Cases reported "Pneumonia, Aspiration"

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1/29. technetium tin colloid test detecting symptomless dysphagia and ACE inhibitor prevented occurrence of aspiration pneumonia.

    Symptomless dysphagia and swallowing disorders play a very important role in the pathogenesis of aspiration pneumonia. A videofluoroscopic examination and a simple two-step swallowing provocation test (STS-SPT) could be useful for detection of swallowing disorders in elderly patients with stroke, however, there is no report on such a test for detection of symptomless dysphagia. We administered 1 ml technetium Tin Colloid (99mTC) to the patient during sleep via a nasal catheter placed in the mouth. At 09:00 h the next day, symptomless dysphagia was checked for by imaging. Improvement of the symptomless dysphagia was observed, and thus we could prevent the occurrence of aspiration pneumonia. The 99mTC test was particularly useful in detecting symptomless dysphagia in elderly patients with stroke.
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2/29. Oculopharyngeal muscular dystrophy complicating airway management.

    Oculopharyngeal muscular dystrophy (OPMD) is an uncommon autosomal dominant disorder characterized by late onset and slow progression. Complications of OPMD include ptosis and progressive dysphagia leading to eventual malnutrition and aspiration. We report a rare case of OPMD complicating mechanical ventilator management following emergent surgery. OPMD and the resulting dysphagia contributed to multiple intubations, tracheostomy, aspiration pneumonia, and a prolonged hospital course. awareness of the possibility of OPMD in intubated patients with a history of dysphagia is crucial for avoidance of complications.
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3/29. Dynamic laryngotracheal closure for aspiration: a preliminary report.

    OBJECTIVES/HYPOTHESIS: An estimated 500,000 patients per year in the united states. are affected by stroke-related dysphagia. Approximately half experience aspiration, which can lead to pneumonia or death. Aspiration may result from many factors, including delayed transport of the bolus, faulty laryngeal elevation, and poor coordination or inappropriate timing of vocal cord closure. Interventions carried out to protect the lungs are usually irreversible, destructive to the upper airway, and rarely prevent the need for enteral tube feeding. STUDY DESIGN: We present a report of the first implantations of a new device in an FDA-approved study to restore dynamic laryngotracheal separation. Two stroke patients needing tracheostomy were selected based on chronic aspiration verified by clinical and radiologic criteria (modified barium swallow [MBS]). methods: The left recurrent laryngeal nerve was exposed and electrically stimulated to verify vocal fold adduction. Huntington Medical research Institute Bipolar Helical electrodes were then implanted around the nerve. The leads were tunneled and linked to a NeuroControl Implantable Receiver-Stimulator placed subcutaneously on the chest wall. Activation of the stimulator was performed through an external transmitter linked by induction. RESULTS: The device was successfully triggered intra- and postoperatively. Serial flexible fiberoptic endoscopies and MBS demonstrate that aspiration is systematically arrested using low levels of electrical stimulation (42 Hz, 48-100 microsec, 1 mA). DISCUSSION: This pioneering work has shown that aspiration can be controlled without airway damage for a wide population of neurologically impaired patients because it appears more physiological than standard therapies. CONCLUSION: Based on the first two patients, paced laryngotracheal separation is clinically effective in controlling aspiration.
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4/29. Surgical revision of dysfunctional colonic interposition after esophagoplasty.

    The redundancy and dysfunction of colonic interpositions is a recognized late complication of esophageal replacement, often occurring decades after the original surgery. A 34-year-old man, whose long-gap esophageal atresia was corrected as a child with large bowel interposition, presented with severe dysphagia and recurrent aspiration pneumonia. Imaging and endoscopy revealed a grossly abnormal and dysfunctional neo-esophagus. Symptoms were refractory to medical therapies, and necessitated occupational retirement on medical grounds. His case illustrates a successful surgical technique for correcting this complication.
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5/29. rehabilitation medicine: 2. diagnosis of dysphagia and its nutritional management for stroke patients.

    Following stroke, patients may have reduced dietary intake, swallowing impairments (dysphagia) and other neurological deficits that could affect their nutritional and hydration status and lead to aspiration pneumonia. Impaired nutritional status is associated with reduced functional improvement, increased complication rates and prolonged hospital stays. This article is aimed at primary care physicians and others caring for stroke patients. We discuss the need for assessing the nutritional status of stroke patients and provide strategies for the management of dysphagia and patients' food and fluid intakes. In addition, we review clinical and radiological options for the diagnosis of dysphagia as well as oral and enteral feeding alternatives.
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6/29. Gastrografin-induced aspiration pneumonia: a lethal complication of computed tomography.

    A 43-year-old man with dysphagia and a tendency to aspirate was found to have squamous cell carcinoma of the esophagus. Curative surgery was planned and preoperative computed tomography of the chest and abdomen was ordered. A ward nurse administered Gastrografin according to a "standing" order, 4 hours before the CT was to be done. The patient aspirated about 50 mL of Gastrografin, and went into cardiorespiratory arrest caused by pulmonary edema. He sustained severe brain damage and died. This is a first report of lethal aspiration of Gastrografin, given in preparation for CT. We advise alerting nurses who administer Gastrografin, especially to patients with dysphagia or impaired consciousness about the grave consequences that can result if the contrast agent is aspirated by the patient. We further advise that responsibility for using contrast agents in radiologic procedures be assumed by the radiologist and not by medical house staff.
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keywords = dysphagia
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7/29. Massive aspiration of barium sulfate during an upper gastrointestinal examination in a child with dysphagia.

    barium sulfate is an agent used widely as a contrast material for imaging studies of the gastrointestinal tract and is not inherently toxic to lung tissue. Aspiration of barium sulfate has been reported on rare occasions, but is more frequently seen in patients with underlying anatomical or neurological defects such as head and neck deformity, esophageal stricture, diverticulum or fistula. We report a previously healthy child suffered from massive aspiration of barium sulfate during the investigation of dysphagia due to an impacted foreign body in the esophagus. Massive aspiration of barium sulfate is potentially life-threatening because of mechanical interference with gas exchange. An obstruction of the esophagus should be considered in the differential diagnosis for children with acute dysphagia and barium contrast should be used with great care in such instance.
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8/29. An unusual cause of aspiration pneumonia.

    We report a case of aspiration admitted to our rehabilitation unit in a patient with dysphagia due to diffuse idiopathic skeletal hyperostosis or Forestier's disease of the cervical spine, in whom an episode of pneumonia had occurred. Clinical and instrumental findings, including radiography of the spine, (CT Scan) and videofluoroscopy, confirmed the diagnosis. The dysphagia was hypothesized to be due to mechanical compression and inflammatory changes, accompanied by fibrosis in the esophagus wall. The aspiration pneumonia probably had multifactorial etiology: dysphagia, abnormal cough reflex, colonization of the oropharynx by virulent bacteria, etc. No aspiration pneumonia occurred after medical treatment and rehabilitation had been started. We review the medical literature on this unusual cause of aspiration pneumonia.
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9/29. Treatment of intractable aspiration using a laryngeal stent or obturator.

    Twenty-five patients were treated with a laryngeal stent for potentially reversible chronic aspiration of life-threatening magnitude. The causes of the intractable aspiration were diverse and included chronic neurologic disease, extensive head and neck surgery, and severe gastroesophageal reflux. The advantages of this technique are noted in comparison to those of more invasive procedures. Disadvantages of the laryngeal stent and complications encountered are also covered. The long-term results show that all but one patient had a significant improvement in their chronic aspiration with the stent in place. However, only eight patients achieved adequate oral deglutition without aspiration following stent removal.
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keywords = deglutition
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10/29. Aspiration pneumonia due to diffuse cervical hyperostosis.

    Diffuse idiopathic skeletal hyperostosis previously has been reported to cause a number of extraspinal manifestations including dysphagia, respiratory distress, dysphonia and cervical myelopathy. We report a case of cervical DISH so extensive as to interfere with the swallowing mechanism and lead to aspiration. patients with DISH who have mechanical compression of the posterior pharynx may be at high risk for aspiration.
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