This paper deals with two types of super-mini fiberoptic telescopes for removal'of bronchial foreign bodies in children. One is a flexible type (outside diameter: 1.8 mm, length: 375 mm). The other is a rigid type (outside diameter: 1.6 mm, length: 296 mm).
Both types of super-mini telescopes can be inserted via the side-port for light guide of a conventional ventilation bronchoscope. The larger viewing angle facilitates orientation. The new system of pediatric ventilation bronchoscope with a super-mini fiberoptic telescope changes pinpoint vision to a panoramic view. During use of the super-mini telescope, anesthetic gas can be easily administered and adequate ventilation is assured.
The most important advantage of this super-mini telescope is its easy maneuverability of the forceps under visual control.

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Use of a newly designed laryngotelescope is reported. The scope consists of a solid optical system with lenses and prisms and is curved appropriately to fit well to the contour of the human vocal tract. The scope is introduced through the mouth of the subject and the tip can be brought closely to the level of the vocal folds to obtain a good visual field. The depth of focus is from 15 to 60 mm and the rate of magnification is twice to 8 times depending on the distance between the tip of the scope to the object. Advantages of the present system, are as follows: (1) Detailed observation of the larynx and photographing can readily be performed. (2) Easy handling. (3) Simple therapeutic procedures and microstroboscopic observation can also be performed.

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In order to understand the characteristics of airway disturbances in children, the cases of infants and children with airway disturbances who were seen at the Jikei University Hospital during the past six years were reviewed statistically.
A total of 110 cases were included in this study. Among these cases there were slightly more males and infants under one year with a tendency of decrease in older children. The common underlying diseases included laryngomalacia, foreign bodies in the bronchus, tonsillar hypertrophy and adenoid vegetation.
Most patients were brought in for examination of stridor (wheezing), dyspnea and hoarseness. To facilitate correct diagnoses, endoscopic examinations have been performed with increasing frequency since the introduction of the FOB (fiberoptic bronchoscope).
From the results of the present study, it was considered that the most important points in the management of these cases are to ascertain the causes and to obtain the cooperation of the departments concerned. Diagnosis and treatment should be made on the basis of good knowledge of the characteristics of airway diseases in children.

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A statistical study was made on 64 cases of foreign bodies in the esophagus, trachea and bronchi treated in our clinic during the period from 1973 to 1980. The results were as follows:
1) In 47 cases foreign bodies were found in the esophagus, while tracheo-bronchial foreign bodies were found in 17 cases.
2) As esophageal foreign bodies, coins were found in 18 cases (38%) who were all infants, while dentures and press through packs (PTP) were found in adults. The incidence of PTP foreign bodies appeared to be increasing.
3) More than 50% of the foreign bodies of the trachea and bronchi were found in infants. In 7 cases (41% of 17 cases) of infants, beans were found as tracheo-bronchial foreign bodies.
4) An appropriate planning must be established for preventing esophageal foreign bodies of dentures and PTP.

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This paper attempts to discuss the pathogenesis and surgical treatment of patients with esophageal diverticulum. Fourteen patients were treated in our department in a ten year period (1965-1975). Of these fourteen patients with esophageal diverticulum, seven patients (fifty percent) complained of clinical symptoms and the others had no symptoms of esophageal diverticulum. Of the fourteen patients, two patients had cervical diverticulum (Zenker's diverticulum) which was discovered accidentally upon examination of hiatus hernia and gastric cancer. Most of our cases involved diverticulum of the middle or lower esophagus.
Excision of esophageal diverticulum was performed only in the seven patients who complained of symptoms of diverticulum of the esophagus. For the patients without clinical symptoms, surgery was not carried out. In the excision of esophageal diverticulum, we have continued to use the “open method” without using crushing instruments (clamps) in order to avoid the so-called two main pitfalls, which are inadequate removal of the sac and the danger of narrowing at the point of excision. The closure of the defect of the esophageal wall must be performed by a two layer method, namely mucosa-tomucosa and muscularis-to-muscularis suture. The mucosal suture is placed, using the method of Sweet's technique, in which the knot lies within the esophageal lumen when tied.
It is the author's opinion that although many techniques have been used for the excision of diverticulum of the esophagus, the “open method” may be the most effective to obtain satisfactory results in the excision of esophageal diverticulum.

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A case of rice-cake foreign body in the larynx was reported. The patient was nearly choked to death but resuscitated successfully without any sequelae. From our experience, the followings should be emphasized for successful treatment of life-threatening foreign bodies in the larynx: (1) Immediate resuscitating procedures should be taken if the diagnosis of foreign body in the larynx is established. (2) Immediate and intensive efforts for dislodging the foreign body must be made, which should be followed by artificial respiration. (3) Quick transportation of the patient to an emergency hospital. (4) Use of emergency facilities such as a hyperbaric chamber should be introduced.

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A case of primary cricopharyngeal achalasia is reported. It is a disease of unknown etiology characterized by a failure of relaxation of the cricopharyngeal muscle which acts as the upper esophageal sphincter.
A 70-year-old man was admitted to the hospital because of severe dysphagia. He had had progressive difficulty in swallowing for 9 years, having been treated by relaxing agents and esophageal dilatation. At the time of admission, he was unable to swallow even his saliva, being dehydrated and had rales over the chest bilaterally. No neuropathy or myopathy was found on examination. However, a barium swallow examination showed arrest of bolus at the cricopharyngeal level and esophagoscopy revealed a tightly contracted cricopharyngeal muscle. After the diagnosis of achalasia was made, the patient underwent extramucosal cricopharyngeal myotomy unilaterally under general anesthesia. The muscle was neither hypertrophic nor atrophic, but contractive. The postoperative course was uneventful and the patient could take normal diet on the 14th postoperative day. A half year postoperatively he has no complaints in swallowing.
Primary cricopharyngeal achalasia is generally seen in elder patients, causing unremitting, progressive and disabling dysphagia, and is hardly curable by conservative treatment. Further, aspiration pneumonitis which endangers the patient's life may result from regurgitation and weight loss may be a predominant symptom. Therefore, an early surgical intervention by cricopharyngeal myotomy is recommended when the diagnosis is established. The operation is safe and simple, and unilateral myotomy would suffice.

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“Cricopharyngeal achalasia” appears to be defined as a failure of the cricopharyngeal muscle to relax or as its premature contraction during the pharyngeal stage of deglutition. Our electromyographic, radiographic and histological investigations led to the conclusion that there are NO such conditions. In the conditions where “cricopharyngeal achalasia” has been thought to exist in association with other neuromuscular diseases, the cricopharyngeal muscle does relax in normal timing. However, since the propelling force is lessened because of weakness of the lingual and/or pharyngeal muscles, bolus does not enter the esophagus during the cricopharyngeal relaxation. Therefore, it is not the cricopharyngeal muscle but the tongue and/or pharyngeal muscles that is responsible for dysphagia. In the conditions where “cricopharyngeal achalasia” appears to be the only problem, again the cricopharyngeal muscle does relax. This was confirmed electromyographically in 5 patients. Results of a histological study suggest that the genesis of dysphagia in these conditions is a decrease in expansibility of the cricopharyngeal muscle resulting from a myopathy. We propose that these conditions should be called “idiopathic cricopharyngeal myopathy.”

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In order to investigate clinically the effects and safety of beclomethasone dipropionate, 31 patients with allergic respiratory diseases were treated by nasal and/or oral inhalations of its aerosol for two weeks. They were 19 patients with allergic rhinitis, one patient with vasomotor rhinitis and 11 patients with nasal allergy complicated with bronchial asthma. Beclomethasone dipropionate nasal spray was administered in a dose of 800 μg daily to 20 patients with rhinitis alone. The utility rate was 100%. Nasal spray and oral inhaler were simultaneously applied in each dose of 400 μg, in a total dose of 800 μg daily to 11 patients with both rhinitis and asthma. Clinical efficacy for rhinitis and asthma was 81.3% and 53.6%, respectively. The utility rate for clinical efficacy was 90.0%. Although side effects such as nasal irritation, headache and vomiting were noted each in one case, 3 cases (15%) in total in patients with rhinitis alone, all of the symptoms disappeared by decrease of the dose or discontinuation of the administration of the aerosol. However, the drugs were still effective. No side effect was noted in patients with both rhinitis and asthma. Plasma cortisol level and values of other clinical laboratory tests did not show any marked changes after treatment.

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