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

A four-year experience with transtracheal aspiration was reviewed in order to determine those patients at risk for developing life-threatening complications. One hundred procedures were performed by at least 20 different physicians trained according to an established protocol. Complications were limited to minimal subcutaneous emphysema in 19 percent (10/52), pneumomediastinum in 3 percent (3/93), and gross but self-limited hemoptysis in 1 percent (one patient); occasional unifocal premature ventricular contractions were noted in one patient. We conclude that patients not at risk of developing life-threatening complications from transtracheal aspiration can be identified. They (1) are able to cooperate and have a clearly identifiable and normal cricothyroid membrane, (2) have the procedure performed only by well-trained or supervised physicians, (3) have an arterial oxygen pressure of at least 70 mm Hg with administration of supplemental oxygen, and (4) have a prothrombin activity of at least 65 percent of the control value or a normal bleeding time or a platelet count of at least 100,000/cu mm. To minimize subcutaneous emphysema or pneumomediastinum, no patient should have therapy with intermittent positive-pressure breathing or any other procedure that might induce coughing for the subsequent 24 hours.
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PMID:Transtracheal aspiration. Guidelines for safety. 49 22

This report reviews the manifestations in fifteen children of proved adenoviral pneumonia. Patients' ages ranged from 43 days to 4 years and 1 month. Twelve cases were younger than 2 years old. Adenoviral infections were proved by positive viral cultures or a four-fold increase of the complement fixation titer. Prolonged fever and cough were found in all cases. In 13 patients, respiratory distress occurred; 5 needed mechanical ventilation. Injected throats, conjunctivae and ear drums were common. Other clinical pictures included abdominal discomfort, hepatomegaly, skin rash, convulsion and bleeding tendency. Abnormal laboratory findings were mild anemia, leukopenia, thrombocytopenia, elevated erythrocyte sedimentation rate and C-reactive protein, impaired liver function test, and prolonged prothrombin time and partial thromboplastin time. Anemia (11 cases), leukopenia (7 cases) and elevated transaminases levels (7 cases) were more common than previously reported. All patients had para-hilar peribronchial infiltrates in chest roentgenography. Segmental atelectasis and compensated hyper-expansion were found frequently. Pleural effusion were noted in six of our cases. Air leak syndrome occurred in three patients who had received mechanical ventilation. Three of the 15 patients expired: one had a preceding measles infection, all had disseminated intravascular coagulopathy. For patients with antibiotic-resistant pneumonia, adenoviral studies should be done. Extrapulmonary manifestations, and some abnormal laboratory findings, i.e., mild anemia, leukopenia, impaired liver function are clues to adenoviral infections, while bleeding tendency can be regarded as a poor prognostic sign for children with adenoviral pneumonia.
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PMID:Adenoviral pneumonia in children. 132 94

Recurrent, bilateral, and severe conjunctival hemorrhages mandate the search for an underlying etiology, such as a blood dyscrasia, blood clotting disorder, or recurrent increased intrathoracic pressure caused by repetitive vomiting or coughing spells. Medical and ophthalmic management is discussed in a case of subconjunctival and external hemorrhage from the eye secondary to prolonged prothrombin time in oral anticoagulation therapy.
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PMID:Subconjunctival and external hemorrhage secondary to oral anticoagulation. 224 71

We evaluated the benefits of bilateral deep cervical plexus block regional anesthesia in healthy and high risk patients undergoing thyroid and parathyroid surgery and assessed its effects on respiratory function. Twenty-one patients undergoing thyroid and parathyroid operations were studied. Bilateral superficial and deep plexus blocks were performed in all patients except one (who received only superficial plexus block because of a slightly prolonged prothrombin time) with 0.375-0.5% bupivacaine with 1:200,000 epinephrine. Intraoperatively, supplemental intravenous sedatives/narcotics were titrated to achieve patient comfort and cooperation. To allay anxiety, patients were allowed to listen to music via headphones intraoperatively. Forced vital capacity was measured before block, 10 minutes after the block and in the recovery room in half the patients. Eighteen patients tolerated the procedure well with supplemental sedation. Two patients required supplemental inhalation anesthesia via mask and one required tracheal intubation because of coughing prior to surgery. Three high risk patients tolerated the procedure well requiring only intraarterial line monitoring. Postoperatively, 11 patients had minimal incisional pain, 13 patients had mild pain on swallowing and 2 patients complained of nausea. There were no significant differences in the baseline forced vital capacity vs. forced vital capacity measured after the block and in the recovery room. This study indicates that regional anesthesia is an appropriate alternative to general anesthesia in selected patients undergoing thyroid and parathyroid surgery and did not compromise respiratory function.
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PMID:Bilateral cervical plexus block for thyroidectomy and parathyroidectomy in healthy and high risk patients. 906 3

Twenty-three episodes of anticoagulant rodenticide toxicity were found in 21 dogs during a retrospective study conducted at The Ohio State University Veterinary Teaching Hospital. Dyspnea (57%), lethargy (48%), coughing/hemoptysis (30%), and pallor (26%) were the most common presenting complaints. Prolonged activated clotting time (ACT), prolonged one-stage prothrombin time (OSPT), and prolonged activated partial thromboplastin time (APTT) were present in all dogs that had not received any prior therapy. Anemia (83%), thrombocytopenia (61%), hypoproteinemia (57%), positive fibrin degradation products (FDPs) (55%, six of 11 tested), and hyperfibrinogenemia (43%, six of 14 tested) were common hematological findings. Treatment included therapy with vitamin K1, blood products, and supportive care. The survival rate was 83%.
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PMID:Anticoagulant rodenticide toxicity in 21 dogs. 993 27

Angiostrongylosis was diagnosed in 23 dogs presenting to the Queen Mother Hospital for Animals between June 1999 and August 2002. The animals' clinical records were reviewed retrospectively and certain risk factors were compared with a control population of 3407 dogs. Twenty-two of the 23 dogs were from south-east England and dogs from Surrey (n=8) were significantly overrepresented. There were also significantly more Cavalier King Charles spaniels (n=5) and Staffordshire bull terriers (n=5) among the affected dogs than in the control group. The median age of affected dogs was 10 months (range five to 90 months). The most common presenting signs were cough (65 per cent), dyspnoea (43 per cent), haemorrhagic diathesis (35 per cent) and collapse (26 per cent). Four dogs were thrombocytopenic and eight had significant prolongations in prothrombin time and/or activated partial thromboplastin time. Thoracic radiographs were abnormal in 18 of 19 dogs. A variety of changes were observed, the most typical being a patchy alveolar-interstitial pattern affecting the dorsocaudal lung fields. Angiostrongylus vasorum larvae were found in seven of 10 bronchoalveolar lavage specimens and 19 of 19 faecal samples. Three dogs died shortly after admission to the hospital. The remainder were successfully treated with fenbendazole at a dose of 50 mg/kg for five to 21 days. A vasorum should now be considered endemic to south-east England.
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PMID:Angiostrongylus vasorum infection in 23 dogs (1999-2002). 1546 Feb 1

We describe an unusual case of unexpected dyspnoea following transfusion of fresh frozen plasma (FFP) in a previously-well 72-year-old woman. Our patient was scheduled for an ultrasonographically-guided liver biopsy for work-up for autoimmune hepatitis. She was given FFP to correct a prolonged prothrombin time. Shortly after the transfusion was initiated, she started coughing and became progressively dyspnoeic. Clinically, she was tachypnoeic with diffuse bilateral crepitations, and rapidly went into respiratory failure. She was intubated and placed on mechanical ventilation. Her condition improved and she was extubated by the second day, with no long-term pulmonary sequelae. A diagnosis of transfusion-related acute lung injury (TRALI) was made, based on the rapidity of onset and association with transfusion. This was confirmed by the findings of anti-human leukocyte antigen antibodies in both the patient and recipient blood. Our case highlights this important but under-recognised condition. The incidence, diagnosis and management of TRALI are also discussed.
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PMID:Dyspnoea due to plasma transfusion-related acute lung injury. 1699 Sep 69

Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi. Acute respiratory distress syndrome (ARDS) is a serious complication of scrub typhus. This study retrospectively reviewed the medical records of 72 patients diagnosed with scrub typhus from January 1998 to August 2006 in Kaohsiung Chang Gung Memorial Hospital in Taiwan. Eight of 72 scrub typhus patients with ARDS were included in the study; the other patients without ARDS were used as controls. The mortality rate for the scrub typhus patients with ARDS was 25%. The eight patients seldom had underlying diseases. Initial presentations of dyspnea and cough, white blood cell count, hematocrit, total bilirubin, and delayed used of appropriate antibiotics use were significant predictors of ARDS. Multivariate analysis showed that albumin, prothrombin time, and delayed use of appropriate antibiotics were independent predictors of ARDS. Identification of these relative risk factors may help clinicians evaluate clinical cases of scrub typhus with ARDS.
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PMID:Acute respiratory distress syndrome in scrub typhus. 1755 27

To investigate clinical course and outcome of dengue with acute respiratory failure (ARF), and to identify related risk factors for acquiring ARF in dengue, we retrospectively studied 11 dengue patients with ARF. From June to December 2002, a total of 606 adult patients were diagnosed as having dengue. Eleven (1.8%) of 606 dengue patients had complications of ARF. The main causes of ARF were sepsis (n = 6, 54.5%) and upper gastrointestinal (UGI) bleeding (n = 3, 27.3%). The mortality rate was 72.7% (n = 8). Additionally, univariate analysis showed that age, dyspnea, cough, prothrombin time, activated partial thromboplastin time, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, albumin, renal insufficiency, acute renal failure, acute hepatic failure, UGI bleeding, and combination bacterial infection were significantly predictive variables associated with dengue patients with ARF.
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PMID:Acute respiratory failure in adult patients with dengue virus infection. 1762 Jun 47

Influenza A/H5N1 infection has become the major emerging infectious disease of global concern again since late 2003. A history of exposure to dead or sick poultry or wild birds occurs in over 60% of cases of human H5N1 infection. The incubation period of avian-to-human transmission is generally between 2 and 5 days and the median duration of symptoms before hospitalization is about 4.5 days. The clinical spectrum has ranged from asymptomatic infection or mild influenza-like illness to severe pneumonia and multi-organ failure. Fever > 38 degrees C, cough and dyspnoea are the major symptoms on presentation, whereas gastrointestinal symptoms such as watery diarrhoea, vomiting and abdominal pain are common early in the course of the disease. In contrast, upper respiratory tract symptoms are less prominent in human H5N1 infection when compared to seasonal influenza. Laboratory features of human H5N1 infection include leucopoenia, especially lymphopenia, elevated amino-transaminases, thrombocytopenia, prolonged prothrombin time and activated partial thromboplastin time, increased D-Dimer, increased serum lactate dehydrogenase and creatinine phospho-kinase, and hypoalbuminemia. A low absolute lymphocyte count on admission is associated with more severe disease and death. Radiographic abnormalities include multi-focal airspace consolidation, interstitial infiltrates, patchy or lobar involvement, with rapid progression to bilateral and diffuse ground-glass opacities consistent with ARDS. However, none of the clinical, laboratory and radiographic features are specific to H5N1 infection. A detailed exposure history needs to be elicited, including any close contact with sick or dead poultry, wild birds, other severely ill persons, travel to an area with A/H5N1 activity or work in laboratory handling samples possibly containing A/H5N1 virus.
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PMID:Review of clinical symptoms and spectrum in humans with influenza A/H5N1 infection. 1836 21


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