technetium-tc-99m-sulfur-colloid and Pneumonia--Aspiration

According to established diagnostic and therapeutic guidelines for chronic pulmonary aspiration, clinical suspicion is raised by coughing and choking with feeding, coughing during sleep, recurrent pneumonia, failure to thrive, and radiologic signs of chronic lung injury. The upper gastrointestinal series accurately defines anatomy and function, can differentiate between direct and reflux aspiration, and identifies conditions that predispose to aspiration. Gastroesophageal scintigraphy lacks anatomic detail but increases observation time, may differentiate between direct and reflux aspiration, and identifies delayed gastric emptying and gastroesophageal reflux. The lipid-laden macrophage index improves identification of aspiration, but cannot differentiate between direct and reflux aspiration. The esophageal pH probe identifies gastroesophageal reflux. Treatment options include medical therapy (thickened feedings, prone positioning, and metoclopramide) and surgical intervention (gastrostomy, fundoplication, and definitive correction of predisposing conditions). Therapy is determined by severity of illness and results of diagnostic evaluation.

Topics: Bethanechol; Bethanechol Compounds; Bronchoscopy; Child; Chronic Disease; Diet Therapy; Gastric Acidity Determination; Gastric Fundus; Gastroesophageal Reflux; Gastrostomy; Humans; Metoclopramide; Phagocytosis; Pneumonia, Aspiration; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A specific technique for detection of pulmonary aspiration during the perioperative period is lacking. In this study, we developed a scintigraphic method for its diagnosis. Technetium 99m sulphur colloid was given orally 2 h before an i.v. infusion of propofol in patients undergoing elective colonoscopy. During the procedure, patients were spontaneously breathing 100% oxygen via a face mask. After recovery from anaesthesia, patients had a chest scinti-scan. As a control group, 10 healthy men were studied. The lung scan was considered positive if any tracer activity greater than background level was detected in the lung field. Among 96 patients studied, three patients had a positive chest scinti-scan. One of the three patients developed pneumonia while the other two remained asymptomatic. In none of the control asymptomatic group was tracer detected in the chest. We suggest that this technique is specific and can be used as a tool to assess the risk of pulmonary aspiration during different anaesthetic procedures.

Topics: Adult; Aged; Anesthetics, Intravenous; Colonoscopy; Female; Humans; Male; Middle Aged; Pneumonia, Aspiration; Propofol; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

The aim of this study was to evaluate the effect of two body positions (supine and semirecumbency) on the dynamics of gastroesophageal reflux (GER) in 15 patients requiring mechanical ventilation and having a nasogastric tube in place. Samples of gastric contents, pharyngeal and bronchial secretions, and blood were obtained at baseline and every hour during a period of 5 h after nasogastric tube isotopic instillation of 37 megabecquerels of Tc99m. Radioactivity counting (RAc) was performed using a gamma counter with correction for decay. Irrespective of the body position, all patients showed at 3, 4, and 5 h after the isotope instillation a significant increase in RAc of the oropharyngeal contents (p < 0.05, each), indicating GER. Although RAc values in the pharynx were higher in supine from 1 through 4 h (p < 0.05), at the end of the study (5 h) the values did not differ between each position. Likewise, the slopes of the regression lines of sequential oropharyngeal RAc values were not different between each position (0.39 +/- 0.09 versus 0.45 +/- 0.11, respectively). In contrast, RAc values in bronchial secretions were higher at 5 h in the supine position compared with baseline (p < 0.05) and to semirecumbency (p < 0.01). These results strongly support that GER in mechanically ventilated patients with a nasogastric tube is a feature occurring irrespective of body position. Semirecumbent position does not protect completely from GER and subsequently from oropharyngeal colonization from gastric origin.

Topics: Cross Infection; Female; Gastroesophageal Reflux; Humans; Intubation, Gastrointestinal; Male; Middle Aged; Oropharynx; Pneumonia, Aspiration; Posture; Radionuclide Imaging; Respiration, Artificial; Supine Position; Technetium Tc 99m Sulfur Colloid

To determine if the semirecumbent position (45-degree angle) decreases aspiration of gastric contents to the airways in intubated and mechanically ventilated patients.. A randomized, two-period crossover trial.. Respiratory intensive care unit.. Nineteen patients requiring intubation and mechanical ventilation.. Patients were studied in the supine and semirecumbent positions on two separate days.. After technetium (Tc)-99m sulphur colloid labeling of gastric contents, sequential radioactive counts in endobronchial secretions were measured at 30-minute intervals over a 5-hour period. Samples of endobronchial secretions, gastric juice, and pharyngeal contents were obtained for qualitative bacterial cultures.. Mean radioactive counts in endobronchial secretions were higher in samples obtained while patients were in the supine position than in those obtained while patients were in the semirecumbent position (4154 cpm compared with 954 cpm; P = 0.036). Moreover, the aspiration pattern was time-dependent for each position: For the supine position, radioactivity was 298 cpm at 30 min and 2592 cpm at 300 min (P = 0.013); for the semirecumbent position, radioactivity was 103 cpm at 30 min and 216 cpm at 300 min (P = 0.04). The same microorganisms were isolated from stomach, pharynx, and endobronchial samples in 32% of studies done while patients were semirecumbent and in 68% of studies done while patients were in the supine position.. We conclude that the supine position and length of time the patient is kept in this position are potential risk factors for aspiration of gastric contents. Elevating the head of the bed for patients who can tolerate the semirecumbent position may be a simple, no-cost prophylactic measure.

Topics: Female; Gastric Juice; Humans; Male; Middle Aged; Pharynx; Pneumonia, Aspiration; Posture; Respiration, Artificial; Risk Factors; Supine Position; Technetium Tc 99m Sulfur Colloid; Trachea

The purpose of our study was to correlate the results of the radionuclide salivagram with the corresponding chest radiography findings on patients being evaluated for salivary aspiration to determine the utility of the salivagram.. We identified 222 patients younger than 21 years who underwent salivagram and chest radiography within 3 months of each other. Salivagrams were blindly interpreted by two readers and chest radiographs were blindly interpreted by two other readers. The kappa coefficient with 95% CI was used to measure the level of interobserver agreement. Multivariate logistic regression was applied to determine whether age, sex, and neurologic diagnosis were predictors of a positive salivagram, with the odds ratio used to estimate association.. Interobserver agreement on salivagram interpretation was excellent (κ = 0.988; p < 0.0001; 95% CI, 0.968-1.000). Interobserver agreement on chest radiography interpretation was excellent (κ = 0.905; p < 0.0001; 95% CI, 0.845-0.965). The salivagram was positive for aspiration in 55 patients (25%). Chest radiography was positive in 54 patients (24%). When the interpretations of the salivagram (normal or abnormal) were compared with interpretations of the chest radiograph (normal or abnormal), there were 213 agreements and nine disagreements (intermethod agreement κ = 0.891; p < 0.0001; 95% CI, 0.831-0.952). Independent of age (p = 0.80) and sex (p = 0.31), patients with a neurologic diagnosis had odds of a positive salivagram 5.6 times higher than other diagnoses (odds ratio = 5.6; 95% CI, 2.5-13.1; p < 0.0001).. Infants with abnormal findings on salivagrams also had a high rate of abnormal findings on chest radiographs, which may indicate that some of the lung disease may be due to aspirated saliva. Salivagrams may be useful in children at risk of aspiration to identify those in whom intervention may help minimize the consequences of aspiration.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Logistic Models; Male; Pneumonia, Aspiration; Radiography, Thoracic; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Saliva; Technetium Tc 99m Sulfur Colloid; Young Adult

To determine patient characteristics and clinical factors that are predictive of positive radionuclide salivagram results.. Retrospective chart review (spanning 32 months).. Tertiary care children's hospital.. The study included 129 consecutive pediatric patients with suspected chronic aspiration.. All subjects underwent radionuclide salivagrams to evaluate for aspiration.. The association of 16 patient characteristics and clinical factors (eg, age, sex, diagnoses, study indications, medications, and previous surgical procedures) with salivagram results. Each factor was examined individually (chi(2) or Fisher exact test). For those factors that were significantly associated with positive salivagram results, the risk was estimated with the odds ratio (OR). A multivariable logistic regression model was constructed to determine how well significantly associated factors together predicted positive salivagram results.. The mean (SD) patient age was 4.5 (5.4) years. There were 84 boys (65%) and 45 girls (35%). Aspiration was identified in 27 of 129 salivagrams (21%). On univariate analysis, positive salivagram results were significantly associated with chronic respiratory infections and/or pneumonia (OR, 2.6), prescription of antireflux medications (OR, 2.7), developmental delay (OR, 2.8), and reactive airway disease exacerbations (OR, 3.3) (P<.05). None of the other clinical factors were significantly associated with salivagram results. On multivariate analysis, salivagram results were significantly associated with the 4 above-mentioned factors (P = .009). However, these 4 predictive factors were not independent of each other owing to the statistically significant associations among them.. We identified 4 clinical factors that are predictive of aspiration on salivagram. A high level of suspicion for aspiration should be maintained in children with these potential risk factors.

Topics: Adolescent; Adult; Chi-Square Distribution; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Inhalation; Logistic Models; Male; Pneumonia, Aspiration; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Risk Factors; Saliva; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

Topics: Deglutition Disorders; Humans; Male; Middle Aged; Pneumonia, Aspiration; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Risk Factors; Technetium Tc 99m Sulfur Colloid

To study the agreement between three tests for aspiration, barium videofluoroscopy, salivagram, and milk scan we studied 63 children with severe non-ambulant spastic quadriplegic cerebral palsy (CP) aged 14 months to 16 years (32 males, 31 females). The salivagram was most frequently positive (56%, 95% confidence interval 43 to 68%); the next most frequently positive was barium videofluoroscopy when aspiration was defined as the presence of either laryngeal penetration of material or frank aspiration (39%, 95% confidence interval 26 to 53%). The milk scan was rarely positive (6%, 95% confidence interval 2 to 16%). Agreement between the tests of aspiration was poor. The maximum agreement (kappa=0.20) was between aspiration as diagnosed with the salivagram and by barium videofluoroscopy. Positive tests for aspiration are frequent in children with severe CP. Frequency varies widely depending on the investigation used. There is poor agreement between tests used for the diagnosis of aspiration. This information is of importance in assessing the significance of test results.

Topics: Adolescent; Animals; Barium; Cerebral Palsy; Child; Child, Preschool; Confidence Intervals; Female; Fluoroscopy; Humans; Infant; Male; Pneumonia, Aspiration; Radiopharmaceuticals; Respiration; Saliva; Sialography; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

It has been shown that many healthy people aspirate secretions at night. Patients with obstructive sleep apnea (OSA) have frequent episodes of gasping at night that may predispose them to aspiration. The purpose of this study was to determine whether patients with symptoms of OSA are predisposed to pharyngeal aspiration.. A prospective study in which patients with symptoms of OSA were compared with a historic group of normal controls by using the same methodology.. The study was offered to patients with symptoms of OSA undergoing a sleep study. The radiotracer Technicium was infused through a plastic tube placed in the nasopharynx after the patient achieved stage II sleep. A chest radionuclide scan determined the amount of material aspirated. The Wilcoxon-rank sum test was used to compare the mean amount aspirated between the experimental and historic control groups.. Fourteen patients successfully completed the study. One normal volunteer in our study aspirated a quantity similar to the historic normal control group. The amount of aspirated material in the study group ranged from 0.152 to 3.648 mL, with a mean of 1.24 mL +/- 0.905 (SD). When compared with the historic normal control group, the patients with symptoms of OSA aspirated significantly more radio-tracer (P <.01). There was a lack of association between respiratory disturbance index and amount aspirated.. The results suggest there is an apparent risk of increased pharyngeal aspiration in patients with symptoms of OSA.

Topics: Adult; Aged; Case-Control Studies; Female; Humans; Inhalation; Linear Models; Male; Middle Aged; Monitoring, Physiologic; Pharynx; Pilot Projects; Pneumonia, Aspiration; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sleep Apnea, Obstructive; Statistics, Nonparametric; Technetium Tc 99m Sulfur Colloid

A simple method to detect silent aspiration during sleep has not been established in postsurgical oral cancer patients.. Radioactive paste consisting of (99m)TcO(4) (-) and carboxylmethylcellulose was prepared and placed in a maxillary prosthesis with a cavity in the palatal space. The patient was requested to wear this appliance during sleep, and the following morning the patient was subjected to scintigraphic scanning. Both the anterior and posterior aspects of the thorax were scanned using a Shimazu Medical gamma camera with window settings adjusted to a low energy collimator at 500 kilocounts per image.. Silent aspiration that had not been detected by videofluoroscopic examination was clearly demonstrated by the scintigraphic method, showing aspiration of radioactive paste during sleep in the left thorax of the patient.. The method reported for establishing aspiration is simple and reliable to assess silent aspiration during sleep in patients with oral cancer.

Topics: Aged; Carcinoma, Squamous Cell; Follow-Up Studies; Humans; Male; Mouth Neoplasms; Neoplasm Recurrence, Local; Pneumonia, Aspiration; Postoperative Complications; Postoperative Period; Radionuclide Imaging; Risk Assessment; Sensitivity and Specificity; Sleep; Technetium Tc 99m Sulfur Colloid

The aim of this study was to use gastroesophageal and pulmonary scintigraphy to evaluate the prevalence of gastroesophageal reflux and airway involvement among patients with posterior laryngitis.. The study included a total of 201 patients (131 females, 70 males; age range, 15-77 y; mean age +/- SD, 49 +/- 16 y). All patients had posterior laryngitis documented by laryngoscopy and symptoms such as a dry cough, painful swallowing, and hoarseness. A control population of 20 healthy volunteers (13 females, 7 males; age range, 19-74 y; mean age, 53 +/- 13 y) was also evaluated. After a 12-h fast, all subjects underwent gastroesophageal scintigraphy through administration of 300 mL orange juice labeled with 185 MBq 99mTc-sulfur colloid. After 18 h, planar anteroposterior thoracic images were acquired with the subjects supine.. Sixty-seven percent of patients (134/201) had scans positive for gastroesophageal reflux; of these, 30 (22%) had distal reflux and 104 (78%) had proximal reflux. In addition, the scans of 31 patients were positive for proximal reflux-associated pulmonary uptake. The frequency, duration, and degree of reflux episodes were significantly greater in patients with proximal reflux than in patients with distal reflux (P < 0.001). The 67 patients in whom reflux was not detected had diseases or reflux-associated cofactors that could account for laryngeal symptoms. No statistically significant difference in symptoms or esophageal motility parameters could be identified among the patient groups, but patients with proximal reflux had significantly prolonged gastric emptying times compared with healthy volunteers.. Most patients with posterior laryngitis had detectable proximal gastroesophageal reflux. Exposure of the proximal part of the esophagus to acid, by setting the stage for microaspiration of gastric material into the larynx, remains a major cause of damage to the laryngeal mucosa. Slowed gastric emptying may be a predisposing factor. Moreover, symptoms such as a dry cough, painful swallowing, or hoarseness may not be reliable predictors of the presence of gastroesophageal reflux or of associated airway involvement.

Topics: Case-Control Studies; Esophagus; Female; Gastric Emptying; Gastroesophageal Reflux; Humans; Laryngitis; Lung; Male; Middle Aged; Pneumonia, Aspiration; Radionuclide Imaging; Radiopharmaceuticals; Stomach; Technetium Tc 99m Sulfur Colloid

To determine the within-subject variability and to estimate the quantity of occult aspiration of nasopharyngeal secretions during sleep in normal humans.. Prospective duplicate full-night sleep studies.. Pulmonary sleep laboratory, university hospital.. Ten normal male volunteers aged 22 to 55 years.. Two full-night polysomnographic recordings with infusion of 2 mL/h radioactive 99mTc tracer into the nasopharynx through a small catheter during EEG-documented sleep. Standard lung scans were conducted immediately following final awakening. Aspiration was defined as the presence of radioactivity in the pulmonary parenchyma on two separate views.. A mean sleep efficiency of 85.7 +/- 2.6% was found with no difference between the two study nights. A total of 5 of the 10 subjects studied had tracer evident in the pulmonary parenchyma following final awakening. Three had the tracer apparent following the first-night study and four had tracer apparent following the second-night study. Thus, two subjects aspirated on both nights. Comparing the subjects who aspirated with those who did not, no significant difference could be found for age, time spent in bed, sleep efficiency, apnea-hypopnea index, arousal plus awakening index, or percent of sleep time spent in a supine position. The quantities of tracer aspirated were on the order of magnitude of 0.01 to 0.2 mL.. Aspiration measured by this technique occurs commonly in healthy young men during sleep, is unrelated to sleep quality, and is variable within subjects studied on more than one occasion. The quantity aspirated is of an order of magnitude likely to contain bacterial organisms in physiologically significant quantities.

Topics: Adult; Age Factors; Arousal; Bacterial Physiological Phenomena; Catheterization; Electroencephalography; Humans; Inhalation; Lung; Male; Middle Aged; Nasopharynx; Pneumonia, Aspiration; Polysomnography; Posture; Prone Position; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sleep; Sleep Apnea Syndromes; Sleep Stages; Supine Position; Technetium Tc 99m Sulfur Colloid; Time Factors; Wakefulness

Chronic salivary aspiration may be responsible for a significant percentage of pneumonia in the neurologically impaired child. The radionuclide salivagram (RS), a simple investigative study, can document salivary aspiration as the source of pulmonary contamination. The purpose of this study was to determine if the results of the RS would accurately identify children with severe and chronic salivary aspiration who would benefit from laryngotracheal separation (LTS). We reviewed 30 records of children with chronic aspiration pneumonitis who underwent LTS between 1988 and 1996. We recorded the number of inpatient days required for respiratory infections before and after LTS. This number was compared with the number of inpatient days for respiratory infection from children (n = 27) who underwent the RS during a ten-month period but who were never referred for LTS. Fifteen children who underwent LTS had a preoperative RS. The RS documented salivary aspiration in 11 of these children. Aspiration was effectively controlled by LTS for this group. There were three studies that failed to show either aspiration or progression of the Technetium 99m sulfur colloid (Tc 99m SC) into the esophagus This finding was felt to represent significant swallowing dysfunction and, therefore, was also considered a positive finding. There was a significant difference in the number of inpatient days for children who had a negative RS and were never referred for LTS when compared with the number of inpatient days for those children who had a positive RS and were referred for LTS. We feel that the RS is an effective tool to document salivary aspiration as the source of recurrent pneumonia. A modification of the technique and interpretation of RS is suggested.

Topics: Child; Child, Preschool; Chronic Disease; Deglutition Disorders; Fundoplication; Humans; Larynx; Pneumonia, Aspiration; Radionuclide Imaging; Retrospective Studies; Saliva; Severity of Illness Index; Technetium Tc 99m Sulfur Colloid; Trachea; Tracheotomy

Purpose. We wanted to demonstrate the utility of the radionuclide salivagram in assessing children whose underlying medical problems suggest that aspiration of oral contents is a factor contributing to otherwise unexplained lung disease or recurrent pneumonias. Materials and methods. Following sublingual administration of 300 μCi (11.1 MBq) of technetium-99m sulfur colloid in a drop of saline, serial images were obtained for 60 min and evaluated for entrance of tracer into the major airways and lung parenchyma. Thirty-four studies were performed on 31 patients (age: 3 weeks - 16.7 years, mean 5.5 years) with recurrent pneumonias or unexplained lung disease. All had medical conditions, most frequently neurological, predisposing to aspiration. Results. Pulmonary aspiration was detected in eight patients. All positive studies demonstrated aspirated tracer distal to the tracheal bifurcation, either in bronchi or in bronchi and lung parenchyma. Aspiration was bilateral in six cases. Clearance of aspirated tracer was noted in one patient. Conclusion. The salivagram is an effective tool for demonstrating aspiration of oral contents and the level to which aspirated fluid penetrates the tracheobronchial tree. Additionally, by allowing for the evaluation of clearance of aspirated tracer, the salivagram may provide information on the status of airway-protective mechanisms.

Topics: Bronchi; Child, Preschool; Female; Humans; Lung Diseases; Male; Pneumonia, Aspiration; Radionuclide Imaging; Risk Factors; Saliva; Technetium Tc 99m Sulfur Colloid; Trachea

That the radionuclide "milk" scan is insensitive for aspiration has been demonstrated. Here the authors review their experience with the radionuclide salivagram in its ability to detect aspiration in children. Tc-99m sulfur colloid, 0.5 to 1.0 mCi in less than 1 mL, is instilled into the mouth and sequential supine posterior images of the thorax are obtained for an hour with delayed images until the oropharynx is cleared of radiotracer. Fourteen studies have been performed in 13 patients aged 1 month to 6.5 years. There are scintigraphic findings consistent with aspiration in 4 of 14 studies (28%); dysmotility (prolonged retention of activity in the esophagus) in 7 of 14 studies (50%); and normal studies in 3 of 13 patients (22%). Eight of 13 patients had milk scans; all were negative for aspiration. One patient studied twice had aspiration on the first examination, and dysmotility on the second study. It is concluded that the salivagram can detect aspiration of oral secretions, is superior to the milk scan in detecting aspiration, and can demonstrate esophageal dysmotility.

Topics: Child; Child, Preschool; Esophageal Motility Disorders; Female; Humans; Infant; Male; Pneumonia, Aspiration; Radionuclide Imaging; Sialography; Technetium Tc 99m Sulfur Colloid

Pneumonia is the feared consequence of persistent aspiration of saliva. Although some persons with impaired protection of the laryngeal airway are thought to be at risk, it is not known with certainty which factors are important. Some patients receive tracheostomies to enhance airway safety, often without clear evidence of aspiration of oropharyngeal secretions. A simple, readily available technique is described by which oral secretions are scintigraphically labeled with technetium-99m sulfur colloid via slow intraoral infusion. Subsequent sequential chest imaging with a gamma camera allows detection and tracking of the aspirated material. Three persons are described in whom this technique was used. In one, the scintigraphic analysis was instrumental in implicating infected saliva as the likely source of recurrent pulmonary infections. Although the method is useful in detecting aspiration of saliva in high risk persons, more study is needed to equate the degree of aspiration visualized with the risk of pulmonary disease.

Topics: Aged; Humans; Inhalation; Lung; Male; Methods; Middle Aged; Pneumonia, Aspiration; Radionuclide Imaging; Risk Factors; Saliva; Technetium Tc 99m Sulfur Colloid

Eleven patients with previously documented aspiration underwent a radioisotopic swallowing study to detect and quantify airway penetration. In those subjects able to complete a rapid-acquisition phase during swallowing, no laryngotracheal penetration was seen despite previous evidence of aspiration. However, sequential static pulmonary imaging showed significant aspiration in three individuals. Attempts were made to measure the percentage of ingested material aspirated and the clearance rate from the airways. Eight patients (73%) failed to show definite evidence of aspiration on scintigrams. It is hypothesized that the lack of scintigraphic detection in previously proven aspirators was due either to interval improvement of the dysphagia or to difficult-to-detect laryngotracheal aspiration. Isotopic imaging during swallowing appears to have little utility; however, after ingestion, the technique can demonstrate more distal penetration not detected on videofluoroscopy. More studies are suggested to better define the sensitivity and specificity of scintigraphy in aspiration detection and to determine whether these techniques have prognostic value that could alter patient management.

Topics: Aged; Deglutition; Deglutition Disorders; Female; Humans; Male; Middle Aged; Nervous System Diseases; Pilot Projects; Pneumonia, Aspiration; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A radionuclide study is described utilizing a small volume of technetium 99m sulfur colloid to demonstrate the pulmonary aspiration of saliva. This is a possible cause of recurrent pulmonary infections even in patients off oral feeding. The salivagram is a useful technique to document these cases.

Topics: Enteral Nutrition; Gastrostomy; Humans; Infant; Male; Pneumonia, Aspiration; Radionuclide Imaging; Saliva; Technetium Tc 99m Sulfur Colloid

The radionuclide "salivagram" was introduced to document the aspiration of oral secretions in patients who are at risk. Approximately one-third of patients studied had positive tests. A positive study does not necessarily imply that patients are at risk for aspiration after gastroesophageal reflux. However, sequential images of the lung fields after the oral radioactivity has cleared may be a sensitive technique for detecting aspiration in infants and children following reflux.

Topics: Adolescent; Cerebral Palsy; Child; Child, Preschool; Chronic Disease; Female; Gastroesophageal Reflux; Humans; Infant; Intellectual Disability; Male; Pneumonia, Aspiration; Radionuclide Imaging; Recurrence; Risk Factors; Saliva; Technetium Tc 99m Sulfur Colloid

It has been suggested that gastroesophageal reflux scintigraphy (GRS) might be useful in assisting one in determining therapy for patients suspected of aspirating or becoming apneic secondary to gastroesophageal reflux. This, however, has not been our experience and in reviewing 23 patients with recurrent pneumonia and/or apnea who had GRS, we were able to detect aspiration in only one. This was especially significant since 13 (59%) of these patients had demonstrable reflux, and of these, eight were treated successfully for suspected aspiration even though none was demonstrated isotopically. To be sure, the demonstration of pulmonary aspiration with GRS had little influence on patient selection and response to therapy. For this reason we feel there is little justification in depending on the GRS for the specific purpose of trying to document pulmonary aspiration in infants and children who are refluxing.

Topics: Apnea; Child, Preschool; Evaluation Studies as Topic; Gastroesophageal Reflux; Humans; Image Processing, Computer-Assisted; Infant; Infant, Newborn; Pneumonia, Aspiration; Radionuclide Imaging; Recurrence; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

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.

Topics: Adolescent; Animals; Barium Sulfate; Child; Child, Preschool; Contrast Media; Deglutition; Gastroesophageal Reflux; Humans; Infant; Infant Food; Milk; Pneumonia, Aspiration; Radiography; Radionuclide Imaging; Sudden Infant Death; Technetium Tc 99m Sulfur Colloid

Aspiration is analyzed by a new scintigraphic technique and standard videofluoroscopy in 78 patients with head and neck pathology and neurologic disorders. When both methods are compared to clinical aspiration and a positive x-ray film of pneumonia, they appear to complement each other and provide a very accurate evaluation. Scintigraphy is a more sensitive method for detecting aspiration below the vocal cords and also provides for flow dynamics and a method of quantifying the amount of aspirated material. Videofluoroscopy shows more clearly the mechanism of the swallowing disorder and how the bolus enters the tracheobronchial tree. Studies in patients following head and neck surgery demonstrate a high incidence of dysphagia, aspiration, and pneumonia.

Topics: Deglutition; Female; Fluoroscopy; Head and Neck Neoplasms; Humans; Male; Pneumonia, Aspiration; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Television

Newborn children, fitted with tracheal prosthesis for mechanical ventilation, may present chronic pulmonary complications due to the repetition of silent aspirations following gastroesophageal reflux. We evaluated, in a newborn intensive care population, the frequency of such aspirations and the relationship between the different parameters and pathologies. This particular group of sick neonates cannot be moved, and as the hospital for the newborn is far from the Nuclear Medicine district, the patients cannot be scanned. We used a simple technique: the injection of a solution of 99Tcm-sulphur colloid in their gastric tube, and the measurement of the tracheal aspiration tubes' radioactivity. Thirty one children were tested; thirteen children (42%) had radioactive tracheal tubes. The study of the relationship between several parameters and our results, shows that the examination was generally positive when the maximal insufflation pressure value was low. Our results prove that silent aspirations are very frequent in such a population and that it will be perhaps useful to prevent them in a systematic way in order to save the neonates from developing pulmonary lesions.

Topics: Female; Gastroesophageal Reflux; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Intubation, Intratracheal; Male; Pneumonia, Aspiration; Radionuclide Imaging; Respiration, Artificial; Technetium Tc 99m Sulfur Colloid

The high incidence of pneumopathy in intensive care units might be due to the pulmonary aspiration of gastric juice following gastro-oesophageal reflux. The paper describes a radio-isotopic method using material easy to install at the patient's bedside. This technique demonstrated aspiration of gastric juice in the lungs of 8 of 25 intensive care patients investigated. Such a method might be useful later to demonstrate that silent bronchial aspirations of gastric juice are responsible for pulmonary complications.

Topics: Humans; Intensive Care Units; Intubation, Gastrointestinal; Pneumonia, Aspiration; Radionuclide Imaging; Rhenium; Technetium; Technetium Compounds; Technetium Tc 99m Sulfur Colloid

Scintigraphic studies of swallowed 99m Tc-sulphur colloid mixed with a few millilitres of liquid, performed on 400 paediatric patients of all ages, allowed visualisation of foregut function and measurement of oesophageal transit time and gastric emptying proportions. This non-invasive and physiological procedure requires a standard gamma camera with computing facilities and was performed as an outpatient routine. It proved very effective for the detection of gastro-oesophageal reflux and aspiration of refluxed liquid in patients of all ages but especially in neonates. The relevance of these scintigraphic results to oesophagitis, repeated respiratory problems, cyanotic and apnoeic spells and alternative methods of investigation is described.

Topics: Apnea; Esophagitis, Peptic; Female; Gastric Emptying; Gastrointestinal Motility; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Pneumonia, Aspiration; Radionuclide Imaging; Respiration Disorders; Sudden Infant Death; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid