Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) - The Importance of Nutritonal Support in Patients with Head and Neck Cancers (HNCs) or Neurogenic Dysphagia (ND).

BACKGROUND: We evaluated the effectiveness and safety of prophylactic PEG performed for the enteral nutrition support during the oncological treatment of patients with HNCs and as a part of the management of neurological patients experiencing neurogenic dysphagia. METHODS: In 2013 we followed up on a group of 23 HNC patients subjected to prophylactic PEG. We assessed the duration of the procedure, intraprocedural incidents and their causes, time to tube-refeeding and discharge after intervention, post interventional analgesia, early and late complications,toleration, costs and postoperative course of these patients after radical surgery maintaining PEG in place. In parallel we followed up on a group of 10 neurological patients who have undergone a PEG placement to improve the nutrional status and to prevent recurrent chest infections due to ND related silent aspiration. RESULTS: The procedures were performed under sedation with Midazolam and the mean duration was about 7 minutes.Postoperative analgesia was minimal. Refeeding through the tube was initiated 2-4h hours later and the patients were discharged 12-24h after the procedure. Early complications were not observed and later we noted 2 cases of peristomal infections, succesfully managed conservatively. After oncologic surgery we noted 2 (8.69%) pharyngocutaneous fistulas.Conservative care obliterated the fistulas at 6 weeks, maintaining the feeding tube in place. We also compared the results with a group of 27 patients fed through the naso-gastric tube and a group of 20 cases with open gastrotomy-tube prophylactically inserted. The 10 neurological patients had varied conditions but degenerative diseases like motor neuron disease (3 cases" 30%) and multiple sclerosis (2 cases -20%) took the lead we encountered one case of peristomal infection and one case of tube blockage resolved by replacement. We evaluated the nutritional status by controling the weight of these patients before and after PEG placement. A mean weight gain of 3.1 kg(range 1.2 â€" 7) was documented. CONCLUSIONS: PEG is a simple minimmaly invasive procedure performed safely under sedation. It takes a very short time and is virtually free of major complications. The requirements of analgesics are minimal. The refeeding is started early and the tube is well tolerated by the patient. PEG has an important role in the conservative healing of pharyngocutaneous fistula.PEG is the procedure of choice for the neurological patients.It prevents weight loss and aspiration pneumonia in patients with neurogenic dysphagia with a low rate of complications.

Morphology and morphopathology of hypopharyngo-esophageal cancer.

Cervical esophageal cancer and hypopharyngeal cancer represent a major diagnostic issue in early stages, considering the fact that the implication of both cervical esophageal and hypopharyngeal cancers shows a poor prognostic from the very beginning. Positive diagnosis can only be made after histopathological analysis and immunohistochemical analysis in addition. The bioptic material is sampled by rigid endoscopy this being the only viable method of assessing data on the tumor prior to the surgery. As much as 95% of tumors located at this site are epidermoid carcinomas with different staging and characteristics, other types of tumors being adenocarcinomas, lymphomas, etc. Several risk factors influence the biology of this site thus inflicting both cellular and molecular modifications that are the origin of cancer development.

Pharyngoesophageal junction neoplasia--therapeutic management.

Not only the anatomy but the treatment and the prognosis of these tumors are intermediate between hypopharyngeal and esophageal tumors. After a portion of the esophagus is removed or complete esophagectomy, a conduit must be established. The authors reviewed the experience of Prof. Cristian Popescu in total pharyngo-laryngectomy and his technique of pharyngoesophageal reconstruction with synthetic esophageal prosthesis. We have some 21 patients who underwent an esophageal reconstruction with Montgomery esophageal tube. This is a very important new, modem, interdisciplinary approach bewteen the head and neck surgeon and the general/thoracic surgeon to treat the pharyngo-laryngo-esofageal neoplasia with one stage reconstruction. The follow up for these patients shows that this reconstruction method is a good, reliable choice with low costs and considerable advantages for the quality of life. Surgery for these patients should be considered primarily palliative and the optimal reconstruction should preserve the quality of life for the duration of survival.

Immunologic and cytogenetic markers expressed in non-Hodgkin lymphoma of head and neck.

Very often, the first doctor who examines a patient with malignant lymphoma is an ENT specialist, because non-Hodgkin lymphoma is five times more frequent than Hodgkin disease in the head and neck region. Approximately 25% of extranodal lymphoma occurs in the head and neck and extranodal presentation is twice as frequent as nodal presentation. This paper present a study of the patients from ENT, Head & Neck Surgery Clinic of Coltea Clinical Hospital, Bucharest, Romania, diagnosed with malignant lymphoma. We developed a specific scheme for collecting data about patients, together with pathology details, immunology and cytogenetic markers. We tried to establish a relation between immunologic and cytogenetic markers and the clinical evolution of non-Hodgkin lymphoma. For this study, we analyzed data regarding CD10, CD5, CD20, Bcl-2, Bcl-6, Ki67 expression obtained from 58 patients with follicular lymphoma. An attempt was made to correlate the presence of certain immunohistochemical and cytogenetic markers with the evolution and aggressiveness of the disease, and we can say that Bcl-2 is positive in all tumor subtypes, being associated relatively frequently with CD5 expression, and is a marker of poor prognosis, while Bcl-6 is positive especially in the tumor forms associated with the predominance of small cells and is a marker of favorable prognosis.

Functional implications of radical neck dissection and the impact on the quality of life for patients with head and neck neoplasia.

Radical neck dissection is a concept that was presented in 1906 by GW Crile and suffered constant improvement ever since. The surgical oncology procedure included the resection of the internal jugular vein, the sternocleidomastoid muscle, and the submandibular gland and the spinal accessory nerve. Deformities and impairment in the functionality of different regions of the neck and scapular regions have great implications on the quality of life of the patients who undergo such a procedure. Modifications to the radical neck dissection were made in the attempt to maintain the efficacy of the surgical oncology therapy. The authors try to assess the functional implications of radical neck dissection and the impact on the quality of life for patients with head and neck neoplasia.

The epidemiology of hypopharynx and cervical esophagus cancer.

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).