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Objective: The sequential generation of swallowing pressure (SP) from the nasopharynx to the proximal esophagus is important for the bolus to pass from the oral cavity to the esophagus. The purpose of this study was to investigate the correlation of the SP sequence mode on high-resolution manometry (HRM) with oral intake difficulty and aspiration pneumonia., Methods: Consecutive patients with dysphagia who were admitted to our dysphagia clinic between November 2016 and November 2020 were enrolled in this cross-sectional study. We classified the HRM pressure topography data according to the SP sequence mode into type A, normal; B, partially decreased; C, totally decreased; and D, sequence disappeared, and according to the upper esophageal sphincter (UES) during pharyngeal swallowing into type 1, flattening and 2, non-flattening. Clinical dysphagia severity was determined based on oral intake difficulty and aspiration pneumonia., Results: In total, 202 patients with dysphagia (mean [standard deviation] age, 68.3 [14.5] years; 140 [69.8%] male) were enrolled. Type C (odds ratio [OR], 10.48; 95% confidence interval [CI], 2.89-51.45), type D (OR, 19.90; 95% CI, 4.18-122.35), and type 2 (OR, 6.36; 95% CI, 2.88-14.57) were significantly related to oral intake difficulty. Type C (OR, 3.23; 95% CI, 1.08-11.12) and type 2 (OR, 4.18; 95% CI, 1.95-9.15) were significantly associated with aspiration pneumonia., Conclusion: The failure of sequential generation of SP was associated with higher risk of oral intake difficulty and aspiration pneumonia. These assessments are useful in understanding the pathophysiology and severity of dysphagia and in selecting safety nutritional management methods., Level of Evidence: 4 Laryngoscope, 134:2127-2135, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: To identify risk factors for pneumonia incidence in patients with dysphagia undergoing a videofluoroscopic swallow study (VFSS) in an outpatient tertiary-care center., Study Design: Historical cohort study., Methods: All individuals undergoing a VFSS between 10/02/13 and 07/30/15 were identified and followed historically for 2 years. Demographic information, medical history, and fluoroscopic data were collected. The 2-year incidence of pneumonia was obtained from the medical records and telephone interview. The incidence of pneumonia and death were calculated and risk factors for pneumonia and mortality were ascertained., Results: 689 patients were followed for 2 years. The mean age (±standard deviation) of the cohort was 65 (±15.5) years. 49% (338/689) were female. The most common causes of dysphagia were cricopharyngeus muscle dysfunction (270/689), head and neck cancer (175/689), and neurodegenerative disease (56/689). The incidence of pneumonia was 22% (153/689). The incidence of death was 11%. Multivariable logistic regression revealed that chronic obstructive pulmonary disorder [COPD] (odds ratio [OR] = 2.36, 95% confidence interval [CI]: 1.33-4.19), hypertension (OR = 1.82, 95% CI: 1.23-2.73), tracheotomy status (OR = 2.96, 95% CI: 1.09-7.99), and vallecular residue (OR = 1.88, 95% CI: 1.24-2.85) were all significantly associated with an elevated risk of pneumonia. Kidney disease (OR = 1.27, 95% CI: 1.02-9.9), COPD (OR = 3.27, 95% CI: 1.65-6.49), vallecular residue (OR = 2.35, 95% CI: 1.35-4.1), male gender (OR = 2.21, 95% CI: 1.25-3.92), and low body mass index (OR: 1.12, 95% CI: 1.06-1.19) were independent adjusted risk factors for death., Conclusions: The incidence of aspiration pneumonia (22%) and death (11%) within 2-years of a VFSS was high. The greatest adjusted risk factors for incident pneumonia were tracheotomy (OR = 3.0), COPD (OR = 2.4) and vallecular residue (OR = 1.9). The greatest adjusted risk factors for death were COPD (OR = 3.3), vallecular residue (OR = 2.3), and male gender (OR = 2.2)., Level of Evidence: 4 Laryngoscope, 132:1172-1176, 2022., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective/hypothesis: Tracheoesophageal diversion (TED) can prevent damage to the respiratory system in patients with swallowing disorders and/or repetitive aspiration pneumonia; however, TED may cause the loss of phonation. Our previous study demonstrated that TED with tracheoesophageal puncture (TEP) prevents aspiration while retaining phonation. In this study, we aimed to further evaluate the feeding status and phonation of patients who underwent TED with TEP to verify the reproducibility of this procedure., Study Design: Case series study., Methods: We retrospectively reviewed the medical records of 11 patients who underwent TED with TEP for intractable aspiration from February 2017 to August 2019 at Fukuoka Sanno Hospital. We evaluated the preoperative penetration aspiration score (PPAS), daily activities, preoperative and postoperative food intake level scale (FILS) score, nutrition route, maximum phonation time(MPT), and postoperative communication method., Results: The study population included 10 men and 1 woman (mean age, 66 years; range, 44-81) with a PPAS of 6.8 ± 1.0. The FILS score changed from 2.1 ± 0.5 preoperatively to 7.5 ± 2.0 postoperatively (paired t-test, P < .05), while the MPT changed from 7.9 ± 4.1 to 10.3 ± 4.2 s (paired t-test, P = .9). Preoperatively, a gastric fistula (eight patients [73%]) was the main nutrition route, followed by a gastric tube (two patients [18%]). Postoperatively, the main nutritional route for eight patients (73%) was oral, while the remaining three patients (27%) used the oral route occasionally. All patients maintained laryngeal phonation function, and eight (73%) used only laryngeal phonation for communication., Conclusions: Patients with intractable aspiration who wish to retain phonatory function should be advised to undergo TED with TEP., Level of Evidence: 4 Laryngoscope, 131:E1965-E1970, 2021., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Gastric aspiration lung injury is one of the most common clinical events. This study investigated the effects of bone-marrow-derived mesenchymal stem cells (BMSCs) on combined acid plus small non-acidified particle (CASP)-induced aspiration lung injury. Enhanced green fluorescent protein (EGFP(+) ) or EGFP(-) BMSCs or 15d-PGJ2 were injected via the tail vein into rats immediately after CASP-induced aspiration lung injury. Pathological changes in lung tissues, blood gas analysis, the wet/dry weight ratio (W/D) of the lung, levels of total proteins and number of total cells and neutrophils in bronchoalveolar lavage fluid (BALF) were determined. The cytokine levels were measured using ELISA. Protein expression was determined by Western blot. Bone-marrow-derived mesenchymal stem cells treatment significantly reduced alveolar oedema, exudation and lung inflammation; increased the arterial partial pressure of oxygen; and decreased the W/D of the lung, the levels of total proteins and the number of total cells and neutrophils in BALF in the rats with CASP-induced lung injury. Bone-marrow-derived mesenchymal stem cells treatment decreased the levels of tumour necrosis factor-α and Cytokine-induced neutrophil chemoattractant (CINC)-1 and the expression of p-p65 and increased the levels of interleukin-10 and 15d-PGJ2 and the expression of peroxisome proliferator-activated receptor (PPAR)-γ in the lung tissue in CASP-induced rats. Tumour necrosis factor-α stimulated BMSCs to secrete 15d-PGJ2 . A tracking experiment showed that EGFP(+) BMSCs were able to migrate to local lung tissues. Treatment with 15d-PGJ2 also significantly inhibited CASP-induced lung inflammation and the production of pro-inflammatory cytokines. Our results show that BMSCs can protect lung tissues from gastric aspiration injury and inhibit lung inflammation in rats. A beneficial effect might be achieved through BMSC-derived 15d-PGJ2 activation of the PPAR-γ receptor, reducing the production of proinflammatory cytokines., (© 2016 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.)

A 66-year-old-male patient with a history of depression voluntarily ingested around 400 ml of an insecticide composed of 5% methylparathion, 75% isoparaffin, 8% etoxylated oleic acid, 4% 1,2,4-trimethylbenzene, 6% naphtha, 1% 1,3,5- trimethylbenzene, 0.4% propylbenzene and 0.3% xylene. The patient was conscious and alert at admission. Gastric lavage was performed and activated charcoal administered. There were no clinical symptoms of organophospate ingestion despite reduced concentrations of erythrocyte and plasma cholinesterase. Chest X-ray showed pulmonary infiltrate compatible with bronco-aspiration. The patient evolved to respiratory failure refractory to treatment and died from multiorganic failure 23 days after ingesting the insecticide. The pathological findings included a pulmonary fibrosis in the alveolar spaces which caused enlargement of the intra-alveolar septa. Abundant lipin-laden macrophages were observed within the alveolar spaces. We review the most relevant aspects of cases of fatal lipoid pneumonia and point out that on occasion severe or fatal intoxication is due to the substances accompanying the active ingredients.

The incidence and origin of contamination of the vocal cords in 53 trauma patients was studied when tracheal intubation was performed before hospital admission. Eighteen patients (34%) had gross contamination which was blood in 15 patients and gastric contents in three patients. This has implications for prehospital airway management and particularly for use of the laryngeal mask airway.

Background: Acid aspiration into one lung is known to cause both a local as well as remote organ injury characterized by neutrophil sequestration and subsequent edema. This study investigated investigated the role of the complement cascade in the development of acid aspiration-induced local lung and remote organ injuries using K-76 COONa (K76), an anticomplement agent that inhibits the complement pathway at the C5 step, and its usefulness as a treatment drug., Methods: Anesthetized rats underwent tracheostomy and insertion of a cannula. K76 was intraperitoneally administrated prior to or immediately after the instillation of 0.1 ml of HCl (0.1N) or phosphate buffer solution (PBS) into the left lung. Inflammatory responses were evaluated by tumor necrosis factor alpha (TNF alpha) in the plasma and the bronchoalveolar lavage fluid (BALF) (n = 4), tissue myeloperoxidase (MPO), wet-to-dry weight ratio (W/D ratio) (n = 6), and protein concentration in the BALF (n = 6)., Results: Acid instillation caused an increase in the plasma TNF alpha, which was significantly attenuated by the administration of K76 prior to or after the acid instillation. Acid instillation to the left lung resulted in an increase of MPO and W/D ratios of the left lung, the right lung, and the small intestine. The administration of K76 inhibited the increase of MPO in these organs. K76 inhibited the increase of W/D ratios of the right non-instillated lung and the small intestine. Acid instillation led to increased protein concentration in the BALF of the left lung, which was not inhibited by K76. K76 administrated after the acid instillation had the same effects. TNF alpha in the BALF was not detected in all groups., Conclusion: These results suggest that localized acid aspiration induces, through the C5a step of the complement system-dependent mechanisms, TNF alpha formation and neutrophil sequestration, which caused the increase of endothelial permeability of the systemic organs. K76 is effective as a treatment drug in modulating some of the injuries caused by the acid instillation, but further investigations is warranted as to its potential as a therapeutic agent.

A 68-year-old woman with a history of hiatus hernia developed aspiration pneumonia after operation for fractured neck of femur. After 8 days, acute respiratory failure was caused by massive retention of air and food in the oesophagus. This was relieved by aspiration, and treated by balloon dilation of the gastric cardia.

The anaesthetic management is described of a nine-month-old male for surgical palliation of the the functional abnormalities associated with Opitz-Frias syndrome. Features of this syndrome of interest to anaesthetists include recurrent pulmonary aspiration of intestinal contents, achalasia of the oesophagus, subglottic stenosis, hypertelorism, micrognathia and a high arched palate. No previous reports of anaesthesia for patients with this condition have been identified.

Two cases of interstitial pneumonitis are described which developed after the acute phase of aspiration pneumonitis. Open lung biopsy revealed an interstitial, granulomatous foreign body response induced by foodstuff aspiration. Steroid treatment was administered and both cases then showed a favourable course, with the pulmonary lesion healing within 12 days.

1. Fifteen baboons were utilized to investigate whether secondary bacterial invasion followed experimentally-induced kerosene pneumonia. They were divided into two groups and used as their own controls, following intratracheal injection of either normal saline or kerosene (0.3 ml/kg). 2. The baboons were X-rayed daily for 3 days and lung biopsies taken for histology, aerobic and anaerobic culture. When killed on day 4, all lungs were examined macroscopically, weighed and lung weight/body weight ratios calculated, while biopsy material was handled as above. 3. In spite of repeated anaesthesia, biopsies, pneumothoraces and atelectasis, no organisms were seen histologically, nor were any aerobic or anaerobic organismsm cultured. 4. The results strongly suggest that secondary bacterial infection following kerosene-induced pneumonitis is rare.