We studied the following nonspecific cellular and humoral immunological factors in 21 fresh cases of hypopharyngeal cancer (Stage II-IV) to evaluate the nonspecific immunological reactivity of hypopharyngeal cancer patients. In cellular factors, cell numbers of blood lymphocyte, stimulation index (S. I.) of PHA-induced lymphocyte transformation, and percentage of IgG-FcR⁺Tlymphocyte were examined. In humoral factors, serum IgG and β1C (C3) were tested. These studies were performed before treatment, after preoperative irradiation, and after surgery. And we could obtain following results.
1) Nonspecific cellular immunological reactivity of hypopharyngeal cancer patients was depressed.
2) Nonspecific cellular immunological reactivity of hypopharyngeal cancer patients was further depressed after the preoperative irradiation (3000 or 4500rad).
3) However, there was no apparent difference in the degree of depression of nonspecific cellular immunological reactivity between 3000rad group and 4500rad group of preoperative irradiation.
4) Nonspecific cellular immunological reactivity of hypopharyngeal cancer patients was not depressed after surgery (extirpation with reconstruction).
5) Postoperative irradiation will be able to be more useful than preoperative irradiation both on nonspecific immunological basis and on the results of randamized studies in literatures.
6) The levels of serum IgG was high, and serum β1C (C3) were low in patients with hypopharyngeal cancer. Serum levels of both factors did not change after irradiation, but elevated a little after surgery.

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The differentiation of the subglottic mucosa in human fetuses has been studied only by light microscopy. We observed for the first time the development of human subglottic mucosa from the 8th to the 21st week of gestation by scanning as well as transmission electron microscopies, and could obtain the following conclusions:
1. Ciliated cells and goblet cells appeared at the 12th week of gestation that was similar to the previous reports, and the detailed cytodifferentiation of both cells could be observed.
2. We could demonstrate for the first time that primary cilia appeared in the subglottic mucosa at the 10th week of gestation. Among these primary cilia, very long ones were observed and were supposed to be the grown forms of short primary cilia.
3. Glycogen granules in non-ciliated cells were observed in parallel with the cell differentiation, so they were seemed to be the source of energy necessary for the cell differentiation.

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The laryngomicrosurgery under a direct laryngoscope has been successfully employed for treatment of the laryngeal lesions. In addition to the conventional method of the laryngomicrosurgery, a therapeutic flexible laryngofiberscope has been used for minor surgery of the laryngeal lesions.
We have employed a therapeutic flexible laryngofiberscope for phonosurgical resection of laryngeal lesions such as vocal fold polyps with monitoring system by using laryngostrobovideography. This new technique has been successfully performed and excellent results have been obtained.
This new method is highly recommended based upon the followings: 1) no uncomfortable and no severe painful sensation during operation, 2) available even for patients who can not open their mouth because of odontological problems, or patients with severe cardiovascular and pulmonary lesions and 3) available under surface anesthesia of pharynx and larynx without admission.

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Since 1982, we had used the Jackson-Ono's direct bronchoscope with Tanaka's adapter for HFJV. This device was attached to the proximal end of the bronchoscope, and had a short channel for HFJV. However, this method resulted in high Pa_CO2 (mean 63.9±20.5mmHg) during long surgical procedure. Therefore, controlled respiration was intermittently required to increase the ventilatory flow per minute.
Recently, a bronchoscope with a long built-in channel has been devised at our department, in which spouting orifice of the oxygen is located inside the scope approxymately 6cm proximal from the tip. Since 1986, this device has been applied to 9 patients with bronchial foreign bodies and relatively lower Pa_CO2 (mean 29.3±11.3mmHg) has been observed during the surgical procedure.
Several basic experiments were performed to clarify the mechanism of better clinical results in blood gas analysis using a model of lung and bronchus complex. Following results were obtained: (1) the pressure at the distal end of the newly devised bronchoscope was significantly higher; (2) the ventilatory flow rate per minute was significantly higher than that of conventional bronchoscope with Tanaka's adapter; (3) there was no significant difference in airway pressure between these two instruments. From these results we concluded that the reason why low Pa_CO2 could be maintained with newly developed bronchoscope during long manipulation was due to high ventilatory flow rate in spite of the similar airway pressure inside the bronchus.

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It has been well known that the normal esophageal epithelium is stained by a modified Lugol's solution. On the other hand, displastic or cancerous mucosa of the esophagus is not stained by Lugol's solution through the endoscopic staining method. It is not clear what kind of mechanism causes the coloring or uncoloring of these esophageal mucosa using Lugol's solution. Therefore, to clarify this mechanism, we examined the sections of surgically resected esophageal tissues with Lugol's solution using the light microscopy. At the same time, we detected an iodine element in each tissue instilled with Lugol's solution by means of X-ray microanalytic technique. In light microscopic study, the cells of the stratum corneum and stratum granulosa of the normal esophageal mucosa were strongly stained by Lugol's solution. Dysplastic epithelium showed a slight coloration property in its superficial layer. No cancerous lesions were histologically stained by Lugol's solution. In X-ray microanalytic study, the cells of stratum corneum and stratum granulosa displayed a high peak for iodine. An intermediate peak for iodine was detected in the superficial zone of the displastic mucosa. No peaks for iodine were found in any other portion of the cancer tissues. These results suggested that the difference in the coloration property of the normal esophageal epithelium, dysplastic regions and cancerous regions corresponded to the affinity of each of these cells of these regions with iodine.

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We analysed 7, 307 outpatients who had visited our clinic in the Dokkyo University School of Medicine Hospital between 1974 and 1987. The number of patients with swelling of the neck was 346 (4.8%). Benign disease accounted for 218 cases (62.1%) and malignant disease 133 cases (37.9%). Malignant disease increased in patients over 50 years old, and exceeded the number of benign disease in those over 60 years old.
There were 171 cases of thyroid disease (35 malignant cases and 136 benign cases) and 180 cases of non-thyroid disease. The latter included 44 cases of inflammation (24.4%), 105 cases of tumors (58.3%) and 31 cases of congenital disease and miscellaneous (17.2%). Out of 105 tumor cases, primary malignant tumors were found in 13 cases, metastatic tumors below the clavicle were in 8 cases, metastatic tumors above the clavicle were in 73 cases, primary benign tumors were in 7 cases and primary unknown malignant tumors were in 4 cases.
In the frontal neck region, almost 80% of neck masses were benign disease and almost 90% were thyroid disease. In the lateral neck region, almost 60% were malignant disease. In the sternocleidomastoideus area, over 90% were metastatic tumors. The metastatic neck masses from the head and neck region were found in the upper and median parts of the neck. Metastatic tumors below the clavicle were found only in the lower part of the neck.
Almost 70% of the patients (230 out of 334 cases) with cervical masses were referred to our department by other departments or institutes. The patients were referred to our department slightly more than one year after noticing the first symptoms. The patients were first treated or diagnosed by referring doctors for a period of 44 days. We wish to enlighten the general public and doctors in other departments about these cervical masses.

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Laryngeal chondroma is quite rare and only 23 cases have been reported in Japan including this case. The patient, a 59-year-old male, visited Tokyo Medical College Kasumigaura Hospital complaining of dyspnea and a slight dysphagia. Indirect laryngoscopy revealed that there was a subglottic tumor, and it seemed that this tumor grew fast and became easy to bleed for the recent three months by the patient's statement. Thus, it was suspected of malignancy. It was so large that total laryngectomy had to be performed. The tumor originated from the posterior part of the cricoid cartilage.
A literature survey was carried out on 16 males and 6 females already reported in Japan, and the following information could be obtained; 18 cases out of 23 including this one were in between 50 and 70 years old, most of laryngeal chondroma originated from the cricoid cartilage, and the thyroid cartilage, the vocal cord and the arytenoid cartilage succeeded in order of incidence. There was no tumor arising from the epiglottis. Surgical removal is the only treatment for this tumor.

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The authors reported a male case of the total calcification of the stylohyoid ligament with vocal polyp. His chief complaint was a hard mass in the submandibular region, which was confirmed to be the hypertrophy of the lesser cornu of the hyoid bone by radiography. He had a false articulation between the calcified stylohyoid ligament and the lesser cornu of hyoid bone. The hyoid bone could rotate clockwise in swallowing, but did not move forward. Therefore, he did not have dysphagia, while the intratracheal intubation of general anesthesia for laryngomicrosurgery was impossible. The authors discussed about stylohyoid syndrome and emphasized the importance in the observation of movements of hyoid bone.

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There seem to be confusions about the usage of the term of “croup” among many textbooks and medical literatures. Although it was originally used to express the symptom of acute laryngeal obstruction (1), its meaning has changed later into the followings; diseases that show symptoms of acute laryngeal obstruction (2), diphtheritic laryngitis (3), and acute (viral) laryngotracheobronchitis (4). Various authors have used “croup” in a different way, and it has caused an embarrassment in understanding contexts correctly. The term of “pseudocroup” is also flustering.
In this paper, we presented the historical changes of the meaning of croup and how it has been dealt in textbooks. We propose that “croup” should be used only as a disease complex or as a syndrome that shows the signs and symptoms of acute upper airway obstruction and this is an appropriate term for temporary diagnosis. And the conditions should be expressed by combinations of agents or irritants, affected site, and pathology soon after the examinations are made.

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The mixture of agar and barium, “agar-barium, ” is used as contrast medium to examine the patients with misdeglutition and dysphagia. Video-fluorography reveals that agar-barium remains once at valleculae and pyriform sinuses during the pharyngeal stage then volitional swallowing propels it into esophagus resulting no apparent misdeglutition, although liquid barium sometimes enters directly into the trachea. The results suggest that for the patients with misdeglutition, agar-barium seems to be a kind of suitable material to evaluate actual swallowing dynamics. Because it can be more easily manipulated and well controlled, although liquid barium is poorly controlled and is likely to promote choking. The jelly-like texture of agar-barium prevents the patients from misdeglutition.

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