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

The impact of environmental risk factors associated with housing was examined in relation to diarrhoeal disease and acute respiratory symptoms in South African coloured children. A multistage cluster sample representative of all coloured people living in the major urban and peri-urban areas of South Africa was used for the study. Interviews were conducted with respondents from 1,227 households. Overall, 8.5% children under 5 years were reported to have had diarrhoea, while 29% had experienced coughing and breathing problems in a 2-week recall period. Individual risk factors identified using the odds ratios (ORs) for diarrhoea included not having an inside tap or a flush toilet in the homes (both yielded an OR of 3.3), not owning a refuse receptacle (OR = 2.5), not being connected to an electricity supply (OR = 2.5), low household income (OR = 1.8), more than 2 people per room (OR = 2.0) and less than Standard 5 maternal education (OR = 1.6). Absence of an inside toilet, not having a refuse receptacle and overcrowding all remained as independent risk factors after logistic regression analyses. Multiple logistic regression analyses revealed that not having a refuse receptacle and the absence of electricity for heating purposes were independently associated with respiratory symptoms. The overall preventive potentials for respiratory symptoms were significantly less than those for diarrhoea. Improving physical access to essential environmental health services in urban areas and improvements in the educational status of women are urgently needed if childhood infections are to be prevented.
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PMID:Environmental determinants of acute respiratory symptoms and diarrhoea in young coloured children living in urban and peri-urban areas of South Africa. 202 Aug 87

Between August 1982 and December 1985, seven patients at a children's hospital developed hospital-acquired pneumonia caused by Legionella pneumophila. Demographic data included the following: mean age 12.3 years (range 9 months to 20.5 years); male/female ratio 5:2; all patients were white. Some previously identified risk factors present in our patients included high-dose corticosteroid therapy (five patients), other immunosuppressive therapy (four), and chronic lung (five) or kidney (three) disease. Symptoms and signs included rapid onset, fever, cough, pleuritic chest pain, dyspnea, abdominal pain, diarrhea, and headache. Rhinitis, myalgia, and neurologic abnormalities were not noted. Chest roentgenograms revealed single-lobe consolidation in three patients, diffuse bilateral alveolar infiltrates in three, and pleural effusion in three. All patients were treated with erythromycin; three patients also received rifampin. Tracheal intubation and mechanical ventilation were required by four patients. Six patients improved after therapy. One child died of persistent lung disease 1 month after the onset of legionnaires disease. L. pneumophila was isolated from potable water in the hospital. Aerosol equipment cleansed with tap water and the showers were implicated as means of exposure by patients to contaminated potable water. No new nosocomial cases were seen after immunocompromised children were prohibited from taking showers, and sterile water was used to cleanse equipment for administering aerosol medications.
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PMID:Nosocomial legionnaires disease in a children's hospital. 273 94

A prospective study of 129 consecutive thoracocentesis in 86 patients at a university medical center evaluated the clinical value, complications, and patient experience with thoracocentesis. Pleural fluid analysis in conjunction with the clinical presentation placed 78 pleural fluids into diagnostic categories: definitive 14 (18 percent), presumptive 44 (56 percent), and nondiagnostic 20 (26 percent). Fourteen of 78 (18 percent) of the nondiagnostic fluids were useful, while only six (8 percent) were not useful clinically; therefore, 92 percent of thoracocentesis provided clinically useful information. Using sequential data analysis, initial diagnostic categorizations of eight of 78 patients were upgraded from presumptive or nondiagnostic to definitive based on data available 24 hours following thoracocentesis. Thus, 70 patients were categorized based on the pleural fluid data obtained within the first 24 hours of thoracocentesis. Thirty-four objective complications occurred in 26 of 129 (20 percent) thoracocentesis. The most common complications were pneumothorax, 15 of 129 (12 percent), and cough, 12 of 129 (9 percent). Sixty-five subjective complications occurred in 56 of 123 (46 percent) thoracocentesis. Anxiety, 26 of 123 (21 percent), and site pain, 24 of 123 (20 percent), were the most common subjective complications noted. Thirty technical problems occurred in 129 (23 percent) thoracocentesis with blood contamination, 14 of 129 (11 percent), and dry tap, nine of 129 (7 percent), being the most common. We conclude that diagnostic thoracocentesis is a clinically valuable procedure if used in conjunction with the patient presentation with an understanding of its limitations for providing a specific etiologic diagnosis. When performed by physicians in training, the number of complications are substantial and the operator often underestimates the degree of patient discomfort. Awareness of the clinical value and complications of thoracocentesis should lead to improved use and safety of this procedure.
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PMID:Thoracocentesis. Clinical value, complications, technical problems, and patient experience. 358 30

Patients with primary varicose veins were examined by a combination of the standard tourniquet test with detection of reflux by Doppler ultrasound. Results were compared with standard clinical tests: impulse or thrill at the saphenous opening on coughing, tap impulse at the groin, and the 'Trendelenburg' tourniquet test. The state of competence of the saphenofemoral junction was noted at operation. One hundred and sixty-one limbs of 105 patients were studied. The saphenofemoral junction was incompetent in 132/161 limbs (82 per cent) and was judged competent in 29/161 limbs (18 per cent). The combined Doppler and tourniquet test assessed the saphenofemoral junction correctly in 82 per cent of limbs and was more accurate than all the other tests. The test had good sensitivity (0.9) but poor specificity (0.45). Poor specificity was a feature of all the tests except for thrill which was a highly insensitive test. The combined Doppler and tourniquet test appears to be the most simple, rapid and accurate means of detecting saphenofemoral incompetence.
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PMID:The demonstration of saphenofemoral incompetence; doppler ultrasound compared with standard clinical tests. 673 23

In August, 1978, in Linnavuori industrial community an epidemic broke reaching nearly one half of the population. The acute disease was manifested by severe respiratory symptoms, fever, cough, and dyspnea. The symptoms were connected with the use of hot water. The symptoms of the disease resembled those of allergic alveolitis or humidifier fever. The tap water of the region was found to be heavily polluted. Besides an ample microbial growth a high endotoxin concentration was found. Specific antibodies to the microbes or radiographic lung changes referring to allergic alveolitis were not found. Leukocytosis and reduced diffusion capacities indicating an inflammatory reaction at the alveolar level were in the acute phase. It may be a toxic lung inflammation caused by endotoxins, at least partly at the bronchiolar-to-alveolar level. According to the follow-up, to date the disease has not caused lung damages.
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PMID:An epidemic of bath water fever--endotoxin alveolitis? 696 75

Since August, 1978, an epidemic characterised by respiratory symptoms and fever spread rapidly in a restricted area near Tampere, Finland. Four months later over half of the adult population reported intermittent or constant symptoms. The most frequent symptoms were cough, dyspnoea, chills, fever, headaches, muscle pain and aching of joints. The symptoms appeared to be associated with exposure to water vapour derived from tap water. Consequently this disease, which resembled extrinsic allergic alveolitis, was given the name 'bathing fever' for lack of any prevailing diagnosis. In clinical provocation tests lung diffusion capacity usually decreased, the leucocyte count increased, and a slight rise in body temperature was observed. Despite many efforts the specific causative agent in the tap water has not been identified. Neither massive chlorination of the water nor changing the sand filter of the water-works had any significant effect on the quality of the water. Therefore the source of water supply was changed in April, 1979. The symptoms have subsequently disappeared. Present knowledge about bathing fever suggests that, though rare, it may be typical of the Scandinavian type of climate.
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PMID:Bathing fever epidemic of unknown aetiology in Finland. 744 43

1. This study was designed to investigate the role of airway receptors in the responses of a range of inspiratory muscles to airway occlusion. The occlusion had a rapid onset (< 10 ms), lasted 250 ms and produced only a slight impediment to inspiration. 2. Based on analysis of single trials and averaged rectified electromyographic responses (EMG) in six subjects, there was a major inhibition (IR) with an onset at 34 +/- 2 ms and a trough at 65 +/- 2 ms, and an excitation (ER) with a peak at 105 +/- 2 ms. These two responses are reflex given that voluntary reaction times to a tap on the chest wall occurred at latencies longer than the peak of ER. 3. The responses to airway occlusion did not appear in limb muscles which contracted phasically with inspiration. 4. Anaesthesia of the surface receptors of the upper airway did not attenuate the responses to occlusion. Because this procedure does not eliminate the inputs from muscle and deep laryngeal pressure receptors, two subjects were tested when intubated with a cuffed endotracheal tube so that the occlusion was delivered only to structures below the level of the trachea. Responses to airway occlusion were preserved when all upper airway receptors were 'bypassed'. 5. Responses to airway occlusion also remained after prolonged inhalation of nebulized lidocaine (lignocaine) sufficient to block the cough reflex. 6. The receptors mediating the responses to airway occlusion are therefore likely to reside in inspiratory muscles acting on the chest wall. If so, the short-latency inhibition contrasts with the excitatory stretch reflex responses observed in limb muscles.
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PMID:Role of airway receptors in the reflex responses of human inspiratory muscles to airway occlusion. 747 56

In this study, 31 cases of childhood empyema thoracis admitted over 4 1/2 years to the Hospital Universiti Sains Malaysia, in Kelantan, Malaysia, were retrospectively reviewed. Twenty-two males and nine females were included, with a mean age of 1.9 years (range: 26 days to 7 years). Frequent symptoms were fever, cough, and dyspnoea, while common signs were temperature above 38 degrees C, decreased breath sounds, dullness to chest percussion, and intercostal recession. Radiography demonstrated unilateral moderate to large effusions in 68 per cent of cases, while consolidated lung was seen in 45 per cent of patients. Pleural fluid cultures were positive for Staphylococcus aureus (48 per cent), Streptococcus pneumoniae (7 per cent), while no growth was seen in 42 per cent of cases. Ninety-four per cent of children had a blood leukocytosis above 10 000 cell/mm3, but blood cultures were negative in 21 out of 26 patients (81 per cent). Most cases were treated with a combination of intravenous antibiotics and chest tube drainage. Antibiotics and pleural tap(s) were used in the remainder. Patients stayed in hospital for an average of 20.7 days (range: 4-52 days). Surgical intervention was necessary in only four children. The mortality rate at the time of discharge was zero, with 100 per cent radiographic resolution among the 23 patients who were followed-up.
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PMID:Empyema thoracis in hospitalized children in Kelantan, Malaysia. 763 41

Australia is currently experiencing an epidemic of malignant mesothelioma. The clinical aspects of malignant mesothelioma were investigated in 295 Australian patients as part of a national study of the disease. Most patients were male (91%), with the mean age at diagnosis being 64 years. The predominant cell type was epithelial (38%) and the majority of primary tumours arose from the pleura (94%). Mean survival was poor (17.6 months from first symptom; 11.8 months from diagnosis). Patients with a pleural primary tumour were more likely to present with dyspnoea, chest pain and cough; to have a pleural effusion diagnosed radiologically; and to have metastatic spread. Patients with a peritoneal primary tumour were more likely to present with weight loss, loss of appetite, abdominal pain and ascites; to have radiologic evidence of asbestos exposure; and to have spread along a needle track created during a diagnostic tap. A minority of patients had past thoracic conditions, or radiologic findings, specifically related to previous asbestos exposure. About one fifth of patients had no known asbestos exposure. Forty-one per cent of subjects received some form of chemotherapy, radiotherapy and/or surgery, but no formal disease staging had been documented for any patient. Proper controlled trials of secondary and tertiary treatments in malignant mesothelioma are now needed.
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PMID:Clinical aspects of malignant mesothelioma in Australia. 846 Sep 68

The response to tracheal stimulation (50 microliters of tap water) during wakefulness, non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep was investigated in adult cats. In wakefulness, repetitive coughing occurred on 80% of the trials. In NREM and REM sleep, the most frequent response (approximately 69% and 58% of the trials, respectively) was arousal, followed by coughing. Apneas occurred following the stimulus and before arousal in 11% and 24% of the trials in NREM and REM sleep, respectively. In NREM sleep, the tracheal stimulus sometimes evoked expiratory efforts following a normal inspiratory effort (11% of the trials). These were much weaker than the expiratory efforts during coughing in wakefulness. In REM sleep, stimulation in 11% of the trials elicited increased inspiratory efforts. Although these may have been diminutive preparatory inspirations for coughing, they were much smaller than preparatory inspirations associated with coughing in wakefulness, and they were never followed by active expiratory efforts. Arousal from either NREM or REM sleep in response to tracheal stimulation was sometimes associated with an augmented breath. This response, which is common upon spontaneous arousal, may lead to deeper aspiration of the tracheal fluid. We conclude that in cats coughing requires wakefulness and that airway stimuli in sleep cause a variety of respiratory responses, some of which may be maladaptive.
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PMID:Respiratory responses to tracheobronchial stimulation during sleep and wakefulness in the adult cat. 886 4


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