Tudor Constantinescu - Academia.edu (original) (raw)
Papers by Tudor Constantinescu
The American journal of pathology, 2015
Maedica, 2013
BACKGROUND Pulmonary arterial hypertension (PAH) represents an emerging pathology in modern medic... more BACKGROUND Pulmonary arterial hypertension (PAH) represents an emerging pathology in modern medicine. Transthoracic echocardiography is an inexpensive and reproducible method and it is the most commonly used non-invasive diagnostic tool to asses pulmonary artery pressure (PAP) and the function of the right ventricle. Although, the right heart catheterization is still considered as the standard for the diagnosis, according to the last guidelines, the new echocardiographic methods may offer an improved value in the PAH evaluation. AIM To evaluate if cardiac ultrasonography data correlate with catheterization results in patients with PAH (Group I Dana Point 2008), and to compare the ultrasonography evaluation of PAH patients with that of normal. METHODS 15 consecutive patients (pts) (52±15 yrs, 5 men, time from onset of symptoms 1.6±1.7 years) with PAH of different aetiologies (12 pts with idiopathic PAH, 2 pts with PAH associated with scleroderma and one with persistent PAH after atri...
Contact address: Alexandru Ioan Deaconu, MD Clinical Emergency Hospital, Department of Cardiology... more Contact address: Alexandru Ioan Deaconu, MD Clinical Emergency Hospital, Department of Cardiology, Bucharest, Romania 8, Calea Floreasca Tel./Fax: 00-4021-3170108; Mobile: 00-4072-7403885 E-mail: alexandru_deaconu@yahoo.com INTRODUCTION Pulmonary arterial hypertension (PAH) is a rare but life-threatening disease. PAH is defi ned as an increase in pulmonary arterial pressure ≥25 mmHg as assesed by right heart catheterization (RHC) associated with a pulmonary artery wedge pressure (PAWP) ≤15 mmHg and a pulmonary vascular resistance (PVR) >3 Wood units in the absence of other causes of precapillary PH1. Echocardiography is currently the most useful method of screening and monitorization for patients diagnosed with PAH, regardless of whether they are undergoing treatment or not. In this category of patients, right ventricular function is a major determinant
Pulmonary arterial hypertension associated with HIV infection is a separate entity. The prevalenc... more Pulmonary arterial hypertension associated with HIV infection is a separate entity. The prevalence is up to one thousand times higher than in general population. The mechanisms are multifactorial and incompletely elucidated. Echocardiography can suggest the diagnosis, but the gold standard method of diagnosing pulmonary arterial hypertension is right heart catheterization. We present clinical and paraclinical findings (NYHA, 6MWD, sPAP, RVGLS) and follow-up in two patients living with HIV, who are included in the Romanian National Program of Pulmonary Arterial Hypertension. In patients, the possible thromboembolism or left heart dysfunction were excluded. Each case has its own particularities, but both of them responded to treatment with sildenafil and improved clinical and paraclinical parameters. Mortality is high, usually due to right heart failure and pulmonary arterial hypertension is considered an independent predictor of death in HIV-infected patients. Co-management with both...
ILD / DPLD of known origin
We present the case of a 37 years old patient with idiopathic pulmonary arterial hypertension (PA... more We present the case of a 37 years old patient with idiopathic pulmonary arterial hypertension (PAH). After initial treatment with calcium channel blockers (CCB), based on a positive vasoreactive response at right heart catheterization, due to disease progression, major vasodilator therapies were introduced in a sequential strategy: sildenafil, bosentan and treprostinil. Finally, the patient received double-lung transplantation with eventually favourable evolution despite immediate postoperative significant complications. Markers of disease progression were monitored before the transplant, and after the intervention the patient was screened according to a specific protocol for bronchiolitis obliterans and infections. According to our knowledge, this case represents a premiere in Romanian medicine, being the first lung transplant in a PAH patient. This case represents a model of PAH with a documented evolution of 8 years. We present the progression of the disease and the effective the...
Background: Echocardiography is currently used as a method of assigning a level of probability fo... more Background: Echocardiography is currently used as a method of assigning a level of probability for pulmonary hypertension (PH), but not for differentiation between pre-capillary and post-capillary PH. We aimed to find echocardiographic parameters able to discriminate between pre-capillary and postcapillary PH. Methods: We analyzed 50 patients referred to our ward from a PH center. Echocardiography was performed according to current guidelines recommendations. Results: There were 2 echocardiographic variables found to distinguish between pre-capillary and post-capillary PH. Patients with post-capillary PH had a more dilated LA and higher values of E/E’ (Table 2) and the correlation had a high statistical significance (p < 0.001) (Table 3). The cut-off values found were: E/E' = 11.6 (with a sensitivity of 0.87 and a specificity of 0.8) and LA volume = 58 mL (with a sensitivity of 0.88 and a specificity of 0.83). Conclusion: Echocardiography, by means of evaluation of the LV dia...
Pneumologia, 2014
UNLABELLED We present the case of a 86-year-old male patient diagnosed with chronic thromboemboli... more UNLABELLED We present the case of a 86-year-old male patient diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) with proximal bilateral obstructions of the pulmonary arteries. The history included systemic hypertension, benign prostate adenoma and in situ colonic adenocarcinoma, cured by local radiotherapy; no prior history of thromboembolic disease was noted. The work-up comprised of a detailed analysis of pulmonary hemodynamics and right ventricular function by echocardiography and right heart catheterization, imagistic evaluation of the pulmonary circulation by contrast tomography, but also a complete evaluation of the left heart, respiratory function, neurologic status, liver and kidney function. A new colonoscopy confirmed the absence of relapse of the colonic carcinoma. The only curative therapy in proximal CTEPH is pulmonary endarterectomy, a very complex surgical procedures available in only a few centres worldwide. The case was discussed in a multidiscipli...
Internal Medicine
A 38-year-old man was admitted to our department with moderate exertional dyspnea, fatigue and a ... more A 38-year-old man was admitted to our department with moderate exertional dyspnea, fatigue and a syncope during exercise. The medical history revealed: left pulmonary sarcoma at the age of four, treated with radiotherapy, chemotherapy and left total pneumonectomy. At admission, laboratory tests showed high BNP (1426 pg/ml), normal calcium and parathormon levels. The transthoracic echocardiography found normal left ventricular (LV) systolic function with severe calcifications of the papillary muscles, mitral annulus, apical segments of the inferior septum and inferior wall (panel A - arrows; panel D) associated with severe mitral regurgitation (panel B). It also revealed severe tricuspid valve regurgitation, severe pulmonary hypertension (estimated to 120 mmHg, panel C) and small amount of pericardial fluid. A thoracic computed tomography described severe cardiac calcifications (panels E and F, arrow), a hypertrophic right lung herniated in left hemythorax and no other pathological f...
Internal Medicine
Introduction. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown origi... more Introduction. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown origin, characterized by multisystemic involvement and a potentially severe evolution. Pulmonary arterial hypertension (PAH) is a rare complication of SLE, with low 5-year survival. Case presentation. We are presenting the case of a female patient, aged 56 years old, diagnosed in 1992 with SLE with cutaneous manifestations (butterfly-shaped erythematous rash), joint manifestations (polyarthritis), serositis manifestations (massive pleuropericarditis), and immunological manifestations (positive anti-dsDNA antibodies, decreased C3), ignored therapeutically for a long time. In 2010 she complained of dyspnea on medium exertion and leg edemas, with marked increase of PAPs by echocardiography. She was diagnosed with severe PAH (confirmed by right heart catheterization) and in the “Marius Nasta” National Institute of Pneumology she started a treatment with an endothelin receptor antagonist (Bosentan...
Pneumologia (Bucharest, Romania)
Lung cancer is responsible for over 1 million deaths annually, worldwide. The disease becomes sym... more Lung cancer is responsible for over 1 million deaths annually, worldwide. The disease becomes symptomatic in advanced stages, so the diagnosis is delayed and 90% of cases cannot benefit from a curative treatment. In NSCLC surgical resection represents the best option for long term survival in resectable stage III and in clinical stage I/II. Patients with stage IIIB or IV usually receive chemotherapy or palliative treatment. For patients with no driver mutation detected platinum based combination chemotherapy is the first choice. Definitive radiotherapy is considered an lternative for patients who are not candidates for combined modality treatment. When a stage IV cancer is diagnosed based on an isolated metastasis, the patient’s benefit from the removal of the etastasis and of the primary tumor if it is resectable. The prognosis in NSLC is mainly influenced by the TNM stage at diagnosis. The rate of survival decreases in opposing correlation with the stage of the cancer. Poor perfor...
European Respiratory Journal, Sep 1, 2014
European Respiratory Journal, Sep 1, 2012
Pneumologia (Bucharest, Romania)
We present the case of a 86-year-old male patient diagnosed with chronic thromboembolic pulmonary... more We present the case of a 86-year-old male patient diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) with proximal bilateral obstructions of the pulmonary arteries. The history included systemic hypertension, benign prostate adenoma and in situ colonic adenocarcinoma, cured by local radiotherapy; no prior history of thromboembolic disease was noted. The work-up comprised of a detailed analysis of pulmonary hemodynamics and right ventricular function by echocardiography and right heart catheterization, imagistic evaluation of the pulmonary circulation by contrast tomography, but also a complete evaluation of the left heart, respiratory function, neurologic status, liver and kidney function. A new colonoscopy confirmed the absence of relapse of the colonic carcinoma. The only curative therapy in proximal CTEPH is pulmonary endarterectomy, a very complex surgical procedures available in only a few centres worldwide. The case was discussed in a multidisciplinary meetin...
Mædica, 2013
Pulmonary arterial hypertension (PAH) represents an emerging pathology in modern medicine. Transt... more Pulmonary arterial hypertension (PAH) represents an emerging pathology in modern medicine. Transthoracic echocardiography is an inexpensive and reproducible method and it is the most commonly used non-invasive diagnostic tool to asses pulmonary artery pressure (PAP) and the function of the right ventricle. Although, the right heart catheterization is still considered as the standard for the diagnosis, according to the last guidelines, the new echocardiographic methods may offer an improved value in the PAH evaluation. To evaluate if cardiac ultrasonography data correlate with catheterization results in patients with PAH (Group I Dana Point 2008), and to compare the ultrasonography evaluation of PAH patients with that of normal. 15 consecutive patients (pts) (52±15 yrs, 5 men, time from onset of symptoms 1.6±1.7 years) with PAH of different aetiologies (12 pts with idiopathic PAH, 2 pts with PAH associated with scleroderma and one with persistent PAH after atrial septal defect (ASD) ...
Revue des Maladies Respiratoires, 2007
Évaluer pour le mésothéliome pleural malin (MPM), la capacité du bilan radiologique pré opératoir... more Évaluer pour le mésothéliome pleural malin (MPM), la capacité du bilan radiologique pré opératoire à déterminer l'étendue et le caractère résécable de la maladie. Matériel et méthodes : Étude prospective portant sur des patients bénéficiant d'un protocole associant une pneumonectomie extrapleurale associée à une irradiation de l'hémithorax à 40 Gy. Une classification TNM selon l'IMIG est réalisée par l'imagerie associant scanner et/ou IRM. Elle est comparée à celle fournie par l'examen anatomopathologique de la pièce de résection. Résultats : 28 patients inclus de 2001 à 2006, 21 hommes pour 7 femmes, 21 ont été exposés à l'amiante, âge médian 62 ans. Tous les patients ont eu un examen tomodensitométrique dont 6 un scanner multi coupe ; 21 ont eu scanner et IRM. Évaluation de l'extension locale (T) par scanner et/ou IRM : 13 cas sous estimés, 2 cas correctement estimés, 13 cas surestimés. Évaluation de l'extension locale (T) par scanner uniquement (7 cas dont 5 scanners multi coupe) : 0 cas sous estimé, 6 cas correctement estimés, 1 cas surestimé. Évaluation de l'extension ganglionnaire (N) par scanner et/ou IRM : 10 cas sous estimés, 13 cas correctement estimés, 2 cas sur estimés, un cas n'a pas eu de curage ganglionnaire. Un cas n'a pu bénéficier d'une pneumonectomie extrapleurale. Conclusion : L'étude montre une sous-évaluation de l'extension des lésions par le scanner et l'IRM. Cependant l'imagerie reste performante pour définir la résécabilité.
Mædica, 2014
We present the case of a 37 years old patient with idiopathic pulmonary arterial hypertension (PA... more We present the case of a 37 years old patient with idiopathic pulmonary arterial hypertension (PAH). After initial treatment with calcium channel blockers (CCB), based on a positive vasoreactive response at right heart catheterization, due to disease progression, major vasodilator therapies were introduced in a sequential strategy: sildenafil, bosentan and treprostinil. Finally, the patient received double-lung transplantation with eventually favourable evolution despite immediate postoperative significant complications. Markers of disease progression were monitored before the transplant, and after the intervention the patient was screened according to a specific protocol for bronchiolitis obliterans and infections. According to our knowledge, this case represents a premiere in Romanian medicine, being the first lung transplant in a PAH patient. This case represents a model of PAH with a documented evolution of 8 years. We present the progression of the disease and the effective the...
European Respiratory Journal, Sep 1, 2014
The American journal of pathology, 2015
Maedica, 2013
BACKGROUND Pulmonary arterial hypertension (PAH) represents an emerging pathology in modern medic... more BACKGROUND Pulmonary arterial hypertension (PAH) represents an emerging pathology in modern medicine. Transthoracic echocardiography is an inexpensive and reproducible method and it is the most commonly used non-invasive diagnostic tool to asses pulmonary artery pressure (PAP) and the function of the right ventricle. Although, the right heart catheterization is still considered as the standard for the diagnosis, according to the last guidelines, the new echocardiographic methods may offer an improved value in the PAH evaluation. AIM To evaluate if cardiac ultrasonography data correlate with catheterization results in patients with PAH (Group I Dana Point 2008), and to compare the ultrasonography evaluation of PAH patients with that of normal. METHODS 15 consecutive patients (pts) (52±15 yrs, 5 men, time from onset of symptoms 1.6±1.7 years) with PAH of different aetiologies (12 pts with idiopathic PAH, 2 pts with PAH associated with scleroderma and one with persistent PAH after atri...
Contact address: Alexandru Ioan Deaconu, MD Clinical Emergency Hospital, Department of Cardiology... more Contact address: Alexandru Ioan Deaconu, MD Clinical Emergency Hospital, Department of Cardiology, Bucharest, Romania 8, Calea Floreasca Tel./Fax: 00-4021-3170108; Mobile: 00-4072-7403885 E-mail: alexandru_deaconu@yahoo.com INTRODUCTION Pulmonary arterial hypertension (PAH) is a rare but life-threatening disease. PAH is defi ned as an increase in pulmonary arterial pressure ≥25 mmHg as assesed by right heart catheterization (RHC) associated with a pulmonary artery wedge pressure (PAWP) ≤15 mmHg and a pulmonary vascular resistance (PVR) >3 Wood units in the absence of other causes of precapillary PH1. Echocardiography is currently the most useful method of screening and monitorization for patients diagnosed with PAH, regardless of whether they are undergoing treatment or not. In this category of patients, right ventricular function is a major determinant
Pulmonary arterial hypertension associated with HIV infection is a separate entity. The prevalenc... more Pulmonary arterial hypertension associated with HIV infection is a separate entity. The prevalence is up to one thousand times higher than in general population. The mechanisms are multifactorial and incompletely elucidated. Echocardiography can suggest the diagnosis, but the gold standard method of diagnosing pulmonary arterial hypertension is right heart catheterization. We present clinical and paraclinical findings (NYHA, 6MWD, sPAP, RVGLS) and follow-up in two patients living with HIV, who are included in the Romanian National Program of Pulmonary Arterial Hypertension. In patients, the possible thromboembolism or left heart dysfunction were excluded. Each case has its own particularities, but both of them responded to treatment with sildenafil and improved clinical and paraclinical parameters. Mortality is high, usually due to right heart failure and pulmonary arterial hypertension is considered an independent predictor of death in HIV-infected patients. Co-management with both...
ILD / DPLD of known origin
We present the case of a 37 years old patient with idiopathic pulmonary arterial hypertension (PA... more We present the case of a 37 years old patient with idiopathic pulmonary arterial hypertension (PAH). After initial treatment with calcium channel blockers (CCB), based on a positive vasoreactive response at right heart catheterization, due to disease progression, major vasodilator therapies were introduced in a sequential strategy: sildenafil, bosentan and treprostinil. Finally, the patient received double-lung transplantation with eventually favourable evolution despite immediate postoperative significant complications. Markers of disease progression were monitored before the transplant, and after the intervention the patient was screened according to a specific protocol for bronchiolitis obliterans and infections. According to our knowledge, this case represents a premiere in Romanian medicine, being the first lung transplant in a PAH patient. This case represents a model of PAH with a documented evolution of 8 years. We present the progression of the disease and the effective the...
Background: Echocardiography is currently used as a method of assigning a level of probability fo... more Background: Echocardiography is currently used as a method of assigning a level of probability for pulmonary hypertension (PH), but not for differentiation between pre-capillary and post-capillary PH. We aimed to find echocardiographic parameters able to discriminate between pre-capillary and postcapillary PH. Methods: We analyzed 50 patients referred to our ward from a PH center. Echocardiography was performed according to current guidelines recommendations. Results: There were 2 echocardiographic variables found to distinguish between pre-capillary and post-capillary PH. Patients with post-capillary PH had a more dilated LA and higher values of E/E’ (Table 2) and the correlation had a high statistical significance (p < 0.001) (Table 3). The cut-off values found were: E/E' = 11.6 (with a sensitivity of 0.87 and a specificity of 0.8) and LA volume = 58 mL (with a sensitivity of 0.88 and a specificity of 0.83). Conclusion: Echocardiography, by means of evaluation of the LV dia...
Pneumologia, 2014
UNLABELLED We present the case of a 86-year-old male patient diagnosed with chronic thromboemboli... more UNLABELLED We present the case of a 86-year-old male patient diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) with proximal bilateral obstructions of the pulmonary arteries. The history included systemic hypertension, benign prostate adenoma and in situ colonic adenocarcinoma, cured by local radiotherapy; no prior history of thromboembolic disease was noted. The work-up comprised of a detailed analysis of pulmonary hemodynamics and right ventricular function by echocardiography and right heart catheterization, imagistic evaluation of the pulmonary circulation by contrast tomography, but also a complete evaluation of the left heart, respiratory function, neurologic status, liver and kidney function. A new colonoscopy confirmed the absence of relapse of the colonic carcinoma. The only curative therapy in proximal CTEPH is pulmonary endarterectomy, a very complex surgical procedures available in only a few centres worldwide. The case was discussed in a multidiscipli...
Internal Medicine
A 38-year-old man was admitted to our department with moderate exertional dyspnea, fatigue and a ... more A 38-year-old man was admitted to our department with moderate exertional dyspnea, fatigue and a syncope during exercise. The medical history revealed: left pulmonary sarcoma at the age of four, treated with radiotherapy, chemotherapy and left total pneumonectomy. At admission, laboratory tests showed high BNP (1426 pg/ml), normal calcium and parathormon levels. The transthoracic echocardiography found normal left ventricular (LV) systolic function with severe calcifications of the papillary muscles, mitral annulus, apical segments of the inferior septum and inferior wall (panel A - arrows; panel D) associated with severe mitral regurgitation (panel B). It also revealed severe tricuspid valve regurgitation, severe pulmonary hypertension (estimated to 120 mmHg, panel C) and small amount of pericardial fluid. A thoracic computed tomography described severe cardiac calcifications (panels E and F, arrow), a hypertrophic right lung herniated in left hemythorax and no other pathological f...
Internal Medicine
Introduction. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown origi... more Introduction. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown origin, characterized by multisystemic involvement and a potentially severe evolution. Pulmonary arterial hypertension (PAH) is a rare complication of SLE, with low 5-year survival. Case presentation. We are presenting the case of a female patient, aged 56 years old, diagnosed in 1992 with SLE with cutaneous manifestations (butterfly-shaped erythematous rash), joint manifestations (polyarthritis), serositis manifestations (massive pleuropericarditis), and immunological manifestations (positive anti-dsDNA antibodies, decreased C3), ignored therapeutically for a long time. In 2010 she complained of dyspnea on medium exertion and leg edemas, with marked increase of PAPs by echocardiography. She was diagnosed with severe PAH (confirmed by right heart catheterization) and in the “Marius Nasta” National Institute of Pneumology she started a treatment with an endothelin receptor antagonist (Bosentan...
Pneumologia (Bucharest, Romania)
Lung cancer is responsible for over 1 million deaths annually, worldwide. The disease becomes sym... more Lung cancer is responsible for over 1 million deaths annually, worldwide. The disease becomes symptomatic in advanced stages, so the diagnosis is delayed and 90% of cases cannot benefit from a curative treatment. In NSCLC surgical resection represents the best option for long term survival in resectable stage III and in clinical stage I/II. Patients with stage IIIB or IV usually receive chemotherapy or palliative treatment. For patients with no driver mutation detected platinum based combination chemotherapy is the first choice. Definitive radiotherapy is considered an lternative for patients who are not candidates for combined modality treatment. When a stage IV cancer is diagnosed based on an isolated metastasis, the patient’s benefit from the removal of the etastasis and of the primary tumor if it is resectable. The prognosis in NSLC is mainly influenced by the TNM stage at diagnosis. The rate of survival decreases in opposing correlation with the stage of the cancer. Poor perfor...
European Respiratory Journal, Sep 1, 2014
European Respiratory Journal, Sep 1, 2012
Pneumologia (Bucharest, Romania)
We present the case of a 86-year-old male patient diagnosed with chronic thromboembolic pulmonary... more We present the case of a 86-year-old male patient diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) with proximal bilateral obstructions of the pulmonary arteries. The history included systemic hypertension, benign prostate adenoma and in situ colonic adenocarcinoma, cured by local radiotherapy; no prior history of thromboembolic disease was noted. The work-up comprised of a detailed analysis of pulmonary hemodynamics and right ventricular function by echocardiography and right heart catheterization, imagistic evaluation of the pulmonary circulation by contrast tomography, but also a complete evaluation of the left heart, respiratory function, neurologic status, liver and kidney function. A new colonoscopy confirmed the absence of relapse of the colonic carcinoma. The only curative therapy in proximal CTEPH is pulmonary endarterectomy, a very complex surgical procedures available in only a few centres worldwide. The case was discussed in a multidisciplinary meetin...
Mædica, 2013
Pulmonary arterial hypertension (PAH) represents an emerging pathology in modern medicine. Transt... more Pulmonary arterial hypertension (PAH) represents an emerging pathology in modern medicine. Transthoracic echocardiography is an inexpensive and reproducible method and it is the most commonly used non-invasive diagnostic tool to asses pulmonary artery pressure (PAP) and the function of the right ventricle. Although, the right heart catheterization is still considered as the standard for the diagnosis, according to the last guidelines, the new echocardiographic methods may offer an improved value in the PAH evaluation. To evaluate if cardiac ultrasonography data correlate with catheterization results in patients with PAH (Group I Dana Point 2008), and to compare the ultrasonography evaluation of PAH patients with that of normal. 15 consecutive patients (pts) (52±15 yrs, 5 men, time from onset of symptoms 1.6±1.7 years) with PAH of different aetiologies (12 pts with idiopathic PAH, 2 pts with PAH associated with scleroderma and one with persistent PAH after atrial septal defect (ASD) ...
Revue des Maladies Respiratoires, 2007
Évaluer pour le mésothéliome pleural malin (MPM), la capacité du bilan radiologique pré opératoir... more Évaluer pour le mésothéliome pleural malin (MPM), la capacité du bilan radiologique pré opératoire à déterminer l'étendue et le caractère résécable de la maladie. Matériel et méthodes : Étude prospective portant sur des patients bénéficiant d'un protocole associant une pneumonectomie extrapleurale associée à une irradiation de l'hémithorax à 40 Gy. Une classification TNM selon l'IMIG est réalisée par l'imagerie associant scanner et/ou IRM. Elle est comparée à celle fournie par l'examen anatomopathologique de la pièce de résection. Résultats : 28 patients inclus de 2001 à 2006, 21 hommes pour 7 femmes, 21 ont été exposés à l'amiante, âge médian 62 ans. Tous les patients ont eu un examen tomodensitométrique dont 6 un scanner multi coupe ; 21 ont eu scanner et IRM. Évaluation de l'extension locale (T) par scanner et/ou IRM : 13 cas sous estimés, 2 cas correctement estimés, 13 cas surestimés. Évaluation de l'extension locale (T) par scanner uniquement (7 cas dont 5 scanners multi coupe) : 0 cas sous estimé, 6 cas correctement estimés, 1 cas surestimé. Évaluation de l'extension ganglionnaire (N) par scanner et/ou IRM : 10 cas sous estimés, 13 cas correctement estimés, 2 cas sur estimés, un cas n'a pas eu de curage ganglionnaire. Un cas n'a pu bénéficier d'une pneumonectomie extrapleurale. Conclusion : L'étude montre une sous-évaluation de l'extension des lésions par le scanner et l'IRM. Cependant l'imagerie reste performante pour définir la résécabilité.
Mædica, 2014
We present the case of a 37 years old patient with idiopathic pulmonary arterial hypertension (PA... more We present the case of a 37 years old patient with idiopathic pulmonary arterial hypertension (PAH). After initial treatment with calcium channel blockers (CCB), based on a positive vasoreactive response at right heart catheterization, due to disease progression, major vasodilator therapies were introduced in a sequential strategy: sildenafil, bosentan and treprostinil. Finally, the patient received double-lung transplantation with eventually favourable evolution despite immediate postoperative significant complications. Markers of disease progression were monitored before the transplant, and after the intervention the patient was screened according to a specific protocol for bronchiolitis obliterans and infections. According to our knowledge, this case represents a premiere in Romanian medicine, being the first lung transplant in a PAH patient. This case represents a model of PAH with a documented evolution of 8 years. We present the progression of the disease and the effective the...
European Respiratory Journal, Sep 1, 2014