The onset mechanisms of mucositis and dermatitis caused by radiation therapy and chemotherapy have yet to be fully clarified. It has recently been suggested that reactive oxides produced by inflammation may result in cell injury, leading to mucositis and dermatitis. Hence, the suppression of reactive oxygen species such as superoxides and hydroxy radicals can be expected to be effective in preventing and treating these diseases. Azelastine hydrochloride suppresses the production of cytokines and reactive oxygen species, and some reports have documented its effectiveness in treating radiation mucositis and dermatitis. Therefore, we investigated the effectiveness of azelastine hydrochloride in preventing these diseases during radiation therapy for laryngeal cancer.
Subjects were patients with laryngeal carcinomas (stages T1 and T2) who received curative radiation therapy. A close of 1 mg of azelastine hydrochloride was administered orally twice a day, from the start of the radiation therapy until one-four weeks after the completion of therapy. Chronological changes in the pharyngo-laryngeal cavity and the neck skin of the patients who received azelastine hydrochloride were compared with those of patients who did not.
In the patients who received the azelastine hydrochloride, the onset of pharyngo-laryngeal mucositis and dermatitis was suppressed ; symptoms were relieved ealier and were not exacerbated. No severe side effects were observed, and the effectiveness of the radiation therapy was not affected.
The administration of azelastine hydrochloride concurrently with radiation therapy for laryngeal cancer suppressed the onset of pharyngo-laryngeal mucositis and dermatitis and alleviated the severity of these diseases, thus suggesting the usefulness of azelastine hydrochloride administered concurrently with radiation therapy.

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In this paper, we consider new material for intrafold injection. This material was a mixture of hydroxy apatite with fibrin glue. We injected the ipsilateral vocal cord in 8 canines, and observed the histological reaction. After 1 and 3 months, the fibrin glue was absorbed, and the apatite remained in part of the intrafold. The mass of the injected apatite was surrounded by thin fibrous connective tissue, and we could see a few inflammatory cells there. Thus, the usefulness and safety of this new material should be noted.

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Surgical treatments for aspiration can be classified as either functional or radical. It is necessary to divide the airway from the feeding tract in order to prevent aspiration in patients complaining of severe aspiration. Thacheoesophageal diversion was established as a surgical management technique for severe aspiration by Lindeman in 1975. This technique, which completely separates the airway and feeding tract is less invasive and reversible procedure for reconstruction. We performed tracheoesophageal diversion in six patients from 1991 to 1997. All patients improved aspiration pneumonia. Five patients who had no swallowing disturbance preoperatively, were able to eat orally after the operation.
This procedure preserving the larynx can lighten the psychological damage to the patient and his/her family. Although tracheoesophageal diversion leaves the unresolved problem of postoperative phonation, it is a useful surgical procedure for the patient who complains of severe aspiration and can improve quality of life.

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Life-threatning bleeding from the innominate artery is sometimes observed as a complication after total laryngectomy. Circulatory insufficiency with the use of a cuff enhances the necrotic process of the tracheal wall, and the tip of the tracheal cannula may provoke pressure necrosis on the anterior wall of the trachea and progressively injure the innominate artery. This hazardous complication is possible, if an improperly shaped cannula is used. The flexion of the tracheal cannulae available as commercial products can not match the trachea after total laryngectomy, because the trachea goes actually almost straight down to the carina, showing only a very slight curvature, this is clearly demonstrated in the MRI of laryngectomized patients. For the prevention of this complication, a new tracheal cannula has been developed, that is almost straight and matches the trachea of laryngectomized patients.

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We conducted experiments to determine the changes in swallowing attributable to differences in the property of the materials to be swallowed. The maximum swallowing capacity for water and 2% Throughsoft S^TM (an aqueous solution containing a starch power) was always larger by about by 20 ml for water than for 2% Throughsoft S^TM, though the absolute amount swallowed varied with each individual. On the other hand, the concept of ease in swallowing, presumably involving a light load was advanced in this study. Bolus volume of each swallow during continuous swallowing was close to that of easy swallowing. The volume did not apparently differ from that of water nor that of 2% Throughsoft S^TM. These results seem to suggest that the root of the tongue judges the property of the material to be swallowed before the completion of the stage II of swallowing, at latest, and actively determines the appropriate amount of material to be swallowed.

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A case of small-cell carcinoma of the larynx was reported in this paper. The patient was a 48-year-old man who had complained of hoarseness and a sore throat. The left false vocal fold had bulged out presented a smooth surface. A CT scan revealed a 2×1.5×3cm submucosal tumor with relatively clear boundaries. A biopsy from the larynx through an operating microscope suggested pleomorphic adenoma or malignancy. Because of a high level of SCC antigen and NSE, the whole tumor was removed. The final histopathological diagnosis was small-cell carcinoma of the larynx. Although the tumor disappeared after the operation and postoperative radiotherapy (linac 60 Gy) for six months, the patient had a metastatic swelling of the right cervical lymph node. A right functional neck dissection and two courses of chemotherapy (carboplatine 450 mg and etoposide 150 mg) have kept the patient alive with no recurrence or distance metastasis for three years. As a result, surgical treatment of small-cell carcinoma was thought to have a curative potential for localized lesions.

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For patients with severe posterior laryngeal web and glottic stenosis, we often take an approach involving open surgery (laryngofissure) and free mucosal transplantation. However, when therapies for laryngeal papilloma, leukoplakia, and carcinoma in situ cause a web and stenosis, open surgery will be undesirable, because of the possibility for the scattering of these diseases. In such cases, all surgical procedures should be performed endolaryngeally. Therefore, we have developed a new surgical approach for the treatment of pesterior laryngeal web and glottic stenosis.
The surgical procedure is as follows.
(1) The web and stenotic regions are removed endolaryngeally.
(2) A little larger stent than the glottic space is inserted and fixed with nylon thread above and below the thyroid cartilage.
(3) Free mucosal flap is placed between the intra-arytenoid region and the stent, fixed only with fibrin glue, endolaryngeally.
(4) 6 weeks later, the stent is removed.
We have seen a patient with severe anterior and posterior laryngeal stenosis. The above procedure was performed for the patient, and the free mucosal flap has been well transplanted and the glottic stenosis improved.

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The case of a large cyst of the mesopharynx leading to difficult endotracheal intubation was reported. The patient was a 52-year-old man whose chief complaint was of a sore throat. This was diagnosed as caused by a large cyst of the mesopharynx in a nasopharyngeal fiberscopic study and with concurrent CT images. Under general anesthesia, the cyst was removed using a direct laryngoscope. At first, endoscopic intubation was impossible due to the size of the cyst. Therefore, just before intubation, the cyst was percutaneously punctured with an ultrasonography-guided fine needle, and the contents were aspirated. Thereafter, endoscopic intubation could be performed easily. We suggest that it is useful to puncture a cyst with an ultrasonography-guided fine needle in the case of a large benign cyst which may require tracheostomy for its removal.

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Traumatic retropharyngeal hematoma is relatively rare. However, hematoma may sometimes cause an airway obstruction, because of the close proximity of the retropharyngeal space to the upper airway. If the upper airway is obstructed and dyspnea develops, an emergency tracheostomy or intubation may be required. We present a case of retropharyngeal hematoma, following a hyperextension injury of the neck, which required emergency surgical intervention. We considered that this retropharyngeal hematoma was associated with a spur-formation on the cervical spine and with the patient's anticoagulation therapy. We also reviewed other published reports of retropharyngeal hematomas.

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Humoral hypercalcemia of malignancy (HHM) is a common complication in lung cancer. Parathyroid hormone-related peptide may play a role in the HHM syndrome.
We report a case of small cell lung cancer hypercalcemia. Serum Intact-PTH was below the normal range and the 1, 25- (OH) ₂D₃ concentrations were not elevated, although the blood plasma PTHrP level was elevated. These findings are consistent with those in HHM.
A 69-year-old man was admitted to our hospital for investigation of appetite loss and nausea. The symptoms of appetite loss and nausea are associated with hypercalcemia. A percutaneous lung biopsy was performed. Histologically, the tumor was small cell carcinoma. Immunohistochemical examination revealed positive PTHrP in the tumor tissues. The staining was mild to moderate, and evenly distributed throughout the cytoplasm of most of the neoplastic cells.

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We report on two cases of anaplastic carcinoma of the thyroid believed to be due to anaplastic transformation.
One case was a 60-year-old man who had a recurrence in the neck after operation for papillary carcinoma of the thyroid. A tumor appeared in the parapharyngeal space. The tumor was non-resectable, since it adhered firmly to the anterior surface of the vertebra. Chemotherapy and radiotherapy were performed without success. The tumor kept on growing. With progressing cachexia, the patient eventually died.
The other case was a 76-year-old woman in whom a goiter, considered a differentiated carcinoma and followed for about 25 years, began to grow rapidly. Histopathological examination revealed a pattern which was suggestive of anaplastic transformation. The tumor infiltrating into the trachea blocked the airway, leading to dyspnea. Therefore a tracheotomy was performed. Since a radical operation was impossible, chemotherapy and radiotherapy were administered without effect. The tumor kept on growing. The patient later developed pneumonia, and eventually died of respiratory insufficiency.
Multidisciplinary therapy was administered in both cases, but it was not effective, and both diseases pregressed rapidly to their termination.

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A rigid contact endoscope is a recently developed optical instrument which allows detailed observations of the superficial layers of the mucosal epithelium. The superficial cells of laryngeal cancer, previously stained with a 1 % solution of methylene blue, were histologically observed using such a rigid contact endoscope adapted for laryngeal use during direct laryngoscopy. In squamous cell carcinoma, this contact endoscopy revealed the irregularity of the cell arrangement as nuclei of different degrees of staining, size and shape. Thus, enlarged color images of the superficial layer of the epithelium could be histologically obtained using this rigid contact endoscope, which in turn will permit new diagnostic approaches in laryngeal pathology.

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Laryngeal hemangioma is a comparatively rare benign tumor of the larynx. Surgical removal, laser therapy, cryosurgery and sclerotherapy are some of the treatment modalities employed.
We report a case of laryngeal hemangioma occurring in the right arytenoid. The patient was a 46-year-old woman complaining of an abnormal sensation in her larynx. The tumor was treated by injecting 5 % ethanolamine oleate, a sclerosing agent which has been used endoscopically in the treatment of esophageal varices through a direct laryngoscope. Two days after the operation, we found a slight edema in the larynx, but it was not necessary to perform a tracheostomy. The tumor had been reduced to a very small one in the right arytenoid one year after the operation. The treatment modality described above has three advantages : there is little bleeding during the operation, almost no scars or organic defects are left after the procedure, and it is easier to perform compared to other surgical treatments. Therefore, we recommend it as a first choice treatment, especially for small laryngeal hemangiomas.

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