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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1967 and 1987, 26 patients with bronchogenic cysts were treated in our institution: 15 females and 11 males, ranging in age from 2 months to 14 years (average 6 years, 4 months). Only four patients (15%) were 1 year old or less. Seven patients presented with asymptomatic lesions discovered on chest film. Nineteen patients presented with respiratory symptoms. Of note are the four patients aged 1 year or less, who presented with dyspnea and cyanotic spells. Only one of them presented with dysphagia. All patients underwent routine chest films and tomography and, later, computed tomography (CT) scan of the thorax once the study became available. Barium esophagogram and bronchoscopy were performed as required. Contrary to what has been published concerning the intraparenchymal location of bronchogenic cysts, the majority of the cysts (65%) were located in the mediastinum, usually in close proximity to the carina, mainstem bronchi, trachea, esophagus, or pericardium. Only 27% (7 of 26) were intraparenchymal, and 8% (2 of 26) were situated in the inferior pulmonary ligament. A correct preoperative diagnosis was made in 19 patients (73%). Intrapulmonary lesions were removed by segmentectomy or lobectomy. Cysts located elsewhere were simply excised. Among the cysts adhering to the trachea, 50% (two of four) required suture of the membranous trachea after excision. Postoperative complications included one pneumonia, which responded to antibiotics, and one transient paresis of the right phrenic nerve. Follow-up averaged 17 months (range, 0 to 17 years). No sequelae were noted and all patients were cured.
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PMID:Bronchogenic cysts. 280 73

Fifty-seven of 101 Nissen fundoplications during the 4-year period, July 1979 to July 1983, were performed on neurologically impaired children. Mean age at the time of surgery was 5.9 years (range 1 month to 22 years). Indications for operation included: persistent vomiting, 57 patients (100%); failure to thrive, 49 patients (86%); repeated episodes of pneumonia, 49 patients (86%); esophagitis, 18 patients (32%); hiatal hernia, 14 patients (25%); episodes of apnea, 10 patients (18%); and esophageal stricture, six patients (10%). Forty-six of the 57 patients had previously failed a standard trial of nonsurgical management. Gastroesophageal reflux was documented by barium esophagograms in 51/56 patients (91%), chalasia scans in 28/32 patients (88%), esophagitis or stricture at endoscopy in 21/23 patients (91%), and acid reflux on pH monitoring in 13/16 patients (80%). Operative management included gastrostomy in 55 of the 57 patients and this was permanent in 50. Gastrostomies had previously been performed in nine patients but had failed to provide a reliable method of enteral feeding because of chronic reflux and aspiration. The surgical complication rate was 12%. Intraoperative esophageal perforation occurred in two patients, splenic tear in one, hepatic vein laceration in one, and a tight wrap in one. After surgery, bowel obstruction from adhesions developed in one patient and a midgut volvulus in another. Five of the children have died, none from causes related to the surgical procedure. Clinical and radiologic follow-up evaluations of all survivors have been done, with a mean follow-up of 3 years. In four patients the repair was felt to be inadequate. One patient had an esophageal stricture and three had recurring episodes of pneumonia. Three children showed radiologic evidence of persistent reflux, but only two were symptomatic. Two patients required a second antireflux procedure for reflux and are now free of symptoms. Nissen fundoplication appears to be a safe and beneficial procedure in neurological impaired children. Long-term follow-up evaluation of these patients showed satisfactory growth as well as a significant decrease in pulmonary disease associated with aspiration.
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PMID:The effectiveness of Nissen fundoplication in neurologically impaired children with gastroesophageal reflux. 2325 71

Congenital tracheoesophageal fistula presents with clinical features of variable types and severity, including choking, coughing, and cyanosis with feeds, pneumonia, and abdominal distension. The rarity of the condition, its nonspecific symptomatology, and limitations in its demonstration by contrast radiology and endoscopy contribute to delays between first presentation and confirmation of the diagnosis. Recognition of symptom complexes and a high index of clinical suspicion should assist early diagnosis. In our experience with 30 infants with "H" fistula, an initial barium swallow demonstrated the fistula in 73%, and in all patients by the third attempt. Refinements in technique have shown contrast radiology to be satisfactory and safe in the initial investigation of infants with suspected congenital tracheoesophageal fistula and enables differentiation from other causes of aspiration.
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PMID:The diagnosis of congenital tracheoesophageal fistula. 337 46

Experimental and clinical data suggest that the valva ileocaecalis under neurogenic and hormonal influences, modulates antegrade and retrograde flow of succus entericus. A priori reasoning suggests that this function may influence nutrient absorption by and intraluminal endogenous microbial flora within the ileum. The hypothesis to be tested was, can anatomical and functional integrity of the valva ileocaecalis be preserved during the performance of a right hemicolectomy with reestablishment of intestinal continuity via a cecocolostomy? The methodology involved utilization of Lewis male rats weighing approximately 500 gm. General anesthesia was induced for all procedures. The animals were randomly assigned to three groups (10 animals/group): (A) sham operation; (B) pericecal dissection (preservation of the arteria et vena ileocolica); and (C) periileal dissection (ligation of the aforementioned vessels). Celiotomy was performed employing standard clean techniques, and was accompanied by a right hemicolectomy and an end-to-end or end-to-side cecocolostomy. Function of the heterotopic valva ileocaecalis was assessed 6-12 weeks post-operatively employing radiographic criteria (fluoroscopic analysis after intraluminal instillation of barium sulfate). Light microscopic analysis was performed subsequent to the radiographic studies. Periileal dissection associated with ligation of the arteria et vena ileocolica uniformly resulted in anastomotic disruption. Pericecal dissection associated with preservation of those vessels resulted in uniform anastomotic integrity, although two animals succumbed secondary to pneumonitis within 5 post-operative days. Radiographic analysis of the heterotopic valva ileocaecalis revealed intermittent antegrade and no retrograde flow of contrast material, which suggested functional integrity. Qualitative light microscopic analysis revealed architectural integrity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Valva ileocaecalis: preservation during ileocolonic surgery employing a rodent experimental model. 348 15

Diagnosis of esophageal-pleural fistulae may be difficult in the absence of mediastinitis. To determine the value of CT in establishing this diagnosis and in detecting mediastinal involvement, CT findings in seven patients with esophageal-pleural fistulae were studied retrospectively. The fistulae were secondary to surgery (five patients), esophageal dilatation (one patient), and esophageal carcinoma (one patient). CT findings included barium, air, and fluid in the pleural space and pneumonia. These abnormalities seemed to distinguish an esophageal fistula from other pathologic processes, such as aspiration pneumonia, lung abscess, spontaneous pneumothorax, pulmonary emboli, and bronchopleural fistulae, and they documented a lack of inflammatory reactions in the mediastinum associated with the fistula. The latter finding is important, because patients with esophageal-pleural fistulae without mediastinitis have a less severe clinical course and respond better to conservative treatment. CT is useful for patients with normal findings on esophagrams when suspicion of esophageal-pleural fistulae remains high and when satisfactory esophagrams cannot be obtained.
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PMID:CT of esophageal-pleural fistulae. 349 Jan 62

Respiratory tract disease was the main indication for surgery in 45 out of the 102 children operated upon for GER in the last 7 years: twenty-four had recurrent bronchitis and pneumonia, 18 had bronchitis with constriction (true asthma in 10), 2 had unbearable cough and 1 apnoeic crises. All had been medically treated before without success. The diagnosis of GER has been accepted only in patients with abnormal results in three or more of the following tests: barium swallow, extended pH-metering, manometry, endoscopy-biopsy and gastro-oesophageal scintigraphy. Nissen fundoplication cured GER in all cases, and its effect on respiratory tract disease after an average follow-up of 17 months (range 6 to 48) was rather encouraging: twenty-six children cured (57%), 9 improved (21%) and 10 remained unchanged (22%). Failures were more frequent in children with bronchoconstriction (45%) and in those without prior digestive symptoms (36%). Surgery is probably indicated more often in the treatment of respiratory tract diseases associated with GER in children than it was previously thought, but indications remain difficult and the results are uncertain in children with either asthma or bronchoconstriction.
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PMID:[Results of surgical treatment of gastroesophageal reflux with respiratory manifestations]. 360 85

A 3-year-old child with cricopharyngeal dysfunction is reported. Swallowing difficulties, nasal regurgitation, and gagging developed at 2 months of age. Repeated aspirations and over 40 episodes of pneumonia necessitating multiple hospitalizations occurred up to 2 years of age, along with pharyngeal pooling of saliva and inability to swallow solid food. Barium was held up at the cricopharyngeal level, and a prominent esophageal impression was seen at the same level. Symptoms were completely alleviated after two esophageal dilatations by mercury dilators, and the relief persisted for the 6 months of follow-up. The diagnosis of cricopharyngeal dysfunction is discussed, and the necessity for manometric studies, in the face of often misleading radiologic appearance, is emphasized. It is suggested that early use of esophageal dilatations might prevent prolonged morbidity and afford long-term symptomatic relief.
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PMID:Cricopharyngeal dysfunction in childhood: treatment by dilatations. 369 45

Two groups of newborns and infants with gastroesophageal reflux (GER) were retrospectively analyzed for the diagnostic accuracy and therapeutic guidance offered by extended intraesophageal pH monitoring. There were 28 patients in group I whose major presenting sign was recurrent pneumonia due to GER, and 22 patients in group II, with apnea caused by GER. The pH probe was 100% accurate in identifying the presence of GER. Barium esophagram was accurate 46% of the time. The pH probe accurately identified the appropriate mode of therapy in all patients. In the medically treated GER/Pneumonia group, the mean number of episodes of GER per 24 hours was 24, whereas in the surgical group the mean number was 63. Similarly, in the medically treated GER/Apnea group, the mean number of reflux episodes per 24 hours was 26, whereas the surgical group experienced 64. Had the pH probe been used to guide therapy, no patient would have been treated inappropriately. The number of patients in this report is not large. Prospective verification of these observations is required before this methodology can be utilized routinely in patients with GER.
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PMID:Gastroesophageal reflux. pH probe-directed therapy. 370 32

Thirty five severely mentally retarded children with significant gastro-esophageal reflux were submitted to surgical treatment. The age range was 2 months to 13 years. Characteristics and presenting symptoms were chronic vomiting (62%), merycism (43%), gastro-intestinal blood loss (37%), recurrent pneumonia (65%) and failure to thrive (57%). Barium esophagogram demonstrated free gastro-esophageal reflux in all patients with an associated hiatus hernia being noted in 3 cases. An upper gastro-intestinal endoscopy was performed in 24 children. Esophagitis of 2 or 3 degrees was present in 16 cases. A standard medical treatment was used in all patients during 1 month to 3 years. The patients were referred for surgery because they had no response to medical management or they had hiatus hernia or esophagitis type II or III. The operative procedure performed was Nissen fundoplication without gastrostomy. The mean duration of follow-up was 5 years (range 6 months to 12 years). We have not reviewed 5 patients. Several post-operative complications occurred: 4 pneumonia (2 deaths), 2 small bowel obstructions, 4 dumping syndrome and 1 death without etiology. Late complications were important too: 6 persistent reflux, 2 small bowel obstructions (2 deaths) and 2 peritonitis (2 deaths). Three patients died of their brain damage during the study period, 6 months to 8 years following their surgical procedure. The authors insist on: The frequency of gastro-esophageal reflux in retardates with a frequent merycism associated. The search for this reflux must be systematically done because it provokes some respiratory problems and a bad general status which distressed the child but also the family or the institution caring for the child.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Nissen's operation in children with brain diseases]. 376 12

A 72-year-old woman who had been given heavy premedication nonetheless developed severe retching at the beginning of a gastroscopy (for suspected gastric ulcer) when the instrument had been advanced only as far as the throat. The investigation was at once terminated, but barium swallow immediately afterwards revealed rupture at the middle third of the oesophagus, with contrast medium flowing into the mediastinum. Despite emergency thoracotomy and suturing of a 4 cm long fresh oesophageal tear in the area of a diverticulum, the patient died from a purulent mediastinitis and confluent pneumonia. The cause of this "spontaneous" rupture of the oesophagus without direct transmission of force (Boerhaave syndrome) in this case was a marked pressure increase in the oesophagus from retching and hyperperistalsis preparatory to gastroscopy. There had definitely not been any instrumental perforation. There was thus no medical negligence.
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PMID:[An unusual case of Boerhave syndrome. Esophageal rupture during preparation for gastroscopy]. 392 25


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