We discussed about the fundermental problems of X-ray examination of oesophagus. In the fluoloscopic examination of oesophagus, hitherto many physicians examined it in the right oblique position. But in my opinion, in the principal methode of fluoloscopic examination of oesophagus, upright postero-anterior position and lateral position should be included. And if necessary, other arbituary positions must be considered. But the examination with lateral position with 60-70 KV X-rays are difficult because of low penetration of the X-ray in these voltage range. 140 KV X-ray is adequate for the oesophagus examination if these positions. The 140 KV X-ray is more usefull for the analysis of oesophagus lesion. Postero-anterior radiogram of oesophagus of about 60 KV is hard to read, as most of delicate changes are obscured by dense Ba shadow. The lower the voltage of X-ray is, the more the exposure dose to patients.
In order to reach the precise diagnosis of pulmonal and mediastinal diseases, we have to examine the oesophagus with X-ray. For instance, we have experienced a patient of the perforation of oesophagus cancer who was misdiagnosed as lung abscess, and this patient did not show any oesophageal complaint, also an other case of oesophageal cancer was overlooked by other physician as this patient did not complain any system due to oesophagus stenosis; this case was diagnosed with our routine oesophagus examination.
We recommend 30 to 50cc hard Ba meal (Ba 2.5: Water 1) for the X-ray examination of oesophagus. This Ba meal can fill the total length of oesophagus for about 5 to 30 minutes and if a small quantity is used, oesophageal mucosal pattern is demonstrated.
Now we are examining routinely with this methode, the oesophageal of patients who come to our department with gastro-intestinal complaint.
We are perfoming this routine examination to find out early cancer of oesophagus.

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1) Referring to a large literature published up to 1963 in the world, 362 tracheo-bronchial plasty cases were commented on statistically. Traumatic injury was the major cause in 113 cases and ranked first. Traumatic injury following a traffic accident has been increasing recently in number. Site of injury was mostly found in the trachea, especially the cervical trachea. Follow-up studies revealed successful recovery in 86% of the cases operated in an early stage and in 72% of that operated rather late. Concerning to the method of surgery, the results of the suture method and the resection-anastomosis method were both satisfactory, that of the transplantation and prosthesis ended mostly in failure except the patch graft method.
2) We experienced 22 cases of tracheo-bronchial plasty in Keio University Hospital. Four cases of them who had undergone cervical tracheal plasty were reported in detail.
3) In order to study the limitation in length of tracheal resection, Dr. Koizumi of our Surgical Department mesured extensibility of the trachea by means of bronchography. He reported that the physiologically natural extensibility of the trachea was 22.7% of its total length and the trachea of the adult extended 26mm on the average. He also measured extensibility of corpses' resected tracheas and found that the extensibility was definitely in inverse proportion to the age. In this study the extensibility was 41.6% in the teenagers, 17.2% in the sixties, and 24.3% on the average. From the results of his study it is concluded that the standard limitation of tracheal resection is 2.5cm in length and that an amount to be resected has to be decided in accordance to pulmonary lesions and an age of a patient.
4) The author, finally, reported the results of his animal experiments on tracheal reconstructive surgery. Reconstruction using “PAIREN” mesh and fascia is the best among other various methods of prosthesis. Satisfactory results were obtained in 60% of the cases using pedicled tracheal cartilages as a support and 56% of the cases using horse-shoe shaped steel wire. These results give us the bright prospects for tracheal prosthesis in clinical use.

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Laminagraphic observations have been made on 25 cases with laryngeal cancer, which were classified in supraglottic (8), glottic (5), subglottic (6) and extrinsic (6) type from the laryngoscopic (25 cases) and macroscopic findings (15 resected cases).
From these observations it was concluded that the laminagraphy of the laryngeal cancer was of value in determining the exact limits of subglottic extension and the invasion to piriform sinus, in the visualization of the regression or the extension of tumor during irradiation therapies, and in the confirmation of the direct and indirect laryngoscopy.

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The authors took statistics of 173 cases of foreign bodies in esophagus and trachea or tracheal trees for the past 22 years since 1943, and discussed the problem concerned with the kind of foreign body, age and sex of patients, motive of accidents and some of complications.

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Patient (37 years old, Female) is no sooner sprayed in pharynx and larynx 4%-Lidocaine in order to inlet Metras's sonde in trachea, than she falled into convulsion (tonic, clonic), dyspnea and cyanosis. And died after three hours in spite of many effective emergency treatment.
As considerable cause:
(a) Hepatic insufficiency (For the patient has long taken PAS, INAH)
(b) Depravation of general appearence (For the patient has long suffered pulmonary tuberuclosis)

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