Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prognosis of inoperable or recurrent esophageal carcinoma is, at best, poor. Once an esophagotracheal fistula has developed, the overall condition of the patient declines rapidly. Aspiration pneumonia and severe coughing are common. The introduction of esophageal tubes does not always seal the fistula sufficiently and may compromise the airway causing stridor and dyspnea. In 30 patients (25 male, 5 female; age 23 to 74 years; mean, 56 years) with very large fistulas and airway problems, we inserted an airway stent (Dynamic) (n = 12) or an esophageal tube combined with a Dynamic airway stent (n = 18) with the aim of sealing the fistula and restoring patency of the airway and GI passage. The tracheobronchial Dynamic stent was chosen because its slightly concave, flexible posterior silicone membrane adapts ideally to the convex esophageal tube. The stents were well tolerated and significantly improved the quality of life. Of 30 patients, 16 could breathe and swallow unimpaired until shortly before their death. Moderate complaints persisted in five patients, dysphagia in eight patients, and dyspnea in one patient. Mean survival time in the double stent group was significantly greater (110 days) than in the airway stent-only group (24 days) or comparable groups in the literature treated with esophageal tubes only. We conclude that carefully selected patients can benefit from double stenting of esophagus and airways.
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PMID:Management of malignant esophagotracheal fistulas with airway stenting and double stenting. 891 5

The effects of cervical bracing on swallowing function have not been evaluated in neurologically intact individuals. An 83-year-old woman fell, striking her head, and suffered C1, odontoid, and C3 fractures. She had no neurologic deficits and was placed in a Minerva brace. Subsequently, she developed coughing during her meals, a low-grade fever, and transient hoarseness, and complained of stiffness in the facial muscles. Aspiration pneumonia in the left lower lobe was diagnosed. In the absence of any neurologic condition, this was attributed to the Minerva brace. Less than 1 week later, the brace was replaced with a halo-vest, and the dysphagia resolved. This case shows that dysphagia and aspiration pneumonia may be caused by wearing a cervical brace and illustrates the importance of assessing swallowing in individuals who wear such braces. Particular attention should be paid to swallowing and cervical bracing in patients with additional risk factors for dysphagia such as advanced age or neurologic deficits.
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PMID:Dysphagia complications of the Minerva brace. 942 97

Aspiration pneumonia is associated with decreases in both swallowing and cough reflexes and is the most common cause of death in the elderly. Basal ganglia strokes might predispose these patients to develop pneumonia owing to reductions of both reflexes, resulting in frequent aspiration during sleep. An impairment of dopamine metabolism in the basal ganglia is observed in these patients and levodopa administration improves the impaired swallowing reflex. Both swallowing and cough reflexes are mediated by endogenous substance P (SP) released from vagal sensory nerves in the pharynx and upper airways. The addition of a low dose of capsaicin to liquid or food, which stimulates the release of SP, may help prevent aspiration pneumonia. Angiotensin-converting enzyme inhibitor decreases SP catabolism resulting in improvements in both reflexes. Oral care and the sitting position after meals may decrease aspiration pneumonia in the elderly.
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PMID:New strategies for aspiration pneumonia. 947 37

The purpose of this investigation was to determine the overall prevalence of aspiration in dysphagic individuals referred for a modified barium swallow and the underlying anatomic and/or physiologic causes. A total of 166 patients were seen during a 1-month period at 5 participating institutions. Aspiration was detected in 51.2% of the patients. The most common causes were decreased laryngeal elevation and delayed triggering of the pharyngeal motor response. A history of aspiration pneumonia was significantly associated with the presence of aspiration on modified barium swallow study. The presence of a protective cough was present in only 53% of patients who aspirated, reinforcing the need for appropriate radiologic assessment in patients with suspected dysphagia.
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PMID:Aspiration: cause and implications. 1018 36

The main complication of enteral feeding in prolonged mechanical ventilation via tracheostomy is the subsequent aspiration pneumonia. We used a scintigraphic method for the detection of enteral feeding aspiration and compared the results with clinical evidence of aspiration. The study population consisted of 62 consecutive tracheotomised patients (16 females, age: 64.1 +/- 11.1 years). The swallowing test was done in an upright or semirecumbent body position with the patients spontaneously breathing. The standard feed consisted of a liquid, semiliquid and solid meal which was labelled by 100 MBQ 99 TC. Scintigraphic aspiration (SA) was defined as positive if radioactivity was detected in the bronchial system. Clinical aspiration (CA) was defined as positive if there was cough, choking and distress after swallowing; furthermore, when receiving enteral feeding during suctioning or bronchoscopy. Both clinically significant aspiration (CA) and scintigraphic aspiration (SA) were found to be identical in 10 of 62 (16%) patients. CA, but not SA: 4/62 (6.5%). SA, but not CA (Subclinical aspiration): 4/62 (6.5%). Nor CA neither SA: 44/62 (71%) patients. Radiolabelled feed can be used as a feasible marker to detect aspiration. The test is a useful screening test and strategy to minimize aspiration. The scintigraphic method failed to identify all tracheotomised patients with clinically significant aspiration. However, scintiscanning did suggest that some patients had subclinical aspiration.
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PMID:[Scintigraphic demonstration of aspiration in long-term ventilation patients with tracheotomy]. 1061 62

A 56-year-old woman came to our hospital with the symptoms of anorexia, body weight loss and sustained cough. Chest radiography showed diffuse, rounded, high-attenuation areas in both lung fields. The diagnosis was difficult, but, because of the symptoms and chest radiograph, we suspected miliary tuberculosis. Finally, we diagnosed her illness as achalasia with aspiration pneumonia, because we found a dilated esophagus and diffuse, rounded, high attenuation areas in chest CT scan films. Neither Mycobacterium tuberculosis nor tuberculous granulation was present in transbronchial lung biopsy specimens. Only inflammation was found in those slides. The gastrofiberscope was useful for searching for tumors, but not for diagnosing achalasia. Consequently, we identified the achalasia from the radiographic findings with the use of barium, but the patient's symptoms might not have led to that diagnosis because she was younger than the age range in which aspiration pneumonia usually occurs. The achalasia was treated with surgery rather than balloon dilation, since that was the patient's choice. Three months after surgery, her lungs had improved and body weight had increased by about 10 kg.
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PMID:[A case of recurrent aspiration pneumonia by achalasia]. 1197 71

Dysphagia is a common complication after stroke, being reported in 30-50% in acute stage patients. It is also critical that dysphagia may occur 3 to 5 days after onset because of brain edema, so clinicians must be careful to treat stroke patients with close observation. Especially elderly patients with dysphagia have a high risk of aspiration pneumonia, which might be life threatening condition for them. Dysphagia generally recovers spontaneously and frequency of the chronic stage cases is thought to be less 6%. The 30 ml water swallow test is used to screen dysphagia. If cough or some symptom of aspiration such as wet voice or breathing difficulties are seen, dysphagia is strongly suspected. Oral care is essential and diet modification and rehabilitation techniques are applied. Fiberoptic evaluation or fluoroscopic examination is recommended for severe dysphagia. The treatment plan should be established according to the pathological conditions. The goal of dysphagia management is to prevent aspiration pneumonia, dehydration and malnutrition. If swallowing difficulties continue, alternative nutrition. PEG or intermittent tube feeding, could be helpfull. Multidisciplinary team approach should be adopted for dysphagia management.
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PMID:[Evaluation and management of dysphagia after stroke]. 1270 45

In three patients, a 44-year-old schizophrenic woman and two men aged 54 and 42, who presented with dyspnoea, a pancreaticopleural fistula was diagnosed as a complication of pancreatitis, i.e. a fistulous tract between the pancreas and the pleural cavity. In general, these fistulas have a good prognosis; however, delay in finding the correct diagnosis influences the prognosis. This is often due to unfamiliarity with the disease and the non-specific presentation of patients with pleural effusion. The initial presentation usually comprises respiratory (dyspnoea, coughing due to pleural effusion) and occasional abdominal symptoms (epigastric pain). A definitive diagnosis is made when elevated pleural effusion amylase levels are demonstrated. Surgical treatment is only indicated if conservative or endoscopic treatment fails, and consists of resection of the fistula and drainage of the pancreatic duct via a lateral pancreaticojejunostomy or resection of the part of the pancreas where the fistula originates. In the first patient, surgical drainage of the fluid accumulation was applied, but she died of aspiration pneumonia after she had removed the feeding tube and had refused further treatment. Pancreatic resection resulted in recovery in the two men.
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PMID:[Pleural fluid in chronic pancreatitis]. 1290 43

Pneumonia is a common cause of death in elderly people. A series of our studies have demonstrated that pneumonia in the elderly is characterized by silent aspiration, impaired swallowing and cough reflex, partly due to cerebral infarctions at basal ganglia. These infarctions probably induce the disruption of the specific central neurotransmitter system including dopamine and substance P, which plays an important role for swallowing and cough reflex. Use of ACE inhibitor and stimulation of the oral cavity by simple oral care, which are effective in increasing substance P. reduced the incidence of aspiration pneumonia. Moreover, use of a dopamine agonist such as amantadine hydrochloride and a folic acid supplement that are known to potentiate dopaminergic neurons also prevented aspiration pneumonia. For patients bedridden due to lowered ADL, it is essential for them to keep an upright position a few hours after meals to prevent aspiration pneumonia caused by the reflux of ingested foods. Also, administration of neuroleptics may cause aspiration pneumonia by suppression of dopaminergic neurons.
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PMID:[Cerebrovascular disease and pneumonia in the elderly]. 1293 58

A 81-year-old man, who had been diagnosed in multiple cerebral infarction and Alzheimer's disease, was followed up in his local clinic since 1997. He had been bedridden before admission, but could eat. He was admitted with severe aspiration pneumonia in December 1999. Since severe dementia and dysphagia were noted after admission, he was examined to find out whether or not he could swallow while the treatment of his pneumonia was conducted at the same time. The water swallowing test indicated a risk of aspiration, thus, percutaneous endoscopic gastrostomy was performed on January 26, 2000 after the completion of the treatment for pneumonia. Although the patient's condition was complicated by aspiration pneumonia, enteral feeding through the gastric fistula gradually became successful, and he was discharged in June 2000. His family physician followed him up by visiting at home to examine and observe his general physical condition including consciousness, vital signs, skin and respiration, while taking measures in cooperation with the local health care visiting nurse. The patient, thereafter, was repeatedly admitted and discharged because of exacerbation and remission of symptoms, including coughing, sputum and fever, probably caused by aspiration pneumonia. When he was admitted in December 2001, which was his sixth admission, since there were troubles with the infusion tube and frequent gastroesophageal reflux, the gastric fistula management was judged to be a great burden on the patient. In January 2002, the gastrostomy tube was removed and the patients, whose alimentation was managed using intra-venous hyperalimentation (IVH), was discharged. Besides periodic visits by his family physician, a 24-hour house visit system was introduced to control his IVH and deal with his family members' anxiety. His general condition, thereafter, has not markedly changed. The patient has continuously received medical treatment for 14 months after being discharged and his condition is stable.
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PMID:[A case of serious aspiration pneumonia associated with multiple cerebral infarctions and Alzheimer's disease followed by hospital and home care service team]. 1468 57


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