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Pleural effusions still represent major problem of respiratory tract pathology because of the invalidity potential of pleural involvement and because of the increasing incidence of diseases frequently accompanied by pleural effusion such as tuberculosis and malignant pleural proliferations. The retrospective study concerned 221 cases with pleural effusions divided into three groups depending on the etiology (bacillary, neoplastic and others). Two categories of features were assessed: parameters assessed in the first 48 hours (epidemiological data, history data, clinical data, IDR and sedimentation rate) and parameters assessed after thoracentesis and/or pleural biopsy (LDH in pleural fluid and BK presence in pleural fluid and biopsy specimens). Bacillary etiology was dominating the studied group but possibly because the hospital was well known as a mainly antituberculous medical unit. The main profile of the investigated patients was: man, teenaged or adult, smoker and often alcoholic living in town. Clinical appearance was influenced by the triad: etiologic agent, age, amount of pleural fluid. Reduced amount of pleural fluid was related to acute onset, usually in young men and symptomatology dominated by thoracic pain. In contrast, massive pleural effusion was related with chronic onset, dyspnea and adult or old age. LDH and glyco-pleuria values are not pathognomic but useful for diagnostic orientation but if microscopic or culture evidence of BK in pleural fluid or tissue specimens are added, the diagnostic accuracy is increasing. In conclusion, a thorough clinical examination completed with a complex panel of laboratory investigations, including biochemical microbiological and special tests from pleural fluid and also a cytological examination could guide the diagnostic in establishing the type and the cause of pleural effusion.

Pleural tuberculosis (TB) is most often treated by a pneumologist. Some cases require operative interventions and may represent a challenge for the thoracic surgeon. There are two specific problems regarding TB pleural effusions: 15-25% of them remain undiagnosed using the conventional methods of diagnosis (imaging, thoracentesis, percutaneous pleural biopsies) and have a tendency for the rapid production of dense adherences and loculations. The authors present their experience in the diagnosis and the treatment of tuberculous pleurisy by means of mini-invasive surgical techniques. The period of study was January 2001-December 2006. In that period, the authors performed 400 video-assisted surgical operations, representing 9% of all the operations carried out in the clinic (3833). The surgical indications were for diagnosis (pleural, pericardial, lung or lymph node biopsy) and for treatment (pleurisy, pleuro-pericarditis, empyema). The contraindications for VATS were the usual ones. 56 cases were diagnosed with pleuro-pulmonary tuberculosis (14% of the VATS). For 43 patients the first approach was strictly thoracoscopic (VATS), while for the rest of 13 we started directly through a minithoracotomy with video assistance. We had 7 conversions to minithoracotomies with video assistance from those 43 aforementioned patients. Minithoracotomy with video assistance was preferred in 13 cases as a primary approach. We used two-port approach in 30 cases and the three-port triangular approach was useful for 6 patients. In 4 cases the bidigital technique was used in order to achieve greater room for exploration. We experienced only one minor intraoperative complication. Our results are comparable to those reported by other authors. The main idea of this paper is that the advantages of VATS in the pathology of the tuberculosis are undeniable.

The aim of this study is to evaluate the frequency of microorganisms isolated from pleural fluids and their resistance to antimicrobial agents. A total of 272 pleural fluids were studied between July 2004 - July 2005 from the patients hospitalized in ICU/surgery (127) and respiratory diseases wards (145) at Marius Nasta Institute. The laboratory investigations included: direct microscopy, cultures for aerobic and anaerobic bacteria, identification, disk diffusion method according with CLSI recommendations for resistance and Etest for detection of metallo-beta-lactamase producing isolates of Pseudomonas aeruginosa. Microorganisms were isolated from 159 samples (58.4%), 48 pleural fluids were positive only in microscopy (17.6%). The most frequent isolated strain was P. aeruginosa (49.6%), followed by Staphylococcus aureus (12.8%) and Enterobacteriaceae (11.2%) polymicrobial infections were mostly due to combinations of Pseudomonas with Enterobacteriaceae. For P. aeruginosa the resistance rate was higher than 71% for all beta-lactams. For aminoglycosides the lower resistance rate was to amikacin (18.0%). For quinolones, resistance of P. aeruginosa was 67.8% to ciprofloxacin. P. aeruginosa isolated from patients hospitalized in ICU/surgery were more resistant to some antimicrobials than the strains isolated in the respiratory diseases wards: resistance to amikacin was 24.5% versus 10% respectively. From 21 P. aeruginosa imipenem and multidrug resistant strains tested, 3 were probably producing of metallo-beta-lactamase. S. aureus showed 47.1% oxacillin resistance, 38.9% resistance to gentamicin and ciprofloxacin and 27.7% to erythromycin. All S.aureus strains were susceptible to linezolid, teicoplanin and vancomycin. The resistance of Enterobacteriaceae strains was high to ampicillin (80.0%), amoxicillin/clavulanic acid and trimethoprim/sulfamethoxazole e(57.6%); the lowest resistance rate was to cefoperazone/sulbactam (7.7%) and to imipenem and ciprofloxacin (10.8%).

Modified Hodge test and a method using a disk with imipenem plus 1000 mg of EDTA were used to determine the presence of metallo-beta-lactamase producing gram-negative rods among 166 clinical isolates from hospitals in Iaşi and Galaţi. Of 9 imipenem resistant strains found, only one Pseudomonas aeruginosa gave positive results with both tests and other two P. aeruginosa clinical isolates gave negative results with both tests. The rest of the strains (2 P. aeruginosa, 2 Acinetobacter baumanii, 1 Sphingomonas paucimobilis) did not give conclusive results. These screening methods are useful, simple and accessible to clinical laboratories. PCR is needed to confirm the presence of metallo-beta-lactamase gene in bacteria and to determine the type of the enzymes.

Our purpose was to investigate the utility of the DNA amplification by ligase chain reaction (LCR) for the direct detection of Mycobacterium tuberculosis complex (MTC) in pleural fluid specimens from patients suspected for tuberculous pleural effusion. We have used the LCx M. tuberculosis kit (Abbott) which uses the amplification of the gene that encodes for antigen b. We have examined 81 pleural fluid specimens by isolation (on Löwenstein-Jensen medium and MB/BacT system) and by LCR. Out of 10 positive specimens in culture, 4 were also positive by LCR; out of 71 negative specimens in culture, 8 were positive by LCR. We have re-evaluated the LCR results according to the clinical diagnosis, sustained by the successful therapy, and to the pathological diagnosis on the pleural biopsy. The sensitivity and specificity of LCR in the diagnosis of tuberculous pleural effusion were 31.5% and 100%. This commercial LCR kit is a rapid, specific, but less sensitive test for the routine diagnosis of the tuberculous pleural effusion.

428 clinical samples were examined by the MB/Bact system and by inoculation on "Tebeglut" medium. 43.9% of the samples were positive for Mycobacterium sp. when examined by MB/BacT system and 29.6% when cultivated on Tebeglut. The reported percent of positivity (43.9%) is highly superior if compared with those reported in other countries: Great Britain (9.1%), France, (7.0%). The MB/BacT system is much more effective in detecting mycobacteria if compared with Tebeglut cultivation, mainly in two categories of samples: those with no evidence of AARB and those with fewer than 10% AARB. From 156 Mycobacterium sp. isolated in MB/BacT system, 88.5% were M. tuberculosis, the others being atypical mycobacteria.

An analysis is made of criteria used for making an etiologic diagnosis of extra-pulmonary tuberculosis over a period of 15 years, and a general correlation is noted between the figures for morbidity and those of bacteriologic confirmations. In the group of patients which has been investigated the diagnosis could be ascertained from urine samples in 44% of the cases, from lymph-nodes and nodules in 15% from pleural fluids in 14%, from purulent collections in 13%, and from the cerebrospinal fluid in 8% of the cases. Human type mycobacteria was evidenced in 90% of the cases. Bovine type of mycobacteria was found in 5% of the cases, with a higher frequency in the cerebrospinal fluid (14%) and in lymph-nodes (11%). In 79% of the cases the antibiogram has evidenced the sensitivity of the isolated strains. Resistance of the strains was noted in 10% of the cases. The strains isolated from lymph-nodes and nodules were resistant in a higher proportion (11%), and those from the pleural fluid in 15%.