Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a consecutive series of 1109 patients undergoing aortic valve replacement (AVR) between January 1988 and December 1990, there were 48 patients (33 female, 15 male) over 80 years of age (mean age 83.5 years, median 82.9 years). Of those, 33 had aortic stenosis and 15 combined aortic valve disease, with additional coronary artery disease being present in 36. Isolated AVR was performed in 25 patients, and it was combined with coronary venous bypass grafting, with 1-4 (mean 1.8) peripheral anastomoses in 23. Two patients died within 30 days (early mortality 4.2%). Non-fatal complications included one hemiparesis, four transient cerebral disorders, two cases of pneumonia which led to ventilatory assistance, three rethoracotomies because of postoperative bleeding, 15 tachycardias and one transient AV block. Late results were obtained after a median follow up time of 22 months. There were eight late deaths (four cardiac related, four not related) and a low incidence of non-fatal complications (two episodes of gastrointestinal bleeding while on oral anticoagulation, one cerebral transient ischemic attack and one acute left ventricular failure). Nine patients are in NYHA Class I, 12 in Class I-II, 11 in Class II, three in Class II-III and three in Class III. Of the surviving 38 patients, four are currently living in a home for the aged or a nursing home, while all the others are living in their own homes and are able to sustain a relatively independent life-style. We conclude that in very old patients with aortic valve disease, AVR can be performed with low mortality and few non-fatal complications.
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PMID:Aortic valve replacement in octogenarians. 134 27

A 8 day-old full-term newborn showed severe cardiac disturbances after intravenous injection of erythromycin. The neonate, suspected of having Chlamydia pneumonitis because of tachypnea and rhinitis, had been given 5 injections of erythromycin without clinical effect. Pallor, vomiting and bradycardia developed a few minutes after the 6th injection, and ECG showed ventricular arrhythmia, prolonged QT interval and an atrioventricular block. The infant died in intensive care unit. This case and the analysis of other published cases of cardiac disturbances following the parenteral use of erythromycin, indicate the potential arrhythmogenic risk of this drug. It is suggested that newborns treated with erythromycin should be monitored by ECG.
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PMID:[QT prolongation and circulatory arrest after an injection of erythromycin in a newborn infant]. 201 21

Over a period of approx. 3 years, electrocardiograms (ECG) were recorded from 138 horses referred as patients to the Medical Clinic. Of these, 22 horses (approx. 16 per cent) has ECG alterations. The 22 ECG's revealed a total of 29 ECG abnormalities. The most frequent ECG alteration was incomplete AV block, that was seen in 9 horses (31 per cent of the ECG abnormalities). Abnormal (i.e. broad, tent-like and, sometimes, inverted) T waves and deviations of the ST segment were seen each in 5 ECG's from 7 horses, 3 of which had both abnormalities which were associated with severe underlying disease (colic, enteritis, pneumonia, strangles a.o.). Premature ventricular beats were seen in 3 horses, two of which had serious cardiovascular dysfunction whereas the third showed no signs of cardiac disease. Atrial fibrillation was observed in two horses. Both were treated with chinidine sulphate but a conversion to sinus rhythm was not achieved in either case. Other ECG abnormalities observed in the study were, parasystole (1 horse), sinus arrhythmia (2 horses), sinoatrial block (1 horse) and wandering pacemaker (1 horse). Each abnormality is discussed with regard to its clinical significance and diagnosis. Cardiac murmurs were detected on auscultation of 26 horses (approx. 19 per cent). The murmurs in 15 horses were short and faint sounds most of which were diastolic. They were considered of no importance. Eleven horses, on the other hand, had distinct, loud (grade 4 or 5), holosystolic or holodiastolic murmurs that were considered pathological. Eight of these horses had actual signs of cardiac disease. Cardiac vector distribution in patients with ECG abnormalities or murmurs showed no systematic differences from vectors in horses showing no cardiac abnormality.
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PMID:Electrocardiography in the horse. (A report of findings in 138 horses). 615 60

Correlative ECG, electrophysiologic (EPS), and pathologic findings of the conduction system (CS) in dystrophica myotonia has not been documented to our knowledge in the English literature. We present such a correlation in two cases. The first at age 55 had right bundle branch block, left anterior fascicular block, and first-degree AV block. At age 65, ECG demonstrated type 1 AV block, and EPS revealed block proximal to the His bundle. Two years later, he died of pneumonia. The CS showed marked degenerative changes and fatty infiltration in the atrial septum and the approaches to the AV node, with marked fibrosis of the right bundle branch and partial interruption of the left bundle branch. Case 2 at age 32 had complete left bundle branch block. At age 35, she had syncope, and the ECG revealed type 2, 2:1, and complete AV block, as well as nonsustained polymorphic ventricular tachycardia; EPS showed block distal to the His bundle. A year later, she died in ventricular fibrillation. The CS revealed fatty infiltration in the approaches to the AV node, fibrosis completely interrupting the left bundle branch, and marked fibrosis of the right bundle branch. In both cases, there was fibrosis of the summit of the ventricular septum with irregularity in the size of the cells, vascular changes, and fatty infiltration of the atrial septum. There was good but not perfect correlation among ECG, EPS, and CS findings. The discrepancy was in the approaches to the AV node in case 2. It appears that dystrophica myotonia is a striated muscle disease and possibly a pan-muscle disease.
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PMID:Dystrophica myotonia. Correlative electrocardiographic, electrophysiologic, and conduction system study. 646 5

Twenty-four-hour ambulatory electrocardiography was performed in 25 young and 29 active elderly subjects. Sinus bradycardia and sinus arrhythmia were common in the young but uncommon in the elderly. Ventricular and supraventricular premature beats and brief runs of supraventricular tachycardia were common in the elderly but uncommon in the young. Complex ventricular arrhythmias only occurred in the elderly but brief episodes of nocturnal Wenckebach AV block were quite common in young and old alike. No significant difference in arrhythmia frequency was found between elderly subjects with heart disease and those without heart disease or between elderly subjects without symptoms and those with non-episodic symptoms such as dizziness. None of the arrhythmias in the young or elderly subjects was associated with symptoms. In follow-up at 30 months, only one elderly subject was deceased (from pneumonia) and none had suffered a stroke or heart attack. It is concluded that transient cardiac arrhythmias are commoner in the elderly than in the young. However, their long-term significance remains unknown, but it is likely that they are relatively benign.
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PMID:The significance of cardiac arrhythmias in the aged. 684 89

Third degree atrioventricular block was diagnosed in 4 dogs with acquired myasthenia gravis (serum acetylcholine receptor antibody titer > 0.6 nmol/L). All 4 dogs had megaesophagus. Two dogs also had mediastinal thymomas, which were resected. One dog with thymoma received a permanent pacemaker at the same time that it underwent thymectomy; the other did not develop third degree atrioventricular block until 3 months after thymectomy. Both dogs with thymoma died of severe aspiration pneumonitis within 3 months after surgery. The third dog received a permanent pacemaker and was treated with pyridostigmine bromide, but also died of aspiration pneumonitis 1 month after the pacemaker was implanted. The fourth dog was treated with prednisolone and pyridostigmine bromide and improved, but did not become clinically normal. Because third degree atrioventricular block as well as myasthenia gravis can cause signs of weakness, acquired myasthenia gravis should be considered in dogs with idiopathic cardiac conduction disturbances. Likewise, an ECG should be evaluated in dogs with acquired myasthenia gravis.
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PMID:Third degree atrioventricular block and acquired myasthenia gravis in four dogs. 776 38

The studies aimed at assessing the kind and the incidence of the complications of monocytic angina in childhood. In 7 out of 343 hospitalized children neurological disorders were found, thrombocytopenia was seen in 5 cases, pneumonia in 3 cases, bronchitis in 12 cases, and AV block in 3 cases. The most frequent complication of monocytic angina was respiratory tract obturation (6.4% of cases).
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PMID:[Complications of monocytic angina in children]. 823 52

Infections after cardiac pacemaker implantation are rare (0.13 to 12.6%) but potentially severe complications. Staphylococcus is the genus most frequently isolated (72 to 100% of cases). The use of systematic prophylactic antibiotics remains controversial. From November 1991 to October 1993, 207 consecutive patients were submitted to a series of measures designed to reduce the risk of infection: a) intravenous bolus injection of Cefamindole, 15 minutes before implantation, b) cutaneous disinfection with iodinated polyvindone, c) injection of an ampoule of rifampin before closure of the pacemaker in the pouch, d) absence of drainage system. Patients were predominantly female (60.9%), with a mean age of 77 +/- 10 years, frequently suffering from heart disease (53.8%). The indication for implantation was atrioventricular block (39.7%), carotid sinus syndrome (27.5%), atrial arrhythmia (27.5%), resection of the node-His tract (5.3%). This procedure corresponded to the first implantation in 88.4% or replacement of a previous pacemaker in 11.6% of cases and the pacing mode was single-chamber (38.4% or replacement of a previous pacemaker in 11.6% of cases and the pacing mode was single-chamber (38.7%), or double chamber (61.3%). The mean duration of the procedure was 51.5 min +/- 30 min. The mean follow-up was 12.7 +/- 5 months. The overall mortality was 14% (11 cases of cardiac failure, 6 sudden deaths, 4 cerebrovascular accidents, 4 cases of pneumonia, 4 neoplasms). Only one infectious problem (endocarditis, i.e. 0.48%) was observed.
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PMID:[Multifactor prevention of endocarditis and cardiac pacemakers. A prospective study apropos of 207 patients]. 876 12

Cystic tumor (endodermal heterotopia) of the atrioventricular (AV) node in a 95-year-old female is described. Electrocardiograms showed complete AV blockage with a narrow QRS morphology resulting from the long-standing first degree of AV blockage since age 61. A cardiac pacemaker was implanted at age 83. The patient died of pneumonia at age 95. Autopsy demonstrated a normal heart weight (320 g), normal coronary artery and normal myocardium. Histological examination of the conduction system revealed a marked fibrotic sinoatrial (SA) node and a cystic lesion in the lower right atrium, including the approaches to the AV node. The bundle of His and its branches were completely intact. Cellular nests and cystically dilated tubules were scattered within a loose tissue stroma, which measured 18 x 12 x 5 mm. There were several mitotic figures among the tubules, as well as nuclear fragments similar to apoptotic bodies and exfoliation of the tumor cells. Immunohistochemical studies demonstrated a positive reaction for epithelial membrane antigen, carcinoembryonic antigen, CA19-9, cytokeratin and secretory component in the tubular cells, and a negative reaction for thrombomodulin. Endocrine cells among the tubules were positive only for calcitonin and serotonin. Ultrastructurally, sparse microvilli and desmosome-like structures between the tumor cells were observed. These findings support that this lesion originates from the endoderm. Moreover, it is likely that progression in the degree of AV block may be explained by the cell proliferation activity of the tumor.
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PMID:Histological evidence for cell proliferation activity in cystic tumor (endodermal heterotopia) of the atrioventricular node. 983 64

The clinical picture of myocarditis/myopericarditis is of importance in differential diagnosis, especially in younger patients with suspected myocardial infarction. Myocarditis/myopericarditis commonly presents with chest pain, and the diagnosis is usually established on clinical grounds. However, endomyocardial biopsy is necessary to confirm the diagnosis. We evaluated the characteristics of acute myocarditis over the years 1980-1998 in 54 patients of the Department of Medicine of the University Hospital, Zurich. Two to 6 patients per year were hospitalised with this diagnosis. In most cases the diagnosis was established by a combination of criteria, such as a preceding infection of the upper respiratory tract, thoracic pain, ST segment elevations in different precordial leads followed by T wave inversions, arrhythmias, elevation of cardiac enzymes, reversible hypokinesia by echocardiography and normal coronary arteries. At least 3 of 5 criteria were requested. In a first step we analysed retrospectively all patients with acute myocarditis/myopericarditis in the years 1980-1993. Among 30 cases of acute myocarditis/myopericarditis the following causes could be identified: one influenza B, one Toxoplasma gondii infection, 2 Epstein-Barr infections and one bacterial myocarditis with gram-negative rods. The aetiology of the other 25 cases remained unknown. The majority of myocarditis/myopericarditis healed without complications. One patient with Epstein-Barr myocarditis and one with Toxoplasma gondii infection died. Two patients developed dilated cardiomyopathy. In a second phase we analysed prospectively all cases with acute myocarditis/myopericarditis over the period 1994-1998: 24 patients with acute myocarditis/myopericarditis were hospitalised. At that time coronary angiography and endomyocardial biopsies were performed more frequently. We found 2 patients with giant cell myocarditis and 2 with Toxoplasma gondii infection and HIV, all of whom died. In addition, there were 2 patients with eosinophilic myocarditis, one with Lyme carditis, one with Epstein-Barr myocarditis, one with myopericarditis after Campylobacter enteritis and one histologically proven myocarditis after pneumonia with Haemophilus influenzae. The aetiology of the remaining 13 cases with myocarditis/myopericarditis could not be established. Three patients with probable viral myocarditis developed cardiogenic shock requiring intraaortic balloon pump, and fully recovered. The patient with Lyme carditis manifested with total atrioventricular block and was treated with a temporary pacemaker. One patient with lymphocytic myocarditis required heart transplantation because of terminal heart failure and one female patient with histologically proven diffuse lympho-monocytic myocarditis died of cardiogenic shock. All the other cases healed without complications. Serologies are of little diagnostic value and should be restricted to serologies with therapeutic implications. We believe that the apparent increase in myocarditis/myopericarditis in recent years is a result of better diagnostic tools, such as more specific cardiac enzyme tests, coronary angiography and endomyocardial biopsies. In most cases the therapy remains symptomatic. In elected, severe cases steroids and other immunosuppressive drugs are sometimes used.
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PMID:[Diagnosis and course of myocarditis: a survey in the medical clinics of Zurich University Hospital 1980 to 1998]. 1102 70


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