The efficacy of synthetic pseudo-ceramide for dry and rough lips.

OBJECTIVE: Lips can easily become dry and rough, one reason being the characteristics of their ceramide (CER) profile. Lips have lower levels of total ceramides, higher percentages of CER[NS] and CER[AS], and lower percentages of CER[NP] and CER[NH] than skin in other regions of the body. The purpose of this study was to clarify the effects of synthetic pseudo-ceramide (pCer; Cetyl-PG hydroxyethyl palmitamide) to improve the dryness and roughness of the lips of healthy subjects in a formulation that exclude an occlusive effect. METHODS: Thirty-one Japanese female subjects with normal skin (age range 21-37 years; mean 28.6) were enrolled in this study. A four-week continuous use test was conducted using samples with or without 0.5% or 2.0% pCer. The degree of lip roughness was scored, and values of capacitance, transepidermal water loss (TEWL) and lip surface elasticity were measured. Endogenous CER profiles and absorption levels of pCer in the stratum corneum (SC) were analysed in tape-stripped skin specimens. RESULTS: Treatment with the pCer-2.0% sample significantly improved the visual roughness score after 2 and 4 weeks compared to 0 weeks and compared to the Blank. Moreover, an improvement in TEWL was observed after 4 weeks of treatment with the pCer-2.0% sample. CER[NP] showed a significant increase in pCer-2.0% treated lips after 4 weeks compared to the Blank. Both pCer-0.5% and pCer-2.0% were significantly absorbed after 2 weeks compared with the Blank. CONCLUSION: The effect of the synthetic pseudo-ceramide pCer to improve the roughness of lips was shown excluding the effect of occlusiveness derived from the formulation for the first time. Since the improvement of TEWL and absorption of pCer was observed, we concluded that pCer was first absorbed in rough lip areas, improved the ceramide profile and consequently restored the barrier function.

OBJECTIF: Les lèvres peuvent facilement devenir sèches et rugueuses, l'une des raisons étant les caractéristiques de leur profil de céramide (CER). Les lèvres présentent des taux plus faibles de céramides totaux, des pourcentages plus élevés de CER[NS] et de CER[AS] et des pourcentages plus faibles de CER[NP] et CER[NH] que la peau des autres régions de l'organisme. L'objectif de cette étude visait à clarifier les effets du pseudo-céramide synthétique (pCer; cétyl-PG hydroxyéthyl palmitamide) pour améliorer la sécheresse et la rugosité des lèvres de sujets en bonne santé avec une formulation excluant un effet occlusif. MÉTHODES: Trente et un sujets de sexe féminin japonais ayant une peau normale (tranche d'âge: 21 à 37 ans; moyenne: 28,6 ans) ont été inclus dans cette étude. Une analyse d'utilisation continue de quatre semaines a été effectuée en employant des échantillons avec ou sans pCer à 0,5 % ou 2,0 %. Le degré de rugosité des lèvres a été noté et les valeurs de capacitance, de perte d'eau transépidermique (transepidermal water loss, TEWL) et d'élasticité de la surface des lèvres ont été mesurées. Les profils CER endogènes et les niveaux d'absorption de pCer de la couche cornée (stratum corneum, SC) ont été analysés dans des échantillons cutanés fixés par bande adhésive. RÉSULTATS: Le traitement avec l'échantillon pCer-2,0% a amélioré de façon significative le score de rugosité visuelle après 2 et 4 semaines par rapport à 0 semaine et par rapport au groupe témoin. En outre, une amélioration de la TEWL a été observée après 4 semaines de traitement avec l'échantillon pCer-2,0%. Après 4 semaines, le CER[NP] a aumenté de manière significative dans les lèvres traitées avec pCer-2,0% par rapport au groupe témoin. Le pCer-0,5 % et le pCer-2,0% ont tous deux été absorbés de manière significative après 2 semaines par rapport au groupe témoin. CONCLUSION: L'effet du pseudo-céramide synthétique pCer pour améliorer la rugosité des lèvres a été démontré, excluant l'effet de l'occlusion dérivé de la formulation pour la première fois. Puisque l'amélioration de la TEWL et l'absorption du pCer ont été observées, nous avons conclu que le pCer était d'abord absorbé dans les zones rugueuses des lèvres, améliorait le profil du céramide et, par conséquent, rétablissait la fonction barrière.

The efficacy of a highly occlusive formulation for dry lips.

OBJECTIVE: Since skin on the lips has a lower water content in the stratum corneum (SC) and a higher transepidermal water loss (TEWL) value than skin on the cheek, the lips are usually very dry and rough areas. Therefore, a lip balm approach to increase occlusivity of the lips is generally used to reduce water loss. Although there have been reports of an improvement effect on lip roughness by specific care agents, differences in the effects due to the occlusivity of a formulation without a specific care agent have not been reported. The purpose of this study was to clarify the improvement effect on dryness and roughness of the lips by a highly occlusive formulation consisting of a combination of common oil and wax, not by a specific care agent. METHODS: Twenty Japanese female subjects with normal skin (age range 20-39 years; mean 28.1) were enrolled in this study. A 4-week continuous use test was conducted using samples with low and high occlusivity. The degree of lip roughness and wrinkles was scored, the hollow index was assessed using ANTERA 3D images, and values of capacitance and TEWL were measured. RESULTS: The hollow index was significantly correlated with both the appearance roughness score and the wrinkle score. The sample with high occlusivity showed significant improvement in the appearance roughness score, wrinkle score, the hollow index and capacitance of the SC. In a comparison between the groups of samples with different occlusive properties, a significant improvement effect in rough appearance was seen in subjects using the highly occlusive formulation. CONCLUSION: The hollow index assessed by ANTERA 3D imaging allowed the objective evaluation of the improvement in appearance. In the case of continuous use of the highly occlusive formulation, an improvement of capacitance in the SC, which is most correlated with lip roughness, was obtained after 2 and 4 weeks. These results demonstrate for the first time that a highly occlusive formulation is effective in improving the roughness of the lips, and this effect is due to the difference in the occlusive property not by a specific care agent.

OBJECTIF: La peau qui recouvre les lèvres ayant une plus faible teneur en eau dans la couche cornée (CC) et une valeur de perte d'eau transépidermique (PETE) plus élevée que la peau des joues, les lèvres sont généralement des zones très sèches et rugueuses. Par conséquent, l'utilisation d'un baume à lèvres pour augmenter l'occlusivité des lèvres est généralement l'approche adoptée pour réduire la perte d'eau. Même s'il y a eu des rapports d'un effet d'amélioration de la rugosité des lèvres grâce à des agents de soin spécifiques, aucune différence par rapport aux effets dus aux propriétés occlusives d'une formule ne contenant pas un agent de soin spécifique n'a été rapportée. Le but de cette étude était de clarifier l'effet d'amélioration de la sécheresse et de la rugosité des lèvres d'une formule hautement occlusive composée d'une association d'huile et de cire courantes, et non pas d'un agent de soin spécifique. MÉTHODES: Vingt sujets de sexe féminin japonais ayant une peau normale (tranche d'âge : 20 à 39 ans ; moyenne : 28,1) ont été inclus dans cette étude. Un test d'utilisation continue pendant 4 semaines a été mené en utilisant des échantillons ayant des propriétés occlusives faibles et élevées. Le degré de rugosité et de ridules des lèvres a été noté, l'indice de creux a été évalué à l'aide d'images 3D ANTERA, et les valeurs de capacitance et de PETE ont été mesurées. RÉSULTATS: L'indice de creux était significativement corrélé avec le score de l'aspect de rugosité et le score de ridules. L'échantillon comportant des propriétés occlusives élevées a démontré une amélioration significative du score de l'aspect de rugosité, du score de ridules, de l'indice de creux et de la capacitance de la CC. Dans une comparaison entre les groupes d'échantillons comportant différentes propriétés occlusives, une amélioration significative de l'effet sur l'aspect rugueux a été observée chez les sujets utilisant la formule aux propriétés occlusives élevées. CONCLUSION: L'indice de creux évalué par l'imagerie 3D ANTERA a permis d'effectuer une évaluation objective de l'amélioration de l'aspect. Dans le cas d'une utilisation continue de la formule aux propriétés occlusives élevées, une amélioration de la capacitance de la CC, qui était le plus corrélée avec la rugosité des lèvres, a été atteinte au bout de 2 et 4 semaines. Ces résultats montrent pour la première fois qu'une formule aux propriétés occlusives élevées est efficace dans l'amélioration de la rugosité des lèvres, et cet effet est dû à la différence dans les propriétés occlusives et non pas à un agent de soin spécifique.

Age-related differences in the functional properties of lips compared with skin.

BACKGROUND/AIMS: Lips can easily become dry and rough and their biggest problems are drying and chapping. The cause of those problems is considered to be that the stratum corneum (SC) moisture is small and its barrier function is low. However, those problems decrease in subjects as they approach 40 years of age, after which problems due to their shape and color increase. The purpose of this study was to investigate relationships between SC properties of the lips during aging and to clarify the cause(s) of lip problems. METHODS: One hundred and 38 Japanese female subjects with normal skin ranging in age from 16 to 78 years were enrolled in the study. The capacitance and transepidermal water loss (TEWL) values, viscoelasticity, and color of their lips were measured and compared with their cheeks. RESULTS: The capacitance values for the lip and the cheek increased and TEWL values for both areas decreased with age. TEWL values for the lip decreased until ~30 years of age and this is considered to be related to the problem of drying. Although the maximum amplitude Uf of the lip increased with age, the Ur /Uf had no correlation with age. As for color, the L* and a* values decreased with age. CONCLUSION: Age-related changes with regard to SC functions, viscoelasticity and color of the lips have been clarified for the first time, and it is clear that these changes are related to problems of the lips. Compared with the cheeks, differences with the lips are more apparent.

The roughness of lip skin is related to the ceramide profile in the stratum corneum.

OBJECTIVE: The structure of skin on the lips is different from skin at other areas of the body; the water content of the stratum corneum (SC) and the barrier function there is low. Therefore, the lips can easily become dry and rough. The SC plays an important role in the barrier and water-holding functions of the skin. Above all, ceramides (CERs) are important SC lipids which maintain SC functions. The purpose of this study was to clarify the relationship between the degree of lip roughness and the CER profile. METHODS: Forty-one Japanese female subjects with normal skin (age range 22-52 years; mean 34.1) were enrolled in this study. The degree of lip roughness was scored, the values of capacitance and transepidermal water loss (TEWL) were measured and CER profiles of the SC were analysed using tape-stripping. RESULTS: The degree of lip roughness was related to the capacitance values but not the TEWL values. The roughness level correlated with the levels of CER[NH], CER[NP], CER[AH], CER[EOS] and CER[EOH] and the average carbon numbers of CER[NDS], CER[NH] and CER[NP] but not with the level of total CERs. The capacitance values of the lips were related not only with the levels of total CERs but also with the levels of CER[NH], CER[NP], CER[AH], CER[AP], CER[EOS], CER[EOH] and CER[EOP] and with the average carbon numbers of CER[NDS], CER[NS], CER[NH] and CER[NP]. The TEWL values of the lips were related not only with the levels of total CERs but also with the levels of CER[NH], CER[AH], CER[AP], CER[EOS] and CER[EOH]. CONCLUSION: The relationship between lip roughness and the CER profile was clarified for the first time. The results suggest that not only the level of total CERs but also the specific CER species and their carbon numbers affect the maintenance of SC function.

Highly sensitive nanoscale spin-torque diode.

Highly sensitive microwave devices that are operational at room temperature are important for high-speed multiplex telecommunications. Quantum devices such as superconducting bolometers possess high performance but work only at low temperature. On the other hand, semiconductor devices, although enabling high-speed operation at room temperature, have poor signal-to-noise ratios. In this regard, the demonstration of a diode based on spin-torque-induced ferromagnetic resonance between nanomagnets represented a promising development, even though the rectification output was too small for applications (1.4 mV mW(-1)). Here we show that by applying d.c. bias currents to nanomagnets while precisely controlling their magnetization-potential profiles, a much greater radiofrequency detection sensitivity of 12,000 mV mW(-1) is achievable at room temperature, exceeding that of semiconductor diode detectors (3,800 mV mW(-1)). Theoretical analysis reveals essential roles for nonlinear ferromagnetic resonance, which enhances the signal-to-noise ratio even at room temperature as the size of the magnets decreases.

Nitric oxide modulates lipopolysaccharide-induced endothelial platelet endothelial cell adhesion molecule expression via interleukin-10.

We have shown previously that nitric oxide (NO) controls platelet endothelial cell adhesion molecule (PECAM-1) expression on both neutrophils and endothelial cells under physiological conditions. Here, the molecular mechanism by which NO regulates lipopolysaccharide (LPS)-induced endothelial PECAM-1 expression and the role of interleukin (IL)-10 on this control was investigated. For this purpose, N-(G)-nitro-L-arginine methyl ester (L-NAME; 20 mg/kg/day for 14 days dissolved in drinking water) was used to inhibit both constitutive (cNOS) and inducible nitric oxide (iNOS) synthase activities in LPS-stimulated Wistar rats (5 mg/kg, intraperitoneally). This treatment resulted in reduced levels of serum NO. Under this condition, circulating levels of IL-10 was enhanced, secreted mainly by circulating lymphocytes, dependent on transcriptional activation, and endothelial PECAM-1 expression was reduced independently on reduced gene synthesis. The connection between NO, IL-10 and PECAM-1 expression was examined by incubating LPS-stimulated (1 µg/ml) cultured endothelial cells obtained from naive rats with supernatant of LPS-stimulated lymphocytes, which were obtained from blood of control or L-NAME-treated rats. Supernatant of LPS-stimulated lymphocytes obtained from L-NAME-treated rats, which contained higher levels of IL-10, reduced LPS-induced PECAM-1 expression by endothelial cells, and this reduction was reversed by adding the anti-IL-10 monoclonal antibody. Therefore, an association between NO, IL-10 and PECAM-1 was found and may represent a novel mechanism by which NO controls endothelial cell functions.

Melatonin inhibits nitric oxide production by microvascular endothelial cells in vivo and in vitro.

BACKGROUND AND PURPOSE: We have previously shown that melatonin inhibits bradykinin-induced NO production by endothelial cells in vitro. The purpose of this investigation was to extend this observation to an in vivo condition and to explore the mechanism of action of melatonin. EXPERIMENTAL APPROACH: RT-PCR assays were performed with rat cultured endothelial cells. The putative effect of melatonin upon arteriolar tone was investigated by intravital microscopy while NO production by endothelial cells in vitro was assayed by fluorimetry, and intracellular Ca(2+) measurements were assayed by confocal microscopy. KEY RESULTS: No expression of the mRNA for the melatonin synthesizing enzymes, arylalkylamine N-acetyltransferase and hydroxyindole-O-methyltransferase, or for the melatonin MT(2) receptor was detected in microvascular endothelial cells. Melatonin fully inhibited L-NAME-sensitive bradykinin-induced vasodilation and also inhibited NO production induced by histamine, carbachol and 2-methylthio ATP, but did not inhibit NO production induced by ATP or alpha, beta-methylene ATP. None of its inhibitory effects was prevented by the melatonin receptor antagonist, luzindole. In nominally Ca(2+)-free solution, melatonin reduced intracellular Ca(2+) mobilization induced by bradykinin (40%) and 2-methylthio ATP (62%) but not Ca(2+) mobilization induced by ATP. CONCLUSIONS AND IMPLICATIONS: We have confirmed that melatonin inhibited NO production both in vivo and in vitro. In addition, the melatonin effect was selective for some G protein-coupled receptors and most probably reflects an inhibition of Ca(2+) mobilization from intracellular stores.

Oculomotor consequences of intraventricular hemorrhages in premature infants.

We report the ocular findings in 11 preterm infants who sustained intraventricular hemorrhages. The defects were similar to those in adults who suffer from hypertensive thalamic hemorrhages. All 11 infants showed tonic downward and esotropic deviations of their eyes. Upgaze response could not be elicited in any of the infants. Although the role of secondary hydrocephalus cannot be discounted, we conclude that the direct effect of the hemorrhage on thalamic and mesencephalic structures is essential in the production of these oculomotor deficits. The prognosis for recovery of the upgaze palsy in these patients is good, although the time course may vary. However, the large-angle esotropia usually persists and requires surgical correction.

Mechanism of the concanavalin A-induced change of membrane fluidity of chicken erythrocytes.

When chicken erythrocytes labeled with a stearic acid derivative spin label was treated with concanavalin A (Con A), ESR spectra showed a change in the peaks due to the labels in membrane lipids, indicating an increase of membrane lipid fluidity. Addition of Con A increased the fluidity rapidly. This change was reversible only up to 30 min after adding Con A, and thereafter it gradually became irreversible. However, if the erythrocytes were treated with cytochalasin B and methyl alpha-D-mannoside, a complete return of fluidity to the normal level could be observed at any stage after the binding of Con A. The observation of freeze-fracture replicas of erythrocyte membranes by transmission electron microscopy also showed that the redistribution of intramembranous particles gradually became irreversible after exposure to Con A. These results suggest that the microfilament-like system, which modulates the distribution of cell surface receptors for Con A, participates in the modulation of membrane fluidity. Phospholipid methylation of chicken erythrocyte membrane was stimulated immediately after the binding of Con A. A methyltransferase inhibitor, 5'-deoxy-5'-S-isobutyl adenosine, abolished the increase of membrane fluidity within the first 10 min and also that occurring later than 60 min after adding Con A, but it was without effect on the elevated fluidity found between 20 and 60 min. Removal of extracellular Ca2+ had an inhibitory effect on the lasting increase of fluidity. These results suggest that the first increase of membrane fluidity by Con A may be caused by phospholipid methylation, while the second increase may depend on the rearrangement of Con A receptor glycoproteins through cross-linking wit Con A. The irreversible part of the membrane fluidity increase probably depends on Ca2+ influx, phospholipid methylation, and peripheral membrane proteins which constitute the microfilament-like system at the membrane inner surface.

Severe radicular pathology in rats with longstanding diabetes.

There few pathological abnormalities in nerves from animals with diabetes. Reported changes consist of mild distal axonal atrophy, axoglial disjunction and minimal segmental demyelination and remyelination. These changes are seen in distal nerves but no studies of radicular pathology in diabetic animals have been reported. We therefore studied peripheral nerve and radicular pathology in rats with longstanding, severe, chemically-induced diabetes. We found marked interstitial edema and severe changes of myelin in the roots of diabetic rats, particularly in the dorsal root. The earliest changes consist of myelin splitting, occurring at the intraperiod line. This progresses to myelin ballooning, accompanied by both tubulovescicular myelin degeneration and macrophage stripping, all of which tend to predominate in large myelinated fibers. There is minimal axonal degeneration. Despite these severe changes in nerve roots, the distal peripheral nerves show no discernible edema and only minimal myelin splitting without demyelination or axonal degeneration. The radicular changes are almost identical to those seen in much older nondiabetic animals. This suggests that they may represent an acceleration of the normal aging process, perhaps related to increased glycation of myelin proteins induced by accumulation of glucose rich interstitial endoneurial edema.

Endoneurial blood supply to peripheral nerves is not uniform.

Peripheral nerves are not uniformly susceptible to the effects of ischemia in human and experimental ischemic neuropathies. Since endoneurial blood flow is directly proportional to the number of endoneurial capillaries, we studied endoneurial capillary density at multiple levels of the peripheral nerves of normal rats. Capillary density was lowest in the sciatic and proximal tibial nerves and significantly higher in dorsal and ventral roots and distal tibial and plantar nerves. Endoneurial capillary density corresponds to the hierarchy of susceptibility to ischemic nerve damage in human and experimental ischemic neuropathies. These findings suggest that susceptibility of peripheral nerves to ischemia is determined, at least in part, by the density of endoneurial capillaries.

Clinical assessment of intralaryngeal ultrasonography.

OBJECTIVES: To assess the clinical use of intralaryngeal ultrasonography. STUDY DESIGN: A retrospective study was conducted of 16 patients with laryngeal lesions treated by laryngomicrosurgery. METHODS: An intraluminal ultrasonic tomography apparatus was connected to a radial scanning 30-MHz miniaturized probe. Under general anesthesia, ultrasonic images were obtained using the filling method. RESULTS: In cases of benign disease, such as vocal cord nodules or polyps, the layers of the mucosa could be identified. Characteristic internal echoes were noted in cases of hemorrhagic polyps, vocal cord cysts, and vocal cord cancer. In case of hemorrhagic polyps, hyperechoic regions were noted within the lesions. In cases of vocal cord cysts, internal echoes were absent, and posterior echoes were mildly enhanced. In cases of vocal cord cancer, infiltration beyond the mucosa could be visualized. CONCLUSIONS: Laryngeal lesions can be diagnosed by intralaryngeal ultrasonography using the filling method. Although it does not replace the combination of conventional endoscopy and a critical evaluation of the clinical symptoms of the individual disease, it can profitably complement them. Intralaryngeal ultrasonography can help in determining the extent of tumor involvement during microscopic laser surgery performed under general anesthesia. Confirmation of the results of this pilot study with a larger series of patients is desirable.

A case of primary small cell carcinoma of the cervical esophagus with long-term survival following concurrent chemoradiotherapy: case report and review of the literature.

The authors describe a case of small cell carcinoma of the esophagus that was treated by concurrent chemoradiotherapy. Both the esophageal tumor and the regional lymph node metastases disappeared after this treatment. The patient is alive and disease free after more than five years. Primary small cell carcinoma of the esophagus is a rare and aggressive neoplasm with a very poor prognosis, and the treatment modality is controversial. This case illustrates the possibility of treating this tumor type with concurrent chemoradiotherapy.

Body weight change and nitrogen efficiencies in growing and adult rats fed diets containing various proportions of essential amino acids to total amino acids.

By using amino acid mixtures, a comparative study of nutritional effects of dietary essential amino acid proportions (EA %) has been made between growing and adult rats. Included were adult rats which were repleting from an 8-day protein depletion. It was shown that for growing rats at least 55 EA% was required to attain the maximum values of growth, nitrogen balance, nitrogen balance efficiency (nitrogen balance/nitrogen intake) and protein efficiency ratio (PER). The maximum biological value was found to be 94 at the 50 EA% level. For adult rats, at least 40 EA% was required to gain the maximum values of nitrogen balance and nitrogen balance efficiency under both maintenance and repletion. The biological values were found to be nearly 60 and 80 for maintenance and repletion, respectively.

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.

The role of low dose cisplatin plus 5-fluorouracil for treatment of recurrent and/or advanced squamous cell carcinoma of the head and neck.

To improve survival rate in advanced head and neck cancer, we scheduled 90 patients to receive low dose cisplatin plus 5-fluorouracil regimen as neoadjuvant(NAC), concurrent(CC), adjuvant(AC), and second line chemotherapy (SC) setting. Our regimen consisted of cisplatin (CDDP 5 mg/m2/1 hr infusion on days 1-5, 8-12, 15-19, 22-26) and 5-fluorouracil (5-FU 200 mg/m2/24 hr infusion or oral administration of tegaful-uracil (UFT-E) 400 mg/body on days 1-28). The concurrent chemoradiotherapy consisted of conventional irradiation with 1.6-2.0 Gy/day on five days per week up to a total dose around 60Gy, and CDDP 3 mg/m2 by intravenous infusion over 1 hour plus 5-FU 150 mg/m2 by intravenous infusion over 24 hours per day on five days per week. For SC, 24 patients evaluable for response, 4 CR and 6 PR with RR of 42% were achieved. For NAC, 14 patients were evaluated for response, 2 CR and 7 PR were achieved. CC was indicated for locally unresectable cases. Of the 33 patients evaluable for response were 17 CR and 9 PR with RR of 79%. Dose limiting toxicities for chemotherapy were anemia and leukopenia and chemoradiotherapy was mucositis. Our treatment modality showed marginal toxicity and good response. Moreover, our regimen could be given in an outpatient setting safely so quality of life for patients was identical. We concluded that for advanced head and neck cancer, these treatment options were effective for second line and adjuvant setting. Chemoradiotherapy with this regimen also gave a impact for improving local control and survival period for locally unresectable cases.

[Effects of transcutaneous silicon injection for aspiration caused by unilateral vocal cord paralysis].

The purpose of this study was to determine the effects of transcutaneous silicon injection on swallowing function in unilateral vocal cord paralysis with aspiration. The preoperative and postoperative swallowing function were evaluated by means of videofluoroscopy and pharyngeal manometry in eight patients who received injection of silicon into the laryngeal vestibule, ventricle and vocal cord. Data analysis compared 1) types of aspiration and pharyngeal clearance, 2) timing of laryngeal closure (complete closure between arytenoid and epiglottic base) that was correlated with the onset of cricopharyngeal (CP) opening as time zero, and 3) swallowing pressure in the pyriform sinus on the side of the paralyzed vocal cord. In seven of the 8 patients, a favorable clinical response was achieved and aspiration and/or penetration were not observed on the fluoroscopic images after the silicon injection. Timing of laryngeal closure could be quantified in six patients, and mean values of the times preceding the onset of CP opening were significantly earlier on the postoperative examinations than preoperative examinations. Pharyngeal clearance on the affected vocal cord side was improved in six of the 8 patients, and swallowing pressure in the pyriform sinus was significantly elevated in four patients following surgery. These results suggested that silicon injection therapy produced earlier laryngeal closure during the swallow and improvement of pharyngeal clearance on the affected side after the swallow, so that aspiration and/or penetration with vocal cord paralysis might be prevented.

[Concurrent chemoradiotherapy for locally unresectable head and neck cancer].

In patients with locally unresectable head and neck cancer with large nodal involvement, the expected five-year survival is as low as 1-2%. To improve the prognosis of these patients, we studied the usefulness of concurrent chemoradiotherapy in a phase II trial. Between September 1996 and May 1999, thirty-five patients with locally unresectable head and neck cancer were administered concurrent chemoradiotherapy consisting of low-dose and long-term treatment with cisplatin (CDDP) plus 5-fluorouracil (5FU), or (L-CF); the L-CF regimen consisted of CDDP, 3 mg/m2 on 5 days of the week and 5FU, 150 mg/m2 as a 24-hour infusion on 5 days of the week. Concurrently, conventional radiotherapy was given up to total dose of around 60 Gy. In the 33 patients evaluable for response, 17 complete and 9 partial responses were noted, with an overall response rate of 79%. Oral mucostis and myelosuppression were the major side effects and mucositis was a dose limiting toxicity. This study demonstrates increase in survival among the responders (complete + partial) in the concurrent chemoradiotherapy setting. However 8 local relapses were eventually noted in the 17 complete responders. We concluded that this treatment strategy was beneficial in patients with locally unresectable head and neck cancer.

[Clinicopathological evaluation of intralaryngeal ultrasonography].

We used a miniature ultrasonic probe to study its diagnostic application in the detection of laryngeal lesions. Using the immersion method and an extracted human larynx, we evaluated ultrasonic images, identified the layered structure of vocal folds, and examined clinical cases following the study of diagnostic application. By the immersion method, ultrasonic images revealed that the membranous vocal fold was separated into three layers. We identified the histological structures of these three layers by comparing the ultrasonic images with the corresponding histologies. The first layer (hyperechoic) was the epithelial and the superficial layer of the lamina propria; the second layer (hypoechoic) was the vocal ligament; and the third layer (hyperechoic) was the deep layer of the lamina propria. On the basis of this study, we then evaluated ultrasonographic images of clinical cases. Benign lesions such as vocal nodules or vocal polyps were noted on the layered structure of the mucosa, especially, polyps as hyperechoic images. Furthermore, glottic cancer lesions demonstrated hypoechoic images and sometimes revealed destruction of the layered structures. These results suggest that intralaryngeal ultrasonography can be useful as a clinical application for the detection of tumor involvement in the vocal folds.