This paper discusses our continuing investigations into the reflex or mechanical changes which influence lung compliance from stimulation of the nasal mucous membrane.
The experiments were performed on 13 laryngectomized patients (11 males and 2 females, age range 41-76 years).
All measurements were made in a sitting position, during normal breathing in the laboratory atmosphere. Lung compliance was measured before and after irritation of the nasal mucosa by continuous cycling method.
No statistically significant changes were observed. As a result of this phenomenon, it is probable that uneven distribution of air plays a role in these changes.

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We performed the esophagocardioplasty with gastric patch in the device of SATO and HIRASHIMA on 44 cases of achalasia of esophagus. We evaluated the post-operative results of these cases with esophago-cardiac manometry and pH measurement, which would be the best indicators on the esophago-cardiac function.
We comfirmed that this method improved the passage prominently even in the progressed cases, judging the resting pressure and manometric configurations, and that this method preserved very well the anti-reflex function of the cardia, judging from the pH measurement.
On the selection of the operative methods, we believe that, on the early cases, Heller's method and esophagocardioplasty with gastric patch are the choice and, on the progressed cases, esophagocardioplasty with gastric patch is to be performed.

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The organized sequence of excitation and inhibition leading to the performance of swallowing is known to be generated in the medullary swallowing center. The center is elementarily triggered into operation by afferent impulses from oropharynx. However, the center receives also influences from the anterolateral frontal cortex as well as from the lateral pontine reticular formation. Any disturbance of such neural areas and/or the routes between them may cause varieties of incoordination of swallowing.
In the infants of early postnatal periods, the coordination of the center is poor, and its achievemeat largely depends upon the oropharyngeal feedback. Asphyxia disturbs also the functioning of the center.
These facts, among other things, have been discussed in relation to clinical occurrences of dysfunction of swallowing

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To study the factors associated with aspiration pneumonia in the aged, 289 cases of senile pneumonia have been reviewed.
These factors included esophageal and neurologic discorders. Treatment comprised administration of oxygen, and administration of steroids, antibiotics, digitoxin, and bronchodilators.
Poth morbidity and mortality, however, were high; morbidity was about 33 percentin old patients.

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In spite of the clinical importance, there is little experimental informations on the influences of deletion of selected muscles upon the protective closure of the larynx during swallowing.
In this study, particular attention was paid to the roll of selected muscles in and around the larynx upon the laryngeal movements during the swallowing. Two different experimental procedures were adopted using mongrel dogs. In the first series of the experiments, laryngeal closure during the swallowing were photographed on 16mm movie films under a suspension laryngoscope. In the second series, electrical activity of several muscles in and around the larynx was recorded during the swallowing simultaneously with up and down movements of the entire larynx with a polygraph unit. Each recording was made while the the action of selected laryngeal muscles were deleted.
On the basis of the results of the experiments, the following conclusions appear justified:
1. In the normal dogs, each muscle is activated under a consistent time program during reflex swallowing.
2. When the bilateral recurrent laryngeal nerves are sectioned, the closure of the larynx is markedly disturbed. Even in this situation, however, a complete closure of the larynx still takes place, although the closed period is extremely short.
3. When the bilateral inferior pharyngeal constrictor muscles are sectioned, in addition to the previous condition, the closure of the larynx is markedly affected and there is no glottic closure are at all.
4. Upward movement of the hyoid bone is performed mainly by the action of the suprahyoid muscles, particularly the geniohyoid muscle. The intrinsic and extrinsic muscles of the tongue also participate in the elevation of the hyoid bone.
5. The elevation of the larynx is chiefly performed by the action of the thyrohyoid muscle with co-operation of the suprahyoid muscles.

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Surgical reconstructive methods after resection of the esophagus varies according to the location of the lesion. For lesions of the esophagocardiac junction, intrathoracic esophagogastrostomy through a left thoracotomy with transdiaphragmatic laparotomy has been done, but recently reconstruction by Roux-Y esophagojejunostomy or segmental jejunal interposition between esophagus and duodenum have been preferred. For lesions of the thoracic esophagus, esophagectomy through a right thoracotomy followed by laparotomy is our routine approach. The reconstructive method is cervical esophagogastrostomy by bringing up the stomach through a retrosternal tunnel.
For lesions of the cervical esophagus, an effort should be made to preserve the larynx. The routine procedure consists of extraction of the thoracic esophagus, bringing up the stomach through the posterior mediastinal tunnel followed by cervical esophagogastrostomy. For advanced lesions of the hypopharynx, extraction of the esophagus is combined with pharyngolaryngectomy and permanent tracheostomy. Reconstruction is effected by pharyngogastrostomy.
The extraction of the esophagus is performed by blunt finger dissection, eversionstripping with a vein stripper, or dissection with ring dissector.
All these esophageal reconstructive procedures have been performed with small surgical risks (operative mortality rate 2/107, 1.9%).

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Dysphagia in childhood to which surgical operation is required, is relatively uncommon. Congenital abnormalities such as esophageal atresia including postoperative disturbance and esophageal stenosis are main subjects of surgical treatment. Current views on surgical care and ultimate management for these conditions are discussed.

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