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

This six-center, retrospective study evaluated the effectiveness, tolerability, and safety of vagus nerve stimulation in children. Data were available for 125 patients at baseline, 95 patients at 3 months, 56 patients at 6 months, and 12 patients at 12 months. The typical patient, aged 12 years, had onset of seizures at age 2 years and had tried nine anticonvulsants before implantation. Collected data included preimplant history, seizures, implant, device settings, quality of life, and adverse events. Average seizure reduction was 36.1% at 3 months and 44.7% at 6 months. Common adverse events included voice alteration and coughing during stimulation. Rare adverse events, unique to this age group, included increased drooling and increased hyperactivity. Quality of life improved in alertness, verbal communication, school performance, clustering of seizures, and postictal periods. We concluded that vagus nerve stimulation is an effective treatment for medically refractory epilepsy in children.
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PMID:Vagus nerve stimulation therapy in pediatric patients with refractory epilepsy: retrospective study. 1173 71

OBJECTIVE: To present current concepts on diagnosis and treatment of upper airway obstruction, mainly related to differential diagnosis between acute viral laryngotracheobronchitis and epiglottitis.METHODS: Bibliographic review covering the last ten years, using both Medline system and direct research. The most relevant articles published about the subject were selected.RESULTS: Viral laryngotracheobronchitis is an acute self-limited disease of the upper airway in a child, clinically characterized by barking cough, stridor, hoarse voice, and upper respiratory symptoms. The disease is diagnosed by clinical signs and symptoms. Rarely, if no immediate airway management is needed, radiography of the neck may help to exclude other entities that cause laryngeal obstruction. In contrast to viral laryngotracheobronchitis, epiglottitis is characterized by inflammation of the supraglottic tissues and is caused mainly by Haemophilus influenzae type b. A previously healthy child suddenly develops a sore throat and fever. Within hours after the onset of symptoms the patient looks toxic, swallowing is painful and breathing is difficult. Drooling and cervical hyperextension are frequently present. Lateral neck radiograph is rarely required to the diagnosis and may delay appropriate management of the airway. Moderate viral laryngotracheobronchitis with stridor at rest and retractions should be treated with steroids (systemic or nebulized) and nebulized epinephrine. Severe viral laryngotracheobronchitis should be treated aggressively while arregements are made for endotracheal intubation. The diagnosis of epiglottitis requires immediate endotracheal intubation in the appropriate unit (emergency department, intensive care unit or surgical unit) and antimicrobial therapy. Alternatively at some medical centers children with severe upper airway obstruction have been treated with a mixture of helium and oxygen (70 to 80% concentration of helium) instead of room air or pure oxygen to avoid intubation.CONCLUSIONS: There are different levels of care for patients with upper airway obstruction, depending on their clinical presentation. The clinical manifestations of viral laryngotracheobronchitis may be confused with the presentation of epiglottitis. Despite this observation we believe that differential diagnosis between viral laryngotracheobronchitis and epiglottitis rests on clinical grounds.
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PMID:[Clinical management of upper airway obstruction: epiglottitis and laryngotracheobronchitis] 1468 64

Patients with cerebral palsy (CP) frequently manifest oral-ingestive problems ranging from mild to severe. Drooling, rejection of solid foods, choking, coughing and spillage during eating may contribute to these problems. The aim of this study was to assess functional feeding skills of patients with CP, aged 4-25 years. They were assessed with the Modified Functional Feeding Assessment Scale (FFAm). Mothers had expressed concern regarding drooling and reluctance in accepting solid foods. None of the mothers thought that there was a major problem with adequate ingestion. However, the study revealed that patients had disabilities in spoon feeding, biting, chewing, cup drinking, straw drinking, swallowing and clearing.
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PMID:Assessment of feeding performance in patients with cerebral palsy. 1557 99

Patients given a more soluble inhaled anesthetic usually take longer to awaken from anesthesia than do patients given a less soluble anesthetic. In the present study, we tested whether such a delay in awakening was also associated with a delay in restoration of protective airway reflexes. Patients were randomly assigned to receive desflurane (n = 31) or sevoflurane (n = 33) via a laryngeal mask airway. Demographics did not differ between groups. The average minimum alveolar anesthetic concentration fraction for both groups was 0.62, and the mean (+/-sd) minimum alveolar anesthetic concentration hours was 1.00 +/- 0.68 for desflurane versus 0.95 +/- 0.57 for sevoflurane, although more patients given sevoflurane also received regional anesthesia (17 for sevoflurane and 8 for desflurane). The time from stopping anesthetic administration to appropriate response to command was longer after sevoflurane (5.5 +/- 3.1 versus 3.4 +/- 1.9 min; P < 0.01). In addition, the time from first response to command to ability to swallow 20 mL of water without coughing or drooling was longer after sevoflurane. At 2 min after responding to command, all patients given desflurane were able to swallow without coughing or drooling, whereas 55% of patients given sevoflurane coughed and/or drooled (P < 0.001). At 6 min after responding to command, 18% of patients given sevoflurane still could not swallow without coughing or drooling (P < 0.05). We conclude that desflurane allows an earlier return of protective airway reflexes.
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PMID:Airway reflexes return more rapidly after desflurane anesthesia than after sevoflurane anesthesia. 1572 54

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

Swallowing is a complex motor event that is difficult to investigate in man. A slowed ability to eat a meal, loss of salivary control with drooling, episodic coughing, and choking and nasal regurgitation occurred due to the dysphagia. Swallowing disorders can be divided into oropharyngeal dysphagia and oesophageal dysphagia. The most common cause of oropharyngeal dysphagia is cerebrovascular accidents; other causes may include oropharyngeal structural lesions, systematic and local muscular diseases, and diverse neurologic disorders. Oesophageal dysphagia may result from neuromuscular disorders, mobility abnormalities, and intrinsic or extrinsic obstructive lesions. Initial evaluation of patients with suspected oropharyngeal dysphagia includes patient history, laryngological and neurological examination, and careful videofluoroscopic study of pharyngeal dynamics. Initial evaluation of patients with suspected oesophageal dysphagia includes patient history and barium swallow with oesophagography. Classifying dysphagia as oropharyngeal, oesophageal and obstructive, or neuromuscular symptom complexes leads to a successful diagnosis in 80% of patients.
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PMID:[The laryngological and neurological aspects of dysphagia]. 1696 13

The vagus nerve stimulator has become a standard modality for intractable pediatric epilepsy. We reviewed our experience with major adverse events, after accidental puncture of a stimulator wire by an emergency room physician seeking intravenous access to treat status epilepticus. The Children's National Medical Center database was reviewed for patients undergoing vagus nerve stimulator placement between January 1988 and June 2006. Patient characteristics, duration of therapy, and treatment-limiting adverse events were noted. Of 62 patients implanted over 8 years, 22 (35%) had adverse events which led to a change in therapy. Adverse events included prominent drooling, coughing, throat discomfort, dysphagia, wound infection, difficulty breathing, vomiting, vocal-cord weakness, lead failure, and iatrogenic (piercing of wire; surgical clipping of wire during revision). Eight patients required nonroutine surgical intervention (13%). There were two unusual case presentations. In a 13-year-old boy with status epilepticus at an outlying emergency department, the stimulator line was pierced in search of intravenous access. In a 25-year-old housepainter, neck paresthesias upon right lateral neck turning were attributed to insufficient strain relief. Treatment-limiting adverse events occurred in approximately one-third of patients. Unanticipated adverse events included misidentification of the wire for intravenous access, clipping of the wire during surgical dissection, and cervical dysesthesias associated with head-turning.
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PMID:Misidentification of vagus nerve stimulator for intravenous access and other major adverse events. 1835 2

Toddlers with Chiari malformations can present with common symptoms, such as cough or drooling, which are associated with respiratory illnesses, delaying a correct diagnosis. Presentation does vary with age, and therefore can be different in older children when compared to infants. We present two cases of unusual presentations in toddlers and review the literature with an emphasis on acute presentation of Chiari in different age groups in children.
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PMID:Unusual presentation of Chiari I in toddlers: case reports and review of the literature. 2266 Nov 47

The purpose of this review is to assess the current state of the literature on the topic of deep brain stimulation (DBS) and its effects on swallowing function in Parkinson's disease (PD). Pubmed, Cochrane review, and web of science searches were completed on all articles addressing DBS that contained a swallowing outcome measure. Outcome measures included the penetration/aspiration scale, pharyngeal transit time, oropharyngeal residue, drooling, aspiration pneumonia, death, hyolaryngeal excursion, epiglottic inversion, UPDRS scores, and presence of coughing/throat clearing during meals. The search identified 13 studies specifically addressing the effects of DBS on swallowing. Critical assessment of the 13 identified peer-reviewed publications revealed nine studies employing an experimental design, (e.g. "on" vs. "off", pre- vs. post-DBS) and four case reports. None of the nine experimental studies were found to identify clinically significant improvement or decline in swallowing function with DBS. Despite these findings, several common threads were identified across experimental studies and will be examined in this review. Additionally, available data demonstrate that, although subthalamic nucleus (STN) stimulation has been considered to cause more impairment to swallowing function than globus pallidus internus (GPi) stimulation, there are no experimental studies directly comparing swallowing function in STN vs. GPi. Moreover, there has been no comparison of unilateral vs. bilateral DBS surgery and the coincident effects on swallowing function. This review includes a critical analysis of all experimental studies and discusses methodological issues that should be addressed in future studies.
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PMID:Swallowing and deep brain stimulation in Parkinson's disease: a systematic review. 2372 61

Oropharyngeal dysphagia is a rather frequent clinical entity in patients with neurological problems that can lead to serious complications such as aspiration pneumonia and other disorders like dehydration or malnutrition due to feeding difficulties. It should be suspected in children with splitting of food intake or prolonged feeding, coughing or choking during feeding, continuous drooling or repeated respiratory symptoms. For the diagnosis, apart from the examination of swallowing, additional tests can be run like the water-swallowing test, the viscosity-volume test (which determines what kind of texture and how much volume the patient is able to tolerate), a fiberoptic endoscopy of swallowing or a videofluoroscopic swallow study, which is the gold standard for the study of swallowing disorders.It requires a multidisciplinary approach to guarantee an adequate intake of fluids and nutrients with minimal risk of aspiration. If these two conditions cannot be met, a gastrostomy feeding may be necessary.
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PMID:Oropharyngeal dysphagia, an underestimated disorder in pediatrics. 2565 94


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