Recently, the detection of anti-neutrophil cytoplasm antibodies (ANCA) has gained worldwide acceptance as an important, additional diagnostic tool in respect to vasculitic and granulomatous syndromes such as Wegener's granulomatosis (WG). The classical ANCA, C-ANCA, which is primarily observed in WG, is defined by an indirect immunofluorescence (IIF) technique yielding an irregular, granular staining of the cytoplasm of neutrophils and monocytes using smeared, alcohol-fixed human leucocytes as substrate. The C-ANCA related antigen is a 29 kD molecule (possibly Proteinase 3), which is retrieved from the azurophil granules of the neutrophils. An enzyme linked immunosorbent assay (ELISA), using azurophil granules as substrate, has proven to correlate well with the IIF assay. Using both assays simultaneously increases the specificity and sensitivity of C-ANCA detection.
A group of patients with vasculitis and glomerulonephritis has autoantibodies against myeloperoxidase (MPO-ANCA). These sera yield an artifactual, perinuclear IIF staining (P-ANCA) distinct from the C-ANCA staining. As perinuclear IIF staining may be due to several autoantibodies, MPO-ANCA must be identified by ELISA.
Detection of C-ANCA has made it possible to identify patients with WG earlier in the course of disease and has increased the number of patients identified by a factor 3. C-ANCA is negative in cases with polymorphic reticulosis, lymphomas and sarcoidosis. C-ANCA often disappears when WG is brought in remission and reappears before and during relapses. In untreated, active cases of WG, C-ANCA can be detected in 50-95% of cases depending on organ manifestations while MPO-ANCA may be detected in 15% of cases with WG and kidney involvement.
A possible pathogenetic role of C-ANCA and P-ANCA has been suggested by the finding that the addition of purified IgG-ANCA to healthy neutrophils in vitro causes activation of these cells. As the circulating neutrophils are not activated, the disease modulating mechanism in WG must be further explored. The detection of ANCA, however, is an important clue to the nature of autoimmune diseases and the rapid development in this particular field of research holds great promise for the future.

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The records of 152 patients with carcinoma of the hypopharynx from 1975 to 1986 were reviewed retrospectively. Defining the geriatric population as 65 years or older, 84 patients were excluded by age criteria alone, leaving 68 patients for further analysis. Distribution by site included 58 (85%) pyriform sinus, 9 (13%) posterior pharyngeal wall, and 1 (2%) with a postcricoid lesion. There were 6 (9%) Stage II, 25 (37%) Stage III, and 37 (54%) Stage IV patients. Treatment groups included surgery alone (24%) and surgery combined with either preoperative or postoperative radiation therapy (76%). Lesions of the pyriform sinus were subdivided into lateral wall lesions (LP) and medial wall lesions (MP). Comparisons between these two sites will be made. The most frequent site of failure was in the neck (18%) followed by distant metastases (16%). Three (4%) patients failed locally in the laryngopharynx. Seven ipsilateral failures occurred in the operated neck while five failures occurred in the unoperated contralateral necks. Comparisons between the geriatric group and the overall index population of patients with carcinoma of the hypopharynx will be made.

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Resectability rate of the aged patients (≥ age of 72) with cancer of the thoracic esophagus in recent ten years (1980-89) increased to 70.5%, as compared with resectability in former ten years (1970-79) of 51.5%. This increase of resectability was attributable to the improvement of the perioperative management such as cardiorespiratory and nutritional supports. Assessing the operability of the aged patients, physiological age, which is based on the reserve function of the vital organ such as heart, lung, liver and kidney, rather than calendar age should be considered.
As a surgical strategy for the aged patients with cancer of the thoracic esophagus, who are assessed not to be indicated to the standard thoracotomy and laparotomy, transhiatal esophagectomy without thoracotomy is useful, even if palliative surgery. Based on this strategy, eight aged cases underwent transhiatal esophagectomy without thoracotomy, and three cases survived more than three years.
There is no significant difference of long term survival between the aged patients and over all cases.

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Forty-one cases of hypopharyngeal cancer and nine cases of cervical esophageal cancer were resected and reconstructed between 1984 and 1990. “Elderly”was defined as age 65 or above in this paper. There were 21 elderly hypopharyngeal patients and 5 elderly cervical esophageal cancer patients.
Surgical procedure, pathological examination, prognosis and recurrence type were compared between elderly and under 65 groups. Reconstruction procedure and functional evaluation were studied via a questionnaire on meal intake and VTR of postoperative barium swallow.
Pharyngolaryngoesophagectomy was performed in all hypopharyngeal cancer cases. Radical neck dissection on the tumor side and functional dissection on the opposite side were mainly performed, while bilateral functional dissection was done in nine patients, 6 of whom were under 65.
Reconstruction in cases of hypopharyngeal cancer after resection of pharynx, larynx and cervical esophagus was by free jejunal transplantation in 38 cases, by gastric tube in two and by myocutaneous flap of latissimus dorsi in one. In the elderly, eighteen cases were reconstructed by free jejunal transplantation and in 3 patients over 80 years old.
Functional evaluation via questionnaire of meal intake and VTR of postoperative barium swallow revealed slightly poor results in the elderly, but reconstruction by free jejunal transplantation should be the first choice after resection of hypopharyngeal carcinoma, without establishing an age limit.

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Material was obtained from 21 cadavers 16 males, ageing range 80-92, mean 84, 5 females aging range 80-81, mean 81 for the histochemical study. Materials of females, ageing range 63-71, mean 67 were utilized for three morphometric dimensional reconstruction, and those of males, aging range 68-75, mean 71 for enzymic stained study (Avidin-Biotin Peroxidase complex method). The whole of the thyropharyngeus muscle and cricopharyngeus muscle was removed from each cadaver. In addition, the configurational analysis of the larynx and hypopharynx during dry swallowing in young adult subjects was assessed using a small caliber fiberoptics and CCD-fiberoptics.
Results were compared with values from samples of hypopharyngeal histopathology and configuration in young adult cadavers and subjects. Degeneration due to ageing of the muscle fiber was clarified by means of measuring the diameter of each muscle fiber. The diameter of the thyropharyngeus muscle fiber (Tp) and cricopharyngeus muscle fiber (Cp) was influenced by ageing from (mean) 16.07μm to 13.14μm and (mean) 16.18μm to 13.96μm individually. The type I fiber of both muscles was refractory to the aged degeneration compared with the type II fiber. The mitochondria near I-band was degenerated and contained the lipofuscin granules which was assured by an electron microscopic study.

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It is well known that swallowing and respiration are highly correlated movement. Respiratory flow rate, abdominal movements and pharyngeal pressure were simultaneously measured during deglutition in 10 aged subjects. SAT were measured in ten times on dry and wet swallowing in each subject. Values of SAT in aged group were longer than normal controls.

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In order to define the influence of age on pharyngeal swallowing, swallows of a liquid bolus and a solid one were examined in two groups: 61 subjects 60-89 years of age and 27 subjects 19-59 years of age. Pathologic conditions occurring with greater frequency in the elderly were as follows: premature swallow in the oral stage, laryngeal penetration in the pharyngeal stage, limited movements of the epiglottis, accumulation of a bolus in the val lecula, and piecemeal deglutition in the pharyngeal stage. These results suggest that reduced swallowing reflex and reduced peristalsis often occur with the increase of age although the individual variability increases with age, and that subjects with those findings has the risk of aspirating a bolus.

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In Japan, the incidence ratio of cancer of the hypopharynx tends to increase, differing from that of cancer of the larynx or cancer of the maxilla. Although the incidence ratio in men in 1966 was 0.3 out of a population of 100, 000 persons, that in 1986 became 0.8; in contrast, no increase in females was seen. According to the Ministry of Welfare, the number of deaths due to cancer of the hypopharynx was 111 persons in 1973, and it increased to 420 persons in 1988; similarly, no increase was seen for females. These data suggest that since carcinogenic factors such as smoking and drinking may not be reduced in the future, there may be further increase in male patients.
The percentage of aged patients, 70 years old or more, with cancer of the hypopharynx was 14% 20 years ago, but it has increased to 47%, recently. Thus, 80% of cases were of piriform sinus cancer of stages III and IV and of the advanced cases, which are found in many men with heavy smoking or drinking. In such cases, it is unlikely that metastasis to regional lymph nodes and distant metastasis can be controlled. Because aged patients of cancer of the hypopharynx with very poor prognosis may have various complications, it will be necessary to select the treatment very carefully.
In consideration of the quality of life of the patient, it will be ideal to obtain cooperation of the family as well as medical staff in postoperative rehabilitation.

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Morphometric analysis of tracheal glandular cells of aged rat (20-30 months after birth) showed a decrease of not only a secretory cell number per unit area of lamina propria but also a serous cell vs. mucous cell ratio, in comparison with those of young rat (8-17 weeks after birth).
A cyst-like structure and mucous acini were observed in aged rats, both of which could not be seen in young rats.
Histochemical studies revealed that two types of glycoprotein were contained in mucosubstances of serous acinar cells of aged rats, one was mucous type and the other serous. Moreover, mucosubstances of serous cells of aged rats contained neutral polysaccharides as well as moderate amounts of sialic acid which was resistant to sialidase. The mucous type of glycoprotein and sialic acids were not observed in serous cells of young rats. The similar results were obtained in human tracheal and laryngeal specimen.
In an electron microscopic study, two kinds of secretory granules were observed in serous cells of aged rats, one of which was homogenous and the other was composed of electron dense core with halo.
Above mentioned findings reflected an alteration of host defence mechanisms of the trachea and larynx.

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Intensity, fundamental frequency of voice and air flow rate during phonation were simultaneously measured in 51 younger adults and 64 older persons. In addition to these parameter were measured expiratory pressure during phonation in 14 younger adults and 18 older persons.
The following results were obtained.
1. Mean intensity of the voice in the older groups took higher magnitude as compared with that of young groups at comfortable and soft levels.
2. Comparing older women with young women, the average fundamental frequency in the older women was lower than that in the younger women at comfortable, soft and loud levels.
3. In the older group air flow rates at the changes of voice levels from comfortable to loud and expiratory pressure decreased. Otherwise in younger groups both air flow rates and expiratory pressures were increased.

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Causative organisms of lower respiratory tract infections have been changed because of the increase in number of the aged and the resistant strains. In the hospital for aged patients, two major pathogens, Staphylococcus aureus (S. aureus) andPseudomonas aeruginosa (P. aeruginosa) are specially seen in nosocomial pneumonia and bronchitis. In these patients, the two major ones were isolated from the oropharynx. Attachment ability ofBranhamella catarrhalis (B. catarrhalis) to oropharyngeal cells coincided with lower respiratory tract infections by this organism. Adherence of indigenous bacteria of the normal flora was found to be an important ecological determinant in the colonization of specific surfaces in human and their role in resistance to infection have already been emphasized. In healthy aged, their oropharynx is usually colonized with non-pathogenic organisms, but after the suffering from Influenza virus infection, their oropharynx will be sometimes attached by pathogenic bacteria.
Oropharyngeal pathogens likeH. influenzae, S. pneumoniae, B. catarrhalis, S. aureus (MRSA) andP. aeruginosawere killed by 100-500 times diluted solution of 7% povidon iodine solution. Mereover the frequency of recurrence of respiratory infections by these bacteria were decreased by gargling of this solution 3-4 times/day.
Control or adjustment of these bacteria in upper respiratory tract may become very important in the future.

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The pathophysiological basis for insufficiency of cough seen in senile patients was examined. Flow-volume curve for patients with chronic lung disease was obtained during cough and maximal expiratory effort. The flow during cough was equal to maximal expiratory flow (V_max) and V_maxdecreased with an age. The chest wall configuration during cough was evaluated Konno-Mead diagram which suggested expiratory muscle weakness and insufficient closure of vocal cords in senile patients. Longitudinal shape of trachea obtained by magnetic resonance imaging (MRI) and cross sectional area of trachea obtained CT scan were evaluated. Longitudinal shape of trachea more curved with an age. These results suggested that deformation of trachea also contributed to the decrease in the flow during cough in senile patients.

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Frequencies of the first (F₁) and second (F₂) formants of five Japanese vowels were extracted from speech samples of forty aged persons. F₁-F₂relationships were plotted and compared to those of younger persons. It was found that the clarity of each vowel and the difference between the sexes were reduced in the elderly.
Spectrographic analysis of the consonant /k/ using the same speech samples revealed that the relative power of /k/ was weakened in aged persons.
These facts suggest that speech characteristics of aged persons are greatly influenced senile changes in the vocal tract and in articulatory movements.

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