Twenty-three patients with bilateral recurrent laryngeal nerve paralysis treated at our clinic over the past 15 years were studied. The vocal cord was fixed in a paramedian position in twelve patients, in a median position in ten patients and in our intermediate position in one patient. No surgical treatment was performed in ten patients, while thirteen patients were surgically treated. Surgical procedures were undertaken as follows: tracheotomy in three patients, endoscopic lateralization of the vocal cord by Kirchner's method in two patients, widening of the anterior glottis combined with Woodman's operation in one patient, arytenoidectomy in five patients, thyroplasty type I (Isshiki's method) in one patient, glottic closure in one patient and laryngectomy in one patient. From our long term observations, we think that arytenoidectomy is the simplest and most reliable method for reducing the laryngeal obstruction in bilateral recurrent nerve paralysis.

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Radiotherapy poses few clinical problems and produces excellent therapeutic results, although a mild mucositis is seen as a side-effect in a majority of patients. However, we occasionally encounter other cases which suffer severe sequelae due to radiotherapy. Of 27 patients with laryngeal cancer (T1; 5 cases, T2; 21 cases, T3; 1 case) who underwent full-dose radiotherapy at this department between January 1987 and January 1992, 7 cases suffered severe sequelae. These included 3 cases which had a severe laryngeal edema requiring tracheotomy, 4 cases which had a fixation of the vocal cord and 2 cases which had an infection extending to the subcutaneous tissue of the neck (2 out of these 7 cases had has two sequelae simultaneously). As factors responsible for the invasion into the laryngeal tissue, mention can naturally be made of the cancer itself, but there are also factors, such as radiation and the infection attendant upon radiation. Furthermore, surgical procedures including excisional biopsy and laser use should be seen as other possible factors in this invasion.

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A clinical study was made of 13 patients with vocal cord adhesion at the authors' clinic during the period from 1971 to 1993. The age of the patients ranged from 0 to 79 years. There were 7 males and 6 females. The following results were obtained.
1) Vocal cord adhesion was found in the anterior glottis in 10 cases, in the membranous portion of the glottis in 1 case, and in the posterior glottis in 2 cases.
2) The causes of the adhesion in the anterior glottis were endotracheal intubation in 6 cases, microlaryngeal surgery in 3 cases, and the insertion of a T-tube in 1 case.
3) The cause of the adhesion of the membranous portion of the glottis was endotracheal intubation.
4) The cause of the adhesion in the posterior glottis was also endotracheal intubation.
5) In 9 cases, a surgical separation of adhesion was attempted endoscopically. Four cases out of these 9 developed a recurrence of the adhesion. Another operation was made successfully in 2 of these 4 patients.

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The influence of the platelet activating factor (PAF) on ciliary activity in the tracheal mucosa was investigated using of an in vitro experimental method. In brief, mucosal cultures from the trachea in the guinea pig were cultured in a medium containing heparinized whole blood, bronchoalveolar lavage fluid (BALF), and/or 10^-10-10^-8M of PAF. The possible changes in ciliary activity in the above medium were then observed. The following results were obtained.
1) BALF had no effect on the ciliary activity.
2) 10^-10-10^-8M of PAF had no effect on the ciliary activity.
3) 10^-10-10^-8M of PAF had no effect on the ciliary activity in the presence of heparinized whole blood or the supernatant of BALF.
4) 10^-10-10^-8M of PAF depressed the ciliary activity in the presence of BALF in a dose-response fashion.
Therefore, it can be inferred from the study that alveolar macrophages are, at least partially, involved in PAF-induced ciliary depression.

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Bilateral tracheobronchial foreign bodies are an emergent disease because they cause cyanosis with dyspnea in patient. We have seen bilateral bronchial foreign bodies, two fragments of peanuts, in a one-year-old girl. She had complained of cyanosis with dyspnea on arriving at our hospital. She had had a one-day history of wheezing and coughing before she acquired cyanosis. A physical examination revealed moist rale in her lung field, and an X-ray examination of her chest showed Holzknecht's sign. During our examination, her cyanosis and breathing became worse. We immediately performed a ligid bronchoscope operation to remove the foreign bodies under emergent general anesthesia. We found two fragments of peanuts, the bilateral bronchial trees were almost totally obstructed due to these foreign bodies, which were removed without after-effect. In the case of respiratory tract foreign bodies, the timing of an operation and a meticulous examination of the bilateral bronchial trees for multiple foreign bodies are necessary.

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A case of multiple polyps originating in a skin tube for esophageal reconstruction was reported in this paper. A 62-year-old man received a subtotal esophagectomy for esophageal cancer in June 1978. A stomach tube was used for the reconstruction of his esophagus. Because of the paralysis of the bilateral recurrent nerve, laryngectomy and a resection of the remnant esophagus were carried out 3 months after the esophagectomy, and the skin tube with a D-P flap was used for reconstruction. 8 years after this operation, multiple polyps developed in the skin tube, and the number of polyps has gradually increased. Since a malignancy was suspected in some of these polyps from an endoscopic examination, tissue specimens taken in frequent biopsies have been examined histologically. However, no malignancy has been found. The histological finding showed an inflammatory squamous polyp without malignancy. Another report of polyps originating in a skin tube has not been seen so far. Because the long survival of patients with esophageal cancer after reconstruction with a skin tube is unlikely, a suficient observation of the skin tube may not be possible.

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Two cases, a 14-month-old boy and a 26-month-old boy, having a foreign body (safety pin) in the esophagus are reported. The safety pins which were observed under X-ray examination, were opened into a V-shape in both cases and lodged in the 1st constriction of the esophagus. In both cases, the removal of the sharp foreign body was performed safely using a rigid esophagoscope under general anesthesia. No complications occurred during or after the operation in either case.

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Extramedullary plasmacytoma of the thyroid gland is uncommon. We report the 18th known case in Japan.
A 76-year-old female with chronic thyroiditis was referred to our hospital because of dyspnea. The thyroid gland was wholly occupied by a large tumor and an X-ray of the neck showed a large mass in the trachea. In an emergency operation, a total thyroidectomy with a resection of the right recurrent laryngeal nerve and tracheal cartilage was performed because they had been invaded. Histopathological examination revealed a IgG/k type plasmacytoma. Multiple myeloma was not found in the bone marrow aspiration, and an X-ray of the bones in the whole body and a bone schintigram showed no abnormality. However, in spite of post operative irradiation therapy for the neck, multiple myeloma with mass lesions in the ribs and skull occurred 4 months after radiation. Chemotherapy has been performed, which has led to the disappearance of the bone lesions.

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