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)

We report about a boy with Barth-syndrome (X-chromosomal cardioskeletal myopathy, neutropenia and abnormal mitochondria) and postinflammatorial pharyngeal stenosis. After a pseudomembranous pharyngitis he developed a dyspnea and an inability to swallow with a resultant aspiration pneumonia. After endoscopic diagnosis of scarred pharyngeal stenoses the child required a tracheostomy and a percutaneous endoscopic gastrostomy tube. Then the boy underwent transoral pharyngoplastic surgery. Thirty five months after pharyngoplasty transoral nutrition was feasible. The tracheostomy was closed and the gastrostomy tube was removed. Throughout a 40 month period of observation the child had no more complaints relating to the minor residual pharyngeal stenoses.
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PMID:Postinflammatorial stenoses of the pharynx in a child with Barth-syndrome. 1262 46

In three patients, a 44-year-old schizophrenic woman and two men aged 54 and 42, who presented with dyspnoea, a pancreaticopleural fistula was diagnosed as a complication of pancreatitis, i.e. a fistulous tract between the pancreas and the pleural cavity. In general, these fistulas have a good prognosis; however, delay in finding the correct diagnosis influences the prognosis. This is often due to unfamiliarity with the disease and the non-specific presentation of patients with pleural effusion. The initial presentation usually comprises respiratory (dyspnoea, coughing due to pleural effusion) and occasional abdominal symptoms (epigastric pain). A definitive diagnosis is made when elevated pleural effusion amylase levels are demonstrated. Surgical treatment is only indicated if conservative or endoscopic treatment fails, and consists of resection of the fistula and drainage of the pancreatic duct via a lateral pancreaticojejunostomy or resection of the part of the pancreas where the fistula originates. In the first patient, surgical drainage of the fluid accumulation was applied, but she died of aspiration pneumonia after she had removed the feeding tube and had refused further treatment. Pancreatic resection resulted in recovery in the two men.
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PMID:[Pleural fluid in chronic pancreatitis]. 1290 43

We report a case of a previously healthy 41-year-old man who was admitted for progressive dyspnea and cough, which culminated in respiratory failure, shock, and death. Lung and muscle biopsy results were consistent with interstitial lung disease secondary to polymyositis. Polymyositis and dermatomyositis are rare autoimmune diseases that primarily affect the muscles and skin, with frequent extramuscular and specifically pulmonary manifestations. Respiratory complications are in 2 categories: primary (the interstitial lung diseases, which can be acute or chronic) and secondary (aspiration pneumonia/pneumonitis, muscle weakness, infection, drug-induced disease, pulmonary congestion secondary to heart failure, pulmonary hypertension, and pneumomediastinum). Diagnosis of a specific interstitial lung disease relies mainly on high-resolution computed tomography of the chest and on tissue diagnosis. Prognosis depends on the histopathology findings and the specific form of interstitial lung disease and its response to therapy, which consists of high-dose steroids and immunomodulating agents. Unfortunately, patients with polymyositis/dermatomyositis associated with pulmonary complications have a worse prognosis than patients with isolated forms.
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PMID:Fatal acute interstitial pneumonitis complicating polymyositis in a 41-year-old man. 1557 43

A 52 year-old woman with gastric cancer treated with surgery and chemotherapy, is admitted in our Internal Medicine Department because of the presence of fever (max 41.2 degrees C), dyspnoea, non-productive cough and mental confusion. The anamnesis and the physical examination address to the diagnosis of CAP (Community-Acquired Pneumonia); in particular the alteration of consciousness and the onset of symptoms after the insertion of a nose-gastric tube let us to consider the diagnosis of aspiration pneumonia. The clinical presentation and radiological imaging (Rx and CT of thorax) suggest the pattern of bronchiolitis obliterans with organizing pneumonia (BOOP). BOOP is not a disease, but a non specific pattern of answer to a lung injury. It can be either idiopathic or associated with a variety of causes, such as infections, drugs, radiations and connective tissue diseases. Besides the clinical course is complicated by the onset of an ARDS (Adult Respiratory Distress Syndrome). The gold standard for the diagnosis is represented by lung biopsy with hystopathologic confirmation but, if it cannot be done, it's necessary to start immediately steroid therapy because BOOP may be fatal. The patient received antibiotic and steroid therapy with success.
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PMID:[A 52 year-old woman with fever, cough and dyspnoea]. 1570 Jun 34

Bronchoesophageal fistulae associated with lymphomas are generally associated with chemo-radiotherapy. We report here an unusual case of lymphoma with a therapy-unrelated bronchoesophageal fistula. Previously, only 10 similar cases have been reported. A 70-year-old male was diagnosed as having gastric diffuse large B-cell lymphoma in May 1998. In January 1999, he noted a cough after eating and drinking. Because of the presence of a febrile temperature, productive cough and dyspnea, he was referred to our hospital and diagnosed as having aspiration pneumonia. Antibiotics did not improve his symptoms. When tracheal intubation was performed with bronchoscopy, a bronchoesophageal fistula was revealed. Malignant lymphoma cells were found around the fistula in the biopsy specimen. The patient died of pneumonia after treatment with airway stenting and chemotherapy. Induction of necrosis by chemotherapy or low blood flow with stenting and dopamine probably caused enlargement of the fistula.
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PMID:[Bronchoesophageal fistula in a patient with untreated malignant lymphoma]. 1644 Jul 67

Because of the close anatomical relationships between thyroid gland and laryngeal nerves, sensory-motor impairment of the laryngeal functions is a well known possible complication of thyroid surgery. Laryngeal nerve paralysis can present with various and often associated symptoms like dysphagia, aspiration, voice alteration or dyspnea. Several examination procedures are mandatory to perform a complete neuro-laryngeal evaluation: rigid and flexible video-stroboscopy will assess the abductor, adductor and tensor functions in breathing, sniffing, talking and eventually singing tasks. Laryngeal electromyography (LEMG), despite its technical difficulties, brings valuable objective and pronostic informations. Aerodynamic assessment of voice production and objective acoustic voice evaluation are important for patients' follow-up, especially for voice professionals like teachers and singers. Treatment of laryngeal sensory-motor nerve paralysis can be conservative, with the help of speech therapy. Early surgical treatment is indicated in cases with severe functional problems like aspiration pneumonia, disabling breathy hypophonia, ineffective cough, disabling dyspnea. Surgical therapy at 6 to 9 months after injury is indicated in patients who demonstrate evidence of denervation or little activity on LEMG and have a poor response to a reasonable trial of speech therapy. Many surgical procedures are available. Depending on the type of neuro-laryngeal deficit, the main and more widely used techniques are: injection laryngoplasty, medialization thyroplasty, arytenoid adduction, arytenoidopexy, crico-thyroid approximation, endoscopic laser cordotomy and re-innervation procedures.
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PMID:Laryngeal dysfunction after thyroid surgery: diagnosis, evaluation and treatment. 1701 88

A 6-year-old boy with multiple severe disabilities was admitted with acute and progressive dyspnoea. A new percutaneous endoscopic gastrostomy (PEG) catheter had been placed 2 weeks earlier, during which the old catheter was cut and left in the stomach. Radiological assessment revealed pneumonia and a traumatic fistula between the oesophagus and the left main bronchus. Respiratory support was required. The patient recovered after oesophagoscopic removal of the remaining portion of the PEG catheter. A 7-year-old boy with multiple severe disabilities presented with an acutely reduced level of consciousness, vomiting and progressive dyspnoea. Chest x-ray revealed signs of aspiration pneumonia and, after respiratory problems worsened, a foreign object in the oesophagus. The foreign object was likely the remaining portion of a PEG catheter that was removed 12 months earlier. The patient was discharged in good condition a few days after oesophagoscopic removal of the remaining catheter. PEG is a commonly used method for enteral feeding in children. The Dutch guideline on enteral feeding in children indicates that endoscopic removal of the PEG catheter is often necessary. In daily practice, however, endoscopic removal is not always performed. To avoid serious complications, authors recommend endoscopic removal ofthe silicon disk when replacing or removing a PEG catheter in children aged less than 6 years and all children with mental retardation, prior laparotomy or constipation. Endoscopic removal of the disk should be considered in all other children if the disk is not passed in stool within 2 weeks and an x-ray shows that the disk is in the oesophagus, stomach or proximal intestine.
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PMID:[Two children with severe complications following incomplete removal of a percutaneous endoscopic gastrostomy (PEG) catheter]. 1740 54

Aspiration of particulate matter is a well-recognized complication in debilitated patients at autopsy but is not widely recognized in surgical pathology material. We have encountered a surprising number of cases on biopsy or resection specimens, and most were unsuspected clinically and pathologically. This study was undertaken to clarify clinical and pathologic features that facilitate the diagnosis of food/particulate matter aspiration pneumonia. Fifty-nine patients were identified with an average age of 57 (range 26 to 85), and a male/female ratio of 2:1. Common presenting symptoms (information available in 36 cases) included dyspnea (14), fever (9), and cough (6). A history of recurrent pneumonia was present in 9. Radiographic data were available in 34 cases. Bilateral infiltrates or nodules were found in 17 cases, whereas the changes were unilateral in 17. Solitary nodules clinically suspicious for neoplasm were present in 13. Aspiration was suspected clinically in only 4 of the 45 cases in which the clinical impression or differential diagnosis was stated. Predisposing factors for aspiration were identified in 32 patients, including esophageal or gastric causes (19), drug use (10), and neurologic conditions (6). Histologically, bronchiolitis obliterans-organizing pneumonia was present in 52 (88%) cases, usually in combination with multinucleated giant cells, acute bronchopneumonia/bronchiolitis, and/or suppurative granulomas. Foreign material was identified in all cases, including most commonly vegetable or food remnants (54 cases), and less often talc or microcrystalline cellulose (7), crospovidone (4), and kayexalate (2). Particulate matter aspiration pneumonia is a more common cause of lung infiltrates and nodules than generally appreciated. The diagnosis should be suspected when multinucleated giant cells, acute bronchopneumonia/bronchiolitis, and/or suppurative granulomas are found in a background of bronchiolitis obliterans-organizing pneumonia. The presence of foreign material confirms the diagnosis.
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PMID:Pulmonary disease due to aspiration of food and other particulate matter: a clinicopathologic study of 59 cases diagnosed on biopsy or resection specimens. 1746 Apr 60

Case 1 was a 59-year-old female who had been taking distigmine bromide 20 mg/day for 2 years. She had concurrently developed pneumonia and was admitted to the hospital. Her pupil diameter was 1.0 mm, serum ChE value was decreased at 25 IU/L. Case 2 was a 72-year-old male who had been taking distigmine bromide 15 mg/day for 8 months. He was transported to the hospital with a chief complaint of dyspnea. His pupil diameter was 2.0 mm, serum ChE value was decreased at 75 IU/L, and he had concurrent pyothorax. Case 3 was a 74-year-old male who had been taking distigmine bromide 10 mg/day for 4 years. He was transported to the hospital with a chief complaint of disturbance of consciousness. His pupil diameter was 2.0 mm, and serum ChE value was decreased at 55 IU/L. He had concurrent aspiration pneumonia. In Case 1, the distigmine bromide concentration was elevated at 13.2 ng/mL at admission. However, it decreased from the following day. The two other patients had low concentrations of distigmine bromide. In all patients, ChE levels recovered after discontinuing distigmine bromide, and respiratory conditions also improved. Distigmine bromide was no longer detected in blood before ChE levels recovered.
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PMID:[Three cases of cholinergic crisis in which serum distigmine bromide concentrations were measured]. 1827 57

Isolated noncompaction of the ventricular myocardium (INVM) was diagnosed with delayed enhancement cardiac magnetic resonance imaging (MRI) in a 12-year-old boy, who developed dyspnea and syncope while running. Chest radiograph showed no marked cardiomegaly, but revealed bilateral consolidation caused by aspiration pneumonia. Laboratory findings showed plasma level of brain natriuretic peptide (BNP) of 768 pg/dl. Echocardiography showed a slightly thickened myocardium, but the trabecular meshwork region was unclear. He was given a diagnosis of unknown heart failure. His dyspnea and cyanosis improved in response to inotropic agents, oxygen and steroid therapy. However, the plasma BNP levels could not be decreased to normal. Cardiac MRI was performed and delayed-enhancement demonstrated hyperenhancement of prominent trabeculation in the lateral and apical regions of the left ventricle, suggesting fibrosis. The patient was given a diagnosis of INVM, but his status was New York Heart Association Class I heart failure. The diagnosis of INVM in children is difficult because heart failure symptoms are present in only 30% of the cases at diagnosis. Delayed-enhancement MRI is a more precise method of assessment.
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PMID:Delayed enhancement cardiac MRI in isolated noncompaction of the left ventricular myocardium in a child. 1836 44


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