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The article presents a case of pharyngeal dysphagia and obstructive sleep apnea syndrome caused by degenerative-dystrophic changes in the cervical spine with the formation of large cervical osteophytes at the C3-C6 level. Osteophytes caused deformation of the posterior wall of the hypopharynx and narrowing of its lumen by 20-25% from the level of the arytenoid cartilages to the upper parts of the epiglottis. CT scan also showed the intervertebral disc heights lost, as well as osteophytes at the posterolateral margins of the vertebral bodies (disc osteophyte complex). Osteosclerosis in combination with facet arthrosis caused spinal and foraminal stenosis.

Anterior cervical osteophytes are a fairly common X-ray finding in people over 50 years old. Incidence of dysphagia in patients with anterior osteophytes varies from 1% in those aged 40-60 years to 10.6% in patients over 60 years old. The most common causes of anterior cervical hyperosteophytosis causing dysphagia are cervical spondylosis deformans and Forestier disease. We present 2 clinical cases of spondylogenic dysphagia in cervical spondylosis deformans and Forestier disease. The review is devoted to the causes and diagnostic methods for dysphagia caused by anterior cervical osteophytes, as well as surgical options for this pathology., Conclusion: Microsurgical resection of anterior osteophytes is an effective method for dysphagia after ineffective therapy for 3 months. Microsurgical osteophytectomy provides stable regression of dysphagia with low recurrence rate.

Stroke is a socially significant neurological disease, the second most common cause of disability and mortality. A wide range of neurological problems that occur after stroke: cognitive, motor, speech, and language disfunction, neuropsychiatric, swallowing disorders and others, complicate rehabilitation, impair social and everyday adaptation, and reduce the quality of life of patients and their caregivers. Cognitive impairment (CI) is one of the most significant and common complications of stroke. Stroke increases the risk of their development by 5-8 times. Dysphagia is also a common symptom of stroke, the cause of aspiration complications (pneumonia), and nutritional imbalance. It increases the possibility of developing CI and dementia, and contributes to an increase in mortality. Older adults with CI are at a higher risk of developing dysphagia, therefore the early symptoms of dysphagia (presbyphagia) should be diagnosed. In recent years, the connection between CI and dysphagia has been actively studied. It is extremely important to identify CI and swallowing disorders as early as possible in patients both before and at all stages after stroke; as well as to develop combined multidisciplinary protocols for the rehabilitation of patients with these disorders with pharmacological support for the process.

Objective: To determine the prognostic aspects of the development of pneumonia in patients with ischemic stroke of various pathogenetic subtypes., Material and Methods: The study enrolled 110 patients (64 men and 46 women), aged 44-95 years, with dysphagia during the acute period of ischemic stroke (IS). The TOAST criteria were used to diagnose the pathogenetic subtype, and the MASA scale was used to determine the presence and severity of dysphagia. To predict the probability of switching to self-feeding from the severity of dysphagia, a non-linear regression method was used using the least squares method., Results: In patients with swallowing disorders in the acute period of IS, pneumonia often developed after 5 days from the onset of clinical manifestations of stroke. In the cardioembolic subtype of IS, the probability of pneumonia in groups with dysphagia severity from 90 to 120 points on the MASA was higher than in the atherothrombotic subtype of IS ( p <0.05)., Conclusion: Patients with cardioembolic stroke subtype are characterized by a worse prognosis for the developing pneumonia compared to patients with atherothrombotic stroke subtype.

Objective: To develop an effective method for percutaneous endoscopic gastrostomy using gastropexy technology., Material and Methods: We retrospectively analyzed 260 ICU patients with dysphagia associated with neurological disorders between 2010 and 2020. All patients were divided into two groups: the main group ( n =50) - percutaneous endoscopic gastrostomy with gastropexy, control group ( n =210) - surgery without fixing the anterior wall of the stomach to the abdominal wall., Results. G: Astropexy significantly reduced the incidence of postoperative complications ( p =0.045) and severe complications (grade IIIa and higher) (χ 2 =3.701, p =0.055). Early postoperative complications occurred in 20 (7.7%) patients. Surgery and subsequent treatment were associated with normalization of leukocyte count ( p =0.041), C-reactive protein ( p =0.024) and serum albumin ( p =0.0012). Mortality was similar in both groups. Overall 30-day mortality rate in both groups was 20.8% that was associated with clinical severity of patients. Percutaneous endoscopic gastrostomy was not the direct cause of death in any case. However, complications of endoscopic gastrostomy aggravated the underlying disease in 2.9% of cases., Conclusion: Percutaneous endoscopic gastrostomy with gastropexy reduces the incidence of postoperative complications.

Fibrovascular polyp is a rare non-epithelial esophageal tumor arising from submucosal layer and consisting of connective and adipose tissue, as well large number of vessels. Large tumors can cause dysphagia, vomiting, chest pain, shortness of breath and/or asthma, while giant neoplasms are potentially life threatening. Despite active introduction of minimally invasive treatment of patients with non-epithelial gastrointestinal tumors, there are still difficulties in surgical treatment of fibrovascular polyps. The patient with a giant fibrovascular esophageal polyp presented with cough, discomfort in the throat, impaired swallowing and episode of tumor migration into oropharynx. Examination confirmed giant highly vascularized esophageal fibrovascular polyp. A novel hybrid surgical technique (endoscopic submucosal dissection with laparoscopic removal of tumor) was applied. Eight-month follow-up revealed no complications. Favorable clinical result was achieved. A hybrid laparo-endoscopic approach in the treatment of patients with large fibrovascular polyps minimizes perioperative risks and improves postoperative outcomes.

Objective: To evaluate the main symptoms of the upper gastrointestinal dysfunction (salivation and swallowing disorders) and to determine their impact on the quality of life for patients with PD of stages I-III, as well as the possibility of their correction by dopamine receptor agonists., Material and Methods: 252 patients (128 women and 124 men, 42-80 years old) with PD of stages I-III were examined using: UPDRS items «salivation», «swallowing» and «anorexia», scale of daily activity (Schwab and England ADL scale), questionnaire quality of life (PDQ-39), measurement of saliva amount, BMI, MMSE scale; 53 patients were treated with piribedil during 6 months., Results: The upper gastrointestinal tract dysfunction of mild to moderate severity was detected in 51.2% of patients. The prevalence of sialorrhea was 38.9, 42.9 and 46.2%, and that of dysphagia was 22.2, 24.3 and 17.3% at stages I-III, respectively. According to the results of the correlation analysis dysphagia is associated with a long history of PD, low BMI, high doses of levodopa and low Sch & En score; and sialorrhea is also associated with low BMI and with old age. For the early stages of PD we can tell, that the quality of patients' life deteriorates, and this to a large extent is due to impaired salivation and swallowing, which manifest themselves in daily activity and communication difficulties., Conclusions: The inclusion of piribedil (150-250 mg/day) in the 6-months therapy reduces the dysfunction of the upper gastrointestinal tract (by 61 and 74% of the initial level of dysphagia and sialorrhea, respectively) regardless the drug use in monotherapy or in complex therapy with levodopa.

Objective: To assess the efficacy of treatment of cricopharyngeal insufficiency in chronic critical illness caused by severe brain injury using non-invasive magnetic stimulation with endoscopic navigation., Material and Methods: Thirty patients (19 men and 11 women, mean age 50±12 years) were studied. The exposure was carried out by a bipolar alternating magnetic field using an inductor located in the projection of the hyoid bone. The study compared the standard therapy and the complex of therapeutic measures, in which the proposed non-invasive magnetic stimulation method with endoscopic navigation was included. The procedure was carried out daily without regime changes, with objective control 1 time in 10 days. The duration of the first course was 10 days, followed by a decision to extend the course for another 10 days, depending on the objective dynamics. Evaluation was performed with the Rosenbek Penetration and Aspiration Scale (PAS), the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), The Mann assessment of swallowing ability (MASA) and the Functional oral intake scale (FOIS)., Results and Conclusion: Improvements of swallowing function were observed in both groups, but qualitative changes were more pronounced in the main group. The use of the proposed method made it possible to obtain a more stable and predictable result.

Aim: To evaluate the efficacy of the training method of rehabilitation of patients with neurogenic dysphagia in ischemic stroke carried out with the use of special nutrient mixtures as part of combination therapy., Material and Methods: The study included 65 patients (35 men and 30 women, aged 45 to 80 years) with dysphagia in the acute period of ischemic stroke. Thirty patients were treated with special binding compounds as part of a combination therapy. Thirty-five patients did not use the mixture. The dynamics of the recovery function of swallowing using PAS (the Penetration-Aspiration Scale) and FEDSS (the Fiberoptic Endoscopic Dysphagia Severity Scale), as well as the transition from tube to independent feeding were studied., Results and Conclusion: The training method of rehabilitation with the help of special nutritional mixtures allows achieving significantly better indicators of restoration of swallowing function assessed with PAS and FEDSS in patients with ischemic stroke and neurogenic dysphagia. This trend is most pronounced in the group of patients with pseudobulbar syndrome. The application of the training method leads to a significantly better transition from tube to independent feeding. Tracheal intubation and mechanical ventilation are an additional factor aggravating swallowing disorders.

Eating disorders in stroke patients are always accompanied by structural and functional changes in the body, which leads to violations of adaptive reserves and trophic homeostasis. It is known that trophic homeostasis, together with optimal oxygen supply, forms the basis of the vital activity of the organism and is a necessary condition for overcoming of many pathological conditions. Insufficient nutrition leads to a slower recovery of patients, increases the risk of complications, predicts prolonged hospital stay, increases mortality. Inability of adequate feeding causes the necessity of obligatory administration of nutritional support to patients in a severe condition. The article provides a review of the main principles of organization of nutritional support in stroke patients and ways to assess its effectiveness.

Aim: To determine the efficacy of post-stroke dysphagia treatment by choline alfoscerate (ChA), succinate combination (SC), and their combination with sip, larynx, and swallowing exercises., Material and Methods: Four groups of primary ischemic stroke (IS) patients (n=80; 62±0.2 y.o., verified by MRI), including controls, admitted to Stroke Unit 24 h after stroke in the area of RAM (29.5%), and LAM (70.5%), were studied. Basic therapy was provided according to National Stroke Treatment Recommendations, treated groups received ChA 14 mg/kg (2 st gr.), SC 0.5 mg/kg (3 nd gr.), combination of two compounds (3 d gr.). Controls (4 th gr.) received placebo. Pharmacological treatment was provided for 10 days with continuation by oral administration. Dysphagia was measured semi-quantitively by MASA scale, three scale determinants were measured on admission, on 5 and 13 days of stay in the hospital., Results and Conclusion: The differences were significant and observed on the 5 th day of treatment. ChA mostly improved sip control, and larynx movements (38% above controls; p<0.01), while SC improved the closure of vocal cords (55% above controls; p<0.01). This may reflect the differences in synaptic control of these functions. Combined treatment was more effective than monotherapy: 15% above ChA, and 21% above SC for swallowing function (p=0.01); 33 and 22% for vocal closure, 37% (p=0.05) and 76% (p=0.01) for larynx movement, which may be due to synergism between two medications. Therefore, sip, larynx, and swallowing exercises with pharmacological support of ChA and SC ameliorated dysphagia after IS.

Pleomorphic adenomas are the most widespread epithelial tumours originating from the salivary glands. In almost 90% of the cases, they are localized in the parotid salivary glands. Pleomorphic adenomas only rarely affect the larynx. To the best of our knowledge, as many as 27 cases of laryngeal pleomorphic adenoma have thus far been described in the special literature. The present article was designed to report a case of pleomorphic adenoma in the larynx of a 76 year-old male patient. The surgical treatment of this condition proved beneficial for the patient whose condition remains uncomplicated by the relapse of the tumour during the 5 year-long postoperative follow-up.

It is presented the results of survey and treatment of 32 patients with upper esophageal sphincter achalasia. In 29 of them achalasia was consequence of stroke in brain stem (Zakharchenko-Wallenberg syndrome). 28 patients were operated using P. Chodoch method in 7 cases and author's technique of myotomy with pharyngoesophageal junction plasty in 21 patients. Plastic myotomy gives excellent and good results in 81% of observations due to preservation of innervation of muscles providing function of epiglottis and pharyngeal constrictors. Severe condition of patients and elderly age are indication for P. Chodoch myotomy.

Unlabelled: Main tasks of early postoperative period in patients after posterior fossa surgery are the timely and safe weaning from mechanical ventilation and extubation. For clinical assessment of the hypopharynx function we use an algorithm developed in the intensive care unit (ICU) of the Burdenko Scientific Research Institute of Neurosurgery. Disadvantages of the clinical test for assessment of patient's readiness for extubation are subjectivity and impossibility to use it in conditions of even superficial sedation. Shot-latency somato-sensory evoked potentials (SSEP) can be applied in conditions of sedation and objectify the brain stem deficit. The goal of the study was to define the changes of cortical SSEP in patients with disorders of swallowing after posterior fossa surgery. To assess the swallowing disorders we used a scale of swallowing disorders in intubated patients with brain stem damage. We compared results of cortical SSEP, test of swallowing disorders in intubated patients and clinical results of extubation. 17 patients with tumors of posterior fossa were included in the study. All patients were divided into two groups depending on duration of mechanical ventilation. Patients of the group-1 were successfully extubated in 4.5 hours. Patients of the group-2 were mechanically ventilated more than 15 hours because of impossibility to pass the test of readiness for extubation., Results: Central conduction time symmetry index after the surgery was lower in the group-1 than in group-2. There was inverse correlation between amplitude of cortical response N20 and time from the patient's admission to the ICU until the moment of extubation., Conclusions: Asymmetry of central conduction time and decreasing of N20 amplitude can be used as additional predictor of swallowing disorder.

The authors aimed to optimize the strategy and technology of regeneration of oesophagus patency and oesophageal anastomosis in a case of tumor stenosis. Results of endoscopic correction of neoplastic stenosis of the oesophagus were studied in 244 patients, the cases of oesophagocolic anastomosis--in 12 patients and outcomes of oesophagogastric--in 8, respectively. A protection of self-expandable stents is an effective method of regeneration of enteral feeding in patients with manifested dysphagia, which is specified by the growth of malignant tumor of the oesophagus or oesophageal anastomosis. A possibility of formation of broncho-esophageal communications limits the usage of silicone tubular and steel self-expandable stents with partial coating of a funnel by special indications: a disposition of proximal border of tumor stenosis less than 3 cm from esophageal--pharyngeal passage--for the first; a necessity of fast recovery of oesophagus patency in rigid stenosis and an impossible single-stage dilatation of constriction zone--for the second. An optimal device for oesophagus and anastomosis protection is a fiber-nitinol self-expandable stent with coating. The stents with antireflux valve should be used in the case of oesophagogastric passage lesions.

Dysphageal complaints in a 65-year-old woman were regarded as a manifestation of mental illness. The autopsy of the patient weighing 32 kg who died from bilateral pneumonia revealed 9-mm osteophytes on the anterior surface of the cervical spine as the cause of dysphagia. Twenty-nine cases of cervical osteochondrosis-induced dysphagia, published in the literature, were analyzed.

The results of operative treatment of 787 patients, suffering hiatal hernia (UH), were analyzed. Depending on the hiatal foramen square the patients were divided into three groups: with a small, large and giant hernias. In large HH a cruroraphy conduction causes a trustworthy more recurrence rate, than in small HH. In large HH the alloplasty performance secures lesser recurrence rate, then in cruroraphy conduction, although the dysphagia rate is bigger. While performing original method the dysphagia rate is minimal in comparison with such, when polypropylene transplant is used for plasty. In a giant HH alloplasty is complicated by trustworthy enhanced recurrence rate (19%), than in large HH, trusting neccessity to elaborate a new methods of correction. Basing on results of a factorial analysis made, concerning an accordance of the hiatal defect square with the recurrence rate in the groups of patients, there was established, that the division levels (10 and 20 cm2) for establishing the HH classification strictly parallels the recurrence rate in each class determined by the authors.

The authors present results of examination and treatment of 272 patients with Zenker diverticulums of different localization. Features and problems in fibroesophagoscopy in patients with Zenker diverticulum are discussed. Surgical interventions with endoscopic assistance were fulfilled in 37 patients with diverticulum. A new way of endoscopic management of Zenker diverticulum using preparation "Disport" and the method of endoscopic incision of cricofaringeal muscle are proposed. Good clinical results of the treatment were obtained.

The article deals with the questions of treatment of diseases developing with constriction of the esophagus lumen using modern minimally invasive techniques. The authors set the tasks to improve treatment of patients with dysphagia using endoscopic stenting. Original solutions of complex problems are presented arising in treatment of such group of patients. A detailed analysis of complications is given and the scheme of the causes of their appearance which is thought to be actual.

Data of 29 patients with pharyngoesophageal impassability are analyzed. The condition was a result of a stroke in 89,6% of patients. Radiographic contrast pharyngo- and esophagoscopy (n=29), video X-ray of the swallowing act (n=20), esophagogastroduodenoscopy (n=29) and pharyngoesophagomanometry (n=18) were performed as diagnostic measures. The basal tone of the upper esophageal sphincter was high in 10 patients and decreased in 8. 25 patients were operated on: Chodosh cricopharyngeal myotomy was performed in 7 patients, 18 standed the pharyngoesophageal plasty with inferior constrictor muscle of pharynx's fibers shift after the original method. Follow-up was carried out from 1 month to 2 years. Superb and good results were achieved in 42,7% patients after cricopharyngeal myotomy and in 77,8% patients after the pharyngoesophageal plasty.

The author describes variants of using magnetic anastomoses in treatment of dysphagia after chemical burns of the esophagus.

Dysphagia appears in 15-17% of cases after removal of tumors of the posterior cranial fossa (PCF), which is one of the most life-threatening postoperative complications due to a risk of acute airway patency impairment, possible aspiration, bronchopulmonary infectious complications. This makes prognosis workse and complicates a patient's rehabilitation. Based on the results of fibrolaryngotracheoscopic study and treatment of 1653 patients operated on for PCF tumors, the authors have developed a scale for rating the severity of bulbar disorders. The proposed scale promotes decision making on the expediency of performing tracheostomy and on the necessity of evaluating the efficiency of performed therapy (trends in bulbar disorders) and predicting the course of a postoperative period.

Early inpatient rehabilitation is a basis of functional state improvement in patients with cerebral stroke (CS) but poststroke complications may have negative influence on the rehabilitation results. The article addresses the influence of dysphagia on the efficacy of early inpatient stroke rehabilitation that has been studied during rehabilitation of CS patients in the Rehabilitation Clinic of Kaunas Medical University in of 2000-2005. Dysphagia was observed in 31.5% of complicated CS patients or in 21.6% of all cases studied. The efficacy of rehabilitation in these patients was lower. At the completion of the early rehabilitation dysphagia persisted in 1.6% of patients with stroke. We conclude that dysphagia in CS patients is important but correctable complication at an early stage of in-patient rehabilitation.

A procedure of argon-plasma coagulation is suggested to be used alone or in conjunction with chemical necrolysis and high-frequency electrosurgery for endoscopic palliation of dysphagia. Its outstanding impact on tumor-induced dysphagia, involving no life-threatening complications, was demonstrated in a group of 97 patients. A number of basic factors immediately influencing the results of therapy are outlined and relevant recommendations on clinical use are provided.

To study peculiarities of clinical symptoms of laryngeal angiomas in children, 71 case histories for children with vascular tumor aged 27 days to 14 years have been analysed. The cases were divided into two groups by location of the tumor: group 1--with hemangioma located in the subvocal larynx (45 children admitted to hospital at the age of 27 days to 2 years); group 2--with laryngeal vascular tumor located in the vocal or supravocal larynx (26 children admitted to hospital at the age of 3 months to 14 years). It was established that the age of the first angioma symptoms and the symptoms manifestation depend on the tumor location. Subvocal hemangioma should be considered an independent nosological unit of the disease.

Forty one 41-82 year-old patients with chronic cerebrovascular diseases were examined neurologically, using ultrasonic dopplerography (USD) of extracranial cerebral vessels and transcranial dopplerography (TCD) of intracranial cerebral vessels. Changes of the blood flow through major cerebral arteries as well as peculiarities of the venous circulation were evaluated. A significant decrease of the cerebral blood flow velocity (BFV) was found by TCD on early stages of cerebrovascular diseases, while USD revealed it on the III stage of dyscirculatory encephalopathy. The changes in the regulation of the venous circulation increase from latent to obvious alterations of both BFV and the pulsatility index. The conclusion is made that manifestation of clinical symptomatology in the diseases studied is undoubtedly connected with cerebral ischemia and TCD plays an important role in its determination.

An analysis of immediate and long-term results of surgical treatment of 170 patients with esophageal obstruction is presented. Esophagoplasty with different fragments of the gastrointestinal tract was used (87--ileocolon, 16--small intestine, 23--left half of the colon, 44--a stalk from the greater curvature of the stomach). The greater amount of complications due to incompetence of the esophageal anastomosis sutures was noted in patients after esophagoplasty with a fragment of the small (50%) and right half of the large (59.7%) intestine, more rarely-after plasty with a gastric stalk (15.9%) and left half of the colon (26.1%). There was no necrosis of the transplant from the left half of the colon. Severe ischemic lesions made their appearance in the fundal portion of the gastric stalk (2.2%), necrosis of the small intestine part of ileocolon developed in 16.1% of the patients. In the patients with less amount of postoperative complications one-stage esophagoplasty was performed. Reconstructive operations on the artificial esophagus were necessary in 43.6% of the patients. The main indication for it was mechanical dysphagia.

Results of functional examination of 176 patients with gastroesophageal reflux disease are presented. 94 patients were were followed up from 1 month to 4 years after laparoscopic antireflux operation (82--by Nissen and Nissen--Rossetty, 6--by Dor, 6--by Toupet). After Nissen operation the pressure in the region of lower esophageal sphincter (LES) increased more than after partial fundoplication and remained the same during 4 years of follow-up (p < 0.05). Postoperative dysphagia in the majority of cases was associated with excessive increase of pressure and length of LES region, decrease of it capacity to relaxation during swallowing (p < 0.05). 360 degrees-fundoplication can not be recommended only in complete loss of contractile capacity of the esophagus.

Videofluoroscopy (VFS) was for the first time used for examining swallowing in 49 patients with nervous diseases. Disturbances in each phase of swallowing act are analyzed with evaluation of the time parameters and defects, causes of aspiration in neurogenic dysphagia are discussed, and cricopharyngeal insufficiency is described. Neurogenic dysphagia is characterized by a combination of disorders which determine the degree of dysphagia. The most severe swallowing disorders were observed in patients with multiple foci in the brain stem and in diphtheritic polyneuropathies. The authors conclude that VFS is the optimal method for the diagnosis of neurogenic dysphagia.

100 patients (88 women, 12 men) of 16-64 years of age with functional dysphagia were examined. In all the cases the disease develops under the influence of stress in individuals with high anxiety, easy formation of dysthymic, obsessive-phobic reactions in the situation of frustration. Functional dysphagia arises most frequently at the age of 20-40 years. 4 stages pass in the course of the disease: a stage of reactive (neurotic) depression; psychosomatic reactions; psychosomatic cycles (mono- and polysomic); psychopathization. Psychopathization manifests pathologic (psychosomatic) development of personality observed usually in long-term course of dysphagia.

One-stage operations for carcinoma of the esophagus and cardia were performed on 100 patients. The substitution of the resected esophagus was made with a isoperistaltic tube from the greater curvature of the stomach with anastomosis on the neck, in the pleural or abdominal cavities. Palliative interventions were fulfilled on 31 patients with inoperable carcinomas. An analysis of the structure and causes of postoperative complications and postoperative lethality has shown that among the most frequent causes of deaths in the postoperative period were purulent-infectious complications as a result of ischemia of gastric transplants and incompetence of sutures of the anastomoses as well as pleuro-pulmonary complications. Special attention was given to an analysis of complications after operations performed without thoracotomy from the cervico-abdominal access. The amount of postoperative complications was 30%, postoperative lethality 15%. One-year survival after operations made up 57%, 3-year survival--less than 30%, 5-year survival--less than 15%. Some recommendations are given for the surgical policy and methods of prophylactics of certain complications. Endolymphatic infusions of cytostatics used as adjuvant chemotherapy in complex treatment of patients with cardioesophageal carcinoma represent a perspective direction providing longer life of the patients without recidivations. From the oncological viewpoint the operation without thoracotomy are not always thought to be justifiable.

The paper analyzes three cases of developed uniphagia and/or dysphagia in long-term postoperative periods. No predictors of late dysphagia were observed. Maintenance of antireflux activity after prosthesis removal is of great interest. The authors recommend that the antireflux prosthesis should be used in the situations at a high risk of routine fundoplication.

Esophageal spasm Teschendorf 's syndrome) is rarely distinguished among neuromuscular diseases of the esophagus, which leads to improper treatment. Primary esophageal spasm and secondary esophageal spasm should be distinguished, the latter developing in cardiospasm or achylia of the cardia. Retrosternal pain and dysphagia prevail in the clinical picture of ++esophageal spasm . X-ray and esophagomanometry are the most informative among the objective methods of examination. In a group of 106 patients 49 had primary and 57 had secondary esophageal spasm . A complex of measures should be applied in the management of esophageal spasm+. Primary esophageal spasm is treated only by nonoperative measures (spasmolytics, tranquilizers, vitamins, acupuncture reflex therapy and psychotherapy according to a suggested scheme), a course of pneumocardiodilatation (no more than 5 sessions) is included in the management of secondary esophageal spasm+. Such treatment produced good and satisfactory results in 100% of patients with primary and in 72% of patients with secondary esophagitis. The management of secondary esophagitis is a more difficult problem which calls for further study.

By examining extraorgan innervation of the pharyngeal-esophageal junction of adult cadavers, it was found that the risk of injury of the superior laryngeal nerve and its branches was very high during larynx resection and extirpation, lateral pharyngotomy, thyroid gland resection according to the method of A.V. Martynov, and Crile's operation. Esophageal branches of the recurrent laryngeal nerve or the inferior laryngeal nerve can be damaged during larynx extirpation or strumectomy according to the method of O. V. Nikolaev. The nervous apparatus of the pharyngeal-esophageal junction consists of nerve bundles located in the adventitia, muscular layer, and submucous base.

Disorders of swallowing of the central genesis can be eliminated by means of a simple surgical operation--longitudinal dissection of the pharyngoesophageal sphincter. Since a positive result was obtained in 4 cases out of 5, the authors hold that the surgical method of dysphagia treatment merits introduction into medical practice.

Under examination there were 29 patients with neuromuscular diseases of the esophagus using clinico-psychodiagnostic investigations on the basis of the method of multilateral examination of the person. The treatment of patients also included a course of psychotropic therapy. The results obtained are discussed in different groups of patients with neuromuscular diseases of the esophagus. Immediate results of the treatment were satisfactory.

The paper discusses the results of treatment of 152 cases of cancer of the esophagus and proximal part of the stomach presenting with grade III-IV dysphagia. In 107 patients, treatment included endoscopic laser coagulation of tumor: in 52 the procedure was combined with radiation and in 18 cases-with chemotherapy, whereas in 37 patients the method was used alone for palliation only attempting at return to enteral nutrition. Histories of 45 patients with esophageal cancer who had received standard treatment served as control. Laser coagulation-associated lethality was 1.9%. Normal food passage was restored in 97.6% of esophageal cancer patients and in 96% of those with cancer of the proximal part of the stomach. The mean overall survival was 8.7, 8.4 and 7.3 months for the study groups and 3.2 months only for controls. The mean dysphagia-free survival was 48.5 days.