Chemoradiation therapy with or without salvage surgery for early squamous cell carcinoma of the hypopharynx

PURPOSE: Early squamous cell carcinoma of the hypopharynx is a rare clinical entity. Our objective was to analyze the outcome of patients with early hypopharyngeal cancer treated with curative radiotherapy or the combination of preoperative radiotherapy with surgery. METHODS AND MATERIALS: Forty-three patients with Stage I-II hypopharyngeal cancer were initially treated with 30-40 Gy of irradiation with or without chemotherapy. Thirty-two patients (74.4%) who demonstrated a complete response continued to receive further radiotherapy, with a median total dose of 61.2 Gy. Eleven other patients (25.6%) received surgery. RESULTS: Local control with laryngeal voice preservation was achieved in 8 (88.9%) of 9 patients with Stage I disease, and in 23 (67.6%) of 34 patients with Stage II disease. The overall and disease-specific 5-year survival rates for all patients were 70.4% and 89.5%, respectively. The disease-specific survival rates according to the T-category were 100% for patients with T1 disease and 87.2% for patients with T2 disease (p = 0.32). Twenty patients (46.5%) had synchronous or metachronous cancers. Four patients died of hypopharyngeal cancer, and 5 died of second-primary esophageal cancer. CONCLUSIONS: A majority of patients with early hypopharyngeal cancer was curable. However, second malignancies influenced the overall outcome of patients with early hypopharyngeal cancer.     

Bobath理论与历史的变迁

Bobath理论是为中枢神经系统疾病患者开发的治疗与康复技术,可应用于成人及儿童。它最初源于Berta与Karel Bo-bath的临床经验以及当时的运动控制理论模型。这种整体性治疗技术经历了50多年的发展,今天已经以新的运动控制和运动学习理论模型为指导。它的理论框架将随着运动科学知识的更新而不断丰富、发展。     

Magnifying pharmacoendoscopy: response of microvessels to epinephrine stimulation in differentiated early gastric cancers

BACKGROUND: Magnifying endoscopy is a promising modality for fine observation of minute surface structures and microvessel architecture in gastric lesions. OBJECTIVE: To observe the response of microvessels to epinephrine stimulation in early gastric cancer tissues and to assess the usefulness of magnifying pharmacoendoscopy for histologic diagnosis. DESIGN: This was a prospective pilot study. SETTING: This study was conducted at an academic hospital. PATIENTS: Twenty-nine patients with differentiated early gastric cancer were enrolled. INTERVENTIONS: Microvessels in both the cancerous lesion and its adjacent non-neoplastic gastric mucosa were observed by magnifying endoscopy before and after focal spray with epinephrine solution (0.05 mg/mL). MAIN OUTCOME MEASUREMENTS AND RESULTS: After epinephrine stimulation, noncancerous gastric mucosa surrounding the cancerous lesion showed a change in color from red to white; no microvessels were evident. On the other hand, all the cancerous lesions examined clearly showed enhancement of tumor microvessels. The rate of detection of tumor microvessels by magnifying pharmacoendoscopy (100%) was significantly higher than that by magnifying endoscopy alone (41.3%). LIMITATIONS: This was small pilot study. CONCLUSIONS: Magnifying pharmacoendoscopy with epinephrine is a powerful tool for assessing tumor vascularity and may contribute to the histologic diagnosis of differentiated early gastric cancers before endoscopic treatment.     

Expression of heat shock protein 72 in rat quadriceps muscles following anterior cruciate ligament resection

 This study investigated the expression of heat shock protein 72 (HSP 72) in quadriceps femoris muscle following anterior cruciate ligament (ACL) resection and running training in rats. A group of 15 Wistar strain male rats (10 weeks old) were divided into three groups: sham-operated (S), ACL resection (A), and running training following ACL resection (R). In the A and R groups, the ACL of the right knee was resected using microsurgical techniques. Rats in the R group were subjected to running training for 9 weeks on a motor-driven treadmill for rodents 1 week after ACL resection. At 10 weeks after ACL resection, glycerinated single fibers were prepared from vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF), and semimembranosus (SM) muscles. To determine the levels of HSP72 (HSP-inducible) in each muscle, we used the Western blotting technique. HSP72 expression in VL and VM increased following ACL resection (P < 0.05) but not in RF or SM. Exercise training caused an elevation in HSP72 expression in VL and VM. There were no significant changes in HSP72 expression in RF or SM following exercise training. These results suggest that some stress would be generated by ACL resection in VM and VL and might cause atrophy in VM and VL. Received: July 29, 2002 / Accepted: October 18, 2002 Acknowledgments. We especially thank Professor H. Aoki of the Department of Orthopaedic Surgery at St. Marianna University School of Medicine for his encouragement and many valuable comments. We also thank Vice President T. Yoshioka of Aomori University of Health and Welfare for his valuable criticism and advice. This study was supported in part by a Grant-in-Aid for Encouragement of Young Scientists (B) from The Ministry of Education, Culture, Sports, Science and Technology (MEXT) to K.G. Offpring requests to: R. Okuyama     

Early and long-term results of arthroscopic treatment for shoulder stiffness

We evaluated the efficacy of arthroscopic treatment in 42 patients with shoulder stiffness. Of 44 stiff shoulders, 30 were classified as primary idiopathic, 7 were classified as traumatic, 4 occurred after prolonged immobilization, and 3 occurred in diabetic patients. Similar intraarticular findings were made in all cases. Bursoscopy suggested subacromial impingement in one third of the patients; they underwent not only capsular release but also subacromial decompression. Gains in motion and the Japanese Orthopaedic Association score were statistically significant at 4 weeks after operation and at a mean follow-up of 7.5 years. The results at the latest follow-up were excellent in 37 shoulders (84%), good in 3 (7%), and poor in 4 (9%). Of the 4 poor results, 2 were in patients with traumatic injury, 1 in a diabetic patient, and 1 in a primary idiopathic patient. There were no complications related to the arthroscopic procedure. Our treatment combines fast recovery with long-term efficacy.     

Decreased resting energy expenditure in patients with Duchenne muscular dystrophy

Background

Skeletal muscle metabolism is a major determinant of resting energy expenditure (REE). Although the severe muscle loss that characterizes Duchenne muscular dystrophy (DMD) may alter REE, this has not been extensively investigated.

Methods

We studied REE in 77 patients with DMD ranging in age from 10 to 37 years using a portable indirect calorimeter, together with several clinical parameters (age, height, body weight (BW), body mass index (BMI), vital capacity (VC), creatine kinase, creatinine, albumin, cholinesterase, prealbumin), and assessed their influence on REE. In addition, in 12 patients maintaining a stable body weight, the ratio of energy intake to REE was calculated and defined as an alternative index for the physical activity level (aPAL).

Results

REE (kcal/day, mean ± SD) in DMD patients was 1123 (10–11 years), 1186 ± 188 (12–14 years), 1146 ± 214 (15–17 years), 1006 ± 136 (18–29 years) and 1023 ± 97 (?30 years), each of these values being significantly lower than the corresponding control (p < 0.0001). VC (p < 0.001) was the parameter most strongly associated with REE, followed by BMI (p < 0.01) and BW (p < 0.05). The calculated aPAL values were 1.61 (10–11 years), 1.19 (12–14 years), 1.16 (15–17 years), and 1.57 (18–29 years).

Conclusion

The REE in DMD patients was significantly lower than the normal value in every age group, and strongly associated with VC. Both the low REE and PAL values during the early teens, resulting in a low energy requirement, might be related to the obesity that frequently occurs in this age group. In contrast, the high PAL value in the late stage of the disease, possibly due to the presence of respiratory failure, may lead to a high energy requirement, and thus become one of the risk factors for development of malnutrition.     

Does Norepinephrine Influence Pain Behavior Mediated by Dorsal Root Ganglia?: A Pilot Study

Background  

Postganglionic neurons in the sympathetic nervous system reportedly are involved in lumbar radicular pain and release norepinephrine (NE), a neurotransmitter. Increased numbers of sympathetic nerve fibers have been found in dorsal root ganglion (DRG) neurons in a root constriction model. Whether this is a reasonable model for pain, however, is unclear     

Anti-diabetic effects including diabetic nephropathy of anti-osteoporotic trace minerals on diabetic mice

Objective

In our previous study to evaluate the effects of soluble silicon (Si) on bone metabolism, Si and coral sand (CS) as a natural Si-containing material suppressed peroxisome proliferator-activated receptor γ (PPARγ), which regulates both glucose and bone metabolism and increases adipogenesis at the expense of osteogenesis, leading to bone loss. In this study, we investigated the anti-diabetic effects of bone-seeking elements, Si and stable strontium (Sr), and CS as a natural material containing these elements using obese diabetic KKAy mice.

Methods

Weanling male mice were fed diets containing 1% Ca supplemented with CaCO₃ as the control and CS, and diets supplemented with 50 ppm Si or 750 ppm Sr to control diet for 56 d. The mRNA expressions related to energy expenditure in the pancreas and kidney were quantified by real-time polymerase chain reaction.

Results

At the end of feeding, plasma glucose, insulin, leptin, and adiponectin levels decreased significantly in three test groups, while pancreatic PPARγ and adiponectin mRNA expression levels increased significantly toward the normal level, improving the glucose sensitivity of β-cells and inducing a significant decrease in insulin expression. The renal PPARγ, PPARα, and adiponectin expression levels, histologic indices of diabetic glomerulopathy, and plasma indices of renal function were also improved significantly in the test groups.

Conclusion

Taken together, anti-osteoporotic trace minerals, Si and Sr, and CS containing them showed novel anti-diabetic effects of lowering blood glucose level, improving the tolerance to insulin, leptin, and adiponectin, and reducing the risk of glomerulopathy through modulation of related gene expression in the pancreas and kidney.