CT and MRI are capable of producing detailed images due to their excellent space and density resolution. CT and MRI examination with contrast material is essential in the diagnosis of tumor invasion into arteries and veins because density of the images created by contrast material injected in the vein is different for tumors, arteries and veins. Helical CT and MRI produce continuous data and high quality images via a computer system. This system makes it possible to construct three dimensional images that are quite objective and very useful for making diagnosis, planning radiotheraphy, planning operations, education, and explanations to patients. A three dimensional system will be used more widely in the near future.

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Using an intraluminal ultrasonic system, a radial scanning catheter of 20 MHz was directly inserted into the laryngeal cavity to obtain a horizontal image of the vocal folds.
A histological specimen was compared with a tomogram of the larynx. The layered structures of the vocal folds could be identified with this method. On the image of the vocal folds, the lamina propria and epithelium were noted as belt-like images. The vocalis muscle showed a hypoechoic image.
These results suggest that intralaryngeal ultrasonography can be useful in the clinic for detecting tumors of the vocal folds, and as a guide during injection therapy.

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To evaluate the usefulness and limitations of three dimensional (3D) imaging of the larynx and trachea using high-speed helical (or spiral) CT scanning, 3D images were reconstructed for one dissected human larynx, 2 patients with laryngeal cancer and 3 patients with tracheal lesions. The larynxes and tracheae were scanned in 2 mm slices and reconstructed using a slice thickness of 1 mm. Using the volume rendering technique, the reconstructed 3D images could be displayed in various colors with differing degrees of transparency. A comparison was made between the macroscopic (or endoscopic) findings and 3D CT images of the larynx and trachea. Almost all of the structures remained distinct. The 3D images obtained by helical CT proved useful for understanding the laryngeal and tracheal anatomy, especially in areas which can not be clearly seen by endoscopy or conventional axial CT.

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From 1994 to 1995, to evaluate the utility of preoperative CT, EUS (endoscopic ultrasonography) and US in the diagnosis of lymph node metastasis in thoracic esophageal ceancr, 94 patients with thoracic esophageal cancer who underwent esophagectomy were studied clinicopathologicaly. The Sensitivity of EUS diagnosis of upper mediastinal lymph node metastasis (85%), left-sided paragastrin lymph node metastasis (73-77%), and especially lower paraesophageal lymph node metastasis (100%) were good. But due to their low-grade specificity in EUS diagnosis, their overall accuracy was not very good. On the other hand, the overall accuracy of the CT diagnosis of lymph node metastasis was fine. However, sensitivity, the most important clinical factor in the CT diagnosis of lymph node metastasis was considerably inferior to EUS. The assessment of the diagnosis of lymph node metastasis around the tracheal bifurcation and the pulmonary hilum and the left para-cardial lesion by CT or EUS was poor. It was concluded that lymph node metastasis of these area must be the pitfall in preoperative diagnosis. The average diameter of the lymph nodes and the proportion of cancerous tissue in the lymph nodes diagnosed as metastatic lymph nodes by CT was larger than that of the false negative lymph nodes. However, the lymph nodes diagnosed as true positives by EUS showed no such tendency. This must be the reason the sensitivity of the EUS diagnosis and specificity of the CT diagnosis were favorable, but the specificity of the EUS diagnosis and especially the sensitivity of the CT diagnosis were not as good.

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Oropharyngeal fluorography is a simple method with high reliability for checking the degree, cause and locus of dysphagia, because we can observe every part of the process of swallowing. This examination is also useful to detect the organic or functional dysfunction of the oral cavity, pharynx, and esophagus.
This paper will describe oropharyngeal fluorography for the image diagnosis of dysphagia.
Deglutition time is too short to evaluate all of the processes of swallowing precisely in a single moment. Examinations do not always reflect usual deglutition conditions because the contrast media used in examinations are different from usual diet contents.
We should pay attention especially to the following in examining the patient who has aspiration.
1. We have to select contrast media carefully, because lower respiratory tract damage occurs using inappropriate media such as Barium or high osmotic substance.
2. We should only do a few trials of swallowing in patients having severe aspiration that might cause respiratory damage.
3. It is difficult to take a X-ray photo in proper timing with deglutition especially in functional dysphagia.
Recording on video tape is preferable for this type of examination, especially in cases having aspiration or some disorder. We could analyze the details of organic or functional disorders with this system by playing back in slow motion many times.
There are limits in evaluating the swallowing function using only oropharyngeal fluorography. It is possible that a more correct evaluation of the swallowing function will be produced in combination with electro-myogram and intrapharyngeal manometry.

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Perennial rhinitis was classified as allergic rhinitis, probable allergic rhinitis, vasomotor rhinitis or eosinophilic nonallergic rhinitis. Then these various types were classified according to whether there was any difference with respect to lower respiratory tract hypersensitivity for methacholine.
The various types of perennial rhinitis were identified through eosinophilic cell number in nasal smears, allergen skin testing, and IgE RIST and IgE RAST determination. In addition, we carried out a methacholine nasal provocation test using an Astograph and an allergen nasal provocative test.
Lower respiratory tract hypersensitivity was determined based on respiratory resistance, spirometry and a flow-volume curve before and after methacholine inhalation through the nose.
The lower respiratory tract of the subjects with perennial rhinitis showed differences in terms of methacholine hypersensitivity. Allergic rhinitis showed methacholine hypersensitivity in the entire lower respiratory tract. Probable allergic rhinitis showed hypersensitivity in the large airway. Vasomotor rhinitis showed hypersensitivity in the relative large airway. Eosinophilic nonallergic rhinitis did not show hypersensitivity in the lower respiratory tract.

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Intractable aspiration may be a life-threatening problem in patients with severe nervous or muscular disease. We report on surgical procedures for the treatment of intractable aspiration in 11 patients ranging in age from 7 months to 22 years. There were 4 patients with cerebral palsy, 3 with anoxic encephalopathy, 1 with spinocerebellar degeneration, progress muscular dystrophy, Werdnig-Hoffmann disease and Mövius' syndrome. The tracheoesophageal diversion procedure was performed in 3 patients, and the laryngetracheal separation procedure in 8 patients. These procedures were successful in preventing aspiration. The incidence of getting pneumonia and the suctioning frequency decreased. Home nursing requirements also decreased. These procedures increased mobility and improved the quality of life in the patients. We think that these procedures are low-risk and effective for the treatment of intractable aspiration in patients with irreversible nervous or muscular disease.

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A case of bronchial artery aneurysm was reported. A woman, aged 54 years, was seen with nasal bleeding but no previous bleeding tendency. At the same time, the patient also had bleeding in the oropharynx which seemed to come from the lower respiratory tract. Image diagnoses such as chest x-rays and CT scans, could not confirm a definitive cause until selected bronchial arteriography was employed. Selected bronchial angiography demonstrated a small bronchial artery aneurysm on the periphery of the upper trunk of the bronchial artery. After bronchial artery embolization, an upper lobectomy of the right lung was performed, resulting in success. In a specimen obtained at surgery, six small aneurysms with a diameter of 3 mm to 8 mm were found along the bronchial artery. Pathological findings included angitis of the bronchial artery, with irregular thickness of the arterial wall and thromboarteritis, implying the possibility of systemic arteritis such as aortitis and periarteritis nodosa. Both of these diseases were not indicated by the clinical findings, and their cause remains unknown.

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Dysphagia is rarely one of the initial symptoms of dermatomyositis, which is characterized by the non-specific inflammation of the muscles and skin. A 65-year-old man complaining only of dysphagia was referred to our department, but a few weeks later, his systemic musculature stopped functioning and the skin of his neck appeared reddish. Following a pathological examination and laboratory investigations (e.g. CPK), he was revealed to have dermatomyositis. He was treated by prednisolone, and his dysphagia improved for approximately 6 months, and the other manifestations disappeared. He also suffered from a neck infection which was probably due to prednisolone.

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