The aim of this retrospective study was to assess whether the possibility of oral intake could be estimated with an endoscopic swallowing examination (VE) in patients with dysphagia after surgery for digestive diseases. The study subjects were 28 patients who had dysphagia after surgery for digestive diseases in Yokohama City University Hospital between January, 2013 and September, 2017. Oral intake status (possibility of oral intake and dependence on alternative nutrition) was evaluated up to 80 days after the first VE. The relationship between oral intake status and patient characteristics (age, sex, history of aspiration pneumonia, presence of tracheostomy, presence of vocal cord paralysis, American Society of Anesthesiologists physical status, operative time), the Hyodo score and the presence of aspiration during VE were examined. The time course for oral intake status (the start of oral intake and the transition from alternative nutrition) was also evaluated by the Kaplan-Meier method according to the Hyodo score (with a cut-off value of 6) and aspiration during VE. In the followup period for up to 80 days after the first VE, 26 patients started oral intake and the remaining 2 did not. Nine patients were dependent on alternative nutrition and 19 were not. There were no statistical differences on the final oral intake status according to the patient characteristics. At the first VE, 19 and 9 patients had a Hyodo score of ≤ 6 and >6, respectively. The numbers of patients with and without aspiration were 10 and 18, respectively. There were no statistical differences on the final oral intake status according to the indexes at the first VE. The Kaplan-Meier estimation revealed that patients with a Hyodo score >6 experienced a later start of oral intake and a slower transition from alternative nutrition than patients with a Hyodo score ≤ 6. Patients with aspiration at the first VE had a longer dependence on alternative nutrition than those without. Although the first VE after the surgery for digestive diseases was not a definitive predictor of the final oral intake status, it could predict the time course for the transition from alternative nutrition as well as the start of oral intake.

　Premaxillary wing is a nasal crest, located at the front-most and inferior part of the nasal septum. Embryologically, it is derived from the premaxilla. We often encounter cases with transformation of the premaxillary wing during operations for caudal-end deviation of the nasal septum. In such cases, removal of the premaxillary wing is an important maneuver to correct the caudal deviation, in addition to correcting the deviated cartilage at the caudal end.

　We analyzed the CT data of 327 cases (except for cases with face injury) that underwent surgery for deviation of the nasal septum between April 2014 and March 2019 at our hospital, and examined the association between caudal-end deviation of the nasal septum and transformation of the premaxillary wing. We calculated the ratio of the area of the narrower nasal cavity to that of the wider nasal cavity at the entrance of the nostril (the N/W ratio), and classified the degree of caudal deviation as follows: mild, N/W ratio 0.8-0.6; moderate, N/W ratio 0.6-0.4; severe, N/W ratio less than 0.4. Also, we classified the transformations of the premaxillary wing into three patterns, as follows: vertical type, cases in which the vertical axis did not incline; tilting type, cases in which the vertical axis inclines; bony-spine type, in which there is transformation with a bony spine. Cases with transformation of the premaxillary wing accounted for 20.9% of all the cases without deviation of the septum at the caudal end, 52.2% of all cases with mild deviation of the caudal end of the septum, 83.3% of all cases with moderate deviation of the caudal end of the septum, and 100% of all cases with severe deviation of the caudal end of the septum. Thus, as the severity of deviation of the caudal end of the septum increased, the percentage of cases with a transformed-type premaxillary wing (especially, the tilting type) also increased. The bony-spine type was recognized in cases with moderate deviation (23.3%) or severe deviation (24.0%) of the caudal end of the septum.

　Our findings lend support to the hypothesis that transformation of the premaxillary wing is caused by excessive load from the septal cartilage, which grows up in the adolescence.

　Relapsing polychondritis is a rare and potentially fatal autoimmune disease of unknown etiology, characterized by inflammation and destruction of different cartilaginous structures, including the ear, nose, larynx, trachea, bronchi, peripheral joints, eyes, heart and skin, with a high risk of misdiagnosis.

　Data of nine patients with this condition were analyzed. The average age at diagnosis of the nine patients (four male and five female) was 56.4 years (33-84 years). The interval from onset to diagnosis varied from three months to two years. Auricular chondritis was detected in six patients, polyarthritis in three patients, nasal chondritis in four patients, inflammation of the eyes in two patients, laryngotracheal chondritis in six patients, and labyrinthine dysfunction in two patients.

　Underlying autoimmune diseases included Behçet's disease, polymyalgia rheumatica, and Vogt-Koyanagi-Harada disease. No biopsy findings are pathognomonic for the diagnosis of RP. Histopathological examination of an involved cartilage can be a valuable tool when accurate diagnosis proves difficult. However, steroid treatment, as in patients with autoimmune diseases can affect the results of histopathological examination and modify the clinical manifestations.

　Until date, therapy for RP is still empiric, due to the lack of standardized guidelines for the treatment, and depends on the basis of the disease activity and severity of organ involvement. Mild forms, such as auricular chondritis alone, are treated with NSAIDs and low-dose corticosteroids. Laryngotracheal complications require high-dose corticosteroids and immunosuppressants. As for convalescence, eight cases survived, and one died of other diseases.

　Activated PI3K delta syndrome (APDS) is a primary immunodeficiency syndrome associated with the development of pneumonia, bronchiectasis, lymphocytopenia, herpes virus infection including Epstein-Barr virus (EBV) infection, middle ear infection, sinusitis, lymphoproliferative disorder (LPD) and malignant lymphoma. We report the case of a female patient with APDS. She needed to be hospitalized for EBV infection at the age of 1 year. Thereafter, she suffered from recurrent fever, eruption, arthritis, gastroenteritis, middle ear infection pharyngitis and LPD. Due to the airway distress caused by LPD, she underwent tracheostomy, palatine tonsillectomy and lingual tonsillectomy at the age of 37 years. Further examination revealed a high concentration of serum EA-IgG and EBV positive cells in the tonsils, and she was diagnosed as having EBV-associated lymphoproliferative disorders. She developed malignant lymphoma at the age of 38 years and received chemotherapy; however, the treatment failed to have effect. She underwent umbilical cord blood transplantation, after which her general condition deteriorated rapidly and she died from disseminated intravascular coagulation. She was diagnosed as having APDS by genetic screening.