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

We report an epidemic of acute pulmonary histoplasmosis which occurred in February 1994 among a group of 24 persons after they had once or twice visited a cave in New Caledonia. This study describes the physical and laboratory findings, which lead to the diagnosis of histoplasmosis. Each test was evaluated. All members of the group had a physical examination, early and late serological tests, pulmonary X-rays (including CT) and some had mycological examination of bronchoalveolar washes. Mycological investigations were made on samples collected from the cave. Histoplasmic skin testing was not possible. We defined a case as a person who visited the cave in January 1994, had evocative radiological features and at least four symptoms among the following: weakness, fever, headache, arthralgia, thoracic pains, dyspnea, cough and nausea. Of the 24 exposed persons, 7 cases were considered as severe, 8 cases as moderate, and 6 cases as mild, for a total of 21 cases and an attack rate of 87.5%. There was no progression towards disseminated histoplasmosis and no recorded death. The incubation period lasted from 5 to 17 days. The symptoms were divided into three groups. In the first group, the symptoms of fever, headache and arthralgia were common and nonspecific. In the second group, the symptoms of chest pain, cough, and dyspnea which often occurred later, were less common and more specific. In the third group, the symptoms of vomiting, diarrhea and dizziness were less common. The chest X-ray showed abnormalities in 100% of the cases, and in 11 of the 21 cases the characteristic finding was a miliary.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Epidemic of pulmonary histoplasmosis after visiting a cave in New Caledonia]. 758 42

In order to reduce the strain on the environment from the deposition of waste in landfills and combustion at incineration plants, several governments throughout the industrialized world have planned greatly increased recycling of domestic waste by the turn of the millennium. To implement the plans, new waste recycling facilities are to be built and the number of workers involved in waste sorting and recycling will increase steadily during the next decade. Several studies have reinforced the hypothesis that exposure to airborne microorganisms and the toxic products thereof are important factors causing a multitude of health problems among workers at waste sorting and recycling plants. Workers at transfer stations, landfills and incineration plants may experience an increased risk of pulmonary disorders and gastrointestinal problems. High concentrations of total airborne dust, bacteria, faecal coliform bacteria and fungal spores have been reported. The concentrations are considered to be sufficiently high to cause adverse health effects. In addition, a high incidence of lower back injuries, probably due to heavy lifting during work, has been reported among workers at landfills and incineration plants. Workers involved in manual sorting of unseparated domestic waste, as well as workers at compost plants experience more or less frequent symptoms of organic dust toxic syndrome (ODTS) (cough, chest-tightness, dyspnoea, influenza-like symptoms such as chills, fever, muscle ache, joint pain, fatigue and headache), gastrointestinal problems such as nausea and diarrhoea, irritation of the skin, eye and mucous membranes of the nose and upper airways, etc. In addition cases of severe occupational pulmonary diseases (asthma, alveolitis, bronchitis) have been reported. Manual sorting of unseparated domestic waste may be associated with exposures to large quantities of airborne bacteria and endotoxin. Several work functions in compost plants can result in very high exposure to airborne fungal spores and thermophilic actinomycetes. At plants sorting separated domestic waste, e.g. the combustible fraction of waste composed of paper, cardboard and plastics, the workers may have an increased risk of gastrointestinal symptoms and irritation of the eyes and skin. At such plants the bioaerosol exposure levels are in general low, but at some work tasks, e.g. manual sorting and work near the balers, exposure levels may occasionally be high enough to be potentially harmful. Workers handling the source-sorted paper or cardboard fraction do not appear to have an elevated risk of occupational health problems related to bioaerosol exposure, and the bioaerosol exposure is generally low.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Sorting and recycling of domestic waste. Review of occupational health problems and their possible causes. 761 Mar 83

Untreated hyperthyroidism during pregnancy is associated with increased maternal and perinatal morbidity. Some features of this disease simulate preeclampsia, which may encourage delivery of the fetus. We report a case of poorly controlled hyperthyroidism associated with generalized seizures, where patient management was directed at a diagnosis of preeclampsia-eclampsia. Although the presence of eclampsia and marked hyperthyroidism is very rare, this case illustrates the importance of aggressive medical management of hyperthyroidism. A 17-year-old gravida was diagnosed with hyperthyroidism at 15 weeks' gestation. At 26 weeks' gestation, she was admitted to the hospital after noting edema of the upper and lower extremities, nausea, vomiting, shortness of breath, and a cough. At admission, she was hypertensive, tachycardic, and dyspneic. The patient was believed to have preeclampsia with pulmonary edema complicated by hyperthyroidism. We initiated magnesium sulfate therapy and administered several bolus doses of hydralazine, with little effect on blood pressure. Oliguria was noted, and a pulmonary artery catheter was inserted. Hours later, generalized seizure activity occurred, and a decision was made for abdominal delivery. Postoperatively, cardiovascular function stabilized. On postoperative day 3, we received the results of the thyroid function tests obtained at admission, which suggested a markedly hyperthyroid condition. Untreated or poorly treated hyperthyroidism may present a clinical picture similar to preeclampsia. In our case, both disease processes coexisted in their severest forms. It is possible, although completely unproven, that a relationship exists between poorly controlled hyperthyroidism and preeclampsia-eclampsia. More importantly, accurate diagnosis of hyperthyroidism should lead to prompt medical or surgical management, thereby decreasing maternal and perinatal morbidity.
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PMID:Hyperthyroidism and seizures during pregnancy. 761 94

Several pharmacologic agents provide antihistamine effects by acting at the H1 histamine receptor site. The classic agents are relatively nonselective, resulting in a wide range of effects, both therapeutic and undesirable. The newer agents preferentially block peripheral H1 receptor sites and, consequently, have fewer side effects, including sedation. Antihistamines are useful in the treatment of allergic conditions, Parkinson's disease, insomnia and some forms of nausea, and provide symptomatic relief of cough and other conditions associated with respiratory tract infections. Certain agents may play a role in the treatment of asthma and anorexia. Selection of a specific agent should be based on cost and the minimization of side effects. The classic antihistamines provide an inexpensive and highly effective means of treating histamine-mediated symptoms. The bothersome central nervous system side effects can be alleviated by taking the drugs at bedtime; their prolonged tissue half-life allows dosing once or twice a day for 24-hour clinical relief. The newer, more expensive nonsedating antihistamines are acceptable alternatives for patients who are incapable of tolerating the effects of classic agents.
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PMID:Antihistamines: the old and the new. 762 32

The objective of this study was to evaluate the reliability and validity of a brief index to measure symptoms in individuals infected with human immunodeficiency virus (HIV). From an ambulatory clinic that specializes in the care of HIV-infected individuals at a university hospital in northeast Ohio, 148 randomly selected outpatients (predominantly homosexual men) with a broad spectrum of HIV disease were enrolled in a prospective, cohort study. In standard interviews, patients rated the frequency of 36 symptoms related to HIV infection on an ordinal scale from zero (never) to three (daily); these interviews were repeated and outcomes determined every 3 months for one year. Clinical data were abstracted from the medical record with a standard chart review. Using specific criteria, 12 symptoms were selected for the HIV Symptom Index: fatigue, fevers, headache, imbalance, paresthesias, memory loss, cough, nausea, diarrhea, sadness, sleep disturbance, and skin problems. The HIV Symptom score (the sum of frequency ratings for the 12 symptoms) ranged from 0 to 31 with a mean of 9.4 (+/- SD 6.6). The test-retest reliability was high (intraclass correlation coefficient = 0.92) as was the internal consistency (Cronbach's alpha = 0.79). The validity of the index was established with three observations. (1) The HIV Symptom Index makes clinical sense and includes a representative spectrum of symptoms of infection. (2) Symptom Index scores were greater in patients with more advanced disease and in patients who were functionally impaired. (3) The Index was responsive to changes in health as the disease progressed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:An index of symptoms for infection with human immunodeficiency virus: reliability and validity. 773 Aug 79

Diesel exhaust is a common air pollutant and work exposure has been reported to cause discomfort and affect lung function. The aim of this study was to develop an experimental setup which would allow investigation of acute effects on symptoms and lung function in humans exposed to diluted diesel exhaust. Diluted diesel exhaust was fed from an idling lorry through heated tubes into an exposure chamber. During evaluations of the setup we found the size and the shape of the exhaust particles to appear unchanged during the transport from the tail pipe to the exposure chamber. The composition of the diesel exhaust expressed as the ratios CO/NO, total hydrocarbons/NO, particles/NO, NO2/NO, and formaldehyde/NO were almost constant at different dilutions. The concentrations of NO2 and particles in the exposure chamber showed no obvious gradients. New steady state concentrations in the exposure chamber were obtained within 5-7 min. In a separate experiment eight healthy nonsmoking subjects were exposed to diluted exhaust at a median steady state concentration of 1.6 ppm NO2 for the duration of 1 h in the exposure chamber. All subjects experienced unpleasant smell, eye irritation, and nasal irritation. Throat irritation, headache, dizziness, nausea, tiredness, and coughing were experienced by some subjects. Lung function was not found to be affected during the exposure. The experimental setup was found to be appropriate for creating different predetermined steady state concentrations in the exposure chamber of diluted exhaust from a continuously idling vehicle. The acute symptoms reported by the subjects were relatively similar to what patients reported at different workplaces.
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PMID:Evaluation of an exposure setup for studying effects of diesel exhaust in humans. 780

The purpose of the present phase IV multicentre trial was to evaluate general patient tolerance to Omnipaque 350 mgI/ml (iohexol) supplied in polypropylene containers compared to that of the same product supplied in routinely used glass vials, with emphasis on allergy-like adverse events. Polypropylene is a pure plastic material with practically no additives, and has been tested in vitro as a contrast medium packaging material for several years. Handling of these containers is easier and safer than handling of glass vials. Iohexol was administered to 1481 patients undergoing urography (741 patients in the glass vial group, 740 in the polypropylene container group), all of whom successfully participated in the trial. Six centres, representing four European countries, participated. Patients were randomized to receive iohexol from either polypropylene containers or traditional glass vials according to a double blind, parallel design. Pre-established inclusion and pre-admission exclusion criteria were followed, as well as routine procedures for preparation of the patients and conduct of the urography examinations at each hospital. Patient tolerance was assessed by recording all adverse events experienced over a period of up to 1 h after the procedure. Allergy-like events were defined as coughing, sneezing, nausea, vomiting, urticaria or itching. No adverse events were experienced by 56.5% of the patients in the glass vial group, nor by 58.0% of those in the polypropylene group. Discomfort (mainly a sensation of warmth) was reported by 39.4% and 38.6% of the patients, and adverse events other than discomfort by 7.4% and 5.9% of the patients, respectively. There seemed to be a correlation between the speed of injection and the frequency of discomfort (an increase with increasing speed), both of which varied a lot between centres. There was no significant difference in the incidence of allergy-like events between the two groups. Such reactions were seen in 2.0% of patients in the glass vial group and 1.9% of those in the polypropylene container group. There was no significant difference between the patients' tolerance to iohexol supplied in traditional glass vials or in polypropylene containers. Therefore, the new polypropylene container can be recommended as a container for Iohexol.
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PMID:Iohexol in patients undergoing urography: a comparison of polypropylene containers (Unique Soft Pack) and glass vials. 783 73

We examined the response to the laryngeal mask (LM) compared to the endotracheal tube (ETT) in patients undergoing ambulatory anesthesia. The differences in management by the anesthesiologists for these two airways were also examined. Peripheral orthopedic procedures were studied in 44 outpatients randomized to receive a LM or ETT, and either spontaneous or controlled ventilation. Anesthesia was induced with propofol and succinylcholine intravenously (i.v.) and maintained with N2O and isoflurane. Anesthesiologists were allowed to determine ventilatory variables and anesthetic concentration. Hemodynamic and ventilatory measurements were made during the anesthesia. Barium sulfate was poured into the oropharynx after the airway was secure. Fiberoptic examination through the LM was performed at the beginning and at the end of the administration of each anesthetic. Radiographs were taken at the end of the anesthetic administration before LM or ETT removal to look for barium in the trachea. After airway removal, presence of blood on the airway, sore throat, coughing, nausea, vomiting, shivering, and amount of morphine demanded during recovery were noted. No barium in the trachea or bronchial tree was seen in any of the radiographs. The ETT was associated with greater hemodynamic response not only to airway placement (P < 0.05), but also to surgical incision (P < 0.05) and airway removal (P < 0.05). Spontaneous or controlled ventilation favored neither airway, although the ETT was associated with increased work of inspiration with controlled ventilation (P < 0.05). Anesthesiologists tended to elect smaller tidal volumes, faster ventilation rates, and lower anesthetic concentrations for patients with the LM (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prospective comparison of use of the laryngeal mask and endotracheal tube for ambulatory surgery. 976 7

We performed a prospective, randomized, double-blind study to determine the effect of bupivacaine on postoperative epidural fentanyl analgesia and thrombelastography in 120 patients who underwent extensive gastrointestinal or genitourinary surgery. The patients were randomized into four groups, 30 patients per group: Group I = epidural fentanyl (EF), 10 micrograms/mL in saline; Group II = EF with 0.1% bupivacaine; Group III = EF with 0.15% bupivacaine; and Group IV = EF with 0.2% bupivacaine. Pain relief was evaluated by a visual analog scale (VAS), both at rest and during coughing, and by a visual rating scale (VRS). The VAS, VRS, degree of sedation, and side effects (nausea, vomiting, and pruritus) were evaluated every 2 h from 8:00 AM to 6:00 PM, for 24 h after surgery. Forced vital capacities (FVCs) were determined before surgery and at 24 h after surgery. Blood was withdrawn for thrombelastography (TEG) measurements preoperatively, in the recovery room (PARR), and 24 h postoperatively. The VAS, VRS, sedation scores, changes in postoperative FVCs, and the incidence of side effects were not statistically different among the four groups. The 24-h total volumes of infusion in the four groups (146 +/- 40 mL, 140 +/- 38 mL, 142 +/- 40 mL, 124 +/- 21 mL, respectively) were not statistically different from each other. There were no significant differences in the TEG values [reaction time (R), coagulation time (K), angle (alpha), and maximum amplitude (mA)] among the four groups at anytime nor was there any difference between the baseline, PARR, and 24-h TEG values within any group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effect of low-dose bupivacaine on postoperative epidural fentanyl analgesia and thrombelastography. 797 9

Even with the best health care available, many patients with epilepsy still suffer from poorly controlled seizures. Patients with intractable partial seizures are often inhibited from realizing their full potential and may experience a less than optimal quality of life. Vagus nerve stimulation (VNS) is being studied in a double-blind, controlled, randomized trial at 17 epilepsy centers throughout the U.S. and Europe as a potential therapy for patients with refractory seizures. During a 14-week controlled phase in three of the centers, the therapeutic group (N = 10) experienced a mean seizure frequency percent reduction (SFPR) of 33.1% as compared to baseline (p = 0.0084) while the subtherapeutic group (N = 12) experienced an SFPR of 0.6% as compared to baseline (p = 0.9183). After the controlled phase, all patients were switched into the therapeutic group in an open extension phase. Results after one year of therapeutic stimulation (N = 15) reveal a mean SFPR of 35.6% (p = 0.0088) with 6 of the 15 patients (40%) achieving at least a 50% seizure reduction. Adverse effects included hoarseness, coughing and nausea. There were no deaths or serious injuries related to the device. Based on these limited data, VNS appears to be a safe and efficacious new therapy for refractory partial seizures.
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PMID:Vagus nerve stimulation for intractable seizures: one year follow-up. 810 30


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