Human Adipose Tissue Derived Extracellular Matrix and Methylcellulose Hydrogels Augments and Regenerates the Paralyzed Vocal Fold

Vocal fold paralysis results from various etiologies and can induce voice changes, swallowing complications, and issues with aspiration. Vocal fold paralysis is typically managed using injection laryngoplasty with fat or synthetic polymers. Injection with autologous fat has shown excellent biocompatibility. However, it has several disadvantages such as unpredictable resorption rate, morbidities associated with liposuction procedure which has to be done in operating room under general anesthesia. Human adipose-derived extracellular matrix (ECM) grafts have been reported to form new adipose tissue and have greater biostability than autologous fat graft. Here, we present an injectable hydrogel that is constructed from adipose tissue derived soluble extracellular matrix (sECM) and methylcellulose (MC) for use in vocal fold augmentation. Human sECM derived from adipose tissue was extracted using two major steps—ECM was isolated from human adipose tissue and was subsequently solubilized. Injectable sECM/MC hydrogels were prepared by blending of sECM and MC. Sustained vocal fold augmentation and symmetric vocal fold vibration were accomplished by the sECM/MC hydrogel in paralyzed vocal fold which were confirmed by laryngoscope, histology and a high-speed imaging system. There were increased number of collagen fibers and fatty granules at the injection site without significant inflammation or fibrosis. Overall, these results indicate that the sECM/MC hydrogel can enhance vocal function in paralyzed vocal folds without early resorption and has potential as a promising material for injection laryngoplasty for stable vocal fold augmentation which can overcome the shortcomings of autologous fat such as unpredictable duration and morbidity associated with the fat harvest.

Novel experimental rabbit model of anterior glottic web formation

CONCLUSION

The rabbit model of anterior glottic web (AGW) formation using the laryngofissure technique resulted in reproducible and stable AGW formation that may facilitate research into this area.

OBJECTIVE

To introduce and validate a novel experimental animal model of AGW formation using the rabbit.

METHODS

The inner larynges of eight New Zealand white rabbits were exposed through the laryngofissure technique. The mucosa of the bilateral true vocal fold was stripped off using the bevel of a needle tip. On the basis of the laryngoscopic findings at 8 weeks postoperatively, the extent of AGW was measured, and the success of this procedure was validated. Laryngeal specimens were sampled at 8 weeks for high-speed recording and histological analysis.

RESULTS

In seven (87.5%) rabbits, laryngoscopic examination revealed the formation of a scar band involving the anterior commissure. The mean extent of AGW ratio on the left and right sides was 0.58 ± 0.073 and 0.55 ± 0.075, respectively. The symmetric formation of AGW (p = 0.655, p = 0.128) and stability of the AGW procedure (p = 0.491, left; p = 0.501, right) were statistically validated. On high-speed recording, the vocal mucosal wave was hindered by AGW formation. Histologically, fibro-connective tissue, especially collagen fiber, was observed in the anterior commissure.

Modified Sistrunk operation: New concept for management of thyroglossal duct cyst

OBJECTIVE

To describe a method of hyoid cartilage division during Sistrunk operation for management of thyroglossal duct cyst (TGDC) and compare postoperative outcomes with those of conventional hyoid bone cutting.

METHODS

Fifty-nine patients who received operative treatment for TGDC from January 2005 to July 2013 were enrolled. The degree of fusion in the cartilaginous portion of the hyoid was evaluated by preoperative neck computed tomography and classified into (1) non-fusion, (2) partial fusion, and (3) complete fusion. Techniques of hyoid management, division of the cartilaginous portion of the hyoid or conventional hyoid bone cutting, during Sistrunk operation were analyzed according to the fusion classification.

RESULTS

Of the 59 patients, 27 were pediatric patients and 32 were adults. In 32 adults undergoing TGDC, there were 13 cases (41%) of complete hyoid fusion and 7 (22%) of non-fusion. A total of 20 adult patients (63%) were treated with the cartilage division. Among the pediatric patients, 96% of cases were classified as non-fusion of the hyoid, and all of these were treated with the cartilage division. Patients who were treated with the cartilage division showed better postoperative results. However, there were no statistical differences.

CONCLUSIONS

Our cartilage division technique at Sistrunk operation for TGDC is feasible and comparable to conventional hyoid cutting with regard to postoperative results.

Nasopharyngeal carcinoma: posttreatment changes of imaging findings

OBJECTIVE

The purpose of this study was to determine the radiologic results of nasopharyngeal carcinoma (NPC) that showed complete responses on follow-up imaging studies after radiation therapy.

MATERIALS AND METHODS

This study is a retrospective review of 23 patients (18 male, 5 female, aged 15-71 years; mean age, 48.5 years) affected with NPC, from August 1995 to July 2000, who were examined with magnetic resonance imaging or computed tomography scan before and after either radical radiotherapy or chemoradiotherapy. The median follow-up was 24.7 months and ranged from 12 to 48 months. We analyzed the primary tumors by ascertaining/measuring tumor size, depth, middle ear effusion, skull base invasion, and lymphadenopathy. The treatment responses for primary tumors were classified as either atrophy, scar (asymmetric elevation without enhancement), or normalized. The tumor response and the appearance of bone regeneration in the previous destructive part of the skull base were also recorded.

RESULTS

The 23 patients consisted of 12 superficial tumors, for whom treatment results were normalized in 10, atrophy in 1, and scar in 1 and 11 deep tumors for whom treatment results were scar in 6, normalized in 3, and atrophy in 2. Skull base invasion was detected in 6 patients, 5 of whom showed complete healing of skull base destruction after radiotherapy. However, the other patient exhibited an unusual hyperostotic change in the skull base mimicking fibrous dysplasia of the skull base.

CONCLUSIONS

The superficial tumors tended to be radiologically normalized even when they were large. However, the deep tumors mainly changed to scar after radiation therapy. On the other hand, skull base invasion could be normalized after radiotherapy.

Dynamic and quantitative evaluation of eyelid motion using image analysis

Evaluation of facial movement, especially eyelid movement, has depended on the subjective judgment of trained clinicians. Recently, a few objective methods have been reported, but they required uncomfortable markers to be attached to the eyelids and a special-purpose, high-speed video camera. This study had two aims: one was to develop a new device for measuring eyelid motion dynamically and quantitatively, without eyelid markers or a high-speed camera; the other was to devise feasible parameters for eyelid motion. The system consisted of a personal computer with a general-purpose multimedia board and a software program that the authors named blepharokymography. A sequence of blinking eyes was recorded with a video camera. After the capturing process of the video, kymograms were produced from the movie file. Kymograms were converted to binary images by threshold filtering. The lower margin of the upper eyelid was traced, and displacement and velocity curves were obtained. Some parameters were devised and verified in preliminary clinical data. The analysis revealed that the displacement (8 mm in normal compared with 5.2 mm in paralysis), average closing velocity (74 mm s(-1) in normal compared with 30.6 mm s(-1) in paralysis) and peak closing velocity (154 mm s(-1) in normal against 63.4 mm s(-1) in paralysis) were useful parameters for differentiating the normal and facial-paralysis states.

Volume of cervical lymph nodes using 3D ultrasonography. Differentiation of metastatic from reactive lymphadenopathy in primary head and neck malignancy

PURPOSE

To assess the usefulness of volume measurement using 3D US for depicting metastatic cervical lymph nodes.

MATERIAL AND METHODS

Thirty-five cervical lymph nodes in 13 patients with primary head and neck malignancy were included in this study. US with volume acquisition was prospectively performed with a 5-10 MHz linear mechanical volume probe. Volume measurement of the node was calculated using a 3D automatic volume calculation program. The excised nodes matched on US were examined histopathologically.

RESULTS

The volume of malignant nodes ranged from 0.444 to 4.442 cm3, the volume of the benign nodes from 0.143 to 1.176 cm3. Combinations of high positive (>80%) and negative (>90%) predictive values were obtained at a cut-off value of 0.7 cm3.

CONCLUSION

Volume measurement of cervical nodes using 3D US can be a useful tool for differentiating metastatic from benign nodes in patients with primary head and neck malignancy.

Volume of cervical lymph nodes using 3D ultrasonography. Differentiation of metastatic from reactive lymphadenopathy in primary head and neck malignancy

PURPOSE

To assess the usefulness of volume measurement using 3D US for depicting metastatic cervical lymph nodes.

MATERIAL AND METHODS

Thirty-five cervical lymph nodes in 13 patients with primary head and neck malignancy were included in this study. US with volume acquisition was prospectively performed with a 5-10 MHz linear mechanical volume probe. Volume measurement of the node was calculated using a 3D automatic volume calculation program. The excised nodes matched on US were examined histopathologically.

RESULTS

The volume of malignant nodes ranged from 0.444 to 4.442 cm3, the volume of the benign nodes from 0.143 to 1.176 cm3. Combinations of high positive (>80%) and negative (>90%) predictive values were obtained at a cut-off value of 0.7 cm3.

CONCLUSION

Volume measurement of cervical nodes using 3D US can be a useful tool for differentiating metastatic from benign nodes in patients with primary head and neck malignancy.

Advanced hypopharyngeal carcinoma treatment results according to treatment modalities

BACKGROUND

The purpose of this retrospective study is to compare the treatment results of locally advanced hypopharyngeal carcinoma according to treatment modalities.

METHODS

Seventy-three patients with locally advanced hypopharyngeal carcinoma treated at the Department of Therapeutic Radiology, Seoul National University Hospital, between August 1979 and July 1997 were retrospectively analyzed. Twenty-three patients were treated with radiotherapy (RT) alone, 18 patients were treated with surgery and postoperative RT, and 32 patients were treated with neoadjuvant chemotherapy (CTx) and RT. Median follow-up period was 28 months.

RESULTS

The overall 5-year survival rates were 15.7% for the RT alone group, 46.8% for surgery and postoperative RT group, and 43.0% for neoadjuvant CTx and RT group. The 5-year disease-free survival rates were 13.9%, 47.4%, and 30.7%, respectively. Surgery and postoperative RT or neoadjuvant CTx and RT showed superiority over RT alone in terms of both overall survival and disease-free survival rates. No significant differences were found in overall and disease-free survival rates between the surgery and postoperative RT group and neoadjuvant CTx and RT group (p =.15, p =.13). In the neoadjuvant CTx and RT group, 12 patients (38%) retained their larynx more than 5 years.

CONCLUSION

Neoadjuvant CTx and RT is an effective strategy to achieve organ preservation without compromising the survival of patients with locally advanced hypopharyngeal carcinoma.

Intratumoral adenovirus-mediated suicide gene transfer for hepatic metastases from colorectal adenocarcinoma: results of a phase I clinical trial

Animal studies have shown that direct injection of an adenoviral vector (Adv.RSV-tk) expressing the herpes thymidine kinase gene into established tumors in the liver, followed by systemic ganciclovir administration, was effective in inducing tumor necrosis. Toxicities were minimal at therapeutically effective vector doses, although severe hepatic necroinflammation was seen at much higher supratherapeutic doses. We conducted a clinical phase I trial in patients with metastatic colorectal adenocarcinoma in the liver to assess the safety of intratumoral Adv.RSV-tk injection (escalating doses) followed by intravenous ganciclovir (fixed dose). The vector was injected into a metastatic tumor in the liver under local anesthesia by percutaneous needle placement with concurrent ultrasonographic monitoring to prevent injection or leakage into adjacent normal liver structures. We treated 16 patients in five dose level cohorts of Adv.RSV-tk, from 1.0x10(10) to 1.0x10(13) virus particles per patient. Hepatic toxicities were low, with transient grade 1 elevations in serum aminotransferase levels in 3 of 16 patients. Other toxicities were also transient: grade 2-3 fevers in 5 of 16 patients, grade 3 thrombocytopenia in 1 of 16 patients, and grade 2 leucopenia in 3 of 16 patients. These results indicate that Adv.RSV-tk can be safely administered by percutaneous intratumoral injection in patients with hepatic metastases at doses up to 1.0x10(13) virus particles per patient, and can provide the basis for future clinical trials involving intratumoral adenoviral vector injection.

Sclerotherapy with picibanil (OK-432) for congenital lymphatic malformation in the head and neck

HYPOTHESIS/OBJECTIVES

Congenital lymphatic malformations of the head and neck (LMHN) present special challenges to the otolaryngologist-head and neck surgeon. Recently, a number of sclerotherapy trials have shown promising results. In this study, we present our experiences with picibanil (OK-432) sclerotherapy for this lesion.

STUDY DESIGN

Retrospectively review.

METHODS

We retrospectively reviewed 21 patients who have undergone sclerotherapy with picibanil for LMHN.

RESULTS

Satisfactory response with complete or nearly complete shrinkage of the lesions was observed in 15 cases after repeated sclerotherapy (average, two times). We did not observe any significant morbidity or complications in the patients treated with picibanil. Reduction in size of the mass was achieved in weeks to months. Some of the patients who had not had any other previous treatment showed remarkable reductions in size even after the first therapy. When we used picibanil sclerotherapy as a primary treatment for the LMHN, most of our patients showed satisfactory results regardless of the size or location of the lesions.

CONCLUSION

Given with our experience and the reports that failure of picibanil sclerotherapy does not hinder subsequent surgical salvage procedures, we recommend trying picibanil sclerotherapy as a primary treatment for the LMHN and performing surgical excision as a secondary modality if the response to the sclerotherapy is not satisfactory.

Association of p53 and BCL-2 expression with Epstein-Barr virus infection in the cancers of head and neck

BACKGROUND

Reports that have both evaluated the site-specific Epstein-Barr virus (EBV) infection and compared it with the expression of the EBV-related proto-oncogenes and tumor suppressor genes in the various cancers of head and neck are scarce.

METHODS

Thirty-eight nasopharyngeal carcinoma (NPC) cases, 32 oropharyngeal or hypopharyngeal carcinoma (OPC/HPC) cases, and 93 laryngeal carcinoma (LC) cases were evaluated with in situ hybridization on EBV-encoded small RNA (EBER) and immunohistochemical assessments of the p53, bcl-2, and epidermal growth factor receptor (EGFR) by use of formalin-fixed paraffin-embedded tissue array slides.

RESULTS

The expression of viral EBERs was observed in more than two thirds (71.1%) of the NPC cases. In contrast, only 1 case of OPC and none of the HPC or LC cases exhibited EBV positivity. In the nonkeratinizing NPC, the EBV positivity was significantly associated with both frequent p53 overexpression (p =.033) and bcl-2 expression (p =.001). In the EBV-positive nonkeratinizing NPC, a correlation between p53 overexpression and the tumor infiltration lymphocyte (TIL) density was noted (p =.012).

CONCLUSIONS

A site-specific expression of viral EBER was demonstrated in the head and neck cancers, which suggests an important role for both p53 and bcl-2 in the carcinogenesis of an EBV-infected NPC. The correlation between p53 overexpression and the TIL density in the EBV-infected NPC suggests that the product of a lymphoepithelial interaction, such as A20, can induce a dysfunctional p53 protein.

A method for assessing the regional vibratory pattern of vocal folds by analysing the video recording of stroboscopy

Stroboscopy and kymography have been used to examine the motional abnormality of vocal folds and to visualise their regional vibratory pattern. In a previous study (Laryngoscope, 1999), we introduced the conceptual idea of videostrobokymography, in which we applied the concept of kymography on the pre-recorded video images using stroboscopy, and showed its possible clinical application to various disorders in vocal folds. However, a more detailed description about the software and the mathematical formulation used in this system is needed for the reproduction of similar systems. The composition of hardwares, user-interface and detail procedures including mathematical equations in videostrobokymography software is presented in this study. As an initial clinical trial, videostrobokymography was applied to the preoperative and postoperative videostroboscopic images of 15 patients with Reinke's edema. On preoperative examination, videostrobokymograms showed irregular pattern of mucosal wave and, in some patients, a relatively constant glottic gap during phonation. After the operation, the voice quality of all patients was improved in acoustic and aerodynamic assessments, and videostrobokymography showed clearly improved mucosal waves (change in open quotient: mean +/- SD= 0.11 +/- 0.05).

Bifid epiglottis associated with Joubert's syndrome

This report presents the case of a 2-year-old boy who had a bifid epiglottis associated with Joubert's syndrome. He had episodic tachypnea and apnea, inspiratory stridor, aspiration, and growth and mental retardation. Direct laryngoscopy demonstrated agenesis of the right half of the epiglottis and hypertrophied mucosa over the arytenoid cartilage. After the hypertrophied mucosa was partially vaporized with a CO2 laser, the inspiratory stridor soon improved and the aspiration was alleviated. Brain magnetic resonance imaging showed cerebellar vermian agenesis and enlargement of the fourth ventricle.

Enhancement of adenoviral transduction with polycationic liposomes in vivo

Although the high transfection efficiency with adenovirus in vitro is well documented, it is still not clear whether adenoviral vectors are effective in vivo in solid tumor models. In our preliminary experiment, transduction of tumor tissue was limited to just around the injection site after intratumoral injection of the adenoviral vector. To improve the transduction efficiency in vivo, we tried a combination of adenoviral vector and liposome in our animal model. Adenovirus carrying human placental alkaline phosphatase (AdALP) and Lipofectamine or 1,3-di-oleoyloxy-2-(6-carboxyspermyl)-propylamide were used as a marker gene and the cationic liposome, respectively. A >15-fold increase in the transfection efficiency was observed in CT26 tumor cell lines with the combination of AdALP adenovirus carrying murine granulocyte-macrophage colony-stimulating factor (AdmGM-CSF), and liposome compared with adenovirus alone, showing the feasibility of the combination treatment. In the animal model, with the combination of liposome and AdALP, deeper and wider distribution of the marker gene in the tumor mass was shown. We conclude that the limitations of direct application of adenoviral vectors in a solid tumor model could be overcome by the use of cationic liposomes. This approach will facilitate the more effective delivery of adenoviral vectors in a clinical trial setting.

Effect of GM-CSF and IL-2 co-expression on the anti-tumor immune response

We evaluated the effect of potential therapeutic genes, GM-CSF and IL-2 respectively, or in combination of both cytokines, on the activation of systemic antitumor responses. CT26 tumor cells were modified to secrete GM-CSF and/or IL-2. The growth rate of the modified tumor cells versus the parental CT26 cells did not show any difference. When we implanted the CT26 tumor cells which secrete either GM-CSF or IL-2, delayed and suppressed tumorigenicity was observed. However, another CT26 cell line which expresses both GM-CSF and IL-2 (CT26/GMCSF/IL-2) did not form any tumor mass in the immunocompetent syngeneic Balb/c mice, showing the potential immune responses. Immunohistochemical examination of the modified tumor masses implanted with the cells expressing GM-CSF or IL-2 showed increased necrosis and infiltration of NK (CD56+) lineage cells and macrophage/monocytes. In the vaccination model, the growth of rechallenged wild-type CT26 was more suppressed int he mice which were injected with GM-CSF or IL-2, however, the wild-type CT26 tumor formed normal tumor mass in the mice vaccinated with CT26/GM-CSF/IL-2 showing acute non-T-cell mediated immune response. As a treatment, we injected those modified tumor cells into the established tumor. There we could find tumor growth suppression by the injection of cytokine-modified CT26 cells, especially by the CT26/GM-CSF/IL-2. In the present study we could induce the eradication of tumorigenicity by the transfection of both GM-CSF and IL-2 genes and a potent role in the growth suppression of an established tumor.

CoMed: a real-time collaborative medicine system

CoMed is a prototype of a real-time collaborative medicine system that allows medical specialists to share patient records and to communicate with each other on the Internet. CoMed consists of a multimedia medical database containing relevant information about laryngeal diseases and a real-time collaboration system including a teleconferencing system, a whiteboard and a chatting system. CoMed is web-based. We adopted the object database O2 and CORBA technologies for the multimedia medical database. Therefore, our system can provide the flexibility, extensibility and location transparency of patient databases. We developed a SeeYou Active X control for the teleconferencing system and a Java applet for the whiteboard and chatting system. CoMed improves the efficiency of the overall system by separating the servers on a UNIX machine and a Windows NT machine. CoMed can be utilized for stand-alone research, for collaborative consultations among medical specialists and for a telemedicine in participation with the patients and medical specialists. Our system can be extended easily into other types of the collaborative systems, such as collaborative distance learning, collaborative science system, etc.

Pyriform sinus fistula: management with chemocauterization of the internal opening

A branchial remnant originating in the pyriform sinus causes a recurrent fistula or abscess in the neck. In spite of excision, recurrence may result from inadequate removal of the fistula tract. We attempted chemocauterization of the internal opening of the fistula tract with trichloroacetic acid (TCA) on direct endoscopy. This is a 6-year review of 18 patients with pyriform sinus fistula. Medical history, barium esophagography, computed tomography scans, operative findings, and treatment results were analyzed. By direct endoscopy, all patients were found to have a fistula opening in the pyriform sinus, exclusively on the left side. In only 9 patients, the fistula tract was identified by barium esophagography before operation. Computed tomography revealed a suspicious fistula tract originating from the pyriform sinus in 8 of 10 patients. Sixteen patients were initially managed by TCA chemocauterization. There were no serious intraoperative or postoperative complications. Four patients had recurrent masses, which were managed by simple excision in 2 patients and repeated TCA cauterization in the other 2 patients with unobliterated internal openings. We recommend barium swallow study and direct endoscopy for all patients presenting with a recurrent lateral neck abscess, especially on the left side. Our results suggest that initial chemocauterization of the internal opening can be a reasonable alternative procedure for the management of pyriform sinus fistula.

Cationic liposome-enhanced adenoviral gene transfer in a murine head and neck cancer model

The effect of combining adenoviral vector and cationic liposomes on the efficiency of gene transfer to head and neck tumor cells was investigated. Two human and two murine cell lines were used for the screening of gene transfer efficiency using an adenoviral vector. Cationic liposome-enhanced gene transfer was checked using a murine squamous carcinoma cell line, SCCVII/SF. A considerable difference in the efficiency of gene transduction was observed among the cell lines. The combination of DOSPER and adenoviral vector containing human alkaline phosphatase showed a remarkable enhancing effect in gene transfer in vitro and in vivo, compared to the adenovirus alone or control groups. With an improvement in the efficiency of gene transfer, it may be possible not only to enhance the expression of transduced genes, but also to deliver a smaller amount of virus, as a result, reducing toxicity and the immune response against adenovirus.

Therapeutic dilemmas in the management of thyroid cancer with laryngotracheal involvement

Invasion of the larynx and trachea by thyroid cancer is an uncommon but difficult problem. There is no consensus on indication for or extent of surgery, particularly when there is a requirement for airway reconstruction. From 1989 through 1996, we treated 22 patients with thyroid carcinoma with invasion of the larynx and trachea. Seventeen of these patients had recurrent disease. We applied radioactive iodine therapy after regional ablative surgery to resectable tumors with or without lung metastasis, larynx-preserving surgery to extraluminal or small intraluminal tumors restricted to the short segment of trachea, or total laryngectomy to recurrent tumors deeply invading the cartilage framework of the larynx. We performed arytenoid adduction or thyroplasty in one stage if the recurrent laryngeal nerve was paralyzed or resected intraoperatively. We could get relatively good survival and functional results by aggressive surgical treatment in 20 patients, but the disease was inoperable in 2 patients. It is stressed that head and neck surgeons who have to deal with cancer of the thyroid should not only be familiar with various techniques of airway reconstruction and voice rehabilitation but also must be aware of the biologic behavior of the thyroid carcinoma.

Reconstruction of human hard-palate mucosal epithelium on de-epidermized dermis

Artificial hard-palate mucosa equivalents were reconstructed using keratinocytes derived from normal human hard-palate and de-epidermized dermis. Reconstructed hard-palate mucosal epithelium formed in three-dimensional culture was compared to native hard-palate mucosal epithelium and reconstructed oral buccal mucosal epithelium with regard to keratin expression. Artificial hard-palate mucosal epithelium reconstructed in medium with delipidized serum showed a differentiation pattern similar to that of hard-palate epithelium in vivo. The present study also confirmed that keratinocytes derived from hard-palate mucosa are intrinsically different from those of nonkeratinizing oral surfaces.

Videostrobokymography: a new method for the quantitative analysis of vocal fold vibration

OBJECTIVES

To develop a new analysis method for the quantitative assessment of vibration of the vocal folds, using conventional videostroboscopic image data.

METHODS

We used prerecorded videostroboscopic images to evaluate quantitatively the vibration of the vocal folds. Successive images were converted as digital images by means of an image-grabbing board, processed for analysis, and reconstructed as kymograms by rearranging the same lines of all processed images along the time axis.

RESULTS

We developed a new technique for evaluating the vibration of the vocal folds. The vibrations of multiple vocal fold regions were easily and objectively evaluated by this technique. The objective parameters, such as open quotient and asymmetry index, could be obtained easily using this technique.

CONCLUSIONS

Videostrobokymography demonstrated objectively the vibrations of several vocal fold regions at the same time. This technique has the potential to be a new tool to analyze and monitor the pathological changes and treatment results of vocal fold movement in a more refined quantitative fashion, using videostroboscopic images.

Neoadjuvant chemotherapy and radiation therapy compared with radiation therapy alone in advanced nasopharyngeal carcinoma

PURPOSE

To analyze the impact of neoadjuvant chemotherapy on the treatment of locoregionally advanced nasopharyngeal carcinoma and to assess the outcomes of patients receiving such treatment.

METHODS AND MATERIALS

We analyzed 137 previously untreated and histologically confirmed advanced stage nasopharyngeal carcinoma patients treated with either radiation therapy only or combined radiation therapy and chemotherapy at the Seoul National University Hospital between 1984 and 1996. The stage distribution was as follows: AJCC Stage III-21, Stage IV-61 in the radiation therapy group (RT group); AJCC Stage III-1, Stage IV-54 in neoadjuvant chemotherapy and radiation therapy group (CT/RT group). The median follow-up for surviving patients was 48 months.

RESULTS

The 5-year overall survival (OS) rates were 71% for the CT/RT group and 59% for the RT group (p = 0.04). The 5-year actuarial disease-free survival (DFS) rates were 63% for the CT/RT group and 52% for the RT group (p = 0.04). Distant metastasis (DM) incidence was significantly lower in the CT/RT group. The 5-year freedom from distant metastasis rates were 84% for the CT/RT group and 66% for the RT group (p = 0.01). The incidence of locoregional failures was also lower in the CT/RT group, although this difference did not reach statistical significance (69% vs. 56%, p = 0.09)

CONCLUSION

While not providing conclusive evidence, historical evidence from this institution suggests that neoadjuvant chemotherapy significantly improves both overall and the disease-free survival of patients with advanced stage nasopharyngeal carcinoma.

Development of videostrobokymography for the quantitative analysis of laryngeal vibratory pattern

We developed a new analysis technique for the assessment of irregular vibratory movement of vocal folds. Successive frames of pre-recorded video images from videostroboscopy were transferred to computer memory and vibratory track of one selected point was described as a waveform by displaying the same lines of all frames along the vertical direction. Glottal area waveform, which was normalized with glottal length, was composed to quantitatively assess the overall vibratory pattern of vocal folds. By applying this technique, irregular vibratory patterns of multiple regions, such as asynchronized registration of glottal cycles, could be easily visualized. It would be possible to monitor and analyze the pathologic changes of vocal fold movement by means of this newly developed system.

Establishment and characterization of human laryngeal squamous cell carcinoma cell lines

OBJECTIVES

Six human laryngeal squamous cell carcinoma cell lines (SNU-46, -585, -899, -1066, -1076, -1214) established from Korean patients are reported.

STUDY DESIGN

In vitro culture of six squamous cell carcinoma cell lines derived from primary tumors of the larynx. Description of the cell line phenotypes and determination of molecular characteristics.

METHODS

Six laryngeal squamous cell carcinoma cell lines were cultured. The cell phenotypes, including the histopathology of the primary tumors and in vitro growth characteristics, were determined. Molecular characterization was also performed, including DNA fingerprinting analysis and abnormalities of p15, p16, p53, and TGF-betaRII genes by polymerase chain reaction-based single strand conformation polymorphism and sequencing analysis.

RESULTS

All cell lines grew as adherent cells; five lines grew as monolayers and one other line grew as stratifying colonies. All lines showed 1) high viability (75%-92%) with various doubling times (36-96 h); 2) absence of Mycoplasma and other bacteria; and 3) genetic heterogeneity by DNA profile analysis. p53 Mutations were found in three lines and p16 mutations were observed in five cell lines. TGF-betaRII mutations were found in two lines: one line had frameshift mutation and another line had a missense mutation at the kinase domain.

CONCLUSIONS

These newly established and characterized laryngeal squamous cell carcinoma cell lines will be useful for investigating the biologic characteristics of laryngeal cancer.

Effects of free radicals on ciliary movement in the human nasal epithelial cells

OBJECTIVE

There have been few reports on the effects of free oxygen radicals on ciliary mobility of nasal respiratory epithelial cells. The aim of this study was to determine the effects of free radicals and antioxidants on human nasal epithelial cells (HNECs) using video-computerized analysis.

METHODS

Human nasal epithelial cells were obtained from the nasal cavity of normal volunteers. Ciliary beat frequency (CBF) was calculated as the mean value of ten randomly selected cells. The proportion of the area with normal CBF (above 8 Hz) was calculated from 10 randomly selected sites per specimen. Free radicals were produced by xanthine-xanthine oxidase enzymatic system. The generation of free radicals was confirmed by chemoilluminometer. CBF and the proportion of the area with normal CBF were measured at every 5 min for 30 min after the addition of enzyme. For the evaluation of the antioxidant effects on free radical-mediated ciliary slowing in HNECs, cells were incubated in superoxide dismutase solution (300 unit/ml) for 30 min and 3-aminobenzamide (5 mM).

RESULTS

Superoxide produced by 0.4 mM xanthine and 400 miliunit/ml xanthine oxidase decreased CBF (7.71 +/- 1.91 Hz). A total of 2 min later, ciliary slowing was evident (3.87 +/- 1.10 Hz). Regarding the changes in proportion of epithelial area that showed normal CBF experimental group showed a significant decrease in percentage of epithelial area with normal CBF over time. Superoxide dismutase prevented ciliary slowing (8.76 +/- 0.99 Hz). Moreover, 3-aminobenzamide, an inhibitor of the DNA repair enzyme poly-ADP ribose polymerase, prevented inhibition of CBF (8.32 +/- 0.61 Hz).

CONCLUSIONS

These results suggest that oxygen-mediated damage to DNA may be the mechanism of the deterioration effects of oxygen radicals on the ciliated respiratory nasal epithelium.

The effect of prostaglandin and its inhibitor on antibody-dependent cellular cytotoxicity against human squamous cell carcinoma of head and neck

The effects of chimeric monoclonal antibodies (cMAbs), prostaglandin E2(PGE2), and indomethacin (INDO) on antibody-dependent cellular cytotoxicity (ADCC) against human squamous cell carcinoma of head and neck (SCCHN) cell line were examined. Using the PCI-50 SCCHN cell line as target and normal human peripheral blood mononuclear cells as the effector, ADCC was enhanced by the treatment of cMAbs (1.25 micrograms/ml), but was inhibited by exogenous PGE2(5 x 10-7M). The effects of cMAb and PGE2 were dose-dependent. Maximal suppression of activity occurred when PGE2 was present during the entire 4 hour 51Cr-release assay period, whereas pretreatment of effector cells with PGE2 had minimal inhibitory effect after washing. These results indicate that decreased ADCC seen with SCCHN targets treated with PGE2 is related to post-binding events, such as binding of effector and target cells. Pre-treatment of effector cells with INDO (1 microgram/ml) resulted in restoration of NK activity which was inhibited by PGE2. Our in vitro results suggest that INDO can increase tumor cell killing by the reversal of the suppression for many immune functions by PGE2.

The significance of CT scan or MRI in the evaluation of salivary gland tumors

Imaging modalities such as CT scan or MRI are frequently employed for the diagnosis of neoplastic lesions in the salivary glands. To evaluate the efficacy of the CT scan and the MRI in differentiating malignant neoplasm from benign lesions, 120 CT scans and 31 MRIs were retrospectively analyzed from 147 patients with salivary gland masses. All images were analyzed focusing on the presence of several relevant features. The pathologic results were matched with radiological features and also tabulated with radiological assessment. For the CT scans, the contour and margin of the lesion and tissue plane obliteration were found to be statistically significant indicators for malignant neoplasms. Among 69 CT scans interpreted as 'benign' by a radiologist, five cases (7%) were histologically diagnosed as 'malignant'. On the other hand, 20 out of 51 CT scans (39%) were misinterpreted as 'malignant'. For MRI, two out of 14 cases (14%) were radiologically misdiagnosed as 'benign' and six out of 17 patients (35%) as 'malignant'. In conclusion, whereas both the CT and MRI showed a similar level of accuracy in evaluation of salivary gland tumors, they showed a considerable tendency of misdiagnosis, especially by interpreting benign tumors as 'malignant'.

Locoregional response and increased natural killer activity after intratumoral injection of HLA-B7/beta2-microglobulin gene in patients with cancer

The purpose of this study was to assess the therapeutic potential of injecting the gene for HLA-B7/beta2-microglobulin into the subcutaneous metastatic nodules of patients who are refractory to conventional treatments. The nine patients evaluated were divided into three groups and given escalating doses of DNA (20, 40, and 100 microg of the HLA-B7 plasmid DNA/lipid complex for each group) every 2 weeks. Biopsy specimens from the treated tumor nodules of all nine patients were positive for the presence of DNA and for HLA-B7 mRNA expression. Moreover, in six of the nine patients, immunohistology of tumor biopsy samples revealed the expression of recombinant HLA-B7 protein. Also, all nine patients showed an increase in NK activity in their circulating peripheral blood lymphocytes. In two lung cancer patients, one partial and one mixed response was observed after gene transfer. These responses were confined to the treated nodules and the untreated locoregional lymph nodes; the lung masses showed no regression. Remission durations were 14 and 6 weeks, respectively, and in a total of 35 cycles no significant toxicities were observed. Immunohistologic analysis revealed an increased infiltration of CD4+ T cells, macrophages, and NK cells after therapy. In two responding cases, direct intratumoral injection of an allogeneic class I gene could elicit an antitumor response in locoregional areas, possibly through the activation of NK cells.

Synergistic anti-tumor effects with co-expression of GM-CSF and IFN-gamma in murine tumors

We explored the potential therapeutic benefit of introducing GM-CSF, IFN-gamma or a combination of both factors into CT26 tumor cells. CT26 cells secreting either GM-CSF or IFN-gamma exhibited delayed tumorigenicity; however, cells expressing both GM-CSF and IFN-gamma did not form tumors. Even when wild type CT26 cells were introduced into a distant site of mice that had been inoculated with CT26/GM-CSF/IFN-gamma cells, no tumors were generated. Furthermore, when we injected GM-CSF + IFN-gamma cells into animals bearing established tumors, the tumors were either rejected or their development was delayed, suggesting that synergistic effects were induced against these tumors via a systemic immune response. Histopathological examination of the tumors injected with cells expressing GM-CSF and IFN-gamma combined showed necrosis and few signs of malignancy. The growth of tumors from mice treated with CT26/GM-CSF/IFN-gamma cells exhibited a delay in tumor formation and no effects were seen in athymic nude mice, which are deficient in T lymphocytes, or in splenectomized nude mice, which are deficient in natural killer (NK) cells, respectively. Our data indicate a dual role for T and NK cells in mediating the anti-tumor activity of this therapy. Our results suggest that transduction of tumor cells with both GM-CSF + IFN-gamma results in a powerful synergistic effect of the 2 cytokines that is of greater therapeutic benefit than transduction with either cytokine alone.

Human tumor antigen-specific T lymphocytes and interleukin-2-activated natural killer cells: comparisons of antitumor effects in vitro and in vivo

Human antitumor effector cells include class I major histocompatibility complex (MHC)-restricted T cells and non-MHC-restricted natural killer (NK) cells. These two types of effector cells have not been directly compared for the ability to eliminate tumor cell targets. Here, we compare in vitro and in vivo antitumor functions of two human T-cell lines specific for a shared tumor antigen to the antitumor functions of A-NK cells, a subset of IL-2-activated NK cells. Human squamous cell carcinoma of the head and neck cell lines cultured in suspensions or as spheroids or tumor xenografts established in nude mice were used to evaluate antitumor functions of IL-2-activated and expanded T and NK effector cells in various assays, both in vitro and in vivo. Both tumor cell targets, PCI-13 and OSC-19, expressed class I and II MHC antigens after IFN-gamma pretreatment, gave rise to tumors upon injection into immunosuppressed nude mice, and were resistant to lysis by resting NK cells but sensitive to lysis mediated by A-NK cells or HLA-A2-restricted T-cell lines specific for a shared squamous cell carcinoma of the head and neck antigen. No significant differences were observed in the ability of A-NK cells or tumor-specific T cells to bind to tumor cell monolayers or to enter into spheroids. However, A-NK cells mediated significantly higher killing than tumor-specific CD8+ T cells in 4-h 51Cr-release assays (a measure of cell membrane damage and necrosis), 1-h [3H]thymidine-release assays (a measure of DNA fragmentation and apoptosis), and in terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assays (a measure of apoptosis). In contrast, CD8+ T cells were consistently more effective than A-NK cells in inducing growth inhibition of tumor cells in 24-h MTT assays. In the presence of tumor-specific antibodies, A-NK cell binding, entry into spheroids, and infiltration into tumor in vivo were significantly increased. In vivo perilesional delivery of effector cells to mice with established tumors indicated that human A-NK cells exert antitumor effects as potent as those of tumor-specific T cells. However, in contrast to tumor-specific T cells, A-NK cells are readily available for cancer therapy, expand rapidly in culture without prior sensitization, and can be armed with antitumor antibodies to increase localization of effector cells to the tumor.

Effects of phenylephrine on ciliary beat in human nasal respiratory epithelium: quantitative measurement by video-computerized analysis

The in vitro effects of phenylephrine solution on ciliary beat frequency (CBF) in terms of different concentrations and exposure times were investigated using a video-computerized analysis technique. Nasal epithelial cells were taken from inferior turbinate of 10 volunteers by scraping the nasal mucosa with a cytology brush. CBF was measured in five different concentrations including 0.125%, 0.25%, 0.5%, 1%, and 2.5%. Each specimen was incubated in different solution for 6 days and CBF was measured at 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, 12 hours, 1 day, 2 days, 3 days, 4 days, 5 days, and 6 days. CBF decreased significantly after 12-hour incubation in 0.125% phenylephrine solution and after 8-hour incubation in 0.25% phenylephrine solution, both clinically used concentrations. There were significant decreases in CBF after incubation in 0.5% phenylephrine for 2 hours, in 1% for 1 hour, and in 2.5% for 30 minutes (P < 0.05, repeated measure analysis of variance [ANOVA]). CBF of the nasal respiratory ciliated cells significantly decreased with increasing concentrations of phenylephrine solution and with increasing incubation times at the same concentration (P < 0.05, repeated measure ANOVA). The results of this study suggest that phenylephrine may inhibit ciliary beat in vitro by its pharmacological effect at lower concentrations than clinically used ones.

Neoadjuvant chemotherapy and radiotherapy for the treatment of advanced hypopharyngeal carcinoma

PURPOSE

To evaluate the efficacy of the neoadjuvant chemotherapy and radiation therapy in treatment of patients with advanced hypopharyngeal cancer, which is notorious for its poor prognosis and severe surgical morbidity with functional deficits.

MATERIALS AND METHODS

Medical records of 62 patients with squamous cell carcinoma of the hypopharynx, Stage III or IV (AJCC, 1992), were retrospectively reviewed.

RESULTS

Neoadjuvant chemotherapy showed an overall response rate of 87% and a complete remission (CR) rate was 67% following chemotherapy and radiation therapy. The patients who did not show CR after chemotherapy had a high likelihood of treatment failure, even though they achieved CR following subsequent radiotherapy. Thirteen of 30 patients were able to preserve their larynges for more than 3 years by chemotherapy and radiation.

CONCLUSION

This approach appeared to be as effective as radical surgery with postoperative radiation therapy without comprising survival. To improve the cure rates, we need to develop better strategies to increase CR rates with chemotherapy and determine the best treatment option for patients who are partially or nonresponsive to chemotherapy.

Fibrosing inflammatory pseudotumors of the central skull base

The most important step in the differential diagnosis of mass lesions of the central skull base is to rule out malignant neoplasms. However, nonneoplastic lesions, such as infections or nonspecific inflammatory lesions of the skull base, can mimic malignant processes. In this study, the authors analyzed seven cases of nonneoplastic noninfectious mass-forming lesions involving the central skull base. In most cases, malignant processes were suspected at the initial phase of diagnostic work-up, but subsequent histologic examinations revealed that these lesions consisted of inflammatory cells and fibrosis without neoplastic cells. Common manifestations were pain and other neurological symptoms related to the involved anatomical sites. A variety of neurological dysfunctions of the cranial nerves not including the olfactory and spinal accessory nerves were observed. No patient developed separate lesions outside the head and neck region. After the pathologic diagnosis, most of the patients were treated with oral steroid therapy, with initial doses of prednisolone, 60 to 100 mg/d. It was difficult to relate responsiveness to steroid therapy with the histologic degree of sclerosis, fibrosis, or chronicity of the disease in these cases. Otolaryngologists should be aware of this disease when making treatment decisions for their patients with skull base lesions.

Distribution mapping of ciliary beat frequencies of respiratory epithelium cells using image processing

Through their rapid periodic actions, the cilia of the human respiratory tract play an important role in clearing inhaled noxious particles. An automated method is developed, based on an image-processing technique, to measure and analyse objectively and quantitatively, ciliary beat frequency (CBF). Microscopic ciliary images are transformed into digitised grey images through an image grabber inside a PC, and signals are extracted from these, based on an image-subtraction algorithm, and are processed through power spectrum analysis using a fast Fourier transform (FFT). By means of the FFT power spectrum, maximum peak frequencies are detected as CBFs in each partitioned block for the entire digitised field. Using these CBFs, distribution maps are composed in various resolutions, showing visually the spatial distribution of CBFs through cells and in a single cell. To measure CBF variations quantitatively, phenylephrine hydrochloride is used, and the changes in CBF influenced by its concentration and duration are observed.

Human oral buccal mucosa reconstructed on dermal substrates: a model for oral epithelial differentiation

To develop a model for the study of oral epithelial differentiation, we reconstructed artificial buccal mucosa equivalents using keratinocytes and fibroblasts or de-epidermized dermis derived from non-cornifying buccal mucosa. The buccal mucosa equivalents reconstructed in this way showed a morphology closely mimicking that of their in vivo counterparts. There was no formation of horny layers and granular layers. The expression of various differentiation markers such as K13, involucrin and loricrin was consistent with that of the in vivo state, and indicative of the hyperproliferative state. We also demonstrated that the differentiation of oral epithelial cells was influenced by the de-epidermized dermis and subepithelial fibroblasts. The epidermis of buccal mucosa equivalents seemed to be less sensitive to retinoic acid than that of the skin. The effects of calcipotriol on the buccal mucosa equivalent and the skin epidermis were different. These results suggest that the pharmacological effects of retinoic acid and calcipotriol on the buccal mucosa are different from those on the skin. A useful model system for studies of oral keratinocyte differentiation and pharmacological research could be based on these artificial buccal mucosa equivalents.

Malignant schwannoma of the liver in a patient without neurofibromatosis: a case report and review of the literature

Primary schwannomas of the liver are extremely rare. We report a case of malignant schwannoma of the liver occurring in a 49-year-old man, who did not have neurofibromatosis, and review the literature. The clinical and histologic findings of benign and malignant schwannomas of the liver are compared.

The role of apoptosis in antibody-dependent cell-mediated cytotoxicity against monolayers of human squamous cell carcinoma of the head and neck targets

Antibody-dependent cellular cytotoxicity (ADCC) against squamous cell carcinoma of the head and neck (SCCHN) targets in the presence of human/mouse chimeric monoclonal antibodies (cMAbs), SF-25 and 323/A3, is mediated by natural killer (NK) cells. In 4-hr 51Cr-release assays with SSCHN targets in suspension, ADCC was always significantly better (P < 0.01) than that measured in parallel with the same target cells in monolayers. No differences were observed in the level of expression of the relevant antigens recognized by cMAbs on these targets. To better explain the difference, 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) monolayer and [3H]thymidine-release assays were used. Cytostasis and cell death measured in monolayer MTT assays and DNA fragmentation measured in [3H]thymidine-release assays were significantly higher (P = 0.028) than cytotoxicity determined using 51Cr-labeled SCCHN monolayers. Cell death observed in monolayer MTT assays was blocked by pretreating SCCHN targets with cycloheximide or actinomycin-D or by paraformaldehyde fixation of effector cells. The presence of apoptotic cells in monolayers co-incubated with effector cells was demonstrated in situ by labeling fragmented ends of DNA with fluorescein-conjugated dUTP and terminal deoxynucleotidyl transferase and also by flow cytometry of target cells obtained from such monolayers. Our results indicate that NK cells preferentially utilize membrane lysis (necrosis) in ADCC with tumor cell targets in single-cell suspensions. However, necrosis is not efficient in monolayers. In the presence of cMAbs, apoptosis is the primary mechanism of NK cell-mediated killing in monolayers of SCCHN targets, which were found to express receptors for tumor necrosis factor and fas ligand.

Protective effects of interferon-gamma on squamous-cell carcinoma of head and neck targets in antibody-dependent cellular cytotoxicity mediated by human natural killer cells

An in vitro model of antibody-dependent cellular cytotoxicity (ADCC) was established, using squamous-cell carcinoma of the head and neck (SCCHN) targets,human/mouse chimeric monoclonal antibodies (cMAbs) SF-25 and 323/A3 and human peripheral blood mononuclear cells (PBMC). We previously showed that natural killer (NK) cells are the main effector population mediating ADCC in the presence of the cMAbs. ADCC was significantly inhibited by the overnight pre-treatment of SCCHN targets with exogenous interferon-gamma (IFN-gamma). This inhibition was dose-dependent, reproducible and consistently observed with various SCCHN cell lines. SCCHN cells pre-treated with IFN-gamma had a significantly higher expression of intercellular adhesion molecule-I (ICAM-I) and major histocompatibility complex (MHC) class I antigens compared with untreated target cells. No differences in expression of the SCCHN-associated antigens on these targets or in the formation of NK-SCCHN conjugates were found, using flow cytometry. IFN-gamma-pre-treated SCCHN cells were less effective in competing with untreated targets in cold target inhibition assays and in inducing cytokine production from NK cells in co-incubation experiments. Protective effects of IFN-gamma on target cell sensitivity to lysis were blocked by pre-treatment of target cells with actinomycin-D or cycloheximide. The susceptibility of the target cells was restored by removal of MHC class I antigens from their surface by acid stripping before ADCC. Our results suggest that the decreased ADCC seen with SCCHN targets pre-treated with IFN-gamma is related to post-binding events, possibly altered signaling from targets to effector cells, and requires protein synthesis in the target cells.

Constitutive production of IL-2 by human carcinoma cells, expression of IL-2 receptor, and tumor cell growth

Human carcinomas spontaneously express abundant IL-2R beta but little IL-2R alpha on the cell surface, contain mRNA for IL-2R beta- and IL-2R alpha-chains, and may be inhibited in growth by exogenous IL-2. To study the relationship between IL-2R expression and growth inhibition by IL-2, carcinoma cells were transduced with IL-2R alpha and IL-2R gamma cDNAs or IL-2R beta antisense cDNA. Transfectants with the IL-2R alpha gene expressed high levels of the alpha- and beta-receptor chains and showed increased binding of [125I]IL-2. Exogenous IL-2 at the picometer concentrations inhibited their growth, and Abs to IL-2R alpha- or IL-2R beta-chains reversed the inhibition. After transduction of IL-2R beta antisense cDNA, gastric carcinoma (HR) cells no longer expressed IL-2R beta-chain, and their proliferation was depressed in the absence of exogenous IL-2. Transduction of IL-2R gamma-chain cDNA into tumor cells increased sensitivity to growth inhibition by exogenous IL-2 of a squamous cell carcinoma line, but not of HR or renal cell carcinoma lines. All of the parental and transduced tumor cell lines were found to constitutively express intracellular IL-2, detectable by immunostaining or flow cytometry of permeabilized cells. IL-2 was present on the surface of some tumor cells. Intracellular IL-2R beta and IL-2R gamma proteins were also detectable in tumor cells. Using reverse-transcription PCR combined with Southern blots or in situ hybridization, mRNA for IL-2 was found to be present in parental and transduced tumor cells. Expression on human carcinomas of IL-2R beta, inhibition of their growth by IL-2R beta antisense cDNA, and their ability to constitutively produce IL-2 and its presence on the cell surface, all suggest that endogenous IL-2 may play a role in tumor cell growth.

Constitutive production of IL-2 by human carcinoma cells, expression of IL-2 receptor, and tumor cell growth

Human carcinomas spontaneously express abundant IL-2R beta but little IL-2R alpha on the cell surface, contain mRNA for IL-2R beta- and IL-2R alpha-chains, and may be inhibited in growth by exogenous IL-2. To study the relationship between IL-2R expression and growth inhibition by IL-2, carcinoma cells were transduced with IL-2R alpha and IL-2R gamma cDNAs or IL-2R beta antisense cDNA. Transfectants with the IL-2R alpha gene expressed high levels of the alpha- and beta-receptor chains and showed increased binding of [125I]IL-2. Exogenous IL-2 at the picometer concentrations inhibited their growth, and Abs to IL-2R alpha- or IL-2R beta-chains reversed the inhibition. After transduction of IL-2R beta antisense cDNA, gastric carcinoma (HR) cells no longer expressed IL-2R beta-chain, and their proliferation was depressed in the absence of exogenous IL-2. Transduction of IL-2R gamma-chain cDNA into tumor cells increased sensitivity to growth inhibition by exogenous IL-2 of a squamous cell carcinoma line, but not of HR or renal cell carcinoma lines. All of the parental and transduced tumor cell lines were found to constitutively express intracellular IL-2, detectable by immunostaining or flow cytometry of permeabilized cells. IL-2 was present on the surface of some tumor cells. Intracellular IL-2R beta and IL-2R gamma proteins were also detectable in tumor cells. Using reverse-transcription PCR combined with Southern blots or in situ hybridization, mRNA for IL-2 was found to be present in parental and transduced tumor cells. Expression on human carcinomas of IL-2R beta, inhibition of their growth by IL-2R beta antisense cDNA, and their ability to constitutively produce IL-2 and its presence on the cell surface, all suggest that endogenous IL-2 may play a role in tumor cell growth.

Bleomycin sclerotherapy in patients with congenital lymphatic malformation in the head and neck

Congenital lymphatic malformations of the head and neck often present challenging problems to the otolaryngologist-head and neck surgeon. Although surgical excision was agreed to be the treatment of choice for this disease, the infiltrating nature of lymphatic channels often increases the frequency of operative complications and recurrences of this lesion.

PURPOSE

Bleomycin sclerotherapy was attempted to avoid surgical risk and to cure this lesion.

MATERIALS AND METHODS

Clinical findings and treatment results were reviewed for patients with congenital lymphatic malformation and treated by bleomycin sclerotherapy.

RESULTS

Bleomycin sclerotherapy was a very effective therapeutic alternative. The best results were seen in cystic type 1 lesions in younger patients.

CONCLUSIONS

Bleomycin sclerotherapy is a useful medical alternative, and we believe that it should be attempted before excision of the lesion.

Natural killer (NK) cells as effectors of antibody-dependent cytotoxicity with chimeric antibodies reactive with human squamous-cell carcinomas of the head and neck

In patients with cancer, antibody-dependent cellular cytotoxicity (ADCC) may be used as a laboratory test or for enhancing immunotherapy with murine monoclonal or chimeric mouse/human anti-tumor antibodies (mMAbs or cMAbs, respectively). We have established an ADCC assay with IgG1 cMAb SF-25, using human squamous-cell carcinoma of the head and neck (SCCHN) cell lines as targets. By flow cytometry, all SCCHN cell lines tested expressed the antigen recognized by cMAb SF-25. Trypsinization of the cell monolayers facilitated binding of cMAb SF-25 to the antigen on the cell surface of SCCHN targets. Using the PCI-50 SCCHN cell line as a target coated with this cMAb at the optimal concentration of 1.0 micrograms/ml, normal human peripheral blood mononuclear cells (PBMC, n = 28) were found to mediate ADCC at a mean level of 283 +/- 42 (SEM) lytic units (LU20/10(7) effector cells). Non-adherent monocyte-depleted PBMC and natural killer (NK) cells purified by negative selection mediated significantly higher levels of ADCC than unseparated PBMC against SCCHN targets. NK cells, defined as CD3-CD56+ cells, could be effectively armed by cMAb SF-25, as confirmed by flow cytometry and ADCC assays. IL2-activated armed NK cells mediated higher levels of ADCC than non-armed NK cells. Binding of cMAb SF-25 to NK cells and their ADCC were enhanced by pre-incubation with polyethylene glycol. Arming of NK cells with chimeric antibodies should be considered in developing novel strategies for treatment of human SCCHN, especially in the adjuvant setting.

Congenital fistula from ectopic accessory parotid gland: diagnosis with CT sialography and CT fistulography

We report a case of congenital fistula from ectopic accessory parotid gland to the cheek demonstrated by CT sialography and CT fistulography. The right parotid gland was abnormally located lateral to masseter muscle. The fistula was arising from an ectopic accessory parotid gland with ectopic duct positioned anterior to masseter muscle. CT sialography and CT fistulography were very helpful in the diagnosis and surgical planning.