1/9. The child with persistent cough.Coughing is a healthy reflex. Causes of a cough can vary from minor upper respiratory illnesses to malignancy. When a child's cough continues for weeks, parents worry. Primary care providers must decide when reassessment is needed and if a vigorous workup and referral to a pulmonologist are required. The above discussion should assist these physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Gavaging the infant lung.An 8-month-old female infant was hospitalized for persistent bilateral infiltrates, failure to thrive, and tachypnea. An extensive diagnostic workup was negative, except for strong oil-red O staining of the white-turbid bronchoalveolar lavage fluid and borderline esophageal ph monitoring. Conservative treatment failed, and she was scheduled for gastrostomy and Nissen-fundoplication until the family physician found that the anxious mother was feeding the child forcibly, which caused chronic aspiration pneumonitis. The mother was given psychological support and was supervised, and the child recovered completely.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Pediatric sand aspiration: case report and literature review.Sand aspiration is a rare but life-threatening event that occurs in the pediatric and adult populations after cave-ins or near drownings. We report the case of a 10-year-old boy who suffered from aspiration of particulate matter after being buried in sand. In addition, we performed a literature review regarding similar cases and their treatment of aspiration of significant amounts of particulate matter. Treatment of the victims ranges from conservative to very aggressive. The treatment employed is dictated by the patient's current condition and the services available to the physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. 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.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. An unusual way of tracheal stoma cleaning could end up with foreign body aspiration in a laryngectomized patient.We report a case of a laryngectomized patient who accidentally aspirated a wooden stick through his tracheal stoma in highly unusual circumstances. He was in a habit of cleaning secretions of upper airway with a wooden stick covered with cotton on the tip soaked in olive oil, via tracheostomy. After applying topical aerolized lidocaine spray through the tracheostomy stoma a flexible video-brochoscopy was performed and a tree twig over 11 cm in length was removed. The patient's symptoms were resolved by a bronchoscopy. With experience and availability of accessories, the removal of the foreign body using flexible bronchoscope under local anesthesia can be performed safely and successfully. This case suggests that the physicians and otolaryngologists should educate their laryngectomized patients about stomal care and discuss any potential life-threatening situation they might encounter.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. Lipoid pneumonia: a preventable complication.BACKGROUND: Lipoid pneumonia is a pneumonitis resulting from the aspiration of lipids, and is commonly associated with the use of mineral oil as a laxative. LP is relatively unfamiliar to clinicians and is probably underdiagnosed. OBJECTIVES: To increase physicians' awareness of LP, its diagnosis and prevention. methods: We present two illustrative cases of LP and review the literature. RESULTS: Two cases of LP were diagnosed within half a year in an internal medicine ward. Both cases were elderly patients, and LP was associated with the use of mineral oil as a laxative agent. Computerized tomography revealed bilateral low attenuation infiltrates, associated with a "crazy paving" pattern in one case. sudan Black staining was diagnostic in both cases--in one on a transbronchial biopsy specimen, and in the other on sputum cytologic examination. Both patients suffered from neurologic diseases and were at risk of aspiration. In both cases clinical symptoms and signs continued for several months prior to diagnosis but resolved after the mineral oil was discontinued. CONCLUSIONS: LP often occurs in elderly patients who are at risk of aspiration. The condition may be underdiagnosed. Since in most cases mineral oil cathartics are the causative agent, an effort at primary prevention is indicated. It is suggested that the licensing of mineral oil for internal use be changed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Foreign body aspiration in the adult: an occult cause of chronic pulmonary symptoms.We describe two otherwise healthy subjects with many years sequelae due to lung aspiration. In both, diagnosis was delayed due to lack of history of aspiration. Recurrent pneumonia in the same segment in one, and migratory pneumonia in the other, could have suggested the diagnosis. review of the literature shows that occult foreign body aspiration poses difficulties in diagnosis and that often a history of aspiration is lacking. However, the recurrent nature and the localization of the pneumonia, as well as the findings during bronchoscopy, should alert the physician to the possibility of foreign body aspiration.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. Lipoid pneumonia secondary to baby oil aspiration: a case report and review of the literature.Baby oil is a common household product that is frequently used when there are infants or toddlers in the house. However, it is often overlooked as a potential source of danger to these youngsters. In 1983, 36,700 cases of ingestion were reported to the poisoning surveillance and epidemiology branch of the food and Drug Administration. Topical preparations used in the care of infants accounted for 480 of the cases. Ten percent of these required hospitalization. In 36 cases, the product ingested was baby oil. This figure does not include baby lotions and other skin products with a mineral oil base. Aspiration of mineral oil, the main component of baby oil, has been described as a cause of lipoid pneumonia and oleomas. However, there is very little information in the modern literature concerning acute lipoid pneumonitis in children. We herein present a patient with lipoid pneumonia caused by aspirated baby oil, who followed a severe clinical course. The paucity of information regarding this subject points to the need for increased public and physician awareness of the problem and for their direct participation in the prevention of this potentially fatal condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Neonatal vocal cord paralysis.The consultants agree that surgery is a common cause of unilateral vocal cord paralysis in neonates. In the absence of a history of surgery, they would evaluate a neonate for cardiovascular or central nervous system anomalies. None believes a relationship between laryngomalacia and vocal cord paralysis exists. But there is disagreement regarding the additional steps required to evaluate this child. The recommendations include endoscopy under general anesthesia with assessment of cricoarytenoid mobility, evaluation for other congenital anomalies, and observation of laryngeal dynamics (Dr. Benjamin), neurologic examination (Dr. Bailey), and no further testing (Dr. Gray). Laryngeal EMG in an infant is not an established technique and none of the consultants routinely performs this test. However, EMGs are part of the research protocol for one physician (Dr. Gray). The consensus is that aspiration is unlikely to be a problem in this case. However, if aspiration does occur, all would recommend conservative treatment. Feedings should be thickened and anti-reflux precautions taken. None was convinced that severe aspiration would be a problem. However, given the need for more aggressive treatment, the considerations would include collagen or Teflon injections or a tracheotomy (Dr. Gray) or a Nissen fundoplication, nasogastric tube feedings, or a gastrostomy (Dr. Bailey). Only one consultant would defer further treatment (Dr. Benjamin). The prognosis is generally good. Two consultants (Drs. Benjamin and Bailey) would follow a child with vocal cord paralysis by periodically repeating a laryngoscopic examination. A reinnervation procedure would be considered by one consultant at the age of 3 if the voice remains weak (Dr. Gray).- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |