In recent years, the definite diagnosis of laryngeal diseases with a minimized discomfort to the patient has become possible by frequent use of flexible laryngofiberscopes. However, there have been difficult cases for an endoscopic examination even by this type of flexible laryngofiberscope because of visual disturbance due to hypersecretion. And also the collection of specimens for histological examination and the therapeutic procedures such as the removal of pedunculated polyps and suction of secretion have not been achieved with the current diagnostic fiberscopes.
Therefore, we have taken those problems into consideration, and recently developed a new therapeutic laryngofiberscope.
We introduce this new fiber-laryngoscope for therapy with its specifications and procedures, and make a clinical report on 6 cases which we have successfully performed endoscopic examinations and therapeutic manipulations with this instrument.

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In order to clarify the release mechanism of the plasminogen activator in the tracheobronchial secretion of rats, the effect of some vasoactive drugs on its activity in the secretion was studied in this experiment The results obtained from this experiment were as follows After the injection of noradrenalin, the blood pressure was temporarily elevated and the fibrinolytic activity in the circulatory blood was also elevated, and then the activity of plasminogen activator in the secretion increased On the other hand, after the injection of atropine sulfate, the blood pressure and fibrinolytic activity were not changed and then the activity of plasminogen activator in secre tion decreased in comparison with the activity after the injection of noradrenalin
From these results it was suggested that the release of plasminogen activator into the lumen of the respiratory tract might be partly regulated by neurogenic system

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Cellular reaction and infiltration in the bronchial walls, bronchopulmonary lymph nodes and spleens were histopathologically investigated in 31 autopsy cases of bronchial asthma and 5 autopsy cases of emphysema.
The number of bronchial mast cells in patients with death during a paroxysm was smaller than that in patients without a paroxysm Mast cells during asthmatic attack showed marked degranulation and decrease in number of granules The infiltration of inflammatory cells such as eosinophils, lymphocytes, and plasma cells in the bronchial wall was much more common in dead patients with suffocation than in those without a paroxysm. Plasma cells were infiltrated in the bronchial wall, especially around the bronchial glands. Lymphocytes were also infiltrated in the bronchial wall, gathering in groups like diffuse lymph tissue.
The bronchopulmonary lymph nodes showed variable histologic pictures. Enlargement of follicles, atrophy of follicles, fibrosis and eosinophilic infiltration were investigated. The spleen was rather small in half cases. Congestion and atrophy of the spleen were remarkable in suffocation.
From these facts, it was considered that degranulation of the mast cells, cellular infiltration and formation of diffuse lymph tissues in the bronchial wall and cellular reaction of the lymph nodes and spleens are possibly related to the occurrence of asthmatic attack.

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IgE, IgG and IgA levels in sputum and serum of eight patients with atopic asthma and of ten patients with non-atopic asthma were studied. Anti-house dust and anti-mite IgE antibody titers in sputum and serum of patients with atopic asthma were also investigated. Concentration of IgE was determined by radioimmunosorbent test and specific IgE antibody was determined by radioallergosorbent test. Concentrations of IgG and IgA were determined by single radial immunodiffusion. All patients were given skin test with extracts of house dust and mite antigen.
The following results were obtained:
1) In both sputum and serum, IgE levels were significantly higher in patients with atopic asthma than in those with non-atopic asthma. In patients with bronchial asthma, IgE levels in sputum were correlated with those in serum.
2) In patients with atopic asthma, anti-house dust IgE antibody titers/total IgE ratio in sputum was correlated with that in serum. Anti-mite IgE antibody titers/total IgE ratio in sputum showed a tendency to correlate with that in serum.
In both sputum and serum, anti-house dust IgE antibody titers/total IgE ratio was correlated with anti-mite IgE antibody titers/total IgE ratio. In seven out of eight patients with atopic asthma, specific IgE antibody titers/total IgE ratio was usually higher in sputum than in serum.
3) In both sputum and serum, IgE/IgG ratio was higher in patients with atopic asthma in those with non-atopic asthma. IgE/IgG ratio in sputum was higher than in that in serum.
4) IgA levels in sputum showed a tendency to be higher in patients with atopic asthma than in those with non-atopic asthma. IgE/IgA ratio in sputum was higher in patients with atopic asthma than in those with non-atopic asthma.
5) In patients with bronchial asthma, IgA/IgG ratio in sputum was higher than that in serum.
6) Anti-house dust and anti-mite IgE antibody titers in both sputum and serum were correlated with the threshold of skin test with extracts of house dust and mite antigen.

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Endoscopic procedures using hard scopes have developed primarily for the removal of foreign bodies in the air and food passages. Since foreign bodies have been removed by ENT doctors in general, endoscopic procedures in the ENT field are carried out mainly with the hard scope. Recently, fiberscopy has also been widely performed because of its easy handling and less discomfort to the examinee.
Selection of equipment for endoscopy should be made depending upon its purpose; for example, observation, biopsy, surgical manipulation, etc.
In order to clarify the differences in the nature of discomfort between hard scopic and fiberscopic procedures, both procedures were carried out on the same subject who was one of the authors of the present paper. It was found that discomfort or pain caused by a fiberscope was much less than that by a hard scope.
In addition, it was found that 4% lidocaine hydrochloride for spraying was very irritating, and dysphagia, painful sensation upon swallowing and foreign body sensation in the pharyngolaryngeal region were noticeable especially after the endoscopic procedure using a hard scope. Thus, the anesthetic method prior to endoscopic procedures must be much more improved.

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In 66 cases with esophageal achalasia who were treated in the authors' clinic during the last 20 years from 1958 to 1978, 22 cases had a history of respiratory complaints. Five cases out of the 22 had been treated for chronic bronchitis or bronchitis, the pertinent symptoms of which had apparently occurred from aspiration of ingested food into the bronchus. Cardioplasty was performed on these 5 cases mainly using the modified Girard's technique with successful results. In this report, the clinical courses of the 5 cases were presented with special reference to chest X-ray findings, preoperative care and anesthetic techniques.

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The clinical significance of cervical esophageal webs has yet to be established. Detailed examination of the pharyngoesophageal junction during the rapid passage of the barium bolus is essential for the diagnosis of the web. One hundred and ninety-one outpatients with globus symptoms were cinefluorographically examined by utilizing a 35mm cine camera incorporated in the fluoroscopy unit with a 9-inch image intensifier. Frontal and lateral views were obtained during the barium swallowing in the sitting position with the camera speed of 48 frames per second. The Tagarno projector was used for the study of cine films.
The classical cervical esophageal webs were demonstrated in 33 cases (17.3%) as thin indentations at the anterior wall of the cervical esophagus just below the cricoid cartilage. The webs varied in depth; 1mm in 7 cases, 2mm in 13, 3mm in 7, 4mm in 3, 5mm in one, 7mm in one, 8mm in one, and 10mm in one. The webs were demonstrated also in various durations; 10 cases in less than 6 frames (0.125 seconds), 8 in 6 to 12 frames (0.25 seconds), 13 in 12 to 24 frames (0.5 seconds), and 2 in more than 24 frames. The depth of the indentation was apparently not correlated with the number of frames of the detectable webs.
Web-like indentations were seen in the distal margin of the pyriform sinus and in the post-cricoid region of the hypopharynx as well, in 31 (16.2%) and 4 (2%), respectively.
It is most likely that the incidence of cervical esophageal webs increases with the use of high-resolution and high-speed cinefluorography.

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Intraepithelial lesion spreading around the main lesion of esophageal carcinoma may be significant for the evaluation of the prognosis. Therefore, we classify it into 5 types from X-ray findings and compare these types with the findings of the resected specimens.
i) A-type is characterized by slight rigidity seen at the margin of the esophagus and coarseness of the mucosal pattern.
ii) In B-type, together with rigidity of the esophageal wall, a fine granular pattern is seen on double contrast film.
iii) C-type, in which nodular and granular features of various sizes are seen, is divided into 2 sub-types, i. e., C₁ and C₂. Small nodular features belong to C₁ and large nodular ones with deep ulcer to C₂.
iv) Big nodules with smooth surface and scattered lesions with fine elevations characterize D-type.
Histological examination of the superficially spread lesion of A-type reveals carcinoma in situ. Likewise, carcinoma in situ with erosion is found in many cases of B-type. In C₁- and C₂-types, carcinoma infiltrates to or beyond the submucosal layer to form nodules. In most cases of D-type, lymphatic vessel invasion is seen in the mucosal layer and metastatic lesion comes out to the surface of the mucosa.
The prognosis of early esophageal carcinoma of A-type is good, but that of B-, C- and D-types is rather poor.

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Cervical periesophageal abscess is one of the complications of foreign bodies in the cervical esophagus. A case of dysphagia due to traumatic cervical periesophageal abscess is reported. The patient was a 58-year-old female who had complained of dysphagia and a foreign body sensation in the larynx for approximately 2 days after a piece of large fish bone was ingested inadvertently. Roentogenological examination revealed a marked thickening of the periesophageal region caused by submucosal emphysema and abscess. Clinical symptoms and roentogenological reviews confirmed the diagnosis. Therefore, the abscess was widely opened by the lateral cervical incision, but no foreign body was found. The submucosal emphysema was supposedly caused by active mobility of the foreign body and the abscess occurred by secondary infection. The main cause of dysphagia was the mechanical obstruction by emphysema and abscess, disturbing the passage of bolus and the elevation of the larynx.

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