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PubMed2000

Lymphadenopathy in children and adolescents: role of fine-needle aspiration in management.

This study was undertaken to assess the role of fine-needle aspiration biopsy in the evaluation of palpable peripheral lymphadenopathy in pediatric and adolescent patients. A 15-year experience in aspiration of patients younger than age 21 was reviewed. These cases were taken from four large university hospitals and clinics. Data included clinical information, anatomic site, cytologic diagnosis, and any follow-up surgical excision at these institutions. From a total of 1,302 lymph node fine-needle aspirates, a subset of 106 aspirates from patients 21 years or younger was selected. This group formed the basis for this study, and these aspirates were obtained from 103 patients. Most of these aspirates (88.7%) were from the head and neck; 11 were from sites other than head and neck; and the site was not stated in one case. One hundred and one of the aspirates produced adequate samples, and only five (4.72%) were unsatisfactory. Of the 106 fine-needle aspirates, 88 (83.0%) were diagnosed as negative for malignancy, five (4.7%) were inconclusive, and three (2.8%) were interpreted as suspicious but not diagnostic of malignancy. Five cases (4.7%) were diagnosed as positive for malignancy, including two cases of metastatic papillary carcinoma of the thyroid, two cases of Hodgkin's disease, and a single case of high-grade non-Hodgkin's lymphoma. No false-positive or false-negative diagnoses occurred, excluding the aspirates classified as inconclusive or suspicious but not diagnostic of malignancy (six cases). Results of aspirates from near adolescent and adolescent patients (ages 11-21 years) were compared with those of younger pediatric patients (age < 10 years). Eighty-one (76%) of the 106 aspirates were obtained from the older group. The percentage of unsatisfactory specimens was smaller and the percentage of inconclusive or suspicious or malignant diagnoses was greater in the older group. Fine-needle aspiration biopsy is reliable in the evaluation of palpable peripheral lymphadenopathy. As most fine-needle aspirates in children and adolescents proved to indicate benign reactive conditions that failed to respond to antibiotics rather than proving to be malignant tumors, we advocate a larger role for the fine-needle aspiration biopsy technique in the evaluation of peripheral lymphadenopathy in this age group. Its early use can direct further testing, saving time, expense, and morbidity for the patient and reducing anxiety for the parents.

Adolescent↗

PubMed1996

Pulmonary aspiration in a long-term care setting: clinical and laboratory observations and an analysis of risk factors.

OBJECTIVE: To determine the incidence and risk factors associated with aspiration in a high risk group in a long-term care setting. DESIGN: A prospective study of demographic, nutritional, clinical, dental, and survival characteristics in 69 patients who suffered 98 aspirations events from May 1, 1990, to December 31, 1990. Demographic and nutritional data from 192 patients who did not aspirate were collected from September 1991 to December 1991. SETTING: A long-term care VA facility. PATIENTS: Long-term care residents, most of whom were neurologically debilitated. MEASUREMENTS: The incidence of aspiration was measured and the clinical and microbiological characteristics of aspiration-associated nosocomial pneumonia described. Mortality and demographic, clinical, and nutritional characteristics were compared between patients who aspirated and those who did not. MAIN RESULTS: Twenty-five percent of the study group aspirated during the 8-month observational period, and 56% of the aspiration events progressed to roentgenographically proven cases of nosocomial pneumonia. Six bacteremic episodes were documented, and results of sputum cultures were consistent with mixed Gram-positive and Gram-negative infections. During the study period, patients who aspirated were at three times the risk of dying compared with patients who did not aspirate. Three years later, only 17% of the original group of patients who aspirated were still alive compared with 60% of the patients who had not aspirated. Multivariate analysis identified tube feeding, presence of a hyperextended neck or contractions, malnutrition, and the use of benzodiazepines and anticholinergics as risk factors. CONCLUSIONS: Pulmonary aspiration is a common and serious event in neurologically impaired long-term care patients. Some risk factors are amenable to change.

Aged↗

PubMed1983

The effect of amniotic fluid aspiration on pulmonary function in the adult and newborn rabbit.

Aspiration of uncontaminated human amniotic fluid was investigated in adult and newborn rabbits and compared with three other experimental groups: 10% meconium solution, saline, and sham-injected controls. Fluids were injected into the trachea of adult animals (4 or 6 ml/kg body weight), newborn vaginally-delivered animals (a mean volume of 8 ml/kg), and cesarean-delivered animals before their first breath (a mean volume of 11 ml/kg). In adult animals aspirating amniotic fluid or saline, arterial PO2 measured over a 24-h period showed a mean difference between groups of less than 5% for both 4 and 6 ml/kg. Meconium aspiration produced a greater depression in PO2 than amniotic fluid aspiration (a mean difference of 16 and 31% for 4 and 6 ml/kg, respectively) and animals aspirating meconium showed a deteriorating trend over 24 h, whereas animals aspirating amniotic fluid improved. One of eight adult animals aspirating amniotic fluid died versus four of five aspirating meconium. All five animals aspirating saline 6 ml/kg survived. Lung weight and resting volume of adult animals aspirating amniotic fluid were not significantly different from animals aspirating saline or nothing. Lung pressure volume curves from adult animals aspirating amniotic fluid were nearly identical to controls. Histology showed significantly greater atelectasis in adult animals that received 6 ml/kg amniotic fluid than controls, but this was not different from saline. There was no association between the number of cells in amniotic fluid and arterial PO2 after aspiration or any other aspect of pulmonary function measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Amniotic Fluid↗

PubMed1996

Role of immunocytochemistry, electron microscopy, and DNA analysis in fine-needle aspiration biopsy diagnosis of Wilms' tumor.

We reviewed the cytologic features and results of ancillary studies in eight fine-needle aspiration biopsies (FNAB) performed by posterior approach in 8 patients with unresectable Wilms' tumor (WT). Chemotherapy was given following the FNAB diagnosis of WT, which was confirmed subsequently by histologic examination of surgically resected specimens. Indications for FNAB included: unresectable tumor, bilateral disease, initial presentation with metastatic disease, uncertainty regarding tumor site, and documentation of recurrence. Cytologic examination revealed blastemal cells (8/8 aspirates), spindle cells (3/8 aspirates), and epithelial differentiation or tubules (3/8 aspirates). There was no cytologic evidence of anaplasia in any of the cases. Immunocytochemical studies on cell blocks and/or smears showed cytokeratin positivity in 5/8 and vimentin positivity in 5/5 of the aspirates in which these studies were performed. Focal positivity for neuron-specific enolase (NSE) was seen in 3/3 aspirates. Stains for actin and leukocyte-common antigen were negative (0/3 and 0/2 aspirates, respectively). DNA ploidy analysis of the aspiration material by flow cytometry revealed near-diploid populations in three aspirates. Electron microscopic findings helpful for diagnosis included: cell junctions, microvilli, flocculent basement membrane-like material, cilia, autophagolysosomes, and lack of neuroectodermal differentiation. Diagnostic morphologic pitfalls for an incorrect diagnosis of neuroblastoma included nuclear molding (all aspirates), pseudorosette formation (one aspirate), and focal NSE positivity (3/3 aspirates). None of the tumors showed anaplasia on histologic examination. Cytologic recognition of the triphasic cellular components of WT (blastemal cells, spindle cells, and epithelial cells) can be helpful for a correct diagnosis; however, in 5/8 aspirates in this study, only the blastemal component was present. In these cases, immunocytochemical stains and electron microscopy proved useful in arriving at a correct FNAB diagnosis of WT. However, NSE positivity can be a pitfall for a diagnosis of neuroblastoma if the radiologic, clinical, and other cytologic features are not clearly delineated. Presence of cytokeratin and vimentin positivity would be helpful in the diagnosis of WT in such instances.

Biopsy, Needle↗

PubMed2004

'Atypical' and 'suspicious' diagnoses in breast aspiration cytology.

BACKGROUND: In 1996, the National Cancer Institute (NCI) recommended five categories for the diagnosis of breast aspiration cytology: benign, atypical, suspicious, malignant, and unsatisfactory. The authors evaluated the usefulness of separating inconclusive diagnoses into the aforementioned atypical and suspicious categories. The current study examined the correlation between cytologic and histologic findings made in breast aspiration cytology specimens that were categorized in accordance with these NCI guidelines. METHODS: From 1992 to 2000, 7727 breast aspirations were performed at the University of Miami/Jackson Memorial Medical Center (Miami, FL). Aspirates were classified using criteria similar to the NCI recommendations. Four hundred eighty-nine aspirates (6%) were classified as being cytologically 'atypical' or 'suspicious'. Of those, 225 'atypical' aspirates and 162 'suspicious' aspirates had available histologic follow-up data and were included in the study. RESULTS: Among the 'atypical' aspirates, 118 (52%) yielded malignant findings on histologic evaluation. Infiltrating ductal carcinoma (n = 87; 74%) was the most common malignant diagnosis, followed by infiltrating lobular carcinoma (n = 12; 10%). Among 'suspicious' aspirates, 135 (83%) yielded malignant findings on histologic analysis. The most common benign diagnosis in both 'atypical' and 'suspicious' aspirates was proliferative fibrocystic changes with or without atypia, followed by fibroadenoma. CONCLUSIONS: Most aspirates that yielded suspicious findings on cytologic examination proved to be malignant, as did > 50% of aspirates that yielded atypical findings. Infiltrating lobular carcinoma commonly was underdiagnosed as being atypical on cytologic examination. Benign lesions with atypical or suspicious cytologic diagnoses included certain cases of atypical ductal hyperplasia. The authors concluded that the distinction between the atypical and suspicious categories, as recommended by the NCI, is not warranted. Therefore, they suggest the use of a single term, such as 'equivocal', to describe inconclusive diagnoses on breast fine-needle aspiration cytology.

Biopsy, Needle↗

PubMed1995

Effect of ultrasonically-guided follicle aspiration on estrous cycle and follicular dynamics in Holstein cows.

Two experiments were conducted to test the effect of ultrasonically-guided follicle aspiration on estrous cycle and follicular dynamics in Holstein cows. The objective of the first experiment was to determine if aspiration of all visible follicles would influence the estrous cycle. All visible follicles > or = 5 mm in diameter were punctured and the oocytes aspirated once during the second and fourth cycle, with no aspirations occurring during Cycles 1, 3 and 5 in 4 Holstein cows. Between aspirations the follicles were scanned ultrasonically every 2 to 3 d to monitor follicular waves. Estrus was monitored twice daily and plasma progesterone concentrations were measured daily. The inter-estrus periods were significantly longer when aspiration was performed than in the 3 cycles in which aspiration did not occur (25.0 vs 21.1 d; P < 0.01). To determine the maximum number of follicles harvestable on a continuing basis, a second experiment was conducted to contrast unstimulated cows subjected to ultrasonically-guided oocyte collection twice-weekly with animals from which oocytes were collected once a week after gonadotrophin stimulation. All visible follicles of multiparous Holstein cows were aspirated every 3 or 4 d (unstimulated group, n = 4), and the total number of follicles was compared with the number of follicles in cows that were aspirated weekly after 400 mg FSH were administered over 2 d (stimulated, n = 6). The study continued for 8 consecutive weeks. The weekly mean number of follicles available for aspiration in the unstimulated cows was 15.7 +/- 3.3 (mean +/-SEM), which was not different from the 14.2 +/- 1.9 follicles available for aspiration from the FSH-stimulated cows. Within the unstimulated cows, there was an increased number of follicles available for aspiration over time during the period of study (P < 0.001). The number of follicles available for aspiration from the stimulated cows did not change, but plasma concentrations of progesterone increased over time as persistent luteal tissue developed on the ovaries.

Journal Article↗

PubMed2006

A comparison of the aspirating abilities of re-usable and partly disposable dental cartridge syringes in vitro.

OBJECTIVES: To compare the ability of re-usable and partly disposable dental cartridge syringes to aspirate in vitro. METHODS: A laboratory investigation comparing two re-usable (Astra and Rotor) and one partly disposable (Ultra Safety-plus) dental cartridge syringes. Forces needed to move the cartridge plunger and forces required to produce aspiration of Bonney's Blue dye were measured using an Instron testing machine. RESULTS: There were significant differences in the forces needed to produce aspiration in the different systems (F = 194, p<0.001). The Astra system needed the least force to produce aspiration. The forces required to aspirate in the Rotor and Ultra Safety-plus systems did not differ. Each system aspirated effectively in vitro at the initial aspiration manoeuvre. The forces available for subsequent aspiration attempts varied with the speed of cartridge plunger movement. The volume of local anaesthetic cartridge used did not affect the force needed to produce aspiration in the Ultra Safety-plus syringe. The method of testing free-flow of solution through the needle affected the force generated at subsequent plunger movements. CONCLUSIONS: The re-usable and partly disposable syringes investigated aspirated effectively at the initial aspiration manoeuvre. The force available to produce aspiration at subsequent attempts varies with the speed of injection. The method of testing free-flow of solution through the needle in a loaded syringe affects the force available at the first aspiration manoeuvre.

Anesthesia, Dental↗

PubMed2005

Effectiveness of transbronchial needle aspiration in the diagnosis of exophytic endobronchial lesions and submucosal/peribronchial diseases of the lung.

The role of transbronchial needle aspiration (TBNA) in diagnosing endobronchial lung cancers has not been elucidated. The definitive combination of procedures that offers the best diagnostic yield following fiberoptic bronchoscopy remains controversial. This study was designed to investigate the diagnostic yield of transbronchial needle aspiration and other cytologic and histologic diagnostic procedures (i.e., forceps biopsy, brushing, and washing) and to assess the optimal combination for diagnosing endobronchial lung cancers. This prospective study included 95 patients presenting with visible tumors detected during bronchoscopic procedure as either an exophytic endobronchial lesion (EEL) or submucosal-peribronchial disease (SPD). Transbronchial needle aspiration, forceps biopsy, brushing, and washing were performed in all patients, and 91 patients were diagnosed. Rates of positive results were 75.8% for needle aspiration, 71.6% for forceps biopsy, 61.1% for brushing, and 32.6% for washing. Needle aspiration was used as the sole diagnostic method in 11, forceps biopsy was the sole diagnostic method in 5, and brushing was the sole diagnostic method in 4 patients. Washing was not used as the sole diagnostic method in any case. Forceps biopsy yielded the highest diagnostic rate for an EEL (86.4%); however, when compared with needle aspiration (77.9%), no significant difference was observed between these two procedures (P = 0.302). In patients with a diagnosis of SPD, needle aspiration was determined to be the sole diagnostic method in eight patients. In this group of patients, the highest rate of diagnosis was achieved with needle aspiration (72.2%), and when compared with forceps biopsy (47.2%), a significant difference between the two procedures (forceps biopsy versus needle aspiration) was observed (P = 0.049). By adding transbronchial needle aspiration to the conventional diagnostic methods (forceps biopsy, brushing, and washing), the rate of diagnosis increased from 82.1% to 95.8% (P = 0.001), and in patients with a diagnosis of SPD, this rate increased from 69.4% to 94.4% (P = 0.008). In patients with a diagnosis of an EEL, addition of needle aspiration led to an increase in diagnostic yield but this difference was not statistically significant (89.8% versus 96.6%, P = 0.250). In endobronchial lung cancers, transbronchial needle aspiration is a safe method that can be used together with conventional diagnostic procedures to increase the diagnostic yield and should be considered a valuable diagnostic tool, particularly in cases of SPD. The highest rate of diagnostic yield in this study was obtained using a combination of forceps biopsy, transbronchial needle aspiration, and brushing; washing did not contribute to this high rate.

Adult↗

PubMed1997

Subpopulations of human granulosa-luteal cells obtained during early timed and during normally timed follicular aspiration in in-vitro fertilization-embryo transfer cycles.

OBJECTIVE: To find the differences between human granulosa-luteal cells obtained during early timed follicular aspiration to prevent severe ovarian hyperstimulation syndrome (OHSS) and during normally timed follicular aspiration. DESIGN: Retrospective analysis of clinical laboratory data. SETTING: In vitro fertilization unit, University Department of Obstetrics and Gynecology, Ljubljana, Slovenia. PATIENT(S): Twenty women undergoing IVF-ET at high risk for OHSS. INTERVENTION(S): Cells were obtained from the follicles of women who were stimulated with hMG and hCG during an early timed follicular aspiration of one ovary, 10-12 hours after hCG, and during a normally timed follicular aspiration of the contralateral ovary, 32-36 hours after hCG administration. MAIN OUTCOME MEASURE(S): Subpopulations of granulosa-luteal cells were observed by computerized image analysis in which hCG was localized using immunoperoxidase staining. RESULT(S): Early timed follicular aspirates contained no oocytes and only a scant number of granulosa cells. Granulosa-luteal cells were smaller than those from normally timed follicular aspirates. We identified three subpopulations in early timed follicular aspirates: nonluteinized, small luteinized, and medium luteinized cells. In normally timed follicular aspirates, four subpopulations were identified, including large luteinized cells. The normally timed follicular aspirates contained more hCG-stained cells. Three staining types of hCG localization were found: on the surface membrane, on the surface membrane and within the cytoplasm, and only within the cytoplasm of cells from normally timed follicular aspirates. Early timed follicular aspirates contained only cells with membrane hCG localization. CONCLUSION(S): We found differences in morphometric characteristics and hCG localization between human granulosa-luteal cells obtained during early timed follicular aspiration to prevent severe OHSS and during normally timed follicular aspiration.

Adult↗

PubMed1998

Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage.

OBJECTIVE: This study was designed to determine and compare the efficacy of sonographically guided percutaneous needle aspiration and percutaneous catheter drainage in the treatment of liver abscesses. SUBJECTS AND METHODS: In a randomized study, 50 patients (38 males and 12 females; age range, 2-72 years; average age, 35 years) with liver abscesses (amebic, 20; pyogenic, 11; indeterminate, 19) underwent either percutaneous needle aspiration (n = 25) or catheter drainage (n = 25) along with appropriate antimicrobial therapy. In patients assigned to the needle aspiration group, an 18-gauge needle was used to aspirate the abscess cavity. Repeated aspiration was attempted only once in each patient not responding to the first aspiration; nonresponse to the second aspiration was considered failure of treatment, and these patients were given catheter drainage (however, these patients were not included in the catheter drainage group). For catheter drainage, 8- to 12-French catheters were introduced into the abscess cavity using the Seldinger technique. In patients with multiple abscesses (seven in aspiration group and five in catheter group), all the abscesses except those smaller than 3 cm were subjected to percutaneous treatment. Patients were followed up to assess the outcome of the percutaneous treatment, length of hospital stay, and development of any complications. Sonography was performed every third day during hospitalization. After discharge of the patient, periodic clinical and sonographic examinations were done until total resolution of abscesses was achieved. RESULTS: Although percutaneous needle aspiration was successful in only 15 (60%) of the 25 patients after one (n = 11) or two (n = 4) aspirations, catheter drainage was curative in all 25 patients (100%) (p < .05). Among the successfully treated patients, the average time for clinical improvement and the mean hospital stay were similar in the two treatment groups. Although the average time needed for a 50% reduction in the size of the abscess cavity was significantly (p < .05) greater in the aspiration group than in the catheter group (11 days versus 5 days), the average time taken for total resolution of abscess was the same (15 weeks) in both groups. No major complications were encountered. No relapse was documented on clinical and sonographic examination during follow-up, which ranged from 8 to 37 weeks. CONCLUSION: Our results show that percutaneous catheter drainage is more effective than needle aspiration in the treatment of liver abscesses. Needle aspiration, if limited to two attempts, has a high failure rate.

Adolescent↗

PubMed1998

Sonographically guided therapeutic aspiration of benign-appearing ovarian cysts and endometriomas.

OBJECTIVE: The purpose of this study was to investigate the feasibility of therapeutic aspiration of symptomatic benign-appearing ovarian cysts and to show that endometriomas can be successfully aspirated when aspirated in conjunction with hormonal suppression therapy. MATERIALS AND METHODS: Forty-three women referred for sonographically guided aspiration of symptomatic ovarian cysts were considered for the study cohort. Criteria for selection included sonographic changes consistent with a simple cyst (n = 32) or endometrioma (n = 9). In two patients, sonography revealed cysts suggestive of malignancy, and these patients were therefore excluded. Seven of the patients were pregnant. Forty-nine aspirations were attempted in 41 patients, 14 using a transabdominal approach and 35 transvaginal. Forty-eight aspirations were successful, and one attempted aspiration was technically unsuccessful. After aspiration, hormonal suppression therapy was recommended for all patients who had endometriomas. RESULTS: Of the 40 patients who successfully underwent aspiration, all experienced relief from symptoms immediately after aspiration. Eleven of the 40 patients eventually experienced recurrence of symptoms. The overall recurrence rate was 27.5%. The recurrence rate for benign-appearing cysts was 16.1%. None of the seven pregnant patients had recurrence of symptoms. The recurrence rate for endometriomas was 66.6%; however, only one of these nine patients complied with hormonal suppression therapy. Those who did ultimately comply after undergoing a second aspiration experienced sustained relief of symptoms. CONCLUSION: Sonographically guided therapeutic aspiration of symptomatic ovarian cysts is a viable alternative to surgical extirpation, even in pregnant women. Aspiration of endometriomas may alleviate symptoms when hormonal suppression therapy is also instituted.

Endometriosis↗

PubMed2001

Assessment of aspiration in patients with tracheostomies: comparison of the bedside colored dye assessment with videofluoroscopic examination.

BACKGROUND: Aspiration is a serious clinical concern in patients with long-term artificial airways. The purpose of this study was to determine the reliability of a bedside colored dye assessment of aspiration in tracheostomized patients and to determine its comparability to a more sophisticated videofluoroscopic study. METHODS: This was a prospective, blinded comparison study conducted in a large, urban, university teaching hospital. We studied 20 consecutive patients who underwent tracheostomy for bronchial hygiene needs and who were referred for videofluorographic evaluation for suspected oropharyngeal dysphagia and possible aspiration. Excluded were patients unable to follow verbal commands and those requiring mechanical ventilatory support. All patients were brought to the videofluorography suite for colored dye assessment for aspiration and videofluorographic assessment of oropharyngeal swallow. A nurse, blinded to the results of videofluorographic swallow study, performed colored dye assessments for aspiration. Speech-language pathologists, blinded to the results of the colored dye assessments, interpreted simultaneous (preliminary) and subsequent complete (final) videofluorographic evaluations of swallow. RESULTS: The colored dye aspiration assessments and the videofluoroscopic studies were compared for the frequency of aspiration detection. Sensitivity and specificity were determined using standard methods. Seven patients showed no aspiration on either the colored dye test or videofluoroscopic examination. Eight patients were judged to aspirate by videofluorography but not by the colored dye test. Five patients were judged to aspirate by both the colored dye test and videofluorography. The data indicate that the colored dye test for aspiration carries a low sensitivity of 38% (95% confidence interval = +/- 7%), but a high specificity of 100%. The videofluoroscopic study detected a significantly greater frequency of aspiration than did the colored dye test (p < 0.01). CONCLUSIONS: The colored dye test for aspiration can provide useful information when positive, but because there is a significant false negative rate, decisions made on the basis of a negative test must be made with caution.

Adult↗

PubMed2001

Prediction of aspiration in patients with newly diagnosed untreated advanced head and neck cancer.

OBJECTIVES: To determine the prevalence of aspiration in patients with newly diagnosed nontreated advanced head and neck cancer and to determine the ability of the clinical examination to predict aspiration in this patient population. DESIGN: A descriptive prevalence study of the presence of aspiration in patients with advanced (stages III and IV) head and neck cancer and a prospective correlation study between variables of the clinical evaluation with the criterion standard videofluoroscopy. SETTING: Regional veterans affairs medical center. PATIENTS: A consecutive sample of 27 patients without previous treatment or tracheostomy. INTERVENTIONS: All patients underwent evaluation by an otolaryngologist and speech pathologist prior to videofluoroscopy. MAIN OUTCOME MEASURES: Variables in the dysphagia evaluation (consisting of a directed medical history, physical examination, and food challenge), the self-rated 45-item questionnaire, and the clinicians "educated prediction" of aspiration were analyzed with reference to aspiration on videofluoroscopy using univariant analysis. RESULTS: The prevalence of aspiration determined by videofluoroscopy was 41% (11 of 27 patients). Two (6%) of 32 items in the medical history, 1 (4%) of 25 items in the physical examination, and 8 (50%) of 16 items in the food challenge were found to be statistically significantly correlated (P<.05) with aspiration on videofluoroscopy by univariate analysis. Nine (25%) of 45 items in the self-rated questionnaire were correlated with aspiration on videofluoroscopy. The clinicians' educated prediction of aspiration was not correlated with aspiration determined by videofluoroscopy. CONCLUSIONS: Clinical evaluation alone is inadequate in predicting patients who aspirated, determined objectively by videofluoroscopic swallowing study. Further study is needed to develop an efficient dysphagia evaluation to identify patients at risk for aspiration.

Aged↗

PubMed1987

Pulmonary aspiration studied by radionuclide milk scanning and barium swallow roentgenography.

We have examined the use of radionuclide milk scanning to detect aspiration and have compared the clinical features of patients with demonstrated aspiration with those of patients in whom aspiration was not demonstrated. One hundred twenty children underwent radionuclide milk scanning for three different clinical indications, namely, respiratory tract symptoms (n = 56), gastroesophageal (GO) reflux (n = 20), and near-miss sudden infant death syndrome (SIDS) (n = 44). Ninety-eight (82%) of the 120 patients had a GO reflux demonstrated on the radionuclide milk scan. The incidence of aspiration was high in the respiratory (23%) and near-miss SIDS groups (20%) but low in the GO reflux group (5%). Only four of the 19 patients with an aspiration-positive scan had an aspiration-positive barium swallow film. The clinical symptoms and signs of those patients with aspiration-positive results were not significantly different from those of patients in whom aspiration was not demonstrated. We conclude that radionuclide milk scanning is more sensitive than barium swallow roentgenography in detecting aspiration; however, the clinical significance of such aspiration is undetermined. In view of the high incidence of GO reflux demonstrated in the absence of aspiration by the use of radionuclide milk scanning, the sole finding of GO reflux in a child with respiratory tract symptoms should not be taken as presumptive evidence that aspiration is contributing to those symptoms.

Adolescent↗

PubMed2005

Restriction of oral intake of water for aspiration lung disease in children.

BACKGROUND: Primary aspiration of food and fluid is commonly seen in children with feeding and swallowing difficulties associated with a range of diseases and complex medical conditions. Respiratory sequelae and pneumonia are known to be associated with primary aspiration of ingested material, however causality between primary aspiration of specific food and fluid types and pulmonary effects in children is yet to be established in controlled trials. The relative pulmonary morbidity of aspiration of ingested food and fluid materials versus other causes of respiratory disease such as viral and bacterial causes, secondary aspiration of gastrointestinal contents and predisposing lung conditions such as chronic neonatal lung disease in a developing immune system is also unclear. Current management decisions for children who aspirate have to optimise oral nutrition and hydration, while reducing the risk of aspiration to preserve pulmonary integrity. This generally includes restricting aspirated food or fluids and providing texture-modified diets and thickened fluids. Young children frequently refuse thickened fluids providing a management dilemma for both families and health professionals. OBJECTIVES: Our objective was to evaluate the efficacy of restriction of oral water ingestion on the pulmonary status of children with thin fluid aspiration demonstrated on a modified barium swallow study. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Airways Collaborative Review Group Specialised Register, MEDLINE, EMBASE and CINAHL databases were searched by the Cochrane Airways Group. The latest search was performed in January 2005. SELECTION CRITERIA: All randomised controlled trials comparing restriction of oral intake of water with unlimited oral water ingestion were eligible to be included. DATA COLLECTION AND ANALYSIS: Results of searches were reviewed against a pre-determined criteria for inclusion. No eligible trials were identified for a paediatric population and thus no data were available for analysis. One trial in an adult population was identified and reported. MAIN RESULTS: No randomised controlled trials examining the efficacy of restriction of oral intake of water in the management of children with thin fluid aspiration were found. In a single study in an adult population with stroke, no significant differences were seen between a control group of oral water restriction and the experimental group of unlimited oral water ingestion on outcomes such as pneumonia, total oral fluid intake and dehydration. AUTHORS' CONCLUSIONS: There are no trials that have adequately evaluated the pulmonary effects of allowing or restricting oral water ingestion in children known to have primary aspiration of thin fluids. Thus, there is currently an absence of evidence to support a strict approach of full restriction of oral intake of water or support a more liberal approach of allowing oral water ingestion in children with primary aspiration of thin fluids.

Child↗

PubMed1994

Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke.

In order to assess the risk of pneumonia, dehydration, and death associated with videofluoroscopic evidence of aspiration following stroke, the clinical records of 26 patients with aspiration and 33 randomly selected, case-matched, dysphagic controls without videofluoroscopic evidence of aspiration were reviewed. The videofluoroscopic modified barium swallow technique included 5 ml-thin and thick liquid barium, 5 ml barium pudding, and 1/4 cookie coated with barium, plus additional 20 and 30 ml of thin liquid barium. Patients were assessed a mean of 2 +/- 1 SD months poststroke and were followed for a mean of 16 +/- 8 SD months poststroke. The odds ratio for developing pneumonia was 7.6 times greater for those who aspirated any amount of barium irrespective of its consistency (p = 0.05). The odds ratio for developing pneumonia was 5.6 times greater for those who aspirated thickened liquids or more solid consistencies compared with those who did not aspirate, or who aspirated thin liquids only (p = 0.06). Dehydration was unrelated to the presence or absence of aspiration. The odds ratio for death was 9.2 times greater for those aspirating thickened liquids or more solid consistencies compared with those who did not aspirate or who aspirated thin liquids only (p = 0.01). Aspiration documented by modified videofluoroscopic barium swallow technique is associated with a significant increase in risk of pneumonia and death but not dehydration following stroke.

Aged↗

PubMed2002

Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing.

Aspiration is an important variable related to increased morbidity, mortality, and cost of care for acute stroke patients. This prospective systematic replication study compared a clinical swallowing examination consisting of six clinical identifiers of aspiration risk, i.e., dysphonia, dysarthria, abnormal gag reflex, abnormal volitional cough, cough after swallow, and voice change after swallow, with an instrumental fiberoptic endoscopic evaluation of swallowing (FEES) to determine reliability in identifying aspiration risk following acute stroke. A referred consecutive sample of 49 first-time stroke patients was evaluated within 24 hours poststroke, first with the clinical examination followed immediately by FEES. The endoscopist was blinded to results of clinical testing. The clinical examination correctly identified 19 subjects with aspiration risk, when compared with the criterion standard FEES, but incorrectly identified 3 patients as having no aspiration risk when they did. The clinical examination incorrectly identified 19 subjects with aspiration risk but determined correctly no aspiration risk in 8 patients who did not exhibit aspiration risk on FEES. Clinical examination sensitivity = 86%; specificity = 30%; false negative rate = 14%; false positive rate = 70%; positive predictive value = 50%; and negative predictive value = 73%. It was concluded that the clinical examination, when compared with FEES, underestimated aspiration risk in patients with aspiration risk and overestimated aspiration risk in patients who did not exhibit aspiration risk. Careful consideration of the limitations of clinical testing leads us to believe that a reliable, timely, and cost-effective instrumental swallow evaluation should be available for the majority of patients following acute stroke.

Aged↗

PubMed1991

Increased incidence of nosocomial pneumonia in mechanically ventilated patients with subclinical aspiration.

Nosocomial pneumonia is frequent and is associated with high mortality in intubated mechanically ventilated patients. To determine whether there is a significant relationship between subclinical aspiration from nasogastric feeding and development of nosocomial pneumonia, we studied 24 ventilated patients who received nasogastric feeding. Endotracheal aspirates were tested twice daily for the presence of glucose using a glucose oxidase reagent strip. Subclinical aspiration was defined by the presence of glucose in nonbloody endotracheal aspirates. Nosocomial pneumonia was defined by the presence of all of the following conditions: (1) new or worsening infiltrate on chest roentgenogram consistent with pneumonia, (2) temperature greater than 38 degrees C and/or white blood cell count greater than 10,000/mm3 with 10% or more band forms, (3) culture of a new organism in the sputum, and (4) purulent tracheobronchial secretions. Twelve patients had no positive glucose tests of their endotracheal aspirates during their intensive care unit stay, one of whom developed nosocomial pneumonia. Twelve patients had endotracheal aspirates that were positive for glucose on 1 to 5 occasions. Of these patients, seven had bloody glucose-positive aspirates, four of whom developed clinical pneumonia. The remaining five patients had nonbloody glucose-positive endotracheal aspirates and all developed nosocomial pneumonia. There was a significantly greater incidence of pneumonia among patients who had nonbloody glucose-positive aspirates than among patients without glucose-positive aspirates (p less than 0.001, Fisher's exact test). We conclude that subclinical aspiration of nasogastric feeding, as detected by nonbloody glucose-positive endotracheal aspiration, is associated with the development of nosocomial pneumonia.

Adult↗