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Aspiration Pneumonia (aspiration + pneumonia)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

General & Introductory Veterinary Medicine	21%
Geriatric Medicine	12%
Neurology	9%
Surgery & Surgical Specialties	6%
14 Other Subdomains	52%

Selected Abstracts

EFFECT OF TEMPERATURE ON SWALLOWING REFLEX IN ELDERLY PATIENTS WITH ASPIRATION PNEUMONIA

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2004
Aya Watando MD
No abstract is available for this article. [source]

Aspiration pneumonia due to polyethylene glycol-electrolyte solution (Golytely) treated by bronchoalveolar lavage

RESPIROLOGY, Issue 1 2008
Gyu-Young HUR
Abstract: Polyethylene glycol (PEG)-electrolyte solution (Golytely), is most commonly used for bowel preparation before colonoscopy, as well as for barium enema and colon surgery. In this case, a 70-year-old man developed ARDS following the administration of Golytely by mouth before a scheduled colonoscopy. Aspiration of PEG-electrolyte solution was suspected, and the patient was successfully treated by BAL. Therefore, early bronchoscopy and BAL should be considered as initial treatment for PEG aspiration, because removal of PEG is most important for managing the disease. [source]

Ampicillin + sulbactam vs. clindamycin ± cephalosporin for the treatment of aspiration pneumonia and primary lung abscess

CLINICAL MICROBIOLOGY AND INFECTION, Issue 2 2004
M. Allewelt
Abstract Aspiration pneumonia, necrotising pneumonia and primary lung abscess are complications arising from the aspiration of infectious material from the oral cavity or stomach. There is limited information on optimal antibacterial therapeutic regimens. Patients with pulmonary infection following aspiration (n = 95) were included in a prospective, open, randomised, comparative multicentre trial to compare the safety, clinical and bacteriological efficacy of ampicillin + sulbactam vs. clindamycin ± cephalosporin. Treated patients (n = 70) received sequential antibiotic therapy with either ampicillin + sulbactam (n = 37) or clindamycin (n = 33), with or without a second- or third-generation cephalosporin, administered until the complete resolution of clinical and radiological abnormalities. Definite or presumptive pathogens were isolated from 58 patients. Mean duration of therapy was 22.7 days for ampicillin + sulbactam and 24.1 days for clindamycin. In patients treated with ampicillin + sulbactam, the clinical response was 73.0% at the end of therapy and 67.5% 7,14 days after therapy. For clindamycin, the rates were 66.7% and 63.5%, respectively. Bacteriological response was similar in both treatment arms. Nine patients died (12.9%), with a Simplified Acute Physiology Score of >,30 points being the only significant predictive factor for therapeutic failure. Ampicillin + sulbactam and clindamycin ± cephalosporin were both well-tolerated and proved equally effective in the treatment of aspiration pneumonia and lung abscess. [source]

Blood Cultures Do Not Change Management in Hospitalized Patients with Community-acquired Pneumonia

ACADEMIC EMERGENCY MEDICINE, Issue 7 2006
Prasanthi Ramanujam MD
Objectives: To determine if blood cultures identify organisms that are not appropriately treated with initial empiric antibiotics in hospitalized patients with community-acquired pneumonia, and to calculate the costs of blood cultures and cost savings realized by changing to narrower-spectrum antibiotics based on the results. Methods: This was a retrospective observational study conducted in an urban academic emergency department (ED). Patients with an ED and final diagnosis of community-acquired pneumonia admitted between January 1, 2001, and August 30, 2003, were eligible when the results of at least one set of blood cultures obtained in the ED were available. Exclusion criteria included documented human immunodeficiency virus infection, immunosuppressive illness, chronic renal failure, chronic corticosteroid therapy, documented hospitalization within seven days before ED visit, transfer from another hospital, nursing home residency, and suspected aspiration pneumonia. The cost of blood cultures in all patients was calculated. The cost of the antibiotic regimens administered was compared with narrower-spectrum and less expensive alternatives based on the results. Results: A total of 480 patients were eligible, and 191 were excluded. Thirteen (4.5%) of the 289 enrolled patients had true bacteremia; the organisms isolated were sensitive to the empiric antibiotics initially administered in all 13 cases (100%; 95% confidence interval = 75% to 100%). Streptococcus pneumoniae and Haemophilus influenzae were isolated in 11 and two patients, respectively. The potential savings of changing the antibiotic regimens to narrower-spectrum alternatives was only 170. Conclusions: Appropriate empiric antibiotics were administered in all bacteremic patients. Antibiotic regimens were rarely changed based on blood culture results, and the potential savings from changes were minimal. [source]

Long-term prognosis and satisfaction after percutaneous endoscopic gastrostomy in a general hospital,

GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2004
Joji Onishi
Background: Percutaneous endoscopic gastrostomy (PEG) has been widely acknowledged as a safer method for enteral feeding; however, its long-term impact on prognosis and quality of life in elderly patients is not sufficiently understood. There are issues still to be studied regarding the indications for PEG, due to the lack of convincing evidence that it reduces expected complications such as aspiration pneumonia or for improving the prognosis of patients with severe dementia. Method: In this study we investigated the survival rate after PEG and the families' satisfaction in 78 inpatients who underwent PEG. We conducted the investigation by sending questionnaires to the families. Results: The results for the 69 cases (88%) in which the patient recovered showed that the 1-year survival rate was 64.0%, and the 2-year survival rate was 55.5%. Fifty-three per cent of patients' families indicated overall satisfaction regarding of PEG. Conclusions: The survival rates were relatively higher than those from previously reported studies. This may be attributed to variations in patients' clinical, socio-economic, or cultural backgrounds in therapeutic interventions. We recognized the importance of clarifying factors that would affect the living and functional prognosis and quality of life in elderly patients who underwent PEG. The indications for PEG are based on a comprehensive assessment of the relevant factors in individual cases, and by taking patients' and families' wishes into consideration. [source]

Bronchopneumonia and oral health in hospitalized older patients.

GERODONTOLOGY, Issue 2 2002
A pilot study
Abstract Aims: To correlate microbial findings obtained by bronchoalveolar lavage in pneumonia patients with the clinical situation of the oral cavity. Method: Quantitative aerobic and anaerobic cultures were carried out in 150 ml samples of bronchoalveolar lavage (BAL) obtained by means of an endoscope (Video Endoscope Pentax®) inserted per as in the infected bronchus. Material: Twenty consecutive patients with a tentative clinical diagnosis of bronchopneumonia in whom BAL was carried out for diagnostic purposes. A clinical evaluation of the oral health status (oral hygiene, caries, periodontal diseases) was subsequently carried out. Results: In seven edentulous subjects wearing complete dentures the culture of anaerobic microorganisms was negative or yielding less than 100 cfu/ml BAL. Two patients yielded high counts of S. aureus and one high counts of P. aeruginosa. In the 13 subjects with natural teeth left one showed high counts of Veillonella spp. (anaerobic)+P. aeruginosa, one high counts of Veillonella spp. +S. aureus, one high counts of P. aeruginosa + S. aureus and one high counts of E. coli. These four subjects showed poor oral hygiene, periodontal pockets and a BAL microflora consistent with periodontal pathology. Conclusion: The results of this pilot study suggest that microorganisms of denture plaque or associated with periodontal diseases may give rise to aspiration pneumonia in susceptible individuals. [source]

Predictive values for aspiration after endoscopic laser resections of malignant tumors of the hypopharynx and larynx

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2004
Manuel Bernal-Sprekelsen MD
Abstract Background. CO2 -laser surgery is a relatively new treatment for selected carcinomas of the upper aerodigestive tract. The purpose of our study was to evaluate prospectively the functional results for swallowing after C02 -laser resections. Methods. The sample was composed of 210 consecutive patients with malignancies of the larynx and hypopharynx treated with CO2 laser between February 1998 and January 2002. Endoscopic resections included all T1 and T2 tumors and selected T3 and T4 tumors. T1 glottic tumors were not included in the analysis. We assessed the need for a feeding tube and the period the tube remained in place, aspiration pneumonia, tracheotomy secondary to aspiration, the need for a permanent or temporary gastrostomy, and total laryngectomy secondary to aspiration. Results. The nasogastric feeding tube was used in 23.2% of small tumors (2.5 ± 8.04 days) and in 63% of locally advanced tumors (13.95 ± 22.55 days). Frequency and period of storage of the feeding tube were higher in locally advanced tumors (p = .0001). Twelve patients (5.7%) had postoperative pneumonia and 59 (28.1%) had temporary postoperative cough during oral intake. Aspiration symptoms correlated with location (p = .001) and locally advanced tumors (p = .016). Eight patients (3.8%) needed a postoperative tracheotomy for severe swallowing difficulties; six (2.9%) of them were definitive and two (0.95%) temporary. Thirteen gastrostomies (6.2%) were performed to avoid severe aspirations; five of them were definitive. The need for gastrostomy correlated significantly with location (p = .002), pT3 and pT4 tumors (p = .002), age (p = .02), and postoperative radiotherapy (p = .04). No correlation was found with the period of feeding tube (p = .38), or aspiration pneumonia (p = .24). Conclusions. Endoscopic resection of laryngeal and hypopharyngeal tumors is associated with good recovery of deglutition. Many tracheotomies are avoided, the need for a feeding tube is usually reduced, and organ preservation is often feasible even in locally advanced tumors. © 2003 Wiley Periodicals, Inc. Head Neck26: 103,110, 2004 [source]

Ten-year study of bacteremia in hemodialysis patients in a single center

HEMODIALYSIS INTERNATIONAL, Issue 1 2005
J.A. Park
Background:,The incidence of infection in patients on chronic hemodialysis in higher than that of the general population. Infection is known to be a major cause of morbidity and mortality in these patients. The vascular access is important for hemodialysis, but infection through this route is the most common source of bacteremia and can be lethal to the patients. Despite the high morbidity and mortality of bacteremia in patients on chronic hemodialysis, the clinical characteristics of bacteremia in hemodialysis patients is rarely reported yet in Korea. Methods:,We included 696 hemodialysis patients from January 1993 to December 2003 at Uijongbu St. Mary's Hospital. We investigated incidence, source, causative organisms, clinical manifestations, complication, and mortality of bacteremia. We compared clinical factors, morbidity, and mortality between arteriovenous fistula and central venous catheter groups. Results:,Total 52 cases of bacteremia occurred in 43 patients. The major source of infection was vascular access (48%). Staphylococcus aureus was most common organism isolated. Major complications were septic shock (9.6%), pneumonia (9.6%), infective endocarditis (3.8%), and aortic pseudoaneurysm (1.9%). Nine patients died from septic shock (n = 4), aspiration pneumonia (n = 2), hypoxic brain injury (n = 1), gastrointestinal bleeding (n = 1), and rupture of aortic pseudoaneurysm. The central venous catheter group (n = 22) had higher incidences of vascular access as a source of infection (81.8% vs 23.3%, p < 0.001) and staphylococcus as a causative organism (77.2% vs 50.0%, p = 0.042) than the arteriovenous group. Conclusion:, This data shows that bacteremia causes high incidence of fatal complications and mortality. Therefore, careful management of vascular access as well as early detection of bacteremia is an important factor for the prevention of infection and proper antibiotic therapy should be started early. [source]

Factors affecting outcome in liver resection

HPB, Issue 3 2005
CEDRIC S. F. LORENZO
Abstract Background. Studies demonstrate an inverse relationship between institution/surgeon procedural volumes and patient outcomes. Similar studies exist for liver resections, which recommend referral of patients for liver resections to ,high-volume' centers. These studies did not elucidate the factors that underlie such outcomes. We believe there exists a complex interaction of patient-related and perioperative factors that determine patient outcomes after liver resection. We sought to delineate these factors. Methods. Retrospective review of 114 liver resections by a single surgeon from 1993,2003: Records were reviewed for demographics; diagnosis; type/year of surgery; American Society of Anesthesiologists (ASA) score; preoperative albumin, creatinine, and bilirubin; operative time; intraoperative blood transfusions; epidural use; and intraoperative hypotension. Main outcome measurements were postoperative morbidities, mortalities and length of stay (LOS). Data were analyzed using a multivariate linear regression model (SPSS v10.1 statistical analysis program). Results. Primary indications for resections were hepatocellular carcinoma (HCC) (N=57), metastatic colorectal cancer (N=25), and benign disease (N=18). There were no intraoperative mortalities and 4 perioperative (30-day) mortalities (3.5%). Mortality occurred in patients with malignancies who were older than 50 years. Morbidity was higher in malignant (15.6%) versus benign (5.5%) disease. Complications included bile leak/stricture (N=6), liver insufficiency (N=3), postoperative bleeding (N=2), myocardial infarction (N=2), aspiration pneumonia (N=1), renal insufficiency (N=1), and cancer implantation into the wound (N=1). Average LOS for all resections was 8.6 days. Longer operative time (p=0.04), lower albumin (p<0.001), higher ASA score (p<0.001), no epidural use (p=0.04), and higher creatinine (p<0.001) all correlated positively with longer LOS. ASA score and creatinine were the strongest predictors of LOS. LOS was not affected by patient age, sex, diagnosis, presence of malignancy, intraoperative transfusion requirements, intraoperative hypotension, preoperative bilirubin, case volume per year or year of surgery. Conclusions. Liver resections can be performed with low mortality/morbidity and with acceptable LOS by an experienced liver surgeon. Outcome as measured by LOS is most influenced by patient comorbidities entering into surgery. Annual case volume did not influence LOS and had no impact on patient safety. Length of stay may not reflect surgeon/institution performance, as LOS is multifactorial and likely related to patient population, patient selection and increased high-risk cases with a surgeon's experience. [source]

Aspiration syndromes: 10 clinical pearls every physician should know

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2007
H. S. Paintal
Summary Aspiration syndromes are clinically and pathologically classified into three sets of disorders: (i) large airway mechanical obstruction caused by foreign bodies; (ii) aspiration pneumonitis; and (iii) aspiration pneumonia. In this article, we discuss the common clinical presentations, risk factors, radiographic features and methods of management of these disorders. We highlight recent recommendations and controversies surrounding the prevention of aspiration pneumonia in the critically ill patient. Finally, we review ethical dilemmas surrounding feeding and aspiration risk concerns in debilitated and demented patients. [source]

Dental hygiene education for nursing staff in a nursing home for older people

JOURNAL OF ADVANCED NURSING, Issue 6 2010
Erika Kullberg
kullberg e., sjögren p., forsell m., hoogstraate j., herbst b. & johansson o. (2010) Dental hygiene education for nursing staff in a nursing home for older people. Journal of Advanced Nursing,66(6), 1273,1279. Abstract Title.,Dental hygiene education for nursing staff in a nursing home for older people. Aim., This paper is a report of a study evaluating the effect of a repeated education programme for nursing staff in a home for older people. Background., A strong relationship exists between oral infections and general health complications (especially aspiration pneumonia) among nursing home residents and hospitalized older people. Thus, nursing staff need to be educated in oral hygiene measures. Methods., Forty-three nursing home resident older people (12 men, 31 women, age range 69,99 years) were included in a dental hygiene and gingivitis evaluation using gingival bleeding scores and modified plaque scores. Evaluation was conducted before and 3 weeks after a repeated dental hygiene education for nursing staff at a nursing home in Sweden in 2008. Dental hygiene education had been given 1·5 years previously. Findings., Forty-one residents (12 men and 29 women) were available for evaluation after the repeated dental hygiene education (one died, one had had teeth extracted). There was a reduction in gingival bleeding scores (P < 0·001), and in plaque scores (P < 0·001). Conclusion., Repeated dental hygiene education improves the dental hygiene among nursing home resident older people. In order to succeed it may be necessary to address attitudes and perceptions towards oral care in such a dental hygiene education programme for nursing staff. Improved oral hygiene contributes to reducing the incidence of healthcare-associated pneumonia among nursing home resident older people, and thus to reduced healthcare costs. [source]

Modification of the Risk of Mortality from Pneumonia with Oral Hygiene Care

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2008
Carol W. Bassim DMD
OBJECTIVES: To investigate the associations between the assignment of an oral hygiene aide staff member and risk factors for mortality from pneumonia in a nursing home and to test the hypothesis that this care would affect the incidence of mortality from pneumonia. DESIGN: Electronic medical records. SETTING: Nursing home. PARTICIPANTS: One hundred forty-three residents of a Veterans Affairs Medical Center (VAMC) nursing home. METHODS: The electronic medical records of 143 residents of a VAMC nursing home were analyzed for risk factors for pneumonia. A certified nursing assistant had been assigned to provide oral hygiene care for residents on two of four nursing home wards. Researchers performed a longitudinal analysis of resident's medical records to investigate the association between the assignment of an oral hygiene aide with the risk of mortality from pneumonia. RESULTS: Initially, the group that received oral care, an older and less functionally able group, showed approximately the same incidence of mortality from pneumonia as the group that did not receive oral care, but when the data were adjusted for the risk factors found to be significant for mortality from pneumonia, the odds of dying from pneumonia in the group that did not receive oral care was more than three times that of the group that did receive oral care (odds ratio=3.57, P=.03). Modified risk factors included age, functionality, cognitive function, and clinical concern about aspiration pneumonia. CONCLUSION: Oral hygiene nursing aide intervention may be an efficient risk factor modifier of mortality from nursing home,associated pneumonia. [source]

A Pilot Study of Banxia Houpu Tang, a Traditional Chinese Medicine, for Reducing Pneumonia Risk in Older Adults with Dementia

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2007
Koh Iwasaki MD
OBJECTIVES: To evaluate whether the traditional Chinese herbal medicine Banxia Houpu Tang (BHT, formula magnolia et pinelliae) prevents aspiration pneumonia and pneumonia-related mortality in elderly people. DESIGN: A prospective, observer-blinded, randomized, controlled trial. SETTING: Two long-term care hospitals for handicapped elderly patients in Japan from March 2005 to February 2006. PARTICIPANTS: One hundred four elderly patients (31 men and 73 women; mean age±standard deviation 83.5±7.8) with dementia and cerebrovascular disease, Alzheimer's disease, or Parkinson's disease. INTERVENTION: Ninety-five participants (mean age 84.0, M:F=28:67) were randomly assigned to the BHT treatment group (n=47) or the control group (n=48) and took BHT or placebo for 12 months. MEASUREMENTS: The occurrence of pneumonia, mortality due to pneumonia, and the daily amount of self-feeding. RESULTS: Complete data were available for analysis on 92 of the 95 subjects randomized. Four patients in the BHT group developed pneumonia, and one of them died as a result. Fourteen patients in the control group developed pneumonia, and six of them died as a result. There was a significant difference between the two groups in pneumonia onset (P=.008), and a tendency toward significance in pneumonia-related mortality (P=.05). The relative risk of pneumonia in the BHT group compared with the control group was 0.51 (95% confidence interval (CI)=0.27,0.84, P=.008) and that of death from pneumonia was 0.41 (95% CI=0.10,1.03, P=.06) according to the Cox proportional hazards model. No adverse events were observed from treatment with BHT. The BHT group was able to maintain self-feeding better than the control group (P=.006). CONCLUSION: Treatment with BHT reduced the risk of pneumonia and pneumonia-related mortality in elderly patients with dementia. [source]

Prevalence of Fever in Patients Undergoing Left Atrial Ablation of Atrial Fibrillation Guided by Barium Esophagraphy

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2009
RUBINDER S. RUBY M.D.
Background: Real-time esophageal imaging is critical in avoiding esophageal injury. However, the safety of esophageal imaging with barium has not been specifically explored. Methods: Three hundred seventy consecutive patients underwent left atrial (LA) ablation of atrial fibrillation (AF) under conscious sedation. One hundred eighty-five patients (50%) underwent the ablation procedure with, and 185 patients (50%) underwent the procedure without administration of barium. Fever, as a surrogate for aspiration, was defined as a maximal temperature ,100°F within the first 24 hours following the ablation procedure. Results: Thirty of the 370 patients (8%) developed fever within 24 hours after LA ablation. The prevalence of fever was 9% (17/185) among patients who received barium and 7% (13/185) among those who did not receive barium (P = 0.6). Evaluation revealed the following causes of fever in 14 of the 30 patients (47%) with no difference in prevalence between the 2 groups: pericarditis, venous thromboembolism, hematoma, and infiltrate on chest radiography. Multivariate analysis failed to reveal any factors associated with development of fever. None of the patients experienced serious complications such as respiratory failure or atrioesophageal fistula. Conclusions: Fever may occur in approximately 10% of patients undergoing LA ablation of AF. Administration of barium is not associated with fever or other complications such as aspiration pneumonia. Real-time imaging of the esophagus with barium administration in conjunction with conscious sedation appears to be safe. [source]

Maternal Mortality Associated with Eclampsia and Severe Preeclampsia of Pregnancy

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2000
Dr. H. Sawhney
Abstract Objective: To analyse factors associated with maternal mortality in eclampsia and preeclampsia. Method: Retrospective analysis of 69 maternal deaths due to (eclampsia-61; severe preeclampsia-8) was carried out during a period of 17 years (1982,1998). Maternal condition on admission, associated complications and principal cause of death was analysed in each case. Results: Mean time interval between hospitalization and maternal death was 49.56 + 62.01 hrs (1,240 hrs). Twenty (28.9%) women died undelivered. Twenty-three (37.7%) women were in grade IV coma and 52.4% of eclampsia patients had recurrent convulsions (> 10) prior to admission. Associated complications in form of hemorrhage, cerebrovascular accidents, acute renal failure, jaundice, aspiration pneumonia and pulmonary oedema were 30.4, 31.8, 34.8, 18.8, 17.8, and 5.8%, respectively. Maternal mortality in eclampsia was significantly low in time period B (4.1%) when magnesium sulphate was used as an anticonvulsant. Conclusions: Maternal condition on admission and associated complications are the major determinant of maternal outcome. Use of magnesium sulphate is associated with significant reduction of maternal mortality. [source]

Review article: the gastrointestinal complications of myositis

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2010
E. C. EBERT
Aliment Pharmacol Ther,31, 359,365 Summary Background, The inflammatory myopathies are a group of acquired diseases characterized by a proximal myopathy caused by an inflammatory infiltrate of the skeletal muscle. The three major diseases are dermatomyositis, polymyositis and inclusion body myositis. Aims, To review the gastrointestinal manifestations of myositis. Methods, Over 110 articles in the English literature were reviewed. Results, Dysphagia to solids and liquids occurs in patients with myositis. The pharyngo-oesophageal muscle tone is lost and therefore patients develop nasal speech, hoarseness, nasal regurgitation and aspiration pneumonia. There is tongue weakness, flaccid vocal cords, poor palatal motion and pooling of secretions in the distended hypopharynx. Proximal oesophageal skeletal muscle dysfunction is demonstrated by manometry with low amplitude/absent pharyngeal contractions and decreased upper oesophageal sphincter pressures. Patients exhibit markedly elevated creatine kinase and lactate dehydrogenase levels consistent with muscle injury. Myositis can be associated with inflammatory bowel disease, coeliac disease and interferon treatment of hepatitis C. Corticosteroids and other immunosuppressive drugs comprise the mainstay of treatment. Inclusion body myositis responds poorly to these agents and therefore a myotomy is usually indicated. Conclusion, Myositis mainly involves the skeletal muscles in the upper oesophagus with dysphagia, along with proximal muscle weakness. [source]

Hemorrhagic bile pleuritis and peritonitis secondary to traumatic common bile duct rupture, diaphragmatic tear, and rupture of the spleen in a dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 6 2008
Gordon D. Peddle VMD
Abstract Objective, To describe the diagnosis and successful treatment of bile pleuritis and peritonitis secondary to traumatic rupture of the common bile duct and a diaphragmatic tear in a young dog. Case Summary, A 1-year-old German Shepherd dog was referred for evaluation of vomiting and icterus 4 days after being hit by a car. Thoracic radiographs, thoracic and abdominal ultrasonographic examinations, thoraco- and abdominocentesis, and positive contrast celiogram indicated hemorrhagic pleuritis and peritonitis, left dorsal diaphragmatic tear, and rupture and infarct of the spleen. Surgical exploration of the abdomen confirmed these findings in addition to a circumferential tear of the common bile duct, leading to a diagnosis of hemorrhagic bile pleuritis and peritonitis. Aerobic and anaerobic bacterial culture of the abdominal fluid yielded no growth. Surgical correction of the traumatic injuries was achieved via common bile duct anastomosis, cholecystojejunostomy, repair of the diaphragm, and splenectomy. The dog developed postoperative signs consistent with aspiration pneumonia but was successfully treated and discharged from the hospital. Clinical signs and laboratory abnormalities resolved and the dog was alive and healthy 8 months after discharge. New or Unique Information Provided, Bile pleuritis is rare in dogs and cats and is usually associated with penetrating, not blunt, abdominal trauma. Multiple organ injury in cases of traumatic bile duct rupture is uncommon; in this dog, rupture of the common bile duct was accompanied by rupture of the diaphragm and spleen. [source]

Medical and surgical management of severe barium aspiration in a dog

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 6 2008
Stacy D. Meola DVM
Abstract Objective, To describe the medical and surgical management of a unique case of barium sulfate aspiration pneumonia in a dog. Case Summary, A 5-year-old spayed female black Labrador Retriever weighing 33 kg was presented for evaluation of barium aspiration pneumonia. Approximately 200 mL of barium had been instilled into the caudal lung lobes via an improperly placed orogastric tube. Right caudal, right middle, and accessory lung lobectomies were performed, and the dog was managed intensively for 19 days in the hospital. New or Unique Information Provided, This is the first report of a complete diagnostic work-up including bronchoscopy, bronchoalveolar lavage, culture, thoracotomy, and pulmonary histopathology for severe barium sulfate aspiration in a dog with an excellent outcome. [source]

CLOSTRIDIUM TETANUS INFECTION IN 13 DOGS AND ONE CAT

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue S1 2004
C Bandt
Clostridium tetani infection is uncommon in dogs and cats. Up to this point in time just single case reports have been published in veterinary medicine. The goal of this retrospective study was to describe the clinical features and outcome of 13 dogs and one cat affected with Clostridium tetani. The medical records of the last ten year were reviewed. Dogs and cats that were identified as being infected with Clostridium tetani on the basis of characteristic clinical signs and/or bacterial culture from infected wounds were eligible for study inclusion. Thirteen dogs and one cat met the criteria for study inclusion. Six different breeds and mix-breed dogs were affected, German Shepherd dogs (n=4, 29%) and Labrador retriever (n=3, 21%) were the most frequently affected breeds. Observed clinical complications were ventricular aspiration pneumonia (n=7), laryngeal spasm (n=6), hypersalivation (n=4), ventricular tachycardia (n=3), and third degree AV block (n=1). Median days from onset of clinical signs until first signs of improvement were 10 days (range: 9,12 days). Median hospitalisation time was 18 days (range: 14,22 days). Six animals showed full recovery and 8 animals died or were euthanized. Death was associated with acute onset of ventricular tachycardia in 2 dogs, 1 dog died with non-responsive third degree AV-block, 3 dogs died after developing aspiration pneumonia, and 1 dog died of unknown causes. [source]

Treatment of a Myasthenic Dog with Mycophenolate Mofetil

JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2000
C.W. Dewey DVM, DACVIM (Neurology), DACVS
Summary A ten-year-old, male castrated Springer Spaniel was presented for dysphagia, ptyalism, and regurgitation. Evidence of megaesophagus and mild aspiration pneumonia were apparent on thoracic radiographs. A diagnosis of focal acquired myasthenia gravis was suspected and subsequently confirmed with a positive serum acetylcholine (ACh) receptor antibody concentration (3.87 nM/L). A gastrostomy tube was placed shortly after presentation; food and drugs (including azathioprine) were administered through the tube. After transient improvement, the dog suddenly deteriorated clinically, experiencing frequent episodes of regurgitation and developing severe aspiration pneumonia. Mycophenolate mofetil (MMF), a novel immunosuppressive drug with relative specificity for lymphocytes, was instituted every twelve hours via the gastrostomy tube. Within four days of beginning MMF therapy, both clinical evidence of pharyngeal/esophageal dysfunction and radiographic evidence of megaesophagus had resolved. Initially, clinical side-effects of combined MMF/AZA administration were not apparent, but the patient experienced several vomiting episodes during the third week of treatment. The vomiting resolved after decreasing the dose of both drugs. The patient made a full recovery, and a one-month follow-up ACh receptor antibody concentration was normal (0.26 nM/L). After one month of combination therapy, the patient was weaned off of AZA and maintained on MMF as the sole immunosuppressive drug. The dog was subsequently weaned off of MMF on two occasions. Mycophenolate mofetil was reinstituted after the first discontinuation due to the development of profound appendicular muscle weakness two days after stopping MMF; the weakness resolved within 24 hours of reinstituting MMF. A positive ACh receptor antibody concentration (0.89 nM/L) after the second MMF weaning prompted the second reinstitution of MMF. Two months following this second MMF reinstitution, the dog was again serologically negative (0.51 nM/L) for myasthenia gravis. At the time of last followup, the dog remained in clinical remission eight months after initial presentation. The use of MMF to treat acquired myasthenia gravis in dogs has not been reported previously. The literature concerning MMF and its potential use in treating patients with autoimmune diseases is discussed. [source]

Clinical evaluation of a new formulation of propofol in a medium-chain and long-chain triglycerides emulsion in dogs

JOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2007
J. I. REDONDO GARCÍA
Propofol formulated in a mixed medium-chain and long-chain triglycerides emulsion has been recently introduced for clinical use as an alternative to the conventional long-chain triglycerides formulation. This prospective multicentric study evaluated the clinical effectiveness and the complications associated with the use of this new formulation of propofol in dogs. Forty-six Spanish veterinary clinics participated in this study. A total of 541 anaesthesias (118 ASA I, 290 ASA II, 101 ASA III and 32 ASA IV) performed for various diagnostic and therapeutic purposes were evaluated. The anaesthetic protocol was not controlled, with the exception that propofol had to be used at least for induction of anaesthesia. The induction dose of propofol and the incidence of anaesthetic complications throughout the procedure were recorded. A chi-square test compared the incidence of complications according to the maintenance agent used (propofol vs. inhalatory anaesthesia), anaesthetic risk (ASA classification) and the reason for the anaesthesia. The patients premedicated with ,2 agonists needed lower doses (mean ± SD, 2.9 ± 1.3 mg/kg i.v.) than the animals premedicated with phenothiazines (3.9 ± 1.4 mg/kg i.v.) or benzodiazepines (4.0 ± 1.4 mg/kg i.v.). The most frequent complications were difficult endotracheal intubation (1.3%), postinduction apnoea (11.3%), cyanosis (0.6%), bradypnoea (2.6%), tachypnoea (2.8%), bradycardia (2%), tachycardia (2.6%), hypotension (0.2%), shock (0.2%), vomiting (4.6%), epileptiform seizures (2.8%), premature awakening (7.4%) and delayed recovery (0.9%). There were no cases of pain on injection or aspiration pneumonia. Three dogs died (0.55%), one during induction and two during recovery from anaesthesia. This study demonstrates that the new formulation of propofol is an useful and effective drug to induce general anaesthesia in dogs. [source]

Sialorrhea in Parkinson's disease: A review

MOVEMENT DISORDERS, Issue 16 2007
Kelvin L. Chou MD
Abstract A significant number of patients with Parkinson's disease (PD) experience sialorrhea. This problem can cause social embarrassment, and because saliva pools in the mouth, may lead to aspiration pneumonia. Sialorrhea in PD is thought to be caused by impaired or infrequent swallowing, rather than hypersecretion. Oral medications, botulinum toxin injections, surgical interventions, radiotherapy, speech therapy, and trials of devices may be used to treat sialorrhea in PD, but few controlled trials have been published. This article reviews current knowledge regarding the frequency, etiology, assessment, and treatment of sialorrhea in PD. © 2007 Movement Disorder Society [source]

Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson's disease

MOVEMENT DISORDERS, Issue 13 2007
Yael Manor MA
Abstract Underreporting of swallowing disturbances by Parkinson's disease (PD) patients may lead to delay in diagnosis and treatment, alerting the physician to an existing dysphagia only after the first episode of aspiration pneumonia. We developed and validated a swallowing disturbance questionnaire (SDQ) for PD patients and compared its findings to an objective assessment. Fifty-seven PD patients (mean age 69 ± 10 years) participated in this study. Each patient was queried about experiencing swallowing disturbances and asked to complete a self-reported 15-item "yes/no" questionnaire on swallowing disturbances (24 replied "no"). All study patients underwent a physical/clinical swallowing evaluation by a speech pathologist and an otolaryngologist. The 33 patients who complained of swallowing disturbances also underwent fiberoptic endoscopyic evaluation of swallowing (FEES). According to the ROC test, the "optimal" score (where the sensitivity and specificity curves cross) is 11 (sensitivity 80.5%, specificity 81.3%). Using the SDQ questionnaire substantially reduced Type I errors (specifically, an existing swallowing problem missed by the selected cutoff point). On the basis of the SDQ assessment alone, 12 of the 24 (50%) noncomplaining patients would have been referred to further evaluation that they otherwise would not have undergone. The SDQ emerged as a validated tool to detect early dysphagia in PD patients. © 2007 Movement Disorder Society [source]

Marked diffuse dilations of the biliary tree associated with intrahepatic calculi, biliary sludges and a mucinous cyst of the pancreatic head in a 99-year-old woman

PATHOLOGY INTERNATIONAL, Issue 8 2003
Tadashi Terada
A 99-year-old woman was admitted to Shizuoka Shimizu Municipal Hospital because of fever and anasarca. Imaging and laboratory tests showed pneumonia, urinary tract infection, and cardiac failure. The patient died 20 days after admission. An autopsy revealed marked diffuse dilations of the biliary tree ranging from the lower common bile duct to intrahepatic bile ducts. Intrahepatic calcium bilirubinate stones and biliary sludges were recognized within the dilated bile ducts. A unilocular cyst (2 cm in diameter) was present in the pancreatic head adjacent to the lower common bile duct, and it appeared to compress the common bile duct. Histologically, the walls of the dilated biliary tree showed proliferation of peribiliary glands, fibrosis, and infiltration of lymphocytes and neutrophils (cholangitis). The lumens of the dilated biliary ducts contained neutral and acidic mucins, fibrinous materials, bacteria, neutrophils, and Aspergillus fungi, in addition to the calculi and sludges. The background liver showed atrophy (400 g). The pancreatic unilocular cyst was composed of mucous columnar cells with a few infoldings, and the pancreas also showed foci of mucinous duct hyperplasia and ectasia; the pathological diagnosis of the cyst was cystic dilations of a pancreatic duct branch (mucinous ductal ectasia or mucinous cyst). Other lesions included aspiration pneumonia, emaciation, atrophy of systemic organs, gastric leiomyoma, serous cystadenoma of the right ovary, and arteriosclerotic nephrosclerosis. The present case suggests that a mucinous cyst of the pancreas may compress the biliary tree and lead to marked diffuse dilations of the biliary tree. Alternatively, the dilations of the bile ducts may be associated with aging or may be of congenital origin. The dilated bile ducts may, in turn, give rise to bacterial and fungal cholangitis and formation of biliary sludges and intrahepatic calcium bilirubinate stones. [source]

Endoscopic Stapled Diverticulotomy: Treatment of Choice for Zenker's Diverticulum,

THE LARYNGOSCOPE, Issue 8 2000
Luke P. Philippsen MD
Abstract Objective To evaluate the efficacy and safety of endoscopic stapled diverticulotomy in the treatment of patients with Zenker's diverticulum. Study Design Cohort study. Methods Fourteen elderly patients (11 men and 3 women) with Zenker's diverticulum were evaluated in a community hospital setting from July 1996 to November 1999. Before surgery patients had significant dysphagia, regurgitation, cough, or aspiration pneumonia. The common septum between the diverticulum and cervical esophagus was visualized with a Weerda diverticuloscope. While using videoendoscopic monitoring, the septum was divided and the edges simultaneously sealed with a linear endoscopic stapler. Average operative time was 31 minutes. Results The operation was successfully performed in 11 of 14 patients. In the three unsuccessful cases, one patient's pouch was too small to staple and the other two patients had a septum that was difficult to visualize with the diverticuloscope. There was no significant postoperative morbidity or mortality. Patients started a liquid diet on the first postoperative day and resumed a soft diet a week later. They were usually discharged on the first postoperative day. Most patients reported significant improvement with resolution of dysphagia and regurgitation. Conclusions Compared with the traditional open technique, the endoscopic stapled diverticulotomy technique is safe, quick, and effective and requires a shorter length of stay in the hospital. Therefore it has become our treatment of choice for elderly, high-risk patients with a large (>2 cm) hypopharyngeal (Zenker's) diverticulum. [source]

Ultrafiltration and Dry Weight,What Are the Cardiovascular Effects?

ARTIFICIAL ORGANS, Issue 3 2003
Article first published online: 2 APR 200, Bernd G. Stegmayr
Abstract: Long-term prognosis in dialysis is poor compared to that in healthy control persons. A worsening of the prognosis is noted especially for patients who at initiation of dialysis have congestive heart failure, ischemic heart disease, or left ventricular dysfunction or hypertrophy. This is the main reason that cardiovascular causes are the most common for morbidity in these patients. The weight obtained when normal urine output is present is the dry weight. With reduced ability to excrete the volume by the kidneys in end-stage renal disease (ESRD), the body will retain water and the patient will gain weight. This extra weight is due to volume overload. While volume overload may induce a rise in blood pressure, if the heart is in acceptable condition, a fast removal of fluid by ultrafiltration (UF) during dialysis may instead cause hypotension. Ultrafiltration failure in peritoneal dialysis (PD) patients may lead to successive water retention and overhydration with subsequent cardiac failure, while volume overload may occur over a few days in hemodialysis (HD) patients. Anemia or even too-high hematocrit may impair cardiac function further and worsen conditions caused by wrong dry weight. Thus, during long-term and sustained volume overload, left ventricular (LV) hypertrophy will occur in an eccentric manner. A sustained overload then may lead to cell death and LV dilatation and, eventually, systolic dysfunction. Once a severe left ventricular dilatation has developed, the blood pressure may decrease during volume overload. A worsened prognosis is seen if malnutrition and low albumin levels are present. Volume overload necessitates ultrafiltration to achieve dry weight. Thereby, volume contraction contributes to exaggerated stimulation of or response to activation of the RAS and alpha-adrenergic sympathetic systems. If ultrafiltration goes beyond these compensatory mechanisms, hypotension will occur and increase the risk for hypoperfusion of vital organs. Such episodes may cause cardiac morbidity, aspiration pneumonia, vascular access closure, or neurological complications (seizures, cerebral infarction), besides a more rapid lowering of residual renal function. Preventive measures are, first, finding the right dry weight; second, minimizing interdialytic weight gain; third, optimizing the target for hemoglobin (110,120 g/l); fourth, lowering dialysate calcium (1.25 mmol/l); and fifth, eventually using higher dialysate potassium if long dialyses are performed. [source]

Tongue weakness is associated with respiratory failure in patients with severe Guillain-Barré syndrome

ACTA NEUROLOGICA SCANDINAVICA, Issue 6 2009
D. Orlikowski
Objective,,, Swallowing impairment may worsen respiratory weakness and conduct to respiratory complications such as aspiration pneumonia in Guillain-Barré syndrome (GBS). We prospectively evaluate how tongue weakness could be associated to bulbar dysfunction and respiratory weakness in severe GBS patients. Measurements and main results,,, Tongue strength, dysphagia and respiratory parameters were measured in 16 GBS patients at intensive care unit (ICU) admission and discharge and in seven controls. Tongue strength was decreased in the GBS patients compared with the controls. At admission, patients with dysphagia and those requiring mechanical ventilation (MV) had greater tongue weakness. All the patients with initial tongue strength <150 g required MV during ICU stay. Tongue strength correlated significantly with respiratory parameters. Conclusion,,, This study confirms the strong association between bulbar and respiratory dysfunction in GBS admitted to ICU. Tongue weakness may be present in GBS, especially during the phase of increasing paralysis, and resolves during the recovery phase. Tongue strength and indices of global and respiratory strength vary in parallel throughout the course of GBS. Further studies are needed to assess if, when used in combination with other respiratory tests, tongue strength measurement could contribute to identify patients at high risk for respiratory complications. [source]

Communicating oesophageal duplication cyst with heterotopic pancreatic tissue , an unusual cause of recurrent pneumonia in an infant

ACTA PAEDIATRICA, Issue 9 2010
Preena Uppal
Abstract Communicating oesophageal duplication cyst with heterotopic pancreatic tissue is rare congenital anomaly and unusual cause of recurrent pneumonia in children. We report a 10-month-old boy who presented with history, examination and investigations suggestive of aspiration pneumonia since birth. The imaging studies revealed a thin walled cavity communicating with the oesophageal lumen that was excised by surgery. Histopathology showed squamous epithelial lining of cyst with heterotopic pancreatic tissue. Conclusion:, Communicating oesophageal cyst causing persistent signs and symptoms can be an unusual cause of recurrent pneumonia in an infant that can be diagnosed by further imaging studies. [source]