OBJECTIVE: This study was conducted to identify the frequency of videofluoroscopic swallow study (VFSS) and characteristics of VFSS findings in the patients diagnosed with aspiration pneumonia. METHOD: We retrospectively reviewed the medical records of 2,885 patients who has been diagnosed with aspiration pneumonia either clinically or radiographically. Overall, 811 patients could not be examined because of medical problems. The rest of the subjects were divided into two groups according to the presence of neurologic deficit. The findings of VFSS were scored using the Penetration-Aspiration Scale (PAS) and Pharyngeal Residue Grade (PRG), and data were analyzed based on descriptive statistics, the χ² test, t-test, ANCOVA and logistic regression. RESULT: A total of 1,267 subjects (43.9%) underwent VFSS. Among patients who could be examined, 61.1% were tested. Only 26.7% of subjects without neurologic deficit underwent VFSS, while 56.5% of the subjects in the other group underwent the procedure. The PAS and PRG scores did not differ significantly between groups. About 32.7% of the findings showed silent aspiration (PAS 8), which difficult to detect by bedside screening tests. CONCLUSION: Subjects with neurologic deficit showed significantly higher test rates than the others. There were no significant differences in VFSS findings between groups. Dysphagia should be evaluated in patients with aspiration pneumonia using precise tools, such as VFSS and fiberoptic endoscopic evaluation of swallowing (FEES), regardless of presence of neurological deficit.
Deglutition ; Deglutition Disorders ; Humans ; Logistic Models ; Mass Screening ; Medical Records ; Methods ; Neurologic Manifestations ; Pneumonia, Aspiration ; Retrospective Studies

BACKGROUND: Pulmonary tuberculosis is one of the diseases characterized granuloma formation which was controlled by cellular immune reactions. In the process of granulomatous changes, activated alveolar macrophages and T lymphocytes secrete many cytokines including interleukin-1 (IL-1), tumor necrosis factor-alpha(TNF-alpha), interferon-gamma (INF-gamma) which mediate inflammatory reactions. Intercelluar adhesion molecule-1(ICAM-1) also known to major role player in inflammatory processes, and increased cellular expressions when endothelial cell was stimulated by IL-1, TNF and IFN. METHOD: To evaluate relationships among cellular immune reactions and clinical stages, pulmonary tuberculosis patients were classifed into three groups according to their clinical stages including minimal, moderate and far advance tuberculosis. TNF-alpha, INF-gamma, sICAM-1 (soluble form of ICAM-1) were measured at the time of diagnosis and after 6-months anti-tuberculosis medications by radioimmuno assay or enzyme linked immunosolvent assay. RESULTS: TNF-alpha, INF-gamma, sICAM-1 were singificantly increased in moderate and far advanced pulmonary tuberculosis patients but no meaningful changes in minimal staged patients. 6-months anti-tuberculosis medications reduced serum sICAM-1 levels significantly, related to clinical improvement but no significnat changes were found in the serum levels of TNF-alpha and INF-gamma. In the point of correlations, positive ones revealed between TNF-alpha and sICAM-1, also between IFN-gamma and sICAM-1 but no correlation between TNF-alpha and IFN-gamma. CONCLUSION: Measurement of serum sICAM-1 could be usuful parameter to evaluate the severity of pulmonary tuberculosis and to monitor disease activities durig anti-tubercoulsis medications.
Cytokines ; Diagnosis ; Endothelial Cells ; Granuloma ; Humans ; Interferon-gamma* ; Interleukin-1 ; Macrophages, Alveolar ; Necrosis ; T-Lymphocytes ; Tuberculosis ; Tuberculosis, Pulmonary* ; Tumor Necrosis Factor-alpha*