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Clinical Cases

Aspects of the surgical treatment in plurivisceral echinococcosis - case report

Ioana Cristina Negoescu1, Ciprian Bolca2, Adrian Istrate2, Olga Dănăilă2, Cristian Paleru2, Ioan Cordoș2
1. Spitalul Clinic de Urgență „Sf.Ioan” București, 2. Institutul Național de Pneumologie „Marius Nasta” București


Hydatid disease remains endemic in many parts of the world, most notably the Mediterranean region, Australia, New Zealand, the Middle East, and South America. Plurivisceral echinococcosis is defined as the concomitant or successive presence of hydatidosis in more than one viscus. It has been noticed that the number of cases with multi-organ localizations and multiple cysts has increased in the last years. As the surgery of plurivisceral echinococcosis remains one of the challenges for the medical world, in this article we present our experience during 2000-2007 with this disease, followed by a case report of one of the most special cases of echinococcosis, discussing the principles of treatment, along with a new classification of this disease. Plurivisceral echinococcosis is associated with higher postoperative morbidity and mortality than uncomplicated cysts, related to organ involvement and surgical treatment. In the sequential approach we recommend resolving first surgically the complicated cysts or those at risk. In the thoracic and abdominal locations, the thoracic cysts will be approached first. The treatment methods will be as conservative as possible. Management of pulmonary and hepatic cysts (diaphragmatic side) simultaneously through the thoracic route is convenient and should be encouraged in patients because this prevents a second operation.

Keywords: plurivisceral echinococcosis, endemic disease, surgical treatment


Paradoxical reaction to salbutamol in an asthma patient

Irina Strâmbu1,3, Roxana Bumbăcea2,3
1. Institutul de Pneumologie “Marius Nasta”, 2. Secţia Dermatologie-Alergologie, Spitalul Clinic de Urgenţă Elias, Bucureşti, 3. UMF “Carol Davila” Bucureşti


Bronchial asthma is a disease with increasing incidence worldwide, being an important cause of morbidity and mortality. The diagnosis and management of the disease are subject to international guidelines, GINA being updated periodically, according to the latest findings about the disease. The recommendations include the use in all severity stages of short acting beta-2-agonists as reliever of asthma symptoms. We present the case of an asthma patient presenting a life-threatening paradoxical bronchospasm at salbutamol, as well as discussions on the possible pathogenesis of this situation. Paradoxical bronchospasm to salbutamol is a rare situation but can turn into a serious problem for the patient, as well as for the physicians who underestimate this possibility.

Keywords: bronchial asthma, salbutamol, paradoxical bronchospasm 

Severe Transfuse Related Acute Lung Injury (TRALI) syndrome in a 14 years old girl with a history of type I von Willebrand Disease

Oana C. Arghir1, Florin C. Ionescu2, Adriana Apostol2
1. Faculty of Medicine Ovidius University, Constanţa, Constanţa, Romania, 2. Clinic Emergency County Hospital, Constanţa, Constanţa, Romania


Von Willebrand disease (vWD) is the most common inherited bleeding disorder based on an autosomal abnormality of von Willebrand factor. Transfusion is a lifesaving medical intervention among patients with bleeding disorders. Patients with vWD are exposed to Transfuse Related Acute Lung Injury (TRALI) when they become recipients of multiple blood products and repeated transfusions. TRALI is a non-hemolytic transfusion reaction induced by infusions of intravenous immunoglobulin, platelets (suspended in plasma), whole blood, cryoprecipitates, and fresh frozen plasma (FFP). We report a 14 years old white girl, with a history of type I von Willebrand disease (vWd), recipient of 2 units' fresh-frozen plasma (FFP) and 1 unit whole blood transfusion who developed an acute respiratory distress with severe hypoxemia and bilateral pulmonary infiltrate on chest X-ray within 3 hours of the whole blood transfusion, completely reversible after ventilation. Concluding, patients with vWd who received recurrent transfusions have an increased risk of TRALI. Physicians must be familiar with it as a cause of white lung X-ray pattern.

Keywords: von Willebrand disease, transfusion, fresh frozen plasma, TRALI