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Pulmonary rehabilitation represents a modern therapeutic approach of respiratory diseases, with a multidisciplinary character, including: physical training, therapeutic education, psychosocial counseling, and nutritional approach. Pulmonary rehabilitation addresses to any patient suffering from pulmonary pathology whose quality of life is affected by the respiratory symptoms, regardless of the degree of functional impairment. This article is an analysis of evidences from the medical literature on outcomes of rehabilitation programs conducted in various lung diseases. The main indication of pulmonary rehabilitation is the chronic obstructive pulmonary disease - COPD (stable state and exacerbation) in which most studies were carried out. Pulmonary rehabilitation in patients with other respiratory pathology has its reason in the pathophysiological changes that they undergo (impaired lung function and gas exchange, muscle atrophy and deconditioning etc.) leading to symptoms, lower exercise tolerance and decrease daily physical activity, all of which ultimately result in impaired quality of life. The role of rehabilitation is reviewed in the following diseases: post-surgical lung volume reduction for emphysema, asthma, bronchiectasis, interstitial lung disease, cystic fibrosis, lung cancer, neuromuscular disease, intensive care, obstructive sleep apnea, pulmonary hypertension, post-tuberculous sequelae, lung transplantation.

Respiratory muscles are essential in maintaining normal ventilation and adequate gas exchanges. Any imbalance in their function can lead to clinical symptoms: dyspnea, hypercapnia, exercise intolerance, ineffective cough. In the pulmonary rehabilitation a particular area is represented by the respiratory muscle training in various lung diseases. Inspiratory muscles training, particularly in COPD patients, has a beneficial effect, resulting in increased strength and endurance of respiratory muscles, decreased dyspnea level, improved quality of life and exercise tolerance. It is a therapy that can be used alone or in combination with generalized physical training, especially in patients with inspiratory muscle weakness.

Esophageal resection remains a dreadfull surgical intervention accompanied by consistently higher morbidity and mortality when compared with other surgical procedures. The respiratory complications are the most important contributor to morbidity and mortality after this kind of surgery. Intimate knowledge on risk factors and physiopathology and careful treatment of these complications go with good postoperative results. This article discusses the factors affecting respiratory complications and strategies to reduce the incidence of these complications after esophagectomy

Identifying and promoting new management techniques for the descentralized pneumology hospitals or wards was one of the most ambitious objectives of the project "Quality in the pneumology medical services through continuous medical education and organizational flexibility", financed by the Human Resourses Development Sectorial Operational Programme 2007-2013 (ID 58451). The "Medium term Strategy on the specific management of the pneumology hospitals or wards after the descentralization of the sanitary system" presented in the article was written by the project's experts and discussed with pneumology managers and local authorities representatives. This Strategy application depends on the colaboration of the pneumology hospitals with professional associations, and local and central authorities.

We present the case of a 51 years old female-patient, with severe dextroscoliosis, having like unique symptom progressive dyspnea. The blood samples reveals polycythemia, the radiological exam shows the opacification of 2/3 of the left thorax, the absence of the lung structure in the other 1/3, the deviation of the mediastinum, and dextroscoliosis; the computed tomography reveals the absence of the left lung artery and the left airways, compensatory hyperinflation of the right lung and dilatation of the trunk and right pulmonary artery; the bronchoscopy does not visualize the carina or the left main bronchus, typical for pulmonary agenesis. Echocardiography confirmed the absence of left pulmonary artery and shows mild pulmonary hypertension (systolic pressure in the pulmonary artery of 33 mmHg) with dilatation of the right cavities, but good cinetics. We face a case of pulmonary agenesis lately diagnosed, with modest functional cardiologic implications, limited therapeutic options and good survival, justified by the late appearance of the pulmonary hypertension of low severity and without worsening in time.

The experts of manipulation are using six principles of persuasion: the consistency, the reciprocity, the social proof; the authority, the sympathy, the rarity. The publicity gets them together in different ways.To establish if the principles of persuasion affect the smoker with or without pulmonary diseases.There were two groups of smokers for a transversal descriptive study: patients from pulmonology hospitals in Bucharest and persons from ambulatory service. The patients were visited in 2003 and 2005. The nest selection (wards) was used. The persons in ambulatory had no known respiratory diseases; they came in two campaigns in 2004--"No smoke" and another to detect asthma. A self-administered questionnaire was used with items about demographic characteristics and the influence of persuasion distributed by age and gender. The data were processed by per cent or by Student test and the Pearson coefficient.There were 428 smokers, 69% men, mean age 45 years. Irrespective of group, men were receptive to publicity (p0.01) and rarity (p0.01); women were sensitive to social proof (p0.01), reciprocity (p0.01), sympathy (p0.05). To social proof; in group 18-30 years, the answers were 80-100%, in either group. To consistency, in group over 31 years, the answers were 80-100% in both groups of smokers.Through persuasion, to men is stimulated the spirit of competition; to women the specific of their personality. The youth are influenced by other smokers; the adults are consistent with their habit. The presence or absence of pulmonary diseases is not relevant for automatic behavior.

We present a survey of 78 TLB which have been performed in Bronchology Service (during 2003-2005) for diffuse interstitial lung diseases--70 cases or located diseases--8 cases; TLB was not performed for solitary peripherally opacities because we have no radiological device with mobile arm (for good position of forceps).In 78% of cases we obtained illustrative lung tissue and in 22% of cases we prelevated just bronchial wall. Histological confirmation was obtained for 53% of cases; 47% of cases have as result lung tissue without significant modifications. Histological diagnosis was obtain in 41% of cases. The diagnosis of lung pathology was: diffuse lung fibrosis, tuberculosis, sarcoidosis stage II-III, malignant lymphoma, carcinomatosis, undifferentiated carcinoma, bronchioloalveolar carcinoma, squamous carcinoma, adenocarcinoma. There were 5 cases (6%) of small pneumothorax with spontaneous resorption and 11 cases with small bleeding (5-10 ml) who stopped spontaneously or at local administration of xilometasolin or oximetasolin. No other incidents were registered.TLB is a good alternative of surgical biopsy. The international guidelines request that the TLB has to be made before the thoracoscopy or the thoracotomy; because of the small size of prelevated fragments the diagnosis sensibility is variable. Our results for the 78 cases are comparable with the international data from literature both from the point of view of the diagnosis and the complications.

The article presents the case of a female admitted for the suspicion of pulmonary TB (clinical and radiological pattern compatible with this diagnosis), in which the lack of bacteriological confirmation together with a rapid and dramatic deterioration of clinical, radiological and functional status excluded tuberculosis and oriented the diagnosis towards a severe alveolar hemorrhage; further tests confirmed a Wegener granulomatosis with pulmonary, renal and ORL manifestations. The evolution was rapidly favorable using pulse-therapy with cyclophosphamide and methylprednisolone i.v. The particularities of this case were: the use of helmet device for correction of the extremely severe hypoxemia for 3 weeks (no other studies reported such a long continuous duration of use of this device) and the lag between the pulmonary and the renal impairment.

Development of non-invasive markers of airway inflammation and remodelling is needed for diagnosis and monitoring of respiratory diseases, like asthma, COPD and interstitial lung diseases. This review is the first in a series evaluating the actual status of this process and is dedicated to induced sputum. We describe the methods of sputum induction, with special reference to efficiency and safety, especially in asthma patient. Methods of sputum processing are reviewed according to the end result: differential cell count, soluble markers assays, and also immunocytochemistry and in situ hybridisation. Finally we review the use of induced sputum in the evaluation of inflammation and remodelling in asthma and COPD and also in the evaluation of inflammation in chronic cough and interstitial lung diseases.

The observation of an massive thoracic opacity at a patient with minimum symptoms, without considerable medical history makes etiologic diagnosis difficult. An uncommon cause is thoracic ectopia of the kidney and a supplementary liver lobe, both in a common mass with fatty tissue and an external fascis, above the diaphragm, with tumor-like appearance. This malformation of kidney and liver is congenital but the diagnosis may be made in adulthood and is useful for further monitoring and prognosis.

A clinical case of dysembryoplasic benign tumor, respectively a lung hamartoma, is presented. In this case, the pre-operational diagnosis was malignant tumor at the operationally limit, but the histopathological examination of the operational specimen was of lung hamartoma.

This study aimed to establish the bacterial profile of bronchopulmonary infections confirmed by the cytobacteriological examination of sputum, in order to find therapeutical guidelines for empirical treatment. We included in the study 408 patients with clinical signs of bronchopulmonary infection (cough and mucopurulent sputum, fever) among which 294 hospitalised patients (5.5% of the 5280 admitted in 1997) and 114 outpatients. The sputum samples collected respecting the decontamination methods were examined cytobacteriologically (smear, culture and antibiogram). The spectrum of isolated bacteria was the following: H. influenzae--198 cases, anaerobes--54, Kl. pneumoniae--53, Ps. aeruginosa--50, S. pneumoniae--17. Analyzing the diseases for which the bacterial examination was performed, we found the following distribution: COPD--66, bacterial infections in TB patients--61, chronic suppurations--33, bronchiectasis--37, pulmonary abscess--24. We noticed the high frequency of H. influenzae and important numbers of anaerobes, Kl. pneumoniae and Ps. aeruginosa especially in COPD patients and patients with chronic suppurations. We performed antibiograms for establishing the sensitivity of bacterial samples (S. aureus, Kl. pneumoniae, Ps. aeruginosa, beta-lactamase-positive H. influenzae). Most of them were multidrug-resistant.1. The cytobacteriological study of sputum may be useful for choosing the right treatment, especially for the patients with multiple antibiotic treatments and infected with multidrug resistant bacteria; 2. Knowing the bacterial spectrum in certain respiratory diseases allows the choice of empirical treatment for bronchopulmonary infections in uncomplicated cases.

A new case of alveolar microlithiasis is reported, demanding for the diagnosis besides the radio-clinical investigations, complete respiratory function tests, also the pathologic proof. Authors recall the diagnostic approach and our present ignorance of the pathogenesis of this curious entity; no valid therapy is presently able to check the relentless course toward progressive respiratory failure.

After a brief review concerning NO biosynthesis, distribution and actions, its main normal and pathological implications are presented. The NO modulatory role on the bronchiolar and vascular smooth muscle basal tone, as well as its involvement in local inflammatory reactions are shown. Physiopathological broncho-pulmonary NO implications are completed with data concerning its inhalatory use in the treatment of pulmonary arterial hypertension, acute respiratory distress syndrome and severe pneumonia.

We studied 60 patients with collagen-vascular diseases with pulmonary manifestations (SLE-25; SSc-13; mixed connective tissue disease-12; RA-6; PD-DM-3; ankylosing spondylitis-1), 54 females and 6 males, mean age 42.4 +/- 9.9 years. We measured lung volumes (total lung capacity-TLC) by spirography (Flowscreen Jaeger) and body plethysmography (Bodyplethismograph Jaeger); compliance of the lungs (CL) and elastic recoil pressures at 100%, 80% and 70% TLC (PL,el 100%, 80%, 70% TLC) by the esophageal catheter method; diffusing capacity of the lungs by the single-breath method (DL,COSB) (Alveo-Diffusionstest Jaeger). DL,CO was diminished in 45 (75%) of cases. 11 patients (18.3%) had an increased elastic recoil, equally distributed between mild and severe decrease of DL,CO. Statistical significant correlations were found between TLC-DL,CO (r = 0.63; p0.001) and TL-CL (r = 0.49; p0.001). No correlations were found between DL,CO and PL,el 100, 80, 70% TLC. The results are expressed as percent of predicted value (% pred.). The mean values and standard deviation (X +/- sd) were calculated.I) DL,CO is the most frequent altered pulmonary function test in collagen-vascular diseases with pulmonary manifestations; it seems to be a sensible parameter for diagnosing these diseases. 2) The alteration of DL,CO,CL and PL,el appears to be rather as a result of "shrinking lungs" due to respiratory muscle involvement than to an interstitial lung disease. 3) Elastic recoil pressures and compliance should be considered as routine pulmonary function test, important for the evaluation of treatment and prognosis.

The evolution of a toxic shock syndrome in a young adult has yielded particular pleural and lung lesions concomittantly with phenomena of insufficiency of other organs and systems (kidney, digestive, CNS a.o.). X-ray aspect of bilateral bronchopneumonia with small diffuse infiltrates are noted, together with an aspect of bilateral spontaneous pneumothorax, which appeared successively with a tendency to relapse. Hemodynamic alterings during the acute phase of the syndrome initiated by staphylococcal exotoxin are similar to those during the initial phase of the septic shock, requiring a careful monitoring during the treatment.

The study starts with presentation of present day knowledge of the disease. Its features are predominantly X-ray images consisting mainly in a round or ovular, usually solitary formation ("coin lesion"). The clinical expression of the disease is usually very discrete, the general state unmodified. The X-ray evidencing follows a routine examination. 3 cases of personal observations are presented. All cases were solved by surgery, by removal of tumour. Etiology is fixed by histological examination of surgery specimen. All aspects risen by the differential diagnosis are largely discussed focusing on lung granuloma (e.g. tuberculoma) lung abscess, limited pneumonia, lipoid pneumonia a.o. Hamartomas are of mesenchymal origin, they are not considered just as tumours but very similar to "tumour-like", without invasive evolution.

HIV infection and its final form as AIDS were ignored by the public opinion in Romania till 1990. Nowadays it is real fact in our country. Out of total number of 2235 AIDS cases declared till March 1st 1993 by the Ministry of Health only 134 were adult persons. The study concerns 65 cases of AIDS in adults in order to find out the lung symptoms proportion as etiologic features, to settle the ways of transmission of HIV infection and to warn the romanian pneumologists on this problem. The study shows that in 56.9% of total cases, lung symptoms were noted and in 49.2% the lung disease revealed the AIDS. Out of the total number of 65 cases, 24.6% showed tuberculosis as a first disease, 12.4% lung pneumocystosis, 7.76 Kaposi syndrome with lung expression and 4.5% other pneumopathies.

A group of 188 adult subjects has been studied as follows: 119 cases of pulmonary tb confirmed by smear and/or culture; 44 cases with other chronic lung diseases; 25 healthy persons. The following serological tests have been performed: immunofluorescence indirect test (FA) using mycobacterial total antigen; ELISA test using two antigens: PPD and a freeze dried crude sonicated extract from H37Rv strain (antigen "Prague"). The results show: sensitivity 77% for FA and 71% for ELISA; specificity 81% for FA and 86% for ELISA. If all positive results (to one or both tests) are being considered the sensitivity increases to 81% but specificity decreases to 77%. The ELISA test with both antigens succeeds in a good discrimination between lung active tb on one side and lung non-tb cases and healthy persons on the other side (p0.001). Using comparatively the two antigens in ELISA test a higher serological confirmation of active tb is reached with "Prague" antigen: 72.7% vs 62.8% with PPD (p0.025).

The problem of the drug induced pulmonary toxicity (cytotoxic and non-cytotoxic drugs) is discussed. This domain of modern pathology is in continuous development, although yet insufficiently delineated. The essential pathogenic mechanisms are presented as well as the main histopathological lesions (i.e., interstitial pneumonia and pulmonary fibrosis). The usual lesional aspects specific to certain drugs are also reviewed. For the principal chemical substances in this category, the clinical and radiological aspects are given, also the various treatment indicated, the evolution and the prognosis of the drugs induced pulmonary disease.

The paper deals with 3 cases of sclerodermia with pulmonary determinations detected by clinical, radiological, functional and histopathological means, of diffuse interstitial fibrosis type. The association with bronchopulmonary cancer is pointed out in one case only.

Two hundred patients with various chronic pulmonary diseases were treated with the bacterial lysate Broncho-Vaxom (BV) in addition to conventional treatment, or alone, over a period of 2 years. The efficacy of BV was assessed ob the basis of clinical symptoms (dyspnoea, cough, expectoration, fever and bronchial rales), pulmonary function, number of relapses and immune status, in particular serum immunoglobulins A, G and M. The results demonstrated the efficacy of BV in the treatment and prevention of chronic pulmonary disease. In patients treated with BV, clinical symptoms improved significantly compared to controls, incidence of infectious episodes was reduced and impaired immune functions were restored. BV was generally well tolerated.

After a short review of phakomatosis nosology, the paper deals with 3 clinical cases, out of which two of Recklinghausen neurofibromatosis and one of tuberous sclerosis (Bourneville's disease), all of them with pulmonary determinations, confirmed bioptically and histopathologically. A "florid" cutaneous syndrome (including all the variants of skin lesions) dating from childhood, subsequently accompanied by phenomena of psychical involution and behaviour troubles were present in two cases; retinal lesions were also associated in the third case. Visceral intrapulmonary determinations (i.e. diffuse interstitial fibrosis, and even bronchopulmonary neoplasm in one case) were registered in all cases, too. The diagnostic importance of investigating all apparatus, systems and organs which can be jointly involved in phakomatosis is emphasized. The importance of an inquiry regarding family history is also noticed. For the studied cases, the contribution of complementary (psycho-neurological, ophthalmological, orthopaedic a.s.o.) examinations--though quite valuable--took a back seat in comparison with the essential elements provided by the dermatological and histopathological examinations.

Clinical and paraclinical experience in HIV infection, though the time elapsed since the first observations is relatively short, begins to get typical outlines. In the case of AIDS, the lung is the main place of opportunistic infections, other inflammatory processes and neoplasia. The present work deals with six clinical cases with positive serum tests for HIV and secondary respiratory phenomena such as: Kaposi sarcoma, pneumonia with Pneumocystis carinii, tuberculosis, candidosis, pneumonia with common germs. Particular aspects of treatment and disease evolution are commented.

The authors show that the medical pneumologic practice meets cases in which, after the accumulation and interpretation of the clinical and paraclinical investigation results and after leaving aside the sets of the improbable, no certain diagnosis can be established. The possible reasons of this failure are: the physician's lack of experience in a radiographic chapter, lack of endowment of that medical unit, patient's refusal to be examined or the atypical evolution of the disease. The authors present two such cases, in which, due to the above-mentioned reasons, no certain diagnosis could be established.