Environmental factors in cancer of the larynx: a second look

During a retrospective case-control study of recent laryngeal cancer patients, several associated factors were studied to determine possible changes in the epidemiology of laryngeal cancer between 1956 and 1974. The large sex difference noted in the early survey (male: female ratio of 14.9:1) diminished considerably in the present sample (4.6:1) because more women are cigarette smokers in the cancer age group today than was the case 20 years ago. Laryngeal cancer patients tended to be less educated than the controls and included a smaller proportion of Jews and more Catholics than the control group. The risk for developing laryngeal cnacer was considerably lower for exsmokers and long-term (10+ years) filter cigarette smokers as compared with non-filter smokers. At each level of alcohol consumption, the risk increased as exposure to tobacco increased. Occupations associated with wood exposure were found to affect the development of laryngeal cancer, independently of smoking status. Future studies should include an extensive study of nutritional deficiencies associated with alcoholism to determine if a correlation exists between such deficiencies, socioeconomic status, and an increased risk of laryngeal cnacer.     

Lack of effect of hematopoietic growth factors on human breast epithelial cell growth in serum-free primary culture

A number of recombinant cytokines believed to regulate normal hematopoiesis are now being used in cancer treatment protocols to reduce the myelosuppressive toxicity of intensive chemoradiotherapy regimens. It is widely assumed that such cytokines are relatively specific for hematopoietic cells, although some cell lines derived from a variety of non-hematopoietic human tumors can respond to some of these factors. However, relatively little is known about their ability to stimulate (or inhibit) the proliferation of freshly isolated normal or malignant non-hematopoietic cells. We have used a serum-free culture medium that selectively supports the growth of human breast epithelial cells (HBEC) obtained directly from normal or malignant tissue samples to evaluate potential stimulatory or inhibitory effects of eight cytokines: granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, Steel factor, interleukin-2, interleukin-3, interleukin-6, transforming growth factor-beta and macrophage inflammatory protein-1 alpha, on these cells cultured both in the presence of epidermal growth factor, a potent stimulator of HBEC growth, and in its absence. HBEC growth was assessed after 7 and 14 days using the tetrazolium-dye reduction assay. Potential effects on the well studied MCF-7 breast cancer cell line, cultured under the same conditions, were also investigated. None of the cytokines (which were tested over a wide range of concentrations) had any modulating effect on the growth of normal or malignant HBEC under the conditions used with the exception of transforming growth factor-beta, which was consistently and significantly inhibitory.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hematopoietic growth factors for the treatment of myelodysplastic syndromes

Administration of recombinant human granulocyte colony-stimulating factor (rhG-CSF), rh granulocyte-macrophage colony-stimulating factor (rhGM-CSF) or rh interleukin-3 (rhIL-3) effectively stimulate and expand marrow myelopoiesis resulting in a dose-dependent increment of peripheral blood neutrophils in most patients with myelodysplasias (MDS). Clinical outcome with fewer infections have been reported in a few studies using rhG-CSF or rhGM-CSF, including a large randomized, controlled trial with rhGM-CSF. Clinical effective stimulation of megakaryopoiesis and erythropoiesis are however infrequent. Recently, rh erythropoietin (rhEpo) has been used to overcome the ineffective erythropoiesis in MDS to reduce transfusions needed. However, the efficiency has been low in most studies with marked differences in response rates. The most impressive clinical results were obtained in patients with milder forms of MDS combined with low prestudy endogenous S-Epo levels. The possible synergistic effect of combining rhEpo with rhG-CSF or rhGM-CSF has been studied with erythropoietic response rates of about 40%. The safety of the cytokine administration seems acceptable with no significant stimulation of leukemic myelopoiesis and subsequent progression into overt acute myeloid leukemia. In conclusion, combinations of hematopoietic growth factors may be of clinical benefit in some patients with MDS. However, due to the cost and unpredictable clinical outcome there is a need for extended laboratory research to understand the functional defects of MDS stem cells and progenitors.     

Consensus on the clinical use of myeloid growth factors

Bone marrow fibroblasts regulate hematopoiesis by interacting directly (cell-to-cell contact) with hematopoietic cells and by secreting regulatory molecules (such as GM-CSF, M-CSF, IL6 and LIF) that modulate hematopoiesis either in a positive or a negative manner. Several cytokines (such as bFGF, EGF, PDGF and TGF-beta) affect the growth of human marrow fibroblasts in vitro. Further in vivo studies are still required to clarify the role of marrow fibroblasts and their interactions with hematopoietic progenitors during myelofibrosis and leukemic diseases.     

Tuberculosis of the larynx

Laryngeal tuberculosis was diagnosed in two men, a 73-year-old man Dutch by birth and a 40-year-old one Turkish by birth. In the former patient it was probably primary tuberculosis, in the latter secondary (he had lung tuberculosis as well). The clinical picture was highly suggestive of laryngeal carcinoma in both patients. They both recovered with chemotherapy. Laryngeal tuberculosis may mimic laryngeal carcinoma. The diagnosis is based on Ziehl-Neelsen staining, culture and polymerase chain reaction (PCR) on Mycobacterium tuberculosis. Because laryngeal tuberculosis is highly infectious, the patient has to be nursed in isolation and people in his or her environment have to be screened. The response of laryngeal tuberculosis to chemotherapy is good.     

Five-year results of 1000 patients operated on for cancer of the larynx

The five-year results of 1000 consecutive cases of cancer of the larynx operated on at the Clinic of Otolaryngology of the University of Florence are presented. The treatment was cordectomy for T1a glottic cancers and total laryngectomy for the other cases. The five year cure rate is 66.5% of the 606 supraglottic cancers, 76.9% of the 294 glottic cancers and 54% of the 100 subglottic cancers. These crude survival rates consider the 7.6% of patients who died from non-tumoral causes and the 1.1% of untraced patients.     

Chondrosarcoma of the larynx

Cartilaginous tumors of the larynx are rare, and of those reported, most are chondromas. To date, approximately 157 cartilaginous tumors of the larynx have been reported, but only 37 have been chondrosarcomas. A review of the records of the past 25 years (1948-1974) of the Johns Hopkins University Hospital and the Greater Baltimore Medical Center was made and revealed only two previous cartilaginous tumors, both chondromas. A case of an exceptionally large chondrosarcoma of the larynx which appeared as a neck mass invading the thyroid cartilage in a patient with a six-month history of hoarseness is presented. A complete review of the literature was made which shows that most chondrosarcomas occur in middle-aged males originating most often from the posterior cricoid lamina, next from the thyroid cartilage. Misdiagnosis has been a problem with low-grade tumors, and although wide local excision has been stated as being the treatment of choice, the authors emphasize the need for more aggressive surgery because of the high recurrence rate discovered in the literature.     

Rheumatoid nodules of the larynx

A 67-year-old woman with rheumatoid arthritis was hospitalized because of dysphagia and severe nodulosis. Over a two-year period the patient had been treated with methotrexate. A computed tomography (CT) scan of the neck showed a 2 x 2 cm large tumour behind the top left lateral thyroid cartilage. A biopsy taken during direct laryngoscopy showed it was a rheumatic nodule. Treatment with colchicine reduced the patient's dysphagia. As methotrexate is used increasingly in the treatment of rheumatoid arthritis and as this particular drug causes rheumatic nodules in five to 10 per cent of the patients, it must be foreseen that the incidence of nodules in the upper airways will increase.     

Functional damage of the larynx

INTRODUCTION: The basic mechanism of the development of functional voice disorders is an excessive collision pressure between the vocal folds during phonation, which occurs between the membranous folds, and/or the vocal processes. Functional-traumatic lesions of the vocal folds appear mainly at the junction between the anterior and the middle thirds of the vocal folds, slightly below the free edge. This is the "predilection site" of the vocal folds, which is the most active part of the vocal folds during phonation, and is therefore mostly exposed to functional-traumatic changes. This study is aimed at establishing the most frequent benign lesions of the vocal folds, which appear at the predilection sites of the vocal folds, and discussing their functional-traumatic aetiology. MATERIAL AND METHODS: During the past 10 years 1550 patients underwent various microsurgical procedures for benign lesions of the vocal folds. They were studied for the precise localization of the lesions by the use of indirect videostroboscopy or microstroboscopy, and direct microlaryngoscopy related to the technique which has been used in each particular patient. In this way an overall number of lesions was established, which were located at the predilection sites of the vocal folds, indicating their functional-traumatic aetiology. RESULTS: It has been established that 1068 lesions (68.6%) were located at the predilection site of the vocal folds (Table 1). Namely, these were nodular lesions, polyps, cysts, and haematoma. Contact hyperplasia appeared at the posterior third of the vocal folds due to a special mechanism of its development. DISCUSSION: Functional-traumatic lesions are mucous stranding, nodular lesions, polyps, cysts, contact hyperplasia and haematoma. All these lesions are either of functional origin or functional voice disorders which contribute, to some degree, to their development.     

Crohn's disease of the larynx

Extraintestinal involvement of Crohn's disease is becoming more readily identified. Laryngeal involvement by Crohn's disease, however, has been reported in only five cases in the medical literature. We present the sixth case as well as an analysis of the prior reports.     

Angiogenic factors expressed by human prostatic cell lines: effect on endothelial cell growth in vitro

Using anterograde transport of WGA-HRP and the experimental degeneration method for identification of corticocuneate (CCT) and primary afferent (PAT) terminals in conjunction with gamma-amino butyric acid (GABA) and glutamate immunocytochemistry, this study has demonstrated that the GABA-immunoreactive (GABA-IR) neurons in the rat cuneate nucleus were post-synaptic to PATs (some of them being glutamate-IR), GABA-IR and GABA-negative terminals. The HRP-labelled CCTs did not make any synaptic contacts with GABA-IR neurons but with some GABA-negative dendrites. PATs labelled by HRP or showing degenerating features made direct synaptic contacts with the dendrites of GABA-IR neurons. Beside the above GABA-IR boutons also showed axosomatic and axodendritic synapses with the GABA-IR neurons. In 'triple labeling' method for GABA, PAT and glutamate, it was found that the PATs which were usually glutamate-positive were presynaptic to the dendrites of GABA-IR neurons. Furthermore, some glutamate-IR terminals which were of non-PAT's origin also synapsed with the dendrites and somata of GABA-IR neurons. It is concluded from this study that the major inputs of GABA-IR neurons were from glutamate immunopositive PATs and glutamate terminals of non-PATs origin; other GABA-IR terminals either intrinsic or extrinsic also contributed to the afferent sources of GABA-IR neurons. The CCTs contributed very little, if any, to this input. It is suggested that the PATs and glutamate-IR terminals on GABA-IR neurons may be involved in lateral inhibition for increase of spatial precision. The synaptic contacts between GABA-IR boutons and dendrites or somata of GABA-IR neurons may provide a possible means for disinhibition.     

Oncocytic cysts of the larynx

Oncocytic cysts make up a pathologically well-defined sub-group of cystic lesions in the larynx. As a rule they originate from the ventricle and occur in middle-aged or elderly persons. Clinically these tumours are uncharacteristic. Such oncocytic cysts are interpretable as retention cysts rather than actual new growths. The question concerning their rare occurrence is discussed on the basis of 5 cases diagnosed within a period of 2 months.     

实验室测量审核结果的评定方法研讨

对多种类型测量审核活动的结果评价方法进行较为系统的研讨。关于测量审核重复性评定:采用单一试样时,可依据方法重复性限r评定;采用能力验证分割试样时,可依据稳健统计实验室内Z比分(ZW)评价。关于测量审核再现性评定:采用能力验证试样时,可依据稳健统计实验室间Z比分(Z或ZB)评价;采用具有指定值的试样时,可依据95%置信水平临界差评定,不同标准方法对于精密度的表述方式不同,其临界差的计算方法也不同,本文介绍了根据不同标准提供的参数计算临界差的方法;当实验室提供不确定度时,其结果也可依据指定值的不确定度En值评定。