[en] Pharyngo-esophageal stricture occurs as an adverse event after chemoradiation therapy for head and neck cancer, although complete obstruction is rare. The patient's quality of life is impaired due to the difficulty in food intake and in swallowing saliva. Endoscopic balloon dilatation and stent insertion have been used for their treatment, but there is still no consensus on the optimal treatment. We report a case in which we were able to release the obstruction by inserting an endoscope through the mouth and the gastrostomy. The patient, a 47-year-old man, was diagnosed as having Stage III squamous cell carcinoma of the mesopharynx (T4N1M0). Because the result of induction chemotherapy was SD (stable disease), we performed tumor resection and administered postoperative chemoradiation therapy. Gastrostomy was performed because swallowing dysfunction was observed at the completion of the post operative radiation sessions. One year later, while imaging studies showed no recurrence of the disease, the swallowing function had not improved at all. We conducted video fluorography and gastroscopy to determine the cause, and detected pharyngo-esophageal obstruction. We attempted to release the obstruction endoscopically in the hope of preserving the vocal functions. We chose to use a dual approach via the mouth and the gastrostomy. The adhesion site of the pharynx and the esophagus was incised with a hook knife while observing from the gastrostomy side. The adhesions were dissected and the proximal and distal sides were opened. Balloon dilatation training was undertaken after the operation. The patient is now able to take liquids and semi-solid foods orally, but nutrition via the gastrostomy was continued. Clearing the obstruction did not completely resolve the dysphagia and treatment of the velopharyngeal insufficiency was necessary in this case. Therefore, the choice of treatment should be based on the wishes of the patient, clinical situation, and the nature of the treatment for the primary disease. (author)

[en] Elevated production of cysteinyl leukotrienes (cysLTs) from sinus tissues and abundant sinus eosinophils are characteristic features of chronic hyperplastic eosinophilic sinusitis (CHS). CysLTs exert their action through G-protein-coupled receptors named cysLTs receptor type I (cysLT1R) and type II (cysLT2R). These expressions of cysLT receptors in the sinus mucosa have yet to be clarified and the relationship between eosinophilia and the expression of these receptors remains obscure. We compared the expressions of cysLT1R and cysLT2R in the sinus mucosa in patients with CHS, non-eosinophilic chronic sinusitis (NECS), and control sinus tissues; and analyzed the correlation between the expression of CysLTRs and the presence of sinus eosinophils by immunohistochemistry and real-time PCR. A significantly higher percentage of eosinophils expressing cysLT2R protein was observed in patients with CHS compared with NECS and controls. In addition, cysLT2R mRNA expression in CHS was significantly higher than in NECS and controls. Furthermore, a positive correlation was observed between cysLT2R mRNA expression and the number of infiltrated eosinophils. In contrast, the cysLT1R mRNA expression did not differ significantly among these groups. The effect of cysLTs on sinus eosinophils may be mediated through the cysLT2R in patients with CHS. These results may suggest the therapeutic benefit of cysLT2R antagonists in CHS