Biomedical subjects

M Kawaida

Publications and source records attributed to M Kawaida.

At least 19 recordsLinked to original sources

PubMed2003

Concurrent chemoradiotherapy with daily low dose intra-arterial cisplatin plus 5-fluorouracil for stage IV nasopharyngeal cancer.

This study aims to treat locally-advanced nasopharyngeal cancer by concurrent conventional irradiation at 2.0 Gy/day five days per week up to a total dose of 68 Gy, and daily intra-arterial infusion of cisplatin 3 mg/m2 plus 24 hours intravenous drip infusion of 5-fluorouracil 150 mg/m2 per day, five days per week. All of five enrolled patients completed the schedule, and treatment compliance was considered to be identical. Of the five patients evaluable for response, four with complete response (80%) and one with partial response (20%), with an overall response rate of 100% was achieved. The median survival time was 26 months. Two-year survival of the patients was 80%. This regimen showed marginal mucositis but well tolerated. We concluded that this treatment option is safe and effective for the locally-advanced nasopharyngeal cancer.

Adult↗

PubMed2001

Video-assisted rigid endoscopic laryngosurgery: application to cases with difficult laryngeal exposure.

In some cases of microlaryngosurgery, laryngeal exposure with a direct laryngoscope is difficult because of a variety of reasons. In such cases, we now use a long rigid endoscope inserted into the side tube of the direct laryngoscope together with a video system. The lesion can be removed while the phonosurgeon observes the magnified images of the larynx on the video monitor. We describe the surgical procedure together with the preoperative and postoperative evaluation of vocal function in 13 patients with benign laryngeal lesions. A good surgical and vocal outcome was achieved in all cases. The method appeared to be useful for treating dysphonia in patients in whom it was difficult to expose the larynx with a direct laryngoscope.

Adult↗

PubMed2000

Survival results of neoadjuvant chemotherapy for advanced squamous cell carcinoma of the head and neck.

BACKGROUND: We carried out an open, randomized multi-center clinical trial for advanced head and neck cancer between April 1991 and December 1992. In this report, we update the results and analyze the 5-year survival results. METHODS: Thirty-two patients with previously untreated stage III and IV resectable squamous cell carcinoma of the oral cavity and pharynx were entered into the study. The PEM regimen consisted of cisplatin 60 mg/m2 2 h infusion on day 1, etoposide 40 mg/m2 1 h infusion on days 1, 2 and 3 and mitomycin-C 7 mg/m2 i.v. bolus on day 1. RESULTS: Among the 32 patients entered into this trial, eight were disqualified from the analysis. Of the remaining 24 patients, 13 were given neoadjuvant chemotherapy (NAC) and 11 underwent surgery alone. Among the 13 patients who received NAC, four achieved a complete response (31%) and three a partial response (23%), with an overall response rate of 54%. Myelosuppression was a major side effect. Thrombocytopenia and anemia were dose-limiting toxicities. Other adverse reactions, including mucositis, were all mild and transient. The overall 5-year survival after NAC and without NAC were 83 and 62%, respectively. The survival difference was not statistically significant (p = 0.33). CONCLUSIONS: NAC does not appear to play a role in the treatment of cancer of the oral cavity and pharynx with our PEM regimen. However, the degree of toxicity was limited in our trial and therefore attempts to increase the dosage and/or revise the administration schedule for cancer of the pharynx and T1 to T3 tumor disease appear warranted.

Adult↗

PubMed2000

Granular cell tumors arising nearly simultaneously in the larynx and subcutaneous cervical region.

Granular cell tumors are benign, relatively rare lesions that can occur in any organ in the body. Tumors are known to occasionally arise in two or more different organs. We report the case of a 60-year-old woman in whom granular cell tumors arose almost simultaneously in her subcutaneous cervical region and her larynx. The two tumors were surgically resected and examined histopathologically, and they exhibited the same histopathologic features. The tumor of the larynx was resected with the help of a carbon dioxide laser. Immunohistochemical staining revealed that both were positive for S-100 protein and neuron-specific enolase. Cases of the nearly simultaneous appearance of granular cell tumors in the neck and larynx are rather unusual. The results of immunohistochemical staining suggested that this tumor originates in nerve tissue.

Biopsy, Needle↗

PubMed1999

Prognosis after salvage chemotherapy for locally unresectable recurrent squamous cell carcinoma of the head and neck.

BACKGROUND: For locally unresectable recurrent squamous cell carcinoma of the head and neck, we investigated two salvage chemotherapy regimens as second-line chemotherapy. In our preliminary study, we observed that both regimens were active. In the present study we analyzed the prognosis of these patients. METHODS: Twenty-six patients with recurrent advanced head and neck cancer, were treated with one of two new regimens as second-line chemotherapy. The PEM regimen consisted of cisplatin 60 mg/m2 on day 1, etoposide 40 mg/m2 on days 1, 2 and 3 and mitomycin-C 7 mg/m2 on day 1. The long CF regimen consisted of cisplatin 8 mg/m2 on days 1-5, 8-12, 15-19 and 22-26 and 5-fluorouracil 300 mg/m2 as a 24 h infusion or oral administration of tegaful-uracil (UFT-E) 400 mg/m2 on days 1-28. Survival curves were calculated using the Kaplan-Meier method and compared by the log rank test. RESULTS: Of 24 patients evaluable for response, three complete responses (CR) and seven partial responses (PR) were achieved, with an overall response rate of 42%. Myelosuppression was the major side effect. One year survival was 100% for CR, 0% for PR and 20% for minor response (MR). All patients who failed to achieve a CR died within 12 months, except one patient with MR. CONCLUSION: Our data suggest that with these salvage regimens survival benefit was demonstrated only in CR patients.

Adult↗

PubMed1998

Multidirectional observations of the larynx using transurethral rigid endoscopes during direct laryngoscopy.

Microscopic direct laryngoscopy (microlaryngoscopy) under general anaesthesia is the optimal method of observing the larynx. However, as microlaryngoscopy does not allow precise observations of the ventricle, inferior surface of the vocal fold and subglottis, multidirectional observations of the larynx using transurethral rigid endoscopes were performed during direct laryngoscopy. This endoscopic technique has been shown to be clinically useful in the diagnosis and treatment of laryngeal lesions. The equipment and methods are introduced herein, and a representative care is presented.

Anesthesia, Inhalation↗

PubMed1998

Lubrication mechanism of the larynx during phonation: an experiment in excised canine larynges.

To evaluate how the viscosity of the laryngeal mucus influences vocal fold vibration, two fluids of differing viscosity were applied separately to excised canine larynges and experimental phonation was induced. Vibration of the vocal folds was measured by use of a laryngostroboscope and an X-ray stroboscope. With the high viscosity fluid, the amplitude of vibration of the free edge and the peak glottal area was decreased while the open quotient was increased. Because the viscosity of this fluid affected the wave motion of the vocal fold mucosa, changes in viscosity of the mucus may be involved in causing such disorders as hoarseness, in the absence of apparent changes in the vocal folds themselves.

Animals↗

PubMed1998

Observations of laryngeal lesions with a rhinolarynx electronic videoendoscope system and digital image processing.

Laryngeal lesions were observed with the Olympus ENF-200 rhinolarynx electronic videoendoscope attached to the Olympus EVIS-200 system, an electronic videoendoscope system of Olympus Optical Co, Ltd. The electronic videoendoscope differs from conventional flexible fiberscopes in having a small light-sensitive charge-coupled device (CCD) chip built into the tip of the endoscope portion. This model has a small CCD chip in its 5-mm-outer diameter tip, and can be introduced into the laryngeal cavity by inserting it through the nasal passages. Dynamic color images obtained by this system were very clear and provided excellent resolution. This electronic videoendoscope system could also be connected to the Olympus EVIP-230 digital image processor, which was compatible with this system. Structure enhancement and color enhancement were performed by processing images. In this paper, the ordinary images and the processed images are described and discussed from the standpoint of diagnostic usefulness.

Equipment Design↗

PubMed1996

Vocal fold vibration in simulated head voice phonation in excised canine larynges.

In order to establish precise vibratory patterns and their clinical implication for phonation, the mode of vibration of the vocal folds around the time of register transition in excised canine larynges was analyzed multi-directionally according to various acoustic parameters. Phonation was simulated by artificially tensing the cricothyroid muscles. Vibration of the vocal folds around the time of register transition was filmed from above using ultra-high-speed cinematography and in a frontal plane using X-ray stroboscopy. Acoustic parameters included subglottic pressure, pitch, intensity and tension and were recorded simultaneously during register transition. The fundamental vibration patterns observed during vocal phonation were the same as that involved in chest voice phonation in excised canine larynges, with respect to the traveling wave of the vocal fold vibration. Changes in the physical properties of the vocal folds were considered to occur at register transition. These changes were probably strongly dependent upon changes in the structure of the lamina propria. Head voice phonation requires adaptability of the lamina propria and is less efficient than chest voice phonation. Hence, head voice phonation would be one method for assessing the condition of the vocal folds.

Animals↗

PubMed1995

Primary adenoid cystic carcinoma of the trachea: a case report of a twelve year survivor.

Malignant tumors arising from trachea are not common. This paper presents an example of primary tracheal adenoid cystic carcinoma treated by surgical resection with good prognosis. A 46-year-old woman presented with a short history of dyspnea. Five months before the onset of dyspnea, the patient had mild wheezing. She had no history of smoking. Physical examination suggested primary tracheal tumor. The patient underwent a V-shaped resection of 3.5 cm of trachea followed by reconstruction with the trough method. Histological examination revealed adenoid cystic carcinoma. Adjuvant chemotherapy was indicated with 50 mg of adriamycin postoperatively. The patient has done well for 12 years with no further treatment. The tumor was an adenoid cystic carcinoma that was slow-growing, infiltration of mucus membrane was few and growth fraction (mitotic index was less than 1%) was low. Those were considered the reason for good prognosis.

Carcinoma, Adenoid Cystic↗

PubMed1995

Salvage chemotherapy with PEM and long-CF regimen in CDDP refractory advanced head and neck cancer.

With the aim of increasing complete response rates and improving survival in cisplatin (CDDP)-based combinations (CDDP + 5-fluorouracil (5FU) and/or CDDP+methotrexate (MTX)+bleomycin (BLM) of refractory advanced head and neck cancer, we scheduled 21 patients to receive PEM and Long CF, PEM regimens consisting of CDDP (P) Etoposide (Etop) (E) and mitomycin-C (MMC) (M) (CDDP 60 mg/m2/2 hr. infusion on day 1; Etop 40 mg/m2/1 hr. infusion on day 1, 2, 3; MMC 7 mg/m2 iv bolus on day 1). Of 12 patients evaluable for response, 2 CR, 3 PR were realized, with an overall response rate of 42%. Myelosuppression was the major side effect, and thrombocytopenia (8% greater than WHO grade III) was the dose-limiting toxicity. Long CF consisted of CDDP (C) and 5FU (F) (CDDP 8 mg/m2/2 hr. infusion on day 1-5, 8-12, 15-19, 22-26; 5FU 300 mg/m2/24 hr. infusion or tegaful.uracil (UFT-E) 400 mg/m2 P.O. on day 1-28. Of 8 patients evaluable for response, 3 PR were realized, with an overall response rate of 38%. N&V and leukopenia were the major side effects. These adverse reactions were all transient. We concluded that these two regimens produced beneficial effects in patients with advanced recurrent head and neck cancer which had already been treated with CDDP-based combinations.

Aged↗

PubMed1994

Surgical treatment for hypopharyngeal cysts with a side-opened direct laryngoscope.

Two cases of hypopharyngeal cyst are reported. Both cysts occurred in the piriform sinus of the hypopharynx. Histopathological examination indicated that both were retention cysts. These cysts were removed by laryngomicrosurgical technique using a side-opened direct laryngoscope. In the cyst with a distinct base, a laryngomicrosurgical snare was used for removal. In the wide-based cyst, the mucous membrane around the cyst was incised with an electrosurgical instrument and then detached to facilitate removal. In this paper, we describe our surgical procedure for removing hypopharyngeal cysts and discuss the causes of such cysts.

Cysts↗

PubMed1994

Primary small cell carcinoma of the larynx.

Small cell carcinoma is a rare tumor of the larynx. We present such a case in a 78-year-old female. The histopathological diagnosis at the time of laryngomicroscopic biopsy was squamous cell carcinoma, upon which basis we initially chose surgical treatment. The surgical specimen, however, revealed small cell carcinoma. Despite the administration of radiotherapy and chemotherapy, the patient died 9 months after initial presentation. We believe that this case illustrates the need for a sufficiently large biopsy specimen in order to arrive at the correct histopathological diagnosis when small cell carcinoma of the larynx is present, and that immunohistochemistry and electron microscopy should be performed to aid the diagnosis.

Aged↗

PubMed1993

Laryngomicrosurgery with carbon dioxide laser for laryngeal papillomatosis: application of a two-stage operation.

Among the many treatments reported, CO2 laser surgery has recently been applied in the field of laryngomicrosurgery to treat laryngeal papilloma. It is exceedingly difficult to cure this disease, however, because of its rapid recurrence following surgery. Incomplete removal of papilloma is believed to be caused by the difficulty of precisely identifying residual papillomas during surgery. In an effort to resolve this problem, we have developed a new surgical method which we call the "two-stage operation," in which a series of two operations are performed about 10 days apart. By the time of the second operation, the bleeding, coagulated blood, and carbonized tissue from the first operation have resolved, and the laryngeal image is much clearer. If additional lesions are found, they are removed at the second operation. We applied this method to several patients with recurrent laryngeal papillomatosis and obtained good results. This new method is clearly useful in the treatment of laryngeal papillomatosis, and it promises to decrease the recurrence rate. In this paper we present the case of a 26-year-old male with laryngeal papilloma who underwent surgery 1 month previously at another hospital. Laryngeal endoscopy revealed multiple papillomas especially of the glottis. The first operation with the CO2 laser was performed on April 16, 1990. Visible lesions appeared to have been completely removed. The second operation was carried out 10 days after the first operation, and the small residual lesions were removed with the CO2 laser. The patient has been disease-free for 18 months.

Adult↗

PubMed1993

Synergistic interaction of natural human tumor necrosis factor-alpha/natural human interferon-alpha mixture alone and in combination with cisplatin against head and neck laryngeal squamous carcinoma multicellular tumor spheroids.

We evaluated the effects of each component, natural human tumor necrosis factor-alpha (nHuTNF-alpha) and natural human interferon-alpha (nHu-IFN-alpha), and the combined nHuTNF-alpha/nHuIFN-alpha preparation with or without cisplatin (DDP) at tumor mass level. Multicellular tumor spheroids (MTS) of approximately 500 microns in diameter were produced from HEp-2 laryngeal squamous carcinoma cell line by liquid overlay culture technique. Cell kill effects of 72 hr exposure to nHuTNF-alpha, nHuIFN-alpha, or nHuTNF-alpha/nHuIFN-alpha against cells in MTS were 2-3-fold less than those in monolayer. In MTS, does response curves become progressively flat at high drug concentrations, indicative of poor drug penetration into the MTS core. Combination nHuTNF-alpha/nHuIFN-alpha produced synergistic cell kill for both MTS and monolayers. For monolayer cells exposure to nHuTNF-alpha/nHuIFN-alpha first (72 hr) followed by DDP (1 hr) after 1 hr rest period was synergistic with combination index (CI) of approximately 0.8 at LD50. Simultaneous (72 hr in nHuTNF-alpha/nHuIFN-alpha with DDP in last 1 hr) or reverse order of exposure were antagonistic. In contrast, for MTS, DDP followed by nHuTNF-alpha/nHuIFN-alpha was most synergistic with CI of approximately 0.2. Simultaneous exposure or nHuTNF-alpha/nHuIFN-alpha followed by DDP showed synergism with CI of approximately 0.5 and 0.8, respectively. The improved efficacy of DDP followed by nHuTNF-alpha/nHuIFN-alpha sequence for MTS cells appears to be due to increased nHuTNF-alpha/nHuIFN-alpha penetration into the MTS core aided by DDP.

Carcinoma, Squamous Cell↗

PubMed1992

Surgical treatment of large epiglottic cysts with a side-opened direct laryngoscope and snare.

Two cases of large epiglottic cysts are reported. Histopathological examination revealed a retention cyst in one case and an epidermoid cyst in the other. We designed a side-opened direct larngoscope and snare for treating epiglottic cysts. This direct laryngoscope is characterized by an opening from the anterior tip to the posterior end of the right side. The removal of the cysts was accomplished by using this direct laryngoscope and a snare under inhalation anesthesia by fiber optic guided endotracheal intubation. The side-opened direct laryngoscope enabled easy insertion of the snare through the right side opening.

Adult↗

PubMed1992

Effects of folinic acid on 5-fluorouracil induced cell lethality with or without cisplatin against head and neck laryngeal squamous carcinoma multicellular tumor spheroids.

We evaluated the efficacy of folinic acid (Leucovorin, LV) on cell lethality induced by 5-fluorouracil (FU) alone or in combination with cisplatin (DDP) by using the HEp-2 laryngeal squamous carcinoma multicellular tumor spheroids (MTS) system. For LV, non-toxic concentration of 10(-5) M was used. For cells in the monolayer, 6 and 24 h exposure to LV increased FU-induced cell lethality approximately 7- and 2-fold, respectively, whereas LV did not influence the effect of FU for MTS. LV's lack of effect on cells in MTS may be interpreted to mean that LV cannot penetrate the MTS. For the monolayer, simultaneous exposure to 3 drugs, DDP, FU and LV, produced synergistic interaction. However, sequential exposures were marginally synergistic or antagonistic, irrespective of sequence of DDP first or last. In contrast, DDP followed by FU plus LV was most synergistic for MTS. Simultaneous exposure was also synergistic, however, FU plus LV followed by DDP was antagonistic. These results suggest that LV is unable to penetrate into the MTS core to potentiate FU activity. DDP appears to have enhanced LV penetration into the MTS core. The exploration of means to overcome limited penetration of LV appears important for successful treatment of head and neck carcinoma.

Carcinoma, Squamous Cell↗

PubMed1992

[Combination chemotherapy of solid tumor--effects of hyaluronidase on doxorubicin (DXR) penetration into multicellular tumor spheroids (MTS)].

We have studied the effects of hyaluronidase (HYD) on the penetration and cell kill effect of doxorubicin (DXR) using multicellular tumor spheroids (MTS). MTS of approximately 500 microns in diameter were prepared by liquid over lay culture technique from PC-10 lung and HEp-2 laryngeal squamous carcinoma cell lines. Cells in MTS and monolayer were exposed for various durations to HYD, followed by 1 hr, rest interval, and by 1 hr. exposure to DXR. MTS and monolayer cells were then trypsinized to a single cell suspension and subjected to clonogenic assay. For PC-10 MTS, pretreatment with HYD for 24 hr. resulted in approximately 10-fold increases in DXR cell kill effects as compared to DXR alone. HEp-2 MTS were more sensitive to HYD pretreatment. Thus, 1 hr. exposure to HYD produced approximately 4-fold increases in DXR-induced cell lethality. Fluorescent microscopic study revealed that 1hr. exposure of MTS to DXR produced DXR fluorescence only 1-2 outer layer of MTS. When MTS were pretreated with HYD, there was an enhanced penetration of DXR fluorescence into the MTS core. HYD-induced enhancement of DXR penetration and its cell kill effect was dependent on the exposure time and tumor cell origin.

Carcinoma, Squamous Cell↗