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We encountered two cases of legionella pneumonia which ran a dramatic course and isolated Legionella dumoffii from one patient and Legionella pneumophila serogroup 5 from the other patient. The patient from whom L. dumoffii was isolated was a 59-year-old male with no basic disease. He presented chill, fever, coughing and other symptoms, starting on July 3, 1986, his disease was diagnosed as pneumonia at the clinic of his company. The patient was then introduced and admitted to our hospital. On admission chest radiography disclosed zonal pneumonia with an unclear border in the right superior lobe of the lung; a beta-lactam preparation was administered, but no effect was obtained and the lung lesion showed a rapid advance. From this condition, we suspected legionella pneumonia and changed the therapy to treatment with erythromycin and rifampicillin. Despite this, no improvement occurred and the patient died on the 26th hospital day. Colonies like Legionella colonies were separated from a total of seven specimens of biopsy aspirated matter from the airway and autopsy collected lung abscess and tracheal secretions, and the bacterium was identified L. dumoffii based on the biochemical and serological properties. In addition, the patient's serum was found to have an increased antibody titer against L. dumoffii. Based on these findings, the patient's disease was diagnosed as pneumonia as caused by L. dumoffii, a relatively rare bacterium as a member of the genus Legionella. The patient from whom Legionella pneumophila serogroup 5 was isolated was an 81-year-old man with basic diseases such as heart failure, anemia and hypothyroidism. He presented fever, general fatigue, anorexia and other symptoms, starting around June 2, 1987; pneumonia was suspected and the patient was urgently admitted to our hospital. The patient died of pneumonia of unknown cause on the second hospital day. To clarify the cause, autopsy was conducted; a large number of colonies like Legionella colonies were noted in the lung tissue. Identification test was then conducted and the bacterium was identified as L. pneumophila; we concluded that the patient's pneumonia had been caused by the identified bacterium L. pneumophila. The isolate was further subjected to slide agglutination test and identified as L. pneumophila serogroup 5.
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PMID:[Legionella dumoffii and Legionella pneumophila serogroup 5 isolated from 2 cases of fulminant pneumonia]. 250 80

To evaluate the usefulness of chemotherapy in non-small cell lung cancer, objective response, length of remission and survival have been considered the main yardsticks. Subjective improvement and gain in Karnofsky performance status have attracted very little attention. Thirty-one patients with stages III and IV underwent combination chemotherapy with high-dose cisplatin, and were assessed with categorical scales and 100 mm visual analogue scales used by patients themselves to report on several symptoms of their illness. After chemotherapy 17 of 19 patients (89%) gained weight; 20 presented anorexia, 10 of those (50%) improved; 15 had pain, 7 of those (47%) were alleviated; cough was reported in 22, in 10 (45%) it was ameliorated; hemoptysis disappeared in 10 of 11 patients (91%); of the 9 patients who had dyspnea, 7 improved (78%); and astenia was attenuated in 8 of 16 patients (50%). Quality of life was reported improved in 75% of those patients who had considered themselves seriously affected prior to the treatment. When compared with Karnofsky performance status, no relationship was found (r = 0.31). It is concluded that, apart from the objective response achieved, a significant proportion of patients did benefit from treatment as demonstrated by a marked relief of symptoms.
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PMID:Quality of life during chemotherapy in non-small cell lung cancer patients. 216 77

Pathological consequences of a severe outbreak of swine influenza (H1N1 virus) in the non immune sow at the beginning of pregnancy, under natural conditions. A sudden acute outbreak of fever, depression, anorexia and coughing in a group of nulliparous sows from a herd that was currently under epidemiological investigation lead to build a particular disposal of observation. The clinical signs were daily recorded including rectal temperature. Blood was taken from the sows at the beginning of the troubles and 3 weeks later for the detection of Aujesky's disease, coronavirus TGE-like, Influenza viruses A/H1N1 and A/H3N2 and Mycoplasma hyopneumoniae. Viral detection was attempted from nasal swabs and aborted fetuses during the acute phase. The clinical study showed fever reaching near 41 degrees C on most of the pigs and lasting usually from 2 to 5 days. The diagnosis of Influenza (virus swine H1N1) was established both on serology (massive seroconversion) and on the detection of the virus from the nasal swabs and from an aborted fetus. The control of the lungs of sows "not in pig" and culled showed extended lesions of bronchopneumonia and Pasteurella multocida was found. The technical consequences of this severe outbreak of Influenza on reproduction were mainly important at the beginning of pregnancy. Over 13 sows inseminated less than 1 week before the outbreak, only 3 farrowed (respectively 5.5 and 12 piglets); 7 returned to oestrus and 3 "not a pig" at 21 days (echotomography) did not show signs of heat and were culled. Over 8 pregnant sows (1 month of pregnancy), 6 farrowed normal litters and total embryonic resorption occurred in 2 sows. Over 18 pregnant sows (more than 45 days gestation) one aborted.
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PMID:[Pathologic consequences of a severe influenza outbreak (swine virus A/H1N1) under natural conditions in the non-immune sow at the beginning of pregnancy]. 255 Jan 69

The antibiotic era has changed the incidence, causal factors, and gravity of empyema. Between 1977 and 1988, 27 children with empyema were surgically managed. Ten cases occurred after an operation (8 esophageal and 2 abdominal). There were 15 girls and 12 boys. The age range was newborn to 12 years. Symptoms included fever, cough, tube drainage postoperatively, anorexia, weight loss, chest pain, tachypnea, and lymphadenitis. Multiple aerobic and anaerobic organisms were cultured. Treatment included thoracentesis and antibiotics, tube thoracostomy, tube thoracostomy and bronchoscopy, decortication, or decortication with lobectomy. The total hospital stay averaged 28.3 days, and after decortication, 11.6 days. Empyemas in children frequently have multiple organisms and should be treated with broad-spectrum antibiotics while awaiting culture results. Thoracentesis and tube thoracostomy are often ineffective in curing the disease. Decortication can abbreviate hospital stay if performed promptly for persistent pleural sepsis.
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PMID:Management of empyema in children. 258 99

A principal side effect of biological response modifiers (BRMs) is a constellation of constitutional symptoms often referred to as a "flu-like syndrome" (FLS). Precisely what this syndrome encompasses is frequently unclear, but its major components appear to be fever, chills, rigors, myalgias, and headache. Other components variously included are anorexia, nausea, upper respiratory symptoms such as nasal congestion and cough, and the ill-defined symptom, malaise. The manner in which the "flu-like" syndrome manifests itself during treatment with interferon (IFN), interleukin-2 (IL-2), tumor necrosis factor (TNF), monoclonal antibodies (MoAbs), and colony stimulating factors (CSFs) will be described with attention to frequency, duration and severity. The common mechanisms underlying the appearance of a flu-like syndrome during biotherapy will be elucidated with emphasis on the role of endogenous pyrogens and prostaglandins and on the physiology of the process. Methods to prevent or alleviate these uncomfortable side effects, including medical interventions such as alterations in schedule/route/dose of BRM administration and premedication with a variety of agents, as well as nursing measures such as patient education will be discussed.
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PMID:Recent advances in the management of biotherapy-related side effects: flu-like syndrome. 268 12

This is a report of the clinical analysis of 250 cases of dengue fever-like patients during the 1987-1988 epidemic in Southern Taiwan at Harn's clinic, Kaohsiung city. The results were: The peak age groups were between 20-40 years old. The ratio of male to female was 1:14. 98% patients presented with fever of mainly 3 to 6 days duration. 98% reported body pain, which included headache (82%), generalized soreness (65%), low back pain (50%). 95% patients had GI symptoms, such as anorexia (73%), nausea (60%), vomiting (45%). 97% patients complained of dizziness and weakness, and 22.4% patients had a bleeding tendency. The common bleeding sites were involving the subcutaneous (skin), gum, uterus, nasal cavity, GI tract, retina, and GU tract. The eruption rate was 78%. A majority of rashes appeared on the extremities, and then spread to the trunk. Less common symptoms were insomnia, chest tightness, urgency of urination, cough, running nose, palpitation, and shock. 45% patients were noted with hair loss. The hair loss was the latest presenting symptom, which tended to occur about two months after the recovery stage, and lasted for about one month. On physical examination, 62.6% patients had conjunctivitis, while only 1.3% had lymph node enlargement. Usually, the whole clinical course lasted for 7 to 14 days. Laboratory examination showed that leukopenia was noted from the second day and reached the lowest count on the fifth day, and recovered on 9th or 10th day. In 247 blood sera tested serologically for dengue fever, 84 were confirmed, while 157 were not confirmed yet due to patients' reluctance to accept a second blood drawing.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical study on dengue fever during 1987-1988 epidemic at Kaohsiung City, southern Taiwan]. 273 68

We studied all patients with community-acquired pneumonia who were admitted to our 800-bed adult acute care hospital from 1 November 1981 to 15 March 1987. The 719 patients had a mean age of 63.2 years; 18% were admitted from nursing homes, and 18% required ventilatory assistance as part of the therapy for pneumonia. Patients with nursing home-acquired pneumonia were significantly older; had a higher mortality (40% vs. 17%); were more likely to be admitted in January; were less likely to complain of cough, fever, anorexia, chills, headache, nausea, sore throat, myalgia, or arthralgia; and were more likely to be confused than those admitted from the community. Pneumonia of unknown etiology and aspiration pneumonia were more common and Mycoplasma pneumoniae infection less common among those with nursing home-acquired pneumonia. Streptococcus pneumoniae accounted for 58% of the 48 cases of bacteremia. None of the bacteremic patients received antibiotics before admission, compared with 34% of the nonbacteremic patients. Aerobic gram-negative rod bacteremia was not more frequent among nursing home patients than among those from the community. The overall mortality was 21% (8.5% for those less than 60 years of age and 28.6% for those greater than 60 years old). By multivariate analysis the following variables were significant predictors of mortality: number of lobes involved by the pneumonic process, number of antibiotics used to treat the pneumonia, age, admission from a nursing home, ventilatory support, and the number of complications that occurred while the patient was in the hospital.
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PMID:Community-acquired pneumonia requiring hospitalization: 5-year prospective study. 277 65

We studied characteristics of past smokers according to the duration of cessation of smoking based on data from a population-based survey. Lifestyle, prevalences of various symptoms and diseases and other factors were compared among current smokers (8507 males and 2012 females), past smokers (4423 males and 684 females) and non-smokers (2431 males and 12,859 females) aged 40 years and over. Compared to current smokers, past smokers consumed more bread, milk, vegetables, fruit and black tea, and less rice, pickles, instant noodles, coffee and alcohol, had lower prevalences of cough, sputum and anorexia, participated more in cancer screening tests, weighed more, included more professional and administrative workers and had more non-smoking spouses. These characteristics resembled those of non-smokers. But past smokers had high prevalences of several cardiovascular and respiratory diseases compared to current smokers. Daily intake of coffee was inversely associated and daily intakes of fruit and milk were positively associated with the duration of abstinence from smoking after adjusting for other factors in both sexes. These results suggest that lifestyle of past smokers may contribute to risk reduction for several diseases.
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PMID:Characteristics of past smokers. 278 28

Serum samples from pig herds in Great Britain have been examined for antibodies to influenza virus since 1968. Antibodies to H3N2 virus strains have been found since 1968 and the serological data presented here suggests that H3N2 virus strains continue to persist in the pig population. An outbreak of acute respiratory disease occurred in a 400-sow unit. The outbreak was characterised by coughing, anorexia, fever, inappetence and loss of condition. The gilts and weaners were affected and the morbidity approached 100 per cent. An influenza A virus designated A/Swine/Weybridge/117316/86 (H1N1) was isolated from the herd and 28 paired serum samples from the affected animals showed increases in the haemagglutination inhibition titres to this isolate. Haemagglutinin and neuraminidase characterisation indicated that the virus is similar to H1N1 viruses isolated recently from pigs in Europe. A total of 91 herds experiencing respiratory disease were investigated, of which 42 gave positive reactions in the haemagglutination inhibition test. Antibodies to A/Port Chalmers/1/73 (H3N2) were also detected in some of the herds but it is not known whether this strain plays any role in the current respiratory disease problems in pigs.
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PMID:Outbreaks of classical swine influenza in pigs in England in 1986. 282 Jan 11

Among 137 members of 30 families, 6% (and 8% of those aged under 15 years) were seropositive for toxocara antibodies. In these seropositive subjects and in 84 patients known to have raised toxocara titres the commonest clinical features were abdominal pain, hepatomegaly, anorexia, nausea, vomiting, lethargy, sleep and behaviour disturbances, pneumonia, cough, wheeze, pharyngitis, cervical adenitis, headache, limb pains, and fever. 61% of patients with raised toxocara titres had recurrent abdominal pain. Eosinophilia was in many cases associated with a raised toxocara titre, but 27% of patients with high titres had normal eosinophil counts. Toxocariasis is common, especially in children, and is associated with clinical features that are generally regarded as non-specific but together form a recognisable symptom complex. Toxocariasis should be considered in the differential diagnosis of such symptoms and especially in recurrent abdominal pain, which might otherwise be labelled as idiopathic. The absence of eosinophilia does not exclude toxocariasis.
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PMID:The expanded spectrum of toxocaral disease. 289 21


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