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Oxygen supply independency and dependency can be found at different times in the same critically ill patient. Our findings are consistent with the concept that VO2/DO2 dependency is a marker of septic shock. Interventions to increase DO2 are probably justified when this phenomenon is present.

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One of the most important complications during thyroid surgery is injury to the recurrent laryngeal nerve (RLN) which leads to dysfunction and palsy of the vocal folds. Adequate knowledge about the location of the RLN supported by neuromonitoring can help the operating surgeon to prevent this complication. Visualization of the nerve alone seems not enough. An estimation of the function of the RLN is very important. Recently, the use of neuromonitoring has been increasingly employed to predict and document nerve function at the end of thyroidectomy. The aim of the study was to verify the usefulness of neuromonitoring in identifying the recurrent laryngeal nerve and to predict postoperative outcome in patients undergoing thyroid surgery for different indications. Between March 2009 and October 2010, 91 patients (26 men, 65 women; mean age 53 (range 26-83) underwent thyroidectomy. Intraoperative neuromonitoring (IONM) was registered for 91 patients. Eighty-four total thyroidectomies and seven lobectomies were performed with IONM. Eight unilateral postoperative transient paresis were identified without any permanent paralysis. Intraoperative neuromonitoring has an excellent specificity and negative predictive value in which an unchanged positive signal is highly predictive of intact nerve function. Intraoperative neuromonitoring during thyroid surgery is a reliable tool for early recurrent laryngeal nerve localization and identification, certainly in complicated thyroid operations. The probability is high for correctly predicting an intact postoperative nerve function by neuromonitoring.

BackgroundThe goal of the study was to determinate the safety of the harmonic scalpel, widely used in thyroidectomy, near the recurrent laryngeal nerve (RLN).MethodsThe study involved ten pigs of either sex. Twenty RLNs at risk were dissected using the new harmonic scalpel FOCUS. The distances between the nerve and the activated instrument were checked with a millimeter ruler. After dissection, the pigs were euthanized, and both RLNs were fixed in formol and examined by histology after staining with hematoxylin–eosin. Due to technical reasons, only 18 RLNs from the ten pigs could be examined.ResultsIn the experiment that investigated the extent of heat injury, ultrasonic dissection did not cause any immediate damage of the nerve even close to the RLN (1 mm away from the RLN).ConclusionThe use of harmonic scalpel FOCUS for thyroid surgery is safe for the surrounding structures (nerves). Careful tissue applications of the device near the RLN (1 mm) did not cause any lesion histologically.

The objective of the study was to evaluate the long term results of the sentinel node (SN) biopsy technique in the management of the clinically negative (N0) neck in patients with early oral squamous cell carcinoma (T1–T2). Patients with positive SN underwent neck dissection. A sentinel lymph node (SLN) biopsy was performed on 31 consecutive patients. Six of the 31 patients were upstaged by the results of the SLN biopsy. The SLN biopsy allowed the identification of node metastasis in 100% of the cases with a sensitivity of 100%, specificity of 100%, and negative predictive value of 100%. There was a mean follow-up of 59 months. The neck control rate was 100% in the SLN negative group and two SLN positive patients developed subsequent neck disease (neck control rate of 88%). One SLN patient presented at the follow-up with a second primary tumor, 18 months later treated successfully by chemoradiotherapy. The overall survival rate was 100% in both groups. The promising reported short-term results have been sustained by long term follow-up. Patients with negative SLN achieved an excellent neck control rate. The neck control rate in SN negative patients was superior to that in SLN positive patients, but not statistically different.

This pilot study indicates that this antibody to E-selectin appears to be safe and may represent a promising form of therapy in septic shock.

HNSCC is a serious disease that often necessitates aggressive treatment. All patients who are medically eligible should receive curative treatment, without age being an exclusion criterion. Taking comorbidity into account, on the other hand, enables treatment options to be optimized.