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

Myotonic dystrophy or Steinert's disease may be discovered during acute respiratory failure, sometimes caused by a general anaesthetic. It complicates chronic respiratory failure which is present in almost all cases, both restrictive and obstructive, the clinical signs of which progress with the myopathy. Apart from myotonic degeneration of the respiratory muscles, a hypoventilation syndrome of central origin has been described, but the etiology of this respiratory failure is dominated by repeated aspiration pneumonia favoured by constant dysphagia and passage of food into the trachea and poor cough reflex. One should attempt to correct this.
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PMID:[Myotonic dystrophy and acute respiratory insufficiency]. 19 96

Aspiration pneumonitis is an important cause of many anesthetic and non-surgical deaths and complication. One hundred and eight cases from 1964 to 1974 were reviewed to study the factors associated with aspiration pneumonia. Forty surgical and 68 non-surgical patients were evaluated and compared. Predisposing factors included impaired consciousness, esophageal and neurological disorders, cardiac resuscitation, debilitation, presence of a nasogastric tube or tracheostomy. The most common findings in both groups were dyspnea, cough, cyanosis, fever, tachycardia, rhonchi, rales and wheezes. Sputa of 64 patients failed to reveal the precise etiologic agent. High mortality (30%) and morbidity were found in both groups even with optimum treatment. The causes of morbidity in both groups of patients were pneumonia, lung abscess, myocardial infarction, gastrointestinal hemorrhage, and pulmonary embolus. Prevention, with particular attention to high-risk patients and to factors influencing aspiration in groups of surgical and non-surgical patients, is the solution to the problem.
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PMID:Aspiration pneumonia: a ten-year review. 45 16

In 196 cases of gastro-oesophageal reflux, simple or connected to a hiatal hernia or to a cardio-tuberous misplacement, the respiratory signs that are found in 1 patient out of 4, are analyzed. The nocturnal fits of coughing (39 cases, 20% of the reflux) is the most frequent sign of laryngo-tracheal aspiration of stomach content. This symptom of great diagnostic value, though neglected, should be looked for systematically. Other troubles are less frequent: bouts of recurring broncho-pulmonary infections, asthma attack, Mendelson's syndrome, pulmonary fibrosis. In absence of a patent cause, the symptoms should lead to suspect a reflux of stomach content in the airways. Similarly to oesophagitis, respiratory signs represent a complication sometimes serious, of gastro-oesophageal reflux, needing more frequently a surgical treatment of hiatal herniae or of the cardiac inefficiency.
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PMID:[Broncho-pulmonary manifestations and gastroesophageal reflux]. 61 79

Optimum surgical management of the hypopharyngeal diverticulum is controversial. The authors discuss 48 consecutive patients (average age 72.1 years) with documented hypopharyngeal diverticula who were treated by cricopharyngeus myotomy, leaving the diverticula in situ. All came to the hospital with dysphagia; other symptoms included postdeglutitive cough, regurgitation, aspiration, and weight loss. Seven patients had had previous surgery for a Zenker's diverticulum with recurrence. Aspiration pneumonia was treated in 9 patients; 28 patients had concurrent chronic obstructive pulmonary disease or cardiovascular disease. Thirty-nine patients had cricopharyngeus myotomy under local anesthesia, 5 had cricopharyngeus myotomy under general endotracheal anesthesia, and 4 patients underwent myotomy with a cervical esophagostomy. There was one mortality (2.1%) and no incidence of postoperative bleeding, sepsis, or cranial nerve injury. Follow-up was done with 30 patients via telephone an average of 64 months after operation. Twenty-one of 30 patients reported excellent relief of symptoms, 5 reported improvement with occasional symptoms, and 4 patients described persistent dysphagia. Cricopharyngeus myotomy under local anesthetic is a safe and effective approach to the patient with a hypopharyngeal diverticulum. The awake patient can swallow on command, which enables the surgeon to identify the upper esophageal sphincter (UES) and to perform an accurate, complete myotomy. The absence of a pharyngeal suture line eliminates the risk of leakage and mediastinal sepsis, and allows early, postoperative feeding and discharge.
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PMID:Treatment of Zenker's diverticula by cricopharyngeus myotomy under local anesthesia. 148 6

A 2 year-old drank from a bottle of viscous lidocaine. Coughing and choking were prompt, and seizures began within 10 to 15 seconds. Intraosseous phenobarbital 40 mg/kg stopped seizures temporarily, 30 mg/kg more plus lorazepam 20 mg/kg were needed for complete control. Suctioning of the airway revealed viscous material compatible with the drug. Bilateral hilar pneumonia ensued rapidly. The syndrome of inappropriate antidiuretic hormone secretion occurred and was countered appropriately. Intubation, performed on admission, could not be discontinued. The adult respiratory distress syndrome, characterized by a typical diffuse X-ray pattern and poor oxygenation, developed. Bilateral pneumothoraces complicated care. The patient required 14 days of extracorporeal membrane oxygenation before recovery. A lidocaine level was obtained at 4 h post-ingestion and was 0.5 micrograms/mL (2 mumol/L). The rapid onset of seizures suggests that the drug was absorbed from the pulmonary bed. This possibility is supported by the finding of viscous-lidocaine-like material in the trachea, the rapid development of aspiration pneumonia, and the development of adult respiratory distress syndrome, which has been observed in adults when lidocaine was used in the trachea for procedures.
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PMID:Rapid onset of seizures following aspiration of viscous lidocaine. 151 14

Imbalance between peptides such as substance P and bradykinin, and related enzymes degrading these peptides may cause the development of cough in various pathological conditions. On the other hand, lack of cough reflex may cause aspiration pneumonia. Down and up regulation by peptides may be useful for treatment of cough and prevention of aspiration pneumonia.
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PMID:[Cough reflex in respiratory disease]. 169 91

Enzymes degrading peptides may participate in the regulation of the cough reflex. Thus, decreases in enzyme activities may enhance cough reflex and a decrease in cough reflex may lead to aspiration pneumonia. Down- and up-regulation of cough reflex is important for the understanding of cough reflex.
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PMID:[Abnormalities in cough reflex]. 171 6

Aspiration pneumonia is the fourth cause of death in Japanese, of which 92% occurs in elderly people aged more than 65 years. Pneumonia in the elderly is mostly due to aspiration. Aspiration is caused by disturbance of the pharyngeal reflex and cough mechanisms are due to disturbances of brain activity. Respiratory diseases including bronchial asthma must be treated with consideration of brain activity.
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PMID:[Management of respiratory diseases in the elderly]. 175 98

Gastroesophageal reflux (GER) has been known to occur in infants but was thought to be normal. As a result of increased recognition of GER and a clear documentation of GER with extended (18 to 24 hour) esophageal pH monitoring, several severe complications of GER in children have become apparent. An immature cardiorespiratory system is susceptible to some complications of GER such as apnea, choking, recurrent cough or wheezing, and recurrent aspiration pneumonia. Noncardiorespiratory complications include weight loss, esophagitis, anemia, irritability, posturing, malnutrition, and developmental delays. Nursing assessment contributes to a complete clinical picture and the subsequent treatment choice of the physician. To form an accurate assessment of the child with suspected GER, the nurse must be aware of the symptoms and complications of this condition and must precisely execute diagnostic studies, particularly extended esophageal pH monitoring. Nursing responsibilities also include providing a safe yet stimulating environment for the child, teaching parents to participate in the child's care, supporting parents through hospitalization, and preparing both the parents and child for discharge and follow-up care at home.
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PMID:Nursing responsibility in the diagnosis, care, and treatment of the child with gastroesophageal reflux. 176 48

Bilateral hypoplasia of the soft palate and aspiration pneumonia occurred in a Standardbred foal. The filly was presented with a history of illthrift, dyspnoea, coughing and bilateral nasal discharge. Abnormal sounds (crackels and wheezes) were auscultated over all lung fields and the cervical trachea. Endoscopy revealed a shortened soft palate with a uvula-like mass protruding from the free border into the nasopharynx. Mucopurulent material was present in the trachea. Samples obtained by tracheal wash were submitted for cytology, culture and sensitivity testing. Results indicated a septic inflammatory process. On lateral radiographs of the thorax there were patchy areas of consolidation and air bronchograms. The foal was euthanased. Necropsy confirmed the presence of a palatal defect and aspiration pneumonia of moderate severity. No other congenital abnormalities were present.
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PMID:Bilateral hypoplasia of the soft palate in a foal. 188 97


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