We report here the long-term prognosis of patients who suffered dysphagia due to cerebrovascular disorders. There have been reported improvements in the case of dysphagia, but there have been few reports on long-term prognosis until now.
Subjects and Method:15 patients with dysphagia due to cerebrovascular disorder who had received treatment for dysphagia at Kanagawa Rehabilitation Hospital were studied. 13 of those underwent surgical treatment. Their ages ranged from 38 to 75 years. None could eat orally before treatment, but they all became free from tube feeding after treatment. Questionnaires that were filled out later either by the patients themselves or their family. The observation periods ranged from 8 months to 10 years and 11 months, the average being 5 years and 0 month.
Results:11 of the 15 patients (73%) had improved swallowing ability after discharge. 11 (73%) patients gained weight, and 3 became obese due to overeating. 6 (40%) patients developed gastroesophageal reflux. All of the patients underwent a combined operation with cricopharyngeal myotomy and laryngeal suspention. The incidence of reflux decreased as time went by. 4 (27%) patients developed pneumonia, but their attacks were not fatal.
Conclusion:The prognosis of dysphagia in persons due to cerebrovascular disorders is satisfactory from the viewpoint of their oral ingestion ability. However, there are many problems affecting patients' lives after they leave hospital. It is necessary to follow up dysphagic patients for a long time to prevent pneumonia, gastroesophageal reflux and obesity.

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Cricoarytenoid arthritis is a frequent complication of rheumatoid arthritis. 17% to 33% patients with rheumatoid arthritis suffering from arthritis of the cricoarytenoid joints have been reported. In association with an upper respiratory infection, this can become life-threatening upper airway obstruction. We report a case of severely symptomatic cricoarytenoid arthritis in a 48-year old woman with rheumatoid arthritis. Dyspnea and stridor had appeared, and the cricoarytenoid joint was swollen. The vocal cord was fixed in the midline. The dyspnea and stridor had not reduced with conservative treatment, and tracheotomy was performed. After CO₂ laser arytenoidectomy was performed, the patient was free of dyspnea for 7 months, and phonatory function was as good as before the surgery.

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We reported two cases of a bridge-like adhesion, with no history of laryngeal instrumentation, at the center of the membranous portion of the vocal fold. Such bridge-like adhesions confined to the center of the membranous portion of the vocal folds as reported in the article, are very rare. Only one other case of central vocal fold adhesion, with no history of laryngeal instrumentation, has been reported to date. The cause of the adhesion in our two cases was unknown. A simple surgical separation of each adhesion was performed successfuly with endolaryngeal microsurgery. Reccurence of the adhesion did not occur.

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We report a case of pulmonary lymphangioleiomyomatosis discovered current with a spontaneous pneumothorax. The patient was a 21-year-old female with chest pain. X ray on admission revealed right pneumothorax. Chest CT showed multiple cystic shadows in the whole lung field. Pulmonary lymphangioleiomyomatosis was diagnosed histopathologically by thoracoscopic lung biopsy. Relatively few cysts were observed on the CT, and their sizes were small. Pulmonary function tests were normal. Therefore, this case may be in a relatively early stage. The patiant is currently being treated with progesterone therapy. Unfortunately, though the patient has been treated for about 1 year, cystic shadows on chest CTs have increased in number and size, and pulmonary function data have slightly declined.

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Among benign esophageal tumors, leiomyoma is the most frequently seen and lymphangioma is extremely rare. This article reports a case of lymphangioma arising in the cervical esophagus.
A 74-year-old man complained of mild swallowing difficulty. Esophageal fiberscopic examination showed a submucosal soft mass with an apparently preserved overlaying mucosa in the cervical portion of the esophagus. MRI revealed a low intensity area on T1-weighted, and a high intensity area on T2-weighted images. The tumor was not enhanced on the T1-weighted image with gadolinium contrast.
The tumor was successfully removed under direct esophagoscopic control without any complications. Lymphangioma was diagnosed by histopathological examination. Postoperatively, the symptoms were resolved, and the patient has remained asymptomatic for 1 year and 10 months.

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We report a rare case of a foreign body, a large snail, in the esophagus. A 20-year-old male, a freshman in college, was invited to a party at a music club and was requested by senior students to do a comical performance. He decided to swallow a large snail in its shell. Severe throat pain was immediately noted. He tried to induce vomiting, but was unable to and came to our hospital for emergency case. No foreign body was found in the hypopharynx. Plain X-ray examination showed a circular shadow in the neck, 3 centimeters in diameter. We identified the foreign body in the esophagus in the neck. We tried to remove the object with an endoscope under general anesthesia. The shell was found at the inlet of the esophagus and was spherical and smooth, which made it impossible to grip with forceps. Therefore, we removed the foreign body via external incision of the neck.

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Intraoperative electrophysiologic monitoring of the recurrent nerve and the facial nerve were performed with a commercially available device (Synax^®), Synax^® was used for auditory brainstem response (ABR) testing. Two recurrent nerves and two facial nerves were successfully monitored with this system in four patients undergoing thyroidectomy or parotidectomy.
The stimulus thresholds for the evoked responses was 0.1 mA for the four nerves. Mechanically evoked potentials with acoustic signals were also detected during the surgical procedures. Synax^® monitoring was compared with a disposable neuro stimulator (Varistim^®). It was concluded that Synax^® monitoring of the recurrent nerves and facial nerves provides a simplified, noninvasive technique.

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We manufactured a trial videoendoscope for the hypopharynx and cervical esophagus with the Asahi Optical Co., LTD. This videoendoscope was equipped with a hood at its tip, so as to observe and treat the hypopharynx and the entrance of the esophagus. This videoendoscope showed better images compared to conventional fiberscopes. Its diameter was relatively thin and thus resulting in less suffering for patients on examination. We could examine patients in a sitting position at our ENT out-patient clinic. We were able to perform not only observation but also examination and treatment such as biopsy and foreign body extirpation with this scope.

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