In consequence of the use of seatbelts, and of the increase in the number of people who keep the traffic rules, the incidence of laryngotracheal injuries induced by car accidents has significantly reduced. Recently, we do not encounter patients of laryngotracheal injuries due to ordinary types of car accidents.
Laryngotracheal injuries in three cases reported in the present paper were induced by unusual types of traffic accidents.
The first case was a boy aged 16, who was strangulated tightly with his long muffler, when he was riding his motor-bike and fell down to the ground.
The second case was an 18-year-old male. While riding his minibike (tiny motorbike), he inadvertently collided on his neck with the chain stretched between school gates. At surgery a complete tracheal separation was recognized.
The third case was a 21-year-old male. While riding his bicycle, he fell on the ground and struck his neck with the handle of his bicycle.
The usual signs and symptoms of blunt laryngotracheal injuries were observed in the present cases. Abrasions and contusions of the cervical skin without a penetrating wound, subcutaneous emphysema, and hemoptysis could be noted. The appearance of the neck was almost normal, though severe laryngotracheal injuries were recognized at surgical exploration.
On the basis of these cases, principles of the diagnosis and treatment in acute laryngotracheal injuries were discussed.

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Four cases of tracheal stenosis following the tracheotomy are presented.
The pathogenesis of tracheal stenosis is also discussed.
In one patient who kept a nasopharyngeal intubation for 8 months, decanulation was not successfully achieved. In all cases including this patient, however, decanulation was completely successful using silicone T-tube. The duration of silicone T-tube insertion in four patients was 7 months, 7 months, 9 months and 12 months respectively.
All patients were allowed to stay at home with T-tube in place.
It is the authors' opinion that silicone T-tube may be the most effective in selected cases, though many techniques have been applied for the treatment of tracheal stenosis.

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Recent advances in surgery have allowed primary anastomosis of the trachea, even in patients who require a long segment resection. Problems of preservation of recurrent laryngeal nerves and airway support, however, have yet to be solved, if transverse division of the airway at the level of the inferior border of the thyroid cartilage is to be performed.
This paper reports an experimental study of reconstructive surgery after excision of the cricoid arch and a half of the posterior cricoid plate with some segments of the trachea in dogs.
Bilateral recurrent laryngeal nerves must be identified on each side and viewed upward to the posterolateral aspect of the cricoid cartilage, where they pass immediately behind the cricothyroid joints and enter the subglottis. The resection line of cricoid is started at the inferior border of the thyroid cartilage in front and is passed posteriorly and inferiorly to cross the lower margin of the cricoid plate below the level of the exposed nerves. In order to transect the airway at the higher level posteriorly, a half of the posterior cricoid plate is removed. This procedure is best done with fine rongeurs. The distal resection line is made through the upper part of trachea. A primary thyrotracheal anastomosis is achieved by advancement of the distal tracheal stump upward. The distal trachea is “telescoped” into the residual cricothyroid joints. Interrupted sutures of 000-Prolene are used for the anastomosis, with the knots tied outside the lumen.
This technique provides a method for resection of the cricoid cartilage with preservation of recurrent laryngeal nerves and reconstruction in one stage operation.

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The new anticholinergic compound Sch 1, 000 (ipratropium bromide) has been reported to be an effective bronchodilator without significant atropine-like side effects.
We evaluated the effectiveness of nebulized Sch 1, 000 in 45 patients with bronchial asthma.
Sch 1, 000 has an effect on slight and moderate asthma attacks. However, the inhibitory action of this drug to asthma attack was not so strong than that of β-stimulants and corticosteroids. The protective effects of Sch 1, 000 on exercise-induced bronchoconstriction and antigen-induced asthma were clearly observed.
These results suggest that Sch 1, 000 has a less effect than β-stimulants, while the protective effects on exercise-and antigen-induced bronchoconstriction are distinguished.

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It is our impression that Holzknecht's signs are not correctly understood by some of clinicians, but through our experience, we have found that Holzknecht's signs are most useful in diagnosis of radiolucent foreign bodies in the bronchi. Holzknecht in 1899 reported that radiological signs of bronchial stenosis were characterized by inspiratory retraction of the mediastinum and heart into the affected chest cavity.
The signs can only be observed by comparison of two posterior-anterior X-ray films; one at deep inspiration and the other at maximal expiration, thus confirming the difference between the two.
The signs can be seen at various stages of changes due to a foreign body progressing from the initial simple stenosis to valvular emphysema and further to atelectasis.

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Sixty-two cases of esophageal varices have been examined in our hospital for the last one and a half years. Bleeding varices were found in 32 cases. The characteristic differences in the esophagoscopic findings between bleeding and non-bleeding varices were as follows. (1) Varices extending the entire length of the esophagus were seen in the bleeding cases more often. (2) Bluish varices were seen in 25% of the bleeding cases, while they were found in 8% of the non-bleeding cases. The red sign was found in the majority of the bleeding cases. (3) The tumorous and nodular forms of varices were found in the bleeding cases more frequently. (4) Erosive esophagitis was rare, and it was seen in only 2 of the bleeding cases.
Forward viewing fiberscopes, such as the esophagofiberscope and the pan-endoscope, were utilized for the examination of the varices. An esophagofiberscope with a tip bendable up to 210 degrees was especially appropriate for observation throughout the esophagus and the gastric cardia.
In 334 cases of urgent endoscopy, gastric or duodenal ulcers were found in 51%. Esophageal varices were seen in 11%, in some of which gastric and/or duodenal lesions were also found.
For the surgical treatment of esophageal varices, esophageal transection, splenectomy and devascularization around the stomach have been carried out. Transection of the esophagus was easily performed using a sewing instrument. In a long-term follow-up over one year after surgery, a relapse of varices was seen in 10% of the cases.

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A boy, aged six, had hoarseness with a history of recurrence after endolaryngeal extirpation of granulomatous lesion in his larynx. Mirror examination revealed a reddish granuloma behind the right false cord. Microlaryngoscopy was employed under general anesthesia but complete resection of the lesion was impossible.
Pathological diagnosis was pyogenic granuloma.
Lateral laryngotomy approach was, then, selected as the treatment of choice. A small piece of shrimp-appendages of about 10mm length was detected within granulation tissue based deep in the ventricle.
Granulation tissue including the foreign body was removed by a cupped forceps and electrocoagulated. The surgical procedure was accomplished safely under N. L. A. together with topical anesthesia without intubation.
No recurrence was observed and postoperative laryngeal function was normal.

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