The tracheoesophageal fistula which occurred during oro-tracheal intubation of a patient in intensive care unit is a true challenge both in diagnostic and in therapeutic approach. The best treatment is prevention, by identifying risk factors but especially is important which the mechanism in the occurrence of tracheoesophageal fistula was. The occurrence of this complication in the evolution of hospitalized patients in ICU is accompanied by significant increase in mortality, contributing to negative prognostic. We have started a large multicentric study in April 2016 regarding all patients who required intubation longer than 7 days. The study will finish at the end of 2020. We are looking for a definite conclusion, in this moment we do not have enough data for a conclusion.[1, 2] INTRODUCTION fistula tracheoesophageal The is an abnormal communication between the esophagus and trachea. It can be congenital or acquired. Most of them are congenital with a frequency of 1 to 3500/ 6000 births. In this case usually are associated, or appear within, with other birth defects (trisomy 13, 18 or 21, tetralogy of Fallot, other digestive problems or muscle skeletal VACTERL Syndrome (Vertebral anomalies, Anal atresia, Cardiac defects, Tracheoesophageal fistula and/or Esophageal atresia, Renal & Radial anomalies and Limb defects.). Then, there are the malignant ones which appear in the posterior infiltrating tracheal wall or the anterior wall of the esophagus. The last ones are those acquired, non- malignant [1, 3, 4]. maneuver, in the operating room but especially in ICU. The first fistula appeared after a prolonged period of intubation and was initially described in 1956 by d’Avignon [2, 4]. in involved factors are Several these serious complications during a prolonged period of intubation. The most important and most discussed about in recent years is represented by the cuff pressure of orotracheal tube. If the cuff is overinflated, it leads to compression on the rear wall membranous trachea, which in time leads to ischemia and necrosis, basically forming an abnormal communication between the trachea and esophagus. Other possible complication of a hyper-inflated cuff is tracheal stenosis or bleeding erosion of a significant blood vessel. Often, both The situations simultaneously. occur can They occur particularly after a prolonged period of intubation with or without mechanical ventilation. intubation Fistula can result from incidents of 1 Carol Davila Central University Emergency Military Hospital, Bucharest 2 Carol Davila University of Medicine and Pharmacy, Bucharest 3 University Emergency Hospital, Bucharest 35
Radical prostatectomy is the gold standard treatment for patients with localized prostatic cancer, but often the pathological diagnosis reveals a locally advanced stage. The aim of this paper is to present the oncological follow-up after radical prostatectomy on a group of 42 patients, patients which have been diagnosed after surgery with a more aggressive stage, locally advanced PCa. Over a period of four years 136 patients have undergone radical prostatectomy. The pathological examination has established that 42 patients presented extracapsular invasion and/or lymph node invasion. 18 patients (pT3-4N0M0) have undergone radiotherapy alone and 24 patients (8 pN1 and 16 pT3-4N1M0) have received androgen deprivation therapy in association with radiotherapy. Over the next two years 15 patients presented biochemical recurrence. For these patients chemotherapy was initiated, but in two cases PSA increase has been observed during periodic evaluation. Although it is not uncommon that postoperatively the histopathological examination establishes a more aggressive disease stage than that established before surgery, radical prostatectomy remains the solution for the localized prostate cancer, solution that can be boosted by radiotherapy and/or androgen deprivation therapy.
