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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report the experience with and evaluation of treatment strategies in fibrosing alveolitis and desquamative interstitial pneumonitis (FA/DIP) over the last 16 years by a review of all cases referred to a tertiary referral center. There were 25 cases, 16 boys and 9 girls (mean age at onset, 2.3 years; range, 7 days to 11.6 years). In each case the diagnosis was confirmed by open lung biopsy at a mean age of 3.3 years (range, 7 weeks to 15.1 years). Presently features were tachypnea (19), cyanosis (15), cough (12), exertional dyspnea (7), recurrent chest infections +/- wheezing (9), and clubbing (8). Four patients recovered without antiinflammatory medication. The others received specific treatment. Of 11 patients given only prednisolone, six improved, two did not, and three died despite treatment. Of five patients receiving only chloroquine, four responded. Five patients received both prednisolone and chloroquine; one died, two responded well. There was poor progress in the remaining two. Of the 10 patients receiving chloroquine six (60%) showed a good response. A younger presentation carried a worse prognosis, but chest radiology at presentation and outcome were not interrelated. Those with mild histological changes all survived, but severe desquamation or fibrosis at biopsy was not related to outcome. In four cases there was a family history (16%). Patients with FA/DIP probably represent a disease spectrum of multiple etiology with a variable prognosis and response to treatment.
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PMID:Fibrosing alveolitis and desquamative interstitial pneumonitis. 809 Jun 6

Cross-sectional morbidity in 2 successive quarterly survey rounds and subsequent 27-months mortality were studied in a random sample of 4238 preschool children in the rural health zone of Bwamanda in northern Ubangi, Zaire. 45-48% of the subjects displayed signs of morbidity such as oedema, marasmus, cough, fever, diarrhea, and tachypnoea. Being particularly vulnerable, children aged 3-6 months exhibited the highest prevalences of all morbid patterns except for isolated fever. Further, while isolated cough was more prevalent in the dry season and probably attributable to nightly indoor woodburning, all other morbid patterns were significantly more prevalent in the rainy season. Diarrhea with cough constituted half of all diarrhea cases. The authors continue by concluding that children at increased risk of death may be readily identified by posing a few simple questions on major symptoms and a brief examination by paramedical health workers. The method could be employed at under-5 clinics. Prognosis, however, is particularly bad in severe malnutrition, especially when associated with diarrhea, in diarrhea with cough, cough with fever/tachypnoea, and for children who are found sick both in the rainy and the subsequent dry season.
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PMID:Child morbidity patterns in two tropical seasons and associated mortality rates. 814 93

The term adult respiratory distress syndrome (ARDS) was first introduced by Ashbaugh and Petty more than two decades ago. Since then, our understanding of this clinicopathologic entity has increased significantly. However, little therapeutic progress has been achieved, and the mortality remains high. ARDS is characterized by diffuse pulmonary microvascular injury resulting in increased permeability and, thus, noncardiogenic pulmonary edema. Ventilation-perfusion lung studies have demonstrated that the predominant pathogenesis of hypoxemia in ARDS is related to intrapulmonary shunts. Common symptoms include dyspnea, tachypnea, dry cough, retrosternal discomfort, and moderate to severe respiratory distress. In most cases the diagnosis of ARDS is that of exclusion. The mainstay of therapy for this syndrome is the management of the underlying disorder causing it. To date, there are no specific pharmacologic interventions of proven value for the treatment of ARDS. Once the potentially treatable sources have been found and their therapy started, the main treatment for ARDS is supportive.
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PMID:Adult respiratory distress syndrome (ARDS): the basics. 816 9

The clinical and radiological features in 38 infants less than 3 months of age with tuberculosis proved by culture are described and may aid early diagnosis of this often fatal condition. Respiratory symptoms, cough in 33 (87%) and tachypnoea in 31 (82%), were the commonest presenting symptoms. Twenty five infants (66%) had hepatomegaly and 20 (53%) splenomegaly. Mantoux testing gave an induration of > 15 mm in three of 17 (18%) infants. In a further five a Tine test gave confluent response. Chest radiography in 27 infants showed miliary tuberculosis in seven (26%) and hilar or paratracheal adenopathy in 14 (52%) and 10 (37%) respectively. Compression of either the bronchi or trachea or both was noted in 15 (56%). Detection of this complication was aided by high kilovolt radiographs. A culture of Mycobacterium tuberculosis was obtained from gastric aspirate in 35 (92%) infants, but positive cultures were also obtained from cerebrospinal fluid, tracheal or bronchial aspirate and liver and lymph node biopsy. Of 30 mothers evaluated seven (23) had previously unsuspected pulmonary tuberculosis.
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PMID:Tuberculosis in infants less than 3 months of age. 821 48

Respiratory tract infections are prevalent in foals, yet the frequency with which the distal airways are affected in clinical episodes of respiratory tract disease has not been evaluated to our knowledge. The objective of the study was to determine the incidence of distal respiratory tract infection (DRTI) in foals on a sample of Thoroughbred breeding farms (n = 10) in Ontario. In a pilot study, clinical criteria commonly used to select foals for antimicrobial treatment (detection of abnormal lung sounds, plus nasal discharge, cough, fever, tachypnea, and/or lethargy) were found to segregate foals with and without endoscopically confirmed DRTI. Mucopurulent exudate and bronchial erythema were observed more frequently (P < 0.005), bronchial lavage total cell count and neutrophil concentration were significantly (P < 0.005) higher, and intracellular cocci were recovered significantly (P < 0.01) more often from bronchial lavage samples of affected foals (n = 8) than of controls (n = 8). These clinical criteria were used to identify cases in a cohort of Thoroughbred foals (n = 219) from May 1 to October 30, 1991. Case morbidity adjusted for clustering was 82 +/- 5% (95% confidence limits, 72 to 92%). Most (74%) episodes of clinical DRTI were detected in July and August, and equal numbers were detected before (53%) and after (47%) weaning of foals. Of 178 cases, 66 (48%) were selected at random for endoscopy and bronchial lavage. Grade-II pharyngeal lymphoid hyperplasia was observed commonly (60% of foals); auditory tube diverticulum (guttural pouch) discharge was observed in 18 of 86 (21%) foals, and guttural pouch infection was confirmed in 6 of 7 foals examined endoscopically.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical and endoscopic study to estimate the incidence of distal respiratory tract infection in thoroughbred foals on Ontario breeding farms. 825 Mar 84

Transbronchial biopsy (TBB) has been considered to be inadequate for the diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP). We describe herein two patients with interstitial pulmonary disease in whom the diagnosis of BOOP was achieved by TBB. The two patients presented with progressive dyspnea, cough, tachypnea, and fine end-inspiratory crackles. The radiologic findings disclosed patchy alveolar infiltrates. Pulmonary function tests showed a restrictive pattern and decreased diffusing capacity. The pathologic findings disclosed bronchioles, alveolar ducts, and alveoli infiltrated with mononuclear cells. The lumina were obliterated with fibroblasts and loose granulation tissue. Corticosteroid treatment resulted in significant improvement. Transbronchial biopsy should be considered as a useful diagnostic tool for BOOP.
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PMID:Bronchiolitis obliterans organizing pneumonia. Diagnosis by transbronchial biopsy. 825 81

Medical records of 21 horses with summer pasture-associated obstructive pulmonary disease were reviewed, and history, signalment, clinical signs, radiographic signs, clinicopathologic data, and therapeutic response were determined. Most affected horses were used as pleasure horses, and for the most part, remained at pasture when not in use. The mean age (+/- SD) was 13.7 +/- 3.6 years. Clinical signs included intermittent nasal discharge, cough, tachypnea, labored expiratory effort, and crackles and wheezes on auscultation. Radiography frequently revealed interstitial patterns in the lung fields; in horses with chronic disease, pulmonary overinflation was evident. Hemogram was usually normal, and transtracheal wash fluid was characterized by nondegenerate neutrophils.
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PMID:Summer pasture-associated obstructive pulmonary disease in horses: 21 cases (1983-1991). 845 16

Immunocompromised patients are considered at increased risk from respiratory syncytial virus (RSV) infection. We examined the incidence and outcome of RSV infection in pediatric renal transplant (Tx) recipients on chronic immunosuppressive therapy. Of 173 recipients transplanted between November 1985 and April 1993, 5 (3%) developed RSV infection (age range 11-39 months). Initial immunosuppression included prednisone, azathioprine, cyclosporine, and polyclonal antibody therapy. Time from Tx to onset of RSV infection was 1 day to 7 months. Symptoms included rhinorrhea, cough, tachypnea, retractions, fever, wheezing, and abnormal chest X-ray. Treatment included bronchodilator therapy, bronchial drainage, ribavirin, and mist tent. Azathioprine was transiently withheld for leukopenia during treatment in 2 recipients. Three recipients developed biopsy-proven acute rejection during (n = 2) or immediately following (n = 1) RSV infection; all responded to corticosteroid treatment. RSV infection is not commonly diagnosed in pediatric renal Tx recipients. The course of RSV infection in our patients did not differ from that reported in normal children. The possible association between RSV and acute rejection warrants further observation. When diagnosed early, RSV infection does not appear to be associated with increased mortality in pediatric renal Tx recipients. Larger numbers of recipients need to be studied to confirm these results.
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PMID:Respiratory syncytial virus infections in pediatric renal transplant recipients. 870 17

High-altitude pulmonary edema (HAPE) occurs in unacclimatized individuals who are rapidly exposed to altitudes in excess of 2450 m. It is commonly seen in climbers and skiers who ascend to high altitude without previous acclimatization. Initial symptoms of dyspnea, cough, weakness, and chest tightness appear, usually within 1-3 days after arrival. Common physical signs are tachypnea, tachycardia, rales, and cyanosis. Descent to a lower altitude, nifedipine, and oxygen administration result in rapid clinical improvement. Physiologic studies during the acute stage have revealed a normal pulmonary artery wedge pressure, marked elevation of pulmonary artery pressure, severe arterial unsaturation, and usually a low cardiac output. Pulmonary arteriolar (precapillary) resistance is elevated. A working hypothesis of the etiology of HAPE suggests that hypoxic pulmonary vasoconstriction is extensive but not uniform. The result is overperfusion of the remaining patent vessels with transmission of the high pulmonary artery pressure to capillaries. Dilatation of the capillaries and high flow results in capillary injury, with leakage of protein and red cells into the alveoli and airways. HAPE represents one of the few varieties of pulmonary edema where left ventricular filling pressure is normal.
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PMID:High-altitude pulmonary edema: current concepts. 871 81

A 4-month-old male infant with Bland-White-Garland (BWG) syndrome complicated myocardial infarction was reported. Signs included tachypnea, coughing, and failure to thrive. However, there was no sign of myocardial infarction. A chest radiograph revealed cardiomegaly (CTR = 65%) and electrocardiogram showed abnormal Q waves in I, aVL, V6 leads. Cardiac catheterization and angiography revealed marked dilatation of left ventricle (end-diastolic volume = 384 ml/m2) and extremely depressed ejection fraction (16%), confirming the diagnosis of BWG syndrome. A 201TlCl-myocardial SPECT demonstrated apical defect and hypoperfusion in the anterolateral, inferoposterior walls, whereas 123I-beta-methyl-p-iodophenylpentadecanoic-acid (123I-BMIPP) SPECT showed a wider defect area. SPECT studies with 201TlCl and 123I-BMIPP, are useful to assess myocardial viability more accurately in BWG syndrome.
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PMID:[Anomalous origin of the left coronary artery from the pulmonary trunk with myocardial infarction and severe left ventricular dysfunction in infancy--assessment of myocardial damage using SPECT studies with 201TlCl and 123I-BMIPP]. 872 Nov 5


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