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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of swallowed foreign body is high in children and young adults. The common age of occurrence is below 10 years of age. It is a well known paediatric emergency often requiring urgent oesophagoscopy. Majority of swallowed foreign bodies (FBs) are impacted at sites known conventionally as constrictions. The commonest FB swallowed by children is coins; by adults - bones, fish bones and large bolus of meat, and in the older age group - dentures. The most common presenting symptoms are drooling of saliva, dysphagia and odynophagia. The anatomic proximity of the upper airway and oesophagus permit the development of respiratory symptoms like cough and stridor. Long standing foreign body impaction with weight loss, consolidated lungs and failure to thrive are documented presentations of FB in the oesophagus. We present a case of a 20 year old male who inadvertently swallowed a coin which got impacted at the thoracic inlet - one of the conventional areas of constriction. He presented late with cough, stridor, odynophagia and weight loss. The presentation of weight loss that could arise from unduely prolonged odynophagia rather than from complications like fistula, empyema thoracis or ominous predisposing lesions like malignancy was noted. The case highlighted the oddity of an adult swallowing a coin, its impaction in the, oesophagus of an apparently healthy adult and the non-surgical retrieval of the FB by fluoroscopic guidance.
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PMID:Radiologic management of impacted coin in the oesophagus--a case report. 1639 58

Pleural effusions associated with malignancy--either malignant or paramalignant diseases--were found in ca. 20% of these patients. Large pleural effusions cause mainly dyspnoea but also cough and chest pain. The presence and degree of dyspnoea depend on the size of the effusion and the patient's underlying pulmonary function. In acute cases and large effusions immediate chest drainage is indicated in symptomatic patients, followed by the treatment of the underlying disease, e. g. chemotherapy. The most effective therapy for controlling reiterated malignant pleural effusions is the thoracoscopic talc poudrage (2.5-10 g) which has been shown to have a success rate of > 90%. Talc induces a broad inflammatory reaction involving mesothelial cells of the pleura, coagulation parameters, fibroblast proliferation eventually leading to symphysis of the pleura. This procedure is reserved for patients who are in good general conditions, who are expected to have a reasonably long survival, and who failed chemical pleurodesis. A good predictor for longer survival time is a Karnofsky Performance Scale > or = 40 indicating a survival time > 30 days, which therefore should be considered prior to the procedure. The adult respiratory distress syndrome (ARDS) is the most important complication initially observed in the US in up to 9% of all cases. ARDS incidence was strongly related to high number (50%) of small talc particles < 15 microm. In summary, talc poudrage or slurry (talc particle size > 10 microm) in malignant pleura effusions is a safe and effective method to induce pleura symphysis. Complaints and complications such as chest pain, transient fever, and empyema are rare or very are which are almost exclusively related to the therapeutic procedure itself.
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PMID:[Talc pleurodesis in malignant pleural effusions]. 1646 49

A 83-year-old man had been treated for pulmonary infiltration was referred to a nearby hospital because of slight fever and cough. His chest radiograph and CT showed right chronic empyema, and in which pleural aspirate was smear positive for acid-fast bacilli and positive for PCR-Mycobacterium intracellulare. He was diagnosed as chronic empyema caused by M. intracellulare. A month later exacerbation of bronchopleural fistula was observed and M. intracellulare infection expanded into the lung. He was treated with combined use of ethambutol, rifampicin, clarithromycin, and streptomycin for six months, and his chest radiograph showed improvement, however, finally he died as he was in advanced age and emaciation due to chronic lung infection.
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PMID:[A case of Mycobacterium intracellulare infection with chronic empyema]. 1683 81

Thoracic empyema is a life-threatening condition in paediatric surgical practice and the appropriate management still remains controversial. The authors reviewed 79 (37 boys, 42 girls) cases of empyema thoracis who underwent thoracotomy and decortication between 1990 and 2005. The initial diagnosis based on history, physical examination and radiology was confirmed by thoracentesis. Fever, cough and dyspnoea were the most common presenting symptoms. In all cases aerobic cultures were performed and Staphylococcus aureus was the most common microorganism isolated. All patients except three received antibiotics and tube drainage as an initial treatment. The decision for early decortication was based on persistence of fever, dyspnoea, air leakage and lack of resolution on CT scan, in spite of medical therapy and tube drainage, at the end of 10 days. All but one with wound dehiscence showed rapid recovery and they were discharged on the fifth to eighth postoperative days. In conclusion, early decortication is a safe and curative treatment in childhood empyema thoracis with low morbidity.
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PMID:Early decortication in childhood empyema thoracis. 1751 78

63-year-old man was admitted to our hospital with fever and cough for about 2 months. Laboratory data showed marked inflammatory changes, and chest computed tomography (CT) scans revealed right-sided hydrothorax, atelectasis of the right middle lobe, and a cystic mass in the right middle lobe. We diagnosed the patients as having lung abscess and empyema. Following the intravenous antibiotic chemotherapy, symptoms and laboratory data showed the improvement, however, on the 11th hospital day, he developed high fever again. A chest CT showed pneumopyothorax suggesting the rupture of lung abscess. Since the chest tube drainage was ineffective, open chest surgery was performed. Curettage of both thoracic and abscess cavity with closure of air leakage successfully cured the pyothorax.
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PMID:[Lung abscess which ruptured during the medical treatment of lung abscess; report of a case]. 1832 96

Two patients were admitted in the paediatric ward with the complaints of fever, cough, loss of appetite and swelling of the chest wall. Both the patients were subjected to a thorough clinical examination with needle aspiration and routine investigations like haemogram, Mantoux test, chest x-ray, computerised tomography scanning of the thorax. Both the patients were diagnosed as cases of empyema necessitatis. The first case had a burst chest wall on the second day of admission and underwent chest intercostal drainage. Later on, thoracotomy, decortication and reconstruction of the chest wall was done. The second patient had got chest drainage and there was no burst chest wall. No thoracotomy was done. Both the patients were discharged after full recovery without antituberculosis therapy.
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PMID:Tuwo cases of empyema necessitatis--experience and management. 1981 Mar 74

A 59-year-old woman with lumbago, presented with cough and right chest pain. Her chest X-ray showed right pleural effusion, and laboratory studies revealed elevated levels of serum C-reactive protein. Right bacterial pleuritis and empyema was diagnosed based on an analysis of the pleural effusion and pus. She was treated with antibiotics and both the right pleural effusion and pus were drained with a chest tube. Staphylococcus aureus was cultured from the pleural effusion and pus. Her fever and chest pain improved after this treatment, however, the lumbago took a sharp turn for the worse. A spinal MRI showed an increased signal intensity at the level of T11-12, thus suggesting a disk space infection and spondylitis with an epidural abscess. Thereafter, she developed left pleural effusion, and the effusion was drained. Her infection was cured with long-term administration of antibiotics. However, the infectious spondylitis relapsed after four months, and she therefore had to undergo surgery. This case suggested that infectious spondylitis produced the exudative pleural effusion. Bacterial pleuritis, empyema and exudative pleural effusion must therefore be treated while keeping in mind the possibility of infectious spondylitis.
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PMID:[Case of infectious spondylitis presenting as exudative pleural effusion]. 1982 86

Spontaneous pneumonia occurred to a considerable extent among stock monkeys at the Army Medical School. This pneumonia occurred chiefly in the form of an epidemic outbreak shortly after the arrival of a large shipment of monkeys, and was shown to be due in large part to transmission of infection from monkey to monkey, either directly or indirectly. That spread of the epidemic was facilitated by overcrowding was indicated by the fact that in a subsequent shipment of monkeys, which were kept in pairs in separate cages and were not allowed to come into contact with the monkeys among which the epidemic occurred, no cases of spontaneous pneumonia developed. The close analogy between the epidemic of lobar pneumonia that occurred among the monkeys and similar epidemics of lobar pneumonia that occurred during the war among certain groups of newly drafted troops shortly after their arrival at camp is very striking, and would seem to indicate that pneumococcus pneumonia may become an epidemic disease among groups of susceptible individuals when they are assembled under conditions that facilitate the ready transfer of infection from individual to individual. Bacteriological examination showed the spontaneous pneumonia to be due in the great majority of cases to infection with Pneumococcus Type IV. Immunological classification of the strains of pneurnococci by cross-agglutination tests showed that the majority fell into two biological groups. Two cases were apparently caused by Streptococcus haemolyticus, two by Streptococcus viridans. The clinical course of spontaneous pneumococcus pneumonia in monkeys was characterized by sudden onset, high sustained temperature, leucocytosis, rapid respiration with expiratory grunt, cough, physical signs of consolidation, invasion of the blood by pneurnococci, and termination in death or recovery by crisis about the 7th to 9th day. In a few instances the disease was complicated by acute fibrinopurulent pericarditis, by empyema, and by purulent meningitis. It was, therefore, clinically identical with lobar pneumonia experimentally produced in monkeys and with lobar pneumonia in man. Study of the pathology of spontaneous pneumococcus pneumonia in monkeys showed that it presented the characteristic picture of lobar pneumonia, both macroscopically and microscopically, and was in all respects comparable with the pathology of lobar pneumonia experimentally produced in monkeys and of lobar pneumonia in man.
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PMID:STUDIES ON EXPERIMENTAL PNEUMONIA : III. SPONTANEOUS PNEUMONIA IN MONKEYS. 1986 12

Twelve normal monkeys inoculated on the mucous membranes of the nose or nose and mouth with a strain of Bacillus influenzae; originally isolated in pure culture from the pleural exudate of a case of empyema following influenzal pneumonia in man and subsequently raised in virulence by animal passage, developed an acute self-limited respiratory disease of from 3 to 5 days duration, characterized by sudden onset with profound prostration, the development of rhinitis and tracheobronchitis, with sneezing, cough, and the outpouring of a scanty mucoid, or mucopurulent exudate, a variable febrile reaction, and either a leucopenia or no significant change in the leucocyte count. This disease was complicated in five instances by purulent sinusitis of one or both antra, in three by bronchopneumonia. Bacillus influenzae was recovered at autopsy from the lesions of the disease either in pure culture or in association with organisms that are normal inhabitants of the upper respiratory tract of monkeys. Of ten normal monkeys injected intratracheally with the same strain of Bacillus influenzae, seven developed bronchopneumonia, two developed tracheobronchitis without pneumonia, and one resisted infection. The general symptoms and duration of the disease were similar to those of the preceding group. There were a severe cough and accelerated respirations. Bacillus influenzae was recovered in pure culture from the lungs, bronchi, or trachea in the animals killed during the active stage of the disease. It disappeared promptly from the respiratory tract with recovery. The significance of the first series of experiments in which monkeys were inoculated in the upper respiratory tract is twofold. First, they establish the fact that Bacillus influenzae can initiate in monkeys an acute infection of the normal mucous membranes of the upper respiratory tract; that is, it can act as a primary incitant of respiratory infection without the assistance of a preceding or concomitant contributing cause. In this respect it differs radically from the pneumococcus and Streptococcus haemolyticus, since experiments previously reported(2, 4) have shown that neither of these organisms possesses the property of initiating an infection of the normal mucous membranes of the upper respiratory tract of monkeys, even though the strains used were incalculably more virulent for monkeys than the strain of Bacillus influenzae used in the foregoing experiments. Secondly, the experiments show that Bacillus influenzae infection of the mucous membranes of the upper respiratory tract may spread by continuity to the paranasal sinuses, setting up an acute sinusitis, that it spreads readily to the lower respiratory tract, producing a tracheobronchitis and permitting the ready invasion of secondary bacteria, and that it may penetrate as far as the terminal bronchioles, alveolar ducts, atria, and alveoli, there setting up a bronchiolitis and true bronchopneumonia. In these respects it likewise differs radically from the pneumococcus and Streptococcus haemolyticus which do not possess these pathogenic properties as previous experiments have shown.(2, 4) The bearing of these facts on the possible etiologic relation of Bacillus influenzae to influenza is important, since they show that Bacillus influenzae possesses certain definite primary pathogenic properties which distinguish it and therefore separate it from the group of recognized secondary organisms in influenzal complications, of which the pneumococcus and the streptococcus are the most frequent. The possible etiologic relation of Bacillus influenzae to influenza is further supported by the character of the respiratory disease that occurred in the monkeys. The sudden onset with profound prostration, the absence of leucocytosis or often a leucopenia, the congestion of the mucous membranes of the respiratory tract, the development on the 2nd or 3rd day of an irritative cough due to an inflammatory tracheitis or tracheobronchitis, the brief self-limited course of the infection, and the irregular febrile reactions are all characteristic of influenza. Many of these symptoms were in striking contrast with the symptoms and course of pneumococcus or streptococcus infections in monkeys in which there were no prostration at onset, invariable leucocytosis, and infrequent cough developing only late in the disease. While all the above features of the disease produced in monkeys are characteristic of influenza in man, none are pathognomonic and, in fact, it is doubtful whether uncomplicated influenza possesses any pathognomonic features by which it may be diagnosed certainly in the absence of an epidemic. Even during epidemic times many respiratory infections arise which, though presumably influenza, it is impossible to diagnose as such with certainty. Nor does pathology help in this respect, since there would appear to be no established distinctive lesions of uncomplicated influenza in man, nor for that matter of the complications of influenza, apart from the complications which have been ascribed by Pfeiffer,(5) MacCallum,(6) Wolbach,(7) and others to infection with Bacillus influenzae because of the association of Bacillus influenzae in pure culture with these complications. For these reasons, although the disease produced in monkeys appears to be essentially identical with influenza in man with respect to its clinical course and complications, it is impossible to determine certainly whether it is actually so. The experiments are advanced, therefore, as evidence in favor of the etiologic relation of Bacillus influenzae to influenza, though they do not permit of a definite conclusion in this respect. Their bearing upon the relation of Bacillus influenzae to certain of the complications of influenza would appear to be reasonably conclusive. The recovery of Bacillus influenzae in pure culture at autopsy from the antra, from the trachea and bronchi, and from the lungs in some of the animals developing sinusitis, bronchiolitis, and a characteristic type of bronchopneumonia confirms by animal experiment the etiologic relation of Bacillus influenzae to these complications of influenza, which hitherto has rested solely upon the frequent association of the influenza bacillus with these lesions in man. The production of tracheobronchitis and the same type of bronchopneumonia by the intratracheal injection of Bacillus influenzae in the second series of experiments serves as additional confirmation of this, but has no direct bearing on the etiologic relation of Bacillus influenzae to uncomplicated influenzae.
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PMID:STUDIES ON EXPERIMENTAL PNEUMONIA : IX. PRODUCTION IN MONKEYS OF AN ACUTE RESPIRATORY DISEASE RESEMBLING INFLUENZA BY INOCULATION WITH BACILLUS INFLUENZAE. 1986 70

A 54-year-old man was admitted to our hospital for investigation of cough, sputum production, and fever of 1 month's duration. His diabetes mellitus was poorly controlled, and his hemoglobin HbA1c value was elevated at 10.9%. Chest X-ray film and computed tomography scan showed bilateral but predominantly right-sided pleural effusion. Aspiration of the pleural fluid from the right-side showed frank pus, and empyema was diagnosed. Capnocytophaga sp. and Actinomyces israelii were isolated in the pleural effusion and were regarded as the pathogens causing the empyema. Klebsiella pneumoniae was isolated in his sputum, and it may also have been a possible pathogen. The patient improved with administration of antibiotics (6 g/day ampicillin/sulbactam, 3 g/day ceftazidime hydrate and 1200 mg/day clindamycin) and chest tube drainage. He was discharged and regularly followed on an outpatient basis. We report this rare case of Capnocytophaga sp. and Actinomyces israelii as the pathogenic causes of empyema.
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PMID:[A case of empyema due to Capnocytophaga sp. and Actinomyces israelii]. 1988 14


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