Shigeji Saito

Neoadjuvant chemotherapy in maxillary sinus carcinoma with cisplatinum and peplomycin intraarterial infusion.

The purpose of this paper is to present our preliminary assessment of a new multimodal treatment including neoadjuvant chemotherapy with cisplatinum and peplomycin for maxillary sinus carcinoma. Fifteen patients with squamous cell carcinoma of the maxillary sinus carcinoma seen at Keio University Hospital, with Stage III and IV disease, were enrolled in this trial between January 1982 and January 1985. Regimen of chemotherapy was as follows: day 1, 50 mg/m2 of cisplatinum, intraarterial infusion over 2 hr, days 2-6, peplomycin at a dose of 5 mg/day, intraarterial infusion over 5 hr. Routinely, radiotherapy of 40 Gy by Linac was given to the primary site, concomitantly combined with 5-fluorouracil intraarterial injections only during the first 10 days, 2 weeks after the end of initial chemotherapy. Additional treatment was performed according to the extent of residual tumor. Response to initial chemotherapy revealed that complete response was achieved in 7 and partial response in 6 out of 15 patients with a response rate of 87%. Nine patients required no surgical intervention while 6 underwent a surgical resection. Median follow-up in this group of patients is 20 months. Thirty-month survival rate calculated by Kaplan-Meiers method was 83%. Chemotherapy toxicity was mild in most cases. This pilot study does not provide conclusive survival information, but the results obtained are encouraging.

Combination Chemotherapy With Cisplatin and Peplomycin in Squamous Cell Carcinoma of the Head and Neck

Ninety-three patients with head and neck cancer were treated with combined cisplatin-peplomycin chemotherapy (CP therapy). Cisplatin (CDDP) 50 mg/m2 i.v. (intravenous) or i.a. (intraarterial) over 2 hr was given with hydration and mannitol diuresis on day 1. From day 2 through day 6, peplomycin (PEP) 5 mg/day was administered by 5-hr i.v. or i.a. infusion, or 24-hr continuous hypodermic injection. Of 85 who were evaluable, there were 22 complete responses or CR (26%) and 36 partial responses or PR (42%), with an overall response rate of 68%. Concerning of the route of administration, i.a. infusion obtained the higher CR and overall response rates than i.v. infusion. Effectiveness was clearly greater in previously untreated cases than in cases that had received some previous therapeutic modality. Looking at response in relation to the number of the courses, at least 2 courses of CP therapy are required. Side effects were recognized in 68 out of 87 evaluable cases (78%). Nausea and vomiting were the most common (62%). Renal toxicity was observed in 24% and was mostly transient. From the above results, it is considered that the CP therapy is effective, not only for the palliative treatment of advanced and recurrent cancer of the head and neck, but also as neo-adjuvant chemotherapy of stage III and IV cases.

Clinical trials on UFT in the treatment of head and neck cancer.

A new anticancer agent, UFT which is a mixture of 1-(2-tetrahydrofuryl)-5-fluorouracil and uracil in a molar ratio of 1:4 was administered orally at a dose of 600 mg/day every day. Forty-three patients were evaluable. Eight patients achieved a complete response and eight achieved a partial response with an overall response rate of 37.2%. In terms of response by histology, a response rate was 32.4% (11/34) in cases of squamous cell carcinoma and 75% (3/4) in cases of adenocarcinoma. A response rate by primary site was 57.1% in the nose and paranasal sinuses, 50.0% in the oropharynx and 30.0% in the oral cavity. A response rate was 36.1% in patients with prior treatment and 42.9% in patients with no prior treatment, but there was no statistical significance. Eight of 43 patients developed toxic effects. Most of them were mild such as anorexia, nausea, and stomatitis, but in one case of maxillary sinus carcinoma, severe bone marrow suppression was observed. UFT is a considerably effective and useful drug in the treatment of head and neck cancer. It is possible to increase cure rate by examining various usages of UFT.

Excision Level and Indication for Contralateral Neck Dissection in Hypopharyngeal Cancer Surgery

Margins of extirpated specimens of hypopharyngeal cancer were examined histopathologically. Residual cancer nest, which is most likely due to directional preponderance of the submucosal lymph flow of the hypopharyngeal cavity, was characteristically demonstrated at the superior margin and in the submucosal layer. We propose that laryngopharyngectomy be done at the extended excision level superiorly at the base of the palatine tonsil and inferiorly at the level of the 2nd thoracic vertebra and with a safety margin of at least 2 cm. The incidence of ipsilateral and contralateral neck metastasis was also histopathologically evaluated from specimens obtained by neck dissection. Contralateral neck metastasis was histopathologically confirmed in more than 30% of the cases examined and showed a difference in incidence related to histological differentiation and T classification. We conclude that bilateral neck dissection is advisable in all cases of hypopharyngeal cancer except for patients with a well-differentiated T2 lesion.

Observation of vocal fold vibration by x‐ray stroboscopy

Every laryngologist wants to observe the vibratory pattern of the vocal cords from all directions. A pulse generated x‐ray equipment has recently been widely used as part of diagnostic procedure especially for cardiovascular lesions. Voice‐synchronized x‐rays can be obtained by use of a pulse signal from a laryngostroboscope as a trigger to this x‐ray equipment. An experimental sound was obtained by use of the resected larynx of a human and a cannine. As contrasting mediae, lead particles were inserted into the vocal cord itself. Therefore, the vibratory pattern of the upper and lower surfaces of the vocal cords, and in addition, the vibratory movements under the epithelium could be simultaneously demonstrated on a videoscope while being photographed using a 35‐mm fluoro‐cinematograph. In addition, this method was applied to the study of the effects of various laryngeal lesions. The vibratory patterns obtained were compared to ones obtained by conventional laryngostroboscopy and discussed from the viewpoi...

Clinical Experience with Cefoperazone in the Field of Otorhinolaryngology

The clinical usefulness of Cefoperazone for the treatment of post-operative infections or prophylaxis was studied in patients with head and neck tumors. In some cases in which local application of an antibiotic was considered to be useful, Polymyxin B Sulfate was used concomitantly. Cefoperazone administration was clinically useful in 17 of the 18 patients enrolled in this study (very useful in 10, useful in 7) and only one patient failed to respond to Cefoperazone therapy. Adverse reactions or laboratory abnormalities possibly related to the therapy were seen in three patients. However, in one case, the adverse reaction could be attributed to the concomitantly administered anticancer agent, and in the other two cases, reactions were mild and transient.

Serum Complement Levels in Patients with Head and Neck Cancer

Complement level and tuberculin reactivity were measured as possible indices of the humoral and cell-mediated immune status of 167 patients with head and neck cancer examined at the Department of Otorhinolaryngology, Keio University School of Medicine, Tokyo, between July 1974 and June 1979. Complement level (CH 50 ) was measured according to Mayers method. In tuberculin tests, 0.1 ml of purified protein-derivative solution (0.5 μg/ml) was injected intracutaneously and formation of erythema and induration was measured 48 hr later. Results were analyzed according to the method of Nishioka, in which the following six stages were classified: stage 0, unaltered tuberculin reactivity and depressed complement level; stage I, unaltered tuberculin reactivity and normal complement level; stage II, unaltered tuberculin reactivity and elevated complement level; stage III, depressed tuberculin reactivity and elevated complement level; stage IV, depressed tuberculin reactivity and normal complement level; stage V, depressed tuberculin reactivity and depressed complement level. Patients were divided into seven different groups: pre-treatment, postradiotherapy, post-surgery, remission, 5-year survival, recurrence and metastasis, and terminal. Complement level was elevated in tumorbearing hosts, meanwhile it was within the normal range in non-tumor bearing hosts. Values of tuberculin reactivity and CH 50 were averaged within each group and analyzed as described above. The results of this study demonstrate that the complement system is elevated while the cell-mediated immune system is depressed in patients with malignant tumors. Thus, this classification system may prove clinically useful in planning treatment of cancer patients and in estimating their prognosis.

A voice analysis system using a digital processor during phonosurgery and its clinical application

In microsurgery of the larynx we have employed a laryngostroboscope by which the pattern of vocal cord vibration can be observed. Neuroleptoanalgesia is also performed during these operations to allow the patient to phonate. Immediately after such operations, an almost normal vibratory pattern of the vocal cords is obtained and normal voice is firmly restored. Therefore, we designed a sound monitoring system for the phonetic and acoustic analysis of the patients voice. This system consists of an online realtime data processor, fundamental frequency extractor, and data recording device. The sound wave, pitch variation, pitch histogram, and sound wave regularity are obtained by use of specially designed programs for this system. In addition, these data are printed by a digital printer. After application of this method to more than 100 cases with various laryngeal lesions, it was concluded that this method is very helpful in clinical use.

Improvement and evaluation of the vibration pick‐up type ear microphone

We developed a vibration pick‐up‐type ear microphone which was formerly reported at the 90th ASA Meeting. After evaluating its function and comparing it with other conventional microphones, we concluded as follows; It is possible to obtain remarkable sensibility without closing the ear canal and to obtain high intelligibility voice in level over 95% of sound articulation. There was no significant difference between voice intelligibility with a mask and that without a mask. Sound articulation in high ambient noise of the vibration pick‐up type ear microphone (110 dB—96%, 125 dB—84%) is much higher than that of noise cancelling microphone (110 dB—87%, 125 dB—77%) and sound pressure type ear microphoen with ear muff (110 dB—85%, 125 dB—68%). By use of the earphone‐microphone, we can simultaneously talk and hear through the ear, thanks to no necessity of obstruction of the ear canal. Applications of the vibration pick‐up type ear microphone are (1) howlingless microphone, (2) free hand microphone, (3) mask microphone, and (4) microphone for voice communication in high ambient noise. We have made communication systems with the vibration pick‐up‐type ear microphone and evaluated in various environments.We developed a vibration pick‐up‐type ear microphone which was formerly reported at the 90th ASA Meeting. After evaluating its function and comparing it with other conventional microphones, we concluded as follows; It is possible to obtain remarkable sensibility without closing the ear canal and to obtain high intelligibility voice in level over 95% of sound articulation. There was no significant difference between voice intelligibility with a mask and that without a mask. Sound articulation in high ambient noise of the vibration pick‐up type ear microphone (110 dB—96%, 125 dB—84%) is much higher than that of noise cancelling microphone (110 dB—87%, 125 dB—77%) and sound pressure type ear microphoen with ear muff (110 dB—85%, 125 dB—68%). By use of the earphone‐microphone, we can simultaneously talk and hear through the ear, thanks to no necessity of obstruction of the ear canal. Applications of the vibration pick‐up type ear microphone are (1) howlingless microphone, (2) free hand microphone, (3) mask mi...

Effect of phase on the timbre and detection of timbre of complex tones

It has been assumed that the human auditory organ can detect only the spectra of complex tones, but recently it would appear that the ear can detect not only these spectra but also the difference of the phase relation among harmonics. In such a case, however, the condition of detecting has not yet been discussed thoroughly. We have made many psychological experiments on complex tones, in which the power spectrum has remained constant but the phase relation of the harmonics has been varied. As a result, we recognized the following: (1) When we changed the phase of one harmonic of the complex tones, most of the observers could detect the difference of timbre when the phase difference was nearly π. (2) When the complex tones are made up of only fundamental and the second harmonic, as the fundamental frequency increased, the effect of the difference of phase on timbre diminished. Therefore, we hypothesized the following law between timbre and phase. If an effect of the phase exists between the harmonics of th...