The purpose of this study was to quantify the changes in the swallowing function that occur as a result of the aging process itself. Videofluoroscopic examinations of oropharyngeal swallowing, 3 bolus volumes (1, 5, 10 ml), were performed by six men over the age of 85 years and by six men under the age of 60 years. None of the subjects had any present or past history related to swallowing problems. Data analysis compared (1) abnormal findings (premature spillage, laryngeal penetration and aspiration); (2) temporal relationships of oropharyngeal events; and (3) biomechanical computer analysis of swallowing events. As bolus volume increased, an increase was observed in the frequency of premature spillage and laryngeal penetration in the aged. The distance of the laryngeal movement during swallowing was significantly longer in the aged than in the controls. However, the degree of the laryngeal elevation at the oral onset was significantly higher in the aged than in the controls, so that the range of laryngeal elevation during the pharyngeal swallow was not different between the two groups. The %LE(P) at the time the bolus arrived at the pyriform sinus was significantly lower in the aged than in the controls. On the other hand, the range of auterior laryngeal movement and the width of the cricopharyngeal opening as the bolus volume increased were significantly higher in the controls. These exhibited the same degree in the aged.
We concluded that normal aging dose not affect the overall efficiency of oropharyngeal swallowing. However, pharyngeal delay, and a small capacity in the range of laryngeal motion and cricopharyngeal flexibility were present with normal aging, and these changes might be contributing factors in the development of potential aspiration and swallowing disturbances in the elderly.

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Laryngo pharyngeal disease associated with gastro esophageal reflux disease (GERD) is usually referred to as laryngo pharyngeal reflux disease (LPRD). In order to investigate this association, we performed a 24-hour pH monitoring in cases of LPRD to directly demonstrate the degree of acid reflux up to the level of the cervical esophagus. Furthermore, we performed a hypopharyngeal mucosal biopsy for histopathological confirmation of the diagnosis.
Among our patients who were suspected to have LPRD, 15 underwent 24-hour pH monitoring and hypopharyngeal mucosal biopsy. They were 10 males and 5 females, with a mean age of 57.4 years. The 24-hour pH monitoring was performed on an ambulatory basis. The hypopharyngeal mucosal biopsy was performed during the insertion of the pH monitor.
The results of the pH monitoring were analyzed by the Amsterdam method. Thirteen of the 15 patients had reflux up to the level of the cervical esophagus. Histopathologically, 14 patients exhibited inflammatory changes in the hypopharyngeal mucosa. A positive correlation was observed between the reflux duration and the severity of the inflammatory changes.
Thus, our observations indicate that LPRD patients with reflux as demonstrated by pH monitoring frequently exhibit histopathological inflammatory changes in the hypopharyngeal mucosa.

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Recently, the effect of cromolyn sodium (DSCG) on Cl channel blockers and the ion transport of airway epithelial cells have become a concern in cases of bronchial asthma. In this study, we examined the change in ion transport in sensitized guinea pig tracheae with ovalbumin (OA) by the voltage clamp method. The guinea pigs were separated non-sensitized (NSE) and sensitized groups (SE), and the latter were sensitized by OA with alum. They were all anesthetized with pentobarbital sodium, and then tracheae were removed for physiological studies. Segments of the tracheae were mounted in Ussing chambers and bathed in Krebs-Henseleit (K-H) solution. The short-circuit current (Isc) and potential difference (PD) were monitored continuously. After Isc stabilization, terbutaline was changed from 1×10^-5 to 1×10^-2 M on the mucosal side after treatment with indomethacin (IND). Terbutaline (3×10^-3 M) was added on the mucosal side after treatment with amiloride, diphenylamine-2-carboxylate (DPC), 4, 4-diisothiocyanato-stilbe-2, 2-disulfonic acid (DIDS), and furosemide. ΔIsc showed a tendency to increased in both the NSE and SE groups after treatment with terbutaline at 1×10^-2 M. ΔIsc was suppressed significantly after treatment with DPC in both the NSE and SE groups (p<0.05). We concluded that the cyclic-AMP-dependent Cl channel was active in both the NSE and SE groups, and there was not a marked difference between the NSE and SE groups.

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Abnormal findings of tracheal wall were detected in our patients by conventional chest CT and bronchoscopic examination. Dynamic CT was then evaluated which showed the flexibility of the tracheal wall, and may provide other information as well.
The dynamic CT was performed at the location of the abnormalities in the trachea by a 5 mm-thick axial slice with a high-resolution filter for one second during inspiration and expiration at one-second intervals in succession. Sequential images were observed in the cine mode. Nine patients were examined between August 2000 and April 2002. Two patients had a flaccid tracheal wall due to a diverticulum or skin flap over a tracheal defect, and 7 patients had airway stenosis due to tumors or injuries. The age range was 28 to 86 years old, and the male-to-female ratio was 5 to 4.
The tracheal wall motion was observed dynamically. In all cases of tracheal stenosis, the degree of the stenosis became prominent in the expiratory phase, and the transverse range of the fixed tracheal wall could be detected. The flaccid tracheal wall in two cases was overextended at the end-expiratory phase.
Dynamic CT can detect the abnormal motion of the tracheal wall, and it will be some help in making therapeutic plans.

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From 1992 to 2001, sixteen patients with recurrent thyroid carcinoma were treated at our department. In this series, 12 patients had a clinical recurrence in the cervical lymph nodes, and 4 patients had a local recurrence. There was no recurrence after the accord operation. Three cases with local recurrence underwent total thyroidectomy with paratracheal lymph node dessection. One case who had cervical lymph node metasis at level V underwent total thyroidectomy with lateral neck dessection. Neck dessection was performed for 12 patients who had recurrent lymph node metastasis, m-RND was performed in 6 cases; SOND in 2 cases; lateral neck dessection in 3 cases. No case had pathological lymph node metasis at the lower level VII. We concluded that lateral neck dessection is a reasonable method in cervical lymph node recurrence of thyroid carcinoma.

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We investigated the pathology, age groups, blood test, CT image, isotope findings and fine-needle aspiration biopsy (FNAB) diagnosis in 92 cervical lymph node biopsies. There were 31 cases of benign causes and 61 cases of malignant cases. 18 patients had been treated for malignant disease previously. Of these 18, 17 had had a recurrence of a previous malignant disease. Eleven of the 15 cases that showed an enhancement in the CT examination were malignant. Sensitivity and specificity for malignant etiology in the gallium isotope examination were 91.4% and 37.5%. The hot spot for scintigraphy with ⁶⁷Ga was helpful for diagnosis of malignancy. In a total of 8 cases of malignant lymphoma and metastatic lymphoepithelial carcinoma, 5 cases were diagnosed as Class I or II by fine-needle aspiration biopsy. However, there was a hot spot for scintigraphy with ⁶⁷Ga in these 5 cases. Therefore, we concluded that the indications of operation in cervical lymph node biopsy are the following.
(1)elderly patients with lymphadenopathy that have shown no spontaneous regression for a long time.
(2)patients who have been treated for malignant disease previously except for class IV or V.
(3)patients who were found to have an enhancement in their CT besides a hot spot for scintigraphy.
(4)suspicion of malignant lymphoma, a hot spot for scintigraphy but in Class I or II.
We also investigated 9 cases-4 men and 5 wowen aged 13-34 years-with necrotizing lymphadenitis that were correctly diagnosed by biopsy. Antibiotics were not effective in all cases. These patients were improving by taking prednisone after their biopsy. We considered a biopsy necessary in cases where it is difficult to distinguish malignant lymphoma from the effects of prednisone.

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Feeding via a nasogastric tube is a commonly available and convenient procedure, and is thus acceptable for various conditions. However, it has recently been reported that prolonged insertion of a naso-gastric feeding tube might result in serious complications. Here, we report a case of supraglottic stenosis induced by prolonged insertion of a nasogastric feeding tube.
A 53-year-old woman who had undergone a clipping operation for an aneurysm of the vertebra artery—posterior inferior cerebellar artery on the left side and a tracheotomy complained of severe dysphagia caused by postoperative IX, X, XI cranial palalysis on her left side. Thus, feeding via a nasogastric tube which was inserted to the left pyriform sinus, perfomed to remain her nuturitional condition. Subsequently, she come down with bacterial meningitis, leading to a loss of consciousness. The use of the nasogastric tube feeding had to be prolonged for three months. After a recovery in her general condition, when the tracheal stoma should have been closed, she complained of inspiratory stridor and dyspnea. Fiberscopic observation revealed that the mucosal membrane of the arytenoid on the left side, with which the nasogastric tube was incontact, was severly swollen. The lesion extended down into the glottic space, causing the inspiratory stridor. When, the tube was taken out and conservative theory performed for three weeks, these symptoms and findings did not improve. Subsequently, we performed a resection of the swelling lesion in the left arytenoid mucosa under laryngomicrosergery with YAG-LASER. After this operation, her symptonms improved completely, and the tracheal stoma could be closed.

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We report a case of involuntary phonation caused by abnormal vocal cord movements during expiration in a patient with Parkinson's desease.
A 60-year-old female had been treated for Parkinsonism at the outpatient clinic of Omiya Medical Center, Jichi Medical School since August 1999. She began to groan involuntarily in the daytime in September 2001. She could not eat well while groaning. Stridor was not noted during sleep at night. Endoscopic examination of the larynx revealed insufficient abduction of the bilateral vocal cords, although the glottis was not so small as to cause stridor during inspiration. During expiration, however, the vocal cords adducted, resulting in the production of involuntary voice. Electromyography showed an increase in the activity of the thyroarytenoid and lateral cricoarytenoid muscles. This muscle activity was further enhanced during inspiration. The involuntary phonation disappeared after a decrease in the patient's dose of L-Dopa, although she also experienced a decrease in her other behavior as well. When her dose of L-Dopa was increased to the therapeutic level, the involuntary phonation recurred, but her behavioral activity improved.
In the present case, we believe that dopaminergic denervation occurred excessively in the nerve innervating the laryngeal adductors. The involuntary voice was thus probably due to hypertonus of the laryngeal adductors with a decreased threshold level for L-Dopa, although the drug was administered at the usual dose.
Since there was no optimal dose of L-Dopa which could maintain behavioral activity as desired while simultaneously causing no involuntary phonation, the patient has been treated with L-Dopa at a dose that maintains good behavioral activity, which seems to be more important for her daily life. We are considering therapy with botulinus toxin injections into the laryngeal muscles to treat this case of involuntary phonation.

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Repeated infection in the neck is frequently observed in patients with piriform sinus fistula. Two patients with recurrent piriform sinus fistula and a previous history of surgical treatment presented at our clinic.
Contrast esophagography showed a piriform sinus fistula in both cases. To visualize the fistula, a liquid dye was injected the day before surgery. The fistula was removed under general anesthesia via 2 approaches, each using an external incision and direct esophagoscopy. A 5-day fast was prescribed after surgery. Postoperative esophagography showed a complete closure of the fistula. No recurrences were noted after the surgery.

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