It is generally accepted that laryngeal cancer has the highest incidence and the best progncsis in head and neck malignancies in Japan. It is, therefore, most suitable fcr studying its long term result and causes of death after 5 years from initial treatment.
A total of 307 cases of laryngeal cancer was treated in 8 years from 1962 through 1969 at National Cancer Center Hospital, Tokyo. There were 185 glottic and 122 supraglottic cancers. A minimum follow up period of 10 years has been cbtained in all but 8 patients. By analysing thcse cases, following results were obtained.
1) Five and ten year survivals calculated by actuarial method were 75% and 62% respectively in glottic carcinoma, 57% and 38% in supraglottic carcinoma and 68% and 53% in total cases.
2) Difference between 5 and 10 year survivals calculated by actuarial method was 15%. But, by relative survival, there was no difference between them.
3) Out of 208 patients who survived well more than 5 years, 45 patients were died within succeeding 5 years. Causes of death in these cases were, carcinoma of the larynx in 5 cases (11%), other malignancies in 10 cases (22%), nonmalignant diseases in 13 cases (29%) and unknown diseases in 17 cases. It might be concluded that the patient of laryngeal cancer is apt to suffer from an additional malignancy, even after 5 year survival.

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Laryngeal tuberculosis is not prevalent now in Japan, though it has not always beeneradicated. Recently we experienced 2 cases of laryngeal tuberculosis.
Case 1: A 55 years old man came to our hospital complaining hoarseness of seven years duration. He had a history of tuberculous pleurisy at the age of 34 and was treated by medication of antitu-berculous agents. Mirror examination showed granulomatous lesion in the left vocal cord, which was proven as tuberculosis by pathological examination. Treatment with antituberculous chemotherapy for about a month improved the hoarseness considerably.
Case 2: A 47 years old woman visited our hospital with complaints of hoarseness, pain and difficulty in swallowing. She had a history of neck dissection due to tuberculous lymphadenitis in the neck and axilla at the age of 39 and of chemotherapy for pulmonary tuberculosis at 42. Many small ulcers were found in the larynx and they were diagnosed as tuberculosis patholog - ically. These complaints were much improved by administration of antituberculous agents for about a month.
By a statistical analysis of 64 cases reported in Japan in the last 15 years, some characteristics of laryngeal tuberculosis in recent days were summarized as follows;
1) Higher age of affection, 44.6 averagly.
2) Slight subjective symptom. 3) High incidence of granulomatous lesion, around 60%.
Thus, laryngeal tuberculosis should always be taken into consideration upon untypable larynge allesion in the middle and higher aged patient.

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It is generally accepted that Plummer-Vinson syndrome may cause an abnormal sensation in the throat and might he a precancercus lesicn of pcstcricoid carcinoma.
We reported three cases of Plummer-Vinscn syndrome. In all three cases, females aged 46, 2 and 63, typical data of sideropenic anemia were obtained by blocd examination including 6 serum Fe and U.I.B.C. A web formation at the pharyngo-esophageal junction was found in radiograms, though not clearly seen in esophagoscopy. They were treated by administration of an iron-derivative. These abnormal findings and their complaints such as dysphagia, angularsto matitis, glossitis and sideropenic anemia were much improved after the treatment.
We should consider an abnormal sensation in the pharyngo-laryngeal region may be driven also by several different causes other than Plummer-Vinson syndrome, and differential diagnosis is not always easy.
We reported a diagnostic schedule which is regularly done in our ho, pital for these patients. Otolaryngological examinations, radiograms of cervical spine, hypopharynx, larynx, esophagus and paranasal sinuses and blood examination should be the minimum routine. Fiberscopic examination and psychiatric approach are also essential.

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A 3-year and 4-month old girl was sent to the Department of Otolaryngology, Mie UniversityHospital, because of difficult decannulation on April 2, 1979. She had a history of cardiacsurgery for patent ductus arteriosus on 40 days after birth. Assisted ventiration by a peroralendotracheal tube was inevitable throughout 30 post-operative days and, finally, a tracheotomywas performed.
Complete obliteration of about 17 mm in length was found in the subglottic region by acontrast radiography, and massive granulation tissue packed in the subglottic space was seen in the endoscopic examination.
On April 13, 21 months after the tracheotomy, a laryngofissure including the cricoid cartilageand upper three thracheal rings was done. After removal of granulation, the subglottic cavitywas wide enough and a silicon T-tube was left as a stent with a piece of split thickness skin, which wrapped up the tip of the tube to be grafted over the denuded wall of the subglottis.Two months later, tracheal stoma was closed. On December 18, eight months after the surgery, T-tube was drawn out successfully, and the patient is row well without any respiratory embarrassment.
We discussed on the etiology and passible treatment of this problem.

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A case of congenital cartilaginous cricoid stenosis was reported and discussed on literatures.A 9-year-old girl was admitted because of stridor and dyspnea after birth. Clinical examinationsrevealed subglottic stenosis and Fallot's tetralcgy with atrial septal defect. After cardiacsurgery with tracheotomy, the patient was referred to ENT Department. With direct laryngosccpyand radiological examinations a hard stenosis was found at the level of the cricoidcartilage immediately below the normal vocal cords, leaving an airway posterioly with a diameterof 3mm in the sagittal plane. A midline incision was made from the tracheostoma to thecricoid cartilage, which was found to be solid homogeneous wedge-shaped bulky mass. Theinner surface of cricoid cartilage was reduced into the shape of normal subglottic lumen andcovered with the niucous membrane preserved as far as possible. In the new subglottic lumena silicon tube with a diameter of 7mm was retained as a stent and the incision was closedprimarily. The stent was extubated endoscopically and the tracheostoma was closed successfullyin three weeks without any respiratory distress. In literatures, 13 cases of cartilaginous cricoidstenosis were collected and the entity of the congenital cartilaginous cricoid stenosis was discussed on the basis of embryological studies of the larynx.

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A 22 years old male patient was hospitalized with complaints of obesity, daytimesomnolence and snorring during sleep. Physical examination revealed slight ptosis in eyelidsand grade III tonsillar hypertrophy, however, no other abnormalities were observed. The chest X-ray film showed slight cardiomegaly. Laboratory tests were all within normal limit.Pulmonary function test was normal except slight reduction of RV and elevation of CV. Theventilatory response tests of respiratory center revealed blunt responce to the lowered oxygenconcentration of inhaled gas and weak response to the higher concentration of CO₂ in the inhaledgas. The distribution of the sleep stage analyzed with EEG showed stage W of 25%, stage I of 11%, stage II of 36%, stage III of 10%, stage IV of 1% and stage REM of 17%, and the marked reduction of deep sleep was clearly demonstrated. The pattern of respirationwas continuously monitored during sleep by means of the capacitance pneumograph, andperiodic apnea lasting for about 60 seccnds was observed. The arterial oxygen saturationmonitored by an earoxymeter droped to 76%, and ECG recording indicated the occurrence ofsinus bradycardia and premature ventricular contraction during the apnea periods. Thecapacitance pneumograph, which was devised to record chest and abdominal wall movementsseparately, initially showed complete cessation and then paradoxical movement of chest andabdominal wall during apnea. This indicated that the apnea was initially central then followedby obstruction. After reduction of body weight and tonsillectomy, daytime somnolenceand snor on sleep were markedly improved and the period of apnea reduced to 35-45 seconds and reduction of SaO₂ was about 90%. The capacitance pneumograph is non-invasive and useful tool for the investigation of sleep induced apnea.

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The Kartagener's syndrcme is cne of the rare congenital diseases. It has three symptoms; chrcnic sinusitis, bronchiectasis and situs inversus. Four cases of this syndrome were firstly reported by Kartagener in 1933. Since then, many cases have been reported clinically but electrcn micrcsccpic study has nct reperted in Japan. Recently we had a case of this syndrome of 43-year-old female. We took biopsy specimens from the mucous membrane of nose, trachea and left main bronchus. These specimens were studied by electron micrcscopy, and several findings were obtained. 1) In the epithelial cells of paranasal cavity, no cilia but many fine microvilli were observed. The secretory mucus filled the lumen surrounded by the epithelial cell lines. 2) In the trachea, on the other hand, cilia was rarely seen and most of them showed defect of dynein arms and discrder of nuicrotubule arrangement and orientation in cross section view. 3) While in the bronchus, the same findings as paranasal cavity was observed. The absence of cilia in the paranasal sinus and left bronchus may cause loss of protective function of the respiratory truct, and may result the storage of mucus in the lumen, which will lead to brcnchiectasis and sinusitis. The abnormality of cilia, the defect of dynein arm of microtubular doublets and disorder of orientation and arrangement of them may cause the immotile cilia syndrome and sterility in male. Further, it may have a relation to the symptom of situs inversus.

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Foreign body accidents in the air and food passages occur to anyone at anytime anywhere. Fcreign body obstruction of the airway usually occurs white the victim is eating. If the victim is a child, however, choking may also occur during play when a small toy or object being mouthed slips back into the airway. Within four minutes of the onset of the attack, the victim will be dead or suffer permanent neurologic deficit. Thus, the rescuer must make the diagnosis immediately. We intrcduce “The Heimlich Maneuver” as a way to save a chocking victim.

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We recently experienced a case of rare bronchial foreign body. A 74-year-old man was sent to our hospital because of a suspicion of foreign body in the lower airway. His chest X-ray showed a peculiarly branching shadow at the left cardiac border, and pneumonia of the left lower lobe.A dental impression material was highly suspected, since he had a history of dental treatment several days before. We diagnosed that the foreign body lodged in the left lower lobe bronchus and ramified in B8, B9 and B10 bronchi. Through a bronchofiberscope, we could successfully remove the foreign body using a biopsyforceps. We discussed on the physio-chemical properties of this material, and its clinical and roentgenological characteristics as a bronchial foreign body.

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