Current indications for remediastinoscopy include an inadequate first procedure, recurrent and se... more Current indications for remediastinoscopy include an inadequate first procedure, recurrent and second primary lung cancer, lung cancer occurring after an unrelated disease such as lymphoma, and restaging after induction therapy. Nowadays, restaging is the most frequent indication for remediastinoscopy. We present the case of a 42 years old male with a mediastinoscopy performed in another surgical unit 4 months before being admitted in our department. The CT scan showed bulky mediastinal lymph node enlargement, in evolution compared with the prior one, and no other lesions in the lung parenchyma. As the histopathological examination from the first specimen was negative, a diagnosis was requested in order to allow a correct treatment. A remediastinoscopy was successfully performed and avoided a more invasive procedure.
The emergence of a secondary pulmonary neoplasm at some time after the primary one raises diagnos... more The emergence of a secondary pulmonary neoplasm at some time after the primary one raises diagnostic and therapeutic issues especially in patients with functional respiratory capacities at the limits of resectability. We present the case of a 53 years old patient which suffered a right upper lobectomy three years before for a moderately differentiated squamous carcinoma and in which a second cancer was discovered in the right main bronchus. Para-clinic explorations demonstrated the lack of local and systemic invasion of the second cancer. The optimal therapeutic way is presented and its result, discussing also the means for long term follow-up of the patients operated for non-small cell lung cancer.
Between November 2001-April 2010, 107 tracheal resections were performed in our department for di... more Between November 2001-April 2010, 107 tracheal resections were performed in our department for different types of tracheal stenosis: iatrogenic or tumoral, benign or malignant. We present the diagnosis and treatment principles that we used, along with our results. We operated on 74 (69.15%) iatrogenic postintubation tracheal stenosis, 6 (5.6%) of them complicated with tracheo-esophageal fistula, 6 (5.6%) benign tumors, 11 (10.28%) primary malignant and 16 (14.97%) secondary malignant ones, with a 3.8% total mortality. Tracheal resection and reconstruction is the only curative treatment for all types of tracheal stenosis. Interventional endoscopy is of a major importance in the assessment and treatment of tracheal stenosis. We believe that each patient diagnosed with a tracheal stenosis should be referred to a tertiary center with multidisciplinary experience in the treatment of tracheal stenosis.
Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies ... more Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies in the world, an important number of such patients can necessitate, at a certain moment, a thoracic surgical intervention, especially pulmonary resections for pulmonary carcinoma. In these cases, the removing of a certain volume of pulmonary tissue from a patient who already has a respiratory malfunction necessitates a judicious preoperative evaluation to establish the correct indication, risk factors and postoperative prognosis (at least regarding the pulmonary function). Although the preoperative evaluation for pulmonary resections has been studied for many years, a parameter has not been found yet, simple or combined, to accurately predict the outcome. The majority of the candidates for pulmonary resections can be operated without previous complicated tests like CPET (cardio-pulmonary exercise testing) and regional pulmonary function, which are expensive and sometimes non accessible. ...
Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies ... more Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies in the world, an important number of such patients can necessitate, at a certain moment, a thoracic surgical intervention, especially pulmonary resections for pulmonary carcinoma. In these cases, the removing of a certain volume of pulmonary tissue from a patient who already has a respiratory malfunction necessitates a judicious preoperative evaluation to establish the correct indication, risk factors and postoperative prognosis (at least regarding the pulmonary function). Although the preoperative evaluation for pulmonary resections has been studied for many years, a parameter has not been found yet, simple or combined, to accurately predict the outcome. The majority of the candidates for pulmonary resections can be operated without previous complicated tests like CPET (cardio-pulmonary exercise testing) and regional pulmonary function, which are expensive and sometimes non accessible. ...
Between November 2001-April 2010, 107 tracheal resections were performed in our department for di... more Between November 2001-April 2010, 107 tracheal resections were performed in our department for different types of tracheal stenosis: iatrogenic or tumoral, benign or malignant. We present the diagnosis and treatment principles that we used, along with our results. We operated on 74 (69.15%) iatrogenic postintubation tracheal stenosis, 6 (5.6%) of them complicated with tracheo-esophageal fistula, 6 (5.6%) benign tumors, 11 (10.28%) primary malignant and 16 (14.97%) secondary malignant ones, with a 3.8% total mortality. Tracheal resection and reconstruction is the only curative treatment for all types of tracheal stenosis. Interventional endoscopy is of a major importance in the assessment and treatment of tracheal stenosis. We believe that each patient diagnosed with a tracheal stenosis should be referred to a tertiary center with multidisciplinary experience in the treatment of tracheal stenosis.
The emergence of a secondary pulmonary neoplasm at some time after the primary one raises diagnos... more The emergence of a secondary pulmonary neoplasm at some time after the primary one raises diagnostic and therapeutic issues especially in patients with functional respiratory capacities at the limits of resectability. We present the case of a 53 years old patient which suffered a right upper lobectomy three years before for a moderately differentiated squamous carcinoma and in which a second cancer was discovered in the right main bronchus. Para-clinic explorations demonstrated the lack of local and systemic invasion of the second cancer. The optimal therapeutic way is presented and its result, discussing also the means for long term follow-up of the patients operated for non-small cell lung cancer.
This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exac... more This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exacerbation which required oro-tracheal intubation. The tracheal stenosis occurred on average after 24 days of intubation and were clinically severe. Treatment algorithm first included bronchoscopic interventional techniques with an immediate success rate of 37%, but the results were unstable in time, requiring tracheal stenting. The surgical approach, which generally is the first choice in the treatment of tracheal stenosis, had discouraging results in these patients, with a low rate of success (20%) and an increased incidence of restenosis. The only solution for those postoperative complications was, again, interventional bronchoscopy. In conclusion, while for various other etiologies of tracheal stenosis the surgical resection is the first choice of treatment, in COPD patients interventional bronchoscopy often remains the only way of solving.
Current indications for remediastinoscopy include an inadequate first procedure, recurrent and se... more Current indications for remediastinoscopy include an inadequate first procedure, recurrent and second primary lung cancer, lung cancer occurring after an unrelated disease such as lymphoma, and restaging after induction therapy. Nowadays, restaging is the most frequent indication for remediastinoscopy. We present the case of a 42 years old male with a mediastinoscopy performed in another surgical unit 4 months before being admitted in our department. The CT scan showed bulky mediastinal lymph node enlargement, in evolution compared with the prior one, and no other lesions in the lung parenchyma. As the histopathological examination from the first specimen was negative, a diagnosis was requested in order to allow a correct treatment. A remediastinoscopy was successfully performed and avoided a more invasive procedure.
Gastric pull-up is the most commonly used procedure for esophageal replacement in both malignant ... more Gastric pull-up is the most commonly used procedure for esophageal replacement in both malignant and benign conditions. In our article we compare the differences in mortality and morbidity between thoracic anastomosis and cervical anastomosis during gastric pull-up. The study group comprised of 126 patients - 58 patients (56%) with cervical anastomosis and 68 patients (64%) with thoracic anastomosis. The overall mortality in the study group was 5.55% (7 patients), while the overall morbidity was higher at 28%. There were no significant differences between the two subgroups regarding mortality and morbidity, although the rate of anastomotic leakage was higher in the cervical subgroup (13.8% vs 1.5%). We recommend performing thoracic anastomosis during gastric pull-up whenever the location of the lesion allows it, since the procedure is safe, relatively easy to master and it shortens operating time by excluding the cervical approach.
Postintubation tracheoesophageal fistula is a severe complication occurring under certain conditi... more Postintubation tracheoesophageal fistula is a severe complication occurring under certain conditions in patients that require prolonged mechanical ventilation. This article focuses on a sample of 11 patients with postintubation tracheoesophageal fistula, operated in our department between 2005 and 2015. The anterior approach with tracheal resection was performed in 10 of these patients, while an atypical surgical technique was preferred in a case involving a large-sized fistula. Three of these patients were subject to surgery while still on the ventilator, in order to help weaning them from mechanical ventilation. Two patients were operated following a relapse of the fistula, after attempts of closing it in other surgical units.Two patients (of those who were still on mechanical ventilation) died from intubation-related complications that persisted after tracheal resection (anastomotic dehiscence with mediastinitis and tracheoarterial fistula in the brachiocephalic arterial trunk). ...
This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exac... more This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exacerbation which required oro-tracheal intubation. The tracheal stenosis occurred on average after 24 days of intubation and were clinically severe. Treatment algorithm first included bronchoscopic interventional techniques with an immediate success rate of 37%, but the results were unstable in time, requiring tracheal stenting. The surgical approach, which generally is the first choice in the treatment of tracheal stenosis, had discouraging results in these patients, with a low rate of success (20%) and an increased incidence of restenosis. The only solution for those postoperative complications was, again, interventional bronchoscopy. In conclusion, while for various other etiologies of tracheal stenosis the surgical resection is the first choice of treatment, in COPD patients interventional bronchoscopy often remains the only way of solving.
Vein pulmonary anomalies are seldom met. They have a prevalence of 0.4-0.7% of the cases (accordi... more Vein pulmonary anomalies are seldom met. They have a prevalence of 0.4-0.7% of the cases (according to the American authors). The case under discussion is a 68-year-old patient, who was admitted in the hospital for hemoptysis in low quantity but recurrent, physical asteny, fever and weight loss. The onset had been two months before admission to the hospital. The thoracic X-ray shows opacity at the left apex with marked subcostal and costal intensity, with a homogenous area of 5/6 cm. The thoracic CT exam shows multiple bilateral fibronodular images and the left upper lobe shows a cavitary image with regular and thin walls; intracavitary there is an oval formation with mixed densities of approximate 3.5/4/4.5 cm, which suggests a lung aspergilloma. Surgery will be performed--left upper lobectomy associated with atypical resection from the left Fowler segment. During the surgery it is noticed that the left upper pulmonary vein is abnormaly in the left pulmonary hilum. It has a cranial trajectory, runs in parallel with the left phrenic nerve on the mediastinal surface of the left upper lobe then goes in the mediastinum and pours into the left vein branchocefalic trunk. The post-surgery recovery was slowly favourable with complete pulmonary re-expansion, but with the persistence of the aerial losses which imposed pleural drainage for a period of over 2 weeks.
The modern treatment of hepato-pleural-pulmonary hydatidosis is based on surgical excision and me... more The modern treatment of hepato-pleural-pulmonary hydatidosis is based on surgical excision and medical treatment with drugs like: Mebendazol, Albendazol or Praziquantel. There are presented 23 patients with multiple hepato-pleuro-pulmonary hydatidosis, operated in the last 4 years. Surgical excision in pleuro-pulmonary hydatidosis is adapted to cysts topography, aiming to eliminate the intact cysts and to close the remaining cavities.
Current indications for remediastinoscopy include an inadequate first procedure, recurrent and se... more Current indications for remediastinoscopy include an inadequate first procedure, recurrent and second primary lung cancer, lung cancer occurring after an unrelated disease such as lymphoma, and restaging after induction therapy. Nowadays, restaging is the most frequent indication for remediastinoscopy. We present the case of a 42 years old male with a mediastinoscopy performed in another surgical unit 4 months before being admitted in our department. The CT scan showed bulky mediastinal lymph node enlargement, in evolution compared with the prior one, and no other lesions in the lung parenchyma. As the histopathological examination from the first specimen was negative, a diagnosis was requested in order to allow a correct treatment. A remediastinoscopy was successfully performed and avoided a more invasive procedure.
The emergence of a secondary pulmonary neoplasm at some time after the primary one raises diagnos... more The emergence of a secondary pulmonary neoplasm at some time after the primary one raises diagnostic and therapeutic issues especially in patients with functional respiratory capacities at the limits of resectability. We present the case of a 53 years old patient which suffered a right upper lobectomy three years before for a moderately differentiated squamous carcinoma and in which a second cancer was discovered in the right main bronchus. Para-clinic explorations demonstrated the lack of local and systemic invasion of the second cancer. The optimal therapeutic way is presented and its result, discussing also the means for long term follow-up of the patients operated for non-small cell lung cancer.
Between November 2001-April 2010, 107 tracheal resections were performed in our department for di... more Between November 2001-April 2010, 107 tracheal resections were performed in our department for different types of tracheal stenosis: iatrogenic or tumoral, benign or malignant. We present the diagnosis and treatment principles that we used, along with our results. We operated on 74 (69.15%) iatrogenic postintubation tracheal stenosis, 6 (5.6%) of them complicated with tracheo-esophageal fistula, 6 (5.6%) benign tumors, 11 (10.28%) primary malignant and 16 (14.97%) secondary malignant ones, with a 3.8% total mortality. Tracheal resection and reconstruction is the only curative treatment for all types of tracheal stenosis. Interventional endoscopy is of a major importance in the assessment and treatment of tracheal stenosis. We believe that each patient diagnosed with a tracheal stenosis should be referred to a tertiary center with multidisciplinary experience in the treatment of tracheal stenosis.
Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies ... more Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies in the world, an important number of such patients can necessitate, at a certain moment, a thoracic surgical intervention, especially pulmonary resections for pulmonary carcinoma. In these cases, the removing of a certain volume of pulmonary tissue from a patient who already has a respiratory malfunction necessitates a judicious preoperative evaluation to establish the correct indication, risk factors and postoperative prognosis (at least regarding the pulmonary function). Although the preoperative evaluation for pulmonary resections has been studied for many years, a parameter has not been found yet, simple or combined, to accurately predict the outcome. The majority of the candidates for pulmonary resections can be operated without previous complicated tests like CPET (cardio-pulmonary exercise testing) and regional pulmonary function, which are expensive and sometimes non accessible. ...
Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies ... more Chronic obstructive pulmonary disease - COPD, being one of the most frequent chronic pathologies in the world, an important number of such patients can necessitate, at a certain moment, a thoracic surgical intervention, especially pulmonary resections for pulmonary carcinoma. In these cases, the removing of a certain volume of pulmonary tissue from a patient who already has a respiratory malfunction necessitates a judicious preoperative evaluation to establish the correct indication, risk factors and postoperative prognosis (at least regarding the pulmonary function). Although the preoperative evaluation for pulmonary resections has been studied for many years, a parameter has not been found yet, simple or combined, to accurately predict the outcome. The majority of the candidates for pulmonary resections can be operated without previous complicated tests like CPET (cardio-pulmonary exercise testing) and regional pulmonary function, which are expensive and sometimes non accessible. ...
Between November 2001-April 2010, 107 tracheal resections were performed in our department for di... more Between November 2001-April 2010, 107 tracheal resections were performed in our department for different types of tracheal stenosis: iatrogenic or tumoral, benign or malignant. We present the diagnosis and treatment principles that we used, along with our results. We operated on 74 (69.15%) iatrogenic postintubation tracheal stenosis, 6 (5.6%) of them complicated with tracheo-esophageal fistula, 6 (5.6%) benign tumors, 11 (10.28%) primary malignant and 16 (14.97%) secondary malignant ones, with a 3.8% total mortality. Tracheal resection and reconstruction is the only curative treatment for all types of tracheal stenosis. Interventional endoscopy is of a major importance in the assessment and treatment of tracheal stenosis. We believe that each patient diagnosed with a tracheal stenosis should be referred to a tertiary center with multidisciplinary experience in the treatment of tracheal stenosis.
The emergence of a secondary pulmonary neoplasm at some time after the primary one raises diagnos... more The emergence of a secondary pulmonary neoplasm at some time after the primary one raises diagnostic and therapeutic issues especially in patients with functional respiratory capacities at the limits of resectability. We present the case of a 53 years old patient which suffered a right upper lobectomy three years before for a moderately differentiated squamous carcinoma and in which a second cancer was discovered in the right main bronchus. Para-clinic explorations demonstrated the lack of local and systemic invasion of the second cancer. The optimal therapeutic way is presented and its result, discussing also the means for long term follow-up of the patients operated for non-small cell lung cancer.
This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exac... more This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exacerbation which required oro-tracheal intubation. The tracheal stenosis occurred on average after 24 days of intubation and were clinically severe. Treatment algorithm first included bronchoscopic interventional techniques with an immediate success rate of 37%, but the results were unstable in time, requiring tracheal stenting. The surgical approach, which generally is the first choice in the treatment of tracheal stenosis, had discouraging results in these patients, with a low rate of success (20%) and an increased incidence of restenosis. The only solution for those postoperative complications was, again, interventional bronchoscopy. In conclusion, while for various other etiologies of tracheal stenosis the surgical resection is the first choice of treatment, in COPD patients interventional bronchoscopy often remains the only way of solving.
Current indications for remediastinoscopy include an inadequate first procedure, recurrent and se... more Current indications for remediastinoscopy include an inadequate first procedure, recurrent and second primary lung cancer, lung cancer occurring after an unrelated disease such as lymphoma, and restaging after induction therapy. Nowadays, restaging is the most frequent indication for remediastinoscopy. We present the case of a 42 years old male with a mediastinoscopy performed in another surgical unit 4 months before being admitted in our department. The CT scan showed bulky mediastinal lymph node enlargement, in evolution compared with the prior one, and no other lesions in the lung parenchyma. As the histopathological examination from the first specimen was negative, a diagnosis was requested in order to allow a correct treatment. A remediastinoscopy was successfully performed and avoided a more invasive procedure.
Gastric pull-up is the most commonly used procedure for esophageal replacement in both malignant ... more Gastric pull-up is the most commonly used procedure for esophageal replacement in both malignant and benign conditions. In our article we compare the differences in mortality and morbidity between thoracic anastomosis and cervical anastomosis during gastric pull-up. The study group comprised of 126 patients - 58 patients (56%) with cervical anastomosis and 68 patients (64%) with thoracic anastomosis. The overall mortality in the study group was 5.55% (7 patients), while the overall morbidity was higher at 28%. There were no significant differences between the two subgroups regarding mortality and morbidity, although the rate of anastomotic leakage was higher in the cervical subgroup (13.8% vs 1.5%). We recommend performing thoracic anastomosis during gastric pull-up whenever the location of the lesion allows it, since the procedure is safe, relatively easy to master and it shortens operating time by excluding the cervical approach.
Postintubation tracheoesophageal fistula is a severe complication occurring under certain conditi... more Postintubation tracheoesophageal fistula is a severe complication occurring under certain conditions in patients that require prolonged mechanical ventilation. This article focuses on a sample of 11 patients with postintubation tracheoesophageal fistula, operated in our department between 2005 and 2015. The anterior approach with tracheal resection was performed in 10 of these patients, while an atypical surgical technique was preferred in a case involving a large-sized fistula. Three of these patients were subject to surgery while still on the ventilator, in order to help weaning them from mechanical ventilation. Two patients were operated following a relapse of the fistula, after attempts of closing it in other surgical units.Two patients (of those who were still on mechanical ventilation) died from intubation-related complications that persisted after tracheal resection (anastomotic dehiscence with mediastinitis and tracheoarterial fistula in the brachiocephalic arterial trunk). ...
This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exac... more This study analyzes a series of iatrogenic tracheal stenosis occurring in patients with COPD exacerbation which required oro-tracheal intubation. The tracheal stenosis occurred on average after 24 days of intubation and were clinically severe. Treatment algorithm first included bronchoscopic interventional techniques with an immediate success rate of 37%, but the results were unstable in time, requiring tracheal stenting. The surgical approach, which generally is the first choice in the treatment of tracheal stenosis, had discouraging results in these patients, with a low rate of success (20%) and an increased incidence of restenosis. The only solution for those postoperative complications was, again, interventional bronchoscopy. In conclusion, while for various other etiologies of tracheal stenosis the surgical resection is the first choice of treatment, in COPD patients interventional bronchoscopy often remains the only way of solving.
Vein pulmonary anomalies are seldom met. They have a prevalence of 0.4-0.7% of the cases (accordi... more Vein pulmonary anomalies are seldom met. They have a prevalence of 0.4-0.7% of the cases (according to the American authors). The case under discussion is a 68-year-old patient, who was admitted in the hospital for hemoptysis in low quantity but recurrent, physical asteny, fever and weight loss. The onset had been two months before admission to the hospital. The thoracic X-ray shows opacity at the left apex with marked subcostal and costal intensity, with a homogenous area of 5/6 cm. The thoracic CT exam shows multiple bilateral fibronodular images and the left upper lobe shows a cavitary image with regular and thin walls; intracavitary there is an oval formation with mixed densities of approximate 3.5/4/4.5 cm, which suggests a lung aspergilloma. Surgery will be performed--left upper lobectomy associated with atypical resection from the left Fowler segment. During the surgery it is noticed that the left upper pulmonary vein is abnormaly in the left pulmonary hilum. It has a cranial trajectory, runs in parallel with the left phrenic nerve on the mediastinal surface of the left upper lobe then goes in the mediastinum and pours into the left vein branchocefalic trunk. The post-surgery recovery was slowly favourable with complete pulmonary re-expansion, but with the persistence of the aerial losses which imposed pleural drainage for a period of over 2 weeks.
The modern treatment of hepato-pleural-pulmonary hydatidosis is based on surgical excision and me... more The modern treatment of hepato-pleural-pulmonary hydatidosis is based on surgical excision and medical treatment with drugs like: Mebendazol, Albendazol or Praziquantel. There are presented 23 patients with multiple hepato-pleuro-pulmonary hydatidosis, operated in the last 4 years. Surgical excision in pleuro-pulmonary hydatidosis is adapted to cysts topography, aiming to eliminate the intact cysts and to close the remaining cavities.
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