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SOCIETATEA ROMÂNĂ DE PNEUMOLOGIE, SECȚIUNEA BRONHOLOGIE

a VII-aCONFERINȚĂ NAȚIONALĂDE BRONHOLOGIECU TEMA: INCURSIUNE ÎN BRONHOLOGIE

LOCAȚIE: GRAND HOTEL NAPOCA | CLUJ-NAPOCA

15-16NOIEMBRIE

2013

Conferința va fi acreditată cu puncte EMC

SPITALUL CLINICDE PNEUMOFTIZIOLOGIE

„LEON DANIELLO”CLUJ-NAPOCA

Spitalul dePneumoftiziologieSibiu




www.medevents.ro/bronhologie2013

carte de rezumate

cuprins7 RIGID BRONCHOSCOPY: STILL ESSENTIAL IN INTERVENTIONAL PULMONOLOGY?

Hervé Dutau

8 ND: YAG LASER RESECTION OF MALIGNANT CENTRAL AIRWAY OBSTRUCTION - ROUTINE TECHNIQUE IN RESPIRATORY ENDOSCOPY UNITSBranislav Perin

9 DILATAREA BRONHOSCOPICA CU BALONUL ÎN MANAGEMENTUL STENOZELOR TRAHEO- BRONŞICE DOBÎNDITE BRONCHOSCOPIC BALLOON DILATATION IN THE MANAGEMENT

OF ACQUIRED TRACHEO-BRONCHIAL STENOSISAramă Amuliu, Iosep Gabriel

10 COMBINED BRONCHOSCOPIC USE OF ELECTROCAUTERY, ARGON PLASMA AND CRYOPROBE IN THE MANAGEMENT OF MALIGNANT CENTRAL AIRWAY OBSTRUCTIONGregoris StratakosGregoris StratakosGr

11 TRATAMENTUL ENDOSCOPIC AL TUMORILOR ENDOBRONȘICE BENIGNE BRONCHOSCOPIC BALLOON DILATATION IN THE MANAGEMENT OF ACQUIRED

TRACHEO-BRONCHIAL STENOSISŞimon Mărioara, Vremproiu Petruţ,Daniela BoldeanuŞimon Mărioara, Vremproiu Petruţ,Daniela BoldeanuŞimon Mărioara, V

13 IS THERE AN OPTIMAL AIRWAY STENT?Hervé Dutau

14 PARTICULARITĂȚI ALE MANAGEMENTULUI ENDOSCOPIC AL STENOZELOR TRAHEALE IATROGENE LA PACIENTII CU BPOC Emilia Crișan, Alina Croitoru, Ruxandra Ulmeanu, Mihai Alexe, Ioan Cordoș,Emilia Crișan, Alina Croitoru, Ruxandra Ulmeanu, Mihai Alexe, Ioan Cordoș,Emilia Crișan, Alina Cr

Nicolae Galie, Genoveva Cadar, Radu Stoica, Codin Saon, Cristian Paleru

15 A MORE UNIFORM APPROACH TO BRONCHOSCOPY TRAININGHenri Colt

16 EBUS – VERIGA LIPSA IN MANAGEMENTUL CANCERULUI BRONHOPULMONAR EBUS – THE MISSING LINK IN LUNG CANCER MANAGEMENT

Mihai Olteanu, Costin Streba, Mimi Nitu, Emilia Crişan, Tudorel Ciurea

18 IS CONVENTIONAL TRANSBRONCHIAL NEEDLE ASPIRATION PASSE?Semra Bilaceroglu, Suat Seren

19 HOW TO DO ENDOSCOPIC VOLUME REDUCTION IN ROMANIA?Tudor TomaTudor TomaT

20 ALCOOLUL, POSIBILA METODA ENDOSCOPICA DE REZOLVAREA A DEHISCENTELOR DE BONT BRONSIC ALCOHOL, POSSIBLE ENDOSCOPIC METHOD OF SOLVING DEHISCENT BRONCHIAL STUMP Mihai Alexe, Cristian Paleru, Radu Matache, Ioan Cordos, Codin Saon, Emilia Crisan, Ruxandra Ulmeanu, Madalina Cretoi, Corina Marica

22 TRACHEOBRONCHIAL STENOSIS – CHALLENGING ISUES Ioan Cordoş, Ciprian Bolca

23 PATTERN -UL CORPI LOR STRĂINI ENDOBRONȘICI LA ADULȚI PATTERN OF ENDOBRONCHIAL FOREIGN BODIES IN ADULTS Elena Tudor, Petru Levcenco, Victor Cozlovschi

25 NAVIGAŢIA ELECTROMAGNETICĂ - METODĂ DE GHIDARE A BRONHOSCOPIEI CU PUNCŢIE ASPIRATIVĂ TRANSBRONŞICĂ ÎN DIAGNOSTICUL NODULULUI PULMONAR SOLITAR ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY – GUIDANCE METHOD OF THE TRANSBRONCHIAL NEEDLE ASPIRATION IN THE DIAGNOSIS OF THE SOLITARY PULMONARY NODULE Gabriela Jimborean, Edith Simona Ianosi, Alexandra Comes

27 PULMONARY ADENOCARCIN OMA AND EGFR MUTATION – CONNECTION REQUIRED TO BE CONFIRMED? Pro: Florin Mihaltan,Oana Deleanu Con: Ruxandra Ulmeanu,Andreea Vladau

29 LAVAJUL BRONHOALVEOLAR - INSTRU MENT DE DIAGNOSTIC IN AFECTIUNILE ALVEOLO- INTERSTITIALE BRONCHOALVEOLAR LAVAGE - A DIAGNOSTIC TOOL IN ALVEOLO- INTERSTITIAL DISEASES Adriana Parau, Lacramioara Toma, V. Muresan

30 EXACERBAREA IN FIBROZELE PULMORE. CUM MONITORI ZAM EVOLUTIA SI EFICIENTA TERAPIEI? Milena Man, Doina Todea, Nicoleta Ariesanu

31 DE LA SUSPICIUNE LA CERTITUDINE IN TUBERCU LOZA CAILOR RESPIRATORII / ENDOBRONCHIAL TUBERCU LOSIS: FROM SUSPICION TO FINAL DIAGNOSIS Cosmina Magdău, Bugnariu Cristian, Motoc Nicoleta

32 ROLUL ENDOSCOPIEI BRONȘICE ÎN BRONȘIECTAZII / THE BENEFIT OF BRONCHOSCOPY IN THE DIAGNOSIS OF BRONCHIECTASIS Ruxandra Râjnoveanu, Monica Pop, Ruxandra Ulmeanu

34 DIAGNOSTICUL ENDOSCOPIC ÎN SARC OIDOZĂ ENDOSCOPIC DIAGNOSIS OF SARC OIDOSIS Ariadna Petronela Fildan, Oana Cristina Arghir, Elena Dantes

36 LOCUL SI ROLUL ENDOSCOPIEI IN TIMPUL SOMNULUI IN MANAGEMENTUL PACIENTILOR CU SASO THE PLACE AND ROLE OF SLEEP ENDOSCOPY IN THE MANAGEMENT OF PATIENTS WITH OSA I Lavinia Davidescu, Ruxandra Ulmeanu

38 PARTICULARI TATI EVOLUTIVE LA UN CANCER ESOFAGIAN CU DETERMINARI TRAHEALE FEATURES IN EVOLUTION OF ESOPHAGEAL CANCER WITH TRACHEAL METASTASIS C. Badescu, E. Crisan

39 PARTICULARI TATI EVOLUTIVE LA UN CANCER ESOFAGIAN CU DETERMINARI TRAHEALE FEATURES IN EVOLUTION OF ESOPHAGEAL CANCER WITH TRACHEAL METASTASIS C. Badescu, E. Crisan

40 EXPERI ENTA SERVICIULUI DE BRONHOLOGIE ORADEA IN DIAGNOSTICUL SI TRATAMENTUL CORPI LOR STRAINI BRONSICI THE EXPERI ENCE OF BRONCHOLOGY DEPARTMENT FROM ORADEA CLINCAL COUNTY HOSPITAL IN THE DIAGNOSIS AND TREATMENT OF BRONCHIAL FOREIGN BODY Florian Andrada, Moldovan Diana Camelia

42 ADENOCARCIN OMUL PULMONAR, DIAGNOSTIC ŞI STADIALIZARE ENDOBRONŞICĂ - SERIE DE CAZURI CLINICE THE ENDOBRONCHIAL DIAGNOSIS AND STAGING OF PULMONARY ADENOCARCINOMA – A SERIES OF CLINICAL CASES Irina Ionela Stoia Djeska, Stelian Eugen Stoia Djeska, Hazm Aljobory, Romanita Glaja, Voicu Tudorache

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a VII-a CONFERINȚĂ NaȚIONaLĂ DE BRONHOLOGIE 15-16 NOIEmBRIE 2013 CLuj-NapOCa www.medevents.ro/bronhologie2013

riGid BrOncHOscOpY:stiLL essentiaL in interVentiOnaL puLmOnOLOGY?

Hervé Dutau, Medical Doctor,Head of the Thoracic Endoscopy UnitThoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France

Complex airway diseases represent a therapeutic challenge and require multidisciplinary input Complex airway diseases represent a therapeutic challenge and require multidisciplinary input including the interventional pulmonologist and thoracic surgeon. Surgery, if feasible, remains including the interventional pulmonologist and thoracic surgeon. Surgery, if feasible, remains the definitive modality. However, minimally invasive endobronchial techniques have resulted the definitive modality. However, minimally invasive endobronchial techniques have resulted in symptom control and, in selected patients, long-term improvements in quality of life. These in symptom control and, in selected patients, long-term improvements in quality of life. These techniques are, in general, safe and well tolerated when performed by experienced operators. techniques are, in general, safe and well tolerated when performed by experienced operators. Endobronchial laser therapy, cryotherapy, electrocautery or argon plasma coagulation and Endobronchial laser therapy, cryotherapy, electrocautery or argon plasma coagulation and photodynamic therapy have been used successfully.

Despite the introduction of new technologies, the rigid bronchoscope remains the method of Despite the introduction of new technologies, the rigid bronchoscope remains the method of choice for the treatment of both benign and malignant central airway obstruction. It allows rapid choice for the treatment of both benign and malignant central airway obstruction. It allows rapid and safe dilation, mechanical debulking, foreign body removal and silicone stent placement. and safe dilation, mechanical debulking, foreign body removal and silicone stent placement. However it has limited use if lesions are located in the upper lobes or lung periphery but significant However it has limited use if lesions are located in the upper lobes or lung periphery but significant technological advances allow for effective treatments using the flexible bronchoscope. Rigid technological advances allow for effective treatments using the flexible bronchoscope. Rigid and flexible bronchoscopes should be seen as complementary procedures and most cases will and flexible bronchoscopes should be seen as complementary procedures and most cases will require the use of both modalities.

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nd: YaG Laser resectiOn OF maLiGnant centraL airWaY OBstructiOn - rOutine tecHniQue in respiratOrY endOscOpY units

Branislav Perin1

Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology

Neodymium: yttrium aluminum garnet - Nd:YAG laser resection is one of the most common Neodymium: yttrium aluminum garnet - Nd:YAG laser resection is one of the most common interventional pulmonology techniques for urgent debulking of malignant central airway interventional pulmonology techniques for urgent debulking of malignant central airway obstruction. The laser beam is delivered through quartz optical fiber, which is easily adaptable obstruction. The laser beam is delivered through quartz optical fiber, which is easily adaptable for flexible or rigid bronchoscope. It operates in the invisible range of the electromagnetic for flexible or rigid bronchoscope. It operates in the invisible range of the electromagnetic spectrum, at wavelength of 1064 nm and thus requires a pilot light for navigation. Even though, spectrum, at wavelength of 1064 nm and thus requires a pilot light for navigation. Even though, the technique was introduced into bronchology and interventional pulmonology over 20 years the technique was introduced into bronchology and interventional pulmonology over 20 years ago, only high volume experienced centers are performing this intervention. In hands of a skilled ago, only high volume experienced centers are performing this intervention. In hands of a skilled and experienced bronchoscoipist the technique is safe and reliable. Over the years this procedure and experienced bronchoscoipist the technique is safe and reliable. Over the years this procedure showed to be beneficial in therapeutic relief of lung cancer signs and symptoms, showing showed to be beneficial in therapeutic relief of lung cancer signs and symptoms, showing potential to improve progression free survival, quality of life and even survival in lung cancer potential to improve progression free survival, quality of life and even survival in lung cancer patients. All of the major interventional pulmonology guidelines are suggesting Nd:YAG laser patients. All of the major interventional pulmonology guidelines are suggesting Nd:YAG laser resection should be considered as a part of multimodality treatment of advanced central lung resection should be considered as a part of multimodality treatment of advanced central lung cancer with endobronchial obstruction. Nd:YAG laser resection alone or in combination with cancer with endobronchial obstruction. Nd:YAG laser resection alone or in combination with other interventional techniques demonstrated potential in treatment of inoperable early stage other interventional techniques demonstrated potential in treatment of inoperable early stage lung cancer, in the treatment of benign central airway obstruction and in multimodality treatment lung cancer, in the treatment of benign central airway obstruction and in multimodality treatment of central, advanced stage lung cancer.of central, advanced stage lung cancer.

Complication rate after Nd:YAG laser resection depends on several factors. One of the most Complication rate after Nd:YAG laser resection depends on several factors. One of the most important is bronchoscopists skillfulness. However, the patient’s general condition as well as important is bronchoscopists skillfulness. However, the patient’s general condition as well as the characteristics of lesions, laser power settings and other procedure related aspects (oxygen the characteristics of lesions, laser power settings and other procedure related aspects (oxygen concentration, duration of pulses) must not be neglected. Reported complication rate varies from concentration, duration of pulses) must not be neglected. Reported complication rate varies from less than 1% to over 35%, depending on the timing of occurrence and complication type. Early less than 1% to over 35%, depending on the timing of occurrence and complication type. Early complications, occurring within a few weeks after intervention, are more common than the late complications, occurring within a few weeks after intervention, are more common than the late complications. Average complication rate is usually around 5%.complications. Average complication rate is usually around 5%.Key words: lung cancer, Nd:YAG laser resection, Key words: lung cancer, Nd:YAG laser resection,

diLatarea BrOnHOscOpica cu BaLOnuL În manaGementuL stenOzeLOr traHeO-BrOnŞice dOBÎndite

Dr. Aramă Amuliu1, Dr. Iosep Gabriel2

Spitalul Clinic de Pneumologie – Iaşi - Romania1.Serviciul de Endoscopie Bronşica 2. Serviciul ATI

Stenozele bronşice cîştigate, fie benigne (post-intubaţie prelungită, post rezecţie – anastomoză Stenozele bronşice cîştigate, fie benigne (post-intubaţie prelungită, post rezecţie – anastomoză traheală/bronşică, post-TBC, sarcoidoză, Wegener, etc), fie maligne, determină adeseori traheală/bronşică, post-TBC, sarcoidoză, Wegener, etc), fie maligne, determină adeseori insuficienţa respiratorie, necesitînd o atitudine intervenţionistă din partea bronhologului.insuficienţa respiratorie, necesitînd o atitudine intervenţionistă din partea bronhologului.Alături de tehnicile de dezobstrucţie cu acţiune imediată (dezobstrucţie mecanică, prin laser-Alături de tehnicile de dezobstrucţie cu acţiune imediată (dezobstrucţie mecanică, prin laser-terapie, prin electro-terapie, etc), dilarea bronhoscopica cu balonul poate contribui semnificativ terapie, prin electro-terapie, etc), dilarea bronhoscopica cu balonul poate contribui semnificativ la mărirea lumenului traheal/bronşic, eventual pîna la dimensiunea necesară plasării unui stent.la mărirea lumenului traheal/bronşic, eventual pîna la dimensiunea necesară plasării unui stent.Trecerea în revistă a două cazuri este insoţită de sinteze ale indicaţiilor dilatarii bronhoscopice Trecerea în revistă a două cazuri este insoţită de sinteze ale indicaţiilor dilatarii bronhoscopice cu balonul, ale tehnicii propriu-zise precum şi ale limitelor şi complicaţiilor. Prin parcurgerea lor cu balonul, ale tehnicii propriu-zise precum şi ale limitelor şi complicaţiilor. Prin parcurgerea lor dorim să aducem argumente în favoarea acestei tehnici simple , netraumatice, rapide şi sigure, dorim să aducem argumente în favoarea acestei tehnici simple , netraumatice, rapide şi sigure, utilă în restabilirea calibrului căilor aeriene centrale.

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BrOncHOscOpic BaLLOOn diLatatiOn in tHe manaGement OF acQuired tracHeO-BrOncHiaL stenOsis

Dr. Arama Amuliu1, Dr. Iosep Gabriel2Clinic of Pulmonary Diseases – Iasi – Romania

1.Bronchial Endoscopy Department 2. ICU

The acquired bronchial stenoses, either benign (after prolonged intubation, after resection – The acquired bronchial stenoses, either benign (after prolonged intubation, after resection – tracheal/bronchial anastomosis, after tuberculosis, sarcoidosis, Wegener, etc.), or malign, often tracheal/bronchial anastomosis, after tuberculosis, sarcoidosis, Wegener, etc.), or malign, often lead to respiratory failure, asking for intervention from the bronchologist. Together with the lead to respiratory failure, asking for intervention from the bronchologist. Together with the techniques of immediate desobstruction (mechanical devices, laser, electrical, etc.), balloon techniques of immediate desobstruction (mechanical devices, laser, electrical, etc.), balloon dilatation could also significantly contribute in increasing the tracheal/bronchial lumen, possibly dilatation could also significantly contribute in increasing the tracheal/bronchial lumen, possibly to the necessary size to insert a stent. The evaluation of two cases is accompanied by syntheses to the necessary size to insert a stent. The evaluation of two cases is accompanied by syntheses of the indications for balloon dilatation, for the technique proper, as well as for its limits and of the indications for balloon dilatation, for the technique proper, as well as for its limits and complications. By reviewing them, we aim at arguing in favour of this simple, non-traumatic, fast complications. By reviewing them, we aim at arguing in favour of this simple, non-traumatic, fast and safe technique, a very useful one in re-establishing the central airway calibre.and safe technique, a very useful one in re-establishing the central airway calibre.

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cOmBined BrOncHOscOpic use OF eLectrOcauterY, arGOn pLasma and crYOprOBe in tHe manaGement OF maLiGnant centraL airWaY OBstructiOn

Gr. Stratakos MD, FCCPHead of the Interventional Pulmonology Unit1st Respiratory Medicine Department, Athens Univesrity“Sotiria” General Hospital, Athens Greece

While lung cancer remains the most prevalent cancer in men and one of the most dismal prognosis, While lung cancer remains the most prevalent cancer in men and one of the most dismal prognosis, 20 - 30 % of the patients during the course of their disease will develop complications or severe 20 - 30 % of the patients during the course of their disease will develop complications or severe symptoms due to malignant central airways obstruction. Likewise, central airway metastases from symptoms due to malignant central airways obstruction. Likewise, central airway metastases from non pulmonary (extra-thoracic) tumours often occur, leading to severe respiratory impairment.non pulmonary (extra-thoracic) tumours often occur, leading to severe respiratory impairment.When surgery is not indicated (80% of the cases), palliative Chemo- Radio therapy can be When surgery is not indicated (80% of the cases), palliative Chemo- Radio therapy can be offered but even this option proves ineffective in case of central airway involvement, where only offered but even this option proves ineffective in case of central airway involvement, where only interventional (therapeutic) Bronchoscopy can release obstruction and restore patency, alleviate interventional (therapeutic) Bronchoscopy can release obstruction and restore patency, alleviate symptoms, improve quality of life and in several cases even prolong survival.symptoms, improve quality of life and in several cases even prolong survival.Interventional bronchoscopy includes several tissue distruction therapeutic modalities usually Interventional bronchoscopy includes several tissue distruction therapeutic modalities usually applied by both flexible and rigid bronchoscopy. LASER, electrocautery, Argon Plasma Coagulation applied by both flexible and rigid bronchoscopy. LASER, electrocautery, Argon Plasma Coagulation and Cryo therapy are only few of the many techniques that may help debulk large endoluminal and Cryo therapy are only few of the many techniques that may help debulk large endoluminal tumors, coagulate their base and safely regain airway patency. Technical characeristics and tumors, coagulate their base and safely regain airway patency. Technical characeristics and published evidence on “Electro-cautery”, “APC” and “Cryo-“ are decribed. There is enough published evidence on “Electro-cautery”, “APC” and “Cryo-“ are decribed. There is enough evidence nowadays to allow us to use each of the above techniques according to their specific evidence nowadays to allow us to use each of the above techniques according to their specific characteristics, not in an antagonistic manner but always in combination, while each in their characteristics, not in an antagonistic manner but always in combination, while each in their respective role. respective role.

tratamentuL endOscOpic aL tumOriLOr endOBrOnȘice BeniGne

Simon Marioara, Vremaroiu Petrut,Daniela Boldeanu

SCOPUL STUDIULUI: Tumorile benigne de căi aeriene reprezintă un procent foarte mic din Tumorile benigne de căi aeriene reprezintă un procent foarte mic din activitatea uzuală a bronhologului. Indepartarea tumorilor este tratamentul de elecție pentru activitatea uzuală a bronhologului. Indepartarea tumorilor este tratamentul de elecție pentru ameliorarea statusului respirator. Electrocauterizarea și electrorezecția cu ansă sunt alternative ameliorarea statusului respirator. Electrocauterizarea și electrorezecția cu ansă sunt alternative eficiente în tratamentul endoscopic al tumorilor benigne de căi aeriene. Vom demonstra eficiența eficiente în tratamentul endoscopic al tumorilor benigne de căi aeriene. Vom demonstra eficiența acestui tratament cu cateva cazuri reprezentative.

MATERIAL ȘI METODA: S-au prelucrat retrospectiv datele a 9800 fibroscopii efectuate între 2007- S-au prelucrat retrospectiv datele a 9800 fibroscopii efectuate între 2007-2012 în Departamentul de Bronhologie al Spitalului Clinic de Pneumoftiziologie “Leon Daniello” 2012 în Departamentul de Bronhologie al Spitalului Clinic de Pneumoftiziologie “Leon Daniello” din Cluj Napoca, Romania. Examinările s-au efectuat cu fibroscoape Olympus, în anestezie locală din Cluj Napoca, Romania. Examinările s-au efectuat cu fibroscoape Olympus, în anestezie locală cu Lidocaina 2% și sedare usoară.

REZULTATE: S-au identificat 14 pacienți cu tumori endobronșice și endotraheale benigne S-au identificat 14 pacienți cu tumori endobronșice și endotraheale benigne confirmate anatomopatologic, din care 2 papiloame, 2 polipi fibroepiteliali, 3 lipoame, 2 confirmate anatomopatologic, din care 2 papiloame, 2 polipi fibroepiteliali, 3 lipoame, 2 hamartoame, 2 fibroame myxoide, 1 neurofibrom, 1 hemangiom și 1 leiomiom. Toți pacientii au hamartoame, 2 fibroame myxoide, 1 neurofibrom, 1 hemangiom și 1 leiomiom. Toți pacientii au prezentat simptome respiratorii, dar numai 35,7% aveau asociat modificări radiologice. Tumorile prezentat simptome respiratorii, dar numai 35,7% aveau asociat modificări radiologice. Tumorile au fost îndepărtate cu succes prin bronhoscopie flexibilă, cu ajutorul electrorezecției cu ansă au fost îndepărtate cu succes prin bronhoscopie flexibilă, cu ajutorul electrorezecției cu ansă si electrocauterizare in suprafata, fără complicații. La examinările de control nu s-au identificat si electrocauterizare in suprafata, fără complicații. La examinările de control nu s-au identificat recidive locale sau rezecții incomplete.

CONCLUZII: Tratamentul endoscopic prin electrorezecție cu ansă este o metodă sigură, ușoară Tratamentul endoscopic prin electrorezecție cu ansă este o metodă sigură, ușoară și cost-eficientă pentru tratamentul tumorilor benigne endobronșice

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endOscOpicaL treatment OF BeniGn tracHeOBrOncHiaL tumOrs

Marioara Simon,P.Vremaroiu,Daniela BoldeanuU

PURPOSE: Benign airway tumors accounts for only a small percentage from the bronchologist’s Benign airway tumors accounts for only a small percentage from the bronchologist’s everyday practice. Tumor removal is thus considered the treatment of choice to improve everyday practice. Tumor removal is thus considered the treatment of choice to improve respiratory status. Electrocautery and electrosurgical snaring may be effective alternatives in respiratory status. Electrocautery and electrosurgical snaring may be effective alternatives in bronchoscopic treatment of benign airway tumors.We will illustrate using some representative bronchoscopic treatment of benign airway tumors.We will illustrate using some representative

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cases the treatment’s efficiency.cases the treatment’s efficiency.

METHODS: METHODS: We present a retrospective analysis of 9800 fibrobronchoscopies performed between 2007-2012 in the Bronchology Department of Pneumology Hospital Cluj-Napoca, Romania. 2007-2012 in the Bronchology Department of Pneumology Hospital Cluj-Napoca, Romania. The examinations were performed using Olympus fibrobronchoscope, in local anesthesia with The examinations were performed using Olympus fibrobronchoscope, in local anesthesia with Lidocaine 2%, and mild sedation. Lidocaine 2%, and mild sedation.

RESULTS: RESULTS: Fourteen patients with pathologically confirmed benign endobronchial and endotracheal tumors were identified: 2 papilloma, 2 fibroepithelial polyp, 3 lipoma, 2 hamartoma, endotracheal tumors were identified: 2 papilloma, 2 fibroepithelial polyp, 3 lipoma, 2 hamartoma, 2 myxoid-fibroma,1 neurofibroma,1 hemangioma,1 leiomioma. All patients were symptomatic but 2 myxoid-fibroma,1 neurofibroma,1 hemangioma,1 leiomioma. All patients were symptomatic but only 35,7% had modified radiological aspects. We report the successful removal of endobronchial only 35,7% had modified radiological aspects. We report the successful removal of endobronchial tumors via flexible bronchoscopy with electrosurgical snare, without complications and present tumors via flexible bronchoscopy with electrosurgical snare, without complications and present some representative cases. Follow-up bronchoscopic examinations showed no residual or some representative cases. Follow-up bronchoscopic examinations showed no residual or recurrent disease.recurrent disease.

CONCLUSIONS: CONCLUSIONS: Bronchoscopic resection with electrosurgical snare appears to be a safe, easy and cost-effective method for benign endobronchial tumorsand cost-effective method for benign endobronchial tumors

is tHere an OptimaL airWaY stent?

Hervé Dutau, Medical Doctor,Head of the Thoracic Endoscopy UnitThoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France

The main purpose of stents designed for use in the central airways is to restore patency of the The main purpose of stents designed for use in the central airways is to restore patency of the airway to as close to a normal caliber as possible when they are affected by endoluminal or airway to as close to a normal caliber as possible when they are affected by endoluminal or extrinsic thoracic diseases responsible for debilitating symptoms such as dyspnea and a significant extrinsic thoracic diseases responsible for debilitating symptoms such as dyspnea and a significant reduction in airway luminal diameter (greater than 50%).

Silicone stents remain the most commonly placed stents worldwide and have been the “gold Silicone stents remain the most commonly placed stents worldwide and have been the “gold standard” for the treatment of benign and malignant airway stenoses over the past 20 years. standard” for the treatment of benign and malignant airway stenoses over the past 20 years. Thus, silicone stents are not the ideal stents in all situations and metallic stents can serve better in Thus, silicone stents are not the ideal stents in all situations and metallic stents can serve better in some selected conditions. Unlike silicone stents, there is a large and increasing variety of metallic some selected conditions. Unlike silicone stents, there is a large and increasing variety of metallic stents available on the market. The lack of prospective or comparative studies between those stents available on the market. The lack of prospective or comparative studies between those stents makes the choice even more difficult and experts-opinion based. International guidelines stents makes the choice even more difficult and experts-opinion based. International guidelines are seldom.

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particuLaritĂȚi aLe manaGementuLui endOscOpic aL stenOzeLOr traHeaLe iatrOGene La pacientii cu BpOc

Emilia Crișan, Alina Croitoru, Ruxandra Ulmeanu, Mihai Alexe, Ioan Cordoș, Nicolae Galie, Genoveva Cadar, Radu Stoica, Codin Saon, Cristian PaleruInstitutul National de Pneumoftiziologie „Marius Nasta” Bucuresti

Studiul își propune analiza unei serii de cazuri de stenoze traheale iatrogene apărute la pacienți Studiul își propune analiza unei serii de cazuri de stenoze traheale iatrogene apărute la pacienți cu bronhopneumopatie cronică obstructivă a căror exacerbare a necesitat intubație oro-traheală. cu bronhopneumopatie cronică obstructivă a căror exacerbare a necesitat intubație oro-traheală. Stenozele traheale s-au dezvoltat în medie după 24 zile de intubație, au fost severe (cu diametru Stenozele traheale s-au dezvoltat în medie după 24 zile de intubație, au fost severe (cu diametru traheal mai mic de 5 mm), cu tablou clinic dramatic. traheal mai mic de 5 mm), cu tablou clinic dramatic.

Algoritmul terapeutic a cuprins într-o primă fază tehnici de bronhoscopie intervențională (dilatație, Algoritmul terapeutic a cuprins într-o primă fază tehnici de bronhoscopie intervențională (dilatație, excizia granuloamelor prin metode mecanice, electroterapie sau laserterapie) cu o rată de succes excizia granuloamelor prin metode mecanice, electroterapie sau laserterapie) cu o rată de succes de 37% dar rezultatele au fost instabile în timp, necesitând protezare. de 37% dar rezultatele au fost instabile în timp, necesitând protezare.

Abordarea chirurgicală (rezectie traheala cu anastomoza), care este de elecție în tratamentul Abordarea chirurgicală (rezectie traheala cu anastomoza), care este de elecție în tratamentul stenozelor traheale în general, în cazul acestor pacienti a avut rezultate descurajante, cu o rată stenozelor traheale în general, în cazul acestor pacienti a avut rezultate descurajante, cu o rată mică de succes (20%) și o incidență crescută a restenozărilor în post-operator. Aceste complicații mică de succes (20%) și o incidență crescută a restenozărilor în post-operator. Aceste complicații post-operatorii au avut ca unică rezolvare tot bronhologia intervențională. Șase pacienți au post-operatorii au avut ca unică rezolvare tot bronhologia intervențională. Șase pacienți au intrat ulterior într-un program de reabilitare respiratorie, cu rezultate favorabile asupra dispneei, intrat ulterior într-un program de reabilitare respiratorie, cu rezultate favorabile asupra dispneei, toleranței la efort și calității vieții. toleranței la efort și calității vieții.

In concluzie, în timp ce pentru diferite alte etiologii ale stenozelor traheale rezecţia chirurgicală In concluzie, în timp ce pentru diferite alte etiologii ale stenozelor traheale rezecţia chirurgicală este prima alegere de tratament, la pacienții cu BPOC bronhoscopia intervenţională rămâne este prima alegere de tratament, la pacienții cu BPOC bronhoscopia intervenţională rămâne adesea singura modalitate de rezolvare. În plus, un beneficiu considerabil este dat de participarea adesea singura modalitate de rezolvare. În plus, un beneficiu considerabil este dat de participarea la un program de reabilitare respiratorie. la un program de reabilitare respiratorie.

a mOre uniFOrm apprOacHtO BrOncHOscOpY traininG

Henri Colt MD, FCCPChairman, World Association for Bronchology and Interventional PulmonologyProfessor Emeritus, University of California, Irvine

The expanding number of effective, health-enhancing bronchoscopic procedures warrants The expanding number of effective, health-enhancing bronchoscopic procedures warrants the design and implementation of educational processes to help physicians efficiently climb the design and implementation of educational processes to help physicians efficiently climb the learning curve toward competence. This way, procedures can be transitioned safely and the learning curve toward competence. This way, procedures can be transitioned safely and more expediently from bench to bedside, augmenting our capacities to conquer disease. This more expediently from bench to bedside, augmenting our capacities to conquer disease. This ambitious endeavor requires a significant change in our way of thinking; a paradigm shift that ambitious endeavor requires a significant change in our way of thinking; a paradigm shift that calls for bronchoscopists interested in the education to consider all manners of techniques, calls for bronchoscopists interested in the education to consider all manners of techniques, methodologies and training philosophies to achieve our goals. We may need to abandon some methodologies and training philosophies to achieve our goals. We may need to abandon some elements of our past, or at the least view them in new ways. We can, however, incorporate those elements of our past, or at the least view them in new ways. We can, however, incorporate those that have withstood the test of time into our daily educational endeavors, but we must have the that have withstood the test of time into our daily educational endeavors, but we must have the courage to embrace new techniques, albeit not always proven yet through research or practice. courage to embrace new techniques, albeit not always proven yet through research or practice. Greater use of simulation, development of structured curricula and competency-oriented Greater use of simulation, development of structured curricula and competency-oriented educational resources, exploration of the powers of computer-based and on-line instruction, and educational resources, exploration of the powers of computer-based and on-line instruction, and a medical environment where patients do not suffer the burden of procedural training already a medical environment where patients do not suffer the burden of procedural training already signal a form of disruptive innovation,

In this lecture, a brief overview of the history of bronchoscopy education is provided, new In this lecture, a brief overview of the history of bronchoscopy education is provided, new ways of thinking about the bronchoscopy educational process are discussed, various tools and ways of thinking about the bronchoscopy educational process are discussed, various tools and techniques used to enhance bronchoscopy-related training around the world are described, and techniques used to enhance bronchoscopy-related training around the world are described, and the importance of curricular structure and liberal access to educational resources is stressed so the importance of curricular structure and liberal access to educational resources is stressed so that programs may be developed to help bronchoscopists achieve and maintain competence, that programs may be developed to help bronchoscopists achieve and maintain competence, regardless of the medical environment in which they practice.

1716


eBus – VeriGa Lipsa in manaGementuL canceruLui BrOnHOpuLmOnar

Mihai Olteanu*, Costin Streba*, Mimi Nitu*, Emilia Crisan*, Tudorel Ciurea**UMF Craiova

Cancerul pulmonar este cel mai frecvent diagnosticat cancer la nivel global (1350000/an) si Cancerul pulmonar este cel mai frecvent diagnosticat cancer la nivel global (1350000/an) si totodata cea mai frecventa cauza de deces prin cancer (1180000/an). Stadializarea clinica a totodata cea mai frecventa cauza de deces prin cancer (1180000/an). Stadializarea clinica a cancerului pulmonar este o parte integranta a conduitei in fata unui astfel de pacient datorita cancerului pulmonar este o parte integranta a conduitei in fata unui astfel de pacient datorita faptului ca indica terapia si are valoare prognostica.faptului ca indica terapia si are valoare prognostica.De ce veriga lipsa? Pentru ca, pana la aparitia endosonografiei, singurele metode prin care De ce veriga lipsa? Pentru ca, pana la aparitia endosonografiei, singurele metode prin care mediastinul era investigat din punct de vedere histopatologic erau cele chirurgicale. Asadar, dupa mediastinul era investigat din punct de vedere histopatologic erau cele chirurgicale. Asadar, dupa o evaluare initiala a tumorii primare prin CT (criteriul T) si o depistare a metastazelor prin PET o evaluare initiala a tumorii primare prin CT (criteriul T) si o depistare a metastazelor prin PET (criteriile N si M), care, la ora actuala, in Romania, este inca o investigatie „de lux”, pacientul inca nu (criteriile N si M), care, la ora actuala, in Romania, este inca o investigatie „de lux”, pacientul inca nu era confirmat histopatologic in absenta unei bronhoscopii cu biopsie. In acest moment, pacientul era confirmat histopatologic in absenta unei bronhoscopii cu biopsie. In acest moment, pacientul era trimis la chirurgie toracica pentru metode invazive de investigare. Examenul extemporaneu era trimis la chirurgie toracica pentru metode invazive de investigare. Examenul extemporaneu era un indicator al continuarii catre chirurgie cu tenta de stadializare si curativa sau al opririi era un indicator al continuarii catre chirurgie cu tenta de stadializare si curativa sau al opririi manevrelor chirurgicale din cauza criteriilor de inoperabilitate. Se simtea de foarte mult timp manevrelor chirurgicale din cauza criteriilor de inoperabilitate. Se simtea de foarte mult timp absenta unor metode minim invazive care sa fie interpuse intre metodele radiologice si cele absenta unor metode minim invazive care sa fie interpuse intre metodele radiologice si cele chirurgicale si care sa le evite pe cat posibil pe acestea din urma pentru confirmare si stadializare.chirurgicale si care sa le evite pe cat posibil pe acestea din urma pentru confirmare si stadializare.Combinatia dintre EUS si EBUS poate atinge aproape toate statiile ganglionare mediastinale Combinatia dintre EUS si EBUS poate atinge aproape toate statiile ganglionare mediastinale cu o sensibilitate raportata de aprox. 93%. Ghidurile curente de stadializare a cancerului cu o sensibilitate raportata de aprox. 93%. Ghidurile curente de stadializare a cancerului bronhopulmonar recunosc endosonografia ca o metoda minim invaziva alternativa chirurgiei bronhopulmonar recunosc endosonografia ca o metoda minim invaziva alternativa chirurgiei pentru detectia metastazelor ganglionare, ceea ce a redus stadializarea chirurgicala cu pana la pentru detectia metastazelor ganglionare, ceea ce a redus stadializarea chirurgicala cu pana la doua treimi din cazuri. Ecografia endobronsica cu punctie aspirativa transbronsica s-a dovedit a doua treimi din cazuri. Ecografia endobronsica cu punctie aspirativa transbronsica s-a dovedit a fi foarte valoroasa in stadializarea mediastinului. Studiile efectuate au aratat ca EBUS este si cost-fi foarte valoroasa in stadializarea mediastinului. Studiile efectuate au aratat ca EBUS este si cost-eficienta, reducand necesitatea unor interventii invazive mai scumpe, cu morbiditate si mortalitate eficienta, reducand necesitatea unor interventii invazive mai scumpe, cu morbiditate si mortalitate mai ridicate, cum sunt mediastinoscopia si toracotomia.mai ridicate, cum sunt mediastinoscopia si toracotomia.

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eBus – tHe missinG LinK in LunG cancer manaGement

Mihai Olteanu*, Costin Streba*, Mimi Nitu*, Emilia Crisan*, Tudorel Ciurea**UMF Craiova

Lung cancer is the most commonly diagnosed cancer worldwide (1350000/year) and also the Lung cancer is the most commonly diagnosed cancer worldwide (1350000/year) and also the most frequent cause of cancer death (1180000/year). Clinical staging of lung cancer is an integral most frequent cause of cancer death (1180000/year). Clinical staging of lung cancer is an integral

part of patient care because it directs therapy and has prognostic value.Why the missing link? Because before endosonography appeared, the only methods through Why the missing link? Because before endosonography appeared, the only methods through which the mediastinum was investigated and, more importantly, sampled, were the surgical ones. which the mediastinum was investigated and, more importantly, sampled, were the surgical ones. So, after initial assessing of the primary tumor by CT (T descriptor) and detecting metastasis by So, after initial assessing of the primary tumor by CT (T descriptor) and detecting metastasis by PET (N and M descriptors), which in Romania is still a luxury method, the tissue was still an issue, PET (N and M descriptors), which in Romania is still a luxury method, the tissue was still an issue, in absence of a bronchoscopy with biopsy. In this moment, the patient was referred to thoracic in absence of a bronchoscopy with biopsy. In this moment, the patient was referred to thoracic surgery for invasive methods of sampling. The onsite histological exam was indicator of pursuing surgery for invasive methods of sampling. The onsite histological exam was indicator of pursuing further with the surgery or stop because of inoperability criteria. The presence of some minimal further with the surgery or stop because of inoperability criteria. The presence of some minimal invasive methods of sampling the mediastinum between radiology and surgery was needed, in invasive methods of sampling the mediastinum between radiology and surgery was needed, in order to avoid unnecessary thoracic surgery at this point. Combined EUS and EBUS can reach almost all mediastinum nodal stations with a reported Combined EUS and EBUS can reach almost all mediastinum nodal stations with a reported sensitivity of 93%. Current lung cancer staging guidelines acknowledge endosonography as a sensitivity of 93%. Current lung cancer staging guidelines acknowledge endosonography as a minimally invasive alternative to surgical staging to detect nodal disease, reducing the need for minimally invasive alternative to surgical staging to detect nodal disease, reducing the need for surgical staging in up to two thirds of patients.EBUS-transbronchial needle aspiration has proved valuable for mediastinal lymph node staging EBUS-transbronchial needle aspiration has proved valuable for mediastinal lymph node staging of lung cancer. Studies have shown that EBUS is cost-effective as it reduces the need for more of lung cancer. Studies have shown that EBUS is cost-effective as it reduces the need for more morbid and costly invasive procedure like mediastinoscopy or thoracotomy.morbid and costly invasive procedure like mediastinoscopy or thoracotomy.

1918


is cOnVentiOnaL transBrOncHiaLneedLe aspiratiOn passe?

Semra Bilaceroglu, MD,Associate Prof. of Pulmonology, Secretary, EABIP,Dr. Suat SerenTraining and Research Hospital for Thoracic Medicine and Surgery, Izmir, Turkey

Conventional transbronchial needle aspiration (c-TBNA) has proved its efficacy, safety and cost-Conventional transbronchial needle aspiration (c-TBNA) has proved its efficacy, safety and cost-effectiveness in diagnosing and staging lung cancer (accuracy: 60-90%) and in diagnosing benign effectiveness in diagnosing and staging lung cancer (accuracy: 60-90%) and in diagnosing benign diseases such as tuberculous lymphadenitis (accuracy: 50-85%) and sarcoidosis (accuracy: 54-diseases such as tuberculous lymphadenitis (accuracy: 50-85%) and sarcoidosis (accuracy: 54-65%). Despite its high specificity with almost no false positives, the sensitivity and accuracy of 65%). Despite its high specificity with almost no false positives, the sensitivity and accuracy of c-TBNA depend on study methods, patient population (disease severity) and prevalence of c-TBNA depend on study methods, patient population (disease severity) and prevalence of mediastinal involvement. The major complication rate of c-TBNA is low (<1%). The most frequent mediastinal involvement. The major complication rate of c-TBNA is low (<1%). The most frequent complication is minimal self-limited bleeding and the most important complication is damage complication is minimal self-limited bleeding and the most important complication is damage to the flexible bronchoscope if c-TBNA is not performed by proper technique. C-TBNA should to the flexible bronchoscope if c-TBNA is not performed by proper technique. C-TBNA should be a “sine quo non” of routine bronchoscopy. However, it has not been used as extensively be a “sine quo non” of routine bronchoscopy. However, it has not been used as extensively as it deserves owing to a multitude of factors. C- TBNA is absolutely not obsolete! It is still as it deserves owing to a multitude of factors. C- TBNA is absolutely not obsolete! It is still sensitive and cost sparing at the first bronchoscopy and decreases the rate of first and restaging sensitive and cost sparing at the first bronchoscopy and decreases the rate of first and restaging mediastinoscopies by 25-35%. Besides being widely available and not requiring selected centers, mediastinoscopies by 25-35%. Besides being widely available and not requiring selected centers, it is a rapidly performed procedure and requires a shorter learning period. Not all institutions it is a rapidly performed procedure and requires a shorter learning period. Not all institutions can have costly endobronchial ultrasound, endoscopic ultrasound or electromagnetic navigation can have costly endobronchial ultrasound, endoscopic ultrasound or electromagnetic navigation systems. Furthermore, needle aspirations guided by these methods obtain cytologic specimens systems. Furthermore, needle aspirations guided by these methods obtain cytologic specimens in addition to requiring sophisticated, costly equipment and extensive operator training. Thus, in addition to requiring sophisticated, costly equipment and extensive operator training. Thus, c-TBNA is not passe and image-guided TBNA should be used for smaller mediastinal lymph c-TBNA is not passe and image-guided TBNA should be used for smaller mediastinal lymph nodes (nodes (≤ 1 cm), difficult and less easily accessible lymph node locations (e.g. 2R/L, 3p, 4L, 8R/L, 9R/L), when lymph node mobility is a problem and after failing c-TBNA. 9R/L), when lymph node mobility is a problem and after failing c-TBNA.

HOW tO dO endOscOpic VOLume reductiOn in rOmania?

Tudor Toma, MD, PhD.Consultant Respiratory PhysicianUniversity Hospitals of Lewisham & Greenwich, London

This presentation highlights the latest developments in the area of bronchoscopic lung volume This presentation highlights the latest developments in the area of bronchoscopic lung volume reduction (BLVR) and the practical aspects of the procedure, with emphasis on the role of reduction (BLVR) and the practical aspects of the procedure, with emphasis on the role of multidisciplinary meetings to facilitate patient selection. Technically, bronchoscopic lung volume multidisciplinary meetings to facilitate patient selection. Technically, bronchoscopic lung volume reduction is easy. However, the main difficulty is to select the right patient for the right procedure. reduction is easy. However, the main difficulty is to select the right patient for the right procedure. The evidence from the randomised clinical trials suggests that complete lobar occlusion in the The evidence from the randomised clinical trials suggests that complete lobar occlusion in the absence of collateral ventilation, or an intact lobar fissure are the key predictors for clinical success absence of collateral ventilation, or an intact lobar fissure are the key predictors for clinical success in BLVR with valves. The proportion of patients that respond to treatment can be improved from in BLVR with valves. The proportion of patients that respond to treatment can be improved from 20% to 75% with appropriate patient selection. The safety profile for BLVR is acceptable and the 20% to 75% with appropriate patient selection. The safety profile for BLVR is acceptable and the main adverse events observed are an excess of pneumothoraces. A network collaborative project main adverse events observed are an excess of pneumothoraces. A network collaborative project is essential for starting these procedures in Romania.

2120


aLcOOLuL, pOsiBiLa metOda endOscOpica de rezOLVarea a deHiscenteLOr de BOnt BrOnsic

Mihai Alexe, Cristian Paleru, Radu Matache, Ioan Cordos, Codin Saon, Emilia Crisan, Ruxandra Ulmeanu, As. Madalina Cretoi, As. Corina Marica

Dehiscenta bontului de rezectie pulmonara reprezinta un moment critic in evolutia pacientului Dehiscenta bontului de rezectie pulmonara reprezinta un moment critic in evolutia pacientului postchirurgical, necesitand reinterventie ceea ce reprezinta o noua agresiune asupra pacientului.postchirurgical, necesitand reinterventie ceea ce reprezinta o noua agresiune asupra pacientului.Din acest motiv au existat mai multe tentative de inchidere a bonturilor dehiscente in mod minim Din acest motiv au existat mai multe tentative de inchidere a bonturilor dehiscente in mod minim invaziv endobronsic: aplicarea de bio-glue, fibrina depusa local, vitamina E local. invaziv endobronsic: aplicarea de bio-glue, fibrina depusa local, vitamina E local. Ideea de a folosi etanolul pur a aparut in urma observarii aparitiei unor granulatii mucoase dupa Ideea de a folosi etanolul pur a aparut in urma observarii aparitiei unor granulatii mucoase dupa inhalarea accidentala de alcool si a unor studii efectuate pe plamanul de iepure care mentionau inhalarea accidentala de alcool si a unor studii efectuate pe plamanul de iepure care mentionau reactie granulomatoasa semnificativa urmata de epitelizare si partiala fibroza ca urmare a injectarii reactie granulomatoasa semnificativa urmata de epitelizare si partiala fibroza ca urmare a injectarii in cantitati mici a etanolului in peretele bronsic. Pacientii la care s-a incercat acest procedeu erau in cantitati mici a etanolului in peretele bronsic. Pacientii la care s-a incercat acest procedeu erau in afara posibilitatii de reinterventie chirurgicala (contraindicatii cardiace, alterarea starii generale, in afara posibilitatii de reinterventie chirurgicala (contraindicatii cardiace, alterarea starii generale, spectrul bacteriologic sau refuzul pacientului) si dupa epuizarea altor tratamente (drenaj pleural spectrul bacteriologic sau refuzul pacientului) si dupa epuizarea altor tratamente (drenaj pleural prelungit, tratament antibiotic).prelungit, tratament antibiotic).Procedeul in sine este relativ simplu de aplicat necesitand doar fibrobronhoscop, ac de punctie Procedeul in sine este relativ simplu de aplicat necesitand doar fibrobronhoscop, ac de punctie transbronsica si etanol, putandu-se efectua in orice sala de endoscopie bronsica echipata transbronsica si etanol, putandu-se efectua in orice sala de endoscopie bronsica echipata standard.standard.Rezultate net favorabile (inchiderea orificiului dehiscent sau ingustarea semnificativa a acestuia) Rezultate net favorabile (inchiderea orificiului dehiscent sau ingustarea semnificativa a acestuia) au fost obtinute in 5 cazuri dintr-un total de 8, fiind necesare mai multe instilatii intramucoase au fost obtinute in 5 cazuri dintr-un total de 8, fiind necesare mai multe instilatii intramucoase bronsice.bronsice.Avand in vedere toxicitatea redusa a etanolului si riscul mic de reactii adverse, probabil ca Avand in vedere toxicitatea redusa a etanolului si riscul mic de reactii adverse, probabil ca merita urmarita in continuare posibilitatea ca aceasta metoda sa devina o alternativa serioasa a merita urmarita in continuare posibilitatea ca aceasta metoda sa devina o alternativa serioasa a reinterventiei chirurgicale. reinterventiei chirurgicale.

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aLcOHOL, pOssiBLe endOscOpic metHOd OF sOLVinG deHiscent BrOncHiaL stump

Mihai Alexe, Cristian Paleru, Radu Matache, Ioan Cordos, Codin Saon, Emilia Crisan, Ruxandra Ulmeanu, As. Madalina Cretoi, As. Corina Marica

Pulmonary resection stump dehiscence represents a critical moment in the evolution of post-Pulmonary resection stump dehiscence represents a critical moment in the evolution of post-surgical patients , requiring reoperation which represents a new assault on the patient.surgical patients , requiring reoperation which represents a new assault on the patient.For this reason there have been several attempts to close the dehiscents abutments with For this reason there have been several attempts to close the dehiscents abutments with minimally invasive endobronchial methods: application of bio -glue , fibrin deposited locally , minimally invasive endobronchial methods: application of bio -glue , fibrin deposited locally ,

Vitamin E locally.The idea of using pure ethanol arose from observing the occurrence of mucosal granulations The idea of using pure ethanol arose from observing the occurrence of mucosal granulations after accidental inhalation of alcohol and some studies on rabbit lung disclosing significant after accidental inhalation of alcohol and some studies on rabbit lung disclosing significant granulomatous reaction followed by epithelialization and partial fibrosis following injection of granulomatous reaction followed by epithelialization and partial fibrosis following injection of small amounts of ethanol in bronchial wall. Surgical intervention was impossible to apply ( small amounts of ethanol in bronchial wall. Surgical intervention was impossible to apply ( cardiac contraindications , impaired general condition, bacteriological spectrum or patient’s cardiac contraindications , impaired general condition, bacteriological spectrum or patient’s refusal) to patients who underwent this procedure and were after exhausting other treatment ( refusal) to patients who underwent this procedure and were after exhausting other treatment ( prolonged pleural drainage, antibiotic therapy ) .The process itself is relatively simple to implement requiring only fibrobronchoscopy , The process itself is relatively simple to implement requiring only fibrobronchoscopy , transbronchial needle aspiration and ethanol and can be performed in any standard equipped transbronchial needle aspiration and ethanol and can be performed in any standard equipped bronchial endoscopy room .Favorable net results (dehiscent hole closure or its significant narrowing) were obtained in 5 cases Favorable net results (dehiscent hole closure or its significant narrowing) were obtained in 5 cases out of a total of 8 , requiring more intramucosal bronchial instillations .Given the low toxicity of ethanol and low risk of side effects, probably it is still worth pursuing this Given the low toxicity of ethanol and low risk of side effects, probably it is still worth pursuing this method in order to become a serious alternative to surgical reintervention.method in order to become a serious alternative to surgical reintervention.

2322


tracHeOBrOncHiaL stenOsis– cHaLLenGinG issues

Ioan Cordoş, Ciprian Bolca1st Clinical Department of Thoracic Surgery, “Marius Nasta” National Institute of Pneumology, Bucharest

Most cases of tracheobronchial stenosis can be solved by simply following the guidelines Most cases of tracheobronchial stenosis can be solved by simply following the guidelines mentioned in the medical literature: establishing a precise diagnosis, performing a carefully mentioned in the medical literature: establishing a precise diagnosis, performing a carefully planned procedure, applying tracheal relaxation inducing methods and avoiding the disruption of planned procedure, applying tracheal relaxation inducing methods and avoiding the disruption of blood supply to the ends chosen for anastomosis.blood supply to the ends chosen for anastomosis.

The most difficult cases can benefit from: 1.sophisticated plastic and reconstructive surgery The most difficult cases can benefit from: 1.sophisticated plastic and reconstructive surgery procedures in which richly vascularized musculocutaneous flaps are used, 2.transplants with procedures in which richly vascularized musculocutaneous flaps are used, 2.transplants with tracheal tissue grown from the patient’s own stem cells, 3.tracheal graft from the aortic segment, tracheal tissue grown from the patient’s own stem cells, 3.tracheal graft from the aortic segment, and with less extent, 4.tracheal stents.and with less extent, 4.tracheal stents.In between these categories, we find the challenging cases, less mentioned in the medical In between these categories, we find the challenging cases, less mentioned in the medical literature and studies, cases in which ad hoc solutions must be found. The challenges lie in literature and studies, cases in which ad hoc solutions must be found. The challenges lie in 1.establishing a correct diagnosis, 2.determining the topography of the region, 3.anticipating and 1.establishing a correct diagnosis, 2.determining the topography of the region, 3.anticipating and managing postoperative events and in 4.the surgical act itself.managing postoperative events and in 4.the surgical act itself.Among the cases listed in the „benign” section, we consider the following to be the most Among the cases listed in the „benign” section, we consider the following to be the most challenging: resection for recurrent stenosis, resection of a complete posttraumatic bronchial challenging: resection for recurrent stenosis, resection of a complete posttraumatic bronchial stenosis, double tracheal stenosis, benign tracheal stenosis in patients with a total laryngectomy. stenosis, double tracheal stenosis, benign tracheal stenosis in patients with a total laryngectomy. From the „primary malignant” section, we mention cases of adenoid cystic carcinoma extended to From the „primary malignant” section, we mention cases of adenoid cystic carcinoma extended to the tissue surrounding the trachea; carinal right upper lobectomies (NSCLC) are also considered the tissue surrounding the trachea; carinal right upper lobectomies (NSCLC) are also considered as difficult cases. From the „secondary malignant” section, the difficult cases are considered to be as difficult cases. From the „secondary malignant” section, the difficult cases are considered to be thyroid carcinomas with tracheal involvement and solitary NSCLC tracheal metastasis resected thyroid carcinomas with tracheal involvement and solitary NSCLC tracheal metastasis resected following previous lung resection.following previous lung resection.

All presented patients had an univentfull recovery.All presented patients had an univentfull recovery.

In this presentation we wish to draw attention to some particular cases which could serve as a In this presentation we wish to draw attention to some particular cases which could serve as a corner stone to other „challenging cases” and at the same time offer solutions which we consider corner stone to other „challenging cases” and at the same time offer solutions which we consider to be relevant and viable, given the good long term results we obtained in most of the patients to be relevant and viable, given the good long term results we obtained in most of the patients we operated on.we operated on.

pattern-uL cOrpiLOr strĂiniendOBrOnȘici La aduLȚi

Elena Tudor, Petru Levcenco, Victor CozlovschiInstitutul de Ftiziopneumologie “Chiril Draganiuc”, Chișinău, Republica Moldova

Corpii străini aspirați continuă să prezinte o problemă majoră de sănătate, care implică diagnosticul Corpii străini aspirați continuă să prezinte o problemă majoră de sănătate, care implică diagnosticul cert, rapid și în condiții de siguranță de extragere a corpului. Diagnosticul precis este dificil din cert, rapid și în condiții de siguranță de extragere a corpului. Diagnosticul precis este dificil din motiv că adesea nu se atrage atenția la momentul inspirării și simptomele întârziate pot mima alte motiv că adesea nu se atrage atenția la momentul inspirării și simptomele întârziate pot mima alte aspecte, cum ar fi astmul bronșic, pneumonie sau infecții ale căilor respiratorii inferioare.aspecte, cum ar fi astmul bronșic, pneumonie sau infecții ale căilor respiratorii inferioare.Obiectivul acestui studiu retrospectiv a fost de a evidenția natura, distribuția în arborele Obiectivul acestui studiu retrospectiv a fost de a evidenția natura, distribuția în arborele traheobronhial și măștile clinice dezvoltate în rezultatul prezenței de lungă durată a corpilor străini traheobronhial și măștile clinice dezvoltate în rezultatul prezenței de lungă durată a corpilor străini în arborele bronşic. În perioada 2003-2012, în Institutul de Ftiziopneumologie au fost efectuate în arborele bronşic. În perioada 2003-2012, în Institutul de Ftiziopneumologie au fost efectuate 14886 bronhoscopii diagnostice. Corpi străini traheobronșici au fost diagnosticați în 36 (0,2%) 14886 bronhoscopii diagnostice. Corpi străini traheobronșici au fost diagnosticați în 36 (0,2%) de cazuri, inclusiv 25 (69,4%) barbați și 11 (30,6%) femei, raportul fiind de 2,2:1. Corpii străini erau de cazuri, inclusiv 25 (69,4%) barbați și 11 (30,6%) femei, raportul fiind de 2,2:1. Corpii străini erau localizați mai frecvent în bronhia lobară inferioară dreaptă - la 13 pacienti (36,1%), bronhia lobară localizați mai frecvent în bronhia lobară inferioară dreaptă - la 13 pacienti (36,1%), bronhia lobară medie - la 8 (22,2%), bronhia principală stângă - la 6 pacienți (16,6%). Mai frecvent corpii străini medie - la 8 (22,2%), bronhia principală stângă - la 6 pacienți (16,6%). Mai frecvent corpii străini aspirați sunt de natură organică, în special oase 19 (52,7%) cazuri şi din manifestările clinice aspirați sunt de natură organică, în special oase 19 (52,7%) cazuri şi din manifestările clinice pneumonia a constituit 38,8% (14 cazuri), bronșita – 30,5% (11 cazuri). Extragerea corpilor străini pneumonia a constituit 38,8% (14 cazuri), bronșita – 30,5% (11 cazuri). Extragerea corpilor străini la toate cazurile s-a efectuat prin intermediul fibrobronhoscopului flexibil. Complicații în procesul la toate cazurile s-a efectuat prin intermediul fibrobronhoscopului flexibil. Complicații în procesul extragerii nu au fost notificate.Concluzie. Corpii străini extraşi au fost preponderent de natură organică şi mai frecvent localizați Concluzie. Corpii străini extraşi au fost preponderent de natură organică şi mai frecvent localizați în arborele bronșic drept. Măștile corpilor traheobronșici străini sunt reprezentate în special de în arborele bronșic drept. Măștile corpilor traheobronșici străini sunt reprezentate în special de pneumonie şi bronşită.

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pattern OF endOBrOncHiaLFOreiGn BOdies in aduLts

Elena Tudor, Petru Levchenko, Victor CozlovschiInstitute of Phthisiopneumology “Chiril Draganiuc”Chisinau, Moldova

Aspirated foreign bodies continue to present a major health problem that involves the clear, fast Aspirated foreign bodies continue to present a major health problem that involves the clear, fast diagnosis and safe removal of the body. Accurate diagnosis is difficult because often it is payed diagnosis and safe removal of the body. Accurate diagnosis is difficult because often it is payed no attention to the moment of inspiration and delayed symptoms can mimic other issues, such no attention to the moment of inspiration and delayed symptoms can mimic other issues, such as asthma, pneumonia or lower respiratory tract infections.

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The aim of this retrospective study was to highlight the nature, distribution in tracheobronchiall The aim of this retrospective study was to highlight the nature, distribution in tracheobronchiall tree and clinical masks developed as a result of long-term presence of foreign bodies in the tree and clinical masks developed as a result of long-term presence of foreign bodies in the bronchial tree. During 2003-2012, in the Institute of Phthisiopneumology were performed 14886 bronchial tree. During 2003-2012, in the Institute of Phthisiopneumology were performed 14886 diagnostic bronchoscopies. Tracheobronchial foreign bodies were diagnosed in 36 (0.2%) cases, diagnostic bronchoscopies. Tracheobronchial foreign bodies were diagnosed in 36 (0.2%) cases, including 25 (69.4%) men and 11 (30.6%) women, with a ratio of 2.2:1. Foreign bodies were located including 25 (69.4%) men and 11 (30.6%) women, with a ratio of 2.2:1. Foreign bodies were located more frequently in the right inferior lobar bronchus - in 13 patients (36.1%), lobar bronchus average more frequently in the right inferior lobar bronchus - in 13 patients (36.1%), lobar bronchus average - 8 (22.2%), left main bronchus - in 6 patients (16.6%).- 8 (22.2%), left main bronchus - in 6 patients (16.6%).More often the aspirated foreign bodies are organic, especially bones 19 (52.7%) cases and the More often the aspirated foreign bodies are organic, especially bones 19 (52.7%) cases and the clinical pneumonia was 38.8% (14 cases), bronchitis - 30.5% (11 cases). In all cases, the extraction clinical pneumonia was 38.8% (14 cases), bronchitis - 30.5% (11 cases). In all cases, the extraction of foreign bodies was performed through flexible fibrobronchoscopy. During the extraction, of foreign bodies was performed through flexible fibrobronchoscopy. During the extraction, complications were not notified. complications were not notified. Conclusion. The extracted foreign bodies were mostly organic and frequently located in the Conclusion. The extracted foreign bodies were mostly organic and frequently located in the right bronchial tree. The masks of tracheobronchial foreign bodies are especially represented by right bronchial tree. The masks of tracheobronchial foreign bodies are especially represented by pneumonia and bronchitis. pneumonia and bronchitis.

naViGaŢia eLectrOmaGneticĂ - metOdĂ de GHidare a BrOnHOscOpiei cu puncŢie aspiratiVĂ transBrOnŞicĂ În diaGnOsticuL nOduLuLui puLmOnar sOLitar

Gabriela Jimborean, Edith Simona Ianosi, Alexandra ComesUMF Tg. Mureş

Navigaţia electromagnetică (NEM) este un mijloc de ghidare a puncţiei aspirative transbronşice Navigaţia electromagnetică (NEM) este un mijloc de ghidare a puncţiei aspirative transbronşice bronhoscopice pentru diagnosticul nodulilor pulmonari solitari periferici (NPS) sau a ganglionilor bronhoscopice pentru diagnosticul nodulilor pulmonari solitari periferici (NPS) sau a ganglionilor mediastinali de etiologie nedeterminată. Diferenţierea rapidă şi neinvazivă a NPS benigni de mediastinali de etiologie nedeterminată. Diferenţierea rapidă şi neinvazivă a NPS benigni de cei maligni şi a tipului histopatologic are o importanţă deosebită pentru conduita terapeutică cei maligni şi a tipului histopatologic are o importanţă deosebită pentru conduita terapeutică ulterioară. În cazul decelării malignităţii NPS (st. IA-T1,No,Mo) intervenţia chirurgicală radicală ulterioară. În cazul decelării malignităţii NPS (st. IA-T1,No,Mo) intervenţia chirurgicală radicală trebuie să fie rapidă şi în acest caz şansele de supravieţuire la 5 ani sunt de peste 80% faţă de trebuie să fie rapidă şi în acest caz şansele de supravieţuire la 5 ani sunt de peste 80% faţă de temporizare şi intervenţie tardivă în stadii avansate în care supravieţuirea este mult scăzută. În temporizare şi intervenţie tardivă în stadii avansate în care supravieţuirea este mult scăzută. În eventualitatea benignităţii în majoritatea cazurilor nu mai este indicată intervenţia chirurgicală sau eventualitatea benignităţii în majoritatea cazurilor nu mai este indicată intervenţia chirurgicală sau alte investigaţii scumpe şi stresante efectuându-se tratamentul etiologic conservativ. NEM permite alte investigaţii scumpe şi stresante efectuându-se tratamentul etiologic conservativ. NEM permite şi ghidarea unor manopere de tratament bronhoscopic în tumorile periferice: brahiterapia, şi ghidarea unor manopere de tratament bronhoscopic în tumorile periferice: brahiterapia, crioterapia, metodele “cyber-knife” sau plasarea ţintită de markere în tumoră pentru radioterapie. crioterapia, metodele “cyber-knife” sau plasarea ţintită de markere în tumoră pentru radioterapie. Tehnica NEM asociază o cuplare a unei CT în 3 planuri, cu stabilirea coordonatelor NPS în câmp Tehnica NEM asociază o cuplare a unei CT în 3 planuri, cu stabilirea coordonatelor NPS în câmp electromagnetic „GPS like”, urmată de bronhoscopie şi biopsie transbronşică ţintită sub ghidare electromagnetic „GPS like”, urmată de bronhoscopie şi biopsie transbronşică ţintită sub ghidare electromagnetică cu randament diagnostic crescut (60-73%) şi fără complicaţii. Asocierea la CT electromagnetică cu randament diagnostic crescut (60-73%) şi fără complicaţii. Asocierea la CT şi NEM a ghidării EBUS (“Endobronchial Ultrasound”) creşte randamentul confirmării etiologice a şi NEM a ghidării EBUS (“Endobronchial Ultrasound”) creşte randamentul confirmării etiologice a NPS periferic la 88%. NEM are şi avantajul unei iradieri reduse şi a indicaţiei de tehnică neinvazivă NPS periferic la 88%. NEM are şi avantajul unei iradieri reduse şi a indicaţiei de tehnică neinvazivă la pacienţii cu contraindicaţii de toracoscopie sau toracotomie.

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eLectrOmaGnetic naViGatiOn BrOncHOscOpY – Guidance metHOd OF tHe transBrOncHiaL needLe aspiratiOn in tHe diaGnOsis OF tHe sOLitarY puLmOnarY nOduLe

Gabriela Jimborean, Edith Simona Ianosi, Alexandra ComesUMF Tg. Mureş

Electromagnetic Navigation (EMN) is a medical procedure of guiding bronchoscopic transbronchial Electromagnetic Navigation (EMN) is a medical procedure of guiding bronchoscopic transbronchial needle aspiration for the diagnosis of the peripheral solitary pulmonary nodules (SPN) and for the needle aspiration for the diagnosis of the peripheral solitary pulmonary nodules (SPN) and for the

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diagnosis of the undetermined mediastinal lymph nodes. Rapid and noninvasive differentiation diagnosis of the undetermined mediastinal lymph nodes. Rapid and noninvasive differentiation of benign or malign nature of the SPN and confirmation of the histological type of the tumor of benign or malign nature of the SPN and confirmation of the histological type of the tumor is important for the future proper therapy. If malignancy is proven, the SPN is on stage IA - T1, is important for the future proper therapy. If malignancy is proven, the SPN is on stage IA - T1, No, Mo and a radical surgery must be quickly performed. In this case the chances of survival at No, Mo and a radical surgery must be quickly performed. In this case the chances of survival at 5 years will be greater than 80 % compared to the low rate of survival in a late intervention in 5 years will be greater than 80 % compared to the low rate of survival in a late intervention in advanced stages. In case of benign SPN surgery is not mandatory indicated, other expensive and advanced stages. In case of benign SPN surgery is not mandatory indicated, other expensive and stressful investigation are excluded and there will be performed a conservative treatment. EMN stressful investigation are excluded and there will be performed a conservative treatment. EMN allows guiding treatment maneuvers using interventional bronchoscopy in peripheral tumors: allows guiding treatment maneuvers using interventional bronchoscopy in peripheral tumors: brachytherapy, cryotherapy, “cyber knife technique” or targeted placement of markers in the brachytherapy, cryotherapy, “cyber knife technique” or targeted placement of markers in the peripheral tumor to allow targeted radiotherapy. EMN is combined with CT in three plans for peripheral tumor to allow targeted radiotherapy. EMN is combined with CT in three plans for establishing the coordinates of the SPN in the electromagnetic field “GPS like”. EMN and CT are establishing the coordinates of the SPN in the electromagnetic field “GPS like”. EMN and CT are followed by bronchoscopy and transbronchial needle aspiration targeted under electromagnetic followed by bronchoscopy and transbronchial needle aspiration targeted under electromagnetic guidance. The procedure has an increased diagnostic yield (60 - 73%) without complications. guidance. The procedure has an increased diagnostic yield (60 - 73%) without complications. EMN associated with CT and EBUS (Endobronchial Ultrasound) guidance increases efficiency EMN associated with CT and EBUS (Endobronchial Ultrasound) guidance increases efficiency of the diagnosis of peripheral SPN to 88%. EMN has the advantage of low irradiation and has an of the diagnosis of peripheral SPN to 88%. EMN has the advantage of low irradiation and has an extended recommendation (being a non-invasive technique) in patients with contraindications extended recommendation (being a non-invasive technique) in patients with contraindications for thoracoscopy or thoracotomy .for thoracoscopy or thoracotomy .

puLmOnarY adenOcarcinOma and eGFr mutatiOn – cOnnectiOn reQuired tO Be cOnFirmed?

Pro : Florin Mihaltan,Oana Deleanu

YES

Active EGFR mutations, present on tumoral cell-surface, predominantly in adenocarcinoma Active EGFR mutations, present on tumoral cell-surface, predominantly in adenocarcinoma subtype of lung cancer, responsive to tyrosin kinase inhibitors (TKI) agents, should be routinelly subtype of lung cancer, responsive to tyrosin kinase inhibitors (TKI) agents, should be routinelly diagnosed. Most studies show a significat benefit cost-effective for target molecular therapy vs standard Most studies show a significat benefit cost-effective for target molecular therapy vs standard cytotoxic chemotherapy. In this comparison, progression-free survival is significantly increased. cytotoxic chemotherapy. In this comparison, progression-free survival is significantly increased. EGFR-TKIs agents – proved to be efficient in molecular therapy, have an excellent tolerance in EGFR-TKIs agents – proved to be efficient in molecular therapy, have an excellent tolerance in patients with lung cancer compared with standard therapy. EGFR-TKIs have also a low rate of adverse effects: hypersensitivity pneumonitis when using EGFR-TKIs have also a low rate of adverse effects: hypersensitivity pneumonitis when using Gefitinib, more rarely with Erlotinib therapy. Overall and even in patients with other histological subtypes of lung cancer (small cell lung cancer Overall and even in patients with other histological subtypes of lung cancer (small cell lung cancer or squamous cell carcinoma), testing for EGFR mutations change the quality and quantity of life. or squamous cell carcinoma), testing for EGFR mutations change the quality and quantity of life. Epidemiologically and in addition through the mutations evaluation with minimally invasive Epidemiologically and in addition through the mutations evaluation with minimally invasive techniques (EBUS), testing for EGFR mutations should be used for screening in lung cancer, techniques (EBUS), testing for EGFR mutations should be used for screening in lung cancer, particulary advanced-stage, especially as new modern techniques of immuhistochemistry and particulary advanced-stage, especially as new modern techniques of immuhistochemistry and cytogenetic analysis are continuosly developing.

Con :Ruxandra Ulmeanu,Andreea Vladau

NO

EGFR mutations, althought widespread in all histological subtypes of lung cancer, is prevalent only EGFR mutations, althought widespread in all histological subtypes of lung cancer, is prevalent only in patients with adenocarcinoma, and especially in the Asian population of female nonsmokers – in patients with adenocarcinoma, and especially in the Asian population of female nonsmokers – not insignificant epidemiological feature (Caucasians have a lower incidence of EGFR mutations). not insignificant epidemiological feature (Caucasians have a lower incidence of EGFR mutations). Despite modern techniques of detection by immunohistochemistry and cytogenetic analysis of Despite modern techniques of detection by immunohistochemistry and cytogenetic analysis of tumoral DNA, testing for EGFR mutations should not be yet a screening to related responsive tumoral DNA, testing for EGFR mutations should not be yet a screening to related responsive adenocarcinomas, but a test widespread in general population and routinely in Asian population. adenocarcinomas, but a test widespread in general population and routinely in Asian population. Variability in sensitivity and specificity of testing methods and their high costs are sufficient Variability in sensitivity and specificity of testing methods and their high costs are sufficient arguments for invalidation of EGFR mutations screening. In addition, not all EGFR mutations is equally responsive to therapy with tyrosine kinase inhibitors; In addition, not all EGFR mutations is equally responsive to therapy with tyrosine kinase inhibitors; exons abnormalities carriers may have different degrees of sensitivity, even some exons with exons abnormalities carriers may have different degrees of sensitivity, even some exons with resistance to therapy, and sometimes may even be present simultaneously in the same tumor. resistance to therapy, and sometimes may even be present simultaneously in the same tumor. Therapeutic desicion becomes more difficult for both physician and patient. Therapeutic desicion becomes more difficult for both physician and patient. Molecular target therapy is usually the alternative after failure of cytotoxic chemothrapy, especially Molecular target therapy is usually the alternative after failure of cytotoxic chemothrapy, especially

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if primary tumor can subsequently be tested for EGFR mutations in case of disease remission. if primary tumor can subsequently be tested for EGFR mutations in case of disease remission. Therefore, testing for EGFR mutations schould be individualised, but more importantly, respiratory Therefore, testing for EGFR mutations schould be individualised, but more importantly, respiratory physicians and others specialties should know the model of molecular target therapy and explain physicians and others specialties should know the model of molecular target therapy and explain individual to patients with lung cancer. individual to patients with lung cancer. It is found alongside a higher incidence of hypersensitivity pneumonitis-related EGFR-TKIs in It is found alongside a higher incidence of hypersensitivity pneumonitis-related EGFR-TKIs in Asians compared to Caucasians, a possible explanation being perhaps more widely use of target Asians compared to Caucasians, a possible explanation being perhaps more widely use of target therapy in Asian population.therapy in Asian population.

LaVaJuL BrOnHOaLVeOLar - instrument de diaGnOstic in aFectiuniLe aLVeOLO-interstitiaLe

Adriana Parau, Lacramioara Toma, V. Muresan

Introducere: Dupa introducerea in practica medicala a fibrobronhoscopului, lavajul bronhoalveolar Introducere: Dupa introducerea in practica medicala a fibrobronhoscopului, lavajul bronhoalveolar (BAL) a devenit un procedeu foarte comun de obtinere a prelevatelor din zonele periferice ale (BAL) a devenit un procedeu foarte comun de obtinere a prelevatelor din zonele periferice ale plamanului, in vederea examinarilor citologice, bacteriologice, sau imunologice.plamanului, in vederea examinarilor citologice, bacteriologice, sau imunologice.Metoda: Prezentarea actuala contine o scurta trecere in revista a aspectelor tehnice, indicatiilor Metoda: Prezentarea actuala contine o scurta trecere in revista a aspectelor tehnice, indicatiilor si valorii diagnostice a BAL, conform noilor ghiduri clinice. BAL ramane un pas important in si valorii diagnostice a BAL, conform noilor ghiduri clinice. BAL ramane un pas important in protocolul de diagnostic al bolilor alveolare si interstitiale difuze, infiltratelor pulmonare periferice protocolul de diagnostic al bolilor alveolare si interstitiale difuze, infiltratelor pulmonare periferice si in diagnosticul infectiilor pulmonare la pacientii imunosupresati sau ventilati mecanic. La final, si in diagnosticul infectiilor pulmonare la pacientii imunosupresati sau ventilati mecanic. La final, prezentam cateva cazuri clinice la care BAL s-a dovedit util pentru diagnostic.prezentam cateva cazuri clinice la care BAL s-a dovedit util pentru diagnostic.Concluzii: In ciuda relativei sale simplitati, BAL necesita un suport tehnic adecvat ce consta in Concluzii: In ciuda relativei sale simplitati, BAL necesita un suport tehnic adecvat ce consta in fibrobronhoscop, pneumolog competent in bronhologie, dotare de laborator corespunzatoare fibrobronhoscop, pneumolog competent in bronhologie, dotare de laborator corespunzatoare si personal instruit, ceea ce face aceasta metoda disponibila doar in cateva spitale universitare din si personal instruit, ceea ce face aceasta metoda disponibila doar in cateva spitale universitare din tara noastra.

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BrOncHOaLVeOLar LaVaGe - a diaGnOstic tOOL in aLVeOLO-interstitiaL diseases

Adriana Parau, Lacramioara Toma, V. Muresan

Background: Sice the fiberoptic bronchoschope became available in practice, the bronchoalveolar Background: Sice the fiberoptic bronchoschope became available in practice, the bronchoalveolar lavage (BAL) developed as a popular procedure for obtaining samples from peripheral zone of lavage (BAL) developed as a popular procedure for obtaining samples from peripheral zone of lungs for cytology, microbial cultures, or immunological analysis.Metod: This presentation contains a short review of technical aspects, indications and diagnostic Metod: This presentation contains a short review of technical aspects, indications and diagnostic value of BAL in lung diseases, based on the new clinical guidelines. BAL remain an important step value of BAL in lung diseases, based on the new clinical guidelines. BAL remain an important step in diagnostic protocol for diffuse alveolar and interstitial lung diseases, peripheral lung infiltrates, in diagnostic protocol for diffuse alveolar and interstitial lung diseases, peripheral lung infiltrates, or suspected pneumonia in immunosuppressed and ventilated patients. Finally, we present a few or suspected pneumonia in immunosuppressed and ventilated patients. Finally, we present a few clinical cases in which BAL provided diagnostically helpful.Conclusions: Despite of its relative simplicity, BAL procedure requires a technical support Conclusions: Despite of its relative simplicity, BAL procedure requires a technical support concerning in flexible bronchofiberscope, trained pulmonologist, special lab devices and medical concerning in flexible bronchofiberscope, trained pulmonologist, special lab devices and medical professionals, making this method available in our country for only a few university hospitals.professionals, making this method available in our country for only a few university hospitals.

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eXacerBarea in FiBrOzeLe puLmOre. cum mOnitOrizam eVOLutia si eFicienta terapiei?

Milena Man, Doina Todea, Nicoleta Ariesanu

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic lung disease that is Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic lung disease that is characterized by fatal scarring of the lung parenchyma and progressive shortness of breath. The characterized by fatal scarring of the lung parenchyma and progressive shortness of breath. The natural history of disease is unpredictable, with many patients experiencing periods of relative natural history of disease is unpredictable, with many patients experiencing periods of relative stability punctuated by episodes of acute worsening. A number of parameters at the time of stability punctuated by episodes of acute worsening. A number of parameters at the time of diagnosis have been proposed as predictors of worse survival in IPF: increasing age, male sex, diagnosis have been proposed as predictors of worse survival in IPF: increasing age, male sex, degree of dyspnea, smoking history, severity of lung function and radiographic abnormality, degree of dyspnea, smoking history, severity of lung function and radiographic abnormality, neutrophilia or eosinophilia on BAL, honeycombing on HRCT, and the extent of fibroblastic foci neutrophilia or eosinophilia on BAL, honeycombing on HRCT, and the extent of fibroblastic foci on surgical lung biopsy specimens. Acute exacerbation (AE) criteria are presentedon surgical lung biopsy specimens. Acute exacerbation (AE) criteria are presented• Disease progression was variably defined by ≥10% relative decline in forced vital capacity (FVC),• Disease progression was variably defined by ≥10% relative decline in forced vital capacity (FVC),• ≥ 15% relative decline in diffusion capacity for carbon monoxide (DLCO),• ≥ 15% relative decline in diffusion capacity for carbon monoxide (DLCO),• ≥ 30 meter decline in 6 minute walk distance (6MWD),• ≥ 30 meter decline in 6 minute walk distance (6MWD),• ≥ 5 point increase in the University of California San Diego (UCSD) shortness of breath • ≥ 5 point increase in the University of California San Diego (UCSD) shortness of breath questionnaire,questionnaire,• ≥ 5 point increase in the St. George’s Respiratory Questionnaire (SGRQ)• ≥ 5 point increase in the St. George’s Respiratory Questionnaire (SGRQ)The Bronchoscopic assessment of fibrosis (helpful in excluding alternative diagnoses : tumor, The Bronchoscopic assessment of fibrosis (helpful in excluding alternative diagnoses : tumor, infection, Langerhans’ cells or occupational dust exposures) include BAL fluid analysis, and infection, Langerhans’ cells or occupational dust exposures) include BAL fluid analysis, and sometimes transbronchial biopsy (TBB)sometimes transbronchial biopsy (TBB)The role of BAL is pivotal in excluding infection as the etiology of exacerbation(the percentage The role of BAL is pivotal in excluding infection as the etiology of exacerbation(the percentage of neutrophils in BAL fluid and fever were significant discriminating parameters between of neutrophils in BAL fluid and fever were significant discriminating parameters between exacerbation of idiopatic fibrosis and infection)exacerbation of idiopatic fibrosis and infection)Endotracheal aspirate or BAL is recommended to investigate a potentially infectious etiology acute Endotracheal aspirate or BAL is recommended to investigate a potentially infectious etiology acute exacerbations of other forms of interstitial lung disease (e.g., nonspecific interstitial pneumonia) exacerbations of other forms of interstitial lung disease (e.g., nonspecific interstitial pneumonia) have been deliberately excluded, although they may turn out to have a similar etiology and/or have been deliberately excluded, although they may turn out to have a similar etiology and/or pathobiologypathobiologyWhen we have a patients with idiopathic pulmonary fibrosis (IPF) in the emergency department When we have a patients with idiopathic pulmonary fibrosis (IPF) in the emergency department with subacute/acute dyspnea we must to evaluated if is (a) Progression to the final end of the with subacute/acute dyspnea we must to evaluated if is (a) Progression to the final end of the disease. (b) ‘True’ IPF exacerbation. (c) IPF exacerbation due to treatable causes.disease. (b) ‘True’ IPF exacerbation. (c) IPF exacerbation due to treatable causes.

de La suspiciune La certitudine in tuBercuLOza caiLOr respiratOrii

Cosmina Magdău, Bugnariu Cristian, Motoc Nicoleta

Tuberculoza endobronsica este definita ca infectia tuberculoasa a arborelui traheo-bronsic, Tuberculoza endobronsica este definita ca infectia tuberculoasa a arborelui traheo-bronsic, evidentiata prin examen microbiologic si histopatologic pozitiv . Simptomele respiratorii ale bolii evidentiata prin examen microbiologic si histopatologic pozitiv . Simptomele respiratorii ale bolii sunt nespecifice. Cel mai frecvent simptom la debut este tusea persistentă, dar productia de sunt nespecifice. Cel mai frecvent simptom la debut este tusea persistentă, dar productia de sputa este variabilă. Dispneea poate să apară ca o consecință a atelectaziei asociate. Poate fi sputa este variabilă. Dispneea poate să apară ca o consecință a atelectaziei asociate. Poate fi prezenta hemoptizia, dar este rareori masiva.

Spre deosebire de tuberculoza cavitara, simptomele generale, cum ar fi febra, scaderea in Spre deosebire de tuberculoza cavitara, simptomele generale, cum ar fi febra, scaderea in greutate, anorexia, si transpiratiile nocturne sunt mai puținfrecvente in tuberculoza endobronsica greutate, anorexia, si transpiratiile nocturne sunt mai puținfrecvente in tuberculoza endobronsica , ceea ce face dificila diferențierea de alte boli respiratorii. Tuberculoza endobronsica poate , ceea ce face dificila diferențierea de alte boli respiratorii. Tuberculoza endobronsica poate avea un debut insidios, poate simula un carcinom bronho-pulmonar sau poate debuta subacut, avea un debut insidios, poate simula un carcinom bronho-pulmonar sau poate debuta subacut, mimând astmul, aspirația de corp străin sau pneumonia.Aproximativ 20% dintre pacienti pot avea o radiografie toracica normala, iar în aceste cazuri, Aproximativ 20% dintre pacienti pot avea o radiografie toracica normala, iar în aceste cazuri, bronhoscopia flexibila este cheia pentru diagnosticului pentru tuberculoza endobronsica.bronhoscopia flexibila este cheia pentru diagnosticului pentru tuberculoza endobronsica.

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endOBrOncHiaL tuBercuLOsis: FrOm suspiciOn tO FinaL diaGnOsis

Cosmina Magdău, Bugnariu Cristian, Motoc Nicoleta

Endobronchial tuberculosis (EBTB) is defined as tuberculous infection of the tracheobronchial Endobronchial tuberculosis (EBTB) is defined as tuberculous infection of the tracheobronchial tree with microbiologic and histopathologic evidence.Respiratory symptoms of tuberculous tree with microbiologic and histopathologic evidence.Respiratory symptoms of tuberculous endobronchitis are nonspecific. The most common symptom at onset is persistent cough. endobronchitis are nonspecific. The most common symptom at onset is persistent cough. Sputum production is variable. Dyspnea can occur as a consequence of associated atelectasis. Sputum production is variable. Dyspnea can occur as a consequence of associated atelectasis. Hemoptysis may occur, but it is rarely massive.

Unlike cavitary TB, constitutional symptoms, such as fever, weight loss, anorexia, and night Unlike cavitary TB, constitutional symptoms, such as fever, weight loss, anorexia, and night sweats are less prominent in EBTB, making it problematic to differentiate from other respiratory sweats are less prominent in EBTB, making it problematic to differentiate from other respiratory problems. EBTB may have an insidious onset, simulating bronchogenic carcinoma, or may be problems. EBTB may have an insidious onset, simulating bronchogenic carcinoma, or may be subacute, mimicking asthma, foreign body aspiration, and pneumonia.A procent of about 20% of patients with EBTB have a normal chest radiograph, and in this cases, A procent of about 20% of patients with EBTB have a normal chest radiograph, and in this cases, flexible bronchoscopy is the key to the diagnosis of EBTB.

3332


rOLuL endOscOpiei BrOnȘice În BrOnȘiectazii

Ruxandra Râjnoveanu1, Monica Pop1, Ruxandra Ulmeanu2

1-Disciplina de Pneumologie, UMF “Iuliu Hațieganu” Cluj-Napoca; Sp.Clinic de Pneumoftiziologie “Leon Daniello”, Cluj-Napoca2- Disciplina de Pneumologie, UMF Oradea ; Institutul de Pneumologie “M.Nasta” București

Bronșiectazia este o afecțiune extrem de complexă, de la etiologie, aspecte clinico-imagistice Bronșiectazia este o afecțiune extrem de complexă, de la etiologie, aspecte clinico-imagistice până la managementul bolii. Toate suspiciunile clinice de bronșiectazie au indicaţie de până la managementul bolii. Toate suspiciunile clinice de bronșiectazie au indicaţie de endoscopie bronșică. Confirmarea diagnosticului îi aparține tomografiei computerizate de înaltă endoscopie bronșică. Confirmarea diagnosticului îi aparține tomografiei computerizate de înaltă rezoluţie. Endoscopia broșică evidențiază atât semne proprii bronșiectaziei, cât și semne proprii rezoluţie. Endoscopia broșică evidențiază atât semne proprii bronșiectaziei, cât și semne proprii bolii de bază. În peste 50% din cazuri etiologia bronșiectaziilor rămâne necunoscută. Brosajul bolii de bază. În peste 50% din cazuri etiologia bronșiectaziilor rămâne necunoscută. Brosajul bronșic protejat, prin tehnica culturii cantitative, permite diferențierea infecției de colonizarea bronșic protejat, prin tehnica culturii cantitative, permite diferențierea infecției de colonizarea bacteriană. Aceeași investigație oferă rata cea mai mare de confirmare bacteriologică comparativ bacteriană. Aceeași investigație oferă rata cea mai mare de confirmare bacteriologică comparativ cu examenul de spută. Bronhoaspirația, evaluarea prechirurgicală, extracția de corpi străini sau cu examenul de spută. Bronhoaspirația, evaluarea prechirurgicală, extracția de corpi străini sau instilarea endobronșică de medicamente sunt alte beneficii pe care endoscopia bronșică le oferă instilarea endobronșică de medicamente sunt alte beneficii pe care endoscopia bronșică le oferă în diagnosticul și tratamentul bronșiectaziilor. Bronhologia intervențională are un rol salutar în în diagnosticul și tratamentul bronșiectaziilor. Bronhologia intervențională are un rol salutar în stenozele de căi aeriene mari cu bronșiectazii și supurații secundare. stenozele de căi aeriene mari cu bronșiectazii și supurații secundare.

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tHe BeneFit OF BrOncHOscOpY in tHe diaGnOsis OF BrOncHiectasis

Ruxandra Râjnoveanu1, Monica Pop1, Ruxandra Ulmeanu2

1-Disciplina de Pneumologie, UMF “Iuliu Hațieganu” Cluj-Napoca; Sp.Clinic de Pneumoftiziologie “Leon Daniello”, Cluj-Napoca2- Disciplina de Pneumologie, UMF Oradea ; Institutul de Pneumologie “M.Nasta” București

Bronchietasis is an extremely complex condition by etiology, clinical and radiological aspects Bronchietasis is an extremely complex condition by etiology, clinical and radiological aspects to managing the disease. All clinical suspicions have the recommandation to perform bronchial to managing the disease. All clinical suspicions have the recommandation to perform bronchial endoscopy. Confirmation of the diagnosis is made by the high resolution thoracic CT scan. endoscopy. Confirmation of the diagnosis is made by the high resolution thoracic CT scan. Bronchial endoscopy shows both signs corresponding to the disease and signs of the disease Bronchial endoscopy shows both signs corresponding to the disease and signs of the disease causing bronchiectasis. In over 50% of cases the etiology remains unknown. The protected causing bronchiectasis. In over 50% of cases the etiology remains unknown. The protected specimen brush, through quantitative culture technique allows differentiation between infection specimen brush, through quantitative culture technique allows differentiation between infection and bacterial colonization. The same investigation offers the highest rate compared with and bacterial colonization. The same investigation offers the highest rate compared with

bacteriological confirmation of sputum examinations. Bronchial aspiration, pre-surgery evaluation, bacteriological confirmation of sputum examinations. Bronchial aspiration, pre-surgery evaluation, extraction of foreign bodies or bronchial instillation of drugs are other benefits offered by extraction of foreign bodies or bronchial instillation of drugs are other benefits offered by bronchoscopy in the diagnosis and treatment of bronchiectasis. Interventional bronchology plays bronchoscopy in the diagnosis and treatment of bronchiectasis. Interventional bronchology plays an important role in the central airway stenosis with supuration and secondary bronchiectasis.an important role in the central airway stenosis with supuration and secondary bronchiectasis.

3534


diaGnOsticuL endOscOpic În sarcOidOzĂ

Ariadna Petronela Fildan, Oana Cristina Arghir, Elena DantesSpitalul Clinic de Pneumoftiziologie Constanta

Sarcoidoza este o boala granulomatoasa sistemica de etiologie necunoscuta ce afecteaza 5-40 Sarcoidoza este o boala granulomatoasa sistemica de etiologie necunoscuta ce afecteaza 5-40 la 100.000 de locuitori, devenind astfel cea mai frecventa cauza de pneumopatie interstitiala la 100.000 de locuitori, devenind astfel cea mai frecventa cauza de pneumopatie interstitiala difuza fibrozanta de cauza necunoscuta in lumea occidentala.difuza fibrozanta de cauza necunoscuta in lumea occidentala.

Diagnosticul se bazeaza pe aspectele clinico-radiologice sustinute de evidentierea Diagnosticul se bazeaza pe aspectele clinico-radiologice sustinute de evidentierea histopatologica a granuloamului epiteloid necazeificat, excluzand implicarea microorganismelor histopatologica a granuloamului epiteloid necazeificat, excluzand implicarea microorganismelor expunerea la diverse particule. In conformitate cu recomandarile ERS, ATS si ale Asociatiei expunerea la diverse particule. In conformitate cu recomandarile ERS, ATS si ale Asociatiei Mondiale pentru Sarcoidoza si Alte Granulomatoze, bronhoscopia ar trebui sa fie primul pas in Mondiale pentru Sarcoidoza si Alte Granulomatoze, bronhoscopia ar trebui sa fie primul pas in stabilirea diagnosticului. Bronhoscopia flexibila este o procedură usor accesibila, sigura si bine stabilirea diagnosticului. Bronhoscopia flexibila este o procedură usor accesibila, sigura si bine tolerata, care permite mai multe modalitati de prelevare a probelor de tesut de la diferite site-tolerata, care permite mai multe modalitati de prelevare a probelor de tesut de la diferite site-uri anatomice. Biopsia pulmonara transbronsica (TBLB) este recomandata ca fiind principala uri anatomice. Biopsia pulmonara transbronsica (TBLB) este recomandata ca fiind principala metoda de confirmare, cu randamente variind 40-90%, in functie de precizia tehnica, numarul de metoda de confirmare, cu randamente variind 40-90%, in functie de precizia tehnica, numarul de probe prelevate si de gradul de afectare interstitiala. Biopsia endobronsica (EBB) poate confirma probe prelevate si de gradul de afectare interstitiala. Biopsia endobronsica (EBB) poate confirma diagnosticul, chiar si fara anomalii endobronhiale aparente, in aproximativ 50% din cazuri. Același diagnosticul, chiar si fara anomalii endobronhiale aparente, in aproximativ 50% din cazuri. Același lucru este valabil și pentru punctia ganglionara transbronsica (50 – 80% senzitivitate diagnostica), cu lucru este valabil și pentru punctia ganglionara transbronsica (50 – 80% senzitivitate diagnostica), cu un plus de valoare diagnostica daca se efectueaza impreuna cu TBLB. Pe langa aceste proceduri, un plus de valoare diagnostica daca se efectueaza impreuna cu TBLB. Pe langa aceste proceduri, aspiratul bronsic se recomanda pentru analize microbiologice, in timp ce lavajul bronhoalveolar aspiratul bronsic se recomanda pentru analize microbiologice, in timp ce lavajul bronhoalveolar cu raportul CD4/CD8 >3,5 are o senzitivitate cuprinsa intre 52-59% si o specificitate de 94-cu raportul CD4/CD8 >3,5 are o senzitivitate cuprinsa intre 52-59% si o specificitate de 94-96%. In ultima perioada, punctia ganglionara aspirativa ecoghidata endobronsic (EBUS-TBNA) 96%. In ultima perioada, punctia ganglionara aspirativa ecoghidata endobronsic (EBUS-TBNA) a apărut ca o procedură precisa, minim invaziva și sigura pentru prelevarea materialului bioptic a apărut ca o procedură precisa, minim invaziva și sigura pentru prelevarea materialului bioptic de la nivelul ganglionilor limfatici mediastinali, rezultând un randament ridicat de diagnostic (85-de la nivelul ganglionilor limfatici mediastinali, rezultând un randament ridicat de diagnostic (85-93% senzitivitate). Deși multe studii recente au aratat rezultate foarte bune ale EBUS-TBNA in 93% senzitivitate). Deși multe studii recente au aratat rezultate foarte bune ale EBUS-TBNA in diagnosticul sarcoidozei, acesta tehnica este inaccesibila în practica de zi cu zi in Romania, unde diagnosticul sarcoidozei, acesta tehnica este inaccesibila în practica de zi cu zi in Romania, unde bronhoscopia cu biopsie endobronsica si LBA rămâne primul pas in diagnosticul acestei afectiuni.bronhoscopia cu biopsie endobronsica si LBA rămâne primul pas in diagnosticul acestei afectiuni.

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endOscOpic diaGnOsis OF sarcOidOsis

Ariadna Petronela Fildan, Oana Cristina Arghir, Elena DantesSpitalul Clinic de Pneumoftiziologie Constanta

Sarcoidosis is a systemic granulomatous disorder of unknown etiology and affects 5–40 per Sarcoidosis is a systemic granulomatous disorder of unknown etiology and affects 5–40 per 100,000, making it the most prevalent interstitial lung disease in the Western world. Its diagnosis 100,000, making it the most prevalent interstitial lung disease in the Western world. Its diagnosis

is based on a compatible clinical and/or radiological picture, supported by pathological evidence is based on a compatible clinical and/or radiological picture, supported by pathological evidence of noncaseating epithelioid cell granulomas in the absence of organisms or particles. According of noncaseating epithelioid cell granulomas in the absence of organisms or particles. According to the available guidelines of the ERS, ATS and World Association of Sarcoidosis and Other to the available guidelines of the ERS, ATS and World Association of Sarcoidosis and Other Granulomatous Disorders, bronchoscopy should be the first diagnostic step. Flexible bronchoscopy Granulomatous Disorders, bronchoscopy should be the first diagnostic step. Flexible bronchoscopy is a readily available, safe and well-tolerated procedure permitting several modalities of tissue is a readily available, safe and well-tolerated procedure permitting several modalities of tissue sampling from different anatomical sites. Transbronchial lung biopsy (TBLB) has been suggested sampling from different anatomical sites. Transbronchial lung biopsy (TBLB) has been suggested to be the method of preference, with yields ranging 40–90%, depending upon skill, number of to be the method of preference, with yields ranging 40–90%, depending upon skill, number of biopsy samples taken and degree of interstitial involvement at the time of biopsy. Endobronchial biopsy samples taken and degree of interstitial involvement at the time of biopsy. Endobronchial biopsy (EBB) has added value, even without apparent endobronchial abnormalities, in up to 50% biopsy (EBB) has added value, even without apparent endobronchial abnormalities, in up to 50% of patients with sarcoidosis. The same holds for blind transbronchial needle aspiration (TBNA) of patients with sarcoidosis. The same holds for blind transbronchial needle aspiration (TBNA) (50 – 80% sensitivity), especially when added to TBLB. Besides these procedures, bronchial (50 – 80% sensitivity), especially when added to TBLB. Besides these procedures, bronchial washing is recommended for microbiological analysis, while bronchoalveolar lavage with CD4/washing is recommended for microbiological analysis, while bronchoalveolar lavage with CD4/CD8 ratio of >3,5 has a sensitivity of 52-59% and a specificity of 94-96%. Lately, endobronchial CD8 ratio of >3,5 has a sensitivity of 52-59% and a specificity of 94-96%. Lately, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as an accurate, ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as an accurate, minimally invasive, and safe procedure for sampling mediastinal lymphadenopathy, resulting in a minimally invasive, and safe procedure for sampling mediastinal lymphadenopathy, resulting in a high diagnostic yield (85-93% sensitivity). Although many recent studies have shown good results high diagnostic yield (85-93% sensitivity). Although many recent studies have shown good results of EBUS-TBNA in diagnosis of sarcoidosis, this technique is inaccessible in routine daily practice in of EBUS-TBNA in diagnosis of sarcoidosis, this technique is inaccessible in routine daily practice in Romania, where bronchoscopy with EBB and LBA remains the first diagnostic step. Romania, where bronchoscopy with EBB and LBA remains the first diagnostic step.

3736


LOcuL si rOLuL endOscOpiei in timpuL sOmnuLui in manaGementuL pacientiLOr cu sasO

Lavinia Davidescu1,2, Ruxandra Ulmeanu2,31.Spitalul Municipal G. Curteanu, Oradea 2.Facultatea de Medicina Oradea, 3.Institutul National de Pneumologie M.Nasta,Bucuresti

Sforăitul și sindromul da apnee in somn obstructiv (SASO),sunt rezultatul colapsului căilor Sforăitul și sindromul da apnee in somn obstructiv (SASO),sunt rezultatul colapsului căilor respiratorii superioare in timpul somnului. Endoscopia in timpul somnului este o evaluare respiratorii superioare in timpul somnului. Endoscopia in timpul somnului este o evaluare dinamică a cailor aeriene superioare, care poate fi utilizată pentru a determina locul sau locurile dinamică a cailor aeriene superioare, care poate fi utilizată pentru a determina locul sau locurile de colaps în timpul evenimentelor respiratorii.de colaps în timpul evenimentelor respiratorii.Polisomnografia (PSG) este obligatorie în diagnosticul SASO,raminind in continuare golden Polisomnografia (PSG) este obligatorie în diagnosticul SASO,raminind in continuare golden standardul in diagnostic,in timp ce endoscopia in timpul somnului (DISE) este o investigatia standardul in diagnostic,in timp ce endoscopia in timpul somnului (DISE) este o investigatia aditionala valida, mai ales atunci cand o interventie chirurgicala sau tratament cu dispozitive orale aditionala valida, mai ales atunci cand o interventie chirurgicala sau tratament cu dispozitive orale este luata in considerare. . DISE este o techina sigura,dinamica si usor de executat ce onstata in este luata in considerare. . DISE este o techina sigura,dinamica si usor de executat ce onstata in vizualizarea locurile anatomice unde se produce sforaitul si apnea , si care ghideaza marcarea unui vizualizarea locurile anatomice unde se produce sforaitul si apnea , si care ghideaza marcarea unui plan de tratament perzonalizat pentru fiecare caz. DISE poate fi efectuata utilizand diferite metode plan de tratament perzonalizat pentru fiecare caz. DISE poate fi efectuata utilizand diferite metode de sedare, dar nu pare sa existe un protocol standardizat privind aceste metode. Medicamentele de sedare, dar nu pare sa existe un protocol standardizat privind aceste metode. Medicamentele cele mai folosite in DISE sunt propofolul si/sau midazolam. Profunzimea anesteziei este cruciala cele mai folosite in DISE sunt propofolul si/sau midazolam. Profunzimea anesteziei este cruciala in tratament. Adancimea tinta a sedarii este o tranzitie dintre constient si inconstient (pierderea in tratament. Adancimea tinta a sedarii este o tranzitie dintre constient si inconstient (pierderea raspunsului la un stimul verbal).raspunsului la un stimul verbal).Pacientii cu AHI mai mic de 30/h ,sau , pentru a fi mai exact, pacientii in pozitie supin cu un AHI Pacientii cu AHI mai mic de 30/h ,sau , pentru a fi mai exact, pacientii in pozitie supin cu un AHI mai mic de 30/h , li se poate efectua o endoscopie in timpul somnului cu midazolam , lucru mai mic de 30/h , li se poate efectua o endoscopie in timpul somnului cu midazolam , lucru realizabil intr-un laborator endoscopic normal. Pacientii cu un scor AHI mai mare de 30/h si/sau realizabil intr-un laborator endoscopic normal. Pacientii cu un scor AHI mai mare de 30/h si/sau cu forme SASO mai severe ar trebui sa li se efectueze DISE in camera operatorie. cu forme SASO mai severe ar trebui sa li se efectueze DISE in camera operatorie. DISE e o metoda folositoare in evaluarea pacientilor cu SASO, ce ofera medicului o evaluare DISE e o metoda folositoare in evaluarea pacientilor cu SASO, ce ofera medicului o evaluare precisa a locului obstructiei, lucru necesar pentru un management si un tratament mai bun al precisa a locului obstructiei, lucru necesar pentru un management si un tratament mai bun al acestor pacienti.acestor pacienti.

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tHe pLace and rOLe OF sLeep endOscOpY in tHe manaGement OF patients WitH Osa i

Lavinia Davidescu1,2, Ruxandra Ulmeanu2,31.Spitalul Municipal G. Curteanu, Oradea 2.Facultatea de Medicina Oradea, 3.Institutul National de Pneumologie M.Nasta,Bucuresti

Snoring and obstructive sleep apnoea (OSA) result from upper airway (UA) collapse during sleep. Snoring and obstructive sleep apnoea (OSA) result from upper airway (UA) collapse during sleep.

Sleep endoscopy is a dynamic evaluation of the UA that can be used to determine the site(s) Sleep endoscopy is a dynamic evaluation of the UA that can be used to determine the site(s) of collapse during respiratory events. Polysomnography (PSG) is mandatory in the diagnostic of collapse during respiratory events. Polysomnography (PSG) is mandatory in the diagnostic workup of OSA; drug-induced sleep endoscopy (DISE) is a valid addition, especially when surgery workup of OSA; drug-induced sleep endoscopy (DISE) is a valid addition, especially when surgery or oral devices treatment is considered. DISE is a dynamic, safe, easy-to-perform technique or oral devices treatment is considered. DISE is a dynamic, safe, easy-to-perform technique that visualizes the anatomic sites of snoring or apneas and guides the making of a tailor-made that visualizes the anatomic sites of snoring or apneas and guides the making of a tailor-made treatment plan in individual cases.DISE can be performed using different sedation methods, but there does not seem to be a DISE can be performed using different sedation methods, but there does not seem to be a standardized protocol for sedation methods. Drugs most commonly reported for use with DISE standardized protocol for sedation methods. Drugs most commonly reported for use with DISE are propofol and/or midazolam. Anesthetic depth is of key importance. The target depth of are propofol and/or midazolam. Anesthetic depth is of key importance. The target depth of sedation is the transition from consciousness to unconsciousness (loss of response to verbal sedation is the transition from consciousness to unconsciousness (loss of response to verbal stimulation).Patients with an AHI below 30/h, or, to be more accurate, patients with a supine AHI below Patients with an AHI below 30/h, or, to be more accurate, patients with a supine AHI below 30/h, can undergo midazolam-induced sleep endoscopy in normal endoscopy laboratory. 30/h, can undergo midazolam-induced sleep endoscopy in normal endoscopy laboratory. Patients with a higher AHI score >30/h and/or more severe OSA should have DISE performed in Patients with a higher AHI score >30/h and/or more severe OSA should have DISE performed in the operating room.DISE is a usuful method in evaluation of OSA patients, providing the clinician an accurate DISE is a usuful method in evaluation of OSA patients, providing the clinician an accurate assessment of the obstruction site(s) , for a better management and treatment of OSA patients.assessment of the obstruction site(s) , for a better management and treatment of OSA patients.

3938


particuLaritati eVOLutiVe La un cancer esOFaGian cu determinari traHeaLe

Dr. C. Badescu, Prof. As. Dr. E. Crisan – Institutul de Pneumologie “Marius Nasta” Bucuresti

Neoplasmul cu punct de plecare digestiv, determina frecvent metastaze pulmonare, Neoplasmul cu punct de plecare digestiv, determina frecvent metastaze pulmonare, Neoplasmul esofagian determina cu precadere invazia peretelui posterior traheal.Neoplasmul esofagian determina cu precadere invazia peretelui posterior traheal.Prezentam cazul unui pacient de 45 de ani, diagnosticat cu neoplasm esofagian si care se Prezentam cazul unui pacient de 45 de ani, diagnosticat cu neoplasm esofagian si care se prezinta in serviciul nostru cu insuficienta respiratorie acuta. Examenul bronhoscopic efectuat in prezinta in serviciul nostru cu insuficienta respiratorie acuta. Examenul bronhoscopic efectuat in urgenta pune in evidenta doua formatiuni tumorale ce obstrueaza cvasitotal ambele primitive. urgenta pune in evidenta doua formatiuni tumorale ce obstrueaza cvasitotal ambele primitive. Se excizeaza tumorile cu electrocauterul si se recalibreaza ambele primitive. La un interval Se excizeaza tumorile cu electrocauterul si se recalibreaza ambele primitive. La un interval foarte scurt de timp ( 10 zile ) acestea se refac, la dimensiuni sensibil mai mari, necesitand a foarte scurt de timp ( 10 zile ) acestea se refac, la dimensiuni sensibil mai mari, necesitand a doua interventie. Dupa inceperea chimioterapiei, tumorile nu se mai refac, in schimb pacientul doua interventie. Dupa inceperea chimioterapiei, tumorile nu se mai refac, in schimb pacientul acuzand tuse in timpul alimentarii ; controlul prin endoscopie bronsica pune in evidenta fistula acuzand tuse in timpul alimentarii ; controlul prin endoscopie bronsica pune in evidenta fistula eso-traheala mare ( 3-4 mm ) cu margini epitelizate ( proba cu albastru de metilen pozitiva ). eso-traheala mare ( 3-4 mm ) cu margini epitelizate ( proba cu albastru de metilen pozitiva ). Pacientul nu acceseaza propunerea stentarii esofagiene si traheale si, dupa aproximativ 2 luni se Pacientul nu acceseaza propunerea stentarii esofagiene si traheale si, dupa aproximativ 2 luni se prezinta cu inchiderea spontana a fistulei.prezinta cu inchiderea spontana a fistulei.

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Features in eVOLutiOn OF esOpHaGeaL cancer WitH tracHeaL metastasis

Dr. C. Badescu, Prof. As. Dr. E. Crisan –Pneumologie Institute “Marius Nasta” Bucuresti

Digestive cancer frequent induce lung metastasis. Esophageal cancer induce particularly posterior Digestive cancer frequent induce lung metastasis. Esophageal cancer induce particularly posterior tracheal wall invasion. We present a case of male pacient at 45 years old, with esophageal cancer tracheal wall invasion. We present a case of male pacient at 45 years old, with esophageal cancer and he presented in our compartiment with acute respiratory failure. Fibrobronchoscopic exam and he presented in our compartiment with acute respiratory failure. Fibrobronchoscopic exam in emergency, notice two tumors which realize almost total obstruction in both primitives. We in emergency, notice two tumors which realize almost total obstruction in both primitives. We had excised with electrocautery and recalibrate primitives bronchial ways. In a very short time – had excised with electrocautery and recalibrate primitives bronchial ways. In a very short time – 10 days – both tumors reapears at sensitive bigger size, requiring a new intervention. After starting 10 days – both tumors reapears at sensitive bigger size, requiring a new intervention. After starting chemoterapy, the tumors don’t pick up again, but pacient manifest cough during eating ; we chemoterapy, the tumors don’t pick up again, but pacient manifest cough during eating ; we check his bronchial ways by bronchoscopy and the result was a big eso-tracheal fistula ( 3-4 mm check his bronchial ways by bronchoscopy and the result was a big eso-tracheal fistula ( 3-4 mm ) with epitelial border and with positive blue methylene test. The pacient don’t access suggestion ) with epitelial border and with positive blue methylene test. The pacient don’t access suggestion of esophageal and tracheal stent and, after 2 month approximate, he had spontaneous closing of esophageal and tracheal stent and, after 2 month approximate, he had spontaneous closing of fistula.of fistula.

particuLaritati eVOLutiVe La un cancer esOFaGian cu determinari traHeaLe

Dr. C. Badescu, Prof. As. Dr. E. Crisan – Institutul de Pneumologie “Marius Nasta” Bucuresti

Neoplasmul cu punct de plecare digestiv, determina frecvent metastaze pulmonare, Neoplasmul cu punct de plecare digestiv, determina frecvent metastaze pulmonare, Neoplasmul esofagian determina cu precadere invazia peretelui posterior traheal.Neoplasmul esofagian determina cu precadere invazia peretelui posterior traheal.Prezentam cazul unui pacient de 45 de ani, diagnosticat cu neoplasm esofagian si care se Prezentam cazul unui pacient de 45 de ani, diagnosticat cu neoplasm esofagian si care se prezinta in serviciul nostru cu insuficienta respiratorie acuta. Examenul bronhoscopic efectuat in prezinta in serviciul nostru cu insuficienta respiratorie acuta. Examenul bronhoscopic efectuat in urgenta pune in evidenta doua formatiuni tumorale ce obstrueaza cvasitotal ambele primitive. urgenta pune in evidenta doua formatiuni tumorale ce obstrueaza cvasitotal ambele primitive. Se excizeaza tumorile cu electrocauterul si se recalibreaza ambele primitive. La un interval Se excizeaza tumorile cu electrocauterul si se recalibreaza ambele primitive. La un interval foarte scurt de timp ( 10 zile ) acestea se refac, la dimensiuni sensibil mai mari, necesitand a foarte scurt de timp ( 10 zile ) acestea se refac, la dimensiuni sensibil mai mari, necesitand a doua interventie. Dupa inceperea chimioterapiei, tumorile nu se mai refac, in schimb pacientul doua interventie. Dupa inceperea chimioterapiei, tumorile nu se mai refac, in schimb pacientul acuzand tuse in timpul alimentarii ; controlul prin endoscopie bronsica pune in evidenta fistula acuzand tuse in timpul alimentarii ; controlul prin endoscopie bronsica pune in evidenta fistula eso-traheala mare ( 3-4 mm ) cu margini epitelizate ( proba cu albastru de metilen pozitiva ). eso-traheala mare ( 3-4 mm ) cu margini epitelizate ( proba cu albastru de metilen pozitiva ). Pacientul nu acceseaza propunerea stentarii esofagiene si traheale si, dupa aproximativ 2 luni se Pacientul nu acceseaza propunerea stentarii esofagiene si traheale si, dupa aproximativ 2 luni se prezinta cu inchiderea spontana a fistulei.

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Features in eVOLutiOn OF esOpHaGeaL cancer WitH tracHeaL metastasis

Dr. C. Badescu, Prof. As. Dr. E. Crisan –Pneumologie Institute “Marius Nasta” Bucuresti

Digestive cancer frequent induce lung metastasis. Esophageal cancer induce particularly posterior Digestive cancer frequent induce lung metastasis. Esophageal cancer induce particularly posterior tracheal wall invasion. We present a case of male pacient at 45 years old, with esophageal cancer tracheal wall invasion. We present a case of male pacient at 45 years old, with esophageal cancer and he presented in our compartiment with acute respiratory failure. Fibrobronchoscopic exam and he presented in our compartiment with acute respiratory failure. Fibrobronchoscopic exam in emergency, notice two tumors which realize almost total obstruction in both primitives. We in emergency, notice two tumors which realize almost total obstruction in both primitives. We had excised with electrocautery and recalibrate primitives bronchial ways. In a very short time – had excised with electrocautery and recalibrate primitives bronchial ways. In a very short time – 10 days – both tumors reapears at sensitive bigger size, requiring a new intervention. After starting 10 days – both tumors reapears at sensitive bigger size, requiring a new intervention. After starting chemoterapy, the tumors don’t pick up again, but pacient manifest cough during eating ; we chemoterapy, the tumors don’t pick up again, but pacient manifest cough during eating ; we check his bronchial ways by bronchoscopy and the result was a big eso-tracheal fistula ( 3-4 mm check his bronchial ways by bronchoscopy and the result was a big eso-tracheal fistula ( 3-4 mm ) with epitelial border and with positive blue methylene test. The pacient don’t access suggestion ) with epitelial border and with positive blue methylene test. The pacient don’t access suggestion of esophageal and tracheal stent and, after 2 month approximate, he had spontaneous closing of esophageal and tracheal stent and, after 2 month approximate, he had spontaneous closing of fistula.

4140


eXperienta serViciuLui de BrOnHOLOGie Oradea in diaGnOsticuL si tratamentuL cOrpiLOr straini BrOnsici

Dr. Florian Andrada-medic primar pneumologie; Dr. Moldovan Diana Camelia- medic primar pneumologie - Spitalul Clinic Municipal Oradea sectia pneumologie.

Obstructia cailor respiratorii prin corpi straini a fost descrisa pentru prima data in 1852 de Struthers, Obstructia cailor respiratorii prin corpi straini a fost descrisa pentru prima data in 1852 de Struthers, ca si cauza de wheezing. Aspiratia de corpi straini este mai frecventa la copii. La adulti apare ca si cauza de wheezing. Aspiratia de corpi straini este mai frecventa la copii. La adulti apare mai frecvent la pacientii varstnici, la cei cu patologie neurologica, la cei cu dentitie deficitara si mai frecvent la pacientii varstnici, la cei cu patologie neurologica, la cei cu dentitie deficitara si la consumatorii de alcool si sedative. Prezentam experienta serviciului de Bronhologie Oradea la consumatorii de alcool si sedative. Prezentam experienta serviciului de Bronhologie Oradea in perioada Septembrie 2007-Septembrie 2013. In acesta perioada au fost efectuate 3862 de in perioada Septembrie 2007-Septembrie 2013. In acesta perioada au fost efectuate 3862 de bronhoscopii in serviciul nostrum. Am depistat si extras 8 corpi straini. Repatritia pe sexe:-7 barbati bronhoscopii in serviciul nostrum. Am depistat si extras 8 corpi straini. Repatritia pe sexe:-7 barbati si 1 femeie. Varsta pacientilor a fost intre 60 si 80 de ani. In 7 cazuri nu s-a putut preciza momentul si 1 femeie. Varsta pacientilor a fost intre 60 si 80 de ani. In 7 cazuri nu s-a putut preciza momentul aspiratiei de catre pacient , fiind desoperiri intamplatoare. Intr-un singur caz bronhoscopia s-a aspiratiei de catre pacient , fiind desoperiri intamplatoare. Intr-un singur caz bronhoscopia s-a efectuat in urgenta dupa aspirarea accidentala de tablete de medicament. Corpii straini extrasi au efectuat in urgenta dupa aspirarea accidentala de tablete de medicament. Corpii straini extrasi au fost: 1 os de pui, 1 boaba de cireasa, 1 bucata de masa plastica ,3 cazuri –boabe vegetale, 1 caz fost: 1 os de pui, 1 boaba de cireasa, 1 bucata de masa plastica ,3 cazuri –boabe vegetale, 1 caz –coaja de paine, 1 caz –tablete de medicament. Pacientii au prezentat urmatoarele complicatii –coaja de paine, 1 caz –tablete de medicament. Pacientii au prezentat urmatoarele complicatii ale corpilor straini:-1 caz abces pulmonar, cu stare septica si insuficienta respiratorie severa,1 caz ale corpilor straini:-1 caz abces pulmonar, cu stare septica si insuficienta respiratorie severa,1 caz pneumonie retrostenotica si insuficienta respiratorie severa (ambele cazuri internate in serviciul pneumonie retrostenotica si insuficienta respiratorie severa (ambele cazuri internate in serviciul de ATI-si ventilate mecanic), pneumonii retrostenotice -3 cazuri descoperire intamplatoare pe CT de ATI-si ventilate mecanic), pneumonii retrostenotice -3 cazuri descoperire intamplatoare pe CT torace la un pacient oncologic, 2 cazuri sindroame tusigene trenante, cu wheezing unilateral. torace la un pacient oncologic, 2 cazuri sindroame tusigene trenante, cu wheezing unilateral. Localizarea corpilor straini a fost urmatoarea:-3 cazuri LID,1 caz LSD, 1 caz la carena,3 cazuri –Localizarea corpilor straini a fost urmatoarea:-3 cazuri LID,1 caz LSD, 1 caz la carena,3 cazuri –primitiva stanga. Concluzie: -corpii straini trebuie luati in calcul in posibila etiologie a pneumoniilor primitiva stanga. Concluzie: -corpii straini trebuie luati in calcul in posibila etiologie a pneumoniilor recurente, hemoptiziilor, abcesului pulmonar, sindomului de lob mediu, bronsiectaziilor. recurente, hemoptiziilor, abcesului pulmonar, sindomului de lob mediu, bronsiectaziilor. Bronhoscopia este singura metoda de diagnostic si tratament ale acestora.Bronhoscopia este singura metoda de diagnostic si tratament ale acestora.

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tHe eXperience OF BrOncHOLOGY department FrOm Oradea cLincaL cOuntY HOspitaL in tHe diaGnOsis and treatment OF BrOncHiaL FOreiGn BOdY

Dr. Florian Andrada-medic primar pneumologie, Dr. Moldovan Diana Camelia- medic primar pneumologie - Spitalul Clinic Municipal Oradea sectia pneumologie.

Airway obstruction caused by foreign body was first described in 1852 by Struthers, as a cause Airway obstruction caused by foreign body was first described in 1852 by Struthers, as a cause

of wheezing. Foreign body aspiration is more common in children. In adults occurs frequently of wheezing. Foreign body aspiration is more common in children. In adults occurs frequently in elderly people, patients with neurological disorders, with poor dentition and consumers of in elderly people, patients with neurological disorders, with poor dentition and consumers of alcohol and sedatives. We are presenting the experience of Oradea Bronchology department between September We are presenting the experience of Oradea Bronchology department between September 2007 and September 2013. During this period 3862 bronchoscopies were performed in our 2007 and September 2013. During this period 3862 bronchoscopies were performed in our service. We found and extracted eight foreign bodies. Repatritia by gender: men - 7 and woman service. We found and extracted eight foreign bodies. Repatritia by gender: men - 7 and woman - 1. Patients age was between 60 and 80 years old. In 7 cases we could not specify the moment - 1. Patients age was between 60 and 80 years old. In 7 cases we could not specify the moment of foreign body aspiration by the patient this being accidentaly discovered. In only one case of foreign body aspiration by the patient this being accidentaly discovered. In only one case we performed an emergency bronchoscopy after accidental aspiration of drug tablets. Foreign we performed an emergency bronchoscopy after accidental aspiration of drug tablets. Foreign bodies extracted were as follow: one chicken bone, one kernel cherry, one piece of plastic, bodies extracted were as follow: one chicken bone, one kernel cherry, one piece of plastic, three vegetable grain, one crust, one tablets medicine. The patients have developed several three vegetable grain, one crust, one tablets medicine. The patients have developed several complications after aspiration of foreign body: 1 patient with lung abscess, severe sepsis and complications after aspiration of foreign body: 1 patient with lung abscess, severe sepsis and respiratory failure, 1 patient with severe retrostenotic pneumonia and respiratory failure (both cases respiratory failure, 1 patient with severe retrostenotic pneumonia and respiratory failure (both cases admitted to ICU service, and mechanically ventilated), 3 patients with retrostenotic pneumonia, admitted to ICU service, and mechanically ventilated), 3 patients with retrostenotic pneumonia, one case of accidental discovery on the chest CT in an oncological patient, two patients with one case of accidental discovery on the chest CT in an oncological patient, two patients with chronic cough syndrome and unilateral wheezing. Foreign body locating was: 3 patients in lower chronic cough syndrome and unilateral wheezing. Foreign body locating was: 3 patients in lower lobe bronchus, 1 patient in right upper lobe bronchus, 1 patient at the carina, 3 patients in left lobe bronchus, 1 patient in right upper lobe bronchus, 1 patient at the carina, 3 patients in left mainstem bronchus. .Conclusion: - Foreign bodies must be taken into account as the possible etiology of recurrent Conclusion: - Foreign bodies must be taken into account as the possible etiology of recurrent pneumonia, hemoptysis, lung abscess, the middle lobe syndrome, bronchiectasis. Bronchoscopy pneumonia, hemoptysis, lung abscess, the middle lobe syndrome, bronchiectasis. Bronchoscopy is the main method for the diagnosis and the treatment of brochial foreign bodies.is the main method for the diagnosis and the treatment of brochial foreign bodies.

4342


adenOcarcinOmuL puLmOnar, diaGnOstic Şi stadiaLizare endOBrOnŞicĂ - serie de cazuri cLinice

Irina Ionela Stoia Djeska1, Stelian Eugen Stoia Djeska1, Hazm Aljobory2, Romanita Glaja3, Voicu Tudorache4

Spitalul Clinic Dr.V.Babes Timisoara,1 Pneumologie, 2 Chirurgie Toracica, 3 Spitalul Clinic Municipal Timisoara, Anatomie Patologica, 4 UMF” Victor Babes” Timisoara, Department Pneumologie.

Adenocarcinomul reprezintă la ora actuală principalul subtip histologic de cancer pulmonar.Adenocarcinomul reprezintă la ora actuală principalul subtip histologic de cancer pulmonar.Rezultatele a numeroase studii susţin rolul major pe care îl are stabilirea tipului histologic şi a Rezultatele a numeroase studii susţin rolul major pe care îl are stabilirea tipului histologic şi a prezenţei mutaţiei EGFR în selecţia chimioterapiei. Material şi metodă – am analizat leziunile prezenţei mutaţiei EGFR în selecţia chimioterapiei. Material şi metodă – am analizat leziunile endobronşice la 14 pacienţi cu adenocarcinom pulmonar: prezenţa, aspectul, distribuţia şi endobronşice la 14 pacienţi cu adenocarcinom pulmonar: prezenţa, aspectul, distribuţia şi extensia modificărilor.Diagnosticul a fost stabilit prin biopsie bronşică în 80% din cazuri.Examinarea extensia modificărilor.Diagnosticul a fost stabilit prin biopsie bronşică în 80% din cazuri.Examinarea imunohistochimică a stabilit caracterul primar sau secundar al adenocarcinomului.imunohistochimică a stabilit caracterul primar sau secundar al adenocarcinomului.Rezultate - am observat o creştere graduată a modificărilor endobronşice odată cu creşterea Rezultate - am observat o creştere graduată a modificărilor endobronşice odată cu creşterea severităţii bolii.Stadiul avansat de boală s-a caracterizat prin îngustarea până la obstrucţie severităţii bolii.Stadiul avansat de boală s-a caracterizat prin îngustarea până la obstrucţie a orificiului bronhiei principale cu atelectazie secundară.Nu a existat nici o corelaţie între a orificiului bronhiei principale cu atelectazie secundară.Nu a existat nici o corelaţie între aspectul macroscopic şi subtipul histologic. Concluzii – bronhoscopia reprezintă primul pas în aspectul macroscopic şi subtipul histologic. Concluzii – bronhoscopia reprezintă primul pas în caracterizarea optimă a adenocarcinomului pulmonar.Examinarea histologică este necesară caracterizarea optimă a adenocarcinomului pulmonar.Examinarea histologică este necesară pentru confirmarea diagnosticului.Stabilirea imunohistochimică a caracterului secundar al pentru confirmarea diagnosticului.Stabilirea imunohistochimică a caracterului secundar al leziunilor endobronşice schimbă radical clasificarea iniţială TNM a neoplaziei.leziunilor endobronşice schimbă radical clasificarea iniţială TNM a neoplaziei.

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tHe endOBrOncHiaL diaGnOsis and staGinG OF puLmOnarY adenOcarcinOma – a series OF cLinicaL cases

Irina Ionela Stoia Djeska1, Stelian Eugen Stoia Djeska1, Hazm Aljobory2, Romanita Glaja3, Voicu Tudorache4

Spitalul Clinic Dr.V.Babes Timisoara,1 Pneumologie, 2 Chirurgie Toracica, 3 Spitalul Clinic Municipal Timisoara, Anatomie Patologica, 4 UMF” Victor Babes” Timisoara, Department Pneumologie.

In recent years adenocarcinoma has become the leading histological subtype of lung cancer. In recent years adenocarcinoma has become the leading histological subtype of lung cancer. Furthermore, substantial evidence has been accumulated and supports the role of histological Furthermore, substantial evidence has been accumulated and supports the role of histological

typing and EGFR mutation status for the chemotherapy selection.Material and methods – We have analyzed the endobronchial lesions for 14 patients with Material and methods – We have analyzed the endobronchial lesions for 14 patients with pulmonary adenocarcinoma; that is the presence, the aspect, the distribution and the extension pulmonary adenocarcinoma; that is the presence, the aspect, the distribution and the extension of abnormalities. The diagnosis was obtained by bronchial biopsy in 80% of the cases. The of abnormalities. The diagnosis was obtained by bronchial biopsy in 80% of the cases. The immunohistochemistry was used in order to differentiate between primary and secondary immunohistochemistry was used in order to differentiate between primary and secondary adenocarcinoma.Results – We have found a gradual increase in the endobronchial changes due to an increasing Results – We have found a gradual increase in the endobronchial changes due to an increasing disease severity. Advanced adenocarcinoma was characterised by a narrowing of the orifice disease severity. Advanced adenocarcinoma was characterised by a narrowing of the orifice of the main bronchus with secondary atelectasis. We haven’t found a correlation between the of the main bronchus with secondary atelectasis. We haven’t found a correlation between the macroscopic aspects and the histological type.Conclusions – Bronchoscopy is the first step for an optimal characterization of the pulmonary Conclusions – Bronchoscopy is the first step for an optimal characterization of the pulmonary adenocarcinoma. Histopathological examination is required for the confirmation of the diagnosis. adenocarcinoma. Histopathological examination is required for the confirmation of the diagnosis. Establishing immunohistochemically the secondary character of endobronchial lesions has Establishing immunohistochemically the secondary character of endobronchial lesions has radically changed the initial TNM classification of neoplasia.

SOCIETATEA ROMÂNĂ DE PNEUMOLOGIE, SECȚIUNEA BRONHOLOGIE

a VII-aCONFERINȚĂ NAȚIONALĂDE BRONHOLOGIECU TEMA: INCURSIUNE ÎN BRONHOLOGIE

LOCAȚIE: GRAND HOTEL NAPOCA | CLUJ-NAPOCA

15-16NOIEMBRIE

2013

Conferința va fi acreditată cu puncte EMC







www.medevents.ro/bronhologie2013

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