CANCER OF THE LARYNX—The Advantages of More Conservative Treatment

Properly administered irradiation therapy for cancer of the larynx in properly selected cases can be successful. Reported herein is the case of a woman 49 years of age with a Grade 3 squamous cell carcinoma of the larynx, who at first was scheduled for radical operation but was treated by irradiation therapy with an estimated total dose of 5292 r given in 29 treatments. The tumor and all subjective and objective symptoms disappeared. The patient was still well when last observed a year later.     

Irradiation influences the expression of substance P and enkephalin in the rat larynx

The effects of radiotherapy on neuropeptide expression in the rat larynx were studied. Irradiation was given for five days, 6 or 8 Gray daily. Ten days after the end of irradiation, the larynx, the laryngeal nerves and different ganglia related to the larynx were dissected out from irradiated and control animals and processed for neuropeptide immunohistochemistry. There was an increased immunolabelling for two of the neuropeptides tested, substance P and enkephalin, in the innervation of the subglottic glands and in the acetylcholinesterase-positive ganglionic cells of the local ganglia. These cells were interpreted as representing postganglionic parasympathetic ganglionic cells. The changes seen in the subglottic glands were interpreted as most likely being related to the changing pattern of staining seen in the local ganglia. No changes in substance P-and enkephalin expression were observed in other laryngeal structures, the nodose ganglia, superior cervical ganglia or laryngeal nerve paraganglia. Thus, in certain respects neuropeptide expression in the larynx is modulated by radiotherapy. Since neuropeptides have both neurotransmitter and/or neuromodulator effects in airway tissue and since they show effects as growth factors, the occurrence of this plasticity in neuropeptide expression should be taken into consideration in future studies examining the effects of irradiation on normal/diseased airway tissues.     

Effect of chemo- and radiotherapy on the growth of human strains of respiratory and excretory organ tumors transplanted in athymic mice

The effect of single and five-fold administration of 12 chemotherapeutic drugs on human strains of larynx, lung and kidney cancers and Wilms' tumor transplanted in nude mice was studied. Wilms' tumor was found to be more responsive to dactinomycin and cyclophosphamide. Larynx, lung and kidney cancers were resistant to all the chemotherapeutic drugs studied. The effect of irradiation of larynx cancer which resulted in short-term tumor growth retardation was also studied.     

激光在喉狭窄治疗中的应用：附13例报告

采用支撑喉镜、喉造口以激光治疗喉狭窄１３例,均观察１年４个月以上。包括先天性喉蹼,声带粘连,双侧喉返神经麻痹,多发性复发性喉乳头状瘤多次手术无效,喉外伤后甲状软骨及其内结构严重破坏,继发感染伴喉腔大是一肉芽生产及瘢痕形成者。     

Carcinoma of the Larynx: Results of Therapy

Prognosis of laryngeal carcinoma varies considerably, depending on its site and stage of development. In the past, laryngectomy was considered the treatment of choice for all but very early lesions. Results of therapy and five-year survival rates were relatively good, but the patient deprived of his larynx frequently presented difficulties in rehabilitation.Recent advances in radiotherapy techniques have permitted treatment of a greater proportion of patients with laryngeal carcinoma by this means, with encouraging results. Results of a survey in the Toronto area suggest that radiotherapy should be used as primary treatment in early and intermediate stages of the disease; radical excision combined with radiotherapy is indicated for treatment failures among early cases and for those with far-advanced disease or carcinoma outside the larynx proper. With this program five-year survival rates are comparable to those achieved when laryngectomy is the primary treatment used, and two-thirds of those who survive maintain laryngeal function.     

Structural and microanalytical changes in dentition after radiotherapy applied in cases of tumour in the oral cavity region

Morphological observations by means of the scanning electron and optical microscopes as well as microanalytical qualitative and quantitative tests concerning content and distribution of calcium, phosphorus and magnesium in the teeth being in irradiation field were made in patients treated for larynx cancer by methods of radiotherapy. The teeth enamel was in some places thinner and in some others it was lacking. The characteristic defects took place in the form of notches, cracks and of superficial destruction. In X-ray microanalyser the enamel showed some features of demineralization. In dentine, features of demineralization and on the other hand features of remineralization were seen. The root dentin, in which destructive processes but also reparation processes developed by root cement could be seen, was rather characteristic. Clear structural changes and disturbances of mineralization in hard tooth tissues being under therapeutic X-ray irradiation were observed.     

Effect of helium-neon laser rays on the processes of postradiation recovery in the skeletal muscles of old rats

The present experiments were conducted to determine the stimulant effect of helium-neon laser on the postradiation recovery in irradiated uninjured skeletal muscle of rats aged 2-2.5. This was indicated by a restored ability of the muscle for posttraumatic regeneration. The both hind rat legs were exposed to local irradiation of 20 Gy and following laser therapy (8-9 procedures at 3 min each, impulsive or continuous one). Then both musculus gastrocnemius were cut across 30 days after irradiation. It was shown that laser therapy employed before injury of the irradiated muscle accelerated fibrin resorption and improved connective tissue, but slightly stimulated muscular tissue. Impulse laser therapy was more favourable for state of skin and healing of the skin wound after irradiation.     

Ovarian irradiation and prednisone therapy following surgery and radiotherapy for carcinoma of the breast.

Following mastectomy, patients with operable breast cancer underwent postoperative irradiation of the chest wall and regional lymph nodes. They were then assigned at random to receive no further therapy, ovarian irradiation (2000 rads in 5 days) or ovarian irradiation in the same dosage plus prednisone, 7.5 mg daily. A total of 705 patients received the randomly assigned treatment and were followed for up to 10 years. In premenopausal patients who received ovarian irradiation the recurrence of breast cancer was delayed and survival prolonged, but not significantly. In premenopausal women aged 45 years or more ovarian irradiation plus prednisone therapy significantly delayed the recurrence of breast cancer (P = 0.02) and prolonged survival (P = 0.02); the survival expectancy of these patients was similar to that of the general population of the same age from the third year after the cancer operation. No value was demonstrated for ovarian irradiation with or without prednisone therapy in postmenopausal patients.     

Effect of ionizing radiation on multidrug resistance of human larynx cancer HEp-2 cells

Effects of ionizing radiation on multidrug resistance (MDR) of human larynx cancer HEp-2 cells have been studied. MDR was determined from sensitivity of HEp-2 cells to daunorubicin, taxol and vincristine in the absence and in the presence of MDR inhibitors (cyclosporin A and avermectin B₁) and from the suppression by cyclosporin A of the rhodamine-123 release from HEp-2 cells. It was found that 8 and 16 h after irradiation (4 Gy), HEp-2 MDR was increased with a further return to the control level by the 24th hour after irradiation. The effect of irradiation was especially well-pronounced by 16 h for cells irradiated with 1 Gy and was manifested in enhanced release of rhodamine-123 and increased resistance of HEp-2 cells to vincristine. Besides, this effect depended on cell density, being at maximum at 80–100 × 10³ cells/cm². It is concluded that the observed dependence of HEp-2 MDR on ionizing radiation and cell density is a result of changes in intracellular content of reactive oxygen species.     

The deduction of the level of the human larynx from bony landmarks: Its relevance to the evolutionos speech

It has been claimed that the capacity for speech in hominids is related to the level of the larynx relative to its surrounding structures. Lower positioned larynges, such as those found in modern humans, have been said to be a prerequisite for articulate speech. In certain fossil hominids, the level of the larynx has been deduced from the angulation of the styloid process and the distance from the posterior nasal spine to the basion (the distance PB). The hypothesis that correlations exist between these bony features and the level of the larynx was tested in this study. The inclination of the styloid process and the level of the larynx were measured on human cadavers and on lateral x-ray cephalograms of the same cadavers. In addition, the distance PB and the level of the larynx were measured on lateral cephalograms of living adult humans. The inclination of the styloid process and the distance PB were also measured on a series of adult dry skulls. Pearson's correlation coefficients for the three sets of measurements were calculated. Only slight correlations between the inclination of the styloid process, the distance PB, and the level the larynx were found. The results of this study indicate that accurate prediction of the level of the larynx from the inclination of the styloid process and the distance PB is not possible.     

The influence of IL-1 treatment on the reconstitution of the hemopoietic and immune systems after sublethal radiation

The influence of IL-1 administration on the recovery of the hemopoietic and immune systems from sublethal irradiation was assessed. Mice were irradiated (750 R) and injected twice daily with purified recombinant derived IL-1 beta (200 ng/injection). At various times after irradiation, the functional capacity of the hemopoietic and immune systems was determined. It was found that IL-1 therapy resulted in a significantly greater number of granulocyte-macrophage-CSF responsive colony-forming cells in the bone marrow of the irradiated mice on days 5 and 11 postirradiation but not at later times. In addition the radiation induced neutropenia recovered quicker in the IL-1-treated mice with significantly greater numbers of peripheral blood granulocytes being seen on days 15 and 20 after irradiation. The influence of IL-1 therapy on the recovery of the immune system was also assessed. Of note was the observation that mice receiving IL-1 therapy had chronically hypoplastic thymi. Although thymic cellularity increased with time after irradiation in the control mice, there was no such increase in the IL-1-treated mice. Similarly, the number of pre-B cells in the marrow of these mice was also diminished. Thus, in the IL-1-treated mice the regeneration of the peripheral immune function was retarded, characterized by a general lymphopenia and decreased splenic responses to mitogenic stimuli.     

The role of radiation therapy for carcinoma of the lung

A large proportion of patients with carcinoma of the lung may benefit from the use of radiation therapy. Operable patients have not been shown to benefit from preoperative irradiation, but postoperative irradiation has improved survival in those found to have involvement of hilar or mediastinal lymph nodes. Radiation therapy is the only potentially curative treatment for patients who are inoperable, but do not have distant metastasis. Control of the local tumor is very dependent upon dose-fractionation-time relationships. Patients who are relatively asymptomatic, i.e., they have a high performance status, are curable if treated promptly with radiation therapy. Small cell carcinoma requires both radiation therapy and chemotherapy. The optimal method of combining the two modalities is yet to be determined, but prophylactic cranial irradiation is necessary to control microscopic metastases that are not affected by systemic chemotherapy, and thoracic irradiation is necessary to give the highest probability of control of the primary tumor. Prophylactic cranial irradiation has also been shown to reduce the frequency of brain metastasis in patients with squamous carcinoma, large cell carcinoma, and adenocarcinoma; it may become more important in these cell types when more effective chemotherapy is developed.     

The dynamics of detecting group-A streptococci in an infectious disease clinic]

The study revealed that the isolation rate of group A streptococci in scarlet fever patients at the time of hospitalization did not exceed 68%. The isolation rate of these streptococci was greatly influenced by antibacterial therapy carried out before hospitalization. Under clinical conditions with intensive penicillin therapy group A streptococci were eliminated from the larynx on days 3-4. In 13% of children repeated streptococcal infection was observed 0.5-3 months after discharge from hospital.     

Therapy of severe stenocardia with ultraviolet blood irradiation (UVB) and various action mechanisms of this therapy

We observed 70 male patients with a seriously proceeding Chronic myocardial ischemia. They were hospitalised because of frequent, permanent and serious attacks of stenocardia at rest and in stress situations. More than 2/3 of these patients had suffered from a myocardial infarct. In the course of two weeks an intensive therapy with all modern preparations for vasodilatation was made. This therapy proved to be unsuccessful. Nearly all patients were administered more than 10 tables of nitroglycerin per day and, in addition, they were injected analgetics as a compensation of attack. The ultraviolet own blood irradiation (UVB) had a positive therapeutic effect in all patients. There was a good success in 46 patients, in all patients satisfactory results could be registered. The effect of therapy was evident by the decrease of administration of nitroglycerin required, by an increase in the degree of stress capacity, and by an easier treatment of stenocardia attacks. The observation time for patients amounted to 2-8 months. The success of therapy remained in 38 patients. After this time the success of therapy could partially be regained by a repeated number of irradiation series. Then, it remained positive in 9 of 22 patients who had been followed-up for 10 months. The half decay period of eliminating 131I from an intradermal depot could be normalised under the influence of ultraviolet own blood irradiation. This ultraviolet own blood irradiation had no significant influence on the fibrinogen level, fibrinolytic activity, and erythrocyte aggregation (examined in 11 patients). A 2 1/2-fold diminution of monomer fibrin complexes in the blood could be observed. The titre of antistreptolysin-O was increased in all patients who had got over the infarct. It had completely normalised a week after finishing the ultraviolet own blood irradiation. Spectroscopic examinations of the blood and plasma made after ultraviolet own blood irradiation revealed that this irradiation will not only affect the properties of Hb, but will also cause a photochemical transformation accompanied by a destruction of some plasma proteins, of the membrane of formed blood elements, and a photosynthesis of biochemically active compounds. The mechanism of action of ultraviolet own blood irradiation is complicated and requires further exact investigations. Even today, however, this method can be recommended as a complex therapy in patients with severe myocardial ischemia.     

Developmental change in the position of the fetal human larynx

The position of the mammalian larynx has been shown to be an important determinant in breathing, swallowing, and vocalizing patterns. While the growth of the adult human larynx has been studied extensively, detailed examination of fetal development has not been undertaken. Thus, crucial developmental change in the fetal period and the effects of this change on normal maturation are still unclear. This study has examined the development of the larynx and its topography during the fetal period. Thirty specimens were preserved in 10% buffered formaldehyde solution for a period of 6 weeks, after which mid-sagittal sections were performed. Fetal ages were calculated from femur diaphyseal lengths and ranged from 15 to 29 weeks. Direct measurements were taken to determine the growth and position of the larynx and trachea relative to the vertebral column and soft palate. Results show that the upper and lower levels of the larynx correspond to the basiocciput and the lower border of the third to upper border of the fourth cervical vertebrae, respectively. The epiglottic cartilage was present at 15 weeks. By 21 weeks, the epiglottis was well developed and in close palatal apposition. At 23 to 25 weeks, the epiglottis and soft palate were found to be in full contact. The acquisition of this contact may be related to fetal respiratory viability.     

Bronchial distribution of gas mixing in a model of the upper and central airways

Longitudinal mixing of He, O2, and sulfur hexafluoride boluses with air flowing through a three-generation tracheobronchial airway model was evaluated as the increase in volume variance of gas concentration distributions monitored at upstream and downstream sampling ports. Mixing was partitioned between tracheal and branched regions of the model at steady inspiratory and expiratory airflows from 0.044 to 0.884 l/s, both in the absence and in the presence of a removable larynx cast. During inspiration in the absence of the larynx, mixing increased as airflow increased, reaching a peak value at 0.2 l/s, and decreasing as airflow increased further. This mixing peak was higher in the branched region than in the tracheal region and was inversely related to the diffusion coefficient of the indicator gas-air mixture. During inspiration in the presence of the larynx, a mixing peak was observed in the tracheal region, but mixing peaks in the branched region were eliminated by turbulence propagated downstream from the larynx. During expiration, laryngeal turbulence was propagated far enough downstream (i.e., proximal to the trachea) that mixing peaks could be observed in both tracheal and branched regions whether or not the larynx cast was present.     

Dose to swallowing structures and dysphagia in head and neck Intensity Modulated Radiation Therapy – A long term prospective analysis

AimTo analyse the long term swallowing function in head and neck cancer patients and correlate with the dose to midline swallowing structures.BackgroundThe use of concurrent chemo radiation (CRT) as the present standard of care resulted in high rates of early and late toxicities. Dysphagia, aspiration, and xerostomia are early as well as late effects of radiation. Not many studies on the dysphagia scores during radiation and follow-up period have correlated dose to the swallowing structures, hence this study.Materials and MethodsHistologically proven head and neck cancer patients treated with intensity modulated radiation therapy were accrued in this study. The pharyngeal constrictors, larynx and cervical oesophagus were contoured and labelled as midline swallowing structures. The volume of the midline swallowing structures which were outside the PTV was delineated separately and was given a mean dose constraint of 45 Gy. Dysphagia was assessed at baseline, weekly intervals during irradiation and follow-up at six years. The dose to the structures for swallowing was correlated with degree of dysphagia.ResultsThere was a gradual increase in the dysphagia grade during the course of radiation. There was a significant recovery of late dysphagia compared to dysphagia during the completion of radiation therapy in patients who received <45 Gy to the swallowing structures (p < 0.0001).ConclusionGiving a constraint to the swallowing structure and limiting it to <45 Gy resulted in earlier recovery of swallowing function resulted in good physical, mental and social well being of the patients when compared to those who received >45 Gy.     

Descent of the hyoid in chimpanzees: evolution of face flattening and speech

The human supralaryngeal vocal tract develops to form a unique two-tube configuration with equally long horizontal and vertical cavities. This anatomy contributes greatly to the morphological foundations of human speech. It is believed to depend on the reduced growth of the palate and on the developmental descent of the larynx relative to the palate. Anatomically, the descent of the larynx is accomplished through both the descent of the laryngeal skeleton relative to the hyoid and the descent of the hyoid relative to the palate. We have studied the development of three living chimpanzees using magnetic resonance imaging. Our previous study showed that, as in humans, chimpanzees show rapid laryngeal descent, with changes in the relative proportion of the vocal tract during early infancy. However, this is not accompanied by the descent of the hyoid relative to the palate, although it is achieved with the descent of the laryngeal skeleton relative to the hyoid. Here, we show that subsequently the chimpanzee hyoid also descends to maintain the rapid descent of the larynx, similarly to humans. We argue that the descent of the larynx probably evolved in a common ancestor of extant hominoids, originally to confer an advantage via a function unrelated to speech. Thus, the descent of the larynx per se is not unique to humans, and facial flattening was probably the major factor that paved the way for speech in the human lineage.     

Transformation and mutagenic potential of porphyrin photodynamic therapy in mammalian cells

The transformation and mutagenic potential of porphyrin photodynamic therapy has been examined in mammalian cells. The mutagenic frequency in Chinese hamster cells at the Na+/K+ ATPase locus was measured by resistance to ouabain following treatment with either photodynamic therapy (PDT) or UV irradiation. The C3H 10T 1/2 mouse embryo cell system was used to document the transformation frequency following PDT, UV irradiation, gamma irradiation or exposure to 3-methylcholanthrene (MCA). Treatments with UV irradiation were effective in producing mutants resistant to ouabain, and treatments with UV irradiation, gamma irradiation and MCA generated transformants at frequencies comparable to those which are reported in the literature. However, PDT treatment conditions (which produced a full range of cytotoxicity) did not induce any mutagenic or transformation activity above background levels.     

Steady pressure-flow relationship in a cast of the upper and central human airways

Pressure drops across the upper (larynx) and central airways of a human lung cast were measured at steady state inspiratory and expiratory flows. Air, HeO₂ and SF6-O₁ gas mixtures were used at tracheal Reynolds' numbers ranging from 145 to 30 000. The pressure-flow characteristics of the model were analysed using standard pressure-flow diagrams and Moody plots. We found that the asymmetry between inspiratory and expiratory resistances, observed in the central airways (larynx excluded), was markedly reduced in the presence of the larynx. However, static pressure differences were greater across the entire model of the upper and central airways than across the model of the five generations of the tracheo-bronchial tree (without larynx) at the same flow-rates. In addition, our results showed that the presence of the larynx tended to reduce the zone of fully developed laminar flow in the Moody diagram with the higher density gas, while extending the zone of turbulent flow even for the low density gas at low Reynold's numbers.