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

A survey of neurosurgeons and neurologists assessed physician practices in the declaration of brain death. Ninety-four per cent of the respondents thought that the diagnosis of brain death was legitimate; most thought that it was justified by a failure of somatic survival after brain death. Fifty-four per cent of the respondents had made the diagnosis themselves 1 to 5 times a year. The criteria used to make the diagnosis varied significantly among the respondents. Most required the absence of a pupillary reflex (88%), the absence of a corneal reflex (85%), a lack of ventilatory effort with disconnection of the ventilator (84%), and the absence of eye movements with head turning (80%). Fewer required an absent cough reflex (61%) or gag reflex (69%), dilated pupils (59%), a body temperature under 90 degrees F (56%), or a blood barbiturate level of zero (43%). Over 65% required an isoelectric electroencephalogram; 29% required only one, and 36% required two electroencephalograms 24 hours apart. Twenty-six per cent required absent deep tendon reflexes. The time required for the declaration varied from 6 to 24 hours. There was wide variation in the response to a hypothetical situation in which the family of a patient fulfilling brain death criteria did not want death to be declared. Seventy-eight per cent of the respondents would continue ventilatory support, although about a third of these would declare the patient dead while doing so. Only 6% would stop the ventilator despite the family's wishes. These results substantiate a wide variation in the actions of neurologists and neurosurgeons in brain death declaration. This has important implications for decisions about death in neurology and neurosurgery.
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PMID:Declaration of brain death in neurosurgical and neurological practice. 648 33

Of 33 patients with psychogenic cough tic, 31 were successfully treated using an unusual reinforced suggestion technique. The cough usually follows an incidental upper respiratory tract infection and persists as a loud paroxysmal barking or honking sound for weeks to months. Paroxysms occur all day but cease with sleep. The diagnosis is often delayed for weeks to months while the patient is exposed to an increasing intensity of diagnostic procedures and therapy. Thirty percent of some 20 patients previously reported in the literature had been hospitalized. The reinforced suggestion technique depends upon the physician's convincing the patient that the persistent cough has weakened the chest muscles, which are now unable to contain the cough, and that a bedsheet tightly wrapped around the chest will provide the necessary support to stop the cough within 24 to 48 hours. The typical patient can produce the cough on command, has an ambivalent response to the prospect of care, is unconcerned about his symptoms, submits willingly to the examination and procedures, and is kept out of school for the duration of the cough. Findings on physical examination are normal except for abnormal gag and corneal reflexes. The gag reflex was depressed in six and absent in 20 of the 31 patients. The corneal reflex was depressed in 16 and absent in 5 of the 31 patients. These abnormal responses help to corroborate the psychogenic etiology. Early recognition of the nonorganic nature of this syndrome will reduce parental anxiety, loss of school time, risk of iatrogenic complications, and unnecessary medical and hospital expense.
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PMID:The cough and the bedsheet. 673 3

Fifteen patients with pharyngeal stage dysphagia were studied clinically and by motion fluoroscopy. Eleven patients demonstrated laryngeal penetration during swallowing. There was high incidence of impaired pharyngeal gag and wet-hoarse voice quality among this group. Other observations were found to correlate poorly with penetration. Cough was an unreliable indicator of laryngeal penetration. Penetration was most likely when liquids were swallowed and least likely when semisolids were swallowed. Motion fluoroscopy of swallowing was necessary for detecting penetration reliably, identifying that dysphagia depends, in part, on bolus qualities, and planning a feeding approach consistent with remaining swallowing functions.
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PMID:Dysphagia: predicting laryngeal penetration. 686 Jan

An immunocompetent 12-year-old boy developed multiple microaerophilic streptococcal lung abscesses after application of orthodontic bands ("braces"). The dental work was done in the supine position. The data suggest that the patient aspirated the organisms and, possibly, flecks of dental cement, during orthodontic treatment. "Rubber dams" should be used to help prevent aspiration in children who receive dental work in the supine position. When a rubber dam cannot be used, as with orthodontic treatment, physicians should advise patients who are at risk for developing pulmonary infection (eg, patients with neuromuscular diseases which compromise cough and/or gag, cystic fibrosis, sickle cell anemia, primary immunodeficiency, etc) to have this dental work, including orthodontic treatment, performed in the erect position.
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PMID:Multiple microaerophilic streptococcal lung abscesses after orthodontic treatment. 713 23

To determine whether anaesthesia of the intrathoracic airways would attenuate the development of exercise-induced asthma, we studied eight symptomless asthmatic patients by cycle ergometry after saline or lignocaine pretreatment while they were breathing air at 24 degrees C with 9.1 mg of H2O/l. Pulmonary mechanics were measured before and after the administration of each agent, and again five minutes after cessation of exercise. Sufficient lignocaine was administered to abolish the gag reflex and the cough response to aerosols of citric acid. Before exercise there were no significant differences for any lung function variable between the saline and lignocaine results. Equally, there were no significant differences between these agents for minute ventilation (VE) during exercise (VE lignocaine = 71.0 +/- 7.4 (SEM) l/min; VE saline 67.2 +/- 8.1 l/min;), or in the severity of the subsequent bronchospastic response (for example, the FEV1 with saline was 22.6 +/- 2.9% decrease, and with lignocaine 23.6 +/- 8.5%). Thus these results do not support the idea that there are thermally sensitive neural receptors in intrathoracic airways that play a role in the pathogenesis of exercise-induced asthma.
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PMID:Controlled-analysis of the effects of inhaled lignocaine in exercise-induced asthma. 715 12

An aerosol of 4% lidocaine was delivered during the last third of inspiration to patients with bronchial asthma while they were quietly breathing. After this procedure, both cough reflex (inhalation of 10% citric acid) and gag reflex (mechanical irritation of the larynx) were absent in all patients for 15 to 20 min. This type of anesthesia was tolerated well by all patients, and did not significantly influence baseline pulmonary function tests. On another day, this procedure was used prior to treadmill exercise testing. Anesthesia blocked the development of exercise-induced bronchoconstriction (EIB) after the exercise period, as measured by FEV1, FEF25-75%, Vmax70% TLC, and specific airway conductance (SGaw). It was also found that the degree of minute ventilation (VE), as measured during exercise with airway anesthesia, significantly decreased (p < 0.01) compared with VE measured during exercise without lidocaine. The results suggested that local anesthesia of the upper and large airways in patients with bronchial asthma can significantly inhibit EIB and significantly decrease VE during moderate exercise. It can be postulated that mucosal receptors in the upper and large airways are directly involved in the initiation of EIB, and that their stimulation may be responsible for increased ventilation during exercise.
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PMID:Effect of lidocaine on the ventilatory and airway responses to exercise in asthmatics. 745 56

1. Although many adult ocular procedures may be done equally well under local or general anesthesia, with children, the anesthesiologist almost always has to administer general anesthesia to guarantee satisfactory surgical conditions. 2. Patient preparation includes parental understanding of the procedure, the anesthetic and its implications, and the care of the postoperative child. In general, anesthetic induction is accomplished in an age-appropriate fashion. 3. Basic discharge criteria include the following: Vital signs should be stable and normal; there should be no signs of respiratory distress; mental status should be age-appropriate and back to baseline; the patient should demonstrate the ability to either swallow fluids, cough, or have an intact gag reflex; the patient should be able to ambulate, if age-appropriate and baseline; and the patient always must have a responsible, well-informed escort home. engaging and diverting; have a collection of stories or songs ready.
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PMID:Anesthetic considerations for pediatric ophthalmologic surgery. 757 Jul 99

1. Although many adult ocular procedures may be done equally well under local or general anesthesia, with children, the anesthesiologist almost always has to administer general anesthesia to guarantee satisfactory surgical conditions. 2. Patient preparation includes parental understanding of the procedure, the anesthetic and its implications, and the care of the postoperative child. In general, anesthetic induction is accomplished in an age-appropriate fashion. 3. Basic discharge criteria include the following: Vital signs should be stable and normal; there should be no signs of respiratory distress; mental status should be age-appropriate and back to baseline; the patient should demonstrate the ability to either swallow fluids, cough, or have an intact gag reflex; the patient should be able to ambulate, if age-appropriate and baseline; and the patient always must have a responsible, well-informed escort home.
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PMID:Anesthetic considerations for pediatric ophthalmologic surgery. 761 82

To identify behaviors associated with the onset of gastroesophageal reflux episodes in infants both systematically and prospectively, each of 10 patients (aged 2 to 32 weeks) was studied during 2 hours of intraluminal esophageal pH probe monitoring, using a split-screen audiovisual recording technique. Videotape analysis of eight infants who had scoreable reflux events revealed six discrete behaviors closely associated temporally (P < .001 to < .05) with the onset of reflux events: "discomfort" (crying or frowning), "emission" (of liquid or gas, i.e., regurgitation, drooling, or burping), yawning, stridor, stretching, and mouthing. Three behaviors (hiccuping, sneezing, and thumb-sucking) were infrequent but were significantly associated with onset of reflux events in one or two patients each. A tenth behavior, coughing or gagging, was significantly associated with onset of reflux events in two patients, but not in the rest, despite relatively frequent occurrence. Exploration of temporal relations between reflux and each behavior suggested that discomfort, emission, mouthing, and cough-gag may have caused reflux episodes, and that all 10 of the behaviors may have been caused by reflux episodes. These findings and a "quiet period" immediately preceding episodes in six of the infants suggest interesting pathophysiologic mechanisms in infants which require further evaluation.
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PMID:Behaviors associated with onset of gastroesophageal reflux episodes in infants. Prospective study using split-screen video and pH probe. 785 24

In early phases of neuromuscular disease, patients are either free of respiratory symptoms or have exertional dyspnea not explained by obvious obstructive or restrictive lung disease. Physical examination may be negative because generalized muscle weakness does not correlate with the degree of respiratory muscle involvement. When the diaphragm is involved, one may detect the absence of outward excursion during inspiration or even paradoxic inward inspiratory movement of the abdomen on one side. A substantial loss of respiratory muscle strength is typically accompanied by little or no change in spirometry or arterial blood gas composition. Other characteristics are moderate loss of maximal voluntary ventilation and an increase in residual volume, yet PImax and PEmax may be as low as 50% of the predicted value. In more advanced neuromuscular disease, patients may have severe symptoms if the onset is acute or subacute; however, patients with chronic advanced generalized muscle weakness do not exercise and, therefore, may not be breathless. Many patients with advanced neuromuscular disease present with daytime somnolence as a manifestation of a sleep-related breathing disorder. Physical examination may reveal generalized muscle weakness and difficulty with speech or swallowing. Signs specific to respiratory involvement include tachypnea, use of neck inspiratory muscles and abdominal expiratory muscles, and loss of chest-abdomen synchrony. Sometimes paradoxic bilateral inward movement of the abdomen with inspiration is overt. Patients may be unable to cough effectively, have scoliosis, and lack a gag reflex. At this advanced stage, PImax and PEmax are lower than 50% of the predicted value, and the vital capacity is reduced. Maximal voluntary ventilation increases, and residual volume increases further. Patients may not yet exhibit CO2 retention during the day and may even have a low PaCO3. A sleep study may reveal significant hypopneas with severe desaturation and hypercapnia, especially during REM sleep. It is important to be aware that overt ventilatory failure can occur abruptly and that measurement of arterial blood gas composition is not a reliable indicator of this danger. Therefore, it is critically important to heed clinical phenomena, such as increasing dyspnea and tachypnea, and symptoms of sleep disturbance, such as morning headache and daytime somnolence. Physicians should make serial measurements of VC and respiratory muscle strength in patients considered to be at risk for further deterioration.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Assessment of ventilatory function in patients with neuromuscular disease. 786 89


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