Professional Documents
Culture Documents
Carte Rezumate 2012
Carte Rezumate 2012
Organizator
–
Societatea Român! de Chirurgie Toracic! 1994
Comitet de organizare:
Dr. Ciprian Bolca
Dr. Andrei Bobocea
Dr. Mihai Dumitrescu
Dr. Cezar Mota"
Dr. Cristian Paleru
Comitet "tiin#ific:
Prof. Dr. Alexandru Bo#ianu
Prof. Dr. Ioan Cordo"
Prof. Dr. Teodor Horvat
Prof. Dr. Alexandru Nicodin
Dr. Cristina Grigorescu
Dr. Cristian Paleru
Cultura, la dub!!...sau în lumi paralele
Deun!zi, când în timpul unui
protest mai mult sau mai pu"in pa#nic,
jandarmii eliberau cu sârg Pia"a
Universit!"ii ajuta"i de materiale de
specialitate: dube, bastoane etc. un
tinerel sfrijit încerca s! le explice, în
timp ce era îndemnat cu delicate"ea tipic! for "elor de ordine spre incinta
unui mijloc de transport, c! nu face parte dintre protestatan"i ci este
reprezentantul unui site cultural. „Ce, cultural... cultura la dub !!” a fost
r !spunsul mai mult decât pertinent al jandarmului care f !cea triajul...
$i totu#i...în aceste vremuri în care cuvântul dat conteaz! mai
pu"in decît în oricare perioad ! istoric!, când profesionistii sunt acuza"i
c! nu sunt îndeajuns de vocali (când? în acela #i timp în care încearc! s!-
#i exercite profesia la cote maxime?), când argumentele logice cedeaz!
prea lesne în fa"a tonului ridicat sau al unui bombardament telefonic,
când o strângere de mân! echivaleaz! de prea multe ori cu un cu"it
înfipt în spate iar apartenen"a la un grup sau partid – nu conteaz! care
atât timp cât traseismul este confundat cu abilitatea politic! – "in loc de
instruc"ie, moralitate sau talent...în aceste vremuri, dup! cum spuneam,
mai exist! #i profesioni#ti, oameni care n-au cedat tenta"iei de a folosi
locul de minim! rezisten"!, medici care n-au v!zut în pacient un fel de
obiect al muncii ci un semen în suferin"!, în c!utarea unui sprijin oferit
cu dezinteres, responsabilitate #i compasiune, chirurgi ai vremurilor
PROGRAM
$TIIN%IFIC
9.00 – 9.30
Alexandru Bo#ianu
Staplerele în 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
José Belda-Sanchis
Surgical controversies in N2 lung cancer patients. Who is wrong and
who is rigth
10.30 – 11.00
Teodor Horvat
Hidrotoraxul hepatic
11.30 – 12.00
Philippe Dartevelle
TO BE ANNOUNCED
12.00 – 12.30
Philippe Dartevelle
TO BE ANNOUNCED
12.30 – 13.00
Ioan Cordo"
Indica # iile chirurgicale în cancerul bronhopulmonar
13.00 – 13.30
Techno-meeting - MEDELA
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 Bucure#ti
15.40 – 15.50
Fistul ! eso-cavitar ! dreapt ! dup! tuberculoz ! pulmonar ! bilateral !
Eusta"iu Memu1, D!nu" Popovici1, Simona Cismaru2, Maria Mih!rtescu3
1
Sec"ia Chirurgie, 2Sec"ia Anestezie-Terapie Intensiv!, 3Sec"ia
Pneumologie I, Spitalul Jude"ean de Urgen"! Drobeta-Turnu Severin
15.50 – 16.00
Chistul hidatic de dom hepatic – abordarea chirurgului toracic
C!lin 'unea, Ovidiu Burlacu, Gabriel Cozma, Voicu Voiculescu, Iris
Miron, Ioan Petrache, Alexandru Nicodin
Clinica de Chirurgie Toracic!, Spitalul Municipal Timi &oara
16.00 – 16.10
Indica $ ii "i rezultate ale toracotomiilor bilaterale în aceea "i "edin $!
operatorie
Bo"ianu Alexandru-Mihail, Lucaciu Oana, Hogea Timur, Batog Olivia,
Giurgiu Ioana, Bo"ianu Petre Vlah-Horea
Clinica Chirurgie IV, UMF Tîrgu-Mure &
16.10 – 16.20
Hemangiopericitomul malign – surpriza din "spatele" pneumoniei
Iulian Mihai R !dulescu, Mihaela Codre&i, Adrian Mihail Iordache, Ioan
Cordo&
Clinica de Chirurgie Toracic!, Institutul Na%ional de Pneumologie
“Marius Nasta”, Bucure&ti
16.20 – 16.30
Importan $ a autofluorescen $ ei în evaluarea bronhoscopic! a cancerului
bronho-pulmonar
Natalia Mota#, Cezar Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Clinica de Chirurgie Toracic!, Institutul Oncologic Bucure#ti
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 Vânvu2
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
Clinica de Chirurgie Toracic!, Institutul Na%ional de Pneumologie
“Marius Nasta”, Bucure#ti, 2Institutul Clinic Fundeni, Centrul de
Chirurgie Generala si Transplant Hepatic “Dan Setlacec”, Bucure#ti
16.50 – 17.00
Liposarcoamele mediastinului anterior
Cezar Mota#, Natalia Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Clinica de Chirurgie Toracic!, Institutul Oncologic Bucure#ti
17.00 – 17.10
Aspecte clinice "i imagistice la supravie # uitorii de lung ! durat ! dup!
toracoplastie cu plombaj pentru tuberculoz !
Bo%ianu Petre Vlah-Horea, Hogea Timur, Batog Olivia, Lucaciu Oana
Raluca, Giurgiu Ioana, Naftali Zoltan, Bo%ianu Alexandu-Mihail
Disciplina Chirurgie IV, UMF Tîrgu-Mure &
17.10 – 17.20
Sindromul Maffucci, entitate rara in chirurgia toracica
Felix Dobritoiu, Ioan Cordos, Codin Saon, Adrian Mihail Iordache,
Valerian Pavaloiu
Clinica de Chirurgie Toracic!, Institutul Na%ional de Pneumologie
“Marius Nasta”, Bucure&ti
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
Clinica de Chirurgie Toracic!, Spitalul Municipal Timi &oara
9.00 – 9.30
Cristina Grigorescu
Actualit !# i medico-chirurgicale în LVRS (lung volume reduction
surgery)
9.30 – 10.00
Alper Toker
TO BE ANNOUNCED
10.00 – 10.30
Ion-Christian Chiricu#!
Actualit !$ i în radioterapia 3D conforma $ ional ! %i cu intensitate
modulat ! în radioterapia cancerului broncho-pulmonar
10.30 – 11.00
Genoveva Cadar
Ventila # ia unipulmonar ! în chirurgia toracic!
11.30 – 11.40
Chirurgia timoamelor
Cezar Mota#, Natalia Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Clinica de Chirurgie Toracic!, Institutul Oncologic Bucure#ti
11.40 – 11.50
Abordului transcervical minim invaziv al bronsiei primitive drepte.
Aspecte tehnice.
Cristian Paleru, Ioan Cordo&, Olga D!n!il!, Mihai Dumitrescu, Adrian Istrate
Clinica de Chirurgie Toracic!, Institutul Na%ional de Pneumologie
“Marius Nasta”, Bucure&ti
11.50 – 12.00
Poate fi chirurgul toracic un bun bronhoscopist?
Voicu Voiculescu, Ioan Petrache, Ovidiu Burlacu, C!lin (unea, Gabriel
Cozma, Iris Miron, Alin Nicola, Alexandru Nicodin
Clinica de Chirurgie Toracic!, Spitalul Municipal Timi &oara
12.00 – 12.10
Rezec # ii-reconstruc # ii parietale largi cu sistemul stratos
Mihnea Davidescu, Elena Moise, Ovidiu Rus, Teodor Horvat
Clinica de Chirurgie Toracic!, Institutul Oncologic Bucure#ti
12.10 – 12.20
Carcinoid tipic la un pacient tanar
Codin Saon, Valentin Soldea, Felix Dobritoiu
Clinica de Chirurgie Toracic!, Institutul Na%ional de Pneumologie
“Marius Nasta”, Bucure&ti
12.20 – 12.30
Chirurgia leziunilor TBC suprainfectate cu Aspergillus
Bo"ianu Alexandru-Mihail, Bo"ianu Petre Vlah-Horea, Lucaciu Oana
Raluca, Hogea Timur, Batog Olivia, Giurgiu Ioana
Clinica Chirurgie IV, UMF Tîrgu-Mure &
12.30 – 12.40
Miastenia Gravis dup! timomectomie
Cezar Mota#, Natalia Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Clinica de Chirurgie Toracic!, Institutul Oncologic Bucure#ti
12.40 – 12.50
Chirurgia toracoscopica uniportala
Gabriel Cozma, Ovidiu Burlacu, Ioan Petrache, C!lin 'unea, Voicu
Voiculescu, Iris Miron, M. Butas, Alexandru Nicodin
Clinica de Chirurgie Toracic!, Spitalul Municipal, Timi&oara
12.50 – 13.00
Toracomioplastia ca re-reinterve # ie
Bo%ianu Petre Vlah-Horea, Bo%ianu Alexandu-Mihail
Clinica Chirurgie IV, UMF Tîrgu-Mure &
SESIUNEA POSTERE
13.00 – 13.30
Decernarea premiului „Traian Oancea” pentru cea mai bun!
prezentare în cadrul sesiunilor de lucr!ri
Închiderea conferin#ei
REZUMATE
CONFERIN%E
LUCR &RI
POSTERE
9.00 – 9.30
Alexandru Bo#ianu
Staplerele în 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)
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 chemo-
radiotherapy 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
10.00 – 10.30
José Belda-Sanchis
Surgical controversies in N2 lung cancer patients. Who is wrong and
who is rigth
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;81:1013–20
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) non–small 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 – 12.00
Philippe Dartevelle
TO BE ANNOUNCED
12.00 – 12.30
Philippe Dartevelle
TO BE ANNOUNCED
12.30 – 13.00
Ioan Cordo"
Indica # iile chirurgicale în cancerul bronhopulmonar
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 Bucure#ti
Introducere
Chiar #i dup! o pneumonectomie atât pl!mânul restant cât #i
spa"iul pleural corespunz!tor pot fi sediul unor afec"iuni chirurgicale
Material #i metod!
Sunt studia"i retrospectiv 12 pacien"i la care s-a intervenit
chirurgical pentru afec"iuni toracice în spa"iul pleuropulmonar
15.40 – 15.50
FISTUL& ESO-CAVITAR & DREAPT& DUP& TUBERCULOZ&
PULMONAR & BILATERAL&
Eusta"iu Memu1, D!nu" Popovici1, Simona Cismaru2, Maria Mih!rtescu3
1
Sec"ia Chirurgie, 2Sec"ia Anestezie-Terapie Intensiv!, 3Sec"ia
Pneumologie I, Spitalul Jude"ean de Urgen"! Drobeta-Turnu Severin
Introducere
Chirurgia tuberculozei pulmonare constituie înc ! o propor "ie
important! a cazurilor operate în serviciile de chirurgie toracic! din
multiple cauze.
Material #i metod!
Prezent!m cazul unui b!rbat de 56 ani, cu multipli factori de risc
pentru evolu"ie nefavorabil! a tuberculozei diagnosticate în 2010, care a
fost tratat #i operat în Spitalul Jude"ean de Urgen"! Drobeta-Turnu
Severin pentru sechele fibrocavitare lob superior drept, fistul ! eso-
cavitar ! #i o forma"iune tumoral! de segment apical lob inferior drept.
Rezultate
S-a practicat lobectomie superioar ! dreapt!, fistulectomie,
esorafie, rezec"ie atipic! LID, gastrostom! temporar ! de alimenta"ie.
Tumora din LID: hamartocondrom. Evolu"ie postoperatorie lent
favorabil!, cu pierderi aeriene prelungite, colec "ie aeric! rezidual!
bazal! dreapt!. Externare în a 23-a zi postoperatorie, vindecat.
Concluzii
La pacien"ii cu tratamente prelungite, recidive, factori
economico-sociali precari, trebuie avute în vedere #i complica"iile mai
rar citate ale tuberculozei, considerate uneori „de interes istoric”.
15.50 – 16.00
CHISTUL HIDATIC DE DOM HEPATIC – ABORDAREA
CHIRURGULUI TORACIC
C!lin 'unea, Ovidiu Burlacu, Gabriel Cozma, Voicu Voiculescu, Iris
Miron, Ioan Petrache, Alexandru Nicodin
Clinica de Chirurgie Toracic!, Spitalul Municipal Timi &oara
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 clínica 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
INDICA%II $I REZULTATE ALE TORACOTOMIILOR
BILATERALE ÎN ACEEA$I $EDIN%& OPERATORIE
Bo%ianu Alexandru-Mihail, Lucaciu Oana, Hogea Timur, Batog Olivia,
Giurgiu Ioana, Bo%ianu Petre Vlah-Horea
Clinica Chirurgie IV, UMF Tîrgu-Mure &
Introducere
Scopul lucr !rii este evaluarea toracotomiei bilaterale în aceea&i
&edin%! operatorie pentru patologie toracic ! bilateral!.
Material &i metod!
Acesta este un studiu retrospectiv efectuat pe un num!r de 20 de
pacien%i, interna%i în Clinica Chirurgie 4 UMF Tîrgu-Mure & în perioada
01.01.1985-01.01.2012, la care s-a practicat toracotomie bilateral! în
aceea&i &edin%! operatorie. Indica%iile acestui abord au fost: boala
hidatic! (inclusiv o toracofrenotomie dreapt ! pentru asociere cu un chist
hidatic hepatic) – 9 pacien%i, traumatisme toracice – 2 cazuri, metastaze
bilaterale – 2 cazuri, empiem bilateral – 2 cazuri, emfizem bilateral – 2
cazuri, cancer pulmonar primar + metastaz! controlateral! – 1 caz,
16.10 – 16.20
HEMANGIOPERICITOMUL MALIGN – SURPRIZA DIN
"SPATELE" PNEUMONIEI
Iulian Mihai Radulescu, Mihaela Codresi, Adrian Mihail Iordache, Ioan
Cordos
Clinica de Chirurgie Toracic!, Institutul Na%ional de Pneumologie
“Marius Nasta”, Bucure&ti
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
IMPORTAN 'A AUTOFLUORESCEN 'EI ÎN EVALUAREA
BRONHOSCOPIC& A CANCERULUI BRONHO-PULMONAR
Natalia Mota#, Cezar Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Clinica de Chirurgie Toracic!, Institutul Oncologic Bucure#ti
Introducere
Bronhoscopia cu autofluorescen"! constituie o etap! extrem de util!
în depistarea, evaluarea #i stadializarea cancerului bronho-pulmonar.
Material #i metod!
În clinica noastr ! au fost efectuate 42 de examin!ri traheo-
bronhoscopice cu autofluorescen"! (din total 1126 bronhoscopii pân ! în
august 2012). Specificul Institutului Oncologic Bucure #ti face ca
principala indica"ie s! fie determinarea extensiei reale endoluminale a
cancerului bronho-pulmonar.
Rezultate
Sunt prezentate indica"iile, contraindica"iile metodei #i
aplicabilitatea bronhoscopiei cu autofluorescen"! în cadrul pacien"ilor
no#tri - cazurile relevante din clinic ! în care bronhoscopia cu
autofluorescen"! a determinat atitudinea terapeutic! ulterioar ! corect!.
Concluzii
Bronhoscopia cu autofluorescen"! se dore#te a fi în viitorul
apropiat un instrument obligatoriu în depistarea precoce a cancerului
bronho-pulmonar la pacien"ii cu risc #i, de asemenea, un standard în
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)
Alin Demetrian1, Dan Ulmeanu1, Monalisa Enache2, Andreea-Lavinia Vânvu2
1
Clinica de Chirurgie Toracic!, 2Clinica ATI, UMF Craiova
Introducere
Pectus carinatum reprezint! o malforma%ie a peretelui toracic ce
const! în protruzia anterioar ! a sternului, întâlnit! mult mai rar decât
malforma%ia opus!, pectus excavatum. Spre deosebire de pacien%ii cu
pectus excavatum, cei care prezint! pectus carinatum sunt adresa%i
chirurgului toracic cel mai frecvent din considerente estetice &i nu
func%ionale, indica%ia chirurgical! vizând de obicei asocierea dintre
pectus excavatum si pectus carinatum. Datorit! implica%iilor psihologice
pentru pacient, cazurile de pectus carinatum pur (neasociat cu pectus
excavatum) pot beneficia de o rezolvare chirurgical! minim invaziv!.
Material &i metod!
Prezent!m cazul unei tinere de 24 de ani, cu un pectus carinatum
important dar simetric, neasociat cu pectus excavatum, f !r !
simptomatologie cardiorespiratorie dar cu probleme psihosociale
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
Clinica de Chirurgie Toracic!, Institutul Na%ional de Pneumologie
“Marius Nasta”, Bucure&ti, 2Institutul Clinic Fundeni, Centrul de
Chirurgie Generala si Transplant Hepatic “Dan Setlacec”, Bucure&ti
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
16.50 – 17.00
LIPOSARCOAMELE MEDIASTINULUI ANTERIOR
Cezar Mota#, Natalia Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Clinica de Chirurgie Toracic!, Institutul Oncologic Bucure#ti
Introducere
Liposarcoamele sunt leziuni maligne localizate rar în mediastin,
cel mai frecvent fiind situate în compartimentul posterior. Topografia
mediastinal! anterioar ! este rar raportat! în literatura de specialitate
Material #i metod!
Sunt analizate 2 cazuri de liposarcoame ale mediastinului
anterior, într-un caz fiind constat ! extensia cervical! #i în
17.00 – 17.10
ASPECTE CLINICE $I IMAGISTICE LA SUPRAVIE%UITORII
DE LUNG& DURAT& DUP& TORACOPLASTIE CU PLOMBAJ
PENTRU TUBERCULOZ&
Bo%ianu Petre Vlah-Horea, Hogea Timur, Batog Olivia, Lucaciu Oana
Raluca, Giurgiu Ioana, Naftali Zoltan, Bo%ianu Alexandu-Mihail
Clinica Chirurgie IV, UMF Tîrgu-Mure &
Introducere
Toracoplastia cu plombaj a fost frecvent efectuat! în anii 1950-
60 pentru tuberculoz!, fiind în prezent abandonat ! sau rareori efectuat!.
Obiectivul prezentei lucr !ri este de a prezenta aspectele clinice &i
imagistice ale unor suravie%uiori de lung! durat! interna%i în Clinica
noastr !.
Material &i metod!
În perioada 01.01.1990-01.01.2012 în Clinica Chirurgie IV
UMF Tîrgu-Mure& au fost interna%i în total 5 pacien%i având în
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 interven%iile ini%iale au fost
efectuate în alte unit!%i sau de c!tre al%i chirurgi din clinic !, acest tip de
interven%ie fiind abandonat de c!tre echipa noastr !.
Rezultate
2 pacien%i au fost interna%i pentru complica%ii legate de plombaj
– recidiv! &i suprainfec%ie, necesitând reinterven%ie (îndep!rtarea
materialului de plombaj &i toracomioplastie). Un pacient a fost internat
pentru un empiem contralateral iar 2 pacien%i nu prezentau acuze
toracice. Materialul de plombaj a fost evident atât pe radiografiile
toracice, cât &i pe imaginile CT. La un an postoperator, nici unul dintre
pacien%ii opera%i nu prezenta semne de recidiv! sau acuze toracice
semnificative. Un pacient a decedat pe perioada intern!rii, cauza
decesului neavând leg!tur ! cu plombajul efectuat (infarct miocardic).
Concluzii
În practica medical! actual! putem întâlni supravie%uitori pe
termen lung ai unor opera %ii considerate istorice cum este toracoplastia
cu plombaj, cu sau f !r ! acuze legate de interven%ia ini%ial!.
Recrudescen%a tuberculozei poate readuce în actualitate acest tip de
interven%ii ca o solu%ie pentru cazuri selectate.
17.10 – 17.20
SINDROMUL MAFFUCCI, ENTITATE RARA IN CHIRURGIA
TORACICA
Felix Dobritoiu, Ioan Cordos, Codin Saon, Adrian Mihail Iordache,
Valerian Pavaloiu
Clinica de Chirurgie Toracic!, Institutul Na%ional de Pneumologie
“Marius Nasta”, Bucure&ti
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
Clinica de Chirurgie Toracic!, Spitalul Municipal Timi #oara
Introducere
Autorii prezint! o cervico-mediastinit! acut! descendent!
necrozant! consecutiv! unui flegmon cervical anterior, asociat! cu
multiple #i grave complica"ii, care a necesitat interven"ii chirurgicale
seriate, în echip! multidisciplinar !, soldate însa cu supravie"uirea cu
sechele a pacientului.
Material #i metod!
Cazul este reprezentat de un pacient de 49 ani, cu o incizie
latero-cervical! efectuat! într-o clinic! ORL pentru un flegmon
9.00 – 9.30
Cristina Grigorescu
Actualit !# i medico-chirurgicale în LVRS (lung volume reduction
surgery)
9.30 – 10.00
Alper Toker
TO BE ANNOUNCED
10.00 – 10.30
Ion-Christian Chiricu#!
Actualit !$ i în radioterapia 3D conforma $ ional ! %i cu intensitate
modulat ! în radioterapia cancerului broncho-pulmonar
Introducere
Progresele realizate în radioterapie fac posibil! aplicarea unui
plan de radioterapie individualizat. Indica"ia terapeutic! este stabilit! în
cadrul comisiei oncologice la care particip! to"i factorii implica"i în
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 indica"iei terapeutice în
cadrul comisiei oncologice, cu recomandarea efectu!rii unei radioterapii
adjuvante sau neoadjuvante, pacientul este supus unei examin!ri CT în
pozi"ia în care va fi efectuat! radioterapia extern!.
Rezultate
Volumele "int! delimitate sunt elaborate de c!tre radioterapeut #i
sunt bazate pe informa"iile ob"inute prin examinare clinic!, investiga"ii
imagistice (CT, IRM, PET/CT) #i rezultatele examin!rii
anatomopatologice a materialului tisular ob"inut prin biopsie sau
rezec"ie. 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
în ghidurile terapeutice elaborate. Dozele aplicate în volumele "int! ce
includ zonele cu boal! microscopic! (CTV) sau macroscopic! (GTV)
sunt cele stabilite în ghidurile terapeutice elaborate #i variaz! de la 50,4
Gy pân! la 70 Gy sau mai mult, aplicate în frac"iuni de 1,8 sau 2,0 Gy.
Iradierea se realizeaz! printr-o tehnic! 3D înalt conforma"ional! sau
prin iradiere cu modularea intensit!"ii (IMRT); în cadrul institutului
nostru folosim o variant! a IMRT numit! VMAT (volume modulated
arc therapy).
Concluzie
Prin aplicarea unei tehnici înalt 3D-conforma "ionale sau IMRT
de tip VMAT, este posibil! aplicarea unui tratament radiologic de înalt !
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
Ventila # ia unipulmonar ! în chirurgia toracic!
11.30 – 11.40
CHIRURGIA TIMOAMELOR
Cezar Mota#, Natalia Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Clinica Chirurgie Toracic!, Institutul Oncologic Bucure#ti
Introducere
Numeroase studii au demonstrat importan"a rezec"iei tumorale în
cazul timoamelor. Un rol important îl joac! #i tratamentul
complementar: radio #i chimioterapia
Material #i metod!
Sunt studia"i retrospectiv 50 de pacien"i cu timom opera"i într-un
singur centru în intervalul octombrie 1994 – octombrie 2009. Lotul
cuprinde 26 de b!rba"i #i 24 femei, distribu"ia 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
clasific!rii OMS au fost: tipul A 11 cazuri, tipul AB 15 cazuri, tipul B1
11 cazuri, tipul B2 9 cazuri, tipul B3 2 cazuri #i în 2 situa"ii au existat
forme mixte B2-B3. Miastenia gravis a fost asociat! în 13 din timoame.
Rezultate
Sunt analizate datele de evolu"ie postoperatorie fiind comparat!
supravie"uirea acestor pacien"i în func"ie de tipul histologic, de stadiul
de dezvoltare, de tipul interven "iei chirurgicale practicate #i în func"ie
de tratamentul complementar postoperator efectuat. Cu excep"ia unui
decees în ziua 4 postoperatorie (ARDS pe pl !mân unic), nu s-au
înregistrat complica"ii notabile postoperator imediat. Din cele 13 cazuri
de miastenie, 5 s-au vindecat postoperator, 6 s-au ameliorat în timp ce
în 2 situa"ii s-a constatat agravarea simptomatologiei. Un pacient care
nu avea miastenie în momentul rezec"iei a dezvoltat miastenia la 6 ani
de la rezec"ia tumoral!. În 7 cazuri s-a constatat asocierea altor leziuni
maligne într-un caz fiind constatat! asocierea chiar a 2 alte cancere.
Concluzii
Tipul interven"iei chirurgicale, stadiul de dezvoltare Masaoka,
tipurile histologice #i tratamentul complementar efectuat sunt principalii
factori care dicteaz! supravie"uirea pacien"ilor cu timom. În cazul
11.40 – 11.50
ABORDULUI TRANSCERVICAL MINIM INVAZIV AL
BRONSIEI PRIMITIVE DREPTE. ASPECTE TEHNICE.
Cristian Paleru, Ioan Cordo&, Olga D!n!il!, Mihai Dumitrescu, Adrian Istrate
Clinica de Chirurgie Toracic!, Institutul Na%ional de Pneumologie
“Marius Nasta”, Bucure&ti
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
11.50 – 12.00
POATE FI CHIRURGUL TORACIC UN BUN
BRONHOSCOPIST?
Voicu Voiculescu, Ioan Petrache, Ovidiu Burlacu, C!lin (unea, Gabriel
Cozma, Iris Miron, Alin Nicola, Alexandru Nicodin
Clinica de Chirurgie Toracic!, Spitalul Municipal Timi &oara
Obiective
Lucrarea are ca scop prezentarea experien"ei noastre în aplicarea
diagnostic! #i terapeutic! a bronhoscopiei în sala de opera"ie sau în
ATI, în cadrul patologiei chirurgicale cu care ne-am confruntat.
Material &i metod!
Sunt analizate 1647 de proceduri, aplicate într-o perioad ! de 12
ani, la un num!r de 1435 pacien"i. Dintre acestea majoritatea au avut
viz! terapeutica – 58% proceduri iar 42% din proceduri au avut viz !
diagnostic!.
Rezultate
Procedurile terapeutice sunt defalcate în func"ie de patologia
abordat! #i complica"iile 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.
În contextul patologiei #i complica"iilor deosebit de grave
mortalitatea este de 6 %, interpretata ca un rezultat terapeutic
remarcabil, în care #i bronhoscopia î#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
12.00 – 12.10
REZEC%II-RECONSTRUC%II PARIETALE LARGI CU
SISTEMUL STRATOS
Mihnea Davidescu, Elena Moise, Ovidiu Rus, Teodor Horvat
Clinica de Chirurgie Toracic!, Institutul Oncologic Bucure#ti
Introducere
Rezec%iile parietale sunt o component! esen%ial! în armamentul
terapeutic al mai multor afec%iuni ale peretelui toracic. Reconstruc%ia
peretelui toracic dup! rezec%ii parietale largi ridic! o serie de probleme
aparte.
Prezent!m folosirea unui sistem relativ nou de reconstruc%ie
parietal! bazat pe un sistem de lame &i clipuri ajustabil din titaniu:
Strasbourg Thoracic Osteosyntheses System — STRATOS, MedXpert
GmbH, Germany.
Material #i metod!
Prezent!m dou! cazuri clinice de rezec%ii reconstruc%ii parietale
largi deosebite atât prin etiologie, m!rimea defectelor parietale cât &i
prin metoda de reconstruc%ie: o pacient! diagnosticat! cu neoplasm
mamar drept &i forma%iune tumoral! gigant! de perete toracic anterior
drept (determinare secundar !) &i o pacient! având în antecedente boala
Graves-Basedow, gu&a nodular ! (2005), diagnosticat! cu carcinom
12.10 – 12.20
CARCINOID TIPIC LA UN PACIENT TANAR
Codin Saon, Valentin Soldea, Felix Dobritoiu
Clinica de Chirurgie Toracic!, Institutul Na%ional de Pneumologie
“Marius Nasta”, Bucure&ti
12.20 – 12.30
CHIRURGIA LEZIUNILOR TBC SUPRAINFECTATE CU
ASPERGILLUS
Bo"ianu Alexandru-Mihail, Bo"ianu Petre Vlah-Horea, Lucaciu Oana
Raluca, Hogea Timur, Batog Olivia, Giurgiu Ioana
Clinica Chirurgie IV, UMF Tîrgu-Mure &
Introducere
Obiectivul acestei lucr !ri este de a evalua rezultatele chirurgiei
pentru leziuni tuberculoase cronice suprainfectate cu aspergillus.
Material &i metod!
Am efectuat un studiu retrospectiv pe 33 de pacien %i opera%i în
Clinica noastr ! între 01.01.1985-01.01.2011 pentru aspergilom
dezvoltat pe leziuni tuberculoase (active sau sechelare). Interven%ia
chirurgical! a constat în rezec%ie pulmonar ! în 26 de cazuri (lobectomie
– 5 cazuri, rezec%ie atipic! – 21, la 5 cazuri asociind &i o aplatizare-
plicaturare a cavit!%ii) &i toracomioplastie la 7 cazuri. To%i pacien%ii au
fost trimi&i dup! e&ecul tratamentului medical &i au primit peroperator
terapie antifungic! specific!. Urm!torii parametri au fost evalua%i:
mortalitate, morbiditate, reinterven%ii, spitalizare. Datele au fost
analizate cu programul GraphPad Prism.
Rezultate
Mortalitatea general! a fost de 6% (2 pacien%i). Am întâlnit 3
cavit!%i reziduale supurate care au necesitat o reinterven%ie major !
12.30 – 12.40
MIASTENIA GRAVIS DUP& TIMOMECTOMIE
Cezar Mota#, Natalia Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Clinica de Chirurgie Toracic!, Institutul Oncologic Bucure#ti
Introducere
Este binecunoscut! rela"ia dintre timoame #i miastenia gravis:
10-15% din pacien"ii cu miastenia gravis au #i un timom #i între 30-
50% din pacien"ii cu timom pot prezenta miastenie.
Material #i metod!
Este prezentat cazul unui pacient care la vârsta de 36 de ani este
operat pentru timom fiind practicat! timotimomectomie cu rezec"ia
peretelui anterior al trunchiului venos brahiocefalic stâng #i
reconstruc"ia acestuia cu petec de Goretex. De men"ionat c! în acel
moment pacientul nu prezenta semnele clinice ale misteniei gravis,
timomul fiind o descoperire radiologic ! întâmpl!toare. Postoperator
urmeaz! tratamentul complementar (chimio #i radioterapia), protocol
încheiat 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 rezec"ie, nu relev! semne de recidiv! tumoral! sau alte
localiz!ri ale leziunii maligne. În plus demonstreaz ! permeabilitatea
grefei vasculare.
Concluzii
De#i rar observat! în practic!, miastenia gravis poate apare #i
trebuie luat! în considerare #i dup! rezec"ia timusului tumoral.
12.40 – 12.50
CHIRURGIA TORACOSCOPICA UNIPORTALA
Gabriel Cozma, Ovidiu Burlacu, Ioan Petrache, C!lin 'unea, Voicu
Voiculescu, Iris Miron, M. Butas, Alexandru Nicodin
Clinica de Chirurgie Toracic!, Spitalul Municipal Timi &oara
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
12.50 – 13.00
TORACOMIOPLASTIA CA RE-REINTERVE%IE
Bo%ianu Petre Vlah-Horea, Bo%ianu Alexandu-Mihail
Clinica Chirurgie IV, UMF Tîrgu-Mure &
Introducere
Rolul interven%iilor de toracomioplastie în tratamentul
empiemelor postoperatorii este controversat. Dificultatea major ! este
dat! de sec%ionarea maselor musculare în cursul
toracotomiei/toracotomiilor ini%iale, având ca rezultat limitarea
volumului &i a posibilit!%ilor de mobilizare a lambourilor din vecin!tate.
Material &i metod!
În ultimii 8 ani am efectuat toracomioplastii la un num !r de 7
pacien%i având în antecedente cel pu%in 2 interven%ii majore efectuate
prin toracotomie (f !r ! a lua în considerare pleurotomia &i fereastra
Eloesser). Indica%ia a fost în toate cazurile prezen%a unui empiem
postoperator ce nu a putut fi controlat prin interven%iile anterioare.
Interven%ia a vizat obliterarea complet! a cavit!%ii &i închiderea
fistulelor bron&ice, cu închiderea primar ! a noii pl!gi. S-au folosit
lambourile sau por %iunile de lambouri musculare r !mase intacte dup!
toracotomiile anterioare (din%at anterior, mare dorsal, pectoral,
subscapular &i intercostal).
Rezultate
La to%i pacien%ii s-a ob%inut desfiin%area cavit!%ii de empiem &i
vindecarea per primam a pl!gii, cu spitaliz!ri postoperatorii între 30 &i
51 de zile, f !r ! morbiditate major ! semnificativ!. Un aspect interesant
este acela c! 3 cazuri au fost diagnosticate cu tuberculoz ! pe baza
probelor recoltate în unitatea noastr !, absen%a asocierii unui tratament
tuberculostatic corect putând fi o explica %ie pentru evolu%ia nefavorabil!
a acestor pacien%i.
Concluzii
Toracomioplastia poate fi o solu%ie definitiv! &i în cazul unor
complica%ii postoperatorii cu caracter recidivant. Prin analiza atent! a
anatomiei locale lambourile musculare pot fi folosite &i dup! mai multe
interven%ii pe torace.
SESIUNE POSTERE
Introducere
Pleuro-pericarditele maligne reprezint! o complica"ie comun!
care poate surveni în cursul oric!rei boli neoplazice.
Material #i metod!
Pentru perioada 01.01.1998 – 31.12.2008 s-a efectuat un studiu
retrospectiv. În aceast! perioad! 46 de bolnavi au fost diagnostica"i #i
trata"i pentru pleuro-pericardite maligne în Clinica de Chirurgie
Toracic! sub coordonarea Prof. Teodor Horvat (din SUUMC).
Rezultate
Un num!r de 42 de pacien"i au fost opera"i prin tehnici
chirurgicale miniinvazive: 36 de bolnavi prin chirurgie toracoscopic ! #i
6 pacien"i prin CTVA.
Introducere
Lucrarea prezint! cazul unui pacient de 37 de ani internat în
sec"ia de chirurgie toracic! pentru un pneumotorax stang recidivat. În
urm! cu 9 ani pacientul a fost diagnosticat în sectia de pneumologie cu
histiocitoz! X #i diabet insipid cu ocazia unui episod de
pneumomediastin spontan.
Material #i metod!
Primul episod de pneumotorax spontan stâng a fost rezolvat în
urm! cu o lun! prin drenaj pleural (pleurotomie minima stâng!). Pentru
rezolvarea celui de-al doilea episod de pneumothorax spontan stâng am
utilizat chirurgia miniinvaziv! prin intermediul c!reia s-a efectuat atât
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 func"iei respiratorii.
Concluzii
Chirurgia miniinvaziv! toracic! este tehnica de elec"ie în
abordarea acestui tip de maladii pleurale datorit! avantajelor
diagnostice, terapeutice, cu mortalitate #i morbiditate sc!zut!, fa"! de
tehnicile chirurgicale clasice.
Introducere
Autorii prezint! cazul unui b!rbat de 64 de ani, fost mare
fum!tor, cunoscut cu BPOC #i insuficien"! respiratorie cronic!, care se
interneaz! de urgen"! cu dispnee sever ! de repaus ( SO2 60% f !r !
oxigen #i 80% cu oxigen pe masc!).
Material #i metod!
Examenul radiologic standard arat! existen"a unor zone de
hipertransparen"! toracic!, localizate bazal bilateral, pe fondul unui
aspect radiologic ce sugereaz! prezen"a unui emfizem pulmonar.
Examenul CT toracic nu poate stabili cu certitudine dac ! zonele bazale
de hipertransparen"! sunt date de prezen"a aerului în cavitatea pleural!
sau de existen"a unor bule gigante de emfizem.
Se procedeaz! la o abordare chirurgical! secven"ial!:
pleurotomie minim! dreapt! cu ob"inerea expansiunii parenchimului
pulmonar #i ameliorarea dispneei, pleurotomie minim! stang!, f !r !
expansiune pulmonar ! #i f !r ! pierderi aeriene, urmat! de toracotomie
stang! cu descoperirea #i rezecarea a 3 bule gigante de emfizem, aflate
în tensiune, care produceau fenomene de compresie a parenchimului
pulmonar adiacent.
Rezultate
Ameliorarea simptomatologiei respiratorii #i a tolerantei la efort
a fost constatat! atât dup! efectuarea pleurotomiei minime drepte cât #i
dup! efectuarea interven"iei chirurgicale de reduc"ie volumic!.
Concluzii
Cazul prezentat a ridicat înc! de la început probleme de
diagnostic la un pacient cu insuficien "! respiratorie sever ! ce impunea
luarea unei decizii terapeutice de urgen"!. Pleurotomia minim! a
constituit practic atât o masur ! terapeutic! salvatoare (pleurotomia
dreapt!) cât #i un mijloc de diagnostic pentru bulele gigante de emfizem
(cea stâng!). Chirurgia de reduc"ie volumic! a constituit un mijloc
terapeutic de completare #i de îmbun!t!"ire a situa"iei respiratorii a
pacientului.
Introducere
Autofluorescen"a se bazeaz! pe proprietatea "esuturilor de a
emite lumin! cu lungime de und! diferit!, dup! stimulare cu lumin!
având lungime de und ! specific!.
Material #i metod!
Sunt prezentate primele imagini de autofluorescen"!
toracoscopic! înregistrate atât în IOB cât #i în chirurgia toracic!
româneasc!.
Rezultate
Autofluorescen"a în chirurgia toracic! are aplicabilitate în
evaluarea pleurei parietale #i viscerale, a pericardului, în afec"iuni
precum pleureziile maligne primare sau secundare, alte pleurezii
exudative, pericardite în suspiciunea de malignitate, pneumotorax
spontan etc.; metoda înl!tur ! reac"iile adverse ale fluorescen"ei induse
medicamentos. Leziunile de tip inflamator dau rezultate fals pozitive.
Concluzii
Autofluorescen"a în chirurgia toracic! (miniinvaziv!) permite
identificarea leziunilor suspect maligne, biopsierea "intit! a acestora,
extensia leziunilor neoplazice #i excizia în limite reale de sigura"!.
Introducere
Atât chistul hidatic pulmonar, cât &i aspergilomul pulmonar sunt
relativ rare. Prezent!m o asociere acestor dou! afec%iuni.
Material #i metod!
Prezent!m 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! în lobul superior stâng, cu un aspect
pledând pentru chist hidatic pulmonar supurat. Interven"ia chirurgical! a
constat în chistectomie, perichistectomie #i capitonajul cavit!"ii restante.
Datorit! aspectului macroscopic, s-a solicitat un examen micologic al
con"inutului chistului, care a ar !tat prezen"a Aspergillus spp. Pacienta a
r !mas febril! postoperator, f !r ! o cauz! evident!.
Rezultate
Evolu"ia postoperatorie a fost favorabil!, cu dispari"ia febrei
dup! introducerea tratamentului antifungic specific (voriconazol) în
ziua a 5-a postoperator #i externare în ziua 20 postoperator. La 3 ani de
la interven"ia chirurgical! pacienta nu prezint! acuze toracice sau
sechele.
Concluzii
În chistele hidatice pulmonare supurate, examinarea micologic !
permite detectarea unor infec"ii fungice #i instituirea unei terapii
specifice, care previne complica"ii ulterioare.
Introducere
Prezent!m un caz de politraumatism cu probleme de diagnostic
&i treatment.
Material &i metod!
Prezent!m un pacient care a suferit un politraumatism prin
c!dere de pe biciclet! pe fondul unei st !ri avansate de ebrietate.
Examenul CT de urgen%! a eviden%iat fisur ! de os temporal drept,
colec%ie lichidiana la nivelul cavit!%ii nazale &i sinusului maxilar drept,
hematom epicranian stâng, fractur ! medioclaviculara stâng!, multiple
fracturi costale la nivelul hemitoracelui stâng, emfizem subcutanat
laterotoracic si laterocervical stâng, pneumotorax stâng &i
pneumopericard. S-a efectuat de urgen%! pleurotomie &i drenaj cu valv!
Heimlich &i intuba%ie oro-traheal! (Odorheiul Secuiesc). Datorit!
evolu%iei nefavorabile – instabilitate hemodinamic! &i accentuarea
emfizemului, pacientul este trimis cu SMURD în serviciul nostru. S-a
practicat cuplarea drenajului la aspira%ie activ!, drenajul emfizemului
subcutanat cu ace, punc%ii repetate &i ventila%ie mecanic! prelungit!
pentru 18 zile – stabilizare pneumatic! intern!. Examin!rile CT,
ecografice, bronhoscopice &i RMN, exclud alte leziuni, cu excep%ia unei
tromboze de sinus carvernos f !r ! indica%ie de tratament chirurgical.
Traheostomia solicitat! pentru ventila%ie mecanic! prelungit! a fost
amânat! pân! când nu a mai fost necesar !.
Rezultate
Evolu%ia a fost lent favorabil!, atât din punct de vedere
neurologic, cât &i din punct de vedere respirator, permi%ând extubarea
pacientului &i externarea lui dup! o spitalizare de 33 de zile. La
controlul efectuat la 3 luni, pacientul nu prezint ! sechele semnificative
cu excep%ia unui sindrom algic toracic.
Concluzii
Cazul este ilustrativ pentru dificult!%ile de diagnostic al comei la
politraumatiza%i în contextul prelu!rii pacientului din alt! unitate
(etilism, traumatism, com! indus! medicamentos) &i pentru necesitatea
de a trata traumatismele toracice severe în centre cu dotare
corespunz!toare &i acces permanent la bronhoscopie, CT, RMN,
ecografie etc. Rezolvarea leziunii toracice s-a datorat în principal
stabiliz!rii pneumatice interne prin ventila %ie mecanic! prelungit!.
Introducere
Prezent!m un caz ce ilustreaz! dificult!%ile de rezolvare a unor
tumori intratoracice benigne de dimensiuni mari.
Material &i metod!
Prezent!m un pacient de 70 de ani, cu patologie cardiac ! sever !
– ICC NYHA III, antecedente de AVC &i carcinom nazo-palpebral
operat în urm! cu 5 ani, internat la Cl. Medical! pentru agravarea
dispneei. Radiografia arat! o opacitate gigant! la nivelul hemitoracelui
drept. Examenul CT eviden%iaz! 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-bron&ic, respectiv a esofagului. S-a intervenit
chirurgical printr-o toracotomie postero-lateral ! larg!. Dup! eliberarea
pl!mânului, s-a g!sit o tumor ! extrapulmonar !, cu 3 pedicoli vasculari
cu originea în vasele intercostale posterioare. S-a practicat excizia
complet! a tumorii, planul de clivaj permi%ând eliberarea de trahee,
esofag si aort!.
Rezultate
Evolu%ia 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
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,
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
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
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!
Prezent!m cazul unui pacient în vârst! de 42 de ani, cu
pericardita hemoragica operata in 2011, ce se interneaz! în 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,
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
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.
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
9.00 – 9.30
Alexandru Bo#ianu
Surgical Staplers in Thoracic Surgery: Past and Future
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
José Belda-Sanchis
Surgical controversies in N2 lung cancer patients. Who is wrong and
who is rigth
10.30 – 11.00
Teodor Horvat
Hepatic hydrothorax
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
15.30 – 15.40
SPECIFIC FEATURES OF OPERATORY INTERVENTIONS ON
SINGLE SURGICAL LUNG
Teodor Horvat, Cezar Mota#, Natalia Mota#, Corina Bluoss, Mihnea
Davidescu, Elena Moise, Ovidiu Rus
Thoracic Surgery Clinic, Institute of Oncology Bucharest
15.40 – 15.50
RIGHT ESOPHAGO-CAVITARY FISTULA AFTER BILATERAL
PULMONARY TUBERCULOSIS
Eusta"iu Memu1, D!nu" Popovici1, Simona Cismaru2, Maria Mih!rtescu3
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 SURGEON’S WAY?
C!lin 'unea, Ovidiu Burlacu, Gabriel Cozma, Voicu Voiculescu, Iris
Miron, Ioan Petrache, Alexandru Nicodin
Thoracic Surgery Clinic, Timisoara Municipal Hospital
16.00 – 16.10
INDICATIONS AND RESULTS OF ONE-STAGE BILATERAL
THORACOTOMY APPROACH
Bo%ianu Alexandru-Mihail, Lucaciu Oana, Hogea Timur, Batog Olivia,
Giurgiu Ioana, Bo%ianu Petre Vlah-Horea
Surgical Clinic IV, UMPh Tîrgu-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
Natalia Mota#, Cezar Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Thoracic Surgery Clinic, Institute of Oncology Bucharest
16.30 – 16.40
PURE PECTUS CARINATUM (NOT ASSOCIATED WITH PECTUS
EXCAVATUM) SOLVED BY MIRPC (MINIMALLY INVASIVE
REPAIR OF PECTUS CARINATUM)
Alin Demetrian1, Dan Ulmeanu1, Monalisa Enache2, Andreea-Lavinia Vânvu2
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
Cristian Paleru1, Gabriel Mitulescu2, Adrian Istrate1, Ianos Pahomea2
1
Thoracic Surgery Clinic, "Marius Nasta" Pneumology Institute,
Bucharest, 2Fundeni Clinical Institute, “Dan Setlacec” General Surgery
and Hepatic Transplant Center.
16.50 – 17.00
LYPOSARCOMAS OF ANTERIOR MEDIASTINUM
Cezar Mota#, Natalia Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Thoracic Surgery Clinic, Institute of Oncology Bucharest
17.00 – 17.10
CLINICAL AND IMAGISTIC ASPECTS IN LATE SURVIVORS
AFTER PLOMBAGE THORACOPLASTY FOR TUBERCULOSIS
Bo%ianu Petre Vlah-Horea, Hogea Timur, Batog Olivia, Lucaciu Oana
Raluca, Giurgiu Ioana, Naftali Zoltan, Bo%ianu Alexandu-Mihail
Surgical Clinic IV UMPh Tîrgu-Mure &
17.10 – 17.20
MAFFUCCI SYNDROME, RARE CONDITION IN THORACIC
SURGERY
Felix Dobritoiu, Ioan Cordos, Codin Saon, Adrian Mihail Iordache,
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
Iris Miron, Ovidiu Burlacu, Ioan Petrache, Alexandru Nicodin
Thoracic Surgery Clinic, Timisoara Municipal Hospital
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
Ion-Christian Chiricu#!
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 – 11.40
SURGERY OF THYMOMAS
Cezar Mota#, Natalia Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Thoracic Surgery Clinic, Institute of Oncology Bucharest
11.40 – 11.50
TECHNICAL ASPECTS OF MINIMALLY INVASIVE
TRANSCERVICAL APPROACH OF RIGHT MAIN BRONCHUS
Cristian Paleru, Ioan Cordo&, Olga D!n!il!, Mihai Dumitrescu, Adrian Istrate
Thoracic Surgery Clinic, "Marius Nasta" Pneumology Institute, Bucharest.
11.50 – 12.00
CAN THE THORACIC SURGEON BE A GOOD
BRONCHOSCOPIST?
Voicu Voiculescu, Ioan Petrache, Ovidiu Burlacu, C!lin (unea, Gabriel
Cozma, Iris Miron, Alin Nicola, Alexandru Nicodin
Thoracic Surgery Clinic, Timisoara Municipal Hospital
12.00 – 12.10
LARGE PARIETAL RESECTIONS-RECONSTRUCTIONS WITH
THE STRATOS SYSTEM
Mihnea Davidescu, Elena Moise, Ovidiu Rus, Teodor Horvat
Thoracic Surgery Clinic, Institute of Oncology Bucharest
12.10 – 12.20
TYPIC CARCINOID IN A YOUNG PATIENT
Codin Saon, Valentin Soldea, Felix Dobritoiu
Thoracic Surgery Clinic, "Marius Nasta" Pneumology Institute,
Bucharest.
12.20 – 12.30
SURGERY OF PULMONARY TUBERCULOUS LESIONS
OVERINFECTED WITH ASPERGILLUS
Bo"ianu Alexandru-Mihail, Bo"ianu Petre Vlah-Horea, Lucaciu Oana
Raluca, Hogea Timur, Batog Olivia, Giurgiu Ioana
Surgical Clinic IV, University of Medicine and Pharmacy, Tîrgu-Mure #
12.30 – 12.40
MIASTENIA GRAVIS AFTER THYMOMECTOMY
Cezar Mota#, Natalia Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Thoracic Surgery Clinic, Institute of Oncology Bucharest
12.40 – 12.50
ONE PORT THORACOSCOPIC SURGERY
Gabriel Cozma, Ovidiu Burlacu, Ioan Petrache, C!lin 'unea, Voicu
Voiculescu, Iris Miron, M. Butas, Alexandru Nicodin
Thoracic Surgery Clinic, Timisoara Municipal Hospital
12.50 – 13.00
THORACOMYOPLASTY AS A RE-REDO PROCEDURE
Bo%ianu Petre Vlah-Horea, Bo%ianu Alexandu-Mihail
Surgical Clinic IV, University of Medicine and Pharmacy, Tîrgu-Mure #
POSTER SESSION
13.00 – 13.30
„Traian Oancea” award for the best presentation during the conference
Closing remarks
ABSTRACTS
CONFERENCES
ORAL
PRESENTATIONS
POSTERS
9.00 – 9.30
Alexandru Bo#ianu
Surgical Staplers in Thoracic Surgery: Past and Future
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)
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 chemo-
radiotherapy 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)
10.00 – 10.30
José Belda-Sanchis
Surgical controversies in N2 lung cancer patients. Who is wrong and
who is rigth
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;81:1013–20
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) non–small 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 – 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
15:30 – 15:40
SPECIFIC FEATURES OF OPERATORY INTERVENTIONS ON
SINGLE SURGICAL LUNG
Teodor Horvat, Cezar Mota#, Natalia Mota#, Corina Bluoss, Mihnea
Davidescu, Elena Moise, Ovidiu Rus
Thoracic Surgery Clinic, Institute of Oncology Bucharest
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
15:40 – 15:50
RIGHT ESOPHAGO-CAVITARY FISTULA AFTER
BILATERAL PULMONARY TUBERCULOSIS
Eusta"iu Memu1, D!nu" Popovici1, Simona Cismaru2, Maria Mih!rtescu3
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 SURGEON’S WAY?
C!lin 'unea, Ovidiu Burlacu, Gabriel Cozma, Voicu Voiculescu, Iris
Miron, Ioan Petrache, Alexandru Nicodin
Thoracic Surgery Clinic, Timisoara Municipal Hospital
Objectives
The aim of our study was to assess the efficacy of the
transthoracic–transdiaphragmatic 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
16:00 – 16:10
INDICATIONS AND RESULTS OF ONE-STAGE BILATERAL
THORACOTOMY APPROACH
Bo%ianu Alexandru-Mihail, Lucaciu Oana, Hogea Timur, Batog Olivia,
Giurgiu Ioana, Bo%ianu Petre Vlah-Horea
Surgical Clinic IV, University of Medicine and Pharmacy, Tîrgu-Mure #
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
Thoracic Surgery Clinic, "Marius Nasta" Pneumology Institute,
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
Natalia Mota#, Cezar Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Thoracic Surgery Clinic, Institute of Oncology Bucharest
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)
Alin Demetrian1, Dan Ulmeanu1, Monalisa Enache2, Andreea-Lavinia Vânvu2
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 .
Materials and methods
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).
R esults
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
16:40 – 16:50
DIAPHRAGM RECONSTRUCTION WITH LATISSIMUS
DORSI IN PULMONARY LUNG CANCER WITH HEPATIC
INVASION
Cristian Paleru1, Gabriel Mitulescu2, Adrian Istrate1, Ianos Pahomea2
1
Thoracic Surgery Clinic, "Marius Nasta" Pneumology Institute,
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
Materials and methods
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 7 th 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
Cezar Mota#, Natalia Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Thoracic Surgery Clinic, Institute of Oncology Bucharest
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.
Materials and methods
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
Bo%ianu Petre Vlah-Horea, Hogea Timur, Batog Olivia, Lucaciu Oana
Raluca, Giurgiu Ioana, Naftali Zoltan, Bo%ianu Alexandu-Mihail
Surgical Clinic IV, University of Medicine and Pharmacy, Tîrgu-Mure #
Introduction
Plombage thoracoplasty was frequently performed in the 1950-
60'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).
17.10 – 17.20
MAFFUCCI SYNDROME, RARE CONDITION IN THORACIC
SURGERY
Felix Dobritoiu, Ioan Cordos, Codin Saon, Adrian Mihail Iordache,
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
Iris Miron, Ovidiu Burlacu, Ioan Petrache, Alexandru Nicodin
Thoracic Surgery Clinic, Timisoara Municipal Hospital
Introduction
The authors present an acute necrotic descent cervico-
mediatinitis 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
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
Ion-Christian Chiricu#!
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 – 11.40
SURGERY OF THYMOMAS
Cezar Mota#, Natalia Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Thoracic Surgery Clinic, Institute of Oncology Bucharest
Introduction
Various studies have demonstrated the importance of tumor
resection in thymomas. The complementary treatment (radio- and
chemotherapy) also plays an important role.
Materials and methods
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
11.40 – 11.50
TECHNICAL ASPECTS OF MINIMALLY INVASIVE
TRANSCERVICAL APPROACH OF RIGHT MAIN BRONCHUS
Cristian Paleru, Ioan Cordo&, Olga D!n!il!, Mihai Dumitrescu, Adrian Istrate
Thoracic Surgery Clinic, "Marius Nasta" Pneumology Institute,
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
Zielinski’s 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
11.50 – 12.00
CAN THE THORACIC SURGEON BE A GOOD
BRONCHOSCOPIST?
Voicu Voiculescu, Ioan Petrache, Ovidiu Burlacu, C!lin (unea, Gabriel
Cozma, Iris Miron, Alin Nicola, Alexandru Nicodin
Thoracic Surgery Clinic, Timisoara Municipal Hospital
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 it’s 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
12.00 – 12.10
LARGE PARIETAL RESECTIONS-RECONSTRUCTIONS
WITH THE STRATOS SYSTEM
Mihnea Davidescu, Elena Moise, Ovidiu Rus, Teodor Horvat
Thoracic Surgery Clinic, Institute of Oncology Bucharest
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
12.10 – 12.20
TYPIC CARCINOID IN A YOUNG PATIENT
Codin Saon, Valentin Soldea, Felix Dobritoiu
Thoracic Surgery Clinic, "Marius Nasta" Pneumology Institute,
Bucharest.
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
Bo"ianu Alexandru-Mihail, Bo"ianu Petre Vlah-Horea, Lucaciu Oana
Raluca, Hogea Timur, Batog Olivia, Giurgiu Ioana
Surgical Clinic IV, University of Medicine and Pharmacy, Tîrgu-Mure #
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 (open-
window or thoracoplasty). At one-year follow-up (clinical, sputum
bacteriology, chest X-ray +/- CT scan) we encountered no recurrence,
12.30 – 12.40
MIASTENIA GRAVIS AFTER THYMOMECTOMY
Cezar Mota#, Natalia Mota#, Ovidiu Rus, Elena Moise, Teodor Horvat
Thoracic Surgery Clinic, Institute of Oncology Bucharest
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.
Materials and methods
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
12.40 – 12.50
ONE PORT THORACOSCOPIC SURGERY
Gabriel Cozma, Ovidiu Burlacu, Ioan Petrache, C!lin 'unea, Voicu
Voiculescu, Iris Miron, M. Butas, Alexandru Nicodin
Thoracic Surgery Clinic, Timisoara Municipal Hospital
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. Today’s
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 condro-
costal 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. It’s 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
Bo%ianu Petre Vlah-Horea, Bo%ianu Alexandu-Mihail
Surgical Clinic IV, University of Medicine and Pharmacy, Tîrgu-Mure #
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, closure-
reinforcement 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
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).
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).
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 can’t 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.
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.
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
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
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
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-
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
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.
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
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
patient’s 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 patient’s medical chart, operating protocols,
hystopathology reports, CT examinations and previous discharge
Introduction
Transthoracic needle biopsy (TNB) has been a safe and rapid
method for achieving histopathological diagnosis for many thoracic
lesions since 19th century.
Materials and methods
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
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.