Proliferating cell nuclear antigen (PCNA), which is an auxiliary protein for DNA polymerase delta specific for the S-phase of the cell cycle, was employed for evaluating the degree of tumor cell proliferation. The expression of PCNA was studied immunohistochemically in 125 specimens from 66 laryngeal carcinomas, by using monoclonal anti-PCNA antibody (DAKO, PC10).
The PCNA labeling index (percentage of positive cells per 500 tumor cells) ranged from 19.0 to 68.4% (average; 41.0%). Speaman Rank Correlation demonstrated a significant relationship between the PCNA labeling index and mitotic index (R=0.654, p<0.01). Between biopsy specimen and surgical specimen, there was no difference in the PCNA labeling index. The PCNA labeling index increased with stage of the disease and T-classification. The labeling index with neck metastasis was highter than that without metastasis. There was no significant correlation between the labering index and tumor cell differentiation or tumor location. After radiotherapy, the labeling index decreased in patients with high pretreatment values, whereas it increased in patients with low pretreatment values. In this study, the PCNA labeling index did not indicate the possibility of tumor recurrence and metastasis during follow-up.

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Etiology of vocal polyps has been investigated by many specialists and hypothesized to be an insufficiency of blood supply associated with inflammatory changes and/or mechanical vibratory factors of the vocal cords. In this paper, we determined the serum complement of C3, C4 and CH₅₀ levels in 268 patients with vocal nodules, vocal polyps or polypoid degeneration and the specific immunofluorescence microscopy was applied to search the distribution of C3 and C4 activities in the excised vocal polyp segments. Among the subjects, allergic disposition was noted in 22.8%, vocal abuse in 50% and smoking in 56%. The heavy smokers were tended to have polypoid degeneration in older ages.
The levels of serum complements of C3 and C4 activities were 78.9±23.7 and 23.7±6.0 mg/dl in vocal nodules, 78.8±10.2 and 24.3±7.3 mg/dl in vocal polyps, and 81.3±16.5 and 22.9±4.7 mg/dl in polypoid degeneration respectively.
The patients who had allergic disposition showed no significant difference in serum complement C3 and C4 levels compared to those of non allergic group. The C3 activity of serum complement were lower in heavy smoker patients with polypoid degeneration than non somoker patients with polypoid degeneration.
Specific immunofluorescence activity of C3 was noted in the basal membrane and the endothelium of small vessels and the mast cells in subepithelial layer in polyp segments. However, C4 specific fluorescence was not found in these tissues.
These data may suggest that the complement activities in the vocal cord associated with inflammatory changes and vocal abuses are related to polypoid changes of the vocal cords.

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Injectable collagen has been conventionally used for vocal fold augmentation in human subjects. One inherent problem with this treatment, however, has lied in the persistence of the implants.
To explore this problem, injectable collagen, 3% atelocollagen extracted from a calf, was injected into both the lamina propria and muscle layers in canine vocal folds. A histologic study was performed one year postoperatively.
We were unable to detect evidence of significant foreign body reaction and migration during the follow-up period. However, two patterns of reaction were seen : 1. cellular infiltration, 2. colonization by host fibroblasts and nourishing capillaries.
In immunohistochemical study it was revealed that when the implanted collagen was colonized by host cells, the immunologic features of the implant were preserved.

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Cricopharyngeus muscle specimens obtained during bilateral lateral cricopharyngeal myotomy were examined histopathologically. Ten cases of dysphagic patients with neuro-muscular diseases were subjected to this study. The results were summarized as follows; 1. In three cases, myogenic atrophy was found unilaterally. The histopathological feature was scattered muscular atrophy with slight fibrosis in these cases. 2. Four cases with unilateral nuclear and/or infranuclear vagal paralysis showed a group muscular atrophy and degeneration of muscle fibers ipsilaterally. 3. Four cases clinically presented with a failure of appropriate relaxation of the esophageal inlet. Two of them showed neurogenic muscular atrophy whereas the other two did not show such a histopathological feature. 4. In two cases of Wallenberg's syndrome neurogenic muscular atrophy was found in the cricopharyngeus and thyropharyngeus muscles. 5. There was no positive histopathological findings in the cricopharyngeus muscle of a case with cricopharyngeal dysphagia.

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Aerodynamic and acoustic characteristics of vocal registers were studied in profressional and non-professional singers. The air flow rate, sound intensity level and fundamental frequency were measured using SH-01 for the speech and singing voices. The rate and magnitude of vibrato were extracted from the singing voices, and an electroglottogram (EGG) was simultaneously recorded.
The results were as follows :
1. In the singing mode of a professional soprano singer, the register change from “Chest” to “Mid” occurred at 350 Hz.
In “Mid” register, the flow rate increased significantly even though the intensity level did not change remarkably. In the speech mode of the singers and in the singing mode of non-professional singers, the flow rate did not increase so much.
2. The estimated open quotient increased when the vocal register changed from “Chest” to “Mid”. At the register changing point, the vibrato tended to be suppressed. Vibrato magnitude was significantly larger in “Mid” register than in “Chest”. There was no significant difference in vibrato rate between the two vocal registers, although it was slightly slower in “Mid” register than in “Chest”. These results suggest that the laryngeal adjustment changes so as to increase the flow rate in “Mid” register, and the change affects vibrato magnitude significantly, but not the vibrato rate.

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Fourteen children were diagnosed as having unilateral or bilateral laryngeal paralysis at the Department of Otolaryngology, Kyoto Prefectural University of Medicine between 1985 and 1991. The ratio of bilateral paralyses was high compared to adult cases. Most of the congenital paralyses were idiopathic, whereas the causes of all acquired paralyses were known. The congenital idiopathic paralyses generally recovered suggesting that birth trauma may be involved in these cases. Management of the respiration was important since stridor besides hoarseness was found even in many of the unilateral paralyses. Tracheostomy was necessary in 3 of 4 bilateral paralyses while endotracheal intubation was necessary in the other one as well as in 2 unilateral paralyses.

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Between 1975 and 1992, 20 patients with squamous cell carcinoma of the larynx (10 supraglottic, 9 glottic, 1 subglottic lesion) underwent partial laryngectomy at the Dokkyo University School of Medicine.
Eleven patients had a lesion of Stage I or II and nine were of Stage III. Of the 11 patients with Stage I or II, seven were radiation failure cases, two could not complete radiotherapy and two underwent partial laryngectomy as the initial treatment. For the nine patients with Stage III lesions, preoperative rediation was employed in five cases, postoperative radiation was given to three and no radiotherapy was combined in one. The 5 year cumulative survival rate was 40% in supraglottic carcinomas and 88% in glottic carcinomas. It did not differ among the stages. We conclude that indications of partial laryngectomy are residual or recurrent glottic T1 and T2 lesions after radiotherapy and selected glottic T3 carcinomas. The criteria of partial laryngectomy for glottic T3 carcinomas are as follows : (1) fixation of the vocal fold due to vocalis muscle involvement without cricoarytenoid joint invasion; (2) localized paraglottic space involvement without transglottic extension and (3) no neck metastasis.

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Radiotherapy, laser surgery or a combination of the two have offered patients with early laryngeal cancer a chance for survival without total loss of vocal function, but there is still much controversy in their selection. Treatment of T1a glottic carcinoma with laser surgery alone has been reported to have a cure rate in the vicinity of 90% which is close to or superior to that achieved with radiation therapy alone. This however is not the case in T1b glottic carcinoma and T2 glottic or supraglottic carcinoma, and pre-or postoperative irradiation is often incorporated in an attempt to improve local control. We have shown in a series of 72 patients with early laryngeal cancer that radiotherapy combined with laser surgery may result in delayed healing of the wound, leaving ulcers with white exudate and granulation which are highly problematic in evaluating the lesion. Coated ulcers were seen 2 months after completion of therapy in 14 of the 28 cases (50.0%) that underwent irradiation following laser surgery, while only 6 of the 24 cases (25.0%) treated with laser alone, and only 1 of the 12 cases (8.3%) treated with radiation alone had delayed healing.

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Laser surgeries for thirteen cases of laryngeal papilloma was reviewed. Laser surgeries were conducted between Jan. 1986 and April 1992 as a treatment for six cases of solitary tumors and seven cases of multiple tumors. Two cases of juvenile laryngeal papilloma were both multiple type. Solitary tumors were successfully controlled by one or two operations of laser surgery alone. Three case of multiple tumors were not controlled by laser surgery alone.
Laser surgery demonstrates to be effective treatment method to control solitary papilloma. However multiple type, not readily controlled by laser surgery alone, need other treatment method along with laser.

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A total of 12 patients (11 males and one female) with laryngeal papilloma were investigated clinically and virologically during the 16 years from 1977 to 1992. Their age ranged from 20 to 62 years with the median of 51 years. Of the 12, 11 were of adult onset whereas one was of juvenile onset. Atypical squamous epithelium was noted in one patient, concomitant squamous cell carcinoma was found in another patient, and one patient developed carcinoma later.
Human papillomavirus (HPV) genomes in laryngeal papillomas were identified with the use of the vira type ^TM in situ hybridization (ISH) method. Of the 12 patients, four presented with positive reaction to the omni probe. HPV type 6 was identified in one of the four, type 11 in another and type 18 in the third. In the remaining one, HPV DNA type could not be identified. These four cases were of multiple type and showed recurrence. HPV Type 18 has been mentioned to be related to malignant change of laryngeal papilloma. In this study, the case with HPV 18 genome demonstrated strongly positive transforming growth factor-_α (TGF-_α). Intensive long term follow-up appeared to be necessary in this case.

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Various treatment modalities for addctor spasmodic dysphonia (ASD) including psychotherapy, relaxation, chewing, audio-visual feedback, tranquillizers, recurrent laryngeal nerve sectioning or botulinum toxin injections into the thyroarytenoid muscle have been reported in the literature. However, these modalities appear to have provided little success toward curing the voice pathology. ASD had long been thought to be largely of psychogenic origin, but recently a few voice scientists have come to believe that the problem reflects an organic disorder of the brain system. Since 1978, we have treated a total of 30 ASD patients by intra-laryngeal sectioning of the thyroarytenoid branch of the recurrent laryngeal nerve. Out of the 30 cases, twenty-seven involved unilateral sectioning while three involved bilateral sectioning. The age of the ASD patients ranged from 18 through 73 years; the average was 47 years. Twelve of the cases were men and 18 were women. Postoperatively, voice rehabilitation programs were administered in all cases weekly, monthly and then yearly until the voice became normal or as nearly normal as possible. Postoperative follow-up periods ran 2 to 15 years. No case showed any complication, including none at all of vocal-cord paralysis, alteration of patient's own voice quality, air-way problem or misdeglutition.
Long-term results indicated normal or nearly normal voice in 26 out of the 30 ASD cases (86.7%). Three other cases yielded moderate improvement. Only one case showed little improvement.

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A 63-year-old man developed hoarseness early in August, 1992. He was referred to the Kurume University Hospital on August 8 for a mass of the vocal fold. Videostroboscopy of the larynx revealed a whitish mass on the right menbranous vocal fold which did not present with any vibratory movements and mucosal wave. A glottic carcinoma was suspected. The patient was hospitalized on August 28. Shortly after the admission he developed exanthema on the extremities and laboratory examinations revealed the existence of abnormal leukocytes, and anti-ATLA antibody, leading us to the diagnosis of adult T cell leukemia (ATL). A biopsy of the vocal fold mass showed infiltration of leukemia cells into the vocal fold. The patient was treated with chemotherapy consisting of Vincristine and Adriamysin in the Hematology Department and the mass of the vocal fold disappeared following chemotherapy. This case indicates that T cell leukemia should be kept in mind in differential diagnosis for laryngeal carcinoma.

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A rare case of laryngeal adenosquamous carcinoma was reported. The patient was a 64-year-old man who visited our clinic with a compliant of hoarseness lasting for about one year. After neoadjuvant chemotherapy, total laryngectomy and radical neck dissection on the left side of neck was performed. The patient has been disease free of 12 months. We discussed its clinical feauture, pathological findings and the treatment as well as a review of the literature of this disease.
Among malignant tumors of the larynx, adensquamous carcinoma seemed to be extremely rare. Only two cases of the laryngeal adenosquamous carcinoma including this case have been reported in Japan.

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Two cases of pharyngolaryngeal myoclonus were reported. The first case was a 59-year-old man who had complaints of hoarseness and lump sensation of the throat. On inspection involuntary rhythmic movements were recognized on the left side of the soft palate, the posterior wall of the pharynx and the arytenoid region. Electromyography of the left side of the soft palate and pharyngeal constrictor muscle showed rhythmic (150-180Hz) and monophasic or polyphasic high amplitude (500-1500μV) potentials. CT and MRI demonstrated multiple brain infarctions. The second case was a 22-year-old woman who encountered a traffic accident three years before. She was referred to our clinic with complaints of dizziness and hearing loss. Right oculomoter nerve palsy, equilibrium disorder and right palatopharyngeal myoclonus were recognized. Rhythmic (180-200Hz) and polyphasic high amplitude (more than 500μV) potentials were obtained by electromyography. MRI showed contusion lesion of the right midbrain and old hemorrhagic lesion of the occipitallobe. Myoclonus in these cases was supposed to be caused by organic lesions of the Guillan-Mollare's trangle.

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