[Clinical characteristics of different cordectomy types with potassium titanium phosphate laser].

OBJECTIVE: To study the clinical characteristics of different potassium titanium phosphate(KTP) laser types and surgical the recuperating course of cordectomy under suspension laryngoscope. METHOD: Follow-up observation were applied on 76 patients with cordectomy. Restoration of laryngeal structure and change of the quality of voice were observed and recorded. RESULTS: Type 1, normal laryngeal structure and function were restored postoperatively after 3 months; Type 2, a fold like vocal cord (new vocal cord) appeared 3 months later. Laryngeal structure was basically restored; Type 3, a mucosal fold appeared postoperatively after 6 months in most patients, but it lost motion function. Recurrence time was mainly found 2-4 months. Recurrence rate was 6.7%. Two and 5-year survival rate were 100%. CONCLUSIONS: Cordectomy with KTP laser can result in good effect and less injury. Type 2, 3 can retain thyroarytenoid muscle as much as possible on the basis of radical cure.

[Clinical study on treatment of early glottic carcinoma with different cordectomy].

OBJECTIVE: To explore the advantage of KTP laser cordectomy in the treatment of early glottic carcinoma. METHOD: Follow-up observation on 30 patients who had KTP laser cordectomy and 18 patients who had laryneal split cordectomy was applied, then their postoperative laryngeal structure's change, the quality of voice and the quality of life (QOL) were compared and analyzed. RESULT: The patient group treated by KTP laser grew out a piece of new cord just at the place where it was excised after half a year, and the quality of voice was obviously improved near to norm, and they had higher QOL. On the contrary, the other group had no newly grown cord, their quality of voice was better in the first half year but was worse last out. Their QOL was lower than the laser group before decannulation and the same as the laser group after the decannulation. There are 2 cases recurrented in the laser group and 1 case recurrented in the laryneal split group, the two groups all had no metastasis and death in laryneal carcinoma by 2-4 years follow up postoperation. CONCLUSION: On the basis of effecting radical cure, the early glottic carcinoma treated with non-contact KTP laser with suspension laryngoscope can result in good recuperating in laryngeal structure, less injury and high QOL. So it makes micro-injury treatment in laryngeal carcinoma come true and better than the laryngeal split cordectomy.

[Multiple primary cancers of oral cavity and pharynx].

Multiple primary cancers were found in 23 of 68 patients (34%) with an index cancer in the oral cavity or pharyngeal area treated in our institute from June 1995 to July 1998. Four cases had triple primary cancers. All 68 cases underwent upper and lower gastrointestinal endoscopy as well as ultrasonography of the liver. Lung CT was performed in cases with abnormal findings on chest roentgenograms. Multiple cancers were found in 5 of 25 oral cavity cases (20%), 6 of 14 mesopharynx cases (43%) and 12 of 29 hypopharynx cases (41%). Nine of 23 cases (39%) were synchronous and 14 (61%) were metachronous. Eighteen of 27 (69%) secondary cancers occurred in the upper aerodigestive tract with an especially high incidence (22%) in the esophagus. Gastroendoscopy also revealed 7 neoplastic lesions, aside from cancers, with the total abnormal rate of 24% (24/68). Thus, gastroendoscopy is useful for the diagnosis of multiple primary cancers. The frequency of multiple primary cancers in males (33%) was not different from that in females (35%). The average age of multiple primary cancer patients (65.1 years) was a little higher than that of single cancer patient (62.7 years). Smoking or drinking was not related to the incidence of multiple cancers. The interval between the first and the second cancer in metachronous cancer cases was 25.5 months on average, and within 4 years in 71% (10/14) of the cases. This result suggests that close follow-up including endoscopy should be required for at least 4 years after treatment of oral or pharyngeal cancer. Radical treatment for each of the multiple cancer lesions was performed in 22 of 23 cases, and the mortality rate of multiple primary cancer cases was not significantly different from that of single cancer cases. Among 7 cases who died of disease, 5 cases died of distant metastasis, suggesting that control of distant metastasis is an important issue in the treatment of multiple primary cancers.

Expression of connexin 26 and Na,K-ATPase in the developing mouse cochlear lateral wall: functional implications.

The immunohistochemical localization of connexin 26 (a gap junction protein) and Na,K-ATPase in the mouse cochlear lateral wall was studied at different ages between 0 and 30 days after birth (DAB). Connexin 26-like immunoreactivity was sparsely distributed among the connective tissue cells just lateral to the future marginal cells of the stria vascularis on 0 DAB. In the mice of 3-6 DAB, connexin 26 was observed in the strial basal cell area, and was increased in its distribution density on 10 DAB. Connexin 26 was sparsely distributed among the fibrocytes in the spiral ligament and the suprastrial zone on 10 DAB, and its distribution density increased rapidly in the mouse on 12 DAB. The immunohistochemical distribution reached the adult pattern in the cochlear lateral wall on 15 DAB. Weak Na, K-ATPase-like immunoreactivity was observed in the epithelial cells, corresponding to the future strial marginal cells, on 0 DAB. Its staining intensity was enhanced with the increase of age, and reached the adult pattern on 10 DAB. In contrast, Na,K-ATPase-like immunoreactivity in the type II fibrocytes and suprastrial fibrocytes was first detected on 12 DAB, and reached the mature level on 15 DAB. It is well known that the endolymphatic potential (EP) reaches the adult level 2 weeks after birth. The expression patterns of connexin 26 and Na,K-ATPase in the fibrocytes of the spiral ligament and the suprastrial zone coincided with the rapid growth and maturation of EP. These findings may suggest a role for the gap junctional communications and Na,K-ATPase activity of the fibrocytes within the cochlear lateral wall in the generation and maturation of EP.

[Simultaneous reconstruction of pharyngoesophagus and phonetic shunt following laryngopharyngoesophagectomy].

Because of its many advantages, free jejunal transfer has gained wide acceptance for pharyngoesophageal reconstruction after ablative surgery. Because the jejunum is well vascularized, it facilitates good wound healing, and has a low incidence of anastomotic insufficiency, fistula formation and stricture. However, voice rehabilitation in this group of patients can be difficult. Therefore, we performed primary tracheojejunal shunt operations for voice restoration with jejunum siphons using Nozaki's method (type 3). In this procedure, after dividing a section of the jejunum into two segments, the reconstructed neopharyngoesophagus is anastomosed in a side-to-end fashion to the fabricated shunt using the other segment of the jejunum, as an "elephant nose shunt" so called because of its appearance. Voice restoration can be achieved in patients who undergo laryngopharyngoesophagectomy through these reconstructive procedures. We performed this surgery for nine hypopharyngeal cancer patients after total pharyngo-laryngo-esophagectomy. Following placement of the shunt, no special care was required. Only one patient developed a severe aspiration. No leakage was seen and the swallowing function was preserved in all patients. Four of nine patients could speak well following these procedures. A vibratory source is created in the neoesophagus, above the elephant shunt. During speech production, narrowing of the inside and vibration of the jejunal mucosa can be observed using a laryngeal fiber scope. In order to study the acoustical characteristics of shunt speech, voice analysis was performed in patients with restored phonatory function using Computerized Speech Lab Model 4300 (KAY). Irregularities of pitch periods in the voice sample were measured using Jita (the pitch period) and Jitt (relative evaluation of the pitch) for the very short term (cycle-to-cycle), and PPQ (pitch period pertubation quotient) for the short term (cycle-to-cycle with a smoothing factor of 5 periods). Irregularities of the peak-to-peak amplitude were measured using ShdB (evaluation in dB of the peak-to-peak amplitude) and Shim (relative evaluation of the peak-to-peak amplitude) for the very short term (cycle-to-cycle), and APQ (amplitude perturbation quotient) for the short term (cycle-to-cycle with a smoothing factor of 11 periods). The pertubation parameters of shunt speech are larger than normal ones not only in terms of the period but also in terms of the amplitude. These results are similar to those of laryngeal polyps, recurrent nerve palsy and esophageal speech. Recovery of phonation using Nozaki's type 3 method with the elephant nose shunt appears promising for pharyngo-laryngo-esophagectomized patients.

[A study on monoclonal antibodies against epithelial cell of endolymphatic sac in guinea pigs].

Using a microdissected endolymphatic sac of the guinea pig (n = 35) as an initial antigen preparation, serials of monoclonal antibodies were established which were used to label the epithelial cells of endolymphatic sac. The antibodies showed strong immunoreactivity with kidney, but not with other organs. It also showed isotopes IgG1, IgG2b and IgM. The results of Western blotting and SDS-PAGE indicated that the epitopes of monoclonal antibodies were proteins or glyoprotein with a molecular weight of approximately 7,400. The locations of the epitopes in epithelial cells suggest that it may play some roles in construction and function of the endolymphatic sac.

ATP-induced increase in intracellular Ca2+ concentration in the cultured marginal cell of the stria vascularis of guinea-pigs.

The primary culture of marginal cells from the explant of the stria vascularis of guinea-pigs was established and confirmed by morphological, immunohistochemical and physiological characters of the cultivated cells. The positive stain of cytokeratin 18 without vimentin and desmin expressions indicated the epithelial origin of the cultured polygonal cells. Electron microscopical findings of cultured cells resembled the morphological characteristics of marginal cells. The addition of 100 microM ouabain to the cultured cells significantly increased the intracellular Na+ concentration, providing the evidence for the presence of Na+ pump. Using the cultured marginal cells identified by the above-mentioned findings, the effects of neurotransmitters and hormones in regulating intracellular Ca2+ concentration ([Ca2+]i) were investigated. The addition of 10(-4) M ATP caused an increase in [Ca2+]i, which was independent of the presence of extracellular Ca2+. The rank order of agonist potency was ATP > alpha, beta-methylene ATP > ADP. Adenosine, however, evoked no response. Cultured marginal cells may possess P2-purinergic receptors which mobilize Ca2+ from the intracellular Ca2+ pool.

Dysgenesis of melanocytes and cochlear dysfunction in mutant microphthalmia (mi) mice.

In order to evaluate the cytological homology of intermediate cells and melanocytes, and to investigate the function of melanocytes in the inner ear, hearing acuity and cochlear pathology were studied in three strains of mice, namely, wild type mice (+/+), albino mice without melanin (c2J/c2J), and microphthalmia mice with no melanocytes (mibw/mibw). Our histochemical data indicated that intermediate cells showed cytological characteristics almost identical to those of melanocytes and that disorders of melanin and/or melanocytes were reflected in the stria vascularis of each mouse. While c2J/c2J presented the same normal hearing acuity and normal structure of the stria vascularis as +/+, the hearing acuity of mibw/mibw mutants was severely impaired. Their stria vascularis was abnormally thin, lacking intermediate cells. According to these results, lack of melanin has little influence on hearing acuity; however, the absence of intermediate cells or melanocytes causes severe hearing loss, presumably due to a strial dysfunction.

Hearing and glycoconjugates: localization of Le(y), Le(x) and sialosyl-Le(x) in guinea pig cochlea, particularly at the tectorial membrane and sensory epithelia of the organ of Corti.

Immunohistological examination of guinea pig cochleas was performed using a panel of 25 monoclonal antibodies directed to various lacto-, ganglio- and globo-series carbohydrate epitopes as well as mucin-type epitopes. Lacto-series structures were found to be localized at specific sites of the tectorial membrane (TM) and Corti's organ, i.e. alpha 1-->3 fucosyl type 2 chain (Le(x)) at Kimura's membrane, marginal band and covering net of TM; alpha 1-->2, alpha 1-->3 difucosyl type 2 chain (Le(y)) at covering net; and sialosyl-Le(x) and sialosyl-i at Kimura's membrane and sensory epithelia, particularly sensory tips of hair cells of Corti's organ. In striking contrast, ganglio-series structures (GM3, GD3, GD2, 9-O-Ac-GD3) were detected at spiral ganglion cells, neuronal fibres and stria vascularis, but were completely absent from Corti's organ and most of the TM. Other epitope structures defined by various antibodies were not detectable at any location. The functional roles of lacto-series carbohydrate epitopes expressed at TM and Corti's organ remain unknown. However, the expression of Le(y) (but not other structures) in association with developmental deficiency of TM induced by 6-N-propyl-2-thiouracil in rats suggests that Le(y) plays some role in normal TM development. The presence of Le(x) at Kimura's membrane and sialosyl-Le(x) at hair cell sensory tips of Corti's organ suggests the intriguing possibility that these fucosylated/sialosylated carbohydrate structures play some role in interactions (either attractive or repulsive) of these inner ear components, which have been implicated in the physiology of hearing, i.e. the conversion of sound waves to nerve impulses.

Effect on cochlear potentials of lateral semicircular canal destruction.

Recording of the cochlear potentials was successfully performed during experimental labyrinthectomy in the guinea pig and in three patients with acoustic neuromas during translabyrinthine removal of the tumors. In the guinea pig, complete interruption of the duct of the lateral semicircular canal including the endolymphatic canal caused little change in the endocochlear DC potential of the first cochlear turn and input-output function curve of the N1 component of the compound action potential elicited by 8-kHz tone bursts. Further drilling of the vestibular labyrinth in the guinea pig caused decline of these potentials when the vestibular was opened. In patients with acoustic neuromas, the interruption of the duct of the lateral semicircular canal hardly altered the N1 input-output function curve and N1 input-latency function curve during the 1-hour observation period. Consistent preservation of cochlear function even after interruption of lateral semicircular canals suggests the possibility of partial surgical labryrinthectomy with preservation of hearing for lesions involving semicircular canals.

Microtubule subunits of guinea pig vestibular epithelial cells.

Guinea pig cochlear supporting cells have microtubules which are composed of 15, instead of the ordinary 13, protofilaments. The microtubules form a large and stiff bundle involving abundant actin filaments to provide effective rigidity to the cell specialized for transduction of extremely high-frequent mechanical stimuli. We examined microtubules in guinea pig vestibular end organs with the transmission electron microscopy after treatment with tannic acid. Solitary microtubules occurred abundantly in the supranuclear region of type I hair cells, but sparsely in type II hair cells. Individual microtubules consisted of an ordinary set of 13 protofilaments in these hair cells as well as in the supporting cells. Supporting cells were characterized by cytoskeletal bundles of 2 to 30 microtubules which were found to be connected with actin filaments via cross-linking units. Results from the present investigation indicate that such less-organized microtubules of 13 protofilaments are sufficient for vestibular supporting cells which are specialized for detection of lower-frequency vibration together with fellow sensory cells.

Extracranial chondroma of the skull base.

We report a case of an extracranial chondroma of the skull base. This tumor occupied mainly the skull base, the nasopharynx and the parapharyngeal space. Magnetic resonance imaging was effective in diagnosis and determining the extent of the lesion. Total extirpation of the lesion was performed via an external cervical approach. A survey of the available literature revealed only three similar cases treated to date.

Effect of high perilymphatic potassium concentration on the guinea pig vestibular sensory epithelium.

The 'rupture theory' has been proposed to explain the vertiginous attack of Meniere's disease, and the high perilymphatic potassium concentration was thought to be the most important factor in this theory. In this investigation, potassium ion was introduced through the round window into the perilymphatic space in guinea pigs by means of iontophoresis, to investigate the effect of high perilymphatic potassium concentrations on the vestibular sensory epithelium, histochemically. Following the iontophoretic procedure, spontaneous nystagmus was observed, directed toward the iontophoretic side (irritative nystagmus) for the first 10 min, and then toward the unaffected side (paralytic nystagmus) for 24 h. Both these nystagmus types were quite reversible and left no morphological change in sensory cells. However, histochemical analysis revealed an increased ATPase activity during the irritative nystagmus and decreased ATPase activity during the paralytic nystagmus in the synaptic area between the hair cells and the nerve endings of the vestibular sensory epithelium on the iontophoretic side. Judging by these results, high perilymphatic potassium concentration is assumed to affect the synaptic area of the sensory epithelium, leading to reversible nystagmus.

Clinical report: cylindrical cell papilloma of the paranasal sinus.

We report a case of cylindrical cell papilloma of the paranasal sinuses. This tumor originated in the medial wall of the left maxillary sinus of a 69-year-old man and extended to the surrounding tissues. Pathological study of tissue sections from the tumor showed typical findings of cylindrical cell papilloma with no evidence of associated malignancy. Histochemical and electron microscopic examinations revealed a large number of mitochondria in the cytoplasm of the tumor cells. The tumor was removed through a Denker's approach. The patient did well following surgery and there has been no sign of recurrence in a 2-year follow-up study.

Biological property of immune complex to prolong the duration of otitis media with effusion.

This study was designed to evaluate the biological properties of a light molecular weight immune complex, in comparison with that of a heavy molecular weight immune complex. Soluble immune complexes were obtained by mixing horseradish peroxidase (HRP) with guinea pig antiserum to HRP and were divided by gel filtration into several fractions according to their molecular weight (MW). After the chemotactic activity of each fraction was examined in vitro, the lightest and the heaviest MW immune complexes were injected into a guinea pig's left and right superior bulla, respectively. Although a middle ear effusion developed in both the bulla, the histopathological feature of an experimentally induced otitis media with effusion varied with the MW of the injected immune complex. The light MW immune complex proved to be a stronger inducer for a macrophage than the heavy MW immune complex, both in vitro and in vivo, and to have a tendency to persist longer in the tympanic cavity than the heavy MW immune complex. These results suggested that otitis media had a tendency to persist when a light MW immune complex was formed in a middle ear. The light MW immune complex was suspected to be involved in the pathogenesis of otitis media with effusion.

Mast cell degranulation in nasal polyps.

Light- and electronmicroscopic observations as well as immunohistochemical studies were made on nasal polyps from 15 patients. The patients included 2 cases of aspirin intolerance (AA), 6 cases of allergic rhinitis (NA) and 7 cases of chronic rhinitis (CS) with negative skin tests against major inhalant allergens. Nasal polyps commonly contained many inflammatory cells such as neutrophils (PMN), eosinophils, plasma cells, mast cells, lymphocytes and macrophages. Two morphological features were conspicuous in our study: 1) PMN migration and attachment to the basal lamina, 2) accelerated degranulation of mast cells. Mean values of degranulated granules were 0.532473/micron2 in AA, 0.492615/micron2 in NA and 0.253591/micron2 in CS. These results indicate that mast cell degranulation in CS is much less than that in AA and NA. Immunohistochemical investigations revealed very few IgE-positive cells in both AA and NA, and none in CS. On the other hand IgG and IgA were frequently observed in all cases of nasal polyps. The present study suggests that mast cell degranulation plays an important role in the formation of nasal polyps, but it may not only be an IgE-dependent mechanism. To elucidate other possibilities, more extensive immunological studies will be required.

Experimental studies on mechanism of the Menière's attack: investigation into vestibulo-cochlear response of the guinea pig induced by potassium ion.

After introducing potassium ion through the round window into the perilymphatic space of 40 guinea pigs by means of iontophoresis, physiological and histochemical investigations were performed to determine the role of the high perilymphatic potassium concentration in the vertiginous attack of Ménière's disease. About 15 min after the iontophoretic procedure, electronystagmography revealed irritative nystagmus for the first 5 min and then paralytic nystagmus for the following 6 to 24 hr. Histochemical analysis of the vestibular sensory epithelia revealed the increased activity of succinic dehydrogenase and Na-K-ATPase during irritative nystagmus and the decreased activity during paralytic nystagmus. The Na-K-ATPase activity was dominant in the synaptic area between the hair cells and the nerve-endings of the vestibular sensory epithelia. There was some delay between the reversal of nystagmus-direction and the change of enzyme activity. This delay was thought to be produced by the central regulatory mechanism for the disturbed tonus-balance in the vestibular nucleus. On the other hand, electrocochleography revealed the decrease of the action potential without any initial irritative cochlear sign, and the enzyme activity of the cochlear sensory cells was decreased from the beginning.