THE LARYNX IN RHEUMATOID ARTHRITIS.
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The mouse pharynx, especially the muscles, was anatomically studied in detail considering the structures of the laryngeal cartilages and the hyoid bone. The nasopharyngeal sphincter was formed by the palatopharyngeus and the levator palati muscles. It was suggested that the former contracted the 'palatopharyngeal eminence' (named by the present authors) and the latter drew up the soft palate, then the nasopharyngeal hiatus was closed. At the rostral end of the esophagus, there existed the 'thyro-pharyngo-esophageus muscle', denominated by the present authors. It was suggested to represent in the area of the esophagopharynx and to compress the tube by any sphincteric functions.
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BACKGROUND AND PURPOSE: The prognostic significance of laryngeal cartilage abnormalities, as seen on CT or MR imaging, in laryngeal or hypopharyngeal cancer, is unclear. The purpose is to determine whether cartilage abnormalities as seen on preoperative CT in laryngeal and pyriform sinus cancer are predictive of local outcome after partial laryngectomy. METHODS: The preoperative CT studies in a consecutive series of 16 patients who underwent extended hemilaryngectomy for squamous cell carcinoma of the glottis (n = 12), supraglottis (n = 1), or pyriform sinus (n = 3) were reviewed retrospectively. Cartilage abnormalities were defined as asymmetric cartilage sclerosis, lysis of ossified cartilage, or tumor visible on both sides of the cartilage. Tumor volume was calculated by using the summation-of-areas technique. Seven patients underwent postoperative radiation therapy. All patients had a follow-up of at least 24 months after treatment or until local recurrence. RESULTS: Eleven patients showed cartilage abnormalities. In six patients, only a single cartilage was abnormal, whereas three patients showed involvement of two cartilages and two patients of three cartilages. The overall average tumor volume was 2.7 mL; the average tumor volume was 1.5 mL in the patients without and 3.3 mL in those with cartilage involvement on CT (P > .05). Two patients suffered a local recurrence. One patient (tumor volume, 1.5 mL) did not show any cartilage abnormalities. The other patient (tumor volume, 1.9 mL) showed abnormalities in all three cartilages and also had evidence of early transcartilaginous tumor spread. CONCLUSION: In patients whose cancer is anatomically suitable for partial laryngectomy, cartilage abnormalities on CT do not preclude speech-preserving surgery.
To approach the mechanism of hemilaryngeal fixation in pyriform sinus carcinoma (PSC), surgical specimens from total laryngectomy and partial hypopharyngectomy in 43 cases of pyriform sinus carcinoma were studied using organ subserial sections. Invasion of intralaryngeal muscles and the upper and outer aspects of arytenoid cartilage via paraglottic space was found to be the main cause of hemilaryngeal fixation in these cases. Presence of tumor on the medial wall of the pyriform sinus makes involvement of intralaryngeal structures easy, and thus is more frequently seen with hemilaryngeal fixation. Clinical T3 lesion of the sinus may infiltrate laryngeal cartilages and adjacent soft tissue to become pathologic T4 lesion. For PSC appearing hemilaryngeal fixation, total laryngectomy is safer to thoroughly remove cancer.
Twenty specimens for laryngectomy in extensive cancer of the larynx were examined after injecting the blood vessels with silicone rubber. The behavior of the vessels during the process of destruction of the laryngeal cartilages by the neoplasm were evaluated, as was the part played by the vascular system in spreading cancer in the larynx and its passage beyond the anatomical borders of this organ. Cartilages are damaged by cancer mainly in ossified and vascularized sites. The nonossified and avascular cartilages, on the contrary, are maintained in an almost unchanged condition amid the extensive tumorous masses surrounding them.
Cartilage invasion of laryngeal cancer has a significant impact on the choice of treatment modality and on the outcome for the patients. Cartilage invasion was evaluated radiologically and histopathologically in 18 patients who underwent total laryngectomy. The histopathological examination showed intracartilaginous tumor spread in nine specimens, whereas in the other nine no cartilage invasion was found. Magnetic resonance imaging (MRI) detected the cartilage invasion in six patients and excluded it in six. There were three false negative and three false positive findings from the MRI examination. The relatively common false findings of MRI should be kept in mind in the choice of treatment.
Proteoglycans extracted with 4M-guanidinium chloride from pig laryngeal cartilage and bovine nasal septum were purified by density-gradient centrifugation in CsCl under 'associative' followed by 'dissociative' conditions [Hascall & Sajdera (1969) J. Biol. Chem. 244, 2384-2396]. Proteoglycans were then digested exhaustively with testicular hyaluronidase, which removed about 80% of the chondroitin sulphate. The hyaluronidase was purified until no proteolytic activity was detectable under the conditions used for digestion. The resulting 'core' proteins of both species were fractionated by a sequence of gel-chromatographic procedures which gave four major fractions of decreasing hydrodynamic size. Those that on electrophoresis penetrated 5.6% (w/v) polyacrylamide gels migrated as discrete bands whose mobility increased with decreasing hydrodynamic size. The unfractionated 'core' proteins had the same N-terminal amino acids as the intact proteoglycan, suggesting that no peptide bonds had been cleaved during hyaluronidase digestion. Alanine predominated as the N-terminal residue in all the fractions of both species. Fractions were analysed for amino acid, amino sugar, uronic acid and neutral sugar compositions. In pig 'core' proteins, the glutamic acid content increased significantly with hydrodynamic size, but in bovine 'core' proteins this trend was less marked. Significant differences in amino acid composition between fractions suggested that in each species there was more than one variety of proteoglycan. The molar proportions of xylose to serine destroyed on alkaline beta-elimination were equivalent in most fractions, indicating that the serine residues destroyed were attached to the terminal xylose of chondroitin sulphate chains. The ratio of serine residues to threonine residues destroyed on beta-elimination, was similar in all fractions of both species. Since the fractions of smallest hydrodynamic size contained less keratan sulphate than those of larger size, it implies that in the former the keratan sulphate chains were shorter than in the latter.