Lasing droplets: highlighting the liquid-air interface by laser emission.

When dye-doped ethanol droplets are irradiated with an intense pulsed laser beam, the resulting laser emission from individual droplets highlights the liquid-air interface. Photographs of the lasing droplets in the micrometer size range taken in a single 10-nanosecond laser pulse clearly show the dynamic changes in droplet size, shape, and orientation.

Surgical management of head and neck cancer.

The management of advanced carcinoma of the head and neck excluding thyroid carcinoma requires a combination of operation and radiation therapy to give the patient the best chance of cure. It is not appropriate to try to extirpate advanced squamous cell carcinoma by operation alone. There is evidence that postoperative radiation therapy is more effective in local regional control at least in certain sites than preoperative radiation therapy and there is better patient acceptance of the treatment plan in which the radiation therapy is administered after the operation.

Randomized study of preoperative versus postoperative radiation therapy in advanced head and neck carcinoma: long-term follow-up of RTOG study 73-03.

This is a report of a 10-year median follow-up of a randomized, prospective study investigating the optimal sequencing of radiation therapy (RT) in relation to surgery for operable advanced head and neck cancer. In May 1973, the Radiation Therapy Oncology Group (RTOG) began a Phase III study of preoperative radiation therapy (50.0 Gy) versus postoperative radiation therapy (60.0 Gy) for supraglottic larynx and hypopharynx primaries. Of 277 evaluable patients, duration of follow-up is 9-15 years, with 7.6% patients lost to follow-up before 7 years. Loco-regional control was significantly better for 141 postoperative radiation therapy patients than for 136 preoperative radiation therapy patients (p = 0.04), but absolute survival was not affected (p = 0.15). When the analysis was restricted to supraglottic larynx primaries (60 postoperative radiation therapy patients versus 58 preoperative radiation therapy patients), the difference for loco-regional control was highly significant (p = .007), but not for survival (p = 0.18). In considering only supraglottic larynx, 78% of loco-regional failures occurred in the first 2 years. Thirty-one percent (18/58) of preoperative patients failed locally within 2 years versus 18% (11/60) of postoperative patients. After 2 years, distant metastases and second primaries became the predominant failure pattern, especially in postoperative radiation therapy patients. This shift in the late failure pattern along with the increased number of unrelated deaths negated any advantage in absolute survival for postoperative radiation therapy patients. The rates of severe surgical and radiation therapy complications were similar between the two arms. Because of an increased incidence of late distant metastases and secondary primaries, additional therapeutic intervention is required beyond surgery and postoperative irradiation to impact significantly upon survival.

Combined radiation therapy and surgery in the management of advanced head and neck cancer: final report of study 73-03 of the Radiation Therapy Oncology Group.

Between March 1973 and June 1979, patients with advanced operable squamous cell carcinoma of the supraglottic larynx or hypopharynx were randomly allocated to receive either preoperative radiation therapy (5,000 rad) or postoperative radiation therapy (6,000 rad). Patients with oral cavity or oropharynx lesions were randomly assigned either preoperative radiation, postoperative radiation, or definitive radiation therapy (6,500-7,000 rad), with surgery reserved for salvage if residual disease was present 6 weeks after completion of irradiation. Three hundred twenty patients were evaluable with a median follow-up of 60 months. Based on results in 277 patients across all four regions combined, locoregional control was significantly better for patients assigned to receive postoperative radiation therapy (65%) compared with those assigned to receive preoperative radiation therapy (48%, P = 0.04). This was due to a higher rate of both persistent and recurrent local and regional disease in the preoperative group. Survival also showed a trend to be better in the postoperative group (38%) compared with the preoperative group (33%, P = 0.10). Rates of severe surgical and radiation therapy complications were similar overall. Forty-three patients were evaluable for each of the three treatment regimens assigned to patients with oral cavity or oropharynx lesions. Due to the small number of patients available for this portion of the trial, the observed differences for overall survival (4-year percentage 33% overall; 30% preoperative, 36% postoperative, 33% definitive radiation therapy) and for locoregional control (45% overall; 43% preoperative, 52% postoperative, 38% definitive radiation therapy) were not statistically significant. The use of definitive radiation therapy with surgical rescue as an ethically justified alternative treatment for these tumors remains a question for further research.

Electrical resistance of the cochlear partition.

The relationship between the calculated value of the effective electrical resistance of the cochlear partition and the distance between the electrode for measuring the EP and the stimulating electrodes has been studied. The calculated value of the effective electrical resistance of the cochlear partition declines linearly with increasing distance between these electrodes. The correlation coefficient (r) is -0.806. In calculations of the effective electrical resistance of the cochlear partition, attention must be paid to the distance between the microelectrodes.

A possible site of production of the negative endocochlear DC potential.

The scala vestibuli or the scala tympani of guinea pigs was perfused with artificial perilymph containing 1, 5, 10, 20, 30, 40 and 50 mM of potassium chloride in a total concentration of 150 mM with the background composed of sodium chloride. With the perfusion of the scala vestibuli, each concentration failed to alter the magnitude of the negative endocochlear DC potential produced by anoxia or the intravenous injection of 100 mg/kg of body weight of furosemide. With the perfusion of the scala tympani, the negative endocochlear DC potential disappeared precipitously and the maximum output of the cochlear microphonic was severely depressed with concentrations of potassium chloride of 30 mM or greater. The magnitude of the negative endocochlear DC potential appears to be closely related to the maximum output of the cochlear microphonic. These results suggest that the site of production of the negative EP is in the hair cells of the organ of Corti.

Pulsatile tinnitus.

Tinnitus is a frequent presenting symptom. Tinnitus that is rhythmic and synchronous with the patient's heartbeat is rare. Pulsatile tinnitus may be the only symptom of life-threatening and treatable diseases. The presence of hearing loss or vertigo focuses the diagnostic evaluation. The cause of pulsatile tinnitus may be found on otoscopic examination. Audiologic assessment and enhanced computed tomography often contribute to the diagnosis. Increased intracranial pressure should be excluded with a fundoscopic examination. Arteriography is required to diagnose life-threatening and treatable lesions in the presence of normal otoscopy, audiologic assessment, and enhanced computed tomography.

Effects of laser irradiation on immature olfactory neuroepithelial explants from the rat.

The photobiological effect of low-output laser irradiation on the maturation and regeneration of immature olfactory bipolar receptor cells of the rat was studied. The maturation and regeneration of the receptor cells of rat fetuses were quantified in neuroepithelial explants with morphometric analysis. The number of explants with outgrowth and the number and length of neuritic outgrowths were determined on a regular basis for 12 days. Explants in the experimental group were irradiated with a helium-neon laser using different incident energy densities (IED). Explants in the fluorescent light control group were exposed to fluorescent light for the same periods of time as those in the experimental group were exposed to laser irradiation. Explants in another control group were not exposed to laser or fluorescent light irradiation. The IED of 0.5 J/cm2 laser irradiation has been found to increase significantly the number of explants with outgrowth and the number and length of the outgrowths. Other laser IEDs or fluorescent light irradiation did not influence maturation or regeneration.

Assessement of surgical procedures for Ménière's disease.

There are numerous surgical procedures for the treatment of Meniere's disease, and the current status of their efficacy is controversial. A review of the literature is presented as a basis for the evaluation of the relative merit of these procedures. Emphasis is placed on endolymphatic sac procedures, sacculotomy, vestibular neurectomy and labyrinthectomy. Vestibular neurectomy and surgical labyrinthectomy provide high rates of improvement in vertigo. The hearing is frequently made worse by vestibular neurectomy. Endolymphatic sac procedures result in improvement in vertigo less frequently. They are most likely to improve hearing. Although sacculotomies are associated with improvement in vertigo in approximately 80% of patients, they are associated with high rates of hearing loss.

Etiologic factors in hypocalcemia secondary to operations for carcinoma of the pharynx and larynx.

Hypocalcemia, although a relatively uncommon sequela of operations for carcinoma of the larynx and pharynx, often presents as an acute medical emergency. In its chronic form, hypocalcemia may be a difficult disorder to control. Understanding the etiologic basis of hypocalcemia secondary to operations for carcinoma of the head and neck requires knowledge of the pathophysiology of the preoperative and postoperative factors affecting calcium homeostasis. These factors include thyroidectomy, hypoparathyroidism, hypomagnesemia, anticonvulsant therapy, estrogen replacement therapy, oral contraceptives, blood transfusions, hyperventilation alkalosis, hypoalbuminemia, corticosteroid therapy, depression, emotional stress and diet. Often the onset of symptoms and signs of hypocalcemia occurs within 24 to 48 hours after the operation. The symptoms may include mental depression, headache, tingling of the hands and perioral region and abdominal pain. Unrecognized chronic hypocalcemia may lead to the development of cataracts, convulsions and psychosis.

Electrophysiological responses from the cochlea and inferior colliculus in guinea pigs after head injury.

Electrical responses from the inferior colliculus (ER) and round window (CP) to acoustical stimuli were compared in control and experimental guinea pigs which had received a single blow to the freely movable head. After the blow to the head, all of the animals showed signs of commotio cerebri, and some of them died. The experimental animals were divided into two groups so that the physiologic responses to sound could be evaluated one day (early group) and seven days (intermediate group) following the head blow. The animals of the early group had elevated ER thresholds over the entire frequency range tested with an average threshold of 37.8 db. The animals of the intermediate group also had elevated ER thresholds which averaged 23.9 db. Input-output intensity function of ER for the experimental animals showed a recruitment-like phenomenon. The CP thresholds in the injured animals did not differ significantly from those in the control group. Damage to the VIIIth nerve and higher central pathways is very likely a more frequent cause of the otoneurologic manifestations following head injury than end organ damage.

Effects of head blow on the development of hearing loss.

The effects of the direction and intensity of the head blow and the effects of the lapse of time after a head blow on the development of hearing loss were studied in guinea pigs. The electrical responses from the right inferior colliculus (ER) and from the left round window (CP) to acoustic stimuli were measured. The elevation in threshold of the ER in the presence of normal CP in guinea pigs after a head blow suggests that the site of the lesion is central to the cochlea.

Adenocarcinoma of the ethmoid following radiotherapy for bilateral retinoblastoma.

Adenocarcinoma of the ethmoid sinus is rare, representing only 4-8% of malignancies of the paranasal sinuses. An extraordinary case of papillary adenocarcinoma of the ethmoid sinus arising 30 years following high-dose radiotherapy for bilateral retinoblastoma is presented. Retinoblastoma, though occurring only once in every 23,000 to 34,000 births, is the most common malignant intraocular tumor of childhood. Second fatal mesenchymal and epithelial primaries have been described in 8.5% of patients with bilateral retinoblastomas previously treated with radiotherapy; however, papillary adenocarcinoma arising within the paranasal sinuses has not been reported. Histologically, the findings of a papillary pattern of poorly differentiated, mucicarmine-staining cells enclosing gland-like spaces, and the absence of pseudorosettes, melanin, mesenchymal and peripheral neural elements supports an epithelial origin of this tumor. Agressive treatment including partial maxillectomy, radical pansinusectomy, radical neck dissection followed by regional radiotherapy and systemic chemotherapy failed to prevent the development of fatal hepatic metastases. The high incidence of second fatal primary neoplasms in patients with bilateral retinoblastomas receiving radiation suggests an innate susceptibility that may add to the risk of radiotherapy. Careful long-term head and neck surveillance is mandatory if early aggressive management of these extremely lethal tumors is to be successful.

Histopathology of the olfactory pathway due to ischemia.

Various agents, such as trauma, viral infections and neoplasms cause olfactory dysfunction. However, little is understood concerning the role of ischemia. An experimental model of brain ischemia was developed in the Mongolian gerbil, and the olfactory pathway was studied. This animal was chosen because of its incomplete circle of Willis, since poor patency of the circle of Willis is not an uncommon finding in the aging human. Ischemia was induced by unilateral ligation of one common carotid artery or temporary occlusion of both common carotid arteries. Under both circumstances, ischemic changes occurred in the lateral olfactory tract, the olfactory ventricle, and the olfactory tubercle. Damage is more severe with bilateral temporary occlusion than unilateral ligation. The olfactory bulbs and neuroepithelium, however, are resistant to ischemia.

Histopathologic correlates of otoneurologic manifestations following head trauma.

The clinical course of patients dying of head trauma and the physiologic evaluation of audition in guinea pigs subjected to several forms of head trauma are correlated with the histopathologic findings in the brains and temporal bones. In the patients there was wide spread hemorrhage, edema, disorganization and disruption of neural tissue. Loss of Purkinje cells and other neural elements was prominent. The temporal bone findings in the patients included laceration of and hemorrhage into the VIIIth nerve as well as bleeding into the scala tympani. The membranous labyrinths demonstrated no specific changes secondary to the trauma. The guinea pigs developed a central form of hearing loss with elevated thresholds for evoked responses from the inferior colliculus and normal AC cochlear potentials. In the animals hemorrhage in the substance of the brain, necrosis of neural tissue, edema, disorganization and disruption were prominent. Although there was extravasation of blood in the tympanic and vestibular scalae, the membranous structures of the inner ears were well preserved.

Immunohistopathology of human olfactory epithelium, nerve and bulb.

The immunohistochemical characteristics of the human olfactory system were (OMP). OMP was detected in the olfactory receptor neurons and processes extending from the olfactory neuroepithelium to the olfactory bulb. The olfactory receptor cells located close to the epithelial surface also contained OMP. In severely degenerate regions, only a few OMP-containing cells were observed. Differences in OMP-staining intensity were noted among the olfactory receptor cells. The thick neuroepithelium. Proliferating olfactory neuroepithelium contained OMP reactive and nonreactive olfactory receptor cells. The presence of OMP reactive and nonreactive olfactory neurons indicates the coexistence of two functionally different phases of olfactory neurons. These findings suggest that continuous cell turnover is occurring in human olfactory neuroepithelium.

Olfactory evoked potentials in the rat.

Routine clinical assessment of the integrity of the olfactory pathway using olfactory evoked potentials remains an elusive goal. One important difficulty arises from the uncertainty of the exact origin of the potentials: are they produced by olfactory or trigeminal elements? To resolve this problem, an animal model using the rat was developed. Amylacetate was used as an odorant stimulus, and potentials were measured and computer averaged after elimination of trigeminal and vomeronasal activity. A positive-negative wave was recorded from the olfactory bulb surface, and a negative wave often followed by a positive wave was recorded from the surface of the cerebral cortex. Measurements from the scalp surface gave comparable results. Lesioning experiments of the olfactory pathway indicate that the evoked potentials recorded at the vertex originate in the ventral forebrain, specifically in the prepyriform cortex, olfactory tubercle, and anterior olfactory nucleus.

Central auditory imperception.

The development of clinically applicable techniques for the evaluation of hearing impairment caused by lesions of the central auditory pathways has increased clinical interest in the anatomy and physiology of these pathways. A conceptualization of present understanding of the anatomy and physiology of the central auditory pathways is presented. Clinical tests based on reduction of redundancy of the speech message, degradation of speech and binaural interations are presented. Specifically performance-intensity functions, filtered speech tests, competing message tests and time-compressed speech tests are presented with the emphasis on our experience with time-compressed speech tests. With proper use of these tests not only can central auditory impairments by detected, but brain stem lesions can be distinguished from cortical lesions.

Randomized preoperative and postoperative radiation therapy for patients with carcinoma of the head and neck: preliminary report.

Two hundred and ninety-eight patients with squamous cell carcinoma of the oral cavity, oropharynx, supraglottic larynx, hypopharynx or maxillary sinus have been randomized for preoperative radiation therapy and surgery vs. surgery and postoperative radiation therapy plus, in the case of patients with lesions of the oral cavity and oropharynx, radical radiation therapy. Data have been analyzed on 243 patients in this interim report. The differences between the three groups with respect to local control and survival are not statistically significant at this time. Additional accrual and continued follow-up are necessary to make definite treatment comparisons.

Surgical quality control in head and neck cancer. Study 73-03 of the Radiation Therapy Oncology Group.

The measurement of quality of medical care has always been a topic of concern to physicians and other health care professionals. During an age of increasing competitiveness in the health care environment, the ability to assess accurately the quality of the care delivered has become increasingly important. The head and neck surgeons within the Radiation Therapy Oncology Group have examined this problem and have developed an evaluation tool that was then applied retrospectively in an attempt to evaluate the quality of surgery performed in a randomized study. The analysis of the results suggested that the retrospective approach to surgical quality control is fraught with hazards and is unlikely to fulfill the goals set for it.