In the present report, a clinical observation on 42 cases of polypoid vocal cord who weretreated in the authors' hospital during the period from June 1975 to January 1983, and a newsurgical procedure were reported. Polypoid vocal cord was classified into three types I, IIand III according to its clinical features.
The results were as follows:
1) Out of the 42 cases, 20 males and 22 females, 38 cases were older than 40 years ofage. Most of the elderly patients were female, and belonged to the type III.
2) Hoarse voice was found in all the patients. Eight cases of the type III group complainedof dyspnea.
3) Bilateral lesions were observed in 36 cases.
4) The duration from the onset of the primary symptom to the beginning of treatment wasapproximately one year or longer in most cases. It was difficult to estimate the period fromthe onset of the disease on the basis of the grade of the polypoid swelling.
5) All the patients were smokers. The rate of the patients who long abused their voicewas 71%. Smoking appeared to be the most effective etiologic factor of polypoid vocal cord. Vocal abuse and aging also seemed to be concerned in occurence of this disease.
6) The mucous membrane covering the polypoid swelling was removed preserving the mucosaat the edge of the vocal cord, and the mucous substance under the inferior surface of the vocalcord was squeezed out. This new surgical procedure was called “squeezing technique” andconsidered to be most appropriate for treating the case of type III.

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Two cases of foreign bodies are reported.
Case 1. Sixty-seven-year-old man aspirated a gold dental cap about oneyear ago during dentaltreatment. At that time he did not have cough and dyspnea at all. Recently, however, henoticed cough and hemosputum and visited a neighbouring hospital in order to undergo thephysical examination. A chest X-ray film revealed a right bronchial foreign body. He wasreferred to our hospital for surgical treatment. The long-standing bronchial foreign body couldbe removed by ventilation bronchoscope.
Case 2. Ninety-year-old man had a tunny's bone stuck in his th roat at breakfast. Ten dayslater he visited our hospital complaining of the increasedpain and swelling of the rightlateral neck. The foreign body was found on the cervical X-ray film. Under esophagoscopy, the swelling and the granulation were seen on the right hypopharyngeal wall. It was suspectedthat the fish bone was excluded from the pharyngeal lumen and induced the abscess outsideof the pharynx. The abscess was drained percutaneou sly by lateral neck incision.

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A 43-year-old man was admitted to our hospital with a complaint of cough provoked byswallowing. Barium esophagogram revealed a fistula between the middle portion of the esophagusand the right lower lobe broncus. On right thoracotomy, the fistula was resected. Histologicallythe fistula was composed of esophageal mucosa and proper muscle, and there was noevidence of inflammation, granulomatous change or cancer. On the basis of these findings, weregarded this case as congenital esophago-bronchial fistula in adult.

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We report a rare case of konjak flour foreign body in the esophagus.
A 68-year-old man complained of a difficulty in passage after he swallowed 4 grams ofkonjak flour wrapped in the wafer without water which he had taken every day for 6 monthsfor the possible prophylaxis of arteriosclerosis. An esophagography revealed a pooling of bariumat the cricopharyngeal constriction and a foreign body shadow of 7cm length.
A direct esophagoscope was performed under general anesthesia. A white mass turnedgelatinous by absorbing water was discovered at the cricopharyngeal constriction. The majoritywere removed bit by bit with forceps, but the rest was fallen into the stomach. After theoperation, a good passage was obtained on the esophagography and the patient was discharged.
The chief component of konjak flour is glucomannan, indigestible polysaccharide. Somepeople have believed that glucomannan has a lowering effect on the concentration of bloodcholesterol. We emphasize a possibility that glucomannan becomes a foreign body by expandingwith water and turning gelatinous in the esophagus.

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In order to diagnose a radiolucent esophageal foreign body, a method to swallow a capsulecontaining contrast medium was used.
Under X-ray fluoroscopy, retention or retrogradation of the capsule and complaint of odynophagiaon passage of the capsule were observed. Its retention and/or retrogradation suspected apresence of foreign body, and odynophagia suspected a damage of the esophageal wall. In case1, we observed a retention of the capsule and removed the meat ball using esophagoscope. Incase 2, we observed a retrogradation of the capsule and removed a fishbone with a length of3.5 cm using esophagoscope. In case 3, we noted odynophagia on passage of the capsule andobserved esophageal erosion by an esophageal fiberscopy (GIF-P3).
This method seems to be useful not only for diagnosis of esophageal foreign body, but alsodiagnosis of esophagostenosis, odynophagia or abnormal feeling of the esophagus.

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Two cases of tracheal stenosis following the tracheotomy were cured using silicone T-tube. Silicone T-tube has many advantages and is an effective mean to tracheal stenosis. In ourtwo cases, a 4-year-old girl and a 4-year-old boy, no problem occurred during tubing. Theygot along well after pulling out T-tube. T-tube may be the most effective in selected cases, though many techniques have been applied for the management of tracheal stenosis.

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We previously reported that there was plasminogen activator (PA) in the tracheobronchialsecretion of rats. It was suggested that PA in the secretion had a significant role in controlof the chronic inflammatory responses, particularly in the clearance of deposited fibrin fromthe local tissue. On the basis of the above-mentioned suggestion, local administration of proteolyticagents was considered to be favorable to exclude the deposited fibrin from the respiratorylumen. Therefore, we attempted to devise the proper administration of proteolytic agents, including PA, by means of ultrasonic nebulizer.
The results obtained were as follows:
1) Proteolytic activity of papain and urokinase (UK) after the nebulization was remarkablylower than that before the nebulization.
2) The addition of Triton X-100 or bovine serum albumin (BSA) to UK solution showedsignificant recovery of the decreased proteolytic activity during the nebulization.
From the above-mentioned results, it was clarified that proteolytic agents could be nebulizedwith minimum loss of activities if any proteins and surfactants were added to these solutions. Furthermore, it was suggested that the detergent, such as Triton X-100, was much availableto prevent the loss of activity during the nebulization of proteolytic agents, since the surfaceactive materials exist in the tracheobronchial secretion under the physiological condition.

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