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CLINICAL CASES

Cystic fibrosis-related diabetes in adolescents

Svetlana Sciuca, Andrian Chiriac, Serghei Covanțev, Xenia Bondareva, Ludmila Balanețchi
Cystic fibrosis-related diabetes in adolescents
Cystic fibrosis-related diabetes is the most common comorbidity of cystic fibrosis patients. It may occur at any age, even in infancy, but the prevalence increases as patients get older. We present a case of a female patient (15 years old) and a male patient (17 years old) hospitalized at the Cystic Fibrosis Center. The patients had lung symptoms as chronic daily cough with mucopurulent, yellow dark viscous sputum in large quantity, intensefied in the morning, with recurrent streaks of blood, dyspnea during moderate physical effort and permanent wheezing. The main complaints were polyuria, polydipsia and after the laboratory tests were performed, they were diagnosed with cystic fibrosis-related diabetes. Cystic fibrosis-related diabetes can be frequently overlooked in clinical practice due to cystic fibrosis symptoms.
Keywords: cystic fibrosis, cystic fibrosis-related diabetes, cystic fibrosis comorbidities

Airway stenting for advanced lung cancer with central airway obstruction a case report

Mărioara Simon, Antonia Haranguș, Ioan Sergiu, Ioan Simon
Airway stenting for advanced lung cancer with central airway obstruction a case report
About 30% of patients diagnosed with lung cancer present endoluminal involvement that cause central airway obstruction (CAO). The debulking endoscopic techniques are: electrocautery, laser therapy, cryotherapy, argon plasma coagulation, mechanical debulking using rigid bronchoscopy and stenting with immediate and delayed effect. Endobronchial stenting has an immediate palliative effect for patients with CAO, significantly improving their quality of life. In this paper, we present the case of a 62-year-old, former smoker patient, admitted at the emergency department for an acute respiratory failure accompanied by stridor and hemoptysis. The medical imaging procedures described a mediastinal tumor, while the endoscopic findings showed mixed obstruction due to extrinsic compression and exophytic endoluminal tumor in the inferior part of trachea and bilateral main bronchus. The histopathological report confirmed the diagnosis of a squamous cell carcinoma. A Y-shaped tracheobronchial stent was inserted. This procedure proved to be life-saving for the patient, and significantly improved his quality of life allowing a subsequent debulking radiotherapy which would not have been possible without the insertion of the stent.
Keywords: CAO, stent, bronchoscopy, lung cancer

The importance of laboratory testing to confirm hereditary thrombophilia and for prophylaxis of thrombotic episodes

Gabriela Jimborean, Paraschiva Postolache, Alpar Csipor, Edith Simona Ianoși
The importance of laboratory testing to confirm hereditary thrombophilia and for prophylaxis of thrombotic episodes
We present the case of a complicated pulmonary embolism in a young patient with factor V (factor V Leiden) (FVL) mutation - induced thrombophilia, aiming to emphasise the role of laboratory testing for thrombophilia in patients with deep vein thrombosis (DVT). A 22-year-old female (non-smoker, with chronic use of contraceptives) was admitted in the Pulmonary Clinic with a brutal episode of thoracic pain and fever. One month before, the patient was diagnosed with an extended femoral DVT. She was treated with anticoagulants and an arterial-venous shunt for vein patency preservation was placed. In our clinic, we found on CT scan a pulmonary infarction with pleural collection. The bacteriology of pleural fluid revealed Staphylococcus aureus. Targeted therapy was instituted (antibiotic guided by antibiogram, anticoagulants and anti-inflammatory drugs). We performed a large panel of tests to detect the etiology of thrombophilia. Factor V (FVL) mutation was found. The patient improved under treatment, and was discharged with recommendation for surgical reduction of the arterial-venous shunt, anticoagulants and contraceptives cessation. She was advised to permanently wear elastic stockings and avoid smoking and prolonged limbs immobilisation. A future pregnancy will need to be closely monitored, given the risk for pregnancy-associated thrombosis (repeated DVT, miscarriages, pre-eclampsia, foetal growth stop).
Conclusion. Sudden thrombosis occurring in young patients benefit from an extended laboratory investigation for hereditary thrombophilia. In these patients, antepartum and postpartum anticoagulation therapy should be a long-term prophylaxis method against thromboembolism and pregnancy complications.
Keywords: thrombophilia, pulmonary infarction, factor V Leiden, prophylaxis