Percutaneous dilatation tracheostomy: does it improve the outcome in ICU?

Percutaneous dilatation tracheostomy [PDT] is increasingly being used in the intensive care unit [ICU], and has probably increased the number of procedures performed. The primary aim of this study was to compare the percutaneous dilatation tracheostomy [PDT] with the traditional surgical tracheostomy [97] as regards ICU outcome. A prospective study was performed in the ICU. 46 patients were divided to undergo surgical tracheostomy [ST] or percutaneous dilatation tracheostomy [PDT]. Perioperative complications were recorded and analyzed. 21 patients underwent [ST] and 25 patients for [PDT]. There were no difference between the two groups in terms of age, sex, BMI, APACHE II score and baseline fractional inspired oxygen [FIO2]. The duration of the procedure and intubation days were significantly decreased in [PDT] group compared with [ST] group. Perioperative complications were significantly more in the [ST] group. The overall outcome was favorable with the [PDT] group compared with the [ST] group

Efficacy of chemoradiation therapy in patients with locally advanced nasopharyngeal carcinoma

External beam radiation therapy is the standard treatment for nasopharyngeal carcinoma. Recently there has been increasing interest of chemotherapy because of the high incidence of distant metastases and the sensitivity of these tumors to chemotherapy. Fourty two patients with locally advanced nasopharyngeal carcinomas were included in this study being either T3, T4, N2 or N3. Thirty one patients [71%] were under the age of 40 years. All patients were treated by 3 cycles of chemotherapy followed by external beam radiation. After three cycles of chemotherapy with cisplatinum and fluorouracil,the total response rate was 83% with a complete response rate of 38% [16/42] and partial response of 45% [19/42]. All patients recieved external beam radiation therapy to a dose of 7000 CGy at least and the complete response rate went up to 85.7% [36/42]. It was found that neither the tumor bulk nor the lymph nodes status in the neck correlated significantly to the response rate after chemotherapy. Patients having poorly differentiated squamous cell carcinoma or undifferentiated carciroma showed significantly better initial response to chemotherapy as compared to patients with moderaltely differentiated squamous cell carcinoma. No treatment related deaths were reported and all complication were reversible