Electromyographic and Roentgenological investigation on deglutition was done by means of simultaneous recordings of E. M. G. beams and X-ray television.
The bolus is transferred to the mesopharynx when the inferior constrictor and thyropharyngeus muscles are fully to be dilated, on the other hand, the mylohyoid and other muscles with hyoid bone are fully contracted.
Right at and after the bolus passes through hypopharyngeal area, thyropharyngeal and inferior constrictor muscles become fully contracted to make bolus reaches to the entrance of esophagus where the functional sphinctor, the cricopharyngeus muscle, is located. This muscle becomes fully dilated in order to accept the bolus to pass this point, then contracts in maximum point to have the bolus is ransferred to the esophagus where the esophageal peristalsis takes place.
Mechanism of the swallowing is really the series of actions of the muscles, namely; relaxation, contraction and relaxation. The only exception is the action of cricopharyngeus muscle. This muscle ordinarily stays in the phase of contraction and relaxes only when bolus reaches to this point.
Amplitudes of the muscle contruction range between 500 and 800 microvolts. The diseased shows the different patterns of deglutition. Generaly, dysphagia with the region of central nervous system shows the abnormal and disorganized patterns with probable abnormally higher and lower amplitudes and that with the region of lower motor neuron shows abnormal E. M. G. potentials besides.

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Basic investigation on the intraluminal pressure of the esophagus and its clinical applications are carried out, and also cinefluoroscopy of the esophagus and pH. changes of content of the esophagus are investigated.
1) Method: The intraluminal pressure is measured by means of Opentip Method and a) the resting pressures, b) pressures during primary and secondary peristalsis are recorded.
Investigations on c) the intraluminal temperature, d) pH., e) E. M. G. f) pneumography are also employed.
2) Results: The patterns of the pressure curve during deglutition in different parts on the lumen of the esophagus are obtained. There are many characteristics of the patterns of the curve in various pathological states such as achalasia, diffuse spasm or cancer of the esophagus.
3) Conclusion: Measurement of the intraluminal pressure of the esophagus is as valuable method as roentgenology and esophagoscopy for observation of the dynamic action of the esophagus and for diagnosis of diseases of the esophagus.

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The intraluminal electric pressure tracings method was applied on the diagnosis of the various esophageal diseases and the treatment of the patients.
An external fistula of the esophagus created on the experimental animals, canine and cats. Using this method the intraluminal resting pressure and the swallowing pressure were measured under the phisiologic condition.
Electromyogram of esophagus was obtained by implanted the electric node in the muscle.
The two methods described above explaine well the motility of the esophagus.
One hundred and eighty cases of the esophageal diseases were observed by the intraluminai electric pressure tracings method. Esophageal varices, short esophagus, esophageal cancer and esophageal achalasia showed different type of the motility of the esophagus and the esophagocardiac jnnction.
The details were discussed.

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The author has presented many radiocinematographs and X-ray films of the esophagus in order to show various kinds of abnormal esophageal movements and to clarify the clinical significance of the oesophagus movements.
The author's presentations of radiocinematographs are those of the normal oesophagus movement, two kinds of esophageal diverticulae, deglutition in cases of sideropenic dysphagia, oesophagitis, cervical and thoracic cancer of esophagus, oesophageal varices, idiophathic dilatation of the oesophagus and functional didisorders of the larynx, oesophagus and cardia.
The author found many interesting figures and abnormal mobilities of the oesophagus in his analysed results of the radiocinematografic figures and X-ray films of the oesophagus just above mentioned. Thus, from the clinical viewpoint, he emphasized the importance of the investigation of the oesophageal movement and also he stressed the necessity of taking the radiocinematographic pictures, or at least serial pictures of the oesophagus to secure the precise diagnosis of the oesophagus abnormalities and diseases.

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Authors found that intraesophageal pressure of patients who had succeed fluent esophageal speech is remarkably low and their esophagus work taking air in all the time.
From the view of these points, authors advise the laryngectomized patients to practise swallowing air and breathing abdominally all the time, which will decrease intraesophageal pressure and increase automatic movement of esophagus.

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The procedures in our laryngectomy cases are classified into two groups, A and B: A-1) preoperative radiation. 2) I or T like skin incision, 3) preservation of hyoid bone, 4) closure of pharyngeal wall with continuous sutures, 5) use of a feeling tube through nose, 6) postoperative radiation, B-1) U like skin incision (not irradiated preoperatively), 2) neck dissection, 3) resection of hyoid bone, 4) closure of pharyngeal wall with interrupted sutures, 5) oral nourishment on the third day after operation, 6) postoperative radiation.
Occurrence of the fistula-formations in our laryngectomy cases is 30% in A group and nothing in B.
If antibiotics are thorughly administered against secondary bacterial infection, we mention the other causative factors as follows: preoperative radiation, conditions of sutured would in pharyngeal wall, preservation of hyoid bone, nourishment by tube, formation of dead space, method of skin incision and closure of pharyngeal opening and procedure to crico-pharyngeal muscle. Refering to literatures, each factor in analyzed about our laryngectomized cases.
To attain the successful postoperative course, following methods are recomended: U like skin incision, resection of hyoid bone, reduction of tension on the upper lateral portions of pharyngeal opening. The pharyngeal opening is closed with interrupted inversionssutures. Inferior pharyngeal constrictor muscle is sutured but in patient with convulsive constitution, cricopharyngeal muscles are extended or cut off operatively External of the neck muscles should be redically removed.
If pharyngeal mucous membrane is too small to close it primarily, after detachment of posterior wall of pharyngeal mucous membrane from the prevertebral fascia, submandibular glands and external of the neck muscles are used.
In avoiding formation of the dead space, mattress suture and pressure dressing are recommended. In neck dissection cases, drain is introduced into the bilateral mandibular angle not deeply and removed the next day.
Pressure dressing is not changed for three days after operation. The patients are not nourished by the feeding tube. control urinary volume and its specific gravity and the patients are nourished solenly parenterally (glucose, aminoacid, vitamine preparations and sometimes blood transfusion). On the third day, nourishment is given orally. Problem of feeding posture is of importance and to prevent postoparative pneumonia, early ambulation is recommended. The broad spectrum autibiotics, to which pyogenic cocci have no resistance, are administered for two weeks at least.
By the treatment above mentioned, complete primary healings of operative would be accomplished, postoperative radiotherapy is started three weeks after and all tumor dosis is irradiated to the directions of tumor invasion and the probably disseminated site. When operating the patients irradiated preperatively, owing to the volume and direction of irradiation, the time of operation may be decided. But the duration is not yet standardized. We have consideration to the point that the contralateral neck dissection by Seiffert's skin incision is necessary some other time.

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A total of 101 cases with a complaint of abnormal sensations in the pharynx, larynx and esophagus was studied clinically and statistically. Various examinations including X-ray examinations of the neck, esophagus and stomach, endoscopic examinations of the esophagus and stomach, gastric juice and serum level were performed.
In 49 cases who did not have any findings to cause such abnormal sensation. I uptake and scintigram of the thyroid gland were done.
It wsa found that I uptake was generally low in these cases and the scintigram revealed slight enlargement of the thyroid gland.

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