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Solid tumors represent chronic disease that can be rarely detected, diagnosed and treated without the use of a multidisciplinary team. When a neoplastic disease is initially evaluated, involvement of a single physician does not seem to be sufficient to establish diagnosis and staging. Assessment of each individual case of malignancy is the main purpose of the entire medical staff engaged in treating cancer patients. In Romania, the use of oncology committee with a multidisciplinary form of organization has been set to work in Bucharest and Cluj-Napoca, since the beginning of 1978 under direct supervision of professors Alexandru Trestioreanu and Ion Chiricuță. The joint session of the tumor board resides into establishing the optimal oncology therapy for each patient. The task of informing the patient about the decision is performed by the physician that is overseeing the patients’ evolution. There is no mandatory oncology therapy action from behalf of the physician after the decision of the tumor board was made. However, it is more likely for head and neck cancer patients to receive better, more accurate staging, as well as optimal oncology therapy in a local or academic hospital tumor board setup.

Since the outbreak of the COVID-19 pandemic in December 2019 there has been an array have studies regarding otolaryngologist and head and neck surgeons considering the exceptionally high risk of exposure. The purpose of this article is to evaluate the current practice in an oncology ENT Department, which ensures health care services for upper aero digestive tract cancer patients. It is of outmost importance that all the health care providers are aware of good clinical practice recommendations and training, according to the current guidelines that needs to be performed as often as possible, so that the implementation of the institution specific guidelines to be optimal. Performing a tracheostomy for an ENT emergency in a patient with suspected or confirmed COVID-19 disease requires preparation from the health care provider so, after reviewing the international literature, we have elaborated a protocol and guidelines in Colțea Clinical Hospital to ensure the possibility of performing emergency surgical interventions for oncology patients. Testing for SARS-CoV-2 is mandatory prior to surgery since opening the trachea and operating on the upper respiratory tract leads to aerosol particles that can infect the surrounding environment and health care providers. Limitations are predictable as long as health care systems are being under tremendous pressure from the general condition and by patients with life threatening disease.

Introduction. Squamous cell carcinoma of the tongue is a very rare disease among children, with only a few cases reported in the literature. The tongue is the most common site for oral malignancy. The main contributing factors to pelvilingual cancer are constant irritants of the oral mucosa, such as tobacco, alcohol, and dentures. In children, however, the risk factors are immunosuppression induced by a hemopathy such as Fanconi anemia or by chemotherapy, Xeroderma Pigmentosum Syndrome or KID (keratitis, ichthyosis, deafness), Plummer-Vinson syndrome. Cases presentations. The authors present two cases of children, 12 and 15 years old, diagnosed with pelvilingual malignant neoplasia, for which review of the clinical manifestations, the methods of diagnosis and treatment used, but also the evolution will be described. Conclusions. Clinical symptoms of tongue cancer are similar to other types of neoplastic diseases developed in the oral cavity (for example oral floor neoplasm). Confirmation of the diagnosis is made by histopathological examination of the tissue specimen obtained from the tumor site. Therapy has a complex multimodal approach and includes, depending on staging, general condition, and the patient’s option, primary and adjuvant methods. Surgery followed by radio-, chemo-, immunotherapy are the preferred methods. Another possibility is tumor stage conversion by radio-, chemo- and immunotherapeutic treatment, followed by surgery. In some cases, surgery is an ultimate method of therapy, a salvage therapy.

Introduction. The quality of life of patients after total laryngectomy is influenced by both the disease and the radical therapeutic interventions. After surgical treatment, vocal rehabilitation, along with pulmonary and deglutition rehabilitation, are necessary. The objective of the study was to assess the quality of life in patients with total laryngectomy. Materials and methods. A questionnaire with 14 questions was randomly addressed to 100 patients with total laryngectomy who presented to Coltea Clinical Hospital, Bucharest, Romania, over a period of three months. Results. Fifty patients answered that they had no pain. Regarding everyday activities, 34 patients answered that they were as active as before surgery. Regarding their appearance, 50 patients answered that there is no change, or the change is minor, while 39 answered that their appearance bothers them, but they remain active, and 5 answered that they feel disfigured and limit their activity, while 6 patients answered that they cannot be with other people because of their aspect. 34 patients answered that they could swallow as well as prior to surgery, other 34 patients answered that they cannot swallow certain foods, while 21 answered that they only swallow liquid food or are dependent on a feeding tube. Regarding everyday activity, 67 patients answered there are times when they cannot keep up with their old pace, but they get out of the house and enjoy life. About their mood, 38 patients answered that they were not in a good mood, nor depressed, while 36 said their mood is generally good and only occasionally affected by cancer. Six patients answered that their mood is excellent, while 15 patients were somewhat depressed and 5 were extremely depressed. Conclusions. The quality of life is influenced by the patients’ appearance after total laryngectomy, and their ability to maintain everyday activities. Swallowing, taste and saliva quality have a great impact on the quality of life of patients with total laryngectomy and also influence their nutritional status.

Recent studies emphasize an increased prevalence of non-motor symptoms in idiopathic dystonia with focal onset (IDFO), but their pathophysiological relationship is not clear. We aimed to identify the prevalence of depression and neurocognitive impairment in a group of patients with idiopathic dystonia with focal onset and their impact on the patients’ quality of life. This study represents a component of an ongoing research project – GENDYS. From the database of this project, we selected 48 patients 56.62+/-14.16 years old who have been examined clinically and using specific scales: Patient Health Questionnaire-9 (for depression), Montreal Cognitive Assessment - MoCA (for cognitive impairment), and a 5-degree analog scale for subjective perception of the severity of the disease. We conducted a descriptive cross-sectional study on patients with depression and cognition evaluated by the above-mentioned scales. We also performed a nested case-control analysis on 20 IDFO patients with and without at least moderate depression matched for age and gender; the cut-offs for depression were PHQ-9 score ≥10 and PHQ9 Depression is more prevalent in patients with IDFO and is associated with a worse perception of the disease severity.

Patients benefit from the use of telescopes and flexible fiber optics when are examined by the ENT specialist. It is not mandatory in all situations but in most cases, some form of optical endoscopic examination of the nasal cavities, pharynx or larynx is needed. There is some reluctance to use this kind of method in patients in COVID 19 era since this is a maneuver that can generate aerosols and thus increase the chance of transmitting SARS-Cov-2 virus. There are several precautions that can be considered and we offer an insight on how fibroscopic examination can be performed with smaller risk for the physician. The question that we address is whether it is safe or not to perform this procedure and in what conditions.

Deep neck space infections are of great risk for patients considering even death in certain cases. Collection of purulent secretions that can accumulate in a particular region of the neck is due to the anatomy of the deep neck fascia, muscles of the neck and compartments for blood vessels and organs in the neck region. Deep neck spaces communicate with each other and in some patients with morbidities like diabetes or other form of immuno-suppression extension can be great. Ludwig's angina is a form of abscess of the floor of the mouth with origin in teeth located on the mandible. Like any other abscess medical and surgical therapy are ways of treatment, but incision and drainage are mandatory. However, surgical management of such a complication might include other type of surgery as tracheostomy, blood vessels ligation, resection of necrotic tissue or even reconstruction.

The ENT practitioner has a principal role for diagnosis, treatment and clinical recovery of vestibular schwannoma patients. These tumors require a special attention, concerning the treatment and the follow-up, because of their location in a deep anatomical region, very rich in vascular and neurological elements. If surgery is chosen as the best treatment modality, the vascular related complications, during surgery or immediately after surgery, can be disastrous for the patient. The surgeon must have the anatomical knowledge and appropriate skills. The anatomy of the venous system has an individual variability, with an impact to the procedure’s surgical risks. The objective of this publication is to synthetize the local venous anatomy and surgical practices in case of venous bleeding at the level of the pontocerebellar angle.

Laryngeal cancer continues to raise challenges for specialists all over the world even if there has been improvement in its diagnosis, therapeutic options and comprehensive view of the malignant tumor process. The decision of the oncological committee is not subject to the preferences of the patient, since in terms of therapy, this is the role of the specialist treating the patient. It is very important that the patient should know the implications of total surgery and that the patient has a poorer quality of life after total laryngectomy. The quality of life of these patients has been assessed by means of European quality of life questionnaires in terms of physical status and symptoms, social integration and psychoemotional status. The absence of voice, the impairment in swallowing, the esthetic impairment, the family and social reintegration need to be addressed by the oncological team so that the quality of life of these patients be at optimal levels. The specific questionnaires for the quality of life evaluation need to be used for any patient with laryngeal cancer and key points need to be addressed individually to meet each patient's expectations.

Total laryngectomy is still the final therapeutic solution in cases of locally advanced laryngeal cancer, as well as in cases of therapeutic failure of organ-sparing surgery or radiation therapy. Following excision of the larynx, the remaining pharynx is reconstructed to obtain continuity of the upper digestive tract. One of the most common complications in these patients, despite constant refinement of the procedure, is the development of a pharyngo-cutaneous fistula. These fistulas prolong hospital stay and often require a second surgical procedure, increasing morbidity and cost for the patient, while diminishing his quality of life. Some risk-factors have been identified, but only some may be corrected before surgery to lower this risk. Managing the fistula once present depends on multiple factors, essential being the size of the fistula as well as the position and concomitant factors, with options ranging from conservative measures to aggressive reconstructive surgery with local miocutaneous flaps. Modern vocal rehabilitation with T.E.P. (tracheo-esophageal puncture) and vocal prosthesis placement presents a new challenge – because of the risk of developing a tracheo-esophageal fistula, with an even higher risk for the patient because of tracheal aspiration. Understanding healing mechanisms of these structures is key to proper management of this complication.

Background In patients at risk of cancer therapy-related cardiac dysfunction (CTRCD), initiation of cardioprotective therapy (CPT) is constrained by the low sensitivity of ejection fraction (EF) for minor changes in left ventricular (LV) function. Global longitudinal strain (GLS) is a robust and sensitive marker of LV dysfunction, but existing observational data have been insufficient to support a routine GLS-guided strategy for CPT. Objectives This study sought to identify whether GLS-guided CPT prevents reduction in LVEF and development of CTRCD in high-risk patients undergoing potentially cardiotoxic chemotherapy, compared with usual care. Methods In this international, multicenter, prospective, randomized controlled trial, 331 anthracycline-treated patients with another heart failure risk factor were randomly allocated to CPT initiation guided by either ≥12% relative reduction in GLS (n = 166) or >10% absolute reduction of LVEF (n = 165). Patients were followed for EF and development of CTRCD (symptomatic EF reduction of >5% or >10% asymptomatic to Results Of 331 randomized patients, 2 died, and 22 withdrew consent or were lost to follow-up. Among 307 patients (age: 54 ± 12 years; 94% women; baseline LVEF: 59 ± 6%; GLS: –20.6 ± 2.4%) with a median (interquartile range) follow-up of 1.02 years (0.98 to 1.07 years), most (n = 278) had breast cancer. Heart failure risk factors were prevalent: 29% had hypertension, and 13% had diabetes mellitus. At the 1-year follow-up, although the primary outcome of change in LVEF was not significantly different between the 2 arms, there was significantly greater use of CPT, and fewer patients met CTRCD criteria in the GLS-guided than the EF-guided arm (5.8% vs. 13.7%; p = 0.02), and the 1-year EF was 57 ± 6% versus 55 ± 7% (p = 0.05). Patients who received CPT in the EF-guided arm had a larger reduction in LVEF at follow-up than in the GLS-guided arm (9.1 ± 10.9% vs. 2.9 ± 7.4%; p = 0.03). Conclusions Although the change in LVEF was not different between the 2 arms as a whole, when patients who received CPT were compared, those in the GLS-guided arm had a significantly lower reduction in LVEF at 1 year follow-up. Furthermore, GLS-guided CPT significantly reduced a meaningful fall of LVEF to the abnormal range. The results support the use of GLS in surveillance for CTRCD. (Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes [SUCCOUR]; ACTRN12614000341628 )

Lung cancer, as the leading cause of death in oncology is one of the most challenging diseases nowadays. Even after the implementation of checkpoint inhibitors and targeted therapy as a standard of therapy for metastatic disease, the chemotherapy backbone remains essential in the treatment of these patients. This study aimed to evaluate how administration particularities in chemotherapy and toxicity management can influence the outcome. We conducted a retrospective single-institution study, at Elias University Emergency Hospital, Bucharest, Romania, between 2014 and 2018, in a heterogeneous patient population with metastatic non-small cell lung cancer that received combination chemotherapy. The inclusion criteria for this trial were&mdash, histological proof of non-small cell lung cancer (NSCLC), stage IV disease, ECOG (Eastern Cooperative Oncology Group) performance status of a maximum of two, treatment with cytotoxic chemotherapy for at least four courses (patients with fewer courses were excluded). All patients received combination chemotherapy. The main focus was on the effect of dose reduction and treatment delay on overall survival and progression-free survival. A total of 129 patients were enrolled. The response rate in the studied population was 69% and 62.8% had no toxicity greater than grade 2. Chemotherapy regimens used had the following distribution&mdash, paclitaxel + carboplatin 41.9%, paclitaxel + carboplatin + bevacizumab 12.4%, pemetrexed + carboplatin 12.4%, gemcitabine + carboplatin 26.4% and other regimens 7%. Mean PFS (Progression Free Survival) was 9.1 months and the mean OS (Overall Survival) was 14 months. OS was not significantly different in the treatment delay group versus the no delay one, p &lt, 0.25 but dose- reduction significantly impacted OS, p &lt, 0.03. Administration particularities, like febrile neutropenia prophylaxis, treatment of chemotherapy-related anemia, respecting the details of chemostability and preparation rules and emesis prophylaxis, were considered reasons for the good outcome. Details regarding cytotoxic chemotherapy administration remain of paramount importance for a good outcome and the benefit for survival they convey is crucial. Sometimes the benefit the patient derives from these details is comparable to the one newer therapies convey.

Objectives. Meniscus repair is a challenge for a practitioner, as an injured meniscus can lead to osteoarthritic joint changes with a greatly disabling outcome. Platelet-rich plasma has been regarded as a promising therapy to help induce healing. The purpose of the study is to clinically assess the effectiveness of PRP treatment in adolescents with meniscal lesions. Methods. This retrospective study analyzed 30 patients with meniscal tears, aged 12 to 17 years, who had documented MRI meniscal lesion and persistent knee pain. In order to evaluate the outcome, the Lysholm knee scoring scale and numerical rating scale were used before injection and 3 months after treatment. Results. Patients had a mean age of 13.93 years, 70% girls and 30% boys. The most affected was the medial meniscus. The mean value before injection on the numerical rating scale (NRS) of pain was 7.73, after the treatment being of 2.0. After treatment, 76.7% of the patients had “excellent” and “good” outcomes, while before injection, just 3% of the patients had a “good” score. Conclusions. Platelet-rich plasma treatment can be effective in improving the clinical outcomes of adolescent patients with meniscus tears, for whom conservative management and physical therapy have failed to achieve pain relief.

Locally advanced larynx cancer benefits from curative surgery therapy. Clinical trials have been proposed for assessing the quality of life for patients with larynx malignant neoplasia who underwent radical surgery. The removal of the “voice box” is known to have great impact on the social reintegration of these patients as well as psychological distress. The presence of tracheostomy and voice impairment are two of the major issues that need to be thought of by patients that will have a total laryngectomy. The quality of life is a multi-dimensional subjective and personal concept which includes normal physical activity, looks, psychological status, somatic symptoms and, non the less, sexual activity. Cancer free survival intervals for patients with larynx cancer must be evaluated physical and psychological modifications with particular considerations to stress, anxiety and depression related symptoms and to functional rehabilitation adaptation regarding swallowing and speech. Oncology surgeons must consider that QoL is impaired in all patients with larynx cancer that benefit from total laryngectomy. However, there is evidence presented below that the difference in QoL parameters is small when comparing radical surgery, total laryngectomy, and larynx conservation by radio and chemotherapy.

Objective. Ultrasound exerts an important role in breast cancer diagnosis protocol, but the use of eco-senometry can also improve therapeutic options, surgical planning and technique. Methods. We describe various measurement formulas and techniques that are applied in order to acquire important information regarding the breast and its lesions. Results. Senometry and ultrasonography have been proven to be very effective, reaching up to reliability levels as high as 0.997 and accuracy levels as high as 99.6%. Conclusions. Senometry and ultrasonography have clearly demonstrated their value in breast cancer diagnosis and treatment. These methods are reliable, inexpensive and can be easily performed by the surgeon. More advances in the domain are expected in the future.

Background. Breast sarcomas are a heterogeneous group of breast neoplasms with a low incidence and a reserved prognosis. No treatment protocol has been yet established, a guideline similar to soft tissue sarcomas is used. Materials and Methods. Our study analyzed all the patients admitted with the diagnosis of malignant breast disease in two specialized centers on a five-year time frame. We compared long term results for the patients who underwent conservative treatment and mastectomy. Results. A total of 76 cases received surgical treatment with curative intent, 24 conservative procedures and 52 mastectomies. Incidence of local recurrence does not appear to be closely related to the type of surgical procedure. There were a number of five local recurrences for patients who received conservative treatment and 7 local recurrences where we used mastectomy. Kaplan-Meier analysis conducted shows no differences statistically significant (sig = 0.459) between the results of conservative treatment and mastectomy. Basically conservative surgery seems to get similar results, provided that R0 resection objective can be met. Conclusions. Treatment options are more limited for breast sarcomas than carcinomas, the role of surgery being more important to therapeutic success. The biological characteristic of the tumor including histological type and sub-type, play an important role in determining the results and the treatment should be tailored and adapted for each case.

Laryngocele is a rare pathology, but because of their clinical evolution and the symptoms they generate, they should always be considered as a differential diagnosis when investigating neck masses. A laryngocele is basically a herniation of the mucosa of the laryngeal ventricle (Morgagni's ventricle) arising usually from the saccular region. This herniation may remain confined to the larynx - in which case the laryngocele is internal- or expand through the thyro-hyoid membrane into the structures of the neck - thus being called an external laryngocele. Usually the laryngocele has both an internal and external component thus being a mixed laryngocele. Diagnosis of laryngoceles still relies heavily on clinical signs such as tympanism, easily depressible neck mass, indirect laryngoscopy, but is now simplified by imagistic investigations (ultrasound, CT and MRI). However, the treatment of this condition is exclusively surgical and consists of total excision of the laryngocele, as well as proper identification of the point of origin from the saccule and also the final suture of the breach in order to prevent recurrence. Investigation of possible causes of obstruction of the laryngeal ventricle should always be performed (because of the possibility of an underlying malignancy) as well as a follow-up protocol of the patient, given the risk of relapse. We present a recently diagnosed case of a 32 year old man with mixed laryngocele, which we have operated in our clinic.

Therapy for those with relapsed or refractory acute myeloid leukemia is suboptimal. Studies have suggested that timed sequential salvage combination cytotoxic chemotherapy may have particular utility for that indication. We report here a series of ten such adult patients treated sequentially at a single center with EMA (cytarabine 500 mg/m(2)/day as continuous infusion on days 1–3 and days 8–10, mitoxantrone 12 mg/m(2)/day on days 1–3, and etoposide 200 mg/m(2)/day as continuous infusion on days 8–10). The overall complete remission rate was 40% (including 3 of 4 of those with relapsed disease) but use of this regimen was associated with prolonged cytopenia and a high rate of infectious adverse events. Even with the availability of modern infectious prophylaxis and therapies, the EMA regimen is likely best reserved for those with relapsed disease treated with curative intent prior to an allogeneic hematopoietic cell transplant.