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)

The natural history of fundoplication in young children with gastroesophageal reflux (GER) had not been analyzed previously. The authors reviewed the charts of 160 children who underwent gastric fundoplication (GF) before the age of 2 years (mean age [+/- SD], 9 +/- 7 months; range, 1 week to 2 years), from 1974 to 1992. Reflux was documented by upper gastrointestinal series in 124 patients, by 24-hour pH probe monitor in 98 patients, and by both in 68 patients. Clinical indications for GF included failure to thrive (FTT) in 68%, emesis (Ems) in 58%, and aspiration pneumonia (Asp) in 53%. Neurological impairment (NI) was present in 47% of all patients, and 13% had esophageal atresia (EA). The type of GF used was a Nissen fundoplication in 79% and an anterior fundoplication (AF) in 21%. Of the 160 patients, 24 (15%) died of unrelated causes. Of the remaining 136, follow-up of at least 2 years was obtained for 96 (mean follow-up period, 5.3 +/- 3.0 years; range, 2 to 15 years). Clinical resolution of symptoms/findings after GF occurred in 87% of children with FTT, 92% with Ems, 70% with Asp, and 71% overall. A second fundoplication was required for 15 children (16%) because of documented recurrent reflux. The type of GF, the age of the patient, and the presence of EA or NI did not significantly affect the success of GF.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Fundoplication in 160 children under 2 years of age. 803 82

The diaphragm of neonatal horses is significantly different from the diaphragm of adult horses in terms of histochemical fiber type composition, myosin heavy chain isoform, and native myosin isoform composition. There is a significant increase in the percentage of type I fibers present in the diaphragm with increasing age from birth through about seven months postnatal age. A possible lack of postural tone in the hiatal region of the neonatal diaphragm is suggested to account for increased incidence of vomiting or aspiration pneumonia in younger horses. The isoform data lead to rejection of the hypothesis that the diaphragm of the horse should, as an ungulate, be relatively precocial in its rate of maturation relative to other non-ungulate mammals that have been studied.
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PMID:Neonatal development of the diaphragm of the horse, Equus caballus. 817 12

Esophageal hiatal hernia was diagnosed in 11 young Chinese Shar-Pei dogs between October 1985 and July 1991. The dogs ranged in age from 2 to 11 months and included 3 females and 8 males. The most common clinical signs were regurgitation, vomiting, and hypersalivation. Physical examination was normal in 6 dogs; abnormal physical examination findings in the other 5 dogs included fever, dehydration, hypersalivation, and pulmonary wheezes and crackles. Laboratory evaluation was significant only for neutrophilia in 5 dogs. A diagnosis of hiatal hernia was made on the basis of survey thoracic radiographic and/or barium esophagram findings of displacement of the esophagogastric junction and stomach into the thoracic cavity; the diagnosis was confirmed by surgery in 9 dogs and at necropsy in 2 dogs. Megaesophagus (n = 7), gastroesophageal reflux (n = 4), and esophageal hypomotility (n = 1) were additional findings in some dogs. Aspiration pneumonia was diagnosed in 7 of the dogs. Medical therapies formulated for the therapy of presumed reflux esophagitis generally failed to resolve the clinical signs associated with the hiatal hernia. Hiatal herniae were surgically repaired in 9 of the Shar-Peis by various combinations of diaphragmatic crural apposition, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and left fundic tube gastropexy. Eight of the animals survived surgery, six of which have been asymptomatic since surgery (19 to 36 months). The megaesophagus, esophageal hypomotility, and bronchopneumonia resolved in all of these dogs.
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PMID:Congenital esophageal hiatal hernia in the Chinese shar-pei dog. 824 9

This case of Boerhaave's Syndrome had several unusual features including a delayed presentation and right-sided esophageal perforation. The patient's initial episode of hematemesis may have been caused by a small mucosal laceration in the area of the Barrett's lesion that later ruptured. On the other hand, if initially there was an esophageal rupture, it did not violate the parietal pleura or mediastinum. The overlying pleura remained intact until digested by gastric contents, thereby causing a right-sided hydropneumo thorax and a marked increase in symptoms, which promoted the patient to come to the ED. Because the patient initially appeared stable and had a history of emesis 4 days before presentation, and because an initial chest X-ray interpretation overlooked the right-sided apical pneumothorax, Boerhaave's Syndrome was not considered initially. Aspiration pneumonia, pancreatitis, alcoholic gastritis, or active peptide ulcer disease were in our initial differential. It was only after the repeat chest X-ray, which more obviously showed the pneumothorax, and insertion of the chest tube that the correct diagnosis was made. Had the pneumothorax not been overlooked initially, the diagnosis may have been made earlier. It is apparent from this case and a review of the literature that Boerhaave's Syndrome is an uncommon clinical entity and has varying modes of presentation, making the diagnosis a difficult clinical challenge. Boerhaave's Syndrome should be considered in all ill-appearing patients presenting with the combination of gastrointestinal and respiratory complaints. The single most important test may be the upright chest X-ray. However, if it is normal, and there is a high index of suspicion, esophagograms and or chest CT may be required to demonstrate the lesion. Because survival is directly related to the time to diagnosis and treatment, a high clinical suspicion can decrease the substantial morbidity and mortality associated with Boerhaave's Syndrome.
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PMID:Boerhaave's syndrome presenting with abdominal pain and right hydropneumothorax. 863 Jan 58

The authors have carried out a prospective trial to assess the safety, tolerability and outcome of early resumption of oral feeding after elective abdominal surgery involving the small or the large bowel. Over the study period, 161 patients undergoing elective laparotomy and bowel resection were randomized to two groups. Patients undergoing laparoscopic surgery were not included. In both groups, the nasogastric tube was removed immediately after surgery. In group I, oral feeding was started on first postoperative day, beginning with clear fluids and gradually progressing to a normal diet over a period of 24 to 48 hours, as tolerated. In group II, oral feeding was started after resolution of postoperative ileus, starting again with clear fluids as in group I. The resolution of postoperative ileus was defined as having bowel movements with no abdominal distention or vomiting. In both groups, nasogastric tube was reinserted if the patient had two episodes of vomiting of more than 100 ml over 24 hours in the absence of bowel movements. Postoperative analgesia was similar in both groups and same criteria for discharge from the hospital were followed. Of the 161 patients, 80 were in the early feeding group and 81 in the other group. The age and sex distribution of the patients in both groups was similar. In both groups, segmental colonic, rectal or small bowel resection was the commonest surgery. In group I, 79% patients tolerated feeds compared to 86% in group II. The incidence of vomiting was thus 21% in group I and 14% in group II, the difference being statistically insignificant. Reinsertion of nasogastric tube was required only in 11% patients in group I and 10% patients in group II. Further, the length of postoperative ileus (3.8 + 0.1 vs 4.1 + 0.1 days), length of hospital stay (6.2 + 0.2 vs 6.8 + 0.2 days) and incidence of complications (7.5% vs 6.1%) were not significantly different between the two groups. However, regular diet was tolerated significantly earlier. (p <0.001) in group I as compared to group II (2.6 + 0.1 vs. 5.0 + 0.1 days). Further, there was no incidence of anastomotic leaks or aspiration pneumonia, complications which could be expected to occur secondary to early feeding. The authors have reviewed the literature which shows a trend towards decreasing use of routine postoperative nasogastric drainage. Based on the results of the current study, they suggest that there is no need to delay oral feeding till resolution of colonic ileus as early feeding is safe and well tolerated. They also suggest that early resumption of oral feeding may have a positive impact on the psychological state of the patient and may help the recovery.
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PMID:Early oral feeding after elective colorectal surgery: is it safe. 885 62

1. After ingestion, Dettol liquid (4.8% chloroxylenol, pine oil, isopropyl, alcohol), a common household disinfectant, can cause central nervous system depression and corrosion of the oral mucosa, larynx and the gastrointestinal tract. The main risk from Dettol poisoning is pulmonary aspiration, leading to pneumonia, adult respiratory distress syndrome (ARDS) and/or sudden cardiorespiratory arrest. 2. To determine to what extent pulmonary aspiration in Dettol poisoning could be prevented, 13 patients treated in a general teaching hospital in Hong Kong were studied. Their clinical details were compared with those of control Dettol poisoning cases without pulmonary aspiration in order to identify possible risk factors for this complication. 3. At presentation, evidence of pulmonary aspiration was present in eight of the 13 patients prior to gastric emptying, but the use of gastric lavage without adequate protection of the airways could have aggravated the problem in three. In two other patients, evidence of aspiration was only present after gastric lavage was performed. The consequences of pulmonary aspiration were pneumonia (n = 10), ARDS (n = 2), acute exacerbation of asthma or chronic obstructive airway disease (n = 2) and sudden cardiorespiratory arrest (n = 1). Three patients with aspiration pneumonia (n = 2), ARDS (n = 1) and/or sudden cardiorespiratory arrest (n = 1) died. 4. Compared with the controls, the median amount of Dettol ingested was considerably larger (400 vs 150 ml), vomiting (100% vs 72.6%) and drowsiness/ confusion (60.2% vs 19.4%) occurred more often. 5. Amongst the 13 patients with Dettol poisoning and pulmonary aspiration, gastric lavage using the nasogastric tube technique without adequate production of the airways had been responsible for the occurrence or worsening of aspiration in two and three patients, respectively. Thus, gastric lavage particularly when using a nasogastric tube appeared to carry more harm than benefits in patients with Dettol poisoning. If the procedure is considered necessary, say because of the concomitant ingestion of the other poisons, the airways must first be well protected and the oropharyngeal aspiration and lavage technique using a wide bore Jacques tube is recommended. 6. Comparison with a control group has identified other risk factors for pulmonary aspiration: the amount of Dettol ingested, the occurrence of vomiting, drowsiness or confusion.
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PMID:Pulmonary aspiration following Dettol poisoning: the scope for prevention. 890 35

An 82-year-old man suffered from recurrent melena due to reflux esophagitis and aspiration pneumonia, which were caused by severe gastroesophageal reflux. We constructed a gastric stoma by percutaneous endoscopic gastrostomy (PEG) and fixed a transgastrostomal jejunal tube (TGJ tube) in the jejunum through the stoma. Direct administration of fluid into the jejunum was followed by a significant reduction in gastro-esophageal reflux. The reflux esophagitis and aspiration pneumonia did not recur. There was no vomiting, self-extubation, or restlessness that might have been caused by dementia, and the patient was could discharged cared for at into home.
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PMID:[Gastro-esophageal reflux successfully treated with transgastrostomal jejunal tube feeding]. 907 7

We report on two cases of aspiration pneumonia which developed during the endotracheal intubation after bladder perforation during TUR. The first case was a 79 y.o. male, who underwent TUR-P and lithotripsy under spinal and epidural anesthesia. The second case was a 69 y.o. male, who had undergone TUR-Bt under nitrous oxide-oxygen-enflurane anesthesia. General anesthesia was selected to perform an laparotomy when the diagnosis was made. They vomited a considerable amount of gastric content just after giving the drugs for induction. The chest X-rays revealed signs of aspiration pneumonia. These X-ray findings improved in a week using antibiotic therapy. Although TUR is performed as scheduled, vomiting may occur in the case of unexpected bladder perforation, which can cause aspiration pneumonia. In such emergency, we should insert a nasal tube before induction, press the cricoid (crush induction), or intubate with the patient awake.
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PMID:[Aspiration pneumonia during the endotracheal intubation on the occasion of bladder perforation by TUR]. 909 13

Death from ferric chloride poisoning has never been reported in Taiwan. We report a fatality from the suicidal ingestion of ferric chloride solution used as an etching agent for printed circuitry. A 25-y-old woman presented with vomiting after ingestion of 200 ml ferric chloride solution (pH 1.0). She had hypoxemia and severe metabolic acidosis with respiratory alkalosis initially. Three hours after her ingestion she presented with drowsy consciousness, tachycardia, tachypnea and protracted vomiting. Laboratory studies showed leukocytosis, elevated glucose, aspartate aminotransferase, amylase, lactate dehydrogenase, and total bilirubin, coagulation defect and hemolysis. Aspiration pneumonia and vision loss were also noted. Four hours after ingestion cardiopulmonary arrest suddenly occurred after severe vomiting and she expired. Toxicological studies showed marked elevation of serum iron (2440 micrograms/dl); the estimated oral dose of ferric chloride was equivalent to 11.52 g (230 mg/kg) of elemental iron. This patient did not receive deferoxamine due to rapid deterioration and a late diagnosis. Deferoxamine should be given in any symptomatic patient or in the presence of anion gap metabolic acidosis with a history of ferric chloride ingestion.
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PMID:A fatal case of acute ferric chloride poisoning. 946 7

A 14-month-old, intact male Labrador retriever was referred for evaluation of vomiting and regurgitation. A diagnosis of gastroesophageal intussusception with aspiration pneumonia was made. The patient responded favorably to aggressive surgical and medical management. The guarded to poor prognosis for gastroesophageal intussusception makes the successful outcome of this case unique.
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PMID:Gastroesophageal intussusception in a Labrador retriever. 981 38


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