Laser applications for tracheo-broncho-esophageal lesions are reviewed from the aspects of diagnosis and treatment. As for diagnosis, tumor localization by fluorescence photostimulation using a tumor-specific photosensitive substance and laser irradiation, and three dimentional analysis with fiber grating are discussed. As for treatment, the photoradiation therapy with hematoporphyrin derivative and argon dye laser is presented. Regarding the treatment utilizing heat effect with CO₂ and Nd-YAG laser, indication for cicatrical or carcinomatous stenosis of the lower respiratory tract is discussed based on the author's experience. As for the indication of endoscopic laser surgery for cicatricial stenosis, the following points are stressed.
1) Partial stenosis is well controlled by laser vaporization alone without insertion of a silicone tube.
2) Insertion of a silicone tube following laser vaporization is a reliable procedure for a circular or segmental stenosis.
3) As for a stenosis just below the vocal fold, the open technique would be employed because of the difficulty of aduquate fixation of a tube.
4) In those cases whose tracheal framework is damaged, the above methods are not suitable but a conventional operation is preferable.
The effect of endoscopic laser surgery for the treatment of carcinomatous lesions is limited, and the technique is mainly used as palliative procedure to preserve the airway.
However, possibility still remains for its application as a part of the multidisciplinary treatment consisting of preoperative procedures for improving general status, chemotherapy and/or radiation

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In order to determine the safety limit of endoscopic Nd-YAG laser irradiation, 28 regions in the mucous membrane of the normal trachea of 13 dogs were subjected to the irradiation, and chronological changes in the trachea were studied from the endoscopic and pathological aspects. The irradiation was applied on half of the circle of 2 to 5 rings in the direction of major axis by way of continuous wave at 40W×3 seconds until the mucous membrane turned white.
The chronological changes of the trachea were classified as ulceration stage (up to the 14th day), granulation stage (up to the 28th day) and scar stage (after the 29th day). At the granulation stage, stenosis was pathologically attributable to the decreased supporting power of the tracheal lumen and hyperplasia of granulation by irradiation at the tracheal ring.
The degree of changes after irradiation was in proportion to the irradiated range of the major axis, if the minor axis was fixed. The cause which brought early death to 2 dogs was the perforation between the tracheal rings. The maximum dose was 1, 000 joule per ring.
There was no exacerbation of stenosis due to reirradiation on the granulation tissue by 20W×3 seconds or 60W×1 second on the 21st day.
From the above, it is surmised that the decreased supporting power of the trachea is concerned with the stenosis of the airway by the laser irradiation. The Nd-YAG laser irradiation should be applied in a small and shallow range to minimize irradiating the whole tracheal ring layer to prevent re-stenosis.

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Ignition or combustion of endotracheal tube during CO₂ laser laryngomicrosurgery may cause fatal lung disorders. We had one experiment on ignition and combustion of endotracheal tubes by CO₂ laser beam. And We obtained several conclusions as follows.
(a) Silicon endotracheal tube was non-flammable.
(b) Spiral endo-tracheal tube was also non-flammable.
(c) Pulse wave was recommended and three second interval was necessary.
(d) Four sheets of moist gauze were necessary to prevent cuff-trouble.
(e) It was desired to set O₂ concentration below 25% in the use of silicon endotracheal tube.

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The incidence of laryngotracheal stenosis secondary to traffic accident, labor disaster, malignant neck tumor and extended indication of tracheostomy has been increasing. Because of post-operative granulation and scar formation, it is well known that surgical management of the stenosis of the larynx and cervical trachea is usually difficult and a long therapeutic term is necessary. During the past 4 years, the authors treated 88 patients with both upper respiratory tract and oral cavity lesions using CO₂ and Nd-YAG laser irradiation. Among those subjects, six cases had airway stenosis caused by granulation and cicatrice secondary to inflammatory and traumatic lesions. Especially, a rare case with tuberculous tracheal stenosis treated successfully by Nd-YAG laser irradiation using flexible fiberscope was reported and discussed. Laser vaporization would be useful to apply for the respiratory stenosis with less bleeding and scarring.

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A successfully operated case by CO₂ laser for stenotic granulation scar in the trachea was reported in this paper.
A 42-year-old woman who complained of dyspnea because of stenosis in the subglottic space due to Wegener's granulomatosis had been treated with tracheal cannulation.
The treatment of subglottic granulation was required before removal of tracheal cannula after an effective systemic therapy for granulomatosis.
The patient was successfully treated with CO₂ laser operation for stenotic lesion.

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Nowadays, the case of double cancer is gradually increasing along with the increasing rate of cancer cases which is resulted by the elongation of life time and the development of medical services in the general society.
Recently, we have had a case of lung-laryngeal double cancer. The patient was 86-year-old male and healthy for his whole life. The chief complaints were hoarseness, cough with sputum and dyspnea for six months before the death.
We could diagnose the patient as a case of double cancer by the sputum examination (pulmonary adenocarcinoma) and laryngeal biopsy (squamous cell carcinoma).
The diagnosis was done according to Warren and Gates rule (1932) with the addition of Keitler rule (1918).
The characteristic features of the case were as following:
1) The patient was very old and the risk of the death was relatively high.
2) The starting time of each cancer was nearly simultaneous.
3) Any hereditary factors could not be noticed for the case.

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