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Query: UMLS:C0032290 (aspiration pneumonia)
 2,291 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aspiration pneumonia occurs in many clinical situations and has far-reaching pulmonary consequences. The chest radiograph may suggest or support the diagnosis. Aspiration of gastric contents leads to exudation of fluid into air spaces, causing an alveolar infiltrate. Although its radiographic pattern may suggest pulmonary edema, aspiration of gastric contents can be distinguished by a normal pulmonary capillary wedge pressure. Aspiration of particulate matter causes airways obstruction and atelectasis. Most commonly there is a shifting mixed infiltrate in the lower lobes.
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PMID:Adult aspiration pneumonia. 738 55

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

Adult respiratory distress syndrome (ARDS) after tricyclic antidepressant (TCA) overdose has been reported, but has not received as much attention in the literature as hemodynamic instability, cardiac arrhythmias or seizures. This report concerns a 33-year-old female who ingested a large amount of imipramine in an attempted suicide. She developed deep coma, hypotension, cardiac dysrhythmias and seizures. Although she survived initially, ARDS developed and she died of severe hypoxia nine days later. Her lung injury may have been the result of a variety of factors including prolonged hypotension, aspiration pneumonia, sepsis or a direct action on the lung parenchyma by imipramine. The literature pertaining to etiology, epidemiology, pathophysiology and management of TCA-induced lung injury has been reviewed. In one series of severe TCA overdose, an ARDS rate of 9% was reported. The risk of developing pulmonary edema and ARDS should be considered in severe TCA-poisoned patients. To try to prevent this complication, early intubation should be considered to avoid aspiration, and cautious volume loading, plus judicious use of alpha-adrenergic agonists, is indicated to prevent protracted hypotension.
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PMID:Adult respiratory distress syndrome and late death following imipramine overdose: a case report. 785 Jun 87

Human status epilepticus (SE) is consistently associated with cognitive problems, and with widespread neuronal necrosis in hippocampus and other brain regions. In animal models, convulsive SE causes extensive neuronal necrosis. Nonconvulsive SE in adult animals also leads to widespread neuronal necrosis in vulnerable regions, although lesions develop more slowly than they would in the presence of convulsions or anoxia. In very young rats, nonconvulsive normoxic SE spares hippocampal pyramidal cells, but other types of neurons may not show the same resistance, and inhibition of brain growth, DNA and protein synthesis, and of myelin formation and of synaptogenesis may lead to altered brain development. Lesions induced by SE may be epileptogenic by leading to misdirected regeneration. In SE, glutamate, aspartate, and acetylcholine play major roles as excitatory neurotransmitters, and GABA is the dominant inhibitory neurotransmitter. GABA metabolism in substantia nigra (SN) plays a key role in seizure arrest. When seizures stop, a major increase in GABA synthesis is seen in SN postictally. GABA synthesis in SN may fail in SE. Extrasynaptic factors may also play an important role in seizure spread and in maintaining SE. Glial immaturity, increased electronic coupling, and SN immaturity facilitate SE development in the immature brain. Major increases in cerebral blood flow (CBF) protect the brain in early SE, but CBF falls in late SE as blood pressure falters. At the same time, large increases in cerebral metabolic rate for glucose and oxygen continue throughout SE. Adenosine triphosphate (ATP) depletion and lactate accumulation are associated with hypermetabolic neuronal necrosis. Excitotoxic mechanisms mediated by both N-methyl-D-aspartate (NMDA) and non-NMDA glutamate receptors open ionic channels permeable to calcium and play a major role in neuronal injury from SE. Hypoxia, systemic lactic acidosis, CO2 narcosis, hyperkalemia, hypoglycemia, shock, cardiac arrhythmias, pulmonary edema, acute renal tubular necrosis, high output failure, aspiration pneumonia, hyperpyrexia, blood leukocytosis and CSF pleocytosis are common and potentially serious complications of SE. Our improved understanding of the pathophysiology of brain damage in SE should lead to further improvement in treatment and outcome.
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PMID:Pathophysiological mechanisms of brain damage from status epilepticus. 838 2

The authors reviewed all chest radiographs obtained for pregnant women at a university hospital over a 15-year period to determine the intrathoracic complications of pregnancy and diseases occurring during pregnancy. The characteristic physiologic changes seen on chest radiographs during normal pregnancy are reviewed. Examples of intrathoracic diseases that may occur in pregnant patients include pulmonary embolism, amniotic fluid embolism, beriberi, aspiration pneumonia, community-acquired pneumonia, viral pneumonia, asthma, systemic disease, trophoblastic disease and peripartum pulmonary edema. The authors discuss the radiation biology implications of performing chest radiography during pregnancy and conclude that the benefit that the fetus receives from diagnosis and treatment of the mother's disease may be greater than the risk of radiation exposure.
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PMID:Radiographic appearance of intrathoracic complications of pregnancy. 894 17

Aspiration pneumonitis describes the inflammatory reaction of the lung parenchyma following contamination by stomach contents. It is an uncommon but potentially lethal complication of general anaesthesia. Protection of the airway from contamination has long been one of the fundamentals of safe anaesthetic practice. Aspiration pneumonitis was first recorded by John Snow in 1858 but not scientifically described until 1946 by Curtis Mendelson, an American obstetrician, who differentiated between the airway obstruction due to inhalation of solid material and aspiration of liquids which resulted in an intense inflammatory reaction of the lung tissue manifesting as bronchospasm, pulmonary oedema and hypoxia. He identified general anaesthesia as a major contributory factor due to the loss of protective airway reflexes and as a result of related animal studies suggested that the aspiration of acidic material resulted in severe pulmonary impairment.
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PMID:Anaesthesia and aspiration pneumonitis. 897 8

Acute pulmonary failure caused by gastric acid aspiration is designated as Mendelson's syndrome. It is characterized by a trias of symptoms comprising bronchial obstruction, pulmonary oedema, and right ventricular failure. The pathomorphological pulmonary alterations show the typical symptoms of ARDS and allow the differentiation of three phases. The initial phase of injury is characterized by cauterization of the bronchial and alveolar epithelium. It is followed by the exsudative second phase during which alveolar oedema are developing. They impair the pulmonary surfactant synthesis and the formation of hyaline membranes. Fibrosis processes are typical of the proliferative third phase. Every of the mentioned three phases may be classified by their corresponding clinical symptoms. The therapy is entirely symptomatic and follows the intensive medical standards of the ARDS-therapy.
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PMID:[Mendelson syndrome in infancy and childhood]. 984 33

A case of pulmonary edema secondary to dislocation of laryngeal mask during awakening from anesthesia is described. The complication has been ascribed to physiopathological changes of the alveolo-capillary membrane caused by inspiratory efforts secondary to dislocation of laryngeal mask during awakening from anesthesia. Other possible causes of pulmonary edema are discussed, especially the cardiogenic one, and among the non cardiogenic edema, the Mendelson's syndrome. The quick identification and the intensive care of post obstructive pulmonary edema lead to a rapid resolution of the pathology.
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PMID:[Acute pulmonary edema from dislocation of a laryngeal mask]. 1052 40

Previously we have demonstrated that prolonged exposure to 100% ambient oxygen leads to a marked loss in functional lung volume and lung compliance, hypoxemia, and surfactant system abnormalities similar to acute respiratory distress syndrome (ARDS). However, 50% oxygen administration is believed to be safe in most clinical settings. In the present study, we have evaluated the effects of a 24-h exposure to 50% oxygen in rabbits immediately following experimental gastric acid aspiration. Mild hypoxemia, but no changes in mortality, lung volume, lung compliance, surfactant metabolism, or edema formation occurred after 24 h of normoxia postacid aspiration. Conversely, a relatively short (24-h) exposure to 50% oxygen after acid aspiration results in increased pulmonary edema, physical signs of respiratory distress, and mortality, as well as decreased arterial oxygenation, lung volume, lung compliance, and type II alveolar cell surfactant synthesis. These results suggest that acid aspiration alters the "set point" for oxygen toxicity, possibly by "priming" cells through activation of inflammatory pathways. This pathogenic mechanism may contribute to the progression of aspiration pneumonia to ARDS.
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PMID:Acid aspiration increases sensitivity to increased ambient oxygen concentrations. 1083 30

Neuroleptic malignant syndrome is a rare (incidence, 0.02%-3.2%) but dangerous complication following the use of neuroleptic drugs. When not promptly recognized, this disease carries a high mortality (10%-20%) and morbidity rate. We report an unusual case of neuroleptic malignant syndrome that presented predominantly with autonomic instability in the form of recurrent episodes of respiratory distress. The respiratory distress was initially caused by pulmonary edema and later was caused by severe bronchorrhea. We propose that aspiration pneumonia resulting in respiratory failure, the leading cause of death in neuroleptic malignant syndrome, may be a result of a combination of altered mental status and bronchorrhea. This has therapeutic implications because early institution of bromocriptine/dantrolene can prevent aspiration pneumonia and, hence, mortality from respiratory failure.
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PMID:Neuroleptic malignant syndrome presenting as pulmonary edema and severe bronchorrhea. 1199 44


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