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PubMed1991

Aspiration pneumonia.

The clinical presentation and course of chemical pneumonitis after inhalation of gastric contents ranges from mild and self-limited to severe and life-threatening, depending on the nature of the aspirate and the underlying condition of the host. In the absence of witnessed inhalation of vomit, diagnosis is difficult and requires a high index of suspicion in a patient who has risk factors for aspiration. In the absence of an obvious predisposition, the abrupt onset of a self-limited illness characterized by dyspnea, cyanosis, and low-grade fever associated with diffuse rales, hypoxemia, and alveolar infiltrates in dependent lobes should suggest aspiration. Treatment consists of supportive care with high-flow oxygen and volume replacement. Bacteria usually play no role in the initial lung injury, and antibiotics should be withheld until there is evidence of superinfection. Prophylactic corticosteroids should not be used. Preventive measures should be employed in patients at high risk for aspiration. Patients with unexplained chronic respiratory syndromes should be evaluated for gastric regurgitation and aspiration.

Humans↗

PubMed1989

Does gastrostomy and fundoplication prevent aspiration pneumonia in mentally retarded persons?

To determine whether gastrostomy and fundoplication prevent aspiration pneumonia in mentally retarded individuals, 105 cases of feeding gastrostomy were examined; 21 subjects had preoperatively diagnosed gastroesophageal reflux. Thirty-nine patients had gastrostomy and fundoplication, 66 patients had gastrostomy alone, and 60 subjects had had aspiration pneumonia before surgery. Recurrent aspiration pneumonia was least in those without preoperative gastroesophageal reflux and who had gastrostomy and fundoplication. Feeding gastrostomy does not prevent aspiration pneumonia. Gastrostomy with fundoplication reduces the likelihood of aspiration pneumonia but still allows a significant number to develop it.

Adolescent↗

PubMed1989

Aspiration pneumonia in nursing home patients fed via gastrostomy tubes.

Aspiration pneumonia is among the most serious complication of gastrostomy tube feedings. However, few data are available from the nursing home setting where tube feedings are used for extended periods. We reviewed 109 nursing facility charts in order to determine the incidence of, and risk factors for, aspiration pneumonia: 22.9% of gastrostomy tube-fed patients aspirated. A history of recent previous pneumonia was found in 40.7% of those who subsequently developed aspiration pneumonia. This was the only risk factor related (p less than 0.05) to subsequent aspiration pneumonia. No association was found with age, mental status, or the method of enteral formula administration (continuous vs. intermittent infusion). We conclude that patients with a previous history of pneumonia are a high risk group in which alternative forms of enteral alimentation (i.e., jejunostomy feedings) should be explored.

Age Factors↗

PubMed1989

[Infection--clinico-pathological profile of diffuse aspiration bronchiolitis (DAB)].

In order to investigate the clinico-pathological profile of the inflammatory disease of the intermediate zone of broncho-pulmonary system, a retrospective study was conducted in consecutively autopsied cases at Tokyo University Hospital (n = 495) and Tokyo Metropolitan Geriatrics Center Hospital (n = 1178). We analyzed clinical findings, laboratory tests, pulmonary function tests and chest roentgenograms. In addition, morphologic changes were assessed semiquantitatively as to the grade as well as the localization of inflammation in the lungs. Aspiration pulmonary diseases were found in 7% of all autopsied cases and diffuse aspiration bronchiolitis (DAB) was observed in 16% (1% of all cases). Macroscopic findings of DAB in an autopsied lung were similar to those found in diffuse panbronchiolitis (DPB). The clinical symptoms and tests were, however, a complex mixture of DPB and aspiration pneumonia. As a result, differential diagnosis of bronchial asthma in the elderly among aspiration pulmonary diseases seemed crucial for the proper management of DAB. Histologic findings of DAB were characterized by more predominant localization of inflammation in bronchioli and the invariable presence of foreign body or related giant cells in this region of the lungs. In view of these findings, the occurrence of DAB might be related to recurrent aspiration of small amounts with superimposed infection of the airways.

Aged↗

PubMed1989

Educational and career aspirations of secondary school students in Grenada following the American intervention.

This paper reports a study of educational and occupational aspirations of secondary school students in Grenada following the 1983 American intervention. Questionnaire data were obtained from 729 students attending 7 of the island's 18 secondary schools. A status attainment model containing parental and family characteristics was tested. It was discovered that Grenadian students have exceptionally and unrealistically high aspirations. Although the opportunity structure in Grenada is very limited compared to that in the United States, the island's students have higher levels of aspirations. The status attainment model was not very useful in explaining either educational or occupational aspirations, as the levels of explained variance were less than 5%. The implications of high aspirations and low opportunities for the future of Grenada are discussed.

Achievement↗

PubMed1987

Aspiration after percutaneous gastrostomy. Assessment by Tc-99m labeling of the enteral feed.

Aspiration pneumonia, a recognized complication of enteral feeding via a nasogastric tube, is considered uncommon with percutaneously placed gastrostomy tube feeding. We report aspiration pneumonia during enteral alimentation in a neurologically compromised but conscious patient. Aspiration continued despite changing the route of enteral feeding from nasogastric to percutaneous gastrostomy. Quantitative scintigraphic studies with Tc-99m-labeled enteral infusion demonstrated frequent episodes of gastroesophageal reflux and aspiration of gastric contents, which increased when the infusion rate was speeded up for nutritional replacement. Gastric retention also occurred at the higher infusion rate. Thus, percutaneous gastrostomy may not decrease the frequency of aspiration in patients at risk.

Adult↗

PubMed1985

Aspiration of oral contents in Parkinson's disease. A case report.

A patient with Parkinson's disease developed a non-ketotic hyperosmolar diabetic coma precipitated by chest infection. Initial improvement from treatment with intravenous insulin, ampicillin and fluid therapies was followed by severe deterioration and hypovolaemic shock. Further improvement occurred only when therapy directed against Gram-negative sepsis was added. A barium examination later demonstrated aspiration of oral contents with pulmonary soilage. The differences between the easily recognized early fulminating 'aspiration syndrome' caused by aspiration of gastric contents of low pH and the aspiration of oral contents, which may remain occult for many hours, is highlighted. Life-threatening Gram-negative or anaerobic infection may then occur but remain undiagnosed because the original aspiration of foreign material is unsuspected.

Diabetic Coma↗

PubMed1995

[Analysis and radiologic staging of the type and severity of aspiration].

The estimated number of the incidence of undiagnosed chronic aspiration pneumonia after cerebral or cerebrovascular injury seems very high. According to American statistics, at least 6% of these patients die from aspiration pneumonia within the first year. The high temporal resolution of cineradiography with frame rates of the complex process of pharyngeal swallowing lasting 0.7 s. The method enables us to differentiate between so-called pre-, intra- and postdeglutitive aspiration, which means aspiration before, during and after the triggering of the swallowing reflex. Together with an established score for the severeness of the aspiration, the method supplies important data for setting up a functional surgical and/or conservative program for rehabilitation and for follow-up-studies.

Barium Sulfate↗

PubMed1993

Aspiration in acute stroke: a clinical study with videofluoroscopy.

To assess the incidence of lung aspiration in acute stroke, and attempt to identify factors which render such patients at risk of aspiration, consecutive patients admitted to hospital within 24 h of their first symptomatic stroke were studied prospectively. Sixty patients who were conscious, and who did not have any preceding neurological or other cause of dysphagia, were assessed clinically and underwent a bedside water-swallowing test and videofluoroscopy within 72 h of stroke. Twenty-five patients (42%) were seen to aspirate at videofluoroscopy; of these 20% did not have overt dysphagia as detected by a simple water-swallowing test. Factors found to be significantly associated with aspiration were reduced pharyngeal sensation, dysphagia and stroke severity. Aspiration is common in the early period following acute stroke; disordered pharyngeal sensation is an important concomitant of this and should be carefully tested in each patient admitted with acute stroke.

Aged↗

PubMed1993

[Aspiration pneumonia].

Pulmonary aspiration of stomach contents is a common clinical problem. Symptoms and consequences depend on the aspired volume, the pH and the content of food particles and bacteria. There are two phases following an aspiration of stomach contents into the lungs. The first phase is nonspecific and begins a few minutes after the aspiration. This phase is due to the chemical injury. The second phase is an inflammatory reaction. The reaction is haemorrhagic, granulocytic and necrotizing when the aspirate is acid (pH < 2.5). The presence of food particles causes granulomas. The immunological reactions are biphasic as well. The bacterial infection is mainly secondary to the chemical inflammation and occurs with an infection rate of 25-50%. The optimum management is symptomatic and should entail immediate endotracheal suction, aggressive ventilatory support with supplemental oxygen, CPAP or PEEP if indicated by clinical assessment and blood gas measurements, adequate fluid replacement and antibiotics if there is evidence of bacterial infection.

Humans↗

PubMed1993

Risk and outcome of aspiration pneumonia in a city hospital.

Because aspiration pneumonia contributes significantly to morbidity and mortality in hospitalized patients, this study was undertaken to identify risk factors for morbidity and mortality associated with aspiration pneumonia. Patients with a discharge diagnosis of aspiration pneumonia in 1985 and 1990 were studied. Factors associated with death from aspiration pneumonia were: altered mental status, cerebrovascular accident, endotracheal intubation, tachycardia, and hypoxemia. Fever, cough, and unilateral infiltrates on chest radiograph were associated with survival. Attention to proper positioning of comatose patients, aggressive treatment of gastroesophageal reflux, and strict attention to endotracheal tubes and tracheostomies should decrease the morbidity and mortality associated with aspiration pneumonia.

Adult↗

PubMed1993

Leukocytes mediate acid aspiration-induced multiorgan edema.

BACKGROUND: Acid aspiration leads to lung injury characterized by polymorphonuclear neutrophil leukocytes (PMN) sequestration and edema. This study investigates whether localized acid aspiration leads to activation of circulating PMN and triggers both local and remote PMN sequestration and whether these cells are responsible for increase in pulmonary permeability and systemic organ edema. METHODS: Rats pretreated with intravenous saline solution or rendered neutropenic (nitrogen mustard or antineutrophil serum) underwent tracheostomy and insertion of a cannula into a lung segment. This was followed by instillation of either 0.1 N HCl or saline solution. RESULTS: After 30 minutes leukopenia was noted (2650 white blood cells/mm3) in saline-treated, acid-lavaged rats, and circulating PMN produced H2O2 (20 femtomole dichlorofluorescein/PMN compared with 3 femtomole in control animals (both, p < 0.05). PMN were progressively sequestered in the nonaspirated lung, the heart, and kidney. Permeability and edema developed in the lungs and systemic organs. In neutropenic rats there was a reduction of aspiration-induced thromboxane B2 and leukotriene B4 synthesis (p < 0.05), decrease in lung wet to dry weight and protein level in bronchoalveolar lavage of the aspirated and nonaspirated lungs, and reduction in myeloperoxidase activity in the heart and kidney and in wet to dry weight of these organs (all, p < 0.05). CONCLUSIONS: These data indicate that localized acid aspiration activates circulating neutrophils and promotes their sequestration in the lungs and systemic organs. These cells are largely responsible for the multisystem organ edema.

Animals↗

PubMed1997

[Pulmonary aspiration in children. Quantification of lipid laden alveolar macrophages].

BACKGROUND: The search for lipid laden macrophages in sputum could be a simple diagnosis method for pulmonary aspiration. AIM: To assess the usefulness of sputum lipid laden macrophages in the diagnosis of pulmonary aspiration. PATIENTS AND METHODS: Sixteen children aged 0 to 4 years old, admitted with aspiration pneumonia were studied. The diagnosis was based on clinical grounds (vomiting or radiologically diagnosed swallowing abnormalities plus persistent pulmonary condensations) or radionucleide milk scanning. As controls, 6 children of 1 to 5 years old, admitted for elective tonsillectomy, were studied. Sputum was stained with Sudan III-Hematoxylin, 100 macrophages were read and each cell received a score from 0 to 4 according to the degree of staining. RESULTS: Lipid laden macrophages of children with aspiration pneumonia had a mean score of 150 +/- 107 (8-323) compared with those of controls that had a score of 1.3 +/- 1.5 (0-4). CONCLUSION: The study of sputum lipid laden macrophages may be a useful diagnostic method for aspiration pneumonia.

Child, Preschool↗

PubMed1990

Gastrointestinal tract hemorrhage. The value of a nasogastric aspirate.

A bloody nasogastric aspirate is believed to imply active upper gastrointestinal tract bleeding, while a nonbloody yellow-green nasogastric aspirate that contains duodenal secretions suggests the absence of bleeding proximal to the ligament of Treitz. To validate these beliefs, physicians were asked to predict the presence of active gastrointestinal tract bleeding and whether bile was present in a nasogastric aspirate obtained immediately before endoscopy in 73 episodes of bleeding in 62 patients. A relationship was found between the physician's assessment of the presence of active bleeding demonstrated endoscopically and the appearance of the nasogastric aspirate. However, the sensitivity and specificity were low (79% and 55%, respectively). No association between the assessment of bile in the nasogastric aspirate and the presence of bile acids was demonstrated. These data do not support the placement of a nasogastric tube to determine whether or not a patient is bleeding, the location of the bleeding, and whether endoscopy should be performed.

Bile↗

PubMed2003

Pulmonary aspiration of nasal secretions in patients with chronic sinusitis and asthma.

BACKGROUND: The role of silent aspiration of nasal secretions in the pathogenesis of asthma has often been questioned. OBJECTIVE: To investigate the presence of pulmonary aspiration of nasal secretions during sleep in patients with chronic sinusitis and asthma and in healthy controls. DESIGN: Prospective, controlled trial. SUBJECTS: The study included 13 patients with chronic sinusitis and asthma and 12 healthy controls. The diagnoses were based on history, physical examination findings, radiologic assessments, and pulmonary function test results. INTERVENTIONS: A radioactive tracer was prepared by diluting 10 mCi of technetium 99m-labeled macroaggregated albumin in 10 mL of physiologic saline. At 10 PM, just before the patients went to sleep, the solution was sprayed into their nostrils. The subjects were examined with a gamma camera to obtain views of the thorax at 8 AM the following morning. The average counts of the lungs and background and the actual lung counts (average lung count minus average background count) were determined. RESULTS: The average counts of the lungs were significantly greater than the average counts of the background in both the sinusitis-asthma group (P =.001) and the control group (P =.002). The difference in the actual counts of the lungs was not significant between the 2 groups (P =.79). CONCLUSIONS: The nasal secretions were aspirated into the lungs both in patients with sinusitis and asthma and in healthy adults during sleep, and the relative amounts that were aspirated did not differ significantly between the 2 groups (P =.79). The amount of the aspirated material alone is probably not responsible for the pathogenesis of asthma in patients with chronic sinusitis.

Asthma↗

PubMed1983

Fine-needle aspiration in squamous cell carcinoma of the head and neck.

Cytological examination of fine-needle aspiration (FNA) specimens from patients with known or suspected squamous cell carcinoma of the head and neck at the University of Virginia, Charlottesville, between 1979 and 1982 was reviewed. Of 229 aspirates, 187 were of cervical or submandibular sites and 42 were of oral cavity sites. The accuracy of cytological diagnoses was determined by histological comparison and clinical follow-up. There were no false-positive aspirates (specificity, 100%) and one false-negative aspirate (sensitivity, 99%). Twenty-one (9%) contained insufficient cellular material for adequate cytological diagnosis. Seventy-eight percent of histologically confirmed aspirations were malignant. Proper use requires close communication between an experienced cytologist and a head and neck surgeon knowledgeable in the indications and limitations of the technique. This study demonstrates that FNA is a highly accurate, safe, predictive, and valuable technique in the management of squamous cell carcinoma of the head and neck.

Adult↗

PubMed1989

Interobserver variability in the interpretation of fine-needle aspiration biopsy of head and neck masses.

Fine-needle aspiration biopsy is gaining acceptance as a clinically useful tool. We set out to evaluate the accuracy of fine-needle aspiration biopsy at our institution by measuring the interobserver variability in cytopathologic interpretation, and by measuring the agreement between cytopathologic and histologic diagnosis. In a prospective study, 253 aspirations were performed on head and neck masses by the otolaryngology service. Specimens were interpreted independently by two cytopathologists (V.J.S. and P.Z.), and interpretations were compared with the surgical histopathologic diagnosis when available. The interobserver variability between cytopathologists was 8% with a specificity of 96% and a sensitivity of 97%. We conclude that fine-needle aspiration biopsy is a safe and useful tool in the diagnosis of head and neck masses. In the diagnosis of epithelial cysts and squamous epithelial malignancies, fine-needle aspiration biopsy is as accurate as open biopsy.

Biopsy, Needle↗

PubMed1997

Fibromatosis colli. The utility of fine-needle aspiration in diagnosis.

BACKGROUND: Fibromatosis colli (FC), also known as sternocleidomastoid tumor of infancy, is a benign spindle cell lesion of the sternocleidomastoid muscle. It usually is seen in the first few weeks of life and is the most common cause of a neck mass in the perinatal period. Although FC may lead to congenital muscular torticollis requiring surgical intervention, if the diagnosis of FC is certain, the usual initial treatment option is conservative management. OBJECTIVE: To show the utility of fine-needle aspiration in the diagnosis of FC. PATIENTS: Five cases in which fine-needle aspiration was used in the evaluation of patients with FC were identified retrospectively by a search of the cytopathology files of the State University of New York Health Science Center at Syracuse and the Virginia Commonwealth University, Medical College of Virginia, Richmond. RESULTS: Fine-needle aspiration yielded an initial diagnosis of FC in 4 of the 5 cases. Smears made from the aspirated material were of low cellularity, but showed a characteristic population of spindle-cell fibroblasts. In addition to these fibroblasts, a variable amount of degenerating skeletal muscle was present in the background. CONCLUSION: With the collaborative efforts of otolaryngologists and pathologists, fine-needle aspiration can be used to confirm a clinical diagnosis of FC while avoiding the expense and risk of open biopsy.

Adult↗