later - presternal colon esofagoplasty. Only in this
case complementary radiotherapy was performed. Both tumors have
relapsed, the irradiated one 10 years after resectionthe other case had
two relapses: 4 years and 6 years respectively after the first
intervention. In the latter case death occured in the postoperative day 4
due to cardiac conditions.
Conclusions
Lyposarcomas are extremely rare lesions in the anterior
mediastinum. With complete resection and associated oncological
treatment one could obtain a good survival.
17:00 17:10
CLINICAL AND IMAGISTIC ASPECTS IN LATE SURVIVORS
AFTER
PLOMBAGE
THORACOPLASTY
FOR
TUBERCULOSIS
Introduction
Plombage thoracoplasty was frequently performed in the 195060's, being now abandoned or very rarely performed. The objective of
this paper is to present the clinical and imagistical aspects of some late
survivors after plombage thoracoplasty who were admitted to our unit.
Methods
Between 01.01.1990-01.01.2012 we admitted in our clinic a
total number of 5 patients with a history of plombage thoracoplasty.
The plombage was performed with: balls (2 cases), autologous rib (2
cases) and oil-filled bag (1case). All the innitial procedures were
performed on other units or by other surgeons from our clinic,
plombage thoracoplasty being abandoned by our team.
Results
2 patients were admitted for complications related to the
plombage thoracoplasty recurrence and overinfection requiring
reoperation (removal of the plombage material and thoracomyoplasty).
One patient presented a contralateral empyema and two patients

presented no thoracic complaints. The plombage material was obvious
on both CXR and CT scans in all cases. At one year follow-up, the
operated patients presented no recurrence and no significant thoracic
complaints. One patient died of causes unrelated to the plombage
thoracoplasty (myocardial infarction).
Conclusions
In current medical practice we may encounter late survivors of
some hystorical operations, such as plombage thoracoplasty. The
recrudescence of TB may bring into attention this kind of procedures as
a solution for selected cases.
17.10 17.20
MAFFUCCI SYNDROME, RARE CONDITION IN THORACIC
SURGERY
Valerian Pavaloiu
Bucharest.
Named after the Italian professor of pathology Angelo Maffucci,
the Maffucci syndrome, or encondromatosis with multiple
hemangiomas, was first described in 1881 and is a rare congenital
disorder characterized by the presence of encondromas, usually located
in the upper limbs, and multiple hemangiomas and lymfangiomas.
From the first documentation of the disease were reported only 200
cases.
A 42 years old female, diagnosed with Maffucci syndrome in
adolescence, undergone multiple surgery procedures in orthopedics
service for pathological fractures of the right limbs, was admitted to our
clinic presenting a 20 cm diameter parietal tumor, located in the right
hemi thorax, that invades II-V right ribs. Besides the parietal tumor, the
patient has multiple tumors and bone deformities in the right limbs and
multiple hemangiomas and lymfangiomas. Being investigated for breast
cancer, the tumor was diagnosed as giant parietal osteocondroma. The
increasing in size, in a short time, and the high risk of malignancy

imposed surgical resection.
We performed a parietal en bloc resection that includes the
tumor along with the anterolateral segments of ribs II to V and the right
margin of the sternum, parietal reconstruction being performed using
titanium metal bars, attached to the sternum and the remaining segments
of the ribs. A polypropylene mesh was anchored on the titanium bars
and fixed with sutures.
Despite its rarity and relative benignancy, Maffucci syndrome
its a disease that requires an extreme carefulness. The condromas must
be treated
with attention and surgically resected before their
malignization.
17.20 17.30
ACUTE
NECROTIC
DESCENDENT
CERVICOMEDIASTINITIS WITH BILATERAL SECONDARY PLEURAL
EMPIEMA AND SEPTIC EROSION OF RIGHT ANTERIOR
JUGULAR VEIN AND RIGHT JUGULO SUBCLAVIAN
VENOUS CONFLUENT
Introduction
The authors present an acute necrotic descent cervicomediatinitis consecutive to a cervical abcess, associated with multiple
serious complications, that required multiple consecutive surgeries, in
multidisciplinary teams, with the survival of the patient.
Material and method
The case is represented by a patient of 49 years old, with a
latero-cervical incision performed in an ORL clinic for a cervical abcess
first admitted for dysphagia, dyspnoea, cervico-thoracic pain, high
fever. The CT imaging was relevant for a voluminous heterogeneous
process that included air bubbles ranging from the sub-mandibulary
level until the anterior and middle mediastinum under the carina and
bilateral pleural effusion. We first performed bilateral pleurotomy and
anterior suprasternal transversal cervicotomy with anterior and middle
mediastinotomy, tactical tracheostomy, lavage with peroxide and

betadine, mediastinal drainage.
Results
The postoperative evolution is complicated by the apparition of
massive cervico-mediastinal bleeding that required on site hemostasis
via finger compression followed by the ligation of right anterior jugular
vein, <<trap door>> sterno-thoracotomy with the suture of right jugulo
subclavian confluent. Complications followed (apical right
pneumothorax, partial superficial venous thrombosis of the right arm,
septic shock with secondary thrombocytopenia, acute kidney failure,
thoracic granuloma) that required specific approaches. The patient is
release4d from the hospital with a parietal suppuration that was treated
ambulatory though debridement, antibiotic treatment.
Conclusions
Mediastinitis is a severe disease, with poor prognosis and the
possibility of massive mediastinal bleeding due to septic erosion, which
implies prompt surgical act to save the patients live.
SATURDAY, OCTOBER 6, 2012

09.00 11.00 - Conferences - Session III
Chairmen: Teodor Horvat, Alexandru Boianu
9.00 9.30
Cristina Grigorescu
Update reports in LVRS (lung volume reduction surgery)
9.30 10.00
Alper Toker
TO BE ANNOUNCED
10.00 10.30
3D Conformational and Intensity-Modulated Radiation Therapy in the
Treatment of Lung
10.30 11.00
Genoveva Cadar
One Lung Ventilation in Thoracic Surgery
11.30 13.00 Scientific Session II
Chairmen: Philippe Dartevelle, Ioan Cordo
11.30 11.40
SURGERY OF THYMOMAS
Introduction
Various studies have demonstrated the importance of tumor
resection in thymomas. The complementary treatment (radio- and
chemotherapy) also plays an important role.
50 patients with thymoma surgery between October 1994 - October
2009, from a single center, are retrospectively studied. There are 26 men
and 24 women. The distribution of tumor development Masaoka stage was:
17 stage I, 9 stage IIa, 10 stage IIB, 9 stage III, 2 stage 3 stage IVa and
IVb. Histological classification WHO forms were 11 cases of type A, type
AB 15 cases, 11 cases of type B1, type B2 9 cases, type B3 2 cases and 2
cases were no mixed forms B2-B3. Myasthenia gravis was associated in 13
thymomas.
Results
Postoperative survival data are analyzed, the survival period is
compared according to histology, stage of development, type of surgery
and postoperative complementary treatment depending performed. Except
for a death occured in a postoperative day 4 (ARDS on single lung), no
noticeable immediat postoperative complications were recorded. Of the 13
cases of myasthenia, 5 were cured after surgery, 6 were improved while in
2 cases the symptoms worsened. A patient without miastenia at the time of
surgery had developed myasthenia gravis 6 years after thymoma resection.
In 7 cases a second cancer was associated, in one of the cases other 2
cancers were associated.
Conclusions
Type of surgery, Masaoka stage of development, histological types
and complementary therapy performed are the main factors which dictate
the survival in patients with thymoma. In associated myasthenia there is

limited beneficial effect of thymoma resection. Thymoma patients have a
higher predisposition to develop a second malignant lesion.
11.40 11.50
TECHNICAL ASPECTS OF MINIMALLY INVASIVE
TRANSCERVICAL APPROACH OF RIGHT MAIN BRONCHUS

Bucharest.
Introduction
We present the minimally invasive transcervical approach of the
right main bronchus as an operating technique. We are currently using
this technique on patients with MDR Tuberculosis of the right lung for
stapling the right main bronchus and dividing it in order to avoid
spillage and dissemination.
Materials and method
By using the Cooper suprasternal retractor and following
Zielinskis guidelines for TEMLA, access to the mediastinum is gained.
The right main bronchus is first encircled and later on stapled and
divided. Hemostasis and aerostasis are important steps of the technique.
Mean operating time was 70 minutes. No postoperative complications
were observed. A simplified right pneumonectomy was performed two
months later. Our purpose is to present the aspects of this simple
technique for the approach of the right main bronchus.
Results
The procedure underwent without incidents and it was well
tolerated, obtaining atelectasis of the right lung. A second operation in
the form of pneumonectomy followed two months later. No
postoperative complications or incidents have been observed after
removal of the lung.
Conclusions
Using a minimally invasive procedure in order to divide the
right main bronchus offers the MDR tuberculosis patients, with poor
health state, a chance at healing. The risk of a bronchial stump fistula
after pneumonectomy is greatly reduced since the bronchus has been
already divided in the mediastinum during the previous procedure, and
it has healed during the period prior to pneumonectomy. So far our

attempts have been successful at stapling and dividing the right main
bronchus.
11.50 12.00
CAN
THE
THORACIC
SURGEON
BE
A
GOOD
BRONCHOSCOPIST?
Objectives
This purpose of this presentation in to reveal the experience of
the surgeons in our clinic regarding the appliance of both diagnostic and
therapeutic bronchoscopy in the OR or the ICU unit, for the thoracic
pathology.
Material and method
We analized 1647 procedures we applied in a period of 12 years
to a number of 1435 patients. Most of these procedures were therapeutic
58% and 42% had diagnostic role.
Results
The therapeutic procedures are classified taking into account
the pathology and complications that we try to treat. On the first place
there is the thoracic trauma, the endobronchial clot, then the ARDS and
bronchopneumony. Out of the therapeutic procedures the most frequent
was the endobronchial aspiration, the last palces were represented due
to limited experience and lack of intruments by bronchial
desobstruction and foreign bodies extractions. One of our future
objectives are to increase the number of theese procedures. In the
context of pathology and the extreme complications that derive from it
we had mortality of 6%, which we interpret as very good, and
bronchopscopy has its well defined role.
The diagnostic procedures were applied especially for the cases
with lung cancers, the error percentage for extension or localisatione
verified intraoperory was under 3%. The biopsy was applied to 76% of
the diagnosed cases, which lead to the decrease of exploratory
thoracotomy rates. The bronchoscopic procedures themselves had no

mortality and the complications were minor, and in low percentage.
Conclusions
The thoracic surgeon with bronchoscopy training alongside his
duties can be of major help in sustaing the surgical treatment, The good
results for bronchoscopy are proportional to his training in surgery and
permanent confrontation with radiological imaging and introperatory
aspect. Brochoscopy cand be applied with no difficulty in our clinic, on
the condition of proper equippement and the will to succeed.
12.00 12.10
LARGE
PARIETAL
RESECTIONS-RECONSTRUCTIONS
WITH THE STRATOS SYSTEM
Background
Parietal resections are an intrinsic component of the therapeutic
armamentarium for multiple diseases of the chest wall. The
reconstruction of large chest wall defects after resection poses a series
of particular problems.
We present the use of relatively new system for chest-wall
reconstruction based on mouldable titanium bars and clips: Strasbourg
Thoracic Osteosyntheses System STRATOS, MedXpert, Germany.
Methods
We present two clinical cases of large chest wall resection and
reconstruction particular particular for their etiology, scale of the
parietal defect and reconstruction technique: a female patient with right
mamary carcinoma and a gigant right anterior chest wall tumor and
another one with follicular undifferentiated thyroid carcinoma, admitted
in our service for a large presternal tumor.
Results
In the first case we performed an antero-lateral chest wall
resection with the removal of the superior half of the sternum, the first
three costal arches, atypical pulmonary resection, right mastectomy
with axillary lymphadenectomy, parietal reconstruction with the
STRATOS system, Dual-Mesh patch, right latissimus dorsi and left

pectoral flaps and a free skin graft raised from the abdomen.
In the second case we performed a total thyroidectomy, a large
anterior chest wall resection with removal of the sternal body and the
2,3 and 4 costal cartilages with preservation of the sternal manubrium
and xiphoid process; parietal reconstruction was performed with two
STRATOS bars, Dual-Mesh patch and bilateral pectoral flaps.
Conclusions
After large chest wall resections, reconstruction with the
STRATOS system is easy, safe, offering superior results to materials
that have been utilized in the past. It allows the reconstruction of larger
chest wall defects leading to the extension of the surgical indications.
12.10 12.20
TYPIC CARCINOID IN A YOUNG PATIENT
Bucharest.
We report the case of a 26 years old male, who has undertaken
approximately 3 years of medical treatment for asthma, admitted in our
service for acute dyspnoea and left thoracic pain. The CT scan and
bronchoscopic examination performed, underline the presence of an
endobronchial tumor, situated in the distal part of the left main
bronchus, completely obstructing the lumen. The left lung is atelectatic,
completely collapsed and the right lung herniated in the left hemithorax.
Taking into consideration the full medical history of the pacient
and the clinical investigations performed, one would be inclined
towards performing a pneumonectomy, nevertheless we opted for a
conservative aproach, as a first step of the surgical intervention by
choosing to divide the left main bronchus allowing for a visual
examination of the distal tracheo-bronchial ramifications located
downstream of the tumour.
After the excision of the tumour and aspiration of the bronchial
secretions, accumulated inside of the collapsed lung, we moved
forward by performing a bronchial anastomosis of the proximal end of
the left main bronchus with the distal end, close to its origin. When
performing the leak test both lobes of the left lung expand and appeared
unaltered macroscopically.
The post operatory bronchoscopic examination, indicate good
permeability of both lobar bronchiae, and the functional respiratory
testing reveal a sizeable improvement. In a young patient, even if the
underlying disease has been evolving for a long period, the aspirated
secretions are purulent and the risk of performing a later
pneumonectomy is present, bronchial resection and anastomosis present
a desirable treatment option.
12.20 12.30
SURGERY OF PULMONARY TUBERCULOUS LESIONS
OVERINFECTED WITH ASPERGILLUS
Introduction
The objective of this paper is to evaluate the results of
surgeryfor chronic tuberculous TB lesions overinfected with
aspergillus.
Material and method
We performed a retrospective study on 33 patients operated in
our unit between 01.01.1985-01.01.2011 for aspergilloma developed on
TB lesions (active or sequelae). Surgery consisted in lung resection in
26 cases (lobectomy 5 cases, non-anatomic 21, with 5 cases
associating an applatisation-plication of the cavity) and
thoracomioplasty in 7 cases. All the patients were referred for surgery
after failure of the medical treatment and received specific antifungal
perioperative treatment. The following main parameters were followed:
mortality, morbidity, need for a reoperation, hospitalisation. Data were
analysed using the GraphPad Prism software.
Results
Overall mortality was 6% (2 patients). We encountered 3
residual suppurated cavities requiring a major reoperation (openwindow or thoracoplasty). At one-year follow-up (clinical, sputum
bacteriology, chest X-ray +/- CT scan) we encountered no recurrence,
with two deaths not related to the thoracic problems. Comparative

evaluation resection vs thoracomioplasty showed no difference in terms
of mortality and incidence of postoperative empyema requiring
reoperation or other major postoperative complications (p>0,05 for all
the parameters). A longer hospitalisation was noted for
thoracomyoplasty patients (resection group: ranges 12-76, median 18
days vs thoracomioplasty group: ranges 10-87, median 42 days,
p<0,05).
Conclusions
Surgical treatment for aspergilloma complicating TB lesions
remains a challenge, involving a significant mortality and morbidity. In
selected cases, both lung resection and thoracomioplasty may give good
results.
12.30 12.40
MIASTENIA GRAVIS AFTER THYMOMECTOMY
Introduction
It is well known the relationship between thymomas and
myasthenia gravis: 10-15% of patients with myasthenia gravis have a
thymoma and 30-50% of patients with thymoma may have myasthenia.
We present the case of a 36 years old patient who has been
operated for a thymoma the resection included the thymus, the
thymoma, the anterior wall of the left brahiocefalic vein with venous
reconstruction with a Goretex patch. Note that at the time the patient
presented no clinical signs of myasthenia gravis, the thymoma being a
radiological accidental discovery. The postoperative complementary
treatment was completed (chemotherapy and radiotherapy) within next
9 months.
Results
At 6 years postoperatively he developed generalized myasthenia
gravis, with sudden onset. Following treatment with cortisone and
anticholinesterase the neuromuscular symptoms improve. The last CT
control performed at 10 years after resection shows no tumor
recurrence and no sign of malignancy; the vascular graft permeability is

visible.
Conclusions
Although rarely observed in practice, myasthenia gravis may
occur and should be considered after resection of thymic tumor.
12.40 12.50
ONE PORT THORACOSCOPIC SURGERY
Introduction
One port thoracoscopic surgery is an alternative both for
diagnosis and treatment of the patients on which other means of
investigation were inefficient or on which major surgery is excessive
for the purpose of diagnosis or is contraindicated. Todays
technological particularities allow the use of VATS in selected cases.
Material and method
Our study is retrospective and is based on 2001-2012 interval.
All the cases for which we performed strictly thoracoscopic, but also
the cases in which thoracoscopy was an intermediary step towards mini
thoracotomy or thoracotomy were taken into account.
Results
During the mentioned period 312 video thoracosopies have been
performed as follows: 119 one port thoracoscopy, 85 - two port
thoracoscopy, 1- three ports. In 107 situations one port thoracoscopy
was mainly exploratory, being followed by conversion to mini
thoracotomy, or in isolated cases by classic surgical approach. The
pathology reports after thoracoscopy was: 58 cases of TB, 72 non
specific chronic inflammatory pleural effusions, 134 malignancies. In
the other situations (47 cases) the one port approach allowed the
treatment of post traumatic pleural effusions, correction of condrocostal malformations (the Nuss technique), establishing the diagnosis of
sarcoidosis.
Conclusions
One port thoracoscopy is a minimal invasive surgery technique
with multiple advantages in the condition of minor risks. Its a
relatively easy approach for the thoracic surgery clinics with proper
equippement. Can be performed in local anesthesia, but it must be done
only in the operating room.
12.50 13.00
THORACOMYOPLASTY AS A RE-REDO PROCEDURE
Introduction
The role of thoracomyoplasty in the treatment of postoperative
empyema is controversial. The major difficulty is given by the
sectioning of the muscular masses during the initial
thoracotomy/thoracotomies, resulting in a limitation of the volume and
of the mobility of the available flaps.
Material and method
During the last 8 years we have performed thoracomyoplasty in
7 patients having a history of at least 2 major procedures performed
through thoracotomy (without considering tube-thoracostomy and the
Eloeser procedure). In all the cases the indication for the
thoracomyoplasty was the presence of an empyema which could not be
controlled by the previous procedures. The principle of our procedure
was to perform a complete obliteration of the cavity, closurereinforcement of the bronchial fistulae (if present) and primary closure
of the new operative wound. We have used flaps or portion of flaps that
were intact after the previous thoracotomies (serratus anterior,
latissimus dorsi, pectoralis, subscapular and intercostal).
Results
In all the patients we have achieved obliteration of the cavity
and per primam wound healing, with hospitalizations ranging between
30 and 51 days and without significant major morbiditiy. An interesting
aspect is that 3 cases were diagnosed with TB based on probes taken in
our unit; the absence of a correct antituberculous treatment may be an
explanation for the unfavourable evolution of these patients.
Conclusions
Thoracomyoplasty may be a definitive solution in cases with
recurrent postoperative complications. A carefull analysis of the local
anatomy allows the use of muscle flaps even after more procedures
involving opening of the chest.
POSTER SESSION
MINIMALLY
INVASIVE
THORACIC
SURGERY
IN
MALIGNANT PLEURO-PERICARDIAL EFFUSIONS
1
2
Introduction
Malignant pleuro-pericardial effusions (MPPEs) are a common
problem in the treatment of patients with cancer and may occur with
any malignancy.
Methods
Between 01.01.1998 - 31.12.2008 we conducted a retrospective
study. During this period of time 46 patients were diagnosed and treated
for malignant pleuro-pericardial effusions in Clinic of Thoracic Surgery
under Prof. Teodor Horvat coordination (from SUUMC).
Results
In this study a total of 42 MPPEs have been approached through
minimally invasive procedures (36 patients underwent thoracoscopic
procedures and 6 patients were subjected to VATS).
In our study, the pulmonary cancers were the most frequent
primary cancers who caused MPPEs (22 cases).
The thoracoscopic pleuro-pericardial window was the most
frequent and efficient procedure used for pericardial drainage (34
cases).
Effective control of the recurent malignant pleural and

pericardial effusions was made most frequent through postoperative
pleural bleomycin instillation (22 cases) and through thoracoscopic
insufflation of talc in 14 cases.
Conclusions
The minimally invasive thoracic surgery is a safe and efficient
method for diagnosis and treatment of pleuro-pericardial effusions.
SECONDARY SPONTANEOUS PNEUMOTHORAX IN A CASE
OF PULMONARY HISTIOCYTOSIS X AND DIABETES
INSIPIDUS
Introduction
The paper presents the case of a 37 years male admitted in the
thoracic surgery department with a recurrent episode of left spontaneous
pneumothorax.
He was diagnosed as having pulmonary histyocitosis X and
diabetes insipidus 9 years before in the pneumology department:
spontaneous pneumomediastinum with pulmonary fibrosis associated
with dryness of mouth and polyuria.
Methods
The first left sponataneous pneumothorax was resolved by left
minimal pleurotomy under local anesthesia, one month before. In the
second episode of left spontaneous pneumothorax the surgery procedure
was video-assisted mechanical and chemical pleurodesis and pulmonary
biopsy with histological confirmation of pulmonary histiocytosis X.
Results
Immediate postoperative results were satisfactory with recovery of
respiratory function and complete pulmonary expansion.
Conclusions
The minimal invasive thoracic surgery is the best approach in
the pleural effusions because of some advantages: lead to a correct
diagnosis, an adequate treatment, with a low mortality and morbidity
(comparative with the classic thoracic surgical approach).
VOLUME REDUCTION SURGERY IN A CASE OF

PULMONARY EMPHYSEMA AND ACUTE RESPIRATORY
FAILURE
Introduction
The paper presents the case of a sixty six years old male, former
great smoker with COPD and chronic respiratory failure, admitted in
the Thoracic Surgery Department of the Emergency University Military
Central Hospital with an acute respiratory distress ( severe dyspnea,
60% oxygen saturation without oxygenotherapy and 80% with nasal
oxygen administration).
Material and methods
Thoracic standard X-ray examination reveals the bilateral
hyperlucent basal teritories and emphysematous aspect of the lungs.
Thoracic CT scan cant differentiate a basal pneumothorax from a giant
bullous emphysema.
The authors presents a secvential surgical approach: right
minimal pleurotomy with complete lung expansion was the first step;
the second approach was a left pleurotomy without pulmonary
expansion and without presence of the air leak; the third step was the
left lung volume reduction surgery through thoracotomy with the
resection of three giant pulmonary bullae.
Results
Has been achieved the improve of respiratory condition both in
repose and effort after pleurotomy and after the volume reduction
surgery.
Conclusions
It was very difficult, in this case, to establish a correct diagnosis
from the begining and the adequate treatment in this emergency
situation. Minimal pleurotomy was both a saving life therapeutical
method (the right pleurotomy) and a diagnostical procedure for a giant
bullous emphysema (the left pleurotomy). The lung volume reduction
surgery was an efficient and complementary way for improving the
respiratory condition of the pacient.
AUTOFLUORESCENCE IN THORACIC SURGERY ROMANIAN

DEBUT AT IOB
Natalia Mota, Cezar Mota, Mihnea Davidescu, Ovidiu Rus, Elena Moise,
Teodor Horvat
Introduction
Tissue autofluorescence is based on the property of emitting light
with different wavelenght after excitation with light with specific
wavelenght.
Methods
First thoracoscopic autofluorescence images are presented first
recorded in IOB and also in our country.
Results
Autofluorescence in thoracic surgery is applicable to the
assessment of visceral and parietal pleura, the pericardium, the pleural
malignant conditions such as primary or secondary, other exudative
pleurisy, pericarditis in suspected malignancy, spontaneous pneumothorax
and so on; the method eliminates the side effects of drug-induced
fluorescence. Inflammatory lesions give false positive results.
Conclusions
Autofluorescence in minimally invasive thoracic surgery allows
identifying suspicious malignant lesions and their targeted biopsy,
extension and excision of neoplastic lesions in the real limits of safety.
HYDATID PULMONARY CYST OVERINFECTED WITH

ASPERGILLUS
Alexandru-Mihail Boianu, Petre Vlah-Horea Boianu, Oana Raluca
Lucaciu, Timur Hogea, Olivia Batog
Introduction
Both hydatid pulmonary cysts and aspergilloma are relatively
rare diseases. We present a combination of these two diseases of the
lung.
Material and method
We report a 28 years old female pacient complaining of fever,
dyspnea and hemoptysis. CXR and CT scan revealed an 8 cm left upper
lobe lesion, with imaging aspect suggesting a suppurated hydatid cyst.

Surgery was performed, with cystectomy, excision of the pericyst and
cappitonage. Due to the macroscopic aspect, a mycologic examination
of the pus was requested, which showed the showed the presence of
Aspergillus spp. The patient remained febrile after surgery, with no
obvious cause.
Results
The postoperative course was favourable, with resolution of the
fever after the introduction of specific antifungal treatment
(voriconasole) on day 5 after surgery. The patient was discharged on the
postoperative day 20. At 3 years after surgery she presents with no
thoracic complaints and no sequelae.
Conclusions
In cases of suppurated pulmonary hydatid cysts, mycologic
examination allows detection of fungal infections, allowing a specific
therapy which prevents further complications.
POLITRAUMA WITH CHEST FLAIL, HEMOPNEUMOTHORAX AND SUBCUTANEOUS EMPHYSEMA SOLVED BY
DRAINAGE, REPEATED THORACENTHESIS AND INTERNAL
PNEUMATIC STABILISATION
1
Surgical Clinic IV, UMPh Trgu-Mure, 2ICU Mure County Hospital
Introduction
We present a case of politrauma with special diagnostic and
treatment problems.
Material and method
We report a pacient who suffered a politrauma by falling from
the bicycle while being under the influence of alcohol abuse.
Emergency CT scan showed a right temporal bone fissure, liquidian
collection in the right nasal cavity and maxillary sinus, left epicranian
hematoma, left medioclavicular fracture, multiple rib fractures on the
left hemithorax, left laterothoracic and laterocervical subcutaneous
emphysema, left pneumothorax and pneumopericardium. At Odorheiul
Secuiesc the medical team performed tube-thoracostomy with Heimlich
valve drainage and oro-tracheal intubation. Due to the unfavourable

evolution unstable hemodynamic status and development of the
subcutaneous emphysema, the patient was referred with SMURD in our
unit. We performed joining of the drain to active aspiration with
negative pressure, drainage of the subcutaneous emphysema with
needles, repeated thoracocenthesis and prolonged mechanical
ventilation for 18 days internal mechanical ventilation. CT,
ultrasound, bronchoscopic and MRI examinations have shown no other
lesions, excepting a thrombosis of the cavernous sinus with no
indication for surgery. The tracheostomy requested for mechanical
ventilation was postponed until it became unnecessary.
Results
The evolution was slowly favourable, both neurologic and
respiratory, allowing the extubation of the patient and discharge after 33
days. At 3 months follow-up the patient presents no significant sequelae
excepting an algic thoracic syndrome.
Conclusions
The case is illustrative for the diagnostic difficulties of the coma
in politrauma cases in a patient referred from other unit (ethilism,
trauma, coma induced by drugs) and for the need to treat severe thoracic
traumas in centers with appropriate facilities and permanent access to
bronchoscopy, CT, MRI, ultrasound etc. The solving of the thoracic
lesion was mainly the result of internal mechanical stabilization through
mechanical ventilation.
GIANT INTRATHORACIC LEFT LIPOMA (17x10x8 cm)
1
Surgical Clinic IV, 2Internal Medicine Clinic III, UMPh Trgu-Mure
Introduction
We present a case that illustrates the difficulties related to the
removal of benign large dimensions intrathoracic tumors.
Material and method
We report a 70 years old male patient, with severe heart disease
resulting in NYHA stage III heart failure and a history stroke and a
naso-palpebral carcinoma operated 5 years ago, admitted to the Internal
Medicine Clinic for worsening dyspnea. Chest X-ray showed a giant

opacity on the right hemithorax. CT showed an 17x10x8 cm
intrathoracic tumor, well-delineated and with tracheal compression and
deviation. Bronchoscopy and digestive endoscopy showed extrinsec
compression, but without invasion of the tracheo-bronchial tree and of
the esophagus. Surgery was performed through a large postero-lateral
thoracotomy. After mobilization of the lung, we found an
extrapulmonary tumor with 3 vascular pedicles arising from the
posterior intercostal vessels. We performed a complete excision of the
tumor, the cleavage plane allowing the mobilization of the tumor from
the trachea, esophagus and aorta.
Results
The postoperative course was extremely difficult due to a
bronchopneumonia and the associated cardiac comorbidities, but
eventually favourable, with improvement of the respiratory status.
Pathologic examination showed the presence of a mixoid fusocellular
lipoma, with no atypia.
Conclusions
The case is interesting due to the rarity of the thoracic location
of this tumor and the huge dimensions.
A RARE CASE OF MEDIASTINAL INFLAMMATORY
MYOFIBROBLASTIC TUMOR
Introduction
The inflammatory myofibroblastic tumor (IMT) or the
inflammatory pseudotumor is a rare benign tumor composed of spindle
cells that is known to develop in various locations such as lung, skin,
breast, gastrointestinal tract, pancreas, bone, epididymis, peritoneum.
Mediastinal localisation of the tumor is very rare. We present the case
of a 16 years old female with such pathology.
Methods
The patient was admitted into our clinic with a history of pain in
the right hemithorax, mild dyspneea and irritative cough. The chest x-
ray showed a great ascension of the right hemidiaphragm. Abdominal

ultrasound revealed the presence of heterogeneous formations, bulky
with liver parenchyma dislocation and fluid collection. The Chest CT
examination showed a giant formation in the right hemithorax having
right upperdiaphragmatic mass effect on the liver, lower mediastinum
and lung parenchyma. A right posterolateral approach was used
revealing a giant tumoral formation (14/13/12 cm) originating from the
mediastinum. Total surgical ablation was performed.
Results
The postoperative outcome of the patient was good, with no
complications and lung reexpansioning. The hospital stay was 7 days.
Immunohistochemistry was positive for desmin, VIM, CD 34, CD 68,
Ki67, and was diagnosed with inflammatory myofibroblastic tumor. No
tumoral recurrence was noticed at the one year and two year follow-up.
Conclusions
The mediastinal inflammatory myofibroblastic tumor is a very
rare pathology. It can raise a series of problems such as the preoperative
diagnosis, technical problems related to its location. If total surgical
ablation is possible the patients have a favorable outcome.
INTRATHORACIC FOREIGN BODIES A 11 YEAR
STATISTICS
Introduction
Although is very rare, the pathology of foreign intrathoracic
bodies, either into the bronchial tree, chest wall or the pleural space is
very challenging and can raise a series of problems, especially if we are
dealing with debilitated patients.
Method
In an 11 year period we had 20 admissions with different types
of foreign intrathoracic bodies, with ages ranging from 16 to 75 years,
with an m/f sex ratio of 17:3. The pathology was represented by 13
thoracic wounds with retention (glass, knife blades, needles, bullets), 3
foreign intra-bronchial bodies (1 syringe needle, 2 rocks), 4

intraoesophageal bodies (1 dental prosthesis, 2 copper wires, 1 bone).
We performed thoracotomy in 9 cases, pleural drainage in 1
case, 1 bronchoscopy, wound explorations, one conservative treatment.
The mean hospital stay was 11 days.
Results
In all the cases the long term prognosis was excellent. We had 3
complications: pleural effusion managed by drainage in a case with
esophageal perforation, aspiration pneumonia and prolonged fever.
Conclusions
The foreign bodies are sometimes a challenge and the
management requires a thoracic and abdominal surgeon, bronchologist,
gastro-enterologist. Thoracotomy is the final solution of approach,
minamally invasive surgery is required in most of the cases.
OVER 2000 CASES OF THORACIC TRAUMA 10 YEARS
EXPERIENCE OF A SINGLE CLINICAL CENTRE
Clin Tunea
Objectives
We present the experience of our clinic in the diagnosis and
treatment of thoracic trauma, there being some controversial issues in
this field in medical literature.
Material and Methods
This study encompasses 2156 cases admitted over a period of 10
years (2002 2011). Patients were analyzed in terms of sex, age,
causative mechanism, as well as thoracic and extrathoracic lesions.
Methods of diagnosis and surgical treatment, complications that occur,
duration of hospital stay, and evolution under treatment are presented.
Results
Hospitalization due to thoracic trauma represents on an average
21% of all admissions. Cases of polytrauma (35%) were managed by a
multidisciplinary team. Regarding diagnostic tools, computerized
tomography was used in 35% of the cases and bronchoscopy in 6%.
Fine needle aspiration biopsy was used for the differential diagnosis of
pulmonary contusions in 1.4% of the cases.
The most frequent thoracic lesions were rib fractures, pleural
effusions, and pulmonary contusions. Pleurotomy was most frequently
used (47%) while thoracotomy was used in 8% of the cases operated
upon. Complications affected 18% of the cases. 76% of patients that
required over 3 weeks of hospitalization presented with extensive
pulmonary contusion. Unfavorable results were seen in 4% of the
patients while 2.6% of the patients died.
Conclusions
Thoracic trauma represents a difficult challenge, often with a
surprising evolution. The diagnosis and application of the best surgical
management, often with the help of a multidisciplinary team, is
paramount. Associated pulmonary contusion prolongs hospital stay.
PRESENTATION OF A RARE CASE OF
MALIGNANT
HEMANGIOENDOTHELIOMA
Ovidiu Rus, Cezar Motas, Natalia Mota, Teodor. Horvat
Introduction
Malignant hemangioendothelioma is a rare vascular tumor, with
a nonspecific clinical picture in wich diagnosis is often delayed or
confused and limit therapeutic possibilities.
Method
We present the case of a patient 42 years old, with hemoragic
pericarditis operated in 2011, wich is admitted in our clinic with a
diagnosis of right pleural effusion . CT scan performed before
admission shows multiple formations liver, nodules in right lung, with
right pleural effusion.
Surgery is delayed due to degadation blood count with
significant thrombocytopenia and anemia, patialy corrected by
transfusion and medication.
Results
Right thoracoscopy is performed: it evacuated approximately
1200 ml pleural fluid (old blood looking), without affected parietal
pleura; in visceral pleura is visualized nodular lesions (metastases). We

decided to extend surgical intervention with minithoracotomy and make
wedge resection at pulmonary lower lobe. IHC exam: malignant
hemangioendothelioma. Favorable postoperative evolution is slow, with
recurrence of thrombocytopenia, partial remitted under medical
treatment.
Conclusion
Malignant hemangioendothelioma, is a rare neoplasia, little
known; late diagnosis generates spread of disease, with complications
(hemoragic malignant pleural effusion), that limit life expectancy.
FIVE IPSILATERAL SUCCESSIVE THORACOTOMIES (AT
THE
SAME
PATIENT).
CASE
REPORT
AND
CONSIDERATIONS.
Cristian Pavaloiu
Bucharest.
Introduction
Recurrent ipsilateral thoracotomies influence the quality of the
surgical act and postoperative recovery through parietal and
intrathoracic changes induced by surgical dissociations and fibrosis. We
wish to report the case of a patient with 5 successive thoracotomies,
which developed intraoperative complications and difficulties, most
likely due to the consistent number of procedures addressing the
patients right hemithorax.
Materials and method
The 42 years old female patient was discovered this year with
pulmonary tumor of the right upper lobe (Rx and CT) for which she
underwent a wedge resection of the right upper lobe and partial
resection of the lateral arches of the third and forth ribs. We know from
the patients history chart that she underwent 4 other thoracotomies in a
time frame of 11 years for recurrent pulmonary hydatid disease. For
information we used the patients medical chart, operating protocols,
hystopathology reports, CT examinations and previous discharge
summaries describing past surgical procedures. Overall, the patient

underwent 2 extensive posterolateral thoracotomies and 3 lateral
thoracotomies.
Results
During the procedure we came across a rigid thoracic wall with
the latissimus dorsi and serratus fused together forming a single muscle
layer; we also found multiple adherences, and noticed the absence of
lung fissures. The inconclusiveness of the extemporaneous pathology
examination and the friability of the lung influenced the quality of the
surgical act, while postoperative recovery was slowed by prolonged air
leaks, lack of re-expansion of the resting lung, which was incompletely
freed, and past postoperative sequelae.
Conclusions
Multiple iterative thoracotomies are responsible for changes of
thoracic wall and lung anatomy which have a negative cumulative
affect on postoperative recovery and influence decision making
regarding future procedures.
TRANSTHORACIC NEEDLE BIOPSY - THE EXPERIENCE OF
1st THORACIC SURGERY CLINIC OF THE "MARIUS
NASTA" NATIONAL INSTITUTE OF PNEUMOLOGY
Olga Danaila, Cristian Paleru, Ciprian Bolca, Mihai Dumitrescu, Dana
Ivascu, Valerian Cristian Pavaloiu, Ioan Cordos
Bucharest.
Introduction
Transthoracic needle biopsy (TNB) has been a safe and rapid
method for achieving histopathological diagnosis for many thoracic
lesions since 19th century.
Between May 2010 and May 2012 we have performed TNB on
42 patients (25 male and 17 female, median age 63 years) in order to
evaluate peripheral lung masses and tumors of the chest wall, pleura,
mediastinum and neck, found after CT examination. Uncooperative
patients or those presenting uncorrectable coagulopathies were
excluded. Most TNB are performed on an outpatient basis by using

local anesthesia. We used 14 or 16-gauge needles, and ultrasound guide
biopsy was performed on 28 patients.
Results
An average of three passes were (range 2-5) performed in order
to obtain sufficient material. Biopsy led to a diagnosis in 83,3% patients
of which 27 (77.1%) patients had malignant lesions. 5 (71.4%) of the 7
patients for whom TNB biopsy failed to yield a diagnosis were found to
have a malignancy at the time of operation. TNB pneumothorax
resulted in 4 patients, with 2 patients requiring chest tube drainage.
There were no major episodes of hemorrhage and no deaths.
Conclusions
The results, which correlate well with those reported in the
literature, indicate that TNB can provide precise histopathological
diagnosis, especially in malignant lesions with minimal tissue injury,
low pain, morbidity and low costs. Only if a specific benign diagnosis is
established the surgical intervention can be avoided, and this is rarely
achieved. Ultrasonographic guidance, a skilled surgeon and an
experienced pathologist increase the accuracy of this procedure.
RIB
FRACTURE
FIXATION
AND
OPERATIVE
STABILIZATION OF FLAIL CHEST. EXPERIMENTAL AND
COMPARATIVE STUDY
Department of Thoracic Surgery, Clinic Hospital Leon Daniello Cluj
Napoca
Background
Operative stabilization of flail chest has few indication. Despite
this situation, a large number of surgical procedure was developed but
no one achieved the gold standard. The aim of this study is to perform
experimentally several surgical techniques and compare their efficiency
and effectiveness.
Methods
The study was performed in Experimental Medical Center of
UMF Cluj Napoca on pigs who suffered flail chest injuries. We used
four surgical techniques, two for rib fracture fixation and two for
stabilizations of flail chest. We recorded the efficiency and
effectiveness, durations, availability and cost/effective.
Results
All of those compared techniques provided a good stabilizations
of flail chest. The ribs osteosinthesys techniques are more difficult,
skills demanding and expensive. The ribs fixation is strong and
definitive. The flail chest stabilization techniques are easier, cheaper
and more familiar.
Conclusion
Nowadays there are no standard surgical technics for flail chest
stabilizations. The indication must be adapted for lesional status,
surgical experience, different implants and techniques available for
fixation.

Carte Rezumate 2012

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Organizator

Societatea Romn de Chirurgie Toracic 1994

Cultura, la dub!...sau n lumi paralele

actuale ba uneori cu un pas nainte, pentru acetia ne strduim s

anatomopatologi, oncologi, specialitii de anestezie i terapie intensiv,

JOI, 4 OCTOMBRIE 2012

VINERI, 5 OCTOMBRIE 2012

11.30 13.30 - Conferine - Sesiunea II

Secia Chirurgie, 2Secia Anestezie-Terapie Intensiv, 3Secia

Clinica de Chirurgie Toracic, 2Clinica ATI, UMF Craiova

Gala dinner 19.00

SMBT, 6 OCTOMBRIE 2012

Clinica de Chirurgie Toracic, Institutul Naional de Pneumologie

Chist hidatic pulmonar suprainfectat cu aspergillus

Cinci toracotomii succesive ipsilaterale (la acelasi pacient). Prezentare

VINERI, 5 OCTOMBRIE 2012

(88.9% and 95.8%; p=0.00) and Negative Predictive Value (NPV)

confirmed) non-small-cell lung cancer. But, in the analysis of overall

After analyzing prior information, some key points should be

punct de vedere lezional examen clinic, imagistic (radiografie

contralateral dup o pneumonectomie. n toate cazurile

Secia Chirurgie, 2Secia Anestezie-Terapie Intensiv, 3Secia

hidro-pneumotorax bilateral carcinomatoz pleural cu plmn

Clinica de Chirurgie Toracic, 2Clinica ATI, UMF Craiova

importante pentru pacient, rezolvat prin tehnica minim invaziv

costale VIII, IX, X, diafragm si de segment hepatic VII, la care s-a

compartimentul visceral a leziunii maligne. n ambele situaii s-a

dreapta, care se prezinta in clinica noastra prezentand o formatiune

cervical, care se interneaz pentru disfagie, odinofagie, dispnee, dureri

SMBT, 6 OCTOMBRIE 2012

11.00 11.30 Pauz de cafea

11.30 13.00 - Lucrri Sesiunea II

asocierii miasteniei se constat efectul benefic limitat al rezeciei

Clinica de Chirurgie Toracic, Institutul Naional de Pneumologie

pneumonectomiei. Raportam astfel success staplarii si sectionarii

aspectul endoscopic n 78% din totalul biopsiilor, ceea ce a dus la

folicular tiroidian difereniat internat n clinica noastr cu o formaiune

si evacuarea secretiilor bronsice, din plamanul atelectaziat, se practica

(fereastr pleural sau toracoplastie). La controalele efectuate la un an

dupa abordul toracoscopic uniportal a fost reprezentat de: 58 cazuri

Cele mai frecvente cancere primitive, care au stat la originea

CHIST HIDATIC PULMONAR SUPRAINFECTAT CU

histopatologic a artat prezena unui lipom mixoid fuzocelular fr

Ki67, si a fost diagnosticata o tumora inflamatorie miofibroblastica. Nu

pentru gastroenterolog. Toracotomia este solutia finala, chirurgia minim

tratament chirurgical, de multe

CAZ RAR DE PREZENTARE A UNUI HEMANGIOENDOTELIOM MALIGN

cu asocierea complicatiilor (pleurezie neoplazica hemoragica), care

aeriene prelungite, lipsa de expansiune a plamanului restant si nedecolat

THURSDAY, OCTOBER 4, 2012

19.00 Opening ceremony and Welcome reception

FRIDAY, OCTOBER 5, 2012

11.30 13.30 - Conferences - Session II

Surgery Department, 2Intensive Care Department, 31st Pneumology

Thoracic Surgery Clinic, 2Anesthesiology and Intensive Care Clinic,

Gala dinner 19.00

11.30 13.00 - Scientific Session II

VOLUME REDUCTION SURGERY IN A CASE OF PULMONARY

INTRATHORACIC FOREIGN BODIES A 11 YEAR STATISTICS

FIVE IPSILATERAL SUCCESSIVE THORACOTOMIES (AT THE SAME

FRIDAY, 5 OCTOBER 2012

(84.1% and 99.6%; p = 0.00) in favor of TEMLA. In the restaging

survival according to interim pathologic response data, N0 status

After analyzing prior information, some key points should be