It has been pointed out by many clinicians that white lesion of the larynx should be treated carefully as a precancerous lesion. Clinically, it is called leukoplakia, hyperkeratosis and pachydermia. Histopathologically, it is varied with the appearance of cell atypia and cancer cell in addition to pathological keratosis. So, its clinical and histopathological concepts have not yet been established.
Fifty-one cases were studied excluding those who were diagnosed as laryngeal cancer on the first histopathological examination among cases of white lesion of the larynx which were treated at this hospital during 12 years from December, 1977 to December, 1989. The 51 cases are broken down to 46 men (34-76 years of age, 56.4 years on the average) and 5 women (42-60 years of age, 49.8 years on the average).
Six cases were intractable-recurrent. Dysplasia was noted in all the cases. Of them, 3 cases had high-grade dysplasia and 3 cases low-grade dysplasia. Three of the 51 cases were suspected of canceration, showing findings of dysplasia.
From the findings above, it is concluded that the presence of dysplasia is the most important factor that affects the prognosis of white lesion of the larynx.

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During the period between 1971 and 1980, the postmortem examinations of 14 infants and young children, ranged from 9 months to 4 years of ages, averaged 1-year-7 month old, who died of foreign bodies in the airway were performed in the Tokyo Metropolitan Examiners Office. The clinical progress of these children was reviewed, and summarized as follows.
1. The foreign bodies in these cases were several kinds of foods such as beans in 5 cases, orange or its skin in 2, other foods in 3 and a candy in one case.
2. Among these, two chidren were eating foods while they were playing or running around, and 3children aspirated foreign bodies into the airway accidentally during vomiting or unknown cause and while changing their dipers.
3. These accidents have tought us that it is very important to feed or give foods to children while they are quiet.
4. Ten children have died at the day of accident, and 3 children have been transferred from clinic to clinic and died in several days after the accident. Every phisician who happens to see children presenting with wheezing or respiratory distress should be aware of foreign body in the airway.
5. In 13 cases, foreign bodies were found in the trachea. The case of foreign body in the trachea usually shows a normal chest X-ray and this makes the precise diagnosis much more difficult than cases with a foreign body in the bronchus. The fiberscopic or bronchoscopic examinations are mandatory for making the exact diagnosis.

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The histochemical differences between young and aged rat tracheal glands were studied. In young rats (8 to 17 weeks after birth), the tracheal gland consisted of duct and secretory units, mucous tubules and serous acini. Mucosubstances of mucous tubular cells were classified as a mucous glycoprotein type, but those of serous acinar cells were serous-typed. Mucous tubular cells contained both neutral polysaccharides and sialidase resistant sialic acids, but little sulfate polysaccharide. Serous acinar cells contained only neutral polysaccharides. In aged rats (20 to 30 months after birth), the tracheal gland was composed of, in addition to ducts, mucous tubules and serous acini, cyst-like structures and mucous acini. The cyst-like structurewas regarded as a dilation of duct, because of abundunt ciliated cells and lack of intercalated components between a cyst-like structure and a mucous tubule. Mucous cells of cyst-like structures and mucous tubules contained both neutral polysaccharides and sialic acids. Mucous acini, containing mainly sulfate polysaccharides, were capped by serous demilunes. Mucosubstances of these three parts were classified as a mucous glycoprotein type. Although serous acini, in aged rats, was composed of a cluster of morphological serous cells, their mucosubstances contained not only neutral polysaccharides, but also moderate amounts of sialic acids.
Morphometric analysis of aged rat tracheal gland cells showed the decrease of not only the number of secretory cell per unit area of lamina propria, but also the serous cell vs. mucous cell ratio, in comparison with those of young rats. In aged rat tracheal serous cells, histochemical findings about sialic acids and the decrease of serous cell number reflected the alteration or the depression of host defence mechanism of the trachea. The reason why various airway diseases increased in the aging could be explained by these results.

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The histochemical and ultrastructural differences between young and aged human tracheal glands were studied. The materials were obtained at necropsy or during surgical procedures of the larynx and trachea. In human tracheal gland, remarkable differences between young (10 to 21-year-old) and aged (61 to 81-year-old) ones were especially seen in serous cells. Mucosubstances of young tracheal serous cells were classified as serum glycoprotein types, but those of the aged cells were mainly mucin types. Ultrastructurally, young tracheal serous cells contained homogeneously electron dense or biphasic secretory granules. On the other hand, the aged cells contained not only homogeneous electron dense granules but also multiform ones, hiphasic or electron lucent, resembling mucous cell granules. In aged human tracheal serous cells, alterations of histochemical and ultrastructural properties of secretory materials reflected depression of host defence mechanism of the trachea. By these results, the reason why various airway deseases increase with aging could be explained. In aged human, in addition, oncocytes were found within the mucous tubule and they occasion ally contained secretory granules. Although appearance of oncocytes in the tracheal gland was closely related with aging, this phenomenon seemed not to directly participate in depres sion of the defence mechanism.

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In our hospital, we have seen six cases with non-malignant esophago-bronchial fistulae. There were four men and two women ranging in ages from 42 to 72. Five of them had a past history of pneumonia. The chief complaints in five of the cases were coughing and fever.
All of them were diagnosed under esophagography. Broncho-fiberscopy was ineffective for diagnosing this disorder. All cases were surgically treated without-operative mortality.
In four cases, fistulectomy was carried out. In the remaining two, the division of fistulae were performed. In one case, the fistula was communicated to the left main bronchus, while in the remaining cases they were communicated to the right lower lobe.
By clinical course and pathological examination, four of them were diagnosed as congenital, and the remaining ones were found to be acquired. The post-operative courses were uneventful except for in one case, which seemed to have been acquired, and this case suffered from respiratory distress for three weeks.
In the treatment of esophago-bronchial fistula, surgical treatment must be selected as soon as possible.

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The patient was a 22-year-old female with Crouzon's disease. Because of the depressed tongue base, sonorous snoring has continued from her childhood. Since several years ago, she suffered from severe sleep apnea. This was so severe that she was forced to sleep in sitting position. A simple tonsillectomy was ineffective. A mandibular osteotomy and UPPP were carried out for this patient with satisfactory effect.

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A case of vocal cord granuloma is reported, which is thought to be caused by chronic intubation and artificial respiratory management for respiratory insufficiency following a radical operation on esophageal cancer. Recently, due to the expansion of surgery for aggressive dissection of the lymph nodes, intubation respiratory management is required in many cases for several days or more after radical operation for esophageal cancer. In such cases, it may be necessary to take into consideration for the possibility of development of postintubation granulomas.

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A 21-month-old male has complained of fever and cough for two weeks. Dec. 2, 1989, because of suspection of pneumonia, X-ray examination was done. The radiograph revealed a foreign body shadow of a safety-pin and pneumonia in the left bronchus. It was not obvious when he had aspirated the safety-pin. In January 11, 1990, providing thracotomy and extracorporeal circulation in advance, the foreign body was removed in three pieces with ventiration bronchoscope through a tracheostoma. The safety-pin was 26×6 mm in size and has been eroded. No sever postoperative complication was observed. He was discharged 4 weeks after the operation. One hundred and ninety four cases of foreign bodies in the air way were treated in our department during past 32 years. Male to female ratio in our cases was about 2.2: 1. One hundred and twenty six cases of these foreign bodies were peanuts. This is the first case of safety-pin in our department.

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There are several reports that the mucosal transplantation has been achieved successfully with a help of fibrin glue in intralaryngeal surgery. We here applied the free mucosal trans plantation with fibrin glue to the reconstruction of the subglottic stenosis.
A 2-year-old female with the subglottic stenosis was consulted for the relief of dyspnea. The emergent tracheostomy followed by direct laryngoscopy was performed. Severe stenosis was observed at the level of the cricoid cartilage and the air way seemed like a pin hole. After tracheothvrotomy, the stenotic scar tissue was resected. The wound was covered with the mucosal membrane of the lip by suturing and fixation with fibrin glue. A stent was inserted into the tracheolaryngeal trough. After the flap was confirmed surviving on the recipient bed, the trough was closed with a free rib cartilage flap on the seventh week. The stoma was closed thirteen weeks after the surgery. Restenosis of the airway has not been observed for six months after the stomal closure.
The human fibrin glue was considered to play an important role to prevent the air coming into the space between the flap and the recipient bed, which lead to the good survival of the flap.

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Large airway stenosis requires emergency treatment because of the critical condition. Usually tracheal intubation is useful for such a case. But, for carinal stenosis unilateral intubation is necessary. However, for a conscious patient unilatelar intubation with the regular intubation tube is difficult. In our department, we newly design a special tracheal cannula for such carinal stenosis cases using the regular intubation tube and the tracheal cannula. Manufacture of this special cannula is simple, economical and can be done in almost any hospital. The cannula is easy to fix and is stable for a relatively long period, for example 3 to 4 weeks for radiation treatment.

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A statistical analysis was made on 639 cases of esophageal foreign bodies treated in the Department of Otorhinolaryngology, Hirosaki and Tohoku Universities, during the years from 1949 to 1989 and from 1972 to 1989, respectively. The results were as follows:
1) The annual mean incidences of the disease were 9.8 and 13.3 at Hirosaki and Tohoku Univ., respectively. Year-to-year change in the incidence was not observed.
2) Male and female ratio was 4: 3, and 327 cases (51%) were under 6 years of age.
3) The foreign objects were coins (44%), fish bones (19%), dentures (12%), P.T.P. (press through pack of medicine, 4%) and others.
4) Comparison of the foreign objects between two periods, 1949-61 and 1982-89, revealed that the frequencies of the disease due to coins and fish bones decreased. P.T.P. and meat as foreign bodies occurred in the later period. These tendencies led to an increased variety of objects in recent years.
5) In the urban area the trends noted in 4) were more prominent than in the rural area.
6) It was noteworthy that in the rural area the aspiration of dentures was more frequent thanin the urban area.
7) Approximately 70% of the foreign bodies were lodged at the entrance of esophagus.
8) Complications of the disease, such as periesophageal abscess, mediastinitis and aspiration pneumonia, occurred only in 7 out of 303 cases in the recent 18 years.

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