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

We examined the response to the laryngeal mask (LM) compared to the endotracheal tube (ETT) in patients undergoing ambulatory anesthesia. The differences in management by the anesthesiologists for these two airways were also examined. Peripheral orthopedic procedures were studied in 44 outpatients randomized to receive a LM or ETT, and either spontaneous or controlled ventilation. Anesthesia was induced with propofol and succinylcholine intravenously (i.v.) and maintained with N2O and isoflurane. Anesthesiologists were allowed to determine ventilatory variables and anesthetic concentration. Hemodynamic and ventilatory measurements were made during the anesthesia. Barium sulfate was poured into the oropharynx after the airway was secure. Fiberoptic examination through the LM was performed at the beginning and at the end of the administration of each anesthetic. Radiographs were taken at the end of the anesthetic administration before LM or ETT removal to look for barium in the trachea. After airway removal, presence of blood on the airway, sore throat, coughing, nausea, vomiting, shivering, and amount of morphine demanded during recovery were noted. No barium in the trachea or bronchial tree was seen in any of the radiographs. The ETT was associated with greater hemodynamic response not only to airway placement (P < 0.05), but also to surgical incision (P < 0.05) and airway removal (P < 0.05). Spontaneous or controlled ventilation favored neither airway, although the ETT was associated with increased work of inspiration with controlled ventilation (P < 0.05). Anesthesiologists tended to elect smaller tidal volumes, faster ventilation rates, and lower anesthetic concentrations for patients with the LM (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prospective comparison of use of the laryngeal mask and endotracheal tube for ambulatory surgery. 976 7

Gastroesophageal reflux (GER) may be normal, functional, or pathogenic. Normal GER is of short duration and seen in all individuals. Functional GER, or effortless regurgitation, is common during infancy, causing no ill effects. Pathogenic GER causes diseases such as failure-to-thrive, coughing, choking, aspiration, apnea and/or bradycardia, esophagitis with irritability and excessive crying. Clinically it becomes imperative to distinguish normal and functional from pathogenic GER. The tests presently employed to detect GER are roentgenogram of the upper gastrointestinal tract (showing barium GER), scintigraphy of the esophagus after ingestion of a 99mTc labeled meal (indicating meal GER) and prolonged pH probe monitoring the lower esophagus (depicting acid GER). There seems to be a controversy regarding the usefulness of these tests for the diagnosis of pathogenic GER. In the present study of 89 infants and children presenting with signs and symptoms of pathogenic GER, 70% had significant acid GER, while 36% and 17% had barium and meal GER respectively. No statistically significant correlations were detected between acid GER, barium GER, and meal GER. We conclude that these three tests probably represent different phenomena, and that prolonged esophageal pH monitoring should be considered the most reliable and gold standard for detection of pathogenic GER.
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PMID:Diagnosis of gastroesophageal reflux in pediatrics. 802 39

A 69-year-old female was admitted for the evaluation of chronic persistent cough of about six week duration which was particularly worse at night and did not respond to antibiotics or cough medicines. She did not smoke and had no history of allergies or abnormal inhalations. Eosinophil counts, serum IgE, CRP, titers of cold hemagglutinin (CHA), and antibody to mycoplasma were all within normal ranges. Chest X-ray films and respiratory function tests showed no abnormalities. Because of her complaint of mild heartburn, gastroesophageal reflux (GER) was thought to be a possible cause of her chronic cough. Upper gastrointestinal X-ray films revealed barium reflux up to the cervical esophagus, and gastrointestinal fiberoscopy showed reflux esophagitis. Bronchial biopsy specimens taken by fiberoptic bronchoscopy showed chronic inflammatory changes of bronchial mucosa with focal squamous metaplasia, mucosal basement membrane thickening, and lymphocytic infiltration in the submucosa. She made favorable progress following treatment with a histamine H2 blocker and cisapride for six weeks. She met Irwin's criteria and we concluded that her cough was caused by GER. We speculate that repeated tracheobronchial microaspirations of refluxed gastric acid may cause chronic inflammatory changes of the bronchial mucosa resulting in persistent cough.
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PMID:[A case of chronic persistent cough caused by gastroesophageal reflux]. 827 65

Oral feeding of children with severe dysphagia and multiple disabilities may result in hypoxemia. Pulse oximetry was used to monitor hemoglobin saturation (SpO2) during oral feeding of five children with multiple disabilities who were referred because of food refusal or coughing and fatigue during feeding. Modified barium videofluoroscopic swallow studies demonstrated deglutition abnormalities. SpO2 values were within the normal range at rest, but routine, upright oral feeding resulted in significant degrees of hypoxemia. The pharyngeal stage of deglutition was abnormal in all five children. In three, the periods of hypoxemia were dependent on food texture. Awareness of meal-time hypoxemia contributed to the decision to use gastrostomy-tube feedings for the other two children. Pulse oximetry during oral feeding should be considered for all children with severe dysphagia and multiple disabilities.
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PMID:Hypoxemia during oral feeding of children with severe cerebral palsy. 844 78

Two infants with intractable wheezing and moist cough were referred to Chiba Municipal Kaihin Hospital. Their symptoms were persistent even after the usual treatment for respiratory disease. No definite etiological agents were detected. They usually gagged while feeding and barium swallow tests revealed nasopharyngeal reflux and cricopharyngeal incoordination. One of the patients had remarkably high titers of IgE and IgE RAST of cow's milk before she received treatment with thickened formula. She also had peripheral eosinophilia and nasal eosinophilia. These findings were thought to be caused by nasopharyngeal reflux. Four months after therapy commenced, those titers and symptoms were greatly reduced. The clinical and roentgenographic findings in these infants, and their response to therapy, strongly support a causal relationship between nasopharyngeal reflux and wheezing. Therefore, nasopharyngeal reflux should be considered when a baby has intractable wheezing, even when there is no developmental problem.
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PMID:Intractable wheezing in infants with nasopharyngeal reflux. 884 May 45

Four patients with developmental foregut cysts were seen in the Singapore General Hospital between 1991 and 1994. Three had bronchogenic cysts while one had features consistent with both enteric and bronchogenic origin. Among those patients with bronchogenic cysts, only one was symptomatic, having presented with cough and dysphagia. Two other patients presented incidentally on chest radiographs done for pre-National Service enlistment while one patient was picked up when a repeat chest radiograph was done following a course of antibiotics. The diagnosis of our first patient with the symptomatic bronchogenic cyst was based on barium swallow and a computerised tomographic scan of the thorax. Two patients were diagnosed on histology following open thoracotomy and surgical resection of the cysts to have a bronchogenic and a cyst of mixed origin as described above respectively. The last patient who underwent video-assisted thoracoscopic surgery with resection of the cyst was confirmed histologically to have a bronchogenic cyst.
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PMID:Four cases of developmental foregut cysts. 892 26

A 52-year-old woman was admitted to our hospital because of repeated episodes of pneumonia in the middle lobe. She had also experienced coughing during meals. The history and chest CT findings suggested the presence of a bronchoesophageal fistula. An upper GI series revealed a fistula between an esophageal diverticulum and the superior segment bronchus of the right lower lobe. Fiberoptic bronchoscopy done immediately after the upper GI series revealed barium sulfate leaking from the superior segment bronchus of the right lower lobe into the middle lobe bronchus. These findings indicated that the repeated pneumonia in the middle lobe was caused by a congenital bronchoesophageal fistula. Examination of the resected fistula showed that it was a Braimbridge type I bronchoesophageal fistula. Although of at least 49 cases of congenital bronchoesophageal fistulas with esophageal diverticula have been reported in the Japanese medical literature, we know of no previous case in which such a fistula was associated with middle-lobe pneumonia.
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PMID:[Repeated pneumonia in the middle lobe caused by congenital bronchoesophageal fistula]. 902 27

The role of videofluoroscopy with the modified barium swallow in the assessment and management of motor neurone disease (MND) is discussed. Nine patients (age range 40-82) with dysphagia secondary to MND were assessed over a four-year period. The examinations were carried out by a multiprofessional team of radiologist, speech and language therapist and dietitian assessing the preoral, oral and pharyngeal phases of swallowing. Preoral feeding abnormalities were present in four out of nine patients, oral phase abnormalities in eight out of nine patients, while 33% of patients demonstrated abnormality in all three phases. Where aspiration occurred (four out of nine cases), no cough reflex was noted. On the basis of these examinations management changes were introduced in all patients. Nonoral feeding was continued or introduced in three patients. Videofluoroscopic examination with the modified barium swallow may be helpful in planning suitable feeding regimes for dysphagia in MND.
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PMID:Videofluoroscopic evaluation of dysphagia in motor neurone disease with modified barium swallow. 906 84

Congenital bronchoesophageal fistula is a rare clinical entity in adults. This anomaly may cause various symptoms such as respiratory infections, coughing bouts when eating or drinking, and even hemoptysis. The fistula can cause symptoms in childhood but may not appear until adulthood. We recently experienced a case of congenital bronchoesophageal fistula associated with esophageal diverticulum in an adult. A 63-year-old woman was admitted to our hospital due to chest discomfort, sore throat and coughing bouts when eating. An empyema with lung abscess had occurred eight years previously. Results of the physical examination were unremarkable. A Barium swallowing revealed a medium-sized diverticulum at the right anterior aspect of the esophagus, which had developed a fistulous connection with the right lower lobe bronchus. The patient was treated by fistulectomy and lobectomy of the right lower lobe. The postoperative course was smooth and uneventful.
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PMID:Congenital bronchoesophageal fistula associated with esophageal diverticulum in the adult. 933 35

Chronic cough is a common problem in patients who visit family physicians. The three most common causes of chronic cough in those who are referred to pulmonary specialists are postnasal drip, asthma and gastroesophageal reflux. The initial treatment of patients with cough is often empiric and may involve a trial of decongestants, bronchodilators or histamine H2 antagonists, as monotherapy or in combination. If a therapeutic trial is not successful, sequential diagnostic testing including chest radiograph, purified protein derivative test for tuberculosis, computed tomography of the sinuses, methacholine challenge test or barium swallow may be indicated. By using a standard protocol for diagnosis and treatment, 90 percent of patients with chronic cough can be managed successfully in the family physician's office. However, in some cases it may take three to five months to determine a diagnosis and effective treatment. For the minority of patients in whom this diagnostic approach is unsuccessful, consultation with a pulmonary specialist is appropriate.
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PMID:An office approach to the diagnosis of chronic cough. 986 76


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