Multidimensional Assessment of Voice Characteristics After Radiotherapy for Early Glottic Cancer

Objectives/Hypothesis: To assess voice characteristics of patients following radiotherapy for early glottic cancer through a multidimensional analysis protocol including vocal function and voice quality measures. Methods: Voice analyses were performed for 60 patients treated with radiotherapy (66 Gy/33 fractions, 60 Gy/30 fractions, or 60 Gy/25 fractions) for early T1 glottic cancer and 20 matched control speakers. There was a longitudinal group of 10 patients for whom data were collected before as well as 6 months and 2 years after radiation. Furthermore, data were collected for five separate groups of 10 patients each, before, 6 months after, 2 years after, 3 to 7 years after, and 7 to 10 years after radiation. Vocal function was investigated by means of videolaryngostroboscopy, phonetography, maximum phonation time, and phonation quotient measures. Voice quality was assessed by means of objective acoustical analysis and subjective perceptual ratings by trained raters. Results: Voice characteristics of patients were decreased before radiotherapy, improved after treatment, and became comparable to the voice characteristics of control speakers in at least 55% of the patients. Following radiotherapy, deviant voice quality was mainly negatively affected by increased age and stripping the vocal cord for initial diagnosis. Stroboscopy revealed that next to increasing age and stripping the vocal cord, continued smoking after treatment decreased vocal function following radio-therapy. Conclusion: Voices of patients diagnosed with early glottic cancer improved but did not normalize fully after radiotherapy. Stripping the vocal cord for initial diagnosis and continued smoking after treatment decreased voice characteristics. A multidimensional analysis protocol including perceptual and acoustical analysis of voice quality and stroboscopic analysis of vocal function is recommended to investigate voice characteristics following treatment for early glottic cancer.     

Triceps tendinitis

Elbow extension is very critical for the throwing athlete. The extensor mechanism of the elbow is a relativelyuncommon source of clinical dysfunction. However, two primary processes may affect the triceps tendon, triceps tendonitis, and triceps avulsion injuries. Triceps tendonitis, the more common of the two, is manifested by chronic posterior elbow pain with extension activities. It occurs almost exclusively in males, usually in the fourth decade of life, and especially in individuals who perform forceful repetitive extension activities, eg, throwing athletes. Two distinct subsets of patients exist: those with and those without an olecranon traction spur. Conservative management involves avoidance of repetitive forceful elbow extension, nonsteroidal anti-inflammatories, and time. Splinting in 45° of elbow flexion may be useful if tolerated. Counterforce bracing is typically unsuccessful because the cross-section of the arm changes with biceps contraction. Corticosteroid injection is contraindicated. Although conservative management is limited in scope, it is usually successful in triceps tendonitis in the absence of an olecranon traction spur. The presence of an olecranon traction spur is associated with a higher failure rate of conservative treatment necessitating surgical intervention. Surgical management, when required, involves subperiosteal exposure and excision of the spur and the olecranon tip and formal repair of the triceps tendon.     

Surface size, curvature analysis, and assessment of knee joint incongruity with MRI in vivo.

The purpose of this study was to develop an MR-based technique for quantitative analysis of joint surface size, surface curvature, and joint incongruity and to assess its reproducibility under in vivo imaging conditions. The surface areas were determined after 3D reconstruction of the joint by triangulation and the incongruity by Gaussian curvature analysis. The precision was tested by analyzing four replicated MRI datasets of human knees in 14 individuals. The algorithms were shown to produce accurate data in geometric test objects. The interscan precision was <4% (CV%) for surface area, 2.9-5.7 m(-1) (SD) for the mean principal curvature, and 4.1-7.4 m(-1) for congruence indices. Incongruity was highest in the femoropatellar joint (79.7 m(-1)) and lowest in the medial femorotibial joint (28.6 m(-1)). This technique will permit identification of the specific role of surface size, curvature, and incongruity as potential risk factors for osteoarthritis.     

Cellular inflammation of fetal exctsional wounds: Effects of amniotic fluid exclusion

The development of an cellular inflammatory response secondary to mechanical wounding has not been observed previously in the fetus. The effect of amniotic fluid exclusion on the inflammatory response in fetal rabbits subjected to full-thickness dorsal excisional wounds on day 25 of gestation (term=31–32) was examined. The fetuses were either returned immediately to the uterus; a silicone cover was sutured over the wound; or a silicone cover with a centrally located hole was sutured over the wound. Seventy-two hours after wounding, uncovered wounds (19 live fetuses) exhibited only occasional inflammatory cells. Covered wounds (14 live fetuses) showed a pronounced cellular inflammatory response. Partially covered wounds (six live fetuses) showed a peripheral, intermediate response. The findings suggest that amniotic fluid contains factors inhibitory to inflammation, which the cover effectively excludes.Portions of this study were presented at the ASPRS Meeting, Boston, Massachusetts, October 21–25, 1990.     

Mortality in a group of tar distillery workers and roofers

Objective: A retrospective cohort mortality study was conducted to assess long-term health risk in a group of tar distillery workers and roofers in order to investigate the existence of carcinogenic effects related to the occupational exposures. Methods: The study population consisted of 907 tar distillery workers and 866 roofers, employed at least one half-year between January 1947 and January 1980. This group was followed for mortality until January 1988. For the deceased workers the cause of death was provided by the Central Bureau of Statistics. The observed cause-specific mortality was compared with the expected cause-specific mortality calculated by means of the national mortality rates of The Netherlands. Results: Mortality from cancer of the lungs and trachea was higher than expected in both groups, but not statistically significant. In addition the roofers had experienced an excess mortality rate from external causes. Conclusions: The study provides some additional support for the carcinogenicity of coal tar exposures, but the findings were not statistically significant. Received: 28 October 1996 / Accepted: 7 February 1997