This paper describes dynamics of the pharyngeal, or the second stage of volitional swallowing in normal and pathological conditions. The description is based upon our current investigations as well as upon available literature. In our investigations, simultaneous recordings of EMG of selected swallowing muscles and X-ray video images were adopted.
In normal swallowing, a series of events take place consistently with respect to timing during the pharyngeal stage. There is no clear-cut distinction between the oral and the pharyngeal stages in the activities of the pertinent muscles as well as in the movements of the food channel. It seems, however, to be practical to assume that the pharyngeal stage begins roughly with the first appearance of bolus in the pharynx and ends with complete disappearance of bolus from the pharynx in normal swallowing. From the neurological point of view, it turned out that this period corresponds to the period of relaxation of the cricopharyngeal muscle, lasting approximately 0.5sec.
Swallowing begins with an elevation of the larynx. Then, the velum and the tongue base begin to rise, the epiglottis to bend backwards, and the supraglottic region to close. Bolus first enters the pharynx when the velopharyngeal closure is about completed. Almost simultaneously with this, the cricopharyngeal muscle relaxes whereas the vocal fold adductors and the thyrohyoid muscle contract. Shortly after, peristaltic movements of the pharynx occur. When bolus is completely transported into the esophagus, the velum and the tongue base begin to fall, the larynx starts opening, and the cricopharyngeal muscle contracts to close the pharyngo-esophageal junction. The entire procedure ends up with a complete fall of the larynx.
Even in some pathological conditions, such as amyotrophic lateral sclerosis, oculopharyngeal muscular dystrophy and “cricopharyngeal achalasia, ” the muscles act in the similar fashion as in normal with respect to timing. This causes an incoordination of muscular activities and the passage of bolus. No feedback mechanism or volitional adaptation seems to be able to modify the timing of muscular exertion during the pharyngeal stage.

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A rare case of supraglottic laryngeal paraganglioma is presented. There have been only twenty-three other reported cases of the tumor recorded in the English, German and French literature. The patient was a 56-year-old woman with a history of hoarseness and stridor for about three years, and with a pink submucosal cherry-sized mass involving the aryepiglottic fold to the false cord on the left side. Treatment was an extralaryngeal excision after a preliminary treacheostomy. Blood loss was estimated at 260ml.
The published cases of laryngeal paraganglioma as well as the present case indicate that in all but one of these cases, laryngeal paraganglioma originated superiorly in the larynx; that involvement of the ipsilateral aryepiglottic fold is common; that the incidence of the tumor is equal in the sexes; and that the average age of patients at the time of diagnosis is 47 years. Surgical resection is the preferred treatment and has been possible in 22 cases. The incidence of malignant behavior with metastasis in reported cases of laryngeal paraganglioma is 17%, which commonly have a characteristic symptom of severe spasmodic laryngeal pain which may be induced by swallowing.

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Stenosis of the hypopharynx was seen in a young adult female. This occurred after healing of ulcerative mucosal lesion. The stenotic site was successfully reconstructed using a subcutaneous pedicle graft. As a diagnosis, Behçet disease was highly suspected. Differential diagnosis and surgical treatment for this condition were discussed.

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This paper concerns nine patients with respiratory embarrassment of various causes. They were eight males and one female, aged from 4 days to 26 months, averaging 11.0±3.0 months. Although some of them had neck tumor or cyanosis, the most common complaints were both stridor and dyspnea. They were introduced by pediatric physicians to our Department within 4 months from the beginning of the symptoms. Bronchoscopy was used to make definite diagnoses. Of the 9 patients, one had double aortic arches, two had subglottic hemangioma, two had diphthelial and nonspecific laryngitis, one had epiglottic cyst; one had retropharyngeal abscess and two had cystic hygroma and nasopharyngeal fibroma. All patients underwent tracheotomy under general anesthesia through endotracheal tube or bronchoscope. Although no early complications were encountered, the late complication of difficult decannulation occurred in two cases. Silicon T-tubes were used for stenting following repair of stenosis in the respiratory tract. In the other seven cases, decannulation succeeded at 10.2±6.2 months after tracheotomy.
Moreover, this paper deals with the several problems of tracheotomy in infants and children, especially the importance of established airway passage during tracheotomy.

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In order to establish endoscopic diagnosis of chronic bronchitis and clarify the problems concerning “aging of the bronchus, ” we investigated the correlation between the appearance of atrophic changes of the bronchi and sex, age, smoking and various diseases, particularly chronic bronchitis, in 683 patients who underwent bronchoscopic examination. Endoscopic findings of atrophic changes of the bronchi are as follows: a) pale-colored, white-spotted and uneven surface; b) marked prominence of cartilage; c) five or more numbered, clearly observed and narrow longitudinal corrugations found in pars cartilaginea; d) transverse ridge; and e) any longitudinal corrugation found in pars cartilaginea.
The following results were obtained:
1) Atrophic changes of the bronchi were found in 162 (38.1%) of the 425 male patients and 42 (16.3%) of the 204 female patients.
2) Atrophic changes of the bronchi appeared from the third decade of age in both sexes and increased with age.
3) The influence of smoking on appearance of atrophic changes of the bronchi was demonstrated in men.
4) Among the underlying diseases, atrophic changes of the bronchi were most frequently found in chronic bronchitis, and also frequently in pulmonary tuberculosis and bronchiectasis.
5) In chronic bronchitis, atrophic changes of the bronchi were found more frequently in patients undergoing examination more than four years after the onset of disease than in those examined less than four years after onset.
6) Patients with chronic bronchitis complicated by lung cancer numbered 31 males and 3 females. Almost all males were heavy smokers, and in those males squamous cell carcinoma and small cell carcinoma of hilar type dominated.

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A study was made to investigate the effect of HS 66 T on both the antigen induced histamine release and the treatment of the various allergic disorders. The results were as follows.
1. Effect on antigen-induced histamine release from leukocytes of asthmatics.
a. Histamine release on challenge with house dust antigen was suppressed with dose response curve by addition of HS 66 T (6×10^-6-6×10^-4g/ml) in 6 asthmatics. (The percentage of mean inhibition rate was 71.0%.)
b. Histamine release on challenge with house dust and mite antigen was slightly suppressed by administration of HS 66 T (150mg/day, during 7 to 14 days) in 8 asthmatics. (The percentage of mean inhibition rate was 14.3%.)
2. Clinical effect on administration of HS 66 T in various allergic disorders.
Clinical effect on administration of HS 66 T (100 to 150mg/day, during 7 to 21 days) was investigated in the various types of asthmatics, allergic rhinitis and urticaria. HS 66 T was obviously effective in 2 cases of allergic rhinitis and one urticaria case. In 7 asthmatics, 3 favorable cases, 3 unfavorable cases and one aggravated cases were observed.

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In previous papers, we reported that the plasminogen activator existed in the tracheobronchial secretion of normal rats, but the activities that inhibit urokinase, papain and trypsin were not found. On the other hand, it has been reported that a protease inhibitor with low molecular weight was found in the nasal secretion and tracheobronchial secretion of humans with acute inflammation of the respiratory tract. Hochstrasser et al. suggested that the protease inhibitor with low molecular weight originated from the plasma inter-α-trypsin inhibitor and a trypsin-like enzyme in the inflammatory locus might play an important role in the production of this inhibitor. In order to examine the occurrence of protease inhibitor in the tracheobronchial secretion of rats, some proteases were infused into the tracheobronchus and the inhibitory activity on proteases was detected in the secretion.
The results obtained were as follows:
1) The occurrence of inhibitory activity on urokinase, plasmin and trypsin was not found.
2) The occurrence of inhibitory activity on papain was evident.
From the results obtained, it was concluded that the inhibitor against papain (SH-protease) was induced by the infusion of papain.

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Sixty patients with bronchial asthma complicated with nasal allergy were administered beclomethasone dipropionate (ALDECIN Nasal).
1) Global clinical efficacy, patients' assessment and utility evaluation of beclomethasone dipropionate were 69.6%. 72.7% and 71.7% respectively.
2) Although there was no significant difference in the efficacy of beclomethasone dipropionate (ALDECIN Nasal) according to the type of asthma, a slightly higher success rate was obtained in the cases of atopic or paroxysmal type.
3) The improvement rate of each symptom of rhinitis was 80.5% for sneezing, 77.8% for nasal blockage, 73.3% for nasal rhinorrhea, 65.7% for olfactory disorder and 55.2% for general difficulty in daily life, in decreasing order.
4) The administration of beclomethasone dipropionate did not decrease the plasma cortisol level. Although side effects, such as irritation (5 cases) were observed in 8 of the 60 cases (13.3%), all of them were slight.
5) The effects appeared within three days and persisted for a week or more even if administration was discontinued.

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Radiological findings of esophageal cancer are usually recognized by tumor-shadow, fillings defect, malignant fold, rigidity and irregularity of the esophageal wall, malignant crater and stenosis, but malignant stenosis in esophageal cancer has not been reported in detail. In this paper, 129 cases of resected esophageal cancer with malignant stenosis observed at the 2nd Surgical Department of Chiba University are discussed in detail.
The grades of stenosis are divided into three stages, grade I stenosis: 3/4<d′/d≤1/2; grade II stenosis: 1/4≤d′/d<1/2; and grade III stenosis: d′/d<1/4. d′ is the diameter of the stenosis of the esophageal cancer and d is the diameter of the normal esophagus radiologically.
These three grades of stenosis are discussed with regard to the location of lesion, horizontal location, vertical extent, X-ray type (superficial, tumorous, serrated, funnelled and spiral according to guidelines in clinical and pathological studies for carcinoma of the esophagus, early (sm), superficial (a₀), intermediate (a_{1, 2}) and deep infiltrative (a₃) type which depends upon the infiltrative histological depth), effects of the preoperative combined therapy on the esophageal cancer, macroscopic findings of the resected esophagus and prognosis. There were 39 cases of grade I stenosis (30%), 75 cases of grade II stenosis (58%) and 15 cases of grade III stenosis (12%) among the 129 cases.
Radiological findings associated with stenosis in esophageal cancer are rigidity and irregularity of the esophageal wall, penetration, perforation, and windings. These severe radiological findings are most recognizable in grade II or grade III stenosis. Spiral type findings are recognized in all grades of stenosis.
As the X-ray type depends upon the infiltrative histological depth, there were no cases of early type (sm) at any grade of stenosis. There tivere only one case each in grades I and II of superficial type. Intermediate type and deep infiltrative type are recognizable at all three stage.
Survival rates for five years were 20% for grade I, 12% for grade II, 0% for grade III and 14% overall.

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