In the present report, a clinical observation on 29 cases of the vocal cord cyst who were treated in Kitasato University Hospital during the period from August 1971 to April 1983.
The results were as follows.
1. The chief complaint of these patients was hoarseness which was worse than expected from their laryngeal appearances.
2. Histopathological study revealed that the most cyst walls consist of the squamous epithelium.
3. Mechanical implantation of the squamous epithelium could be considered as one of the causative factors.

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Living canine larynx was blown through the trachea with both arytenoid cartilages fixed in the median position. The sound pressure level and fundamental frequency of the voice were measured under various flow rates and subglottal pressures, with and without electric stimulation of the thyroarytenoid muscles. From this experiment, the role of the thyroarytenoid muscles in voice regulation was found to be as follows:
1) When the glottis is sufficiently closed, contraction of the thyroarytenoid muscles does not affect the relationship between aerodynamic power (flow rate times pressure) and the sound pressure level, in spite of increased glottal resistance (pressure divided by flow rate).
2) When the glottis is sufficiently closed, contraction of the thyroarytenoid muscles decreases the fundamental frequency in relatively large aerodynamic powers.

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In this study, the ileocecal valve function was evaluated in aspect of prevention of postoperative reflux esophagitis. We have been actively employed ileocolon interposition method for reconstruction following total or proximal gastrectomy since October 1979. Up to September 1983, 24 patients received this operation.
Twenty-three patients consuming a house diet had no symptoms of reflux esophagitis.
In 21 of 23 patients examined by endoscopy, no esophagitis was found.
Manometric study and pH measurement after acid-loading were performed in the interposed ileocolon segment and esophagus in 12 patients under fluoroscopy.
According to the analysis of pressure curve and the change of pH value, they were classified into the following four types.
Type I (3 cases), high pressure zone (HPZ) is confirmed in the ileocecal junction and pH values change quickly from low to high one in this region.
Type II (1 case), HPZ is not clearly observed in the ileocecal junction, but pH curve is similar to that of Type I.
Type III (7 cases), neither HPZ nor prompt pH variation was obvious.
Type IV (1 case), pressure curve is the same as that of Type I, but pH values do not change at the ileocecal junction.
Retching was often noted in each patient, but intraesophageal pH levels were not reduced.
Based on these findings, the ileocecal valve appears to have an excellent antireflux function, and we emphasize the usefulness of the ileocolon interposition method to prevent postoperative reflux esophagitis.

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In this study admitted esophageal cancer cases were divided into two groups in the randomization method. The pre- and post-operative irradiation was carried out in group A and only the post-operative irradiation was performed in group B. The one-year-survival rate of group A was 38% (3/8) and that of group B was 46% (6/13). There was no significant difference between these two groups. Evaluation of the pre-operative irradiation was not estimated in the one-year-survival rate. Organ metastases, such as the liver, the lung and the bone metastasis, were observed frequently in both groups during the follow-up periods. So cases of widely spreading intraabdominal lymph node metastasis, those with high grade of vascular invasion and those of undifferentiated cancer were thought to be cases with the limitation of the post-operative irradiation. The immunochemotherapy is indicated for these cases.

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Comparison of esophageal endoscopy using a nasopharyngolaryngo-fiberscope (ENF type LB, Olympus Co., Ltd.) and a gastrointestinal-fiberscope (GIF type P3 or P2, Olympus Co., Ltd.) have been attempted. After a diagnosis of esophageal ulcer was made by a GIF in case 1, the ulcer was followed by an ENF, and an easier practice by ENF has been demonstrated in this case. In case 2, reflux esophagitis of the lower esophagus could be observed by an ENF, but the esophageal hiatus hernia in the distal portion was not found by an ENF and it was found by a GIF. In case 3, right recurrent nerve paralysis and cancer infiltration into the trachea could be detected by an ENF, but cancer located near the upper end of the esophagus could be only found by a GIF. In case 4, the ectopic gastric mucosa around the upper end of the esophagus could be found by an ENF when air was sent. Case 5 was a 2-year-old girl who visited us under suspicion of swallowing a plastic foreign body into the trachea, bronchi or into the esophagus. No foreign body could be found in the trachea, bronchi, stomach and esophagus by an ENF under local anesthesia.

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A rare case of recurrent solitary extramedullary plasmacytoma of the trachea is reported.
A 52-year-old woman with the complaint of cough and dyspnea of three months' duration was referred to our hospital by an otolaryngologist for diagnosis and treatment. The patient had the same symptoms 13 years before. The tracheal tumor was found at the level of the first and the second tracheal rings by various examinations. It was extirpated with laryngofissure. The tumor did not destroy the tracheal cartilage. The histopathological examination of the specimen revealed a lymphomatous tumor at that time.
This time, endoscopic examinations and CT scanning revealed the tumor occurred at the same place as before, invading to the outside of the trachea. Then tracheostomy, laryngoscopy and reduction surgery were performed. The histological section of the tumor showed an extramedullary plasmacytoma. The blood examination showed a slight iron deficient anemia, but urinary Bence-Jones protein and myeloma protein were not detected. There was no abnormal ⁶⁷Ga uptake in the whole body. The endotracheal reduction surgery and ⁶⁰Co irradiation of 6000 rads could control the endotracheal tumor, however, they did not reduce the extratracheal lesion because of its radioresistance. The patient refuses the total removal of the tumor, so she is followed up regularly at the outpatient clinic.
The symptoms and the nature of the solitary extramedullary plasmacytoma and its relation to plasma cell tumor are discussed.

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Bulbar spinal muscular atrophy is very rare disease. The disease is characterized by clinical onset in adult, slowly progressive course, sex-linked recessive inheritance, signs of bulbar palsy, generalized fasciculation and absence of pyramidal tract lesion.
This paper describes a family in which 6 members, all male, were affected by the disease. In our cases, clinical onset was fifth and sixth decades and bulbar palsy appeared in four cases and muscular weakness came out in proximal muscles initially. We summarized the clinical features and the prognosis of this disease through a survey of the literatures. Moreover, we investigated a cause of dysphagia of the present cases by the measurement of the pharyngoesophageal intraluminal pressure and esophagogram. As a result of the measurement, it was revealed that the pharyngeal phase of deglutition was disturbed.

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A 70-year-old Japanese male with a past history of dysphagia following surgery in December, 1979 for squamous cell carcinoma of the thoracic esophagus (Im) visited our department in September, 1982 with a complaint of hemosputum and of a foreign body sensation in the hypopharynx. On physical examination, he was noted to have a pendulous tumor involving the entire surface of the epiglottis. By using the microlaryngosurgery, the tumor was removed and proved histopathologically to be composed of fibroblast-like cells and histiocyte-like cells, and diagnosed as a malignant fibrous histiocytoma. Irradiation was administered to a total of 40 Gy. Our report reviews this rare case of combined laryngeal malignant fibrous histiocytoma and esophageal squamous cell carcinoma.

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