Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0032290 (aspiration pneumonia)
 2,291 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In Japan, elderly patients who develop myasthenia gravis (MG) are increasing in number. However, there are few clinical reports concerning this issue. We evaluated the clinical manifestations, inducing or exacerbating factors, complications, treatments and prognosis of systemic MG in 11 patients older than 60 years of age. Bulbar symptoms were more frequent in these patients compared with younger MG patients, and 6 out of 11 cases (54.5%) were mistakenly diagnosed as cerebrovascular disorders. Among inducing or exacerbating factors of MG were psychological problems inherently involved with the aged, physical factors, and inappropriate termination or rejection of medication. Increase in the level of anti-Ach-R antibodies was recognized in 10 out of 11 cases (90.9%). A high percentage of the patients had thymoma (36.4%) and thyroid diseases (45.5%): 3 with Hashimoto's thyroiditis (27.3%), 1 with thyroid ophthalmopathy associated with hyperthyroidism, and 1 with simple goiter. Others were accompanied by ischemic heart disease, prostatic hypertrophy or stomach cancer. We treated these patients with corticosteroids, immunoglobulin, radiation for thymoma, or thymectomy in addition to administration of anticholinesterase agents. Prognostically, we found that duration of illness before death was shorter in those with onset later than 70 years of age. Seven out of 11 (63.6%) patients died of either aspiration pneumonia (4 cases), complications of thymectomy, congestive pulmonary edema or stomach cancer. There were no deaths associated with myasthenic crisis.
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PMID:[Clinical evaluation of myasthenia gravis in elderly patients]. 764 74

The medical records of 91 patients who underwent thyroidectomy from 1990 to 1993 were reviewed to evaluate airway management and operative morbidity in patients with marked thyroid enlargement. Twenty-nine patients with marked thyroid enlargement were identified: 13 unilateral, defined by a weight of > or = 40 g (mean 122 g, range 41-380 g), and 16 bilateral, defined by a weight of > or = 80 g (mean 160 g, range 82-404 g). Twenty-five patients had compressive symptomatology, 18 had tracheal narrowing and/or displacement, 19 had substernal extension, and one had superior vena cava syndrome. Unilateral vocal cord dysfunction was present in two of three patients with carcinoma and one of 26 patients with benign disease (P = 0.03). Pathology consisted of nodular goiter (11), adenoma (5), carcinoma (3), Grave's disease (5), and toxic multinodular goiter (5). All patients had an uncomplicated endotracheal intubation without the use of a fiberoptic bronchoscope as predicted on the basis of preoperative laryngoscopic findings. Ease of intubation was unrelated to the extent of abnormality seen on imaging studies of the neck. Thyroidectomy alone was effective in relieving compressive symptoms with no incidence of nerve injury, permanent hypoparathyroidism, or tracheomalacia. Six (21%) of 29 patients had temporary hypocalcemia compared to eight (13%) of 62 patients with lesser thyroid enlargement (P = 0.36). One patient with an unresectable follicular carcinoma died from aspiration pneumonia three weeks following tracheostomy placement. Marked thyroid enlargement and upper airway compression is predominantly caused by benign disease; however, when there is associated recurrent laryngeal nerve dysfunction, carcinoma is more common.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Thyroidectomy in patients with marked thyroid enlargement: airway management, morbidity, and outcome. 803 Aug 13

Patients with substernal thyroid disease, defined by the presence of enlarged thyroid tissue below the plane of the thoracic inlet, were identified from a prospective database maintained for patients who have undergone thyroidectomy at our institution since 1990. Substernal thyroid disease was present in 116 (30%) of 381 patients, anterior mediastinal in 109 (94%), and posterior mediastinal in seven (6%). Indications for surgery included compressive symptoms in 75 (65%) patients, an abnormal fine-needle biopsy in 45 (39%), progressive thyroid enlargement in 41 (35%), thyrotoxicosis in 11 (10%), and superior vena cava syndrome in two (1.7%). A median sternotomy and thoracotomy were performed in one patient each for a primary intrathoracic goiter. In all other patients thyroidectomy was accomplished through a cervical incision. Parathyroid autotransplantation was performed in 41 (37%) patients with retrosternal disease compared with 57 (22%) with disease confined to the neck (P < 0.01). Twenty-five patients (22%) had malignancy; four of these had unresectable disease. Postoperative complications included transient hypocalcemia (n = 46), transient hoarseness (n = 7), recurrent laryngeal nerve injury (n = 1), and wound infection (n = 1). One patient died from aspiration pneumonia. In summary, substernal thyroid disease is typically present in the anterior mediastinum and with rare exceptions can be resected through a cervical incision. Parathyroid devascularization is more common with resection of a substernal goiter and autotransplantation can prevent permanent hypoparathyroidism.
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PMID:The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. 1189 2