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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective study of clinical tularaemia in an emergent area in Sweden is presented. 234 patients seen during the y 2000-2004 were studied, using case files and a questionnaire. There was a predominance of ulceroglandular tularaemia (89%), occurring in late summer and early autumn, reflecting the dominance of mosquito-borne transmission. The incubation period varied from a few hours to 11 d, with a median of 3 d. Cutaneous manifestations of tularaemia, apart from primary lesions, were noted in 43% of the cases. Coughing was common, even in patients with ulceroglandular tularaemia, supporting the view that haematogenous spread to the respiratory system occurs. Regular laboratory tests, such as WBC, ESR and C-reactive protein, were in general only moderately elevated. In the earlier y studied, the Doctor's Delay was substantial as was the misdiagnosis and prescription of inadequate antibiotics. In the later y, however, the delay and misdiagnosis were significantly lower, reflecting the increased recognition of the disease by the physicians in the area. A few relapses occurred, all in patients treated with doxycycline. No lethality was seen, reflecting the benign course of tularaemia type B infection.
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PMID:Tularaemia in an emergent area in Sweden: an analysis of 234 cases in five years. 1788 25

A 47-year-old man with pulmonary hyalinizing granuloma is herein presented. The patient, whose chief complaint was a mild cough, was found by chest radiograph to have multiple bilateral nodules. Subsequent high-resolution computed tomography demonstrated multiple slightly irregular nodules, perinodular ground-glass opacity, peribronchovascular interstitial thickening, and cysts. A mild enlargement of systemic lymph nodes was also noted. Laboratory tests disclosed a slight elevation in the C-reactive protein, gamma-globulin, interleukin-6, and soluble interleukin-2 receptor levels. A histopathologic examination of the specimen yielded from a thoracoscopic lung biopsy resulted in a definite diagnosis of pulmonary hyalinizing granuloma.
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PMID:High-resolution CT findings in pulmonary hyalinizing granuloma. 1804 99

An 82-year-old man was admitted with a 1-week history of chilling fever and dry cough. Laboratory tests revealed pancytopenia and elevated levels of C-reactive protein and lactic dehydrogenase (LDH). Screening for infectious diseases was negative. A bone marrow biopsy showed aspecific findings. The combination of pancytopenia, persistent fever, elevated LDH and hepatomegaly (demonstrated by ultrasound examination of the abdomen) was suggestive of the haemophagocytic syndrome. This was confirmed by very high levels of ferritin and soluble interleukin-2 receptor in the blood. In addition, re-examination of the bone marrow showed several haemophagocytic histiocytes. A polymerase chain reaction for Epstein-Barr virus (EBV) revealed a very high viral load. Since the patient had a history of an increased level of anti-EBV immunoglobulin-G, this was explained by a reactivation of the EBV infection. On the sixth day in hospital the patient developed signs of bilateral pneumonia and subsequent multiple organ failure. Despite intensive treatment the patient died. Autopsy revealed no haematological or other malignancies, but did show haemophagocytosis in many organs. It was then concluded that the patient had a virus-associated haemophagocytic syndrome, due to a reactivation of EBV, for which no underlying cause was found.
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PMID:[Clinical reasoning and decision-making in practice. A patient with fever and pancytopenia]. 1878 29

Clinical features such as cough, sputum production, fever, and the presence of a new lung infiltrate seen on radiograph are not specific to respiratory tract infection, nor do they define the need for antibiotic therapy. Therefore, investigators have looked for biological markers that can supplement clinical information to determine whether the etiology of the infection is more likely bacterial, needing antibiotic therapy, or viral. There are studies of a number of biological markers in serum and bronchoalveolar lavage fluid, including cytokines, acute-phase reactants, and immunoglobulins. The 2 most promising markers in serum are C-reactive protein and procalcitonin (PCT). PCT is a hormokine, produced primarily by parenchymal cells in response to microbial toxins and in response to certain host inflammatory mediators (interleukin-1beta, tumor necrosis factor-alpha, and interleukin-6). Because PCT is down-regulated in the presence of viral infection, PCT seems most promising for defining the need for antibiotic therapy among patients with radiographic evidence of pneumonia. Studies using the highly sensitive Kryptor assay have shown that PCT guidance can lead to the safe withholding of antibiotics among patients with low PCT levels (<0.25 microg/L) and no clinical signs of severe illness. In addition, serial measurements of PCT have been reported to correlate with clinical response to therapy and may be able to guide short durations of therapy. In the future design of trials for community-acquired pneumonia, we may want to exclude patients with low PCT levels, because they are unlikely to benefit from antibiotic therapy. On the other hand, inclusion of patients with low PCT values creates heterogeneity in the study population and confounds the interpretation of clinical trial end points.
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PMID:Biological markers to determine eligibility in trials for community-acquired pneumonia: a focus on procalcitonin. 1898 78

Numerous false positive findings are a problem in computed tomography based lung cancer screening trials. The potential patient-related variables that could predict the existence of such lung nodules were studied. 526 construction workers (age 38-81 yrs.) previously screened with spiral computed tomography were evaluated. Background features (age, body mass index, stature, sex, C-reactive protein, erythrocyte sedimentation rate, asbestos exposure and smoking history), reported symptoms (general condition, cough, mucous production, dyspnoea, chest pain) and findings in high resolution CT were related to the existence of nodules with logistic regression. There were 107 patients with one or more nodules recorded at least by two of the three observers. Advancing age (OR = 1.042/year, 95% CI = 1.000-1.085, p = 0.048) and dyspnoea symptom (p = 0.014) were positively associated with the existence of nodules, while smoking, asbestos exposure history and other studied parameters were not. Nodules < or = 5 mm (50 patients) were inversely associated with the maximal thickness of pleural plaques (OR = 0.384, 95% CI = 0.169-0.873, p = 0.022). No variables helpful to sample subjects for lung cancer screening studies to reduce the number of false positive findings were found. Poor inspiration or associated pathology such as thick pleura may hamper nodule detection. Further studies should focus especially on the possible effect of computer tomography technology on finding nodules.
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PMID:Factors influencing the prevalence of pulmonary nodules in lung cancer screening trials: re-evaluation of a CT study. 1899 Dec 40

A retrospective study was undertaken to investigate the clinical aspects of Q-fever pneumonia. Six sporadic cases, 5 men and 1 woman, aged between 36 and 81 years were diagnosed by testing paired serum samples using an indirect immunofluorescence assay from July 2004 to June 2007. Of these, 5 suffered from concomitant or chronic disease. The predominant clinical features were fever, cough, sputum, and chest pain. The WBC count was within normal values in half of the patients. C-reactive protein was elevated in all patients. Liver dysfunction was noted in 2 patients. Chest computed tomography revealed air space consolidation and small nodules in all patients and pleural effusion in 1 patient. Anti-phase II IgG titers of paired serum samples were elevated, but anti-phase II IgM titers were within normal limits in all the patients. Antibiotics were given to all the patients, and, beta-lactum agents were prescribed for 3 patients. The outcome was favorable in all the patients. These patients demonstrated nonspecific clinical, radiological, and laboratory manifestations, and we were able to distinguish Q-type pneumonia from other forms of community-acquired pneumonia only by testing anti-phase II IgG titers of paired serum samples.
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PMID:[Clinical features of Q-fever pneumonia]. 1919 95

A 80-year-old man was admitted to our hospital because of coughing, hemosputum and dyspnea. As a chest X-ray showed infiltrates of the right lung, he was diagnosed as bacterial pneumonia and treated with antibiotics. However, after a few days, he exhibited hemoptysis and developed severe dyspnea, while laboratory findings showed rapid elevation of the serum creatinine level (5.55 mg dL). Computed tomography (CT) revealed large areas of ground glass opacity in the right lung, hence the hemoptysis was considered to be due to alveolar hemorrhage. As he had been diagnosed as chronic renal failure a few years before this admission and we also noticed that interstitial pneumonia with a slightly elevated level of C-reactive protein had existed from that time, ANCA-associated vasculitis was suspected to be the underlying pathogenesis. Accordingly, he was started on methylprednisolone pulse therapy and temporary hemodialysis resulted in improvement of dyspnea and renal function. PR3-ANCA was 12.4 EU, so he was diagnosed as PR3-ANCA-associated vasculitis. After a few days, he suddenly complained of abdominal pain, developing hypotension and anemia. Abdominal CT showed an irregular low-density mass in the right muscle, so he was diagnosed as rectus muscle hematoma. Surgery was performed and a massive hematoma was found in the rectus muscle without any ruptures of macroscopic vessels in the abdomen. Bleeding could not be stopped followed by multiple organ failure and the patient died four days postoperatively. Rectus muscle hematoma is an uncommon cause of acute abdomen, and has been reported in about 100 cases in Japan. It occurs because of a tear in epigastric vessels and is usually managed conservatively with a good prognosis, although hemodynamically unstable cases require surgery. To the best of the authors' knowledge, this is the first case of rectus muscle hematoma complicated with ANCA-associated vasculitis.
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PMID:[Autopsy case of PR3-ANCA-associated vasculitis complicated with rectus muscle hematoma]. 1971 63

A 59-year-old woman with lumbago, presented with cough and right chest pain. Her chest X-ray showed right pleural effusion, and laboratory studies revealed elevated levels of serum C-reactive protein. Right bacterial pleuritis and empyema was diagnosed based on an analysis of the pleural effusion and pus. She was treated with antibiotics and both the right pleural effusion and pus were drained with a chest tube. Staphylococcus aureus was cultured from the pleural effusion and pus. Her fever and chest pain improved after this treatment, however, the lumbago took a sharp turn for the worse. A spinal MRI showed an increased signal intensity at the level of T11-12, thus suggesting a disk space infection and spondylitis with an epidural abscess. Thereafter, she developed left pleural effusion, and the effusion was drained. Her infection was cured with long-term administration of antibiotics. However, the infectious spondylitis relapsed after four months, and she therefore had to undergo surgery. This case suggested that infectious spondylitis produced the exudative pleural effusion. Bacterial pleuritis, empyema and exudative pleural effusion must therefore be treated while keeping in mind the possibility of infectious spondylitis.
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PMID:[Case of infectious spondylitis presenting as exudative pleural effusion]. 1982 86

Valsartan is a nonpeptide angiotensin receptor antagonist that selectively blocks the binding of angiotensin II to the angiotensin II type 1 receptor. The efficacy, tolerability and safety of valsartan have been demonstrated in large-scale studies in hypertension, heart failure (HF) and post-myocardial infarction (MI). This review focuses on what was learned from the valsartan clinical research programme and other comparative trials published from 1997 to the present. Many studies have demonstrated the efficacy of valsartan in lowering blood pressure (BP) in a variety of patient populations (including elderly, women, children, obese patients, patients with diabetes mellitus, patients with chronic kidney disease [CKD], patients at high risk of cardiovascular [CV] disease, African Americans, Hispanic Americans and Asians) and in improving outcomes in CV disease and CKD. In hypertension, valsartan exhibits dose-dependent efficacy in reducing both systolic and diastolic BP over the once-daily dose range of 80-320 mg; doses as high as 640 mg/day have been studied and found to be efficacious and safe. BP control can be enhanced with a more consistent 24-hour BP-lowering profile by using single-pill, fixed-dose combination therapy with valsartan plus hydrochlorothiazide (HCTZ). The cardioprotective benefits of valsartan have been demonstrated in large-scale outcome trials and include significant reductions in CV morbidity and mortality in HF, following MI, and in patients with co-morbid hypertension and coronary artery disease and/or HF; reductions in HF hospitalizations; and reductions in the incidence of stroke. The magnitude of these effects is comparable with that demonstrated with angiotensin-converting enzyme (ACE) inhibitors; however, valsartan has a more favourable tolerability profile, with a significantly lower incidence of cough and only rare reports of angio-oedema, both class effects of ACE inhibitor use. Consistent with its angiotensin receptor-blocking effects, valsartan also reduces circulating levels of biochemical markers that are associated with angiotensin II-mediated endothelial dysfunction and CV risk (e.g. high-sensitivity C-reactive protein or oxidized low-density lipoprotein). Improvements in CKD with valsartan include statistically and clinically meaningful reductions in urinary albumin and protein excretion in patients with type 2 diabetes and in nondiabetic patients with CKD. In short-term studies, valsartan has improved or stabilized various indices of metabolic function in at-risk patients, including those with co-morbid hypertension, obesity and/or metabolic syndrome. Because of this, valsartan is being prospectively investigated for its ability to reduce the incidence of new-onset diabetes and provide cardioprotection in patients with impaired glucose tolerance. Valsartan and valsartan/HCTZ are well tolerated. In clinical trials, adverse events during valsartan treatment were similar to those occurring with placebo. The combination of valsartan/HCTZ was better tolerated than HCTZ alone. Valsartan is administered once daily for hypertension; doses are usually taken upon awakening. In patients with HF or MI, valsartan is administered twice daily.
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PMID:Valsartan: more than a decade of experience. 1991 55

During the past few years, biomarkers have emerged as an indispensible tool in the diagnosis of pneumonia. To find an ideal diagnostic biomarker for pneumonia is not an easy task. Not only should it allow an early diagnosis of the condition, but it should also allow differential diagnosis from other noninfectious conditions. Ongoing research is being done in this field so as to put an array of biomarkers at the disposal of doctors to improve the diagnosis of pneumonia when patients present to them with cough or nonspecific symptoms which could easily be misinterpreted as symptoms of other conditions. Procalcitonin and soluble triggering receptor expressed on myeloid cells-1 have emerged as reliable diagnostic markers in pneumonia, and are better when compared to other markers, namely, C-reactive protein, leukocyte count, and proinflammatory cytokines. Many other biomarkers are being studied for their probable use in diagnosing pneumonia but have yet to prove their benefit.
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PMID:Biomarkers: a definite plus in pneumonia. 2001 58


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