Chemotherapie mit Cisplatin-Bleomycin und nachfolgende Strahlentherapie bei fortgeschrittenen Kopf-Hals-Tumoren

Summary 42 patients with advanced stage III and IV squamous cell carcinoma of the head and neck were treated with initial cisplatin and bleomycin chemotherapy and subsequent radiotherapy. 39 were evaluable for results, and 3 for toxicity only. 8 patients suffered from stage III and 31 from stage IV tumors, of these 10 with distant metastases. 5 patients underwent later a rescue operation. 27 were previously untreated (= group A) including 2 cases with localized relapses beyond the margins of surgical and/or radiotherapeutic treatment fields. 12 patients had a recurrence within pretreated areas (= group B). The induction chemotherapy alone showed the following results: In group A 4 (15%) CR, 10 (37%) PR, 7 (26%) MR; in group B 3 (25%) PR, 2 (17%) MR. The subsequent radiotherapy mostly consisted of a 65 Gy tumor dose given in 61/2 weeks. The results after completion of the combined modality therapy were: In group A 44% CR, 28% PR; in group B 10% CR and 30% PR. No patient resistant to the initial chemotherapy responded to the radiotherapy. The median survival time of stage III patients was 20 months but only 7 months in stage IV patients. 4 of all live with NED now between 30+ and 41+ months; 1 patient is alive with relapse. All the others are dead after a survival time of max. 32 months, included the 5 with rescue operation. In general, hematologic and renal toxicities were not severe, but nausea and vomiting were the worst tolerated side effects. 1 patient died from septic myocarditis having a WBC nadir of 2000/µl, probably due to additional immunologic deficiency because of inactive liver cirrhosis. The poor results concerning NED survival are discussed. We conclude, that an initial chemotherapy with CDDP and BLM gives good remission effects but its combination with radiotherapy at present fails to produce a NED survival benefit. Further efforts are necessary to improve the CR and the long time survivor rates.

Die Autoren danken folgenden Kollegen für ihre Mitarbeit: Drs. Garbea (HNO), B. Bienko, M. Danker, N. Birke, M. Klessing, K. Lottner, W. Palm     

Marked non-uniformity of fiber-type composition in the primate suboccipital muscle obliquus capitis inferior

 Obliquus capitis inferior (OCI) is a monoarticular suboccipital muscle linking the transverse process of the atlas (C1) to the spinous process of the axis (C2). Histochemical analysis of fiber-type composition showed that the muscle has a marked gradient of fiber-type distribution in which type I fibers comprise 95–100% of fibers in the deepest region but less than 10% of fibers in the superficial layer. Step-like changes in fiber-type proportions occurred between groups of fascicles. In most instances the boundaries between these fascicles did not exhibit different perimysial features from those fascicles with similar fiber-type proportions. OCI contained large numbers of muscle spindles, which were concentrated in deep regions rich in type I fibers. The degree of nonuniformity in fiber-type distribution seen in OCI is unusually large when compared with patterns described in other primate muscles, and has implications for the way that the muscle is studied anatomically and physiologically. Received: 11 August 1998 / Accepted: 23 September 1998     

The relationship between the electromyogram-amplitude and isometric extension torques of neck muscles at different positions of the cervical spine

A group of 12 healthy men volunteered for the experiment. Electromyograms (EMG) were obtained from semispinalis capitis, splenius capitis, levator scapulae, and trapezius muscles. The flexion angle of the cervical spine was precisely adjusted to 0°, 10°, 20°, and 30° relative to the horizontal, with a constant angle of the atlanto-occipital joint. The subjects made eight short (about 2 s) vertical extension forces (6%, 12%,18%, 24%, 30%, 36%, 42%, and 48% of maximal voluntary peak contraction force). For each position, the centre of pressure under the head was determine as the basis for the calculation of the external lever arm. The presence of motor endplate regions was ascertained by multiple surface electrodes. The slopes of individual linear regression lines for the root mean square (rms)-values were dependent on the existence of endplates in the area of the electrodes — endplates caused smaller rms values per Newton metres of external torque. Significant intersubject differences between regression equations could not be eliminated by the normalization of EMG-parameters and/or torques. The elimination of gravity, the continuous monitoring of positions, and the consideration of localization of motor endplate regions were essential prerequisites for the acquisition of reliable relationships between EMG of different neck muscles and external torques. Two important conclusions were derived for the prediction of torques from EMG measurements: firstly, individual regression equations which take into account the position of the head and neck should be used; secondly, normalization procedures do not justify the application of average regressions to a group of subjects.     

Method of quantitative anatomical study of the dorsal neck muscles

Summary Biomechanical models of the cervical spine require knowledge of the position, size and orientation of the individual muscles that act on the cervical spine. We have developed a technique to stereometrically measure anatomical specimens. The apparatus is composed of three graduated metallic rods, which slide along a fixed support. This method is accurate to map the anatomy of individual muscles and provides quantitative data on their lines of action. Results are obtained from one specimen. The computer processing of the collected data allows formulation of a three-dimensional model of the neck muscles in man.

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Méthode d'étude anatomique quantitative des muscles de la nuqueEtude préliminaire

Résumé Pour élaborer un modèle biomécanique de la colonne cervicale, il faut connaître la position, la taille et l'orientation des différents muscles du cou. Nous avons mis au point une méthode de mesure stéréométrique sur des sujets anatomiques. L'appareil est composé de 3 axes métalliques gradués qui coulissent sur un support fixe. Cette technique permet une étude anatomique précise de chacun des muscles de la nuque, fournissant des données quantitatives sur les différents faisceaux ou lignes d'action. Les résultats sont obtenus sur un sujet. Leur traitement informatique permettra l'élaboration d'un modèle mathématique tridimensionnel des muscles du cou chez l'homme.

     

Properties and localization of the anterior semicircular canal-activated vestibulocollic neurons in the cat

Summary Unit activites of secondary vestibular neurons that selectively responded to stimulation of the anterior semicircular canal nerve (ACN) were recorded extracellularly in the anesthetized cat. Axonal pathways and projections in the spinal cord of the ACN-activated neurons were examined by recording their antidromic responses to stimulation of the lateral and medial vestibulospinal tracts (LVST and MVST), and the bilateral neck extensor motoneuron pools in the C₁segment (C₁dorsal rami [DR] motoneuron pools). In order to determine whether the neurons had ascending axon collaterals to the extraocular motoneurons, the contralateral (c-) inferior oblique (IO) motoneuron pool was also stimulated. Twenty-seven neurons sent their axons to the ipsilateral (i-) C₁DR motoneuron pool via the LVST without any projection to the extraocular motoneuron pool. All the cells except one were located in the ventral part of the lateral vestibular nucleus. This pathway produced monosynaptic EPSPs with short time-to-peak and short half-width in C₁DR motoneurons (16/16 motoneurons). Eight neurons sent axons to the i-C₁DR motoneuron pool via the MVST without any to the extraocular motoneuron pool. Cell somata were located in the descending nucleus or in the ventral part of the lateral nucleus. These neurons did not produce postsynaptic potentials (PSPs) in any C₁DR motoneurons. All thirty-five neurons sending axons to the c-C₁DR motoneuron pool have ascending axon collaterals to the c-IO motoneuron pool.     

Transcutaneous electrical stimulation and vibration of neck muscles in neglect

Four neglect patients without visual field defects, one with a lesion of the right basal ganglia and three with a right, predominantly parietal lesion, were examined with a cancellation and a copying task before, during and after neck muscle vibration, during transcutaneous electrical stimulation of neck muscles and during vibration of hand muscles on the left side. In all patients, neck muscle vibration improved task performance, while transcutaneous electrical stimulation and hand vibration had little or no effect. The present results demonstrate that the effect of neck muscle vibration cannot be explained as arousal and activation due to unspecific sensory stimulation on the contralesional side of the body. They rather argue for the assumption that the compensatory effect of neck muscle vibration on neglect is an effect induced by the predominant activation of afferent Ia nerve fibres and their specific contribution to the central representation of egocentric space.     

Neuronal responses to horizontal neck deflection in the group X region of the cat's medullary brainstem

Summary Neuronal responses to natural stimulation of neck proprioceptors were studied in the region of the small cell group x in the dorsolateral medullary brainstem of slightly anesthetized and paralyzed cats. Stimulation consisted of horizontal trunk rotations about C₁ with the head fixed in space. Out of 74 neurons recorded, 92% showed an increase in discharge rate with ipsilateral neck stretch and a decrease with contralateral stretch (Type N I responses); 8% showed the reverse response pattern (Type N II responses). In the primary head-to-trunk position, almost all neurons had tonic activity that probably stemmed from prestretched neck proprioceptors. Responses to sinusoidal stimulation and position trapezoids showed a static (position-sensitive) as well as a dynamic (essentially velocitysensitive) component. The relative weight of the two components varied considerably among the neurons. It was not possible to distinguish discrete neuronal populations on the basis of the dynamic characteristics. There was no evidence of a convergent input from other receptor systems, such as the horizontal canal system. Several neurons responded to muscle tapping and showed an increase of the velocity component following systemic injection of succinylcholine. We take this as evidence that they may receive input from muscle spindle receptors.Supported by the Deutsche Forschungsgemeinschaft, SFB 70/U4     

Participation of Ia reciprocal inhibitory neurons in the spinal circuitry of the tonic neck reflex

Summary As part of our studies of the spinal circuitry of the tonic neck reflex, we have recorded extracellularly from Ia reciprocal inhibitory neurons of the decerebrate, labyrinthectomized cat. The activity of a majority of neurons driven by stimulation of the quadriceps nerve was modulated by sinusoidal rotation of the neck; such modulation was much less frequent in the case of neurons driven by stimulation of nerves to more distal muscles. The results suggest that some of the inhibition which is part of the tonic neck reflex is mediated by Ia reciprocal inhibitory neurons, but that other pathways must also play an important role.     

颈部囊肿与瘘管的诊断和治疗

目的：总结颈部囊肿与瘘管的诊治经验。方法：93例行手术治疗,其中鳃裂囊肿15例,鳃裂瘘管10例,皮样囊肿1例,囊状淋巴管瘤4例,甲状舌骨囊肿37例,甲状舌管瘘管25例,癌性淋巴液囊肿1例,随访1－10年。结果：93例中,囊性淋巴管瘤1例复发后失访,另1例行2次手术,癌性淋巴液囊肿1例半年后死于肺转移,鳃裂瘘管2例3次手术,甲状舌管瘘管1例复发,鳃裂瘘管术后1例迟发性面瘫,一次手术治愈,无术后并发症。结论：颈部囊肿与瘘管的诊断除依据术前检查外,主要是依据术中的发现和术后病理检查。B超、CT等是有效的辅助检查.手段治疗上应彻底切除囊壁与瘘管,避免复发。术中应避免损伤颈部的大血管和神经。甲状舌管瘘管须切除舌骨中段2cm,这是防止术后复发的关键。