We succeeded in the regeneration of an injured vocal fold in a canine by the transplantation of bone marrow derived stromal cells (BSCs). This therapy required a cell culture. The safety of the ordinal culture medium with an animal serum such as fetal bovine serum (FBS), however, has not yet been confirmed. In this in vitro study, we investigated the potentiality of a culture medium of autologous blood serum (ABS) which would be the safest additive for clinical applications. Canine ABS and the following three types of medium were prepared. Mediums I, II and III were alpha-Minimum Essential Medium (alpha-MEM) as blood serum free medium for control, alpha-MEM with 15% ABS and Dulbecco's Modified Eagle's Medium (D-MEM) with 10% FBS for ordinal medium, respectively. The growth rates of the canine cultured BSCs in these three mediums were estimated. After 2 weeks culture, the number of cells in medium I, II and III increased by 2, 8-10 and 14-15 times, respectively. These results showed that ABS had a satisfactory cell growth promoting action to apply clinically as a substitute for FBS.
The aspiration pneumonia in bedridden patients with cerebrovascular disorders or progressive neural disease is severe and can recur frequently. The cuffed tracheostomy has been commonly used, but it is insufficient to prevent aspiration pneumonia, which makes it difficult to manage the tracheostoma in many cases. We developed a new glottic closure procedure. The laynx was opened via a midline thyrotomy after removing both thyroid and cricoid cartilages to gain a wide field of operation. The horizontal incision was made at the level of the bilateral vocal cords, and this was separated to superior and inferior mucosal flaps and sutured at the midline above and below. The sternohyoid muscle flap was inserted into the open space between superior and inferior closures. In this study, five cases with tracheal cannulas were treated by this method under local anesthesia. All cases achieved complete inhibition of aspiration without the dehiscence of the closure sites or postoperative infection, and their tracheostomae had been enlarged by the removal of cricoid cartilage. Finally, the large tracheostomae did not require any tracheal cannulas, and the absence of aspiration made it easier to manage the respiratory tract. In conclusion, this procedure produces minimal surgical trauma and is highly useful and safe and can be applied to high risk bedridden patients.
Laryngeal granuloma is intractable and tends to recur. Recently, the relationship between laryngeal granuloma and gastro-esophageal reflux disease (GERD) or laryngo-pharyngeal reflux disease (LPRD) has been scrutinized. In the case of LPRD, it is widely acknowledged that the first choice of the treatment for laryngeal granuloma is antireflux medicines; however, there are some patients who are not cured by this conventional treatment. In this study, we investigated the benefits of powered instruments, i.e. Microdebrider to treat this disease. Fifty-six cases of the treatment were retrospectively analyzed. The overall cure rate was such as; 26% in patients treated with cold instruments, 53% in patients treated with laser vaporization, 75% in patients administered proton pump inhibitors, and 100% in patients treated with Microdebrider. On the other hand, we analyzed the effect of Microdebrider in patients with recurrent granuloma after initial treatment. Five recurrent cases after treatment with other methods were performed surgery with the use of Microdebrider. The use of the Microdebrider has shown no recurrence to date. These findings indicate that the Microdebrider is superior to conventional surgical procedures, although administration of antireflux medicine is the first choice.
Objective : To evaluate the treatment results of patients with early glottic cancer with respect to laryngeal preservasion. Patients and Methods : Between 2001 and 2005, 93 patients with laryngeal cancer were treated at Kobe University Hospital. In general, T1 and T2 glottic cancers were treated with conventional and hyperfractionated radiotherapy, respectively. Conservative surgery with laryngeal preservation was considered as salvage for radiation failure. Results : The larynx was preserved in 95.8% of the patients with T1 glottic cancer (45/47) and 82.6% of the patients with T2 glottic cancer (19/23). Conclusion : Although the follow up periods were not long enough, promising results were obtained. Development of treatment strategies for more advanced cancers is an issue to be solved.
A retrospective review was performed on 12 patients (10 male and 2 female ; mean age of 62.1 years) with subglottic cancer who received initial treatment at Kurume University Hospital between 1979 and 2006. In T classification, there were 4 T2 cases and 8 T4 cases. In N classification, there were 8 NO cases, 3 N1 cases and 1 N2 case. 3 were at stage 2 and 9 were at stage 4a. The 3-year and 5-year survival rates as determined by the Kaplan-Meier method were 81.8% and 70.1% respectively. The 3-year and 5-year survival rates for cases at stage T2 were both 75%, whereas those at T4 were 83.3% and 62.5%. 6 patients died. 3 patients died of the primary disease (lymph node death : 1, distant metastasis death : 2). Total laryngectomy with bilateral paratracheal neck dissection was performed in 9 cases. (3 T2 cases and 6 T4 cases). Radiotherapy as additional treatment was performed on 4 out of 9 cases. Laryngeal preservation operations were performed in 3 cases (1 T2 cases and 2 T4 cases). Radiotherapy and chemotherapy were performed in 2 cases while super-selective intra-arterial chemotherapy with radiotherapy was performed in 1 case. This particular patient did not experience recurrence. It is conceivable that super-selective intra-arterial chemotherapy with radiotherapy is one of the more effective treatments in laryngeal preservation.
It is not common to encounter patients affected by respiratory distress. We received and treated five cases (three with laryngeal cancer, one with a deep neck infection and one with acute epiglottitis) of laryngeal diseases requiring airway management. Oral tracheal intubation was performed in all cases by emergency room doctor and consecutive tracheotomies were performed on two by otorhinolaryngologist. The 57 years old male patient who had a relapse of laryngeal carcinoma presenting dyspnea visited to our hospital. Although the patient was strongly recommended an urgent hospitalization and tracheotomy, he denied our recommendation. Unfortunately, he was transferred to the emergency medical care center in a cardiopulmonary arrest the next day. Except for this patient, all other patients were discharged from the hospital without any sequelae. In two of the five cases, final diagnoses were determined by an otorhinolaryngologist utilizing a flexible fiberscope and CT scan imaging. Once airway patency was established, the prognosis of these diseases was favorable. Management of airway intervention is as follows : The treatment of the laryngeal disease presenting dyspnea is limited to the medical institution that have enough medical staff, an intensive care unit and the inspection system. When the patient is in a life-threatening situation such as shock, apnea, unconsciousness, hypoxia, or unventilated then urgent oral intubation must be performed. When the patient is in a sitting position with stable cardiopulmonary function, nasal intubation using a fiberscope while they are awake should be performed. When the patient can maintain a supine position and has stable cardiopulmonary function then we can choose either tracheotomy or intubation.
The aim of this study is to investigate the therapeutic effects of combining both proton pomp inhibitor (PPI) administration and voice therapy for the treatment of muscle tension dysphonia with laryngopharyngeal reflux disease (LPRD) -related organic findings and to reveal the mediation of voice therapy. We evaluated the effect of tentative voice therapy during the first consultations and the outcomes of both voice therapies and PPI administration in 18 dysphonic cases with both LPRD-related laryngopharyngeal signs and supraglottic contraction. In regard to the effects of the tentative voice therapy, 9 cases (50%) showed an immediate improvement in both the vocal and supraglottic findings when performing the hamming method. 12 patients (67%) ultimately demonstrated a complete improvement in the vocal findings. 14 cases (78%) demonstrated a gradual improvement in supraglottic contraction. The LPRD-related organic findings exhibited an apparent improvement in 12 cases (67%). When investigating any associations among the degrees of improvement in these findings, a significant association (p<0.05) was found between the difference of the vocal findings and that of the supraglottic contraction; however, no such association was observed with the laryngopharyngeal organic findings either before or after the therapies. In conclusion, these data suggests that administration of both PPI and voice therapy against MTD with LPRD-related findings is effective.