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PubMed1984

Accuracy of aspiration cytology in detecting breast cancer.

To evaluate the role of needle placement in determining accuracy and to establish criteria for clinical decision making, we used aspiration cytology to diagnose 49 palpable breast masses in patients undergoing excisional biopsy. Closed cytology, obtained by percutaneous aspiration, and open cytology, obtained by aspiration of the excised mass, were compared with histology. Nineteen (39%) of the breast masses were carcinoma. Unsatisfactory cytologic findings were frequent after both closed (37%) and open (24%) aspiration. Most of these aspirates were from mammary dysplasia, suggesting that acellularity rather than needle placement was responsible. Closed aspiration was falsely negative in one patient and falsely suggestive of cancer in five. If atypical, suspicious or malignant cytologic findings were considered to be carcinoma; closed cytology had high sensitivity (94%), low specificity (64%), and a false positive fraction of 36%. The positive predictive value was 76% and the negative predictive value 90%. Accuracy was 81%. If only suspicious or malignant results were considered positive, specificity and positive predictive value increased at the expense of sensitivity and negative predictive value but accuracy did not change. Even with optimal needle placement (open aspiration), accuracy of aspiration cytology was less than 90%.

Biopsy, Needle↗

PubMedDate not supplied

Limitations of aspiration cytology in the diagnosis of primary neoplasms.

A discussion of the limitations of aspiration cytology in the diagnosis of primary neoplasms is presented. Based on the 50-year experience in needle aspiration cytology at the Memorial Sloan-Kettering Cancer Center as well as on the comments and publications of other workers, the difficulties are considered for the various lesions and sites to which the technique has been applied. Five general considerations are emphasized: (1) aspiration samples should not be used in preference to larger biopsies when the latter can be easily and safely secured; (2) the histologic architecture is lost in aspiration samples, and diagnoses that are based on histology are not possible; (3) diagnoses must be made within the known clinical context, and incomplete or erroneous clinical information can lead to errors in cytologic diagnosis; (4) the diagnosis of cancer is simpler than is its classification; and (5) only positive findings give real information, with negative reports leaving the matter unsettled. Lesions in which aspiration cytology can readily contribute to the diagnosis are contrasted to those in which the differential diagnosis cannot be resolved on the basis of aspiration samples. Emphasis is also placed on those lesions for which needle aspiration should be considered an unwarranted, high-risk procedure. Needle aspiration is a valuable diagnostic technique that must not be misused and thereby discredited .

Biopsy, Needle↗

PubMedDate not supplied

Endosonography-guided real-time fine-needle aspiration biopsy.

Twenty-six patients were prospectively evaluated with endosonography-guided real-time fine-needle-aspiration biopsy. This cohort comprised 14 patients with a pancreatic mass revealed by CT or a stricture of the main pancreatic duct seen at ERCP, 7 patients with mediastinal lymphadenopathy, 3 patients with extrapancreatic abdominal masses, and 2 patients with subepithelial or infiltrative lesions. Endosonography-guided real-time fine-needle-aspiration biopsy was diagnostic in 18 of 20 patients in whom surgical confirmation was available or in whom malignancy was found and confirmed by clinical follow-up (accuracy of 90%). In the subgroup of patients with pancreatic lesions, 3 had previously undergone nondiagnostic CT-guided fine-needle-aspiration biopsy and 2 did not have evidence of a mass by CT. Real-time fine-needle-aspiration biopsy was diagnostic for malignancy in 4 of these individuals. In the 7 patients with mediastinal lymph nodes, 2 had nondiagnostic transbronchial biopsy and 2 had no evidence of mediastinal lymphadenopathy by CT scan. Endosonography-guided real-time fine-needle-aspiration biopsy diagnosed malignancy in both individuals with nondiagnostic transbronchial studies and was able to identify mediastinal lymphadenopathy in the 2 patients with negative CT scans (malignancy confirmed with real-time fine-needle-aspiration biopsy in 1). Overall, in 9 of 10 lesions in which visualization by CT was not possible (5), CT-guided fine-needle aspiration was unsuccessful (3), or prior nonsurgical biopsy techniques were unsuccessful (2), real-time fine-needle-aspiration biopsy was diagnostic.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Neoplasms↗

PubMed1995

[Broncho-pulmonary complications due to aspiration of foreign bodies by children].

The paper describes 239 children with bronchopulmonary disease due to foreign body (f.b.) aspiration treated in our center during between 1980-1992. Twenty-eight percent of the cases had been referred to hospital without any suspicion of f.b. aspiration. Almost half of the children (49.7%) were below the age of 2 years. Boys were affected more often (61.5%) than girls. In 61.1% the cases the f.b. had been aspirated into the right bronchial tree. Pieces of nuts were the most common f.b. - 35.1%. The most common chest X-ray symptoms were disturbances of bronchial patency (74.1%). Non-metalic, but potential shadowing f.b. like bones and teeth gave the clear signs only in 17.6% of the cases. After f.b. aspiration chronic irreversible lesions such as bronchiectasis and lung fibrosis were observed in 18.8% of the children. The prevalence of bronchiectasis was proportional to the duration of deposition. If the f.b. had been removed within the first month after aspiration we observed no complications. After aspiration of ears of grain, bronchiectasis was present in 80% of cases. Aspiration of f.b. into the left bronchial tree very often caused ventilation disturbations. Such cases were diagnosed and treated earlier than cases of right side f.b. aspirations. As a consequence bronchiectasis in the left lung was observed 2.7 less frequently.

Bronchi↗

PubMed1996

Seminal vesicle aspiration of fertile men.

PURPOSE: Whether sperm normally reside in the seminal vesicles of fertile men without ejaculatory duct obstruction, and the effect of duration of sexual abstinence on results of seminal vesicle aspiration were determined. MATERIALS AND METHODS: Bilateral seminal vesicle aspiration was performed on 12 fertile volunteers under transrectal ultrasound guidance with randomization according to 0 and 5 days of abstinence. Seminal vesicle aspirates were examined microscopically for number and motility of sperm. A positive aspirate was defined as greater than 3 sperm per high power microscopic field. RESULTS: Duration of abstinence had a significant effect on outcome of seminal vesicle aspiration in fertile volunteers. No volunteer with 0 days of abstinence had a positive aspirate from either seminal vesicle, whereas a third of those with 5 days of abstinence had at least 1 positive seminal vesicle aspirate. CONCLUSIONS: Significant numbers of sperm are not normally found in the seminal vesicles of fertile men immediately after ejaculation. Diagnostic seminal vesicle aspiration should be performed after 0 days of abstinence. Longer periods of sexual abstinence may be used in patients undergoing seminal vesicle harvesting of sperm for assisted reproduction.

Adult↗

PubMed1997

Videofluoroscopic evaluation of aspiration with visual examination of the gag reflex and velar movement.

The purpose of the present study was to investigate the relationship between prevalence of aspiration as determined by videofluoroscopic evaluation and prevalence of the gag reflex and velar movement as determined by direct visual examination. One hundred adult patients underwent a videofluoroscopic evaluation of aspiration with either an esophagram (n = 31), upper gastrointestinal series (n = 18), small bowel series (n = 23), or modified barium swallow procedure (n = 28), and concomitant evaluation of the gag reflex and velar movement on phonation. All studies were performed using the lateral, upright position, and all patients drank at least 5 cc of single contrast barium. Aspiration was defined as penetration of material below the level of the true vocal folds. A normal gag reflex and normal velar movement on phonation were observed in 14 of 15 (93%) patients who exhibited objective documentation of aspiration with videofluoroscopy. Conversely, 19 of 20 (95%) patients without a gag reflex were observed with videofluoroscopy to be without aspiration. Normal velar movement on phonation was observed in 99 of 100 (99%) patients. There was no significant age difference between patients with or without a gag reflex. No relationship was found between the prevalence of aspiration and the gag reflex or velar movement on phonation. It was concluded that the presence of a gag reflex does not protect against aspiration, and the absence of a gag reflex does not predict aspiration.

Adolescent↗

PubMed1997

Papillary carcinoma of the thyroid: can operative management be based solely on fine-needle aspiration?

BACKGROUND: Fine-needle aspiration cytology is sensitive for detecting malignancies such as papillary carcinoma of the thyroid gland. Because fine-needle aspiration specificity for papillary carcinoma of the thyroid is variable, routine intraoperative frozen section is often advocated. STUDY DESIGN: To define the roles of fine-needle aspiration and frozen section in papillary carcinoma of the thyroid gland, we reviewed data from 82 patients who underwent thyroidectomy between August 1989 and August 1995 for papillary carcinoma of the thyroid cytology. Results of fine-needle aspirations were grouped into three categories: diagnostic of papillary carcinoma of the thyroid; diagnostic of follicular-variant of papillary carcinoma of the thyroid; or suspicious for papillary carcinoma of the thyroid. Definitive diagnoses were made on permanent histology. RESULTS: A fine-needle aspiration revealing papillary carcinoma of the thyroid was 98 percent specific for cancer or 100 percent specific for follicular-variant of papillary carcinoma of the thyroid. A fine-needle aspiration that was suspicious for papillary carcinoma of the thyroid (n = 24) was only 54 percent specific for cancer. On the basis of gross intraoperative findings, 5 of these 24 patients underwent total thyroidectomy without frozen section, and all had carcinoma. The other 19 had frozen section analysis. Of the 5 patients with cancer detected by frozen section, 4 had cancer on permanent histology. Findings on frozen section demonstrated a follicular neoplasm in the other 14 patients, of which 4 ultimately were cancer. CONCLUSIONS: When papillary carcinoma of the thyroid or follicular-variant of papillary carcinoma of the thyroid is definitively diagnosed on fine-needle aspiration, the surgeon can perform definitive thyroidectomy without frozen section because of the high specificity for cancer. If the fine-needle aspiration is suspicious for papillary carcinoma of the thyroid, the incidence of cancer is 54 percent, and patients with these conditions should undergo surgery with frozen section. When either gross findings or frozen sections suggest malignancy, definitive thyroidectomy can be performed because 90 percent of such cases will be cancer. If frozen section is not diagnostic of malignancy, a thyroid lobectomy/isthmusectomy is recommended because 71 percent have a benign lesion. This systematic approach to papillary carcinoma of the thyroid will obviate unnecessary frozen sections while maintaining excellent diagnostic specificity.

Adolescent↗

PubMed1997

In search of specimen adequacy in fine-needle aspirates of nonpalpable breast lesions.

Pathology-related medical malpractice claims frequently concern fine-needle aspirations (FNAs) of breast lesions, and diagnostic errors have been attributed in part to the inadequacy of the specimens. Cytologic criteria for adequate FNA specimens, specifically in cases without malignancy, have not been clearly defined. From January 1988, to August 1995, 669 ultrasonographic-guided FNAs of nonpalpable, solid breast lesions with subsequent histologic examination were performed at our institution. From these, 54 cases with cytologic diagnoses of insufficient or nonspecific benign findings were identified. All aspirates were reviewed, and the number and size of the epithelial cell groups were quantitated in each case. By using criteria for adequate aspirates of palpable breast lesions (six or more epithelial cell groups per case with a minimum of 5-10 cells per group), 23 of the 54 aspirates were deemed inadequate and 31 adequate. Eleven (48%) of the inadequate aspirates and 17 (55%) of the adequate aspirates were from histologically confirmed carcinomas (ductal carcinoma in situ, 6; invasive carcinoma, 22, of which 12 were ductal, 7, lobular, and 3, mixed ductal and lobular). For the mammographic diagnoses "probably benign," "indeterminate," and "suggestive of malignancy or malignant," the probability of malignancy in aspirates of adequate cellularity (eg, > 6 epithelial groups) was 9%, 40%, and 93%, respectively. These findings indicate that a significant proportion of breast aspirates still may yield false-negative results despite adequate to high cellularity. Although a definition of adequacy based on cellularity is useful in reducing false-negative results, cellularity alone cannot be relied on in the management of nonpalpable lesions. For mammographic findings that are indeterminate or suggestive of malignancy or malignant, nonspecific FNA findings should be followed by core or excisional biopsy to exclude carcinoma.

Adult↗

PubMed1998

[Optimizing plasma cell content in bone marrow aspirates].

Bone marrow samples used for flow cytometric analysis of plasma cells frequently provide a low plasma cell content. Regularly, samples used for flow cytometry are provided by second step aspiration while the first aspirate is used for cytologic examination. We investigated whether the use of secondary aspirates leads to a systematic underestimation of the bone marrow plasma cell content as a consequence of an increased blood contaminant. To test the hypothesis, plasma cell (CD38bright) percentages were established by flow cytometry in 13 pairs of primary/secondary aspirates. In all cases we found lower plasma cell contents in secondary as compared to primary aspirates (p = 0.0015). Median plasma cell counts in secondary aspirates were 57% lower compared to primary aspirates. We conclude that the use of secondary aspirates leads to systematic underestimation of the bone marrow plasma cell content.

Bone Marrow↗

PubMed1999

Lipid-laden macrophages in bronchoalveolar lavage fluid as a marker for pulmonary aspiration.

An increased lipid content in alveolar macrophages of bronchoalveolar lavage (BAL) fluid is thought to be a useful indicator for recurrent pulmonary aspiration. To assess whether pulmonary diseases unrelated to aspiration can raise the lipid content in alveolar macrophages, we evaluated Oil-Red-O-stained smears of BAL fluid in 18 children aged 3-15 years undergoing elective surgery for nonpulmonary illnesses under general anesthesia and in 18 children aged 1-16 years who had pulmonary diseases without clinical evidence of aspiration (pneumonia, exogenous allergic alveolitis, or cystic fibrosis). A semiquantitative lipid-laden macrophage (LLM) index was determined for each patient. LLM indices in children without pulmonary disease were higher than those published for healthy adults. In children with pulmonary diseases but without evidence of aspiration, a significantly higher LLM index was observed compared to controls. The LLM indices of children with pulmonary diseases were similar to those published by other authors for children with pulmonary aspiration. We conclude that an elevated LLM index in alveolar macrophages of BAL can be found in a variety of pulmonary diseases in which there is no clinical evidence of aspiration and is therefore unlikely to be a specific parameter for silent pulmonary aspiration.

Adolescent↗

PubMed1999

Lipid-laden macrophages in the tracheal aspirate of ventilated neonates receiving Intralipid: A pilot study.

Lipid-laden macrophages (LLM) in tracheal aspirates are reported to be pathognomonic findings in exo- and endogenous lipoid pneumonia in adults. A pilot study was carried out to evaluate the effect of lipid infusion on the LLM index of the tracheal aspirates from ventilated neonates. All intubated infants were eligible for the study. Infants receiving parenteral nutrition had intravenous (IV) lipid introduced by 4-7 days of age; most samples after 7 days were from infants receiving IV lipid. Four infants received minimal gastric feeding; none had evidence of aspiration pneumonia. Tracheal aspirates from 28 infants were analyzed for the LLM index. Alveolar macrophages were graded 0-4 in direct relation to the amount of lipid per cell. One hundred macrophages were graded; the maximum possible LLM index was 400. Two hundred forty-five of 387 tracheal aspirate samples were acceptable for analysis. LLM indices increased during the first week after birth; the mean LLM index then continued in the same range, but with a wide distribution of individual values. The mean LLM index from infants receiving an IV lipid infusion during days 4-7 was 87.9 (SD = 44.8), and was significantly higher compared to 58.7 (SD = 40.8) in infants receiving no IV lipid (P < 0. 003). Tracheal aspirates from infants with and without IV lipid infusion yielded many LLM index values >100. These observations invalidate the use of the LLM index >100 as proof of aspiration pneumonia in this group of infants.

Cell Count↗

PubMed2001

Mechanisms of cholinergic dysfunction in rabbits following recurrent aspiration of cow's milk.

Recurrent aspiration of cow's milk has been shown to alter neural control of airways in young rabbits (Gelfand et al., 1997). The purpose of this study was to define the mechanisms responsible for in vitro cholinergic hyperresponsiveness in this model. Beginning at 1 week of age, rabbits received either 0.5 mL/kg whole cow's milk or sterile saline intranasally while under light anesthesia. This was repeated each weekday for 2 weeks. At 8 weeks of age, rabbits were sacrificed. Portions of lungs underwent lavage with sterile saline. Tracheal smooth muscle (TSM) segments were also removed. Segments were assessed for acetylcholine (ACh) release by high-performance liquid chromatography ( HPLC) with electrochemical detection or acetylcholinesterase (AChE) kinetic activity by spectrophotometry. Substance P (SP), a neuropeptide that can increase ACh release from nerves, was also assessed using an enzyme immunoassay to define the content in lavage and TSM segments. Immunohistochemistry for SP within airways was also assessed. We found that recurrent aspiration of milk led to statistically significant alterations in many parameters. Acetylcholine release was significantly greater in segments of airways from rabbits that had aspirated cow's milk (27.5 +/- 1.7 vs. 20.1 +/- 1.6 pmol/min/g tissue) than saline. At the same time, AChE activity was less in the group that aspirated milk (8.7 +/- 0.4 vs. 10.2 +/- 0.5 nmol/min/mg protein) compared to saline. The amount of SP within both lavage as well as tissue homogenates was greater in the group that had aspirated the foreign protein (159.1 +/- 28.9 vs. 41.9 +/- 5.2 pmol/mg protein in lavage; 158.7 +/- 31.9 vs. 80.5 +/- 7.8 pmol/mg protein in tissues) than saline controls. While total cholinergic nerve density as assessed by choline acetyltransferase was not significantly different between groups, SP-positive immunoreactive nerves were easily identified in the group that aspirated cow's milk. This study suggests that cholinergic hyperresponsiveness caused by repeated aspiration of milk is due to several abnormalities, including prejunctional (increase in ACh release) as well as junctional (decrease in AChE) mechanisms within the airways. In addition, an upregulation of SP within airways is part of this process.

Acetylcholine↗

PubMed1988

A retrospective survey of treatment and mortality in aspiration pneumonia.

A retrospective survey was conducted of all patients with severe aspiration pneumonitis requiring artificial ventilation in our Intensive Care Unit from 1982-1986 inclusive. Of 38 patients, 8 (21%) died. Five of these deaths were due to severe primary intracranial pathology, and occurred after complete or almost complete resolution of the pneumonitis. One death (2.5%) due to myocardial infarction was possibly related to aspiration, and 2 deaths (5%) were definitely related to aspiration. The 7.5% mortality related to aspiration is considerably lower than in previous clinical studies of severe aspiration pneumonia. There was only one death due to aspiration in patients under the age of 70. The mean arterial to alveolar oxygen tension ratio was 0.221, and the mean predicted mortality by apache II was 43%. Patients were managed with rapid intravascular volume restoration using crystalloid fluids, early ventilation, no steroids, and no immediate antibiotics. We conclude that with such management it is possible to achieve a low hospital mortality in severe aspiration pneumonia, particularly in young patients.

Adult↗

PubMed1981

The effect of inhalation of nebulized steroid on the acid aspiration syndrome.

The effects of acid aspiration on lung mechanics, gas exchange, haemodynamics and lung water, and their modification by nebulized dexamethasone were studied in 10 dogs. Each dog received 0.1 N HCl pH of 1.0 (15 ml/l vital capacity), instilled down the tracheal tube. PEEP 0.98 kPa (10 cm H2O) was introduced 20 minutes after aspiration and was continued until the completion of experiment. Treated animals (N = 5) received dexamethasone 5 mg . kg-1 by continuous nebulization over a two hour period starting 20 minutes after aspiration. Untreated (N = 5) animals received nebulized saline. Measurements were taken before aspiration and at 20 minutes 2.5 and 5.0 hours after aspiration. Red blood cells labelled with 51Cr were injected before sacrifice. After sacrifice multiple lung samples were taken for measurement of pulmonary extravascular water (PEW) by the gravimetric technique. Acid aspiration caused significant changes in lung volumes, PaO2, and intrapulmonary shunt. Pulmonary extravascular water was 6.16 +/- 0.93 ml/g dry tissue in treated and 6.47 +/- 0.60 ml/g dry tissue in untreated animals. These results indicate the presence of severe pulmonary oedema. There were no significant differences in any measured parameter between treated and untreated animals. We conclude that nebulized dexamethasone is of no value in treatment of the acute changes induced by acid aspiration.

Animals↗

PubMed2002

Predictors of aspiration pneumonia in nursing home residents.

Aspiration pneumonia is a serious problem for the elderly institutionalized person, often requiring transfer to a hospital and a lengthy stay there. It is associated with a high mortality rate and is very costly to the health care system. The current study sought to determine the key predictors of aspiration pneumonia in a nursing home population with the hope that health care providers could identify those residents at highest risk and focus more efforts on prevention of this serious disease. A cross-sectional, retrospective analysis was done, using the Minimum Data Set (MDS) nursing home assessment data for three states (New York, Mississippi, Maine) from 1993 to 1994 (N = 102842). Nursing home residents were aged 65+. Standardized MDS summary scales and their component items were used, including: the Activities of Daily Living (ADL) scale, the cognitive performance scale (CPS), and the Resource Utilization Groups (RUGs). Results of these analyses showed the prevalence of pneumonia among this population was 3% (n = 3118). Results from the logistic regression models indicated 18 significant predictors of aspiration pneumonia. The strongest to weakest predictors of pneumonia were, respectively, suctioning use, COPD, CHF, presence of feeding tube, bedfast, high case mix index, delirium, weight loss, swallowing problems, urinary tract infections, mechanically altered diet, dependence for eating, bed mobility, locomotion, number of medications, and age, while both CVA and tracheotomy care were inversely predictive of pneumonia. The emergence of these significant predictors suggested a different pathogenesis of pneumonia in the elderly nursing home resident from the acute care patient or the outpatient. Nursing home residents have chronic medical conditions that gradually lead to "decompensation" in functional status, nutritional status, and pulmonary clearance. Dysphagia and aspiration are common complications of their medical conditions and may slowly worsen as their status deteriorates. Alternatively, a sudden adverse event may dramatically increase the amount aspirated or the ability to resist infection and lead to sudden decompensation. Clinical staff must identify residents with dysphagia and aspiration and work to prevent decline in functional status in all residents. They must be aware of the dangers of adverse events that lead to sudden inactivity or illness and increase the risk of aspiration pneumonia. Prevention of this disease whenever possible will reduce costs, improve health outcomes, and improve our quality of care.

Aged↗

PubMed2005

Effects of multiple pulmonary aspirations of enteral solutions on lung tissue damage.

BACKGROUND & AIM: The aim of this study was to compare the pulmonary histopathologic effects of enteral solutions with various lipid content, after multiple aspirations in rats. METHODS: Thirty Wistar albino rats were randomly assigned to one of three groups (n = 10). Saline solution (0.9%) (group C, control), Impact (lipid content, 28 g/l; group I), Pulmocare (lipid content, 93.3g/l; group P) were injected into the lung through the trachea, in a volume of 0.8 ml/kg. The aspiration procedure was performed three times in total, in every 2 days. After seven days from the first aspiration, rats were killed, and lungs were examined for histopathologic examination. RESULTS: Alveolar histiocytes were statistically higher in left lungs of the group I than the left ones of the control group (P < 0.05). Lipid-laden alveolar macrophages were significantly higher in left lungs of groups I and, P than left lungs of the control group (P<0.05). CONCLUSION: Lung tissue damage occurring after multiple pulmonary aspirations of Impact and Pulmocare, is histopathologically similar to each other, and is in the form of lipoid pneumonia. In cases of multiple pulmonary aspirations, volume of the aspirate and chronicity of the aspiration look like major impact factors rather than the amount of the lipid.

Animals↗

PubMed2005

Acid aspiration prophylaxis in labour: a survey of UK obstetric units.

BACKGROUND: The risk of acid aspiration is still a major concern in pregnant patients. In view of the increasing numbers of drugs available to decrease gastric acid production, it seemed timely to reassess acid aspiration prophylaxis policies in the UK. METHOD: An OAA-approved postal survey of 250 UK lead consultant obstetric anaesthetists was conducted in 2004 in order to establish the current practice of acid aspiration prophylaxis in labour. If acid aspiration prophylaxis was used, further questions were asked relating to subgroups of patients, category, dose and route of administration of drugs used and whether there was an anticipated change in practice. RESULTS: A response rate of 83% was achieved. There had been a decrease in the routine use of acid aspiration prophylaxis to 32% of units, an increase in the use of acid aspiration prophylaxis in "at risk" groups to 61% and a decrease in the number of units never using prophylaxis to 7%. Oral ranitidine administered six-hourly is the most common practice. There is little use of proton pump inhibitors. CONCLUSION: Compared to previous surveys of UK practice there has been an overall increase in the use of acid aspiration prophylaxis.

Antacids↗

PubMed2004

Risk of aspiration pneumonia after an epileptic seizure: a retrospective analysis of 1634 adult patients.

We reviewed the incidence of aspiration pneumonia secondary to seizures in three populations of patients with chronic epilepsy: 733 outpatients seen in an Epilepsy Foundation clinic; 806 adult patients admitted to two university video telemetry units; and 95 institutionalized, profoundly retarded adult patients with chronic epilepsy. Two of the 733 adults who had seizures in the outpatient setting and 2 of the 806 patients who had one or more epileptic seizures in the telemetry units developed aspiration pneumonia. In the 95 institutionalized patients, there were 17 instances of aspiration pneumonia after a generalized seizure and 32 instances of aspiration unrelated to seizures over a 12-month period. Our findings suggest that aspiration pneumonia is not a common complication of seizures in otherwise healthy adults. The increased incidence of aspiration in developmentally delayed individuals seems to derive from a combination of factors. Increased oral secretions, impaired swallowing mechanisms, and difficulty in attaining adequate patient positioning significantly increased the risk of aspiration.

Adult↗