scholarly journals Videolaryngostroboscopy in early vocal fold carcinoma diagnosis

2021 ◽  
pp. 77-77
Author(s):  
Jasmina Stojanovic ◽  
Dragan Milovanovic ◽  
Slobodanka Mitrovic ◽  
Andra Jevtovic ◽  
Natalija Bozovic ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Medical Center ◽  
Stage Iv ◽  
Vocal Folds ◽  
Stage Iii ◽  
Controlled Study ◽  
Glottic Carcinoma ◽  
Therapeutic Modalities ◽  
Vocal Fold Vibration ◽  
Early Glottic Carcinoma

Introduction/Objective. Vocal folds are the most common primary site of laryngeal carcinoma. Advancement in diagnostic and therapeutic modalities have provided better prognosis for patients with early glottic carcinoma. We aimed to report the role of videolaryngostroboscopy (VLS) in early diagnosis of vocal fold carcinoma. Methods. Prospective controlled study included 300 dysphonic patients admitted to the tertiary medical center for microlaryngoscopy with biopsy. All patients underwent stroboscopic examination prior to biopsy. VLS findings were classified according to Hirano into 4 stages, with a adynamic vocal fold segment and absence of vocal fold vibration, suspected for vocal fold carcinoma as a stage IV. Histopathological findings have been graded according to Ljubljana classification into simple hyperplasia, abnormal hyperplasia, atypical hyperplasia and carcinoma in situ. Results. Analysis of VLS findings showed that 41.67% of patients (n = 125/300) had asymmetrical and irregular vocal fold vibration with a mucosal wave reduction (VLS stage III) while adynamic vocal fold segment and absence of vocal fold vibration (VLS stage IV), suspected for vocal fold carcinoma, was noticed in 17.33% of patients (n = 52/300). HP report showed that vocal fold carcinoma was verified in 5.6% of patients in VLS stage III (n = 7/125), while in VLS stage IV carcinoma was detected in 26.92% of patients (n = 14/52). Adynamic segment or entire nonvibrating vocal fold finding predicts early glottic carcinoma with a sensitivity of 66.77%, specificity of 86.4%, and moderate diagnostic accuracy (AUC = 0.844). Conclusion. VLS plays an important role as a timely indicator for microlaryngoscopy with biopsy in diagnosis of vocal fold carcinoma.

Reinke's Edema: Phonatory Mechanisms and Management Strategies

1997 ◽  
Vol 106 (7) ◽  
pp. 533-543 ◽  
Author(s):  
Steven M. Zeitels ◽  
Glenn W. Bunting ◽  
Robert E. Hillman ◽  
Traci Vaughn
Keyword(s):  
Lamina Propria ◽  
Fundamental Frequency ◽  
Vocal Fold ◽  
Management Strategies ◽  
Vocal Folds ◽  
Vocal Fold Vibration ◽  
Reinke’S Edema ◽  
Subglottal Pressure ◽  
Almost All ◽  
Superficial Lamina

Reinke's edema (RE) has been associated typically with smoking and sometimes with vocal abuse, but aspects of the pathophysiology of RE remain unclear. To gain new insights into phonatory mechanisms associated with RE pathophysiology, weused an integrated battery of objective vocal function tests to analyze 20 patients (19 women) who underwent phonomicrosurgical resection. Preoperative stroboscopic examinations demonstrated that the superficial lamina propria is distended primarily on the superior vocal fold surface. Acoustically, these individuals have an abnormally low average speaking fundamental frequency (123 Hz), and they generate abnormally high average subglottal pressures (9.7 cm H20). The presence of elevated aerodynamic driving pressures reflects difficulties in producing vocal fold vibration that are most likely the result of mass loading associated with RE, and possibly vocal hyperfunction. Furthermore, it is hypothesized that in the environment of chronic glottal mucositis secondary to smoking and reflux, the cephalad force on the vocal folds by the subglottal driving pressure contributes to the superior distention of the superficial lamina propria. Surgical reduction of the volume of the superficial lamina propria resulted in a significant elevation in fundamental frequency (154 Hz) and improvement in perturbation measures. In almost all instances, both the clinician and the patient perceived the voice as improved. However, these patients continued to generate elevated subglottal pressure (probably a sign of persistent hyperfunction) that was accompanied by visually observed supraglottal strain despite the normalsized vocal folds. This finding suggests that persistent hyperfunctional vocal behaviors may contribute to postsurgical RE recurrence if therapeutic strategies are not instituted to modify such behavior.

Effects of Voice Therapy as Objectively Evaluated by Digitized Laryngeal Stroboscopic Imaging

2002 ◽  
Vol 111 (10) ◽  
pp. 902-908 ◽  
Author(s):  
Renée Speyer ◽  
Pieter A. Kempen ◽  
George Wieneke ◽  
Willem Kersing ◽  
Elham Ghazi Hosseini ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Lesion Size ◽  
Voice Therapy ◽  
Benign Lesions ◽  
Objective Measurements ◽  
Significant Parameter ◽  
Surface Areas ◽  
Vocal Fold Vibration ◽  
Maximal Opening

Objective measurements derived from digitized laryngeal stroboscopic images were used to demonstrate changes in vocal fold vibration and in the size of benign lesions after 3 months of voice therapy. Forty chronically dysphonic patients were studied. By means of a rigid stroboscope, pretreatment and posttreatment recordings were made of the vocal folds at rest and under stroboscopic light during phonation. From each recording, images of the positions at rest and during vibration at maximal opening and at maximal closure were digitized. The surface areas of any lesions and of the glottal gap were independently measured in the digitized images by 2 experienced laryngologists. Referential distances were determined in order to compensate for discrepancies in magnification in the various recordings. After 3 months of voice therapy, significant improvement in lesion size and degree of maximal closure during vibration could be demonstrated in about 50% of the patients. The degree of maximal opening did not prove to be a significant parameter.

Videostrobolaryngoscopy of Mucus Layer during Vocal Fold Vibration in Patients with Laryngeal Tension-Fatigue Syndrome

2002 ◽  
Vol 111 (6) ◽  
pp. 537-541 ◽  
Author(s):  
Tzu-Yu Hsiao ◽  
Chia-Ming Liu ◽  
Kai-Nan Lin
Keyword(s):  
Mechanical Properties ◽  
Vocal Fold ◽  
Rough Surfaces ◽  
Voice Disorders ◽  
Vocal Folds ◽  
Voice Disorder ◽  
Mucus Layer ◽  
Vocal Fold Vibration ◽  
Fatigue Syndrome ◽  
Functional Dysphonia

The mucus layer on the vocal folds was examined by videostrobolaryngoscopy in patients with laryngeal tension-fatigue syndrome, a chronic functional dysphonia due to vocal abuse and misuse. Besides the findings in previous reports (such as abnormal glottal closure, phase or amplitude asymmetry, and the irregular mucosal wave), the vocal folds during vibration had an uneven mucus surface. The occurrence of an uneven mucus layer on vocal folds was significantly greater in subjects with this voice disorder (83% or 250 of 301 patients in this series) than in those without voice disorders (18.5% or 5 of 27). The increase of mucus viscosity, mucus aggregation, and the formation of rough surfaces on the vocal folds alter the mechanical properties that contribute to vibration of the cover of the vocal folds, and thereby worsen the symptoms of dysphonia in patients with laryngeal tension-fatigue syndrome.

A single institution experience of lung cancer treatment in octogenarians

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18141-18141
Author(s):  
S. McCormack ◽  
A. Pleister ◽  
D. Young ◽  
P. Confer ◽  
G. A. Otterson
Keyword(s):  
Medical Center ◽  
Stage Iv ◽  
The Elderly ◽  
Study Data ◽  
Stage Iii ◽  
Disease Stage ◽  
Treatment Modalities ◽  
Seer Database ◽  
Surgical Disease ◽  
Ecog Ps

18141 Background: In the NCI’s SEER database nearly 15% of NSCLC patients were = 80 years during the years 1973–2003. As the “elderly” population increases, the percentage of octogenarians with NSCLC will increase. To better understand this population we investigated the patient and tumor characteristics and treatment modalities by stage in octogenarians with NSCLC over a recent 5 year period at The Ohio State University Medical Center. Methods: Patients aged 80 years and older with biopsy-proven NSCLC seen between 1998–2003 were included in the analysis. 74 patients met criteria for study. Data was gathered from the cancer registry and chart reviews. Characteristics included stage, histology, treatment, and co-morbid conditions (pulmonary and non-pulmonary co-morbidities, weight loss, and ECOG PS). PS was either explicitly stated or inferred from the records, or recorded as “unknown” when PS could not be determined. Results: The 74 patients averaged 82.8 years of age (range 80–91), with 53% males and 47% females (83 years of age with 56% males and 44% females from the SEER database). 46% of patients had “surgical” disease (Stage IA, IB, and IIB), 20.3% had stage III disease, 29.7% had stage IV disease, and 4.0% had indeterminate staging. 82.4% of “surgical” disease patients received some variety of treatment (70.6% surgery[S], 23.5% radiation[RT], and 12.5% chemo[Ch]); 80% of stage III patients received treatment (53.3% S, 40% RT, and 33.3% Ch); 50% of stage IV patients received treatment (0% S, 31.8% RT, and 40.9% Ch). Patients with an ECOG PS of 0–1, 2, 3–4, or “unknown” equaled 44.6%, 20.3%, 16.2%, and 18.9% respectively with 81.8%, 100%, 41.7%, and 78.6% of these patients receiving treatment. Conclusions: There is little data on treatment of the ‘extreme elderly.‘ Our analysis of this subset of the elderly reveals that most octogenarians seen at a referral center can receive treatment. The majority of “surgical” disease octogenarians received surgical resection of their primary tumor and the majority of all patients received some treatment. Further studies of outcomes based on staging, co-morbidities, and PS will be important in this population. Additional studies of this population in non-referral centers are of interest. No significant financial relationships to disclose.

ENGOT-EN6/NSGO-RUBY: A phase III, randomized, double-blind, multicenter study of dostarlimab + carboplatin-paclitaxel versus placebo + carboplatin-paclitaxel in recurrent or primary advanced endometrial cancer (EC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. TPS6107-TPS6107
Author(s):  
Mansoor Raza Mirza ◽  
Robert L. Coleman ◽  
Lars Christian Hanker ◽  
Brian M. Slomovitz ◽  
Giorgio Valabrega ◽  
...  
Keyword(s):  
Objective Response ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Disease Status ◽  
Phase Iii ◽  
Stage Iii ◽  
Controlled Study ◽  
Double Blind ◽  
Primary Stage ◽  
Patient Reported

TPS6107 Background: Carboplatin-paclitaxel is considered standard systemic anticancer therapy for recurrent or advanced EC for which surgery and/or radiation are not curative. Dostarlimab (TSR-042) is an anti-programmed cell death (PD)-1 humanized monoclonal antibody that has demonstrated antitumor activity and an acceptable safety profile in patients (pts) with recurrent or advanced EC in the GARNET trial. The RUBY trial was designed to evaluate the efficacy and safety of dostarlimab in combination with carboplatin-paclitaxel in recurrent or primary advanced EC compared with carboplatin-paclitaxel alone. Methods: This is a global, randomized, double-blind, multicenter, placebo-controlled study. Eligible pts must have first recurrent or primary stage III or stage IV EC with a low potential for cure by radiation therapy or surgery alone or in combination. Pts with carcinosarcoma are eligible for enrollment. 470 pts will be enrolled from approximately 160 sites in the ENGOT countries, United States, and Canada. Stratification factors are microsatellite instability (MSI) status (MSI-high [MSI-H] or microsatellite stable [MSS]), prior external pelvic radiotherapy (yes or no), and disease status (recurrent, primary stage III, or primary stage IV). Pts will be randomized 1:1 to receive combination dostarlimab 500 mg or placebo + carboplatin AUC 5 + paclitaxel 175 mg/m2 every 3 weeks for 6 cycles followed by dostarlimab 1000 mg or placebo monotherapy every 6 weeks for up to 3 years in the absence of progressive disease, death, unacceptable toxicity, or patient/physician decision to withdraw from the study. The primary endpoint is progression-free survival (PFS) as assessed by the investigator in the all-comers population and the MSI-H population per RECIST version 1.1. Secondary efficacy endpoints are PFS assessed by blinded independent central review per RECIST version 1.1, overall survival, objective response rate, duration of response, disease control rate, safety and tolerability, and patient-reported outcomes. Clinical trial information: NCT03981796.

Finite Element Modeling of Vocal Fold Vibration in Normal Phonation and Hyperfunctional Dysphonia: Implications for the Pathogenesis of Vocal Nodules

1998 ◽  
Vol 107 (7) ◽  
pp. 603-610 ◽  
Author(s):  
Jack J. Jiang ◽  
Carlos E. Diaz ◽  
David G. Hanson
Keyword(s):  
Finite Element ◽  
Finite Element Modeling ◽  
Mechanical Stress ◽  
Vocal Fold ◽  
Vocal Folds ◽  
Element Modeling ◽  
Modeling Technology ◽  
Vocal Fold Vibration ◽  
Vocal Nodules ◽  
High Mechanical Stress

A computer model of the vocal fold was developed using finite element modeling technology for studying mechanical stress distribution over vibrating vocal fold tissue. In a simulated normal phonation mode, mechanical stress was found to be lowest at the midpoint of the vocal fold and highest at tendon attachments. However, when other modes predominated, high mechanical stress could occur at the midpoint of the vocal folds. When a vocal fold mass was modeled, high shearing stress occurred at the base of the modeled vocal fold mass, suggesting that the presence of a vocal nodule or polyp is associated with high mechanical stress at the margins of the mass. This finding supports a hypothesis that mechanical intraepithelial stress plays an important role in the development of vocal nodules, polyps, and other lesions that are usually ascribed to hyperfunctional dysphonia.

Empirical Eigenfunctions and Medial Surface Dynamics of a Human Vocal Fold

2005 ◽  
Vol 44 (03) ◽  
pp. 384-391 ◽  
Author(s):  
N. Tayama ◽  
D. A. Berry ◽  
M. Döllinger
Keyword(s):  
Vocal Fold ◽  
High Speed ◽  
Computational Models ◽  
Imaging System ◽  
Vocal Folds ◽  
Sustained Oscillation ◽  
Medial Surface ◽  
Physical Mechanisms ◽  
Vocal Fold Vibration ◽  
Modes Of Vibration

Summary Objectives: The purpose of this investigation was to use an excised human larynx to substantiate physical mechanisms of sustained vocal fold oscillation over a variety of phonatory conditions. During sustained, flow-induced oscillation, dynamical data was collected from the medial surface of the vocal fold. The method of Empirical Eigenfunctions was used to analyze the data and to probe physical mechanisms of sustained oscillation. Methods: Thirty microsutures were mounted on the medial margin of a human vocal fold. Across five distinct phonatory conditions, the vocal fold was set into oscillation and imaged with a high-speed digital imaging system. The position coordinates of the sutures were extracted from the images and converted into physical coordinates. Empirical Eigenfunctions were computed from the time-varying physical coordinates, and mechanisms of sustained oscillation were explored. Results: Using the method of Empirical Eigenfunctions, physical mechanisms of sustained vocal fold oscillation were substantiated. In particular, the essential dynamics of vocal fold vibration were captured by two dominant Empirical Eigenfunctions. The largest Eigenfunction primarily captured the alternating convergent/ divergent shape of the medial surface of the vocal fold, while the second largest Eigenfunction primarily captured the lateral vibrations of the vocal fold. Conclusions: The hemi-larynx setup yielded a view of the medial surface of the vocal folds, revealing the tissue vibrations which produced sound. Through the use of Empirical Eigenfunctions, the underlying modes of vibration were computed, disclosing physical mechanisms of sustained vocal fold oscillation. The investigation substantiated previous theoretical analyses and yielded significant data to help evaluate and refine computational models of vocal fold vibration.

Nonlinear behavior of vocal fold vibration: The role of coupling between the vocal folds

1999 ◽  
Vol 13 (4) ◽  
pp. 465-476 ◽  
Author(s):  
Antoine Giovanni ◽  
Maurice Ouaknine ◽  
Bruno Guelfucci ◽  
Ping Yu ◽  
Michel Zanaret ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Nonlinear Behavior ◽  
Vocal Folds ◽  
Vocal Fold Vibration

scholarly journals Exploration of the Appropriate NT-Probnp Level for AL Amyloidosis Staging

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3777-3777
Author(s):  
Hana Kim ◽  
Darae Kim ◽  
Jinoh Choi ◽  
Eunseok Jeon ◽  
Jung Eun Lee ◽  
...  
Keyword(s):  
Overall Survival ◽  
Mayo Clinic ◽  
Medical Center ◽  
Stage Iv ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Al Amyloidosis ◽  
School Of Medicine ◽  
Staging Systems

Abstract Exploration of the Appropriate NT-proBNP Level for AL Amyloidosis Staging Hana Kim, MD 1, Darae Kim, MD, PhD 2, Jin-Oh Choi, MD, PhD 2, Eun-Seok Jeon, MD, PhD 2, Jung Eun Lee, MD, PhD 3, Ju-Hong Min, MD, PhD 4, Joon Young Choi, MD, PhD 5, Jung-Sun Kim, MD, PhD 6, Seok Jin Kim, MD, PhD 1, Kihyun Kim, MD, PhD 1 1 Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 2 Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 3 Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 4 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 5 Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 6 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea The most important factor affecting prognosis of systemic light chain (AL) amyloidosis is severity of cardiac damage. For this reason, cardiac biomarkers are used in European 2015 and Mayo clinic 2012, two representative staging systems for AL amyloidosis. Since the NT-proBNP levels of the existing AL amyloidosis staging systems are different, we tried to find the appropriate NT-proBNP level in our 16-year AL amyloidosis patient cohort. Newly diagnoded AL amylodosis patients between August 2004 and July 2020 were included in this study (n=401). Patients who did not have laboratory results for staging had been exclude (n=86). Among them, 86 patients of stage III and 145 patients of stage IV patients (according to Mayo clinic 2012 stage) were analyzed (n=231). Of the 231 stage III, IV patients, 25, 82, 47, and 77 patients were classified as a group of NT-proBNP ≤1800, 1800 < NT-proBNP ≤5000, 5000< NT-proBNP ≤8000, and NT-proBNP >8000 (ng/L), respectively. The characteristics and overall survival of each group were investigated through statistical analysis. Age at diagnosis (p=0.016), ECOG (p=0.046), serum creatinine(p=0.001), and Estimated glomerular filtration rate (eGFR) (p=0.003) had statistically significant differences in the groups divided by the NT-proBNP criteria. With 54.4 months of median follow up, the overall survivals analyzed by Mayo clinic 2012 were stage I: not reached, stage II: 49.6 months, stage III: 46.8 months, and stage IV: 11.9months, respectively. As a result of European 2015 analysis, stage I: not reached, stage II: 65.9 months, stage IIIa: 41.4 months, stage IIIb: 4.3 months.) In our analysis according to NT-proBNP (ng/L) in stage III and IV patients, the overall survival of NT-proBNP ≤1800 group has not yet been reached. The median OS of group 1,800<NT-proBNP ≤5000, 5000< NT-proBNP ≤8000, and NT-proBNP >8000 were 54.8 months, 11.9 months, and 4.5 months, respectively (p <0.001). The Kaplan-Meier's curve for OS had a clear difference at NT-proBNP 5000 value. On the basis of NT-proBNP, the OS of less than 5000 group was 62 months, and the OS of 5000 or more group was 5.9 months. In analysis of factors affecting the OS, statistically significant results were age at diagnosis (p = 0.018), ECOG (p = 0.002), and NT-proBNP 5000 ng/L or higher (p < 0.001). The dFLC included in the Mayo clinic 2012 was found to have a statistically insignificant on the overall survival (p=0.584). Although disease stage is important in predicting the prognosis of AL amyloidosis, it was revealed that NT-proBNP is the most important factor in predicting survival prognosis. In this study we confirmed that AL amyloid patients with high NT-proBNP of >5000 ng/L may have particularly poor survival rate. When staging AL amyloidosis, it can be considered based on NT-proBNP 5000 ng/L level. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Complications of Total Laryngectomy

2020 ◽  
Vol 25 (1) ◽  
pp. 10-18
Author(s):  
Mohammad Ashequr Rahman Bhuiyan ◽  
Md Zakaria Sarker ◽  
Md Nazmul Haque ◽  
Saif Rahman Khan ◽  
Towsif Bin Mamoon ◽  
...  
Keyword(s):  
Wound Infection ◽  
Total Laryngectomy ◽  
Stage Iv ◽  
Stage Iii ◽  
Pharyngocutaneous Fistula ◽  
Glottic Carcinoma ◽  
Carcinoma Larynx ◽  
Postoperative Hematoma ◽  
The Mean ◽  
Advanced Laryngeal Carcinoma

Objective: To observe Post-operative complications of Total Laryngectomy in advanced Laryngeal Carcinoma Patients. Methods: This prospective observational study was conducted in National Institute of ENT, Tejgaon, Dhaka. Study duration 3 years, from January 2015 to December 2017. 17 patients were selected who underwent total laryngectomy for histologically proven advanced carcinoma larynx. Patients were followed up monthly for 3 months & then after 6 months for life long. Results: The age of the patients ranged from 39 to 66 years. The mean age was 47 years. Most of the cases are supraglottic carcinoma 12 (70.59%), Glottic carcinoma in 5 (29.41%) & no subglottic carcinoma. In this study, out of 12 supraglottic cases, 4 patients were presented in stage III & 8 in stage IV. Among the glottic cases 1 patient presented in stage I, 2 in stage III & 2 patients presented in stage IV. Patients were followed up monthly for 3 months & then after 6 months for life long. 2 patients (11.76%) developed pharyngocutaneous fistula within 7th to 15th post-operative day & these patients were managed conservatively which involved adequate drainage, frequent dressing & fresh blood transfusion. With these conservative management fistula healed completely within 3 to 4 weeks. 3 patients (17.65%) developed wound infection. Wound swab was sent for culture & sensitivity and antibiotics changed accordingly. Wound healed within 2-3 weeks with conservative treatment & adequate aseptic dressing. 1 patient (5.88%) developed postoperative hematoma which was drained immediately. This patient developed wound infection later on & was managed conservatively. 2 patients (11.76%) developed stomal recurrence 4 months after surgery, which was confirmed by biopsy. The cases were inoperable & were sent for radiotherapy. 2 patients (11.76%) developed dysphagia due to pharyngeal stenosis 4 months after surgery. Conclusion: The most frequent troublesome immediate complication is pharyngocutaneous fistula all of which have been treated conservatively with satisfactory result. Preoperative radiotherapy is an important risk factor for the development of pharyngocutaneous fistula in total laryngectomy. Bangladesh J Otorhinolaryngol; April 2019; 25(1): 10-18

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