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The clinical features, chest radiographs and computed tomographic (CT) images were evaluated in 11 cases with serologically proved adult measles complicated with pneumonia (10 were previously healthy and one had sarcoidosis). Pneumonia appeared during the rash period in all cases. Respiratory symptoms were cough (9/11), dyspnea (3/11), and hypoxemia (10/11). Pneumonia manifestations were detected in only 4 cases by chest radiograph; on the other hand, they were seen in all cases by CT scan and consisted of ground-glass opacities (73%), nodular opacities (64%) and consolidation (27%). CT seems to be a useful method to detect measles pneumonia if it is suspected. Measles pneumonia in previously healthy patients had a good prognosis, as the hypoxemia disappeared within 6 days in all cases. The sarcoidosis patient showed prolonged pneumonic shadows and period of hypoxemia. Measles pneumonia occurring in a host with cellular immunodeficiency may have a severe clinical course.
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PMID:[Clinical features of measles pneumonia in adults: usefulness of computed tomography]. 825 23

Hydatid lung disease due to Echinococcus granulosus in the Canadian northwest and Alaska is often asymptomatic and usually benign. We reviewed the course and outcome of three children with giant hydatid lung cyst seen over a 2-year period. All were North American Indian children aged 9 to 12 years who presented with cough, fever, and chest pain. One had a rash. There was a history of exposure to domestic dogs who had been fed moose entrails in each case. Chest x-rays showed solitary lung cysts with air-fluid levels, from 6 cm to 12 cm in diameter. Aspiration of each cyst demonstrated Echinococcus hooklets and protoscolices. Serology was unhelpful, being negative in two cases. Transient pneumonitis and pneumothorax were seen as complications of needle aspiration. Two cysts gradually resolved over the following 6 months. One child returned after 9 months with a lung abscess due to superimposed infection of the cyst remnant with Haemophilus influenzae, and eventually required lobectomy. The existence of an endemic benign variant of E granulosus in Canada is not widely known, and it is important to distinguish it from the more aggressive pastoral form of the disease seen in immigrants from sheep-rearing countries. The native Canadian disease usually resolves spontaneously, does not cause anaphylaxis, and does not implant daughter cysts if spilled. Surgical treatment should be avoided except for complications such as secondary bacterial infection.
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PMID:Giant hydatid lung cysts in the Canadian northwest: outcome of conservative treatment in three children. 830 79

This case presentation will discuss the pathophysiology of a child in septic shock due to Neisseria meningitidis. The most prevalent nursing care concerns of this case encountered during the pediatric intensive care unit (PICU) and during the general floor stay will be addressed. The nursing skill required for identifying problems and planning care that clearly fall under the nursing domain also will be covered. In addition, the complexities of this case demonstrate that collaboration between the PICU nurse and the general pediatric nurse is imperative for successful patient outcome. A.W. was a 5 1/2-month-old infant transported to our PICU from a referral hospital in the state. Diagnosis at time of admission was meningococcemia, disseminated intravascular coagulopathy, septic shock, respiratory failure, and purpura fulminans. There was a 2- to 3-day history of a runny nose, cough, and vomiting. On the day of admission, A.W. had three seizures and developed a fever and a purpuric rash.
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PMID:Nursing care of a child with meningococcemia. 841 Jun 41

We investigated the long-term health effects of HIV-1 infection in homosexual men not close to developing AIDS by comparing 916 HIV-1-seropositive (SP) men at least 1.67-3.67 years prior to a clinical AIDS diagnosis to 2,161 HIV-1-seronegative (SN) controls. The SP group reported a higher total of 12 distinct symptoms (fatigue, shortness of breath, night sweats, rash, cough, diarrhea, headache, thrush, skin discoloration, fever, weight loss, and sore throat/mouth) than did the SN group (p < 0.0001), corresponding to at least 5.6 more days/year of such symptoms. The SP group had lower body mass index (p < 0.0001) and lower hemoglobin (p < 0.0001). The SP group was more depressed, as measured by CES-D score (p = 0.047), before knowledge of one's serostatus was likely, and became even further depressed (p = 0.038 for increase in depression) after the HIV-1 serostatus test was accessible to high-risk groups. These associations remained unchanged in multivariate models, incorporating other covariates.
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PMID:Signs and symptoms of "asymptomatic" HIV-1 infection in homosexual men. Multicenter AIDS Cohort Study. 826 59

A 24-year-old man presented with a nonproductive cough, fever, and occasional shaking chills of one week's duration. he also had pleuritic left-sided chest pain on deep inspiration and a rash on his palms, soles, trunk, and mouth. His wife had been sick with "pleurisy" two weeks earlier; her symptoms had resolved with antibiotic therapy.
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PMID:A case of pneumonia with extrapulmonary manifestations. 859 12

A 43-year-old man who had been treated for bronchial asthma presented with an increase in dry coughing and wheezing for one and a half years. In August 1994, the patient noted progressive dyspnea on exertion. A chest radiograph revealed nodular opacity in the right upper lung field. In November 1994, the patient was admitted to Kinki University Hospital with an erythematous rash on the soles of both feet. Examination of a specimen biopsy of the skin lesion revealed granuloma with eosinophil infiltration. Peripheral blood eosinohilia was noted and a bone marrow examination also revealed an increased level of eosinophils. Another chest radiograph revedaled that the nodular opacity had disappeared and a new bilateral pleural effusion was seen. Eosinophils were the predominant cells in the pleural effusion. the patient's condition was further complicated by myocarditis. Allergic granulomatous angitis (Churg-Strauss syndrome) was diagnosed and steroid therapy was started. After the start of steroid therapy, the skin eruption disappered and the myocarditis became less severe. Symptoms of asthma were also well controlled. The eosinophils had hypersegmented unclei and increased expression of adhesion molecules on their surfaces.
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PMID:[Allergic granulomatous angitis with hyper expression of eosinophilic adhesion molecules]. 874 37

A 29-year-old woman developed fever and sore throat 14 days before admission. Six days later she noted the onset of a rash and ten days later she noted a dry cough. The chest X-ray film showed no abnormal shadow, but a chest CT scan showed a diffuse ground-glass shadow and a 67Ga-scintigram showed abnormal lung uptake. The level of anti-cytomegalovirus antibody of the IgM class was high; cytomegalovirus mononucleosis was diagnosed and cytomegalovirus pneumonia was suspected. Cytomegalovirus DNA was detected in bronchoalveolar lavage fluid by the polymerase chain reaction method. We known of no previously reported case of cytomegalovirus mononucleosis in which cytomegalovirus DNA was found in bronchoalveolar lavage fluid by the polymerase chain reaction method.
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PMID:[Cytomegalovirus mononucleosis with cytomegalovirus pneumonia in an adult]. 874 43

We encountered a patient with dermatomyositis complicated by sarcoidosis. A 57-year-old woman was admitted to our hospital because of fever dry cough, and myalgias. There were reticular shadows on her chest X-ray film. Although the typical skin rash and myositis suggested the diagnosis of dermatomyositis biopsy specimens from a salivary gland, muscle, and lung revealed noncaseating granulomas as well. Uveitis was also noted. These findings suggested the coexistence of sarcoidosis with dermatomyositis. Examination of the lung-biopsy specimens showed interstitial pneumonia compatible with dermatomyositis, except for the granuloma. The typical rash of dermatomyositis and pathological findings of the lung specimen were inconsistent with sarcoidosis. Therefore we concluded that this patient had both dermatomyositis and sarcoidosis. This case sheds new light on the importance of pathological examinations.
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PMID:[Dermatomyositis complicated by sarcoidosis]. 897 83

Verbal autopsy uses a caretaker interview to determine the cause of death. We conducted a study of the major causes of child death in Namibia to determine the validity of this method. A questionnaire, including signs and symptoms of the diagnoses of interest was administered to the caretaker in 135 deaths of children < 5 years old who were identified from hospital records. The 243 diagnoses included malnutrition (77), diarrhoea (73), pneumonia (36), malaria (33), and measles (24). Sensitivity and specificity of various algorithms of reported signs and symptoms were compared to the medical diagnoses. An algorithm for malnutrition (very thin or swelling) had 73 per cent sensitivity and 76 per cent specificity. An algorithm for cerebral malaria (fever, loss of consciousness or convulsion) had 72 per cent sensitivity and 85 per cent specificity, while for all malaria deaths the same algorithm had low sensitivity (45 per cent) and high specificity (87 per cent). For diarrhoea, loose or liquid stools had high sensitivity (89 per cent), but low specificity (61 per cent). Cough with dyspnoea or tachypnoea had 72 per cent sensitivity and 64 per cent specificity. An algorithm for measles (age > or = 120 days, rash) had 71 per cent sensitivity and 85 per cent specificity. The study results suggest verbal autopsy data can be useful to ascertain the leading causes of death in childhood, but may have limitations for health impact evaluation.
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PMID:Validation study of a verbal autopsy method for causes of childhood mortality in Namibia. 900 66

The results of a drug use evaluation of lisinopril at a large teaching military medical center are reported. Indicators and thresholds were developed and approved by the Pharmacy and Therapeutics Committee. The medical charts of 227 patients for whom lisinopril was prescribed from June 1991 to June 1992 were reviewed for appropriateness of prescribing, appropriateness of monitoring, occurrence of any adverse drug reactions, and detection of drug interactions. Prescribing was appropriate in 97% and monitoring was appropriate in all reviewed cases. The most common adverse drug reactions detected were cough (7%), hypotension (3%), and rash (2%). Patients were also prescribed several drugs that may interact with lisinopril. Lisinopril appeared to be well tolerated and efficacious. Forty patients (18%) experienced adverse drug reactions related to lisinopril. There did not appear to be any major deficiencies with lisinopril prescribing and no corrective action needed to be taken other than educational activities for the appropriate use of lisinopril. Information from this drug use evaluation is useful in formulary decision making.
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PMID:Lisinopril use in a large military medical center. 903 30


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