Approximately 25% of the patients admitted in the Intensive Care Units require tracheostomy, especially for prolonged mechanical ventilation or for difficult weaning. The advantages of this maneuver are multiple, most important being the improvement of the respiratory parameters, the increase in the patient’s comfort and the decreasing risk of complications associated with prolonged endotracheal intubation. There are no absolute criteria in order to forbid this maneuver. The benefits of this method in different subgroups have been revealed by a series of clinical studies according to the specialized literature. Choosing the technique for mounting a tracheostomy, as well as the person who performs are up to each ICU. Finally, a perfect timing for performing this maneuver has not yet been established, therefore leaving this topic open to future research.

Background. Malignant tumors of the head and neck have an increasing incidence in the population worldwide, including population of Romania. From all the tumors of the head and neck region oral cavity and pharynx tumors, with extension towards the larynx, have a great impact on the overall survival rates, functional implications and quality of life of the patients. Despite early symptoms, patients have a tendency to present themselves to the specialist in late stages of the disease because of ignorance, fear of diseases or bad advice from unknowing persons. This situation is a great challange for the oncology team considering the poor prognosis of locally advanced cancer. Development of malignant tumors of the oral cavity and pharynx in specific anatomical regions leads to particular ways of approach for each tumor located in different regions of the head and neck. Surgery is the main thod in locally advaced tumors of the oral cavity and pharynx alongside with neck dissection for regional metastasis in lymph nodes. Material and methods. Tumor resection needs to be performed with oncological safe margins of resection which means that a good exposure of the site of the tumor needs to be obtained. In the case of oral cavity and pharynx tumors there are several possibilities of approach. T1 and T2 tumors can be resected by using a transoral approach. T3 tumors have a great local extension thus the need for a better exposure of the site of location through the check. The greater tumors in diameter, T4 tumors, need to be approached by a transmandibular procedure so that the entire tumors can be resected with oncological safe margins of resections. The authors present their experience with the locally advanced malignant tumors of the oral cavity and pharynx in Coltea E.N.T. Clinic. Results. The use of the transmandibular approach in managing cases of locally advanced tumors of the oral cavity and pharynx has some complications that can be avoided if a proper surgical technique is used. Patients operated using the transmandibular technique have a good quality of life despite some complications associated with radiotherapy performed after surgery.

The purpose of this study was to assess the relation between glycemic control and the severity of sepsis in a cohort of patients with vasopressor-dependent septic shock treated with corticosteroids [1,2]

OBJECTIVES:The presence of neck metastases represents one of the most important prognostic factors for carcinomas of the anterior tongue, the five-year survival rate being under 20% in patients with regional metastases. The aim of this study was to demonstrate the efficacy of prophylactic selective neck dissection in patients without detectable nodal metastases.MATERIALS AND METHODS:A matched case-control study with prospective follow up was conducted in ENT Department of Coltea Clinical Hospital for 86 patients with T1-T2N0 stage carcinoma of the anterior tongue surgically treated between January 2000 and January 2005 with or without concurrent selective supraomohyoid neck dissection (SND). The patients were divided in two groups, comparable in age and sex distribution. Descriptive statistics, risk of recurrences, Kaplan Maier five-year survival curves and the global and specific mortality rates were performed using EpiInfo software. The level of significance was established at p<0.05.RESULTS:After a mean follow-up time of 90.5 months, for all variables considered as outcomes of SND efficacy evaluation, significance differences (p < 0.05) were registered between groups: the frequency of patients who developed neck metastases was lower in the group of subjects who underwent prophylactic selective neck dissection; the all-cause mortality rate at the end of the follow-up period was three times lower in SND study group compared with controls; the specific mortality rate due to regional recurrences was five times lower in test-group compared with controls.CONCLUSIONS:Our study suggest that prophylactic selective neck dissection could be indicated for patients with T1-T2N0 carcinomas of the anterior tongue in order to increase both overall and free of recurrence survival time, respectivelly.

Although the administration of hydrocortisone in septic shock generates adverse effects, the risk of corticosteroid-induced hypernatremia may be reduced by continuous administration of the drug [1][2].

At the beginning of the 21st century the hypopharynx and the cervical esophagus cancer represents a major issue for all countries of the world. The epidemiology of the hypopharynx and cervical esophagus cancer deals with the spread of the disease in the human population with regard to sex, age, profession, time and space, as well as risk factors that contribute to these phenomena. The main goal is to investigate the causes and the factors involved in the development of the tumors at the pharyngoesophageal junction, knowledge that contributes to the latest therapeutic assessment through interdisciplinary collaboration (E.N.T. surgeon, general surgeon, radiation oncologist, chemotherapist, and nutritionist). The epidemiology of the hypopharynx and cervical esophagus cancer includes three major areas of interest: descriptive (the study of the spread in mass population), analytical (the study of causal risk factors on the disease) and experimental (that verifies by experiments on animals the prior identified hypothesis).