Most of the surgical operations designed to resect cancer with a safe margin and at the same time to conserve the functions of the larynx are known collectively as “conservation surgery”. The one feature that most of these various operations share in common is a saw cut through the thyroid or cricoid cartilage. It is important, therefore, to know whether the laryngeal framework (thyroid or cricoid cartilage) has been invaded by cancer arising in the mucous membrane of the larynx.
Serial section studes of over 200 laryngeal specimens removed for cancer indicate that the surface appearance of the primary growth is important in estimating the extent of invasion into the soft tissues within the larynx or the possibility of invasion into the laryngeal framework. For purpose of presentation, cancer will be grouped under five headings: Glottic, Subglottic, Supraglottic, Transglottic and Pyriform Sinus.

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Microsurgery of the larynx has been satisfactorily employed in more than 2000 cases of various kinds of laryngeal lesions. This new surgical procedure can be used not only for cure of lesions, but also for improving phonatory function. In addition, stroboscopic light was employed for the light source of microlaryngoscopy in place of conventional light source. Thus, microsurgery of the larynx can be carried out under stroboscopic observation of the vibratory pattern of the vocal cords. This “Stroboscopic microsurgery of the larynx” has been employed in almost 400 cases of various kinds of laryngeal lesions.
Advantages of this method are as follows.
(1) Thanks to stroboscopic view, it is much easier to know where in vocal cords and how surgical procedures should be carried out.
(2) As confirming the vibratory pattern of the vocal cords, more precise and active surgery can be performed.
(3) Exact completion time of the operation can be obtained by observation of the vibration of the vocal cords.
(4) It is almost without failour to obtain post operative improvement of the voice.
(5) Prognosis of post operative phonatory function can be gained just when the operation is finished.
From the above-mentioned facts, it could be emphasized that this newly developed surgical procedure is remarkably useful for improving phonatory function.

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319 cases of esophageal cancer were stastistically analysed in this report. They had been treated in 158 ENT institutes in Japan during the past five years.
The data in this series included cancers restricted in the cervical esophagus (Ce) and those extended either into the thoracic portion (Ce-Iu) or into the hypopharynx (Ce-Ph).
Analysis was carried out with special reference to
1. sex preponderance
2. grouping into the decade of age
3. end-results of treatment
4. relationship between T and alival-rate
5. relationship between N and alival-rate
6. relationship between type of therapy and alival-rate
7. relationship between type of reconstruction and alival-rate
8. relationship between type of reconstruction and functional prognosis
9. possibility of laryngeal conservation
10. cause of death
11. cause of death in the group of No
12. clinical significance of prophylactic neck dissection

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During the years 1961 through 1974, 82 patients with Carcinoma of cervical esophagus were treated primarily at the Cancer Institute Hospital.
(1) 55 patients were treated mainly by external radiation therapy alone, and its five-year crude survival rate was 10.9%.
(2) 15 patients were treated by preoperative irradiation (4000 R) and radical surgery, nine of these still survived and lived well for many months postoperatively. It was clear from these data that the most effective treatment method was the combined therapy of radiation and surgery.
(3) 32 cases of cervical esophagus were reconstructed by the various types of skin flaps;
D-P flap (12 patients), lining antenior chest flap (10 patients), lining D-P flap (6 patients) and local skin flaps (4 patients). The operative techniques of reconstruction were discussed.

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The author has discussed on irradiation techniques for the cervical esophageal cancer.
We have applied the “Water conpensated irradiation technique” instead of the double wedge technique because of the practicability for the routine work.
However, we are now trying a new rotational irradiation technique for the cervical and upper intrathoracic esophageal cancer.

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For the surgical treatment of the cervical esophogieal cancer, one stage operation (resection and reconstuction was performed through the neck dissection, right thoracotomy and laparotomy.
Visceral replacements were employed by the stomack (25 patients), the colon pedicle graft (6 patients), the skin-roll graft (4 patients) and the jejunal free graft (2 patients).
Stomach replacement has a very rare possibility of remaning the invasivei cancer at the end of anal sidle and missing the skip lesions in the remaining esophageal wall, and then it is possible to remove the lymph nodes of the posterior mediastinum. The more advantage is the least anastornosis (pharyngo-gastrostomy) and the early oral intake of food.
In our all stomach replacements, it was easy to draw the stomach up to the pharynx and establish an immediate pharyngo-gastric anastomosis.
From this above reasons, it may be recommended this stomach replacements is adequate for the treatment of the cervical esophageal cancer.

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Several considerations were undertaken on the problems in surgical treatment of carcinoma of the cervical esophagus on the basis of our experience on 12 cases. Of 8 patients who underwent resection of the lesions and reconstruction of the esophagus, 5 had the resected portion of the esophogus replaced by a colon segment with vascular pedicle, and showed a satisfactory postoperative result. In one of the recent cases, “blunt dissection” of the esophagus was performed and a skip lesion was disclosed in the esophageal mucos a far apart from the primary. On deciding the surgical indication and extent of lymph node removal in this particular lesion, we pay a special attention to the local findings and locate the lesion based on the level of the esophageal orifice at the lowest line of the 6th vertebral body evident on the x-ray films.
We would like to emphasize that a combined resection of the pharynx in association with esophagectomy and wide-spread removal of the cervical lymph nodes should be considered depending upon the findings of each case. One of our patients receiving cervical esophagectomy and reconstruction with a colon segment now postoperative at 6 years and 3 months is capable of “colonophony” and uneventful for his routine living.

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29 cases of the cervical esophageal cancer (including the cases of which cancerous invasion reached the upper thoracic esophagus) have been resected in our hospital. In six cases of these, the resection was carried out, but the esophagoplasty was not performed. In the remaining 23 cases, the esophagoplasty was carried out at the same time of the resected procedure.
The digestive tract (such as the stomach and colon) was utilized for the esophagoplasty in all cases. The per oral nutrition was able to taken on ten days after operation.
Free transplantation of the intestive and colon between pharynx and cervical esophagus, colon interposition between pharynx and stomach, and pharyngogastrostomy were carried out as the operative methods. The operative mortality rate was 9%. Recently pharyngogastrostomy was performed more freaquently. To elongate the gastric tube, the circular cuttings in the sero-muscular layer of the stomach were carried out throughout the stomach tube.

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The bronchial hyperreactivity in bronchial asthma was studied by means of measuring the changes of forced expiratory volume one second (FEV_1.0), flow-volume (F-V) curve and respiratory resistance (Rr) with methacholine inhalation in 92 patients with asthma, 50 patients with respiratory disease withont asthma and 20 normal subjects in total of 162 individuals. Various relating factors to the bronchial hyperreactivity were also investigated.
The results were as follows.
1. An increased Rr (p<0.001) and decreased FEV_1.0, V₅₀/VC (p<0.001) and V₂₅/VC (P<0.05) by methacholine inhalation were recognized in asthmatic patients, and clear hyperreactivity in upper and peripheral air ways was revealed in those patients of respiratory diseases without asthma and normal individuals.
2. Rr was inproved by inhalation of bronchodilator (P<0.01) and FEV_1.0, V₅₀/VC (p<0.05) but V₂₅/VC was changed unclearly. The improvement of peripheral air ways were uncertain compared with the upper air ways.
3. The bronchial hyperreactivity to methacholine, histamine and acetylcholine inhalation had similar response with one another.
4. The patients with asthmatic history over 20 years' duration or severe asthma revealed a clear decreased FEV_1.0, F-V curve and increased Rr by methacholine inhalation, which indicated the hyperreactivity of the air ways. However, specific relation could be found between the hyperreactivity of air ways and the other factors such as age, sex, type of asthma, family history and so forth.
5. The response to methacholine was supressed by the treatment before inhalation of bronchodilator and beclomethasone aerosols. Although any definite difference was not suggested among these drugs, the pursuit of the identical subjects indicated the tendency of a decreased response to methacholine during the treatment of hyposensitization and inhalation of DSCG and beclomethasone.

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We have investigated, changes in the optic glass-fiber due to X-ray irradiation from the stand point of radiation chemistry.
Measurements of the absorption spectrum and the free electrons to the each sample of the optic glass-fiber which was irradiated by different X-ray dose, were made at room temperature with a Electron Spin Resonance apparatus. Measurements were taken immediately after and monthly follow up. Following conclusion were made after this study;
1. ESR absorption changes appeared in the optic glass-fiber at more than 100 R of exposure.
2. 300, 1000 and 2000 R of X-ray irradiation to the optic glass-fiber produced distnct ESR absorption curves and the shape of these curves were proportional to X-ray dose.
3. Thermal anneal phenomena were confirmed by ESR absorption curve data during monthly follow up. Thermal anneal occurs more rapidly in samples exposed to less irradiation.
4. ESR changes below 75 R of X-ray irradiation to the optic glass-fiber did not demonstrate ESR absorption curves, however, their existence is strongly suggested by data obtained at larger exposures.

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In a non-contrasted foreignbody in esophagus, it has been forbidden to use barium sulfate as a contrast media.
We reported that we could remove it without difficult after we had performed esophagogram with barium sulfate to one patient with a non-contrasted foreignbody (a bone of a sea bream) in esophagus. It is beneficial to use contrast media, because man can know a position of a staying foreignbody and diagnose it's complication. On the other hand, as barium sulfate remains in esophagul wall, there is great posibility to makeinfection reinforced and prolonged. But, due to the current development of antibiotics and the systemic management, it is able to protect it. Barium sulfate is less irritative than iodine. Moreover it is easily and earlier excreted. We conclud that in a non-contrasted foreignbody in esophagus, man tries to remove it after esophagogram with barium sulfate.

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