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

Utilizing a Doppler ultrasonic flowmeter catheter, right carotid artery blood velocity was measured during 91 coughing episodes in 16 patients. Such coughing reduced carotid blood velocity by 40 +/- 22% (control = 34 +/- 8 cm per second, cough = 20 +/- 9 cm per second, p less than 0.001). There was an insignificant low degree of corrleation between the level of simultaneously recorded mean right pressure and the percent decline of peak carotid blood velocity, suggesting that impaired venous return was not the only factor responsible for the observed changes. It is concluded that (1)coughing diminishes phasic carotid blood velocity and (2)reduced cerebral perfusion may play a role in the pathogenesis of cough syncope.
Stroke
PMID:Carotid blood velocity during cough studies in man. 96 Jan 64

Vertebral artery dissection has a characteristic presentation that should be considered when symptoms are preceded by any trauma that causes neck movement. We present the case of a man with vertebral artery dissection following severe coughing that presented as a postero-inferior cerebellar artery territory stroke. The patient was anti-coagulated, and his neurologic deficits were partially resolved. The mechanism and presentation of vertebral artery dissection are discussed with an emphasis on early detection.
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PMID:Vertebral artery dissection from neck flexion during paroxysmal coughing. 153 97

During a population survey in 1982-1983 among all community-dwelling elderly aged 65 years and over in East Boston, Massachusetts, measurements of peak expiratory flow rate using the mini-Wright peak flow meter were made on 3,582 participants (80% of those eligible). The average peak flow rate was 315 liters/minute, and a measure of peak flow rate adjusted for age, sex, height, and weight was computed. This was a highly significant (p less than 0.0001) predictor of 5-year total mortality, whose ascertainment was virtually complete. The relative risk was 1.27 (95 percent confidence interval 1.19-1.36) per 100 liters/minute decrease in peak flow rate, using a proportional hazards model including terms for age, sex, and smoking. There was no apparent modification of the effect of this measure in various categories of smoking, with relative risks of 1.24 for nonsmokers, 1.29 for ex-smokers, and 1.26 for current smokers. This finding also persisted after adjustments for other covariates, including respiratory symptoms such as cough, phlegm, and wheeze; cardiovascular risk factors such as history of myocardial infarction and stroke; and systolic and diastolic blood pressures; socioeconomic status; scores on simple tests of cognitive function; measures of physical activity and functional ability; and self-assessed state of health. In a stepwise model including all of these variables, the relative risk was 1.16 (p less than 0.0001) per 100 liters/minute decrease in peak flow rate, indicating that peak flow rate is a strong independent predictor of total mortality in the elderly.
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PMID:Peak expiratory flow rate and 5-year mortality in an elderly population. 202 Nov 45

Phenylpropanolamine (PPA) is contained in about 106 products, over half of which are available over-the-counter (OTC). Most are cough/cold remedies; nine are OTC diet aids. More than nine million Americans were using OTC diet aids in 1981, making PPA the fifth most used drug in the United States, responsible for over $200 million in revenues. The safety of PPA remains controversial. Although most controlled studies indicate minimal pressor effects with recommended doses, adverse drug reactions (ADRs) continue to be documented. Since 1965, 142 ADRs have been reported in 85 studies, 69% of these in North America. Many such cases may go unrecognized. About two thirds of all ADRs occurred in females and in patients under 30. Of ADRs attributed to legitimately sold PPA products, 85% occurred after consumption of OTC products versus only 15% after prescription drugs. The PPA product often contained combination ingredients, or PPA was consumed along with additional drugs. An overdose of PPA was taken in about a third of the cases. After ingestion of non-overdose amounts, 82% of the ADRs were severe. The most frequent side effects involved symptoms compatible with acute hypertension, with severe headache the most common complaint. Twenty-four intracranial hemorrhages, eight seizures, and eight deaths (most due to stroke) were associated with PPA ingestion. We have summarized these data in an effort to alert clinicians to the prevalence of usage of PPA products and the potential for adverse effects. In patients who present with elevated blood pressure or signs of acute hypertension, especially hypertensive encephalopathy of undetermined origin, we recommend inquiry about recent ingestion of PPA-containing diet aids and cough/cold products and suggest having such patients remain upright rather than supine.
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PMID:Adverse drug effects attributed to phenylpropanolamine: a review of 142 case reports. 220 Feb 64

Using both transthoracic and transesophageal echocardiography we studied 13 consecutive patients with recent CT-proven ischemic stroke in which a carotid arteries high-resolution ultrasound study failed to detect thrombosis or other relevant atherosclerotic lesions in the pertinent arteries. The mean age was 53 years (range: 36-65). Two patients exhibited clinical signs of cardiac disease at physical examination i.e. absolute arrhythmia, mitral stenosis. Conventional transthoracic echocardiography allowed the detection of potential cardiac sources of emboli in 2/13 patients (15.4%): mitral stenosis in one patient and dilated cardiomyopathy in another. Transesophageal echocardiography was successfully performed without general sedation in all patients. Potential cardiac sources of emboli could be identified in 12/13 patients (92%). Left atrial thrombi were found in 3 patients: in two of them they were associated with rheumatic alterations of mitral valve leaflets; in the third patient a small thrombus was located inside a normal-sized, poorly contracting left atrial appendage. Left atrial appendage could be clearly visualized in all patients. A myxoid degeneration of a prolapsing mitral leaflet was found in 3 patients and an interatrial septum aneurysm in 2. Furthermore, at color-flow Doppler and contrast transesophageal echocardiography, 7 patients (54%) showed patency of the foramen ovale. In 5 of these patients paradoxical right to left shunting after cough or Valsalva manoeuvre could be evidenced. With reference to 11/13 patients with no clinical signs of cardiac disease at physical examination, subclinical potential cardiac sources of emboli could be detected at conventional transthoracic echocardiography in 1 and at transesophageal echocardiography in 10 patients (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Transesophageal echocardiography in the definition of intracardiac sources of emboli in patients with recent ischemic stroke. 227 17

Over a six months' period we prospectively studied the prevalence of patent foramen ovale (PFO) in patients under 50 years of age admitted for cerebral infarction as assessed by cerebral computed tomography. The study recruited 16 patients (9 male, 7 female, mean age 39 +/- 10 years). Before the contrast study, 5 patients had other identifiable sources of stroke after neurologic investigations and 2-D echocardiography with color-Doppler, whereas 11 had no precise origin. The overall prevalence was 50% with 8 PFO demonstrated, 6 during normal breathing and two during a coughing test. All were in the sub-group of 11 patients without a predetermined source of stroke (prevalence 73%) and in 83% of patients aged under 40. In accordance with the literature, we found a high prevalence of PFO in the ischemic cerebral infarction population aged under 50 years and without another possible source of stroke; this prevalence is higher in patients under 40 years old. This observation confirms the suspicion of paradoxical embolism in these cases.
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PMID:[Patent foramen ovale and cerebral infarct in young patients]. 236 7

A population survey was conducted in 1982-1983 among 3,812 persons aged 65 years and older residing in East Boston, Massachusetts, a geographically defined urban community. Three measurements of peak expiratory flow rate were obtained by using calibrated mini-Wright meters. Peak expiratory flow rate was strongly related to age, sex, smoking, and years smoked. After adjustment for these factors, low peak expiratory flow rate was associated with chronic respiratory symptoms (cough, wheeze, shortness of breath, exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea; p less than 0.0001) and with certain cardiovascular variables (history of stroke, p = 0.0014; angina, p = 0.05; and high pulse rate, p = 0.004). No significant associations were found with history of myocardial infarction or systolic and diastolic blood pressures. Peak expiratory flow rate was positively related to education (p less than 0.0001) and income (p less than 0.0001). Peak expiratory flow rate also was strongly related (p less than 0.0001) to measures of functional ability and physical activity, self-assessment of health, and simple measures of cognitive function. The correlations of peak expiratory flow rate with pulmonary symptoms and other indices of chronic disease raise the possibility that peak expiratory flow rate will predict mortality in an elderly population.
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PMID:Peak expiratory flow rate in an elderly population. 278 11

Post-marketing surveillance in general practice represents an important part of the monitoring of adverse events associated with newly introduced drugs. Such a study of the angiotensin-converting enzyme inhibitor enalapril maleate has been undertaken in 11 710 patients with essential hypertension. Serious adverse events occurred in 1.7% of patients, though most of these were not thought to be related to the treatment. The incidence rates of death (0.09%), stroke (0.11%) and myocardial infarction (0.15%) were compatible with rates predicted from age, sex and blood pressure considerations. Other events reported were hypotension (0.3%), angioneurotic oedema (0.03%), rash (0.5%), taste disturbance (0.2%) and cough (1.0%). The degree of blood pressure reduction attained was similar to that previously reported from pre-marketing development studies, as was the overall nature and frequency of both serious and non-serious adverse events. The most frequently reported event during enalapril therapy was of an improvement in well-being (19.8%).
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PMID:Post-marketing surveillance of enalapril: experience in 11,710 hypertensive patients in general practice. 283 50

The study is a retrospective analysis of the clinical features of 122 patients from Finland, whose serum showed in immunoelectrophoresis (IEP) a cathodic elongation of the albumin line, "tailing albumin" (TA), not associated with an M-component. One hundred and seventeen of these cases were found among about 40,000 consecutive routine serum IEP examinations in two laboratories during 1967-1980. Five further cases were detected during the collection of the control series. Only a few TA cases of corresponding type have been reported from elsewhere. Previous studies of some of the patients of the present series had shown that the TA phenomenon was due to complexes between albumin and IgG class autoantibodies against albumin. Clinical data were collected mainly from the hospital records. The chest radiographic findings were classified by the ILO (International Labour Office) method. The author herself examined 33 of the patients during the current disease or during the follow-up. One hundred and ten patients were followed up for a period of three months to nine years (mean 2.5 years). The patients were mostly elderly, and 93% of them were women. Most of the patients had one or more previously diagnosed chronic illnesses, for which they were receiving one or several drugs as long-term therapy. Eighty percent of the patients were receiving nitrofurantoin (NF) as prophylaxis for recurrent urinary tract infections. However, urinary tract infection was not a current problem in any of the cases. There was evidence of a role of NF in the development of both the immunologic abnormalities and the clinical disease in the TA patients. On the basis of long-term NF treatment the patients were divided into two groups: 1) 97 patients with NF therapy (NF+ group) and 2) 25 patients without NF therapy (NF- group). The patients had mostly undergone the examinations because of cough, dyspnoea, and general symptoms (fatigue, weakness, malaise, loss of weight). The symptoms had usually started insidiously, and in 50% of the patients they had lasted for at least three months. Eight of the patients had been hospitalized because of various acute diseases (e.g. cerebral stroke). Ten of the patients were subjectively symptomless. The most common pathologic laboratory findings were high erythrocyte sedimentation rate (over 100 mm/h in 47%), IgG class antinuclear antibodies (in 88%; the titre was greater than or equal to 1000 in 56%), high serum IgG (mean 30.6 g/l), and elevated levels of serum aminotransferases (in 54% of the patients examined).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Immunoelectrophoretic tailing albumin phenomenon. Associations with clinical characteristics of the patients and with nitrofurantoin treatment. 320 74

Neurogenic dysphagia following stroke is not limited to brainstem involvement. Among 21 patients with stroke, one-third demonstrated only unilateral signs. In eight patients with silent aspiration, less subjective complaints, weaker cough, and dysphonia occurred more often. Videofluoroscopy must be used liberally in unilateral and bilateral strokes.
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PMID:Silent aspiration following stroke. 334 Mar 1


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