The effectiveness of indirect therapy was discussed with reference to patients with dysphagia.
The first patient was an 90-year-old male with lumbago due to fracture of the lumbar caused by collapsing. He had dysphagia four months before the accident. After the accident his dysphagia worsened. Ten months after the accident he underwent physical therapy. After four months he came to eat without aspiration. He acquired the Mendelsohn maneuver without instruction.
The second patient was a 73-year-old male who had had cerebral infarction twice; however, he was independent in ADL. He had dysphagia five years after his second cerebral infarction. He underwent physical therapy one year after the onset of dysphagia. After one month he came to eat without aspiration.
Indirect therapy such as adjustment of muscle tone, widening the range of motion in joints, relaxation training and oral massage improved the patient's condition. Indirect therapy changes the patient's condition in a way suitable to swallowing.
Swallowing without aspiration requires normal movements of muscles, as well as determination of the appropriate amount of bolus. Why is indirect therapy for the second phase of dysphagia, which is reflective, effective? This is because indirect therapy facilitates initiation of the swallowing reflex by changing the patients' condition in a way suitable to swallowing, like the Jendrássik maneuver which is used for inducing the patella tendon reflex. In conclusion, indirect therapy for dysphagia is effective. The indication of indirect therapy is reversible pharyngeal dysphagia.

View full abstract

We reviewed 46 foreign bodies (males: 29, females: 17) in the larynx, trachea or bronchus treated between 1990 and 2004 at our hospital. The patients' ages ranged from 3 months to 93 years. Cases were most prevalent among infants around one year old (34.8%). The most common foreign body was a peanut (32.6%), as noted in other reports. The 33 cases of foreign bodies were radiolucent. In 9 of those 33 cases (27.3%), Holtzknecht's sign was useful in diagnosis. Four foreign bodies (tooth crown) in the bronchi were suspected to be related to endotracheal intubation.

View full abstract

We performed a retrospective analysis of 23 patients who were surgically treated for deep neck space abscesses at Takeda General Hospital, Fukushima, Japan, between January 1, 2001, and December 31, 2003. This institution is one of the country's largest health care facilities in an urban setting. Demographics, presentation, site of abscess, associated systemic diseases, bacteriology, treatment, airway management, and outcome were reviewed.
Enhanced neck CT was taken for all patients at the initial examination. We classified the severity of the deep neck abscesses according to the site of the abscess on the CT image. All patients were admitted and underwent an operation on the day of admission. Medical and surgical interventions for each patient were evaluated, and organisms isolated from pus drained intraoperatively were recorded. Findings indicated that airway management was very important, as was the decision to perform a tracheotomy.

View full abstract

Spasmodic dysphonia is one of the diseases that present a formidable problem for the attending otorhinolaryngologist. To treat adductor-type spasmodic dysphonia, an injection of botulinum toxin (BT) into the thyroarytenoid muscle is universally accepted as the first choice of treatment, but unfortunately it is not covered by National Health Insurance in this country and there is not a common practice. In its place, various other therapeutic modalities have been reported. Furthermore the efficacy of BT therapy is not permanent, which is another reason calling for the design of a surgical procedure with more lasting effect as an alternate choice to correct this affliction.
In the current study, we conducted a thyroarytenoid myectomy on patients with adductor-type spasmodic dysphonia, the results of which are presented below.
This cases of three patients with adductor-type spasmodic dysphonia who visited our department between 2001 and 2005 are described. The details of BT therapy and the surgical procedure were informed to the patients and their families. Because all three desired to undergo the surgical therapy, a bilateral thyroarytenoid myectomy via laryngomicrosurgery was conducted.
The constriction was eliminated immediately after surgery and the patients became capable of smooth phonation. However, hoarseness B grade 3 related to breathing was recognized; but this began to ease after a month or two and was corrected to B grade 1-0 after about 6 months after the surgery. Improvement in the condition was noted in all three patients according to evaluations based on the Mora method before and after surgery. All patients are currently in the B grade 0 state, free of recurrence but are still under observation.
Bilateral thyroarytenoid myectomy is a therapeutic option for cases of spasmodic dysphonia if they expect an effect of long term.

View full abstract

We reported two adult cases of congenital esophagobronchial fistula. Case 1 is a 65-year-old female who had a history of chronic cough. She was admitted to our hospital because of a fistula revealed by barium esophagogram, which was performed in a mass survey. Chest CT demonstrated an esophagobronchial fistula in the middle of the thoracic esophagus, which was connected to the right B6. Bronchoscopy was performed. Outflow of the pigment medium from the right B6 was detected, as the medium was infused through a tube that passed into the esophagus. Resection of the fistula was performed. Pathological examination showed that the fistula was covered with squamous epithelium and had muscularis mucosa. Congenital esophagobronchial fistula was diagnosed.
Case 2 is a 57-year-old male who was admitted with fever and hemoptysis. Esophagography in a previous mass survey revealed a fistula from the esophagus to the right bronchus. Chest CT showed an esophagobronchial fistula. Esophagoscopy revealed a diverticulum and an orifice of the fistula. Existence of a fistula between the esophagus and the right B6 was demonstrated by the same technique using the pigment medium as in Case 1. Resection of the fistula and right lower lobectomy were performed. Inflammatory changes were found in the surrounding tissues of the residues of the fistula. Based on the patient's history, we conjectured that the lung abscess probably had resulted from leakage of food through the fistula.
These findings suggest that chest CT can play an important role in the early diagnosis of an esophagobronchial fistula.

View full abstract

We report our experience of a case in which administration of octreotide acetate and injection of OK-432 into the pleural cavity proved effective for late chylothorax following surgery for esophageal cancer. The patient was a 54-year-old male diagnosed with progressive cancer C-T3N2(#7)M0 of the lower thoracic esophagus and given preoperative chemoradiotherapy in September 2004. Efficacy was assessed as PR, and in December the thoracic esophagus was excised completely via the right open thorax and lymphadenectomy of three sections was performed. Postoperative progress was favorable and the patient was discharged on day 32. On day 53 after surgery, bilateral pleural fluid was noted, and upon penetration of the pleural cavity, 3,000 ml of chylothoracic pleural fluid was recognized. The patient was admitted immediately and prohibited from eating a thoracic drain was implanted on the right side and octreotide acetate was administered daily. As it was found that drainage volume declined as a result, OK-432 10KE was injected into the pleural cavity. This enabled removal of the pleural drain, and the patient was discharged. This case suggests that octreotide acetate administration is a highly effective therapy against chylothorax.

View full abstract

In 15 of 44 patients of differentiated thyroid cancer with nerve invasion, recurrent nerve could be preserved by procedure performed under microscope. This 15 patients was compared with the residual 29 resected group about invasion to other organs, local recurrence, and prognosis. The rate of other organ invasion and the rate of local recurrence in the preserved group were higher than those in the resected group. The rate of distant metastasis was almost equal during the two groups. One dead case by other disease was observed in the preserved group. On the other hand, one dead case by primary disease in the resected group. These findings suggest that if the recurrent nerve can be microscopically preserved, microscopic procedure is available in some cases. Definition of invasion to the recurrent nerve should be clarified.

View full abstract