The incidence of tuberculosis has markedly decreased since the introduction of effective chemotherapy. However, laryngeal tuberculosis has been on the increase in recent years.
Seven cases of laryngeal tuberculosis treated in our department between 1992 and 1999 are presented in this paper. The tuberculosis involved the vocal cords in 4 patients and the epiglottis in 3. Six out of the 7 patients complained of hoarseness, and 3 complained of pharyngalgia. Chest radiography, sputum tests, PPD were supplemental tools for diagnosis. Chest radiographic findings were interpreted as showing advanced pulmonary disease in 6 patients. In the sputum cytology, 4 patients were positive for acid-fast bacilli, and 3 were negative.
Pathological examination is mandatory to make final diagnosis and to rule out malignancies.

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A statistical study was made of 69 cases of esophageal foreign bodies treated after hospitalization at our clinic during the 21 years from 1978 to 1998 and 20 ambulatory cases of esophageal foreign bodies treated at our clinic during the 9 years from 1990 to 1998. Two peaks were observed in age distribution, one in children below age 4 and the other in elderly people above 70. Coins were found especially in children. Dentures and PTPs were found in the elderly. Cerebrovascular disease was the most common past history.

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One hundred fifty patients have been tracheostomised in the past five years at Yamada Red Cross Hospital. Of these 150 patients, 90 were proposed for tracheostomy by other departments, and such cases are on the increase. Thirty-two patients showed indications for tracheostomy in the stenosis of the aero-tract caused by the tumors or mucosal swelling. Prophylactic tracheostomy was performed in 23 cases due to a delayed stenosis of the aero-tract. Emergent tracheostomy was performed in 31 cases, and, of these cases, an incision of the cricothyroid membrane was performed in one case. Though tracheostomies have been performed in many departments, the determination of accurate indications and safe operative techniques for different cases are best assisted when performed by head and neck surgeons.

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Two cases of laryngotracheal amyloidosis, who had been followed up for 15 and 8 years after their first treatment, were reported, and their long-term course was discussed. In Case 1, although the extent of the lesion was wide (from the supraglottic to the bronchus), the patient was followed up for 15 years after a first tracheostomy and biopsy, wearing a speech cannula without regrowth and progress of the disease. In Case 2, although the lesion was within the subglottic region, regrowth of the amyloid mass occurred after tracheostomy and endoscopic surgery. Case 2 required a laryngofissure, curettage of the amyloid, skin grafting and hyoid bone implantation, as a third operation, with no further recurrence. In the treatment of amyloidosis arising in the larynx and trachea, long-term follow-ups are needed after a proper diagnosis of the extent and progress of the lesion, as well as accurate procedures and timing of any operations.

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A 70-year-old woman was admitted to our hospital because of a cervical esophageal perforation caused by a flexible fiberscope. After an esophageal fish-bone foreign body was removed by a flexible fiberscope, the patient's cheek, neck and anterior chest wall started swelling. Chest X-ray and computed tomography revealed mediastinal and subcutaneous emphysema. Dyspnea was not observed, oral intake was withheld, and antibiotics were administered. Surgery was not attempted, since no symptoms were observed within 72 hours after the injury. Four days after admission, a fluoroscopic X-ray examination of the neck, thorax and esophagus was performed. Oral intake was restarted on the fifth day, and the patient was discharged on the tenth day.

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We report on a prolonged case of a foreign body in the esophagus, which was overlooked more than one month. An 84 year old female complained of gradually increasing pain in swallowing and tenderness of the neck. Flexible fibro-optic esophagoscopy was the only medical examination which revealed a foreign body lodged in her esophagus. Direct esophagoscopy was performed, and the foreign body, a plum seed, was successfully removed.
Esophageal foreign bodies present for prolonged periods can cause life-threatening complications. Clinicians therefore need to suspect the presence of a foreign body from the time of the first medical examination.

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Three reconstructions of the trachea using a piece of clavicular bone attached to a deltopectoral flap (D-P flap) were reported. Two cases had thyroid cancer, and one the other adenoid cystic cancer arising from the thachea. More than half of the trachea wall was resected in various lengths due to the invasion of the respective tumors. Excellent results were obtained by this procedure, although two staged operations were inevitable. The natural physiological length of the trachea was preserved.
Postoperatively, these patients are free from any respiratory compromise or difficulties in verbal communication. Thus, this procedure could become a useful, safe and reliable method for tracheal reconstruction in cases with considerable tumor invasion into the trachea.

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The stroboscope is a useful piece of equipment to help diagnose diseases of the vocal cords. However, the stroboscope with a xenon lamp light source is not small and requires a high voltage power supply. The laryngo-stroboscope is also heavy and expensive. As a solution to these problems, we constructed a laryngo-stroboscope with a light-emitting diode (LED) light source. This LED stroboscope is composed of a probe and a processor. The probe equipped with LEDs and a small CCD video camera is inserted into the pharynx via the mouth. As the red LED pulses synchronously with the vibration of the vocal cords, the stroboscopic vocal cord movement can be observed via the CCD video camera. The frequency of the LED pulses is manually controlled by a processor. In the non- stroboscopic mode, a white LED is used and color video laryngoscopy is possible. This system operates on dry batteries. The LED laryngo-stroboscope is simple, lightweight and less expensive than a xenon lamp stroboscope.

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