Seventeen cases of hypopharyngoesophageal cancer were radically operated at the Second Department of Surgery, Osaka University Medical School, from 1965 to 1982. Reconstruction was divided into two types, gastric tube transposition after total esophagectomy with laryngectomy (11 cases) and segmental colonic interposition after cervical esophagectomy with laryngectomy (6 cases). Segmental colonic interposition was superior to gastric tube transposition in various factors such as surgical invasion, postoperative complaints and digestive functions. There was no difference in types of recurrence between these two reconstructive procedures.

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A modified technique for the avoidance of aspiration in Amatsu's T-E shunt operation is described in this paper. An ideal maneuver to minimize the aspiration in the T-E shunt speaker may be to add a valve mechanism or sphincteric function to the constructed shunt.
However, there are some difficulties to realize it. The author's idea to minimize the aspiration aims to construct a laterally deviated and collapsed shunt which opens only by exhalation for phonation.
The technique consists of the following two points.
1. Proximal end of the tracheal flap is cut on one side slightly upwards to the midline.
2. Lower end of the constructed shunt is sutured to the stomal margin on the other side.
In this way a laterally deviated and collapsed shunt can be constructed.

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Various kinds of skin flaps were applied to the secondary repair of large fistulas followingthe failure of ante-thoracic esophageal reconstructions and a large defect after resection of thetumor recurred at the cervical anastomosis.
At the beginning, the hinged skin flaps or compound D-P flaps (Tai's method) were used inthese cases, however, recently the myocutaneous flaps of pectoralis major or latissimus dorsicome into use, because the myocutaneous flaps are very reliable for reconstruction in any kindof clinical situations and the flaps can be transferred immediately without a delay.
The other merits and demerits of various skin flaps were discussed.

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Twenty two cases with Plummer-Vinson syndrome were reported. These cases were diagnosedand treated at the author's clinic during the period from 1975 to 1980. The incidence was 1.1 % of the total of 2, 008 cases or 2.3% of 965 cases of female cases who underwent bariumswallow during the above period for the examination of the region of esophageal entrance.Twenty cases out of the 22 account for 4.8% of 735 female cases with paresthesia pharynges.Signs of esophageal web were assessed in 59.1% of the present cases on proximal esophagograms. The clinical nature and the effect of iron therapy for this syndrome were analysedbased on the roentgenological classification of webs previously reported by the present author. The results were as follows:
1. Dysphagia for solid diet could be present in cases with low grade of web even in theabsence of mechanical stenosis. On the other hand, dysphagia often dramatically disappearedafter iron therapy despite the presence of high grade of web. It appeared thatdysphagia was not only dependent on mechanical stenosis but on mucosal change in thestatus of iron deficiency.
2. Changes in the grade of web formation following iron therapy was confirmed radiologically. The shortening of the size of web was obtained at 6 months to 1 year after theoral administration of Ferrous sulphate.
Iron deficiency was considered to play the most important role in the growth of webs andto be the etiology of Plummer-Vinson syndrome.

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During 10 years from 1971 to 1981, 213 cases of the foreign bodies in the tracheo-bronchusand esophagus were treated in our clinic.
Tracheo-bronchial foreign bodies were detected in 51 cases (male: 38, female: 13) andesophageal foreign bodies were in 162 cases (male: 81, female: 81). Their incidence was0.56% and 1.85%, respectively, of our all inpatients in the Department of Otorhinolaryngology, Kitasato University Hospital.
Eighty-four percent of tracheo-bronchial foreign bodies and 46% of esophageal ones werefound in the infants under 3 years of age.

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For the recent 5 years, reconstructive operations were performed in nine patients of traumaticlaryngotracheal stenosis in our clinic.
The stenosis of three patients was caused by cervical blunt trauma, and that of six patientswas formed after tracheostomy.
The sites of stenosis were the glottic area (2 cases), the area from glottis to trachea (2cases), the transglottic area (1 case), and the trachea (4 cases).
For treatment of the stenosis, the reconstructive operation of open method was performed in3 cases and the operation of semiclosed method in 2 cases. The remainders were treated bythe conservative manipulation.
Silicone T-tube was used as a stent in 7 cases following the reconstructive operation.
In two patients treated by the open method, a composite graft of the nasal septum was usedto repair the anterior defect of the laryngeal or tracheal airway.
In two patients the cervical trauma was accompanied with foreign bodies, which could beextirpated by the open method under the X-ray fluoroscope.
By the above-mentioned operations, the decanulation from tracheostoma succeeded in allcases with the exception of one patient who is in a short time after the operation.

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Sinobronchial syndrome is defined as a coexisting pathology of chronic sinusitis and nonspecificchronic inflammatory lesion of the lower airway (e. g. chronic bronchitis, bronchiectasis, and diffuse panbronchiolitis).
Forty six patients with sinobronchial syndrome and 184 normal controls were typed for HLA-A, B, C antigens.
Significant findings obtained after HLA data analysis in sinobronchial syndrome were asfollows; HLA-Bw54 was found in 50.0 percent as compared to 11.4 percent in the controls (X²=33.0, corrected P=8.31×10^-3, relative risk 7.76). HLA-Bw54 in diffuse panbronchiolitiswas found more frequently in 68.4 percent (X²=36.2, corrected P=2.04×10^-9, relative risk16.8).
Sinobronchial syndrome, especially diffuse panbronchiolitis, was associated with HLA-Bw54, which was found specifically in Japanese and not in Caucasians. These facts may suggestthat there is a gene controlling the susceptibility to sinobronchial syndrome, especially diffusepanbronchiolitis, and linked with a Japanese-specific HLA antigen.

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Lymphangioma of the larynx is extremely rare. We have been able to find out 17 cases reported in the world literature. Recently we studied a case with lymphangioma of the larynx in our department.
The patient, female, aged 36, complained of hoarseness for a few months, and visited us on July 28, 1979. Indirect laryngoscopy revealed that the growth occupied her right false vocal cord. Under general anesthesia, tracheostomy and larygofissure were performed for removal of the neoplasm. The tumor was diagnosed as lymphangioma microscopically. The complaint disappeared after surgery and there was no recurrence.
The pertinent literature on this rare disease is reviewed.

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A rare case of tracheal pleomorphic adenoma is reported . The patient was a 24-year-old female who had complained of stridor after running for about one year . As a bronchial asthma, she had received the drug by some doctor, but no relief had been obtained.
On June, 1982, a tracheal tumor with a pink submucosal cherry-sized mass originating from the tracheal wall on the right side was diagnosed by both tomography and fiberscope. Under an extratracheal approach following a preliminary tracheostomy, the tumor excision without any tracheal cartilage resection could be done successfully, because no malignancy was revealed histologically by a frozen section.
The diagnostic and therapeutic importance of tomography and flexible fiberscopy in the pa -tients with unknown stridor was stressed.
Pleomorphic adenoma in the tracheal benign tumors is extremely rare and there have been no reported case of this tumor recorded in the Japanese literatures.

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