Cancer of the junction at the cervical and thoracic segment of the esophagus has been thought to lie beyond the scope of surgical intervention, but the author treated 6 cases of cancer of this area with one-stage operation consisting of thoracotomy, cervical and thoracic esophagectomy, total laryngectomy, elevation of the stomach in the anterior chest wall and gastrohypopharyngeal anastomosis. All patiens were able of deglutition in the early postoperative days. postoperative function studies of the recontructed food passage revealed satisfactory results, and two patients still survived and lived well for three years postoperatively.
Considering the surgical methods and the postoperative functional result of so-called cancer of the cervical esophagus, in which carcinomata localized only in the cervical esophagus, by the operative method mentioned above it was feasible to minimize the possibility of leaving any remnant of cancer tissue in the cut end of the esophagus, and to remove the intrathoracic lymph nodes as much as attempted. The use of the stomach as a substitute of the esophagus was preferable because of the technical ease and of abundant blood supply as well as of elasticity of the stomach.

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237 patients were diagnosed as the cancer of hypopharynx in the recent 13 years (1958-1670). Among them, a total of 162 patients were treated primarily at the Osaka University Hospital.
The most reasonable treatment was the pharyngo-laryngo-esophagectomy with hemithyroidectomy following irradiation with the the dose of 4000R. in three weeks as the pre-operative irradiation.
The five-year crude survival rate of this disease was 83% in stage 1, 41% in stage 2, 25% in stage 3, 5% in stage 4, and 25% on the average, respecctively.
In each treatment, the five-year crude survival rates were 9% in irradiation only, 36% in operation only, and 50% in the pre-operative irradiation, respectively.
Consequently, the combined therapy becomes necessary.

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Technics and results of radiotherapy of hypopharyngeal and cervical esophageal cancer were surveyed. Remarkable improvement was found in the recent results of treatment both by radiation and surgery. Especially the combined treatment was the best in the result. Accurate treatment technics using modern supervoltage radiations enabled us to cure cases of early stage with minimum loss of function and with minimum radiation injury. Our treatment policy was as the following: T₁ N₀; Radiotherapy is the first choice. T₁N₊, T_2-3 N₀ or₊; Preoperative irradiation and surgery. Advanced cases; by radiation alone. 5 year survival rate for National Cancer Center cases were 18/63 28.5% for total cases, 18/44 41.0% for radically treated cases, 6/20 30% by radiation alone, 11/21 53% by radiation and surgery and 1/3 33% by surgery alone respectively. Certain number of far advanced cases who had extended primary and metastatic lesions including pulmonary metastasis showed surprizingly good responses to the radiotherapy and survived more than 5 years. These interesting cases highly stimulated us to consider the role of host resistance in the radiotherapy.

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Chemotherapy of hypopharyngeal and cervical esophageal cancer generally is considered to have minimal clinical significance, useful only as an adjuvant therapy.
As to the methods of chemotherapy performed on actual clinical cases, there are intraarterial infusion combined with surgery and general adminstration for the purpose of prevention of distant metastasis. The intra-arterial infusion chemotherapy is hardly available for this disease, since it is difficult to infuse chemotherapeutics into the hypopharynx and cervical esophagus by retrograde catheterization through Truncus thyreocervicalis. On the other hand, general adminstration of anticancer agent is performed for the purpose of the prevention of distant metastasis, especially for the inhibition of pulmonary metastasis.
As to the effect of Bleomycin in treatment of this disease, the rate of effectiveness is 42.8% in total 35 cases.
The posibility of this disease being caused by means of Bleomycin alone was exceedingly small. But, the expectation was greater when the agent was adminstered in combination with irradiation treatment, in which the dosage of the either may be much smaller than when using them alone. The direct local injection of Bleomycin on recurrent foci is a curative therapy.

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Clinical and histopathological examinations were performed on 188 cases of vocal cord polyp.
In our patients the vocal cord polyps were most frequently found in males than females, the ratio being 6 to 4. In one half of these cases, namely 89 cases, the polyps were located approximately at the junction of the middle and anterior thirds of the total cord length. The size of polyps was mostly either miliary or rice grain in size. As to the duration of symptoms (hoarseness), about six months had elapsed before operation in most cases.
After the histological examination, the epithelial layer of the polyps showed less histological changes as compared with the subepithelial layer.
The subepithelial layer showed various changes, and the author observed regional circulatory disturbances such as hemmorrhage, seruminfiltration, vascular expansion and thrombosis. After our examination the histopathology of the vocal cord polyp would be classified in the following four types, d. i. exudative (102 cases), proliferative (40 cases), combined (22 cases) and granulation (8 cases) types.
Some correlation between the duration of the lesion and their histological findings was observed. Either exudative or proliferative type was observed in both cases with shorter or longer duration, but there were more cases belonging to the proliferative type than those of exudative type in the cases of more than 4 years duration. After these findings it is considered that the initial exudative histological changes might become proliferative with time.
The author would conclude that the vocal cord polyps might appear owing to eigher the localized circulatory disturbances or inflammations, since there were histopathologically findings caused by the circulatory disturbances and also some findings associated with inflammation.

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In order to estimate the articulation grade of pronunciation of an esophageal voice, the pronunciation test which had reported by Okamoto and others were undertaken in seven laryngectomized patients who were operated at the Department of Esophagobronchology of the Osaka Red Cross Hospital. The results were as follows:
1) Percentage of the correct articulation grade of pronunciation of esophageal voice which can commonly talk with man were between 60% and 70%. This percentage would not be change unless the general condition of the patients become worse. And there were no difference between “talk with man fluently” and “talk with man” in view of study.
2) The correct pronounced syllables were /Su/ /So/ /Na/ /Chu/ and /Nya/, and the incorrect pronounced syllables were /Ha/ /Ho/ /Hyu/ /Hi/ and /He/.
3) In order to estimate the correct articulation grade of pronunciation of esophageal voice, the author had selected 100 Japanese syllables. And from this study, it would be available better to select Taguchi's test words.

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It is a principle that the upper bronchoscopy should be used to remove the foreign bodies in the bronchus. However, lower bronchoscopy can be used in the following cases, that is, severe dyspnea, little confidence to remove with upper bronchoscopy, no sufficient instruments for removal, foreign body may be dropped off at the time passing through the glottis and so on. In cases of lower bronchoscopy, many problems will be occured concerning with the tracheotomy, especially attention should be paid to decannulation.

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