Effects of poor maternal diet during gestation are detected in F2 offspring.

Poor maternal nutrition of F0 ewes impairs F1 offspring growth, with minimal differences in glucose tolerance or select metabolic circulating factors, and independent of differences in residual feed intake (RFI). To determine if poor maternal nutrition in F0 ewes alters F2 offspring growth, circulating leptin, feed efficiency, or glucose tolerance, F0 ewes (n = 46) pregnant with twins were fed 100% (control), 60% (restricted), or 140% (over) of National Research Council requirements from days 30 ±â€…0.02 of gestation until parturition. At 16 to 19 mo of age, female F1 (n = 36) offspring were bred to generate F2 offspring [CON-F2 (n = 12 ewes; 6 rams), RES-F2 (n = 7 ewes; 13 rams), or OVER-F2 (n = 13 ewes; 9 rams) corresponding to diets of the granddam (F0)]. Lamb body weights (BW) and blood samples were collected weekly from days 0 to 28 and every 14 d until day 252 of age. Circulating leptin was measured in serum at days 0, 7, 14, 56, 210, and 252. An intravenous glucose tolerance test was performed at days 133 ±â€…0.28. At days 167 ±â€…0.33, individual daily intake was recorded over a 77-d feeding period to determine RFI. Rams were euthanized at days 285 ±â€…0.93, and body morphometrics, loin eye area (LEA), back fat thickness, and organ weights were collected and bone mineral density (BMD) and length were determined in the right hind leg. During gestation, OVER-F1 ewes tended to be 8.6% smaller than CON-F1 ewes (P ≤ 0.06). F2 offspring were of similar BW from birth to day 70 (P ≥ 0.20). However, from days 84 to 252, RES-F2 offspring tended to be 7.3% smaller than CON-F2 (P ≤ 0.10). Granddam diet did not influence F2 ram body morphometrics, organ or muscle weights, LEA, adipose deposition, or leg BMD (P ≥ 0.84). RES-F2 (-0.20) and CON-F2 (-0.45) rams tended to be more feed efficient than CON-F2 ewes (0.31; P ≤ 0.08). No effects of granddam diet were observed on glucose or insulin average or baseline concentrations, area under the curve, first-phase response, or ratio (P ≥ 0.52). However, CON-F2 rams (297 mg/dL ±â€…16.5) had a greater glucose peak compared with RES-F2 rams (239 mg/dL ±â€…11.2; P = 0.05). Peak insulin concentrations were not influenced by granddam diet (P = 0.75). At d 56, RES-F2 and OVER-F2 offspring had 53.5% and 61.8% less leptin compared with CON-F2 offspring, respectively (P ≤ 0.02). These data indicate that poor maternal nutrition impacts offspring growth into the second generation with minimal impacts on offspring RFI, glucose tolerance, and circulating leptin.

Concurrent chemoradiotherapy with daily low dose intra-arterial cisplatin plus 5-fluorouracil for stage IV nasopharyngeal cancer.

This study aims to treat locally-advanced nasopharyngeal cancer by concurrent conventional irradiation at 2.0 Gy/day five days per week up to a total dose of 68 Gy, and daily intra-arterial infusion of cisplatin 3 mg/m2 plus 24 hours intravenous drip infusion of 5-fluorouracil 150 mg/m2 per day, five days per week. All of five enrolled patients completed the schedule, and treatment compliance was considered to be identical. Of the five patients evaluable for response, four with complete response (80%) and one with partial response (20%), with an overall response rate of 100% was achieved. The median survival time was 26 months. Two-year survival of the patients was 80%. This regimen showed marginal mucositis but well tolerated. We concluded that this treatment option is safe and effective for the locally-advanced nasopharyngeal cancer.

Video-assisted rigid endoscopic laryngosurgery: application to cases with difficult laryngeal exposure.

In some cases of microlaryngosurgery, laryngeal exposure with a direct laryngoscope is difficult because of a variety of reasons. In such cases, we now use a long rigid endoscope inserted into the side tube of the direct laryngoscope together with a video system. The lesion can be removed while the phonosurgeon observes the magnified images of the larynx on the video monitor. We describe the surgical procedure together with the preoperative and postoperative evaluation of vocal function in 13 patients with benign laryngeal lesions. A good surgical and vocal outcome was achieved in all cases. The method appeared to be useful for treating dysphonia in patients in whom it was difficult to expose the larynx with a direct laryngoscope.

Microlaryngosurgery for benign posterior glottal lesions using a posterior glottis direct laryngoscope.

When endolaryngeal microscopic laryngosurgery (microlaryngosurgery) with a direct laryngoscope is used to remove lesions of the posterior glottal area under endotracheal general anesthesia, the endotracheal tube interferes with the surgical field. To overcome this problem, we developed a special direct laryngoscope with a concave groove on the upper portion of its distal tip. The concave groove is used to move the endotracheal tube anteriorly, making it possible to obtain a good surgical field in the posterior glottal area. This laryngoscope facilitates the removal of posterior glottal lesions. The utility of this microlaryngosurgical technique for the removal of benign posterior glottal lesions is described.

Survival results of neoadjuvant chemotherapy for advanced squamous cell carcinoma of the head and neck.

BACKGROUND: We carried out an open, randomized multi-center clinical trial for advanced head and neck cancer between April 1991 and December 1992. In this report, we update the results and analyze the 5-year survival results. METHODS: Thirty-two patients with previously untreated stage III and IV resectable squamous cell carcinoma of the oral cavity and pharynx were entered into the study. The PEM regimen consisted of cisplatin 60 mg/m2 2 h infusion on day 1, etoposide 40 mg/m2 1 h infusion on days 1, 2 and 3 and mitomycin-C 7 mg/m2 i.v. bolus on day 1. RESULTS: Among the 32 patients entered into this trial, eight were disqualified from the analysis. Of the remaining 24 patients, 13 were given neoadjuvant chemotherapy (NAC) and 11 underwent surgery alone. Among the 13 patients who received NAC, four achieved a complete response (31%) and three a partial response (23%), with an overall response rate of 54%. Myelosuppression was a major side effect. Thrombocytopenia and anemia were dose-limiting toxicities. Other adverse reactions, including mucositis, were all mild and transient. The overall 5-year survival after NAC and without NAC were 83 and 62%, respectively. The survival difference was not statistically significant (p = 0.33). CONCLUSIONS: NAC does not appear to play a role in the treatment of cancer of the oral cavity and pharynx with our PEM regimen. However, the degree of toxicity was limited in our trial and therefore attempts to increase the dosage and/or revise the administration schedule for cancer of the pharynx and T1 to T3 tumor disease appear warranted.

Granular cell tumors arising nearly simultaneously in the larynx and subcutaneous cervical region.

Granular cell tumors are benign, relatively rare lesions that can occur in any organ in the body. Tumors are known to occasionally arise in two or more different organs. We report the case of a 60-year-old woman in whom granular cell tumors arose almost simultaneously in her subcutaneous cervical region and her larynx. The two tumors were surgically resected and examined histopathologically, and they exhibited the same histopathologic features. The tumor of the larynx was resected with the help of a carbon dioxide laser. Immunohistochemical staining revealed that both were positive for S-100 protein and neuron-specific enolase. Cases of the nearly simultaneous appearance of granular cell tumors in the neck and larynx are rather unusual. The results of immunohistochemical staining suggested that this tumor originates in nerve tissue.

Video-assisted endoscopic laryngosurgery using a direct laryngoscope and a long rigid endoscope.

Endolaryngeal microscopic laryngosurgery (microlaryngosurgery) using a direct laryngoscope is the preferred surgical method for treating laryngeal lesions under general anesthesia. However, this method does not provide a wide-angle view of the larynx and does not allow detailed observations of the ventricle and subglottis of the laryngeal cavity, resulting in blind areas. Video-assisted endoscopic laryngosurgery using a direct laryngoscope and a long transurethral rigid endoscope was therefore utilized to allow clear observations and complete resection of laryngeal lesions in these blind areas. This endoscopic surgical technique is introduced, and clinical cases are presented.

Prognosis after salvage chemotherapy for locally unresectable recurrent squamous cell carcinoma of the head and neck.

BACKGROUND: For locally unresectable recurrent squamous cell carcinoma of the head and neck, we investigated two salvage chemotherapy regimens as second-line chemotherapy. In our preliminary study, we observed that both regimens were active. In the present study we analyzed the prognosis of these patients. METHODS: Twenty-six patients with recurrent advanced head and neck cancer, were treated with one of two new regimens as second-line chemotherapy. The PEM regimen consisted of cisplatin 60 mg/m2 on day 1, etoposide 40 mg/m2 on days 1, 2 and 3 and mitomycin-C 7 mg/m2 on day 1. The long CF regimen consisted of cisplatin 8 mg/m2 on days 1-5, 8-12, 15-19 and 22-26 and 5-fluorouracil 300 mg/m2 as a 24 h infusion or oral administration of tegaful-uracil (UFT-E) 400 mg/m2 on days 1-28. Survival curves were calculated using the Kaplan-Meier method and compared by the log rank test. RESULTS: Of 24 patients evaluable for response, three complete responses (CR) and seven partial responses (PR) were achieved, with an overall response rate of 42%. Myelosuppression was the major side effect. One year survival was 100% for CR, 0% for PR and 20% for minor response (MR). All patients who failed to achieve a CR died within 12 months, except one patient with MR. CONCLUSION: Our data suggest that with these salvage regimens survival benefit was demonstrated only in CR patients.

Squamous cell carcinoma with sarcomatous stroma of the mesopharynx.

A case of squamous cell carcinoma with sarcomatous stroma of the mesopharynx is presented. The patient was a 62-year-old man who complained of a foreign body sensation. Endoscopic examination revealed a large pedunculated mass arising from the posterior wall of the mesopharynx. The lesion was surgically resected, using a cutting snare by the endo-oral approach, and was completely removed. A diagnosis of squamous cell carcinoma with sarcomatous stroma was made histopathologically. The clinicopathological features of this case are described and compared with those of previously reported cases.

Lubrication mechanism of the larynx during phonation: an experiment in excised canine larynges.

To evaluate how the viscosity of the laryngeal mucus influences vocal fold vibration, two fluids of differing viscosity were applied separately to excised canine larynges and experimental phonation was induced. Vibration of the vocal folds was measured by use of a laryngostroboscope and an X-ray stroboscope. With the high viscosity fluid, the amplitude of vibration of the free edge and the peak glottal area was decreased while the open quotient was increased. Because the viscosity of this fluid affected the wave motion of the vocal fold mucosa, changes in viscosity of the mucus may be involved in causing such disorders as hoarseness, in the absence of apparent changes in the vocal folds themselves.

Observations of laryngeal lesions with a rhinolarynx electronic videoendoscope system and digital image processing.

Laryngeal lesions were observed with the Olympus ENF-200 rhinolarynx electronic videoendoscope attached to the Olympus EVIS-200 system, an electronic videoendoscope system of Olympus Optical Co, Ltd. The electronic videoendoscope differs from conventional flexible fiberscopes in having a small light-sensitive charge-coupled device (CCD) chip built into the tip of the endoscope portion. This model has a small CCD chip in its 5-mm-outer diameter tip, and can be introduced into the laryngeal cavity by inserting it through the nasal passages. Dynamic color images obtained by this system were very clear and provided excellent resolution. This electronic videoendoscope system could also be connected to the Olympus EVIP-230 digital image processor, which was compatible with this system. Structure enhancement and color enhancement were performed by processing images. In this paper, the ordinary images and the processed images are described and discussed from the standpoint of diagnostic usefulness.

Multidirectional observations of the larynx using transurethral rigid endoscopes during direct laryngoscopy.

Microscopic direct laryngoscopy (microlaryngoscopy) under general anaesthesia is the optimal method of observing the larynx. However, as microlaryngoscopy does not allow precise observations of the ventricle, inferior surface of the vocal fold and subglottis, multidirectional observations of the larynx using transurethral rigid endoscopes were performed during direct laryngoscopy. This endoscopic technique has been shown to be clinically useful in the diagnosis and treatment of laryngeal lesions. The equipment and methods are introduced herein, and a representative care is presented.

Electronic videoendoscopy of laryngeal lesions using a new type of rhinolarynx endoscope portion.

Patients with laryngeal lesions were observed and the lesions were recorded with an electronic videoendoscope system using the PENTAX EPM-3300 video processor and the PENTAX VNL-1330 endoscope portion. The electronic videoendoscope system differs from the conventional fiberoptic endoscope connected to a video camera in that a small monochrome charge-coupled device (CCD) chip is built in the tip of the endoscope portion. The PENTAX VNL-1330 rhinolarynx endoscope portion has a tip and insertion tube of approximately 4mm in outer diameter to allow its introduction through the nasal passages into the larynx. The dynamic color images provided by this system were superior to those obtained by a conventional rhinolarynx flexible fiberscope connected to a video camera in both quality and resolution of detail. This system should be useful in diagnosing laryngeal lesions.

Verrucous carcinoma of the larynx presenting as a hairy whitish tumor.

A patient was encountered with verrucous carcinoma of the larynx that presented as a hairy whitish tumor. There was a recurrence because simple excision with forceps by endolaryngeal microsurgery was performed in the first operation. However, in the second operation endolaryngeal microscopic laser surgery using a direct laryngoscope was performed and followed by adjuvant chemotherapy with oral UFT, a combination of uracil and tegafur in a molar ratio of 4:1. The patient's course has been favorable to date. The case is reported in this paper and discussed from the viewpoint of diagnosis and treatment of this neoplasm.

Isolated non-Hodgkin's malignant lymphoma of the larynx presenting as a large pedunculated tumor.

This paper presents a case of non-Hodgkin's lymphoma (NHL) of the larynx. The patient was an 86-year-old man who complained of foreign-body sensation and dysphagia. Laryngoendoscopic examination revealed a large pedunculated mass arising from the left aryepiglottic fold. A diffuse, large, B-cell-type NHL was diagnosed histopathologically. The patient was treated with combination chemotherapy, resulting in complete clinical remission. The clinicopathological features of this case have been described and compared with previously reported cases.

Vocal fold vibration in simulated head voice phonation in excised canine larynges.

In order to establish precise vibratory patterns and their clinical implication for phonation, the mode of vibration of the vocal folds around the time of register transition in excised canine larynges was analyzed multi-directionally according to various acoustic parameters. Phonation was simulated by artificially tensing the cricothyroid muscles. Vibration of the vocal folds around the time of register transition was filmed from above using ultra-high-speed cinematography and in a frontal plane using X-ray stroboscopy. Acoustic parameters included subglottic pressure, pitch, intensity and tension and were recorded simultaneously during register transition. The fundamental vibration patterns observed during vocal phonation were the same as that involved in chest voice phonation in excised canine larynges, with respect to the traveling wave of the vocal fold vibration. Changes in the physical properties of the vocal folds were considered to occur at register transition. These changes were probably strongly dependent upon changes in the structure of the lamina propria. Head voice phonation requires adaptability of the lamina propria and is less efficient than chest voice phonation. Hence, head voice phonation would be one method for assessing the condition of the vocal folds.

Newly designed specula for laryngomicroscopy.

We produced specula for laryngomicroscopy to observe blind spots in the operating field. Use of these specula has facilitated detailed observation of the lower surface of the false vocal folds, laryngeal ventricle, and subglottis, which were previously in blind spots. The specula are useful in the following ways: 1) clarifying blind spots for improved diagnosis and providing more accurate surgical margins; 2) observing the lower lips of the vocal folds in phonosurgery; and 3) Vaporizing with laser reflection. The specula are cheap and easy to use and are well worth considering for application to laryngomicroscopy.

Conservative therapy for nonspecific granuloma of the larynx using a beclomethasone dipropionate inhaler.

Nonspecific granuloma of the larynx is a benign tumor that usually occurs on the posterior glottis. Conventional treatment for this laryngeal lesion has consisted of surgical resection. However, this lesion has a strong tendency to recur postoperatively and may require multiple repeated operative procedures. Conservative treatment, consisting mainly of beclomethasone dipropionate inhalation therapy, was instituted in 20 cases with good results. We discussed the effect of beclomethasone dipropionate on this lesion as well as the etiology of this disease.

Salvage chemotherapy with PEM and long-CF regimen in CDDP refractory advanced head and neck cancer.

With the aim of increasing complete response rates and improving survival in cisplatin (CDDP)-based combinations (CDDP + 5-fluorouracil (5FU) and/or CDDP+methotrexate (MTX)+bleomycin (BLM) of refractory advanced head and neck cancer, we scheduled 21 patients to receive PEM and Long CF, PEM regimens consisting of CDDP (P) Etoposide (Etop) (E) and mitomycin-C (MMC) (M) (CDDP 60 mg/m2/2 hr. infusion on day 1; Etop 40 mg/m2/1 hr. infusion on day 1, 2, 3; MMC 7 mg/m2 iv bolus on day 1). Of 12 patients evaluable for response, 2 CR, 3 PR were realized, with an overall response rate of 42%. Myelosuppression was the major side effect, and thrombocytopenia (8% greater than WHO grade III) was the dose-limiting toxicity. Long CF consisted of CDDP (C) and 5FU (F) (CDDP 8 mg/m2/2 hr. infusion on day 1-5, 8-12, 15-19, 22-26; 5FU 300 mg/m2/24 hr. infusion or tegaful.uracil (UFT-E) 400 mg/m2 P.O. on day 1-28. Of 8 patients evaluable for response, 3 PR were realized, with an overall response rate of 38%. N&V and leukopenia were the major side effects. These adverse reactions were all transient. We concluded that these two regimens produced beneficial effects in patients with advanced recurrent head and neck cancer which had already been treated with CDDP-based combinations.