Basement membrane functions as a barrier against the invasion of cancer cells; therefore, the investigation of the mechanism of basement membrane degradation by matrix metalloproteinases (MMPs) is important. MMPs are a family of more than 25 endopeptidases dependent on zinc and share a common modular domain structure. In the past, it was thought that cancer cells self-produced MMPs; however, current views indicate that most MMPs in cancer are made by stromal cells rather than cancer cells. EMMPRIN (Extracellular Matrix Metalloproteinase Inducer), a glycoprotein to stimulate stromal cells to produce MMPs, was first extracted from human lung cancer cells. Soluble EMMPRIN acted on stromal cells both adjacent and distant from cancer sites in paracrine fashion, and further stimulated the production of MMPs and additional EMMPRIN, which consequently contributes to cancer invasion, and metastasis. Recent studies suggest that the role of MMPs in cancer is far more complicated than initially presumed. MMPs promoted cell migration and the release of growth factors sequestered in the extracellular matrix. In this study, we confirmed that EMMPRIN and soluble EMMPRIN were expressed in human laryngeal cancer cells. We investigated the effects of soluble EMMPRIN on fibroblasts which belong to stromal cells to induce production of MMPs. Our present study suggests that soluble EMMPRIN may promote cancer cells invasion and migration indirectly.
Videofluorography (VF) provides a dynamic view of deglutition; however, its clinical utility is compromised by the need to transport gravely ill patients to a radiology suite and by the potential hazard of radiation exposure. Videoendoscopy (VE), in contrast, can be performed at the bedside. VE has limited ability to assess swallowing function because its field is obscured by epiglottic excursion. These limitations led us to pursue a new method for periodic evaluation of swallowing function. To compare our technique combining ultrasonography (US) and VE with VF in a healthy control, these images were displayed simultaneously. Both VF and US identified the commencement of laryngeal elevation. The pharynx, thereafter, became invisible with VE (A). Next the bolus head reached the pyriform sinus (P). After that, laryngeal elevation was at maximum height for both VF and US (M). The timing of elevation as measured by VF and US (0.83±0.17sec and 0.85±0.19, respectively) were almost equivalent, and the averages of laryngeal elevation were 35.0±3.0mm and 33.5±2.9mm, respectively. The A-P interval was 0.18±0.07sec, which suggested that P can be visible in dysphagic patients with a delay of swallowing reflex. Our technique, like VF, can demonstrate the key attributes in the quantitative parameters of swallowing.
Thyroplasty, arytenoid adduction, and vocal fold injection are surgical treatment options for unilateral vocal fold paralysis. Injection laryngoplasty is performed without making an incision in the neck and gives less stress to the patient compared to other procedures. Thus injection laryngoplasty is appropriate treatment option for patients who have cosmetic requirements or whose general condition prefer the procedure which induce lowest stress on the patient. Recently, calcium phosphate bone paste (BIOPEX®;) has been reported to be a good candidate as injection material which induces little tissue reaction and stabilizes for years after injection. We tentatively prepared an injector using commercial clamps to establish easy and consistent injection technique of BIOPEX®. We used this injector in 5 cases and injection procedure could be smoothly performed with less stress on the operator than manual injection. Satisfactory results were obtained in all the cases with significantly improved maximum phonation time.
The purpose of this study was to observe the clinical characteristics of laryngeal epithelial hyperplasia and investigate how many cases developed carcinoma. A total of 119 patients with epithelial hyperplasia of the larynx were treated with endolaryngeal microsurgery from January 1991 to April 2005 at the Kurume University Hospital. 90 cases were treated with combined endolaryngeal microscopic CO2 laser surgery. 29 cases were treated with endolaryngeal microscopic stripping alone. The majority of the patients were male and smokers. The range of age for the majority of patients was from 50 to 70 years. Histopathologically, there was simple hyperplasia in 61 cases, mild dysplasia in 32 cases, moderate dysplasia in 15 cases and severe dysplasia in 11 cases. After the treatment, recurrence was found in 20 cases (17%); from which there were 9 cases (15%) of simple hyperplasia and 11 cases (19%) of dysplasia. 12 cases (10%) developed to carcinoma; among which there were 4 cases (7%) with simple hyperplasia and 8 cases (14%) with dysplasia. 3 cases were finally treated with total laryngectomy. These results indicate that, in laryngeal epithelial hyperplasia (with either of simple hyperplasia or dysplasia), careful follow up is necessary to exclude a change to carcinoma.
A case of an 84-year-old female with an anterior laryngeal saccular cyst was reported. Her chief complaint was hoarseness. A fiberoptic examination revealed swelling of the left false cord above the left vocal fold. The swelling was suspected as a submucosal mass. MRI imaging revealed cystic lesion. A following laryngomicroscopic examination revealed bilateral laryngeal cystic lesions in the false cords. The cyst on the left side was entirely removed with a Ho : YAG laser and the small cyst on the right side was treated by a partial resection of the cyst wall. Based on clinical and histopathological findings, we diagnosed the disease as bilateral anterior saccular cysts. No recurrence has been found 13 months after resection.
Laryngeal stenosis is caused by various reasons and we are usually able to detect a cause in many cases. Occasionally we encounter a case without an obvious cause. Recently we observed such a case, and we suspected that chlorine detergent possibly caused it. The patient was a 66-year-old female whose main complaint was stridor. She had been using chlorine detergent everyday for about ten years. She had been diagnosed and treated for bronchial asthma because of the stridor. Subsequently, supraglottic stenosis was observed and it was caused by this lesion. There was no particular past history and no distinguishing pathological character in the stenosis lesion. The stenosis was removed by laryngo-fissure with a supra-hyoid approach while a surgical lumen was maintained using a core mold. She stopped using the detergent after the treatment. After sixteen months of follow-up since the operation, the patient has shown no evidence of recurrent disease.
We reported on a case of Reinke's edema with dyspnea following resection of the right recurrent laryngeal nerve during surgery for thyroid papillary carcinoma. A 55-year-old female, who was a smoker, presented with a greater than 20-year-history of hoarseness of the voice, without dyspnea. She was diagnosed as having type III Reinke's edema according to Yonekawa's classification of Reinke's edema. She had undergone total thyroidectomy with modified selective neck dissection for thyroid papillary carcinoma involving right vocal cord, at the Department of Surgery, Kitasato University Hospital. The right vocal cord was fixed at the paramedian position. The patient had developed dyspnea transiently for a few days. Subsequently, she began to suffer from dyspnea upon exertion or when she developed a cold. The patient was diagnosed as having Reinke's edema. The dyspnea disappeared after endolaryngeal microsurgery. The right vocal cord was fixed at the median position, the mean air flow rate improved, and the fundamental frequency of her voice was higher than before the operation.