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)

Respiratory complications occur in advanced multiple sclerosis (MS) but may also complicate acute relapses earlier in the disease. We present 19 patients with MS who developed respiratory complications at a mean of 5.9 (range 1-12) yrs after the onset of neurological symptoms. Fourteen patients developed severe respiratory insufficiency presenting with a combination of reduced forced vital capacity (FVC), hypoxaemia or hypercapnia (12 patients) and respiratory arrest (four patients). Two patients presented with apneustic breathing, one with paroxysmal hyperventilation, one with obstructive sleep apnoea and one with bulbar weakness leading to aspiration pneumonia. Respiratory muscle weakness was a major factor in 14 patients (predominantly diaphragm involvement in six), bulbar weakness in seven patients, impaired voluntary control in three and impaired automatic control in three. Twelve patients received mechanical respiratory support of whom seven have subsequently died. The methods of support used were intermittent positive pressure ventilation (nine patients), iron lung (three), cuirass (two) and rocking bed (one). Six patients were maintained on respiratory support until they died after intervals varying from 24 h to 6 yrs (mean 17.7 mths). Five patients received temporary ventilation for between 6 d and 42 d: of these four remain alive at up to 4 yrs and one died after 16 yrs. One patient remains on domiciliary nasal intermittent positive pressure ventilation (IPPV) after 1 yr.
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PMID:Respiratory involvement in multiple sclerosis. 160 78

An 11-year-old girl developed a severe brainstem encephalopathy thought to be due to multiple sclerosis. She has been left with a severe long-standing bulbar palsy and a permanent tracheostomy. A new operation of laryngeal closure is described which gave relief from recurrent aspiration pneumonia and cardiorespiratory failure.
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PMID:Laryngeal closure in the management of severe long-standing bulbar palsy in a child. 731 4

Signs of respiratory distress including coughing, choking, and gagging are not uncommon during oral feedings in patients with severe dysphagia. Aspiration pneumonia and chronic lung disease are recognized complications. Pulse oximetry, respiratory inductance plethysmography, and nasal airflow measurement by thermistors are accurate noninvasive methods of monitoring cardiopulmonary adaptation during oral feedings in patients with severe dysphagia. We report significant, previously unrecognized, acquired hypoxemia during oral feedings in two patients with severe cerebral palsy and one with multiple sclerosis. The episodes of hypoxemia occurred only while swallowing specific food textures. Periods of hypoxemia most probably resulted from aspiration during oral feedings. Cardiopulmonary adaptation may prove to be an important consideration in decisions regarding the method and advisability of continued oral feedings in patients with severe dysphagia.
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PMID:Hypoxemia during oral feedings in adults with dysphagia and severe neurological disabilities. 843 21

This study examined the effects of brain lesions and neuropsychological impairment on the efficacy of treatment for depression in patients with comorbid diagnoses of multiple sclerosis (MS) and major depressive disorder (MDD). Thirty patients meeting criteria for MS and MDD received 1 of 3 16-week treatments for depression and were followed for 6 months following treatment cessation. T2-weighted magnetic resonance imaging and neuropsychological evaluations were also obtained. End-of-treatment Beck Depression Inventory (BDI; A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) results residualized for baseline BDI were related to right temporal periventricular lesion volume (R2=.32, p=.002) and left temporal grey-white junction lesion volume (R2=.19, p=.02) but were not statistically related to lesion volume in any other brain region or to neuropsychological function. BDI results at 6-month follow-up, residualized for end-of-treatment BDI, were predicted by total lesion volume (R2=.22, p=.005), lesion volume in many discrete areas, and neuropsychological functioning (R2=.29, p=.0009). The effect of total lesion volume on 6-month follow-up BDI results was fully mediated by neuropsychological function.
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PMID:Brain lesion volume and neuropsychological function predict efficacy of treatment for depression in multiple sclerosis. 1462 77

Although there are ever increasing reports of extraintestinal human infections caused by Aeromonads, in both immunocompromised and immunocompetent patients, respiratory tract infections remain uncommon. We describe a case of aspiration pneumonia in an immunocompetent patient with multiple sclerosis, caused by a community acquired, multidrug resistant strain of Aeromonas hydrophila sensitive only to meropenem. The case highlights the clinical significance of Aeromonas hydrophila as a respiratory pathogen, as well as the community origin of multidrug resistance and the utility of newer carbapenems in such cases.
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PMID:Aeromonas hydrophila and aspiration pneumonia: a diverse presentation. 1470 21

Over 30% of persons with multiple sclerosis (pwMS) suffer from swallowing symptoms, a higher rate than previously assumed. Neurogenic dysphagia (ND) may cause many different kinds of oropharyngeal sensorimotor dysfunctions in pwMS, and is associated with both the amount of disability and brainstem signs. About 15% of pwMS with mild disability may also suffer from ND. Diagnostic tools comprise history taking, bedside screening examination (50 ml water test combined with assessment of pharyngeal sensation or with pulse oximetry) and sometimes a videofluoroscopic swallowing study (VFSS) and fibreoptic endoscopic evaluation of swallowing (FEES). VFSS and FEES are complementary methods and both have advantages and disadvantages. Interventions for ND in pwMS are mainly based on functional swallowing therapy, including methods of restitution, compensation and adaptation. The aim of intervention is to prevent aspiration and aspiration pneumonia. Outcome assessment should focus on clinically relevant parameters, such as activity limitation, participation restriction and health-related quality of life.
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PMID:Dysphagia and multiple sclerosis. 1512 13

Decisions on ventilatory support (VS) in multiple sclerosis (MS) are complex. All patients with MS requiring mechanical ventilation or tracheostomy since 1969 (22) at Mayo Clinic were reviewed. Seventeen had progressive (PMS; 11 secondary and six primary progressive) and one had relapsing remitting MS (RRMS). Four had neuromyelitis optica (NMO). Of those with PMS, all but two required a wheelchair or were bedbound before VS and survived a median of 22 months; 14 were mechanically ventilated and seven underwent subsequent lifelong tracheostomy; three had tracheostomy only. The indications (usually multiple) for VS in PMS patients were aspiration pneumonia, poor ventilation because of mucous plugging, mechanical failure, and airway control/protection for seizures and coma. The RRMS patient required mechanical ventilation for 10 days, with subsequent short-term tracheostomy during a brainstem exacerbation. Of the four patients with NMO one made a dramatic recovery after plasmapheresis. Compared with PMS, the NMO group had a shorter time from disease onset to VS, a longer duration of ventilation, and the three patients not treated with plasma exchange or steroids did worse. The prognosis for independent ventilation (+/- tracheostomy) was worst for patients with NMO, except for one patient who received plasma exchange, and better then expected for PMS, despite poor preventilation functional status.
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PMID:Mechanical ventilation and tracheostomy in multiple sclerosis. 1531 26

Oropharyngeal dysphagia is not a single disease but a symptom complex that is recognized by difficulty in transfer of a food bolus from mouth to esophagus or by signs and symptoms of aspiration pneumonia or nasal regurgitation. Its etiologies are legion, with the most common result of underlying neuromuscular disease, including cerebrovascular accidents, Parkinson's disease, multiple sclerosis, and muscular dystrophy. There are two methods of treatment for oropharyngeal dysphagia; one is specific and directed at the underlying disease and the other is general (supportive) and designed to preserve oral intake for nutrition while preventing aspiration pneumonia. Following a general discussion of the etiology and clinical presentation of orophyarngeal dysphagia, a description of the methods for supportive care is presented as well as the approach to the treatment of cricopharyngeal dysfunction and Zenker's diverticulum.
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PMID:Oropharyngeal dysphagia. 1600 27

The relationship among therapeutic alliance, psychotherapy outcomes, and interpersonal problems was examined. The present study hypothesized therapeutic alliance would mediate the relationship between interpersonal functioning and outcome among patients with multiple sclerosis entering psychotherapy for depression. Nineteen clients received 16 weeks of individual cognitive-behavioral therapy (CBT) for depression as described by D. C. Mohr, A. C. Boudewyn, D. E. Goodkin, A. Bostrom, and L. Epstein (2001). Participants completed the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), the Inventory of Interpersonal Problems-Circumplex (IIP-C; Alden, Wiggins, & Pincus, 1990), and the Working Alliance Inventory-Client Form (WAI-C; Horvath & Greenberg, 1989). The IIP-C significantly predicted Week 16 BDI and the WAI-C at 4 weeks. When controlling for the WAI-C, the relationship between the IIP-C and BDI was no longer significant, supporting the mediational hypothesis.
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PMID:Therapeutic alliance mediates the relationship between interpersonal problems and depression outcome in a cohort of multiple sclerosis patients. 1681 Jun 63

The object of this study was to monitor the safety and efficacy of long-term use of an oromucosal cannabis-based medicine (CBM) in patients with multiple sclerosis (MS). A total of 137 MS patients with symptoms not controlled satisfactorily using standard drugs entered this open-label trial following a 10-week, placebo-controlled study. Patients were assessed every eight weeks using visual analogue scales and diary scores of main symptoms, and were followed for an average of 434 days (range: 21 -814). A total of 58 patients (42.3%) withdrew due to lack of efficacy (24); adverse events (17); withdrew consent (6); lost to follow-up (3); and other (8). Patients reported 292 unwanted effects, of which 251 (86%) were mild to moderate, including oral pain (28), dizziness (20), diarrhoea (17), nausea (15) and oromucosal disorder (12). Three patients had five 'serious adverse events' between them--two seizures, one fall, one aspiration pneumonia, one gastroenteritis. Four patients had first-ever seizures. The improvements recorded and dosage taken in the acute study remained stable. Planned, sudden interruption of CBM for two weeks in 25 patients (of 62 approached) did not cause a consistent withdrawal syndrome, although 11 (46%) patients reported at least one of--tiredness, interrupted sleep, hot and cold flushes, mood alteration, reduced appetite, emotional lability, intoxication or vivid dreams. Twenty-two (88%) patients re-started CBM treatment. We conclude that long-term use of an oromucosal CBM (Sativex) maintains its effect in those patients who perceive initial benefit. The precise nature and rate of risks with long-term use, especially epilepsy, will require larger and longer-term studies.
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PMID:Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis. 1708 95


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