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)

A 58-year-old man presented with the clinical signs and symptoms of a large right upper lobe lung abscess. His course was complicated by diffuse bilateral necrotizing pneumonitis, and death occurred as a result of massive aspiration of lung abscess contents into uninvolved lung. At postmortem examination, an esophageal carcinoma with a direct fistulous communication with the abscess cavity was present. Although rare, asymptomatic malignant esophageal disease should be considered in the differential diagnosis of a lung abscess which does not follow a typical course.
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PMID:Asymptomatic esophageal carcinoma with esophagopulmonary fistula masquerading as a primary lung abscess. 76 Feb 28

Oesophageal perforations associated with cervical fractures occur from a variety of injuries. Fractures of the cervical spine, blunt trauma and penetrating injuries such as gunshot wounds, knives and missiles, perforate the cervical oesophagus. This retrospective study consists of 24 patients with an oesophageal perforation and cervical fracture. Motor vehicle accidents were responsible for 54% of the oesophageal perforations. The other oesophageal injuries were related to anterior spine surgery, gunshot wounds and sports-related activities. The clinical features related to these injuries included the obvious signs of an oesophageal perforation as well as fever of unknown origin, leukocytosis and unexplained persistent tachycardia. A variety of techniques was used to establish the diagnosis. All the patients had treatment for the cervical fracture and 20 patients required surgical repair of the oesophagus. The most common oesophageal complications were stricture of the oesophagus (54%) and oesophageal diverticulum (10%). The other complications were atelectasis, pneumonia, tracheobronchitis, pulmonary embolism, cervical osteomyelitis, cervical abscess, mediastinitis, septicemia and cervical fistulae. These patients have a serious life-threatening illness that may be difficult to diagnose and treat.
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PMID:Oesophageal trauma in patients with spinal cord injury. 128 44

Oesophageal replacement with an interposed graft of the large intestine on a vascular pedicle between the cervical oesophagus and oesophageal stump over the diaphragm was performed in four children for Vogt's classification Type-I and II oesophageal atresia. A tracheooesophageal fistula was closed in three, and gastrostomy was established in four neonates to provide nutrition. Oesophageal replacement was performed in patients aged 2 years and 5 months to 5 years and 4 months. One girl died following oesophageal replacement for bilateral pneumonia. A non-functioning oesophageus was extirpated for corrosive oesophageal stricture with simultaneous replacement by means of colonoplasty in two boys aged 3 1/4 years and 3 1/2 years. As regards complications, a shortly persisting salivary fistula developed in the cervical anastomosis, and an abundant graft was made shorter and a fundoplication for gastrooesophageal reflux was established in the same patient. To prevent leakage of the anastomosis and its stricture, the anastomoses were constructed obliquely and sutured in two layers using thin atraumatic suture with silk thread. The patients have been on follow-up for 3 to 12 years (mean 6.5 years) after oesophageal replacement; their ability to swallow, psychosomatic development and surgical criteria were employed to evaluate the outcome as excellent in four, and good in one of the children operated on.
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PMID:[Esophageal replacement using the large intestine in children]. 147 16

Esophagus cancer surgery often becomes complicated with fistulas and above all with infections. In 50 cases, the authors relate 7 fistulas and 60 nosocomial infections among which pneumonia takes the first place. The pneumonia diagnosis has been established on the criteria of the "National Nosocomial Infection Study" and on bacteriologic samples. Those mostly isolate Gram-bacilli and streptococci. The diagnosis and etiologic factors leading to prophylactic measures are studied.
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PMID:[Nosocomial pneumonia following surgery of esophageal tumors (apropos of 50 cases)]. 188 70

In a 6.5 year period starting January 1982, 121 patients (74 male, 47 female; 1.6:1) with complicated gastroesophageal reflux referred to Alberta Children's Hospital, University of Calgary, required a Nissen fundoplication at a mean age of 35.5 months (range 3 weeks to 18 years). The median age of onset of symptoms was less than 1 month. Symptoms and indications for surgery included regurgitation (88%), failure to thrive (52%), reflux-associated pulmonary symptoms and aspiration (48%), biopsy evidence of esophagitis (35%) with heartburn (17%), dysphagia (18%), hematemesis (17%), anemia (13%), and hypoproteinemia (22%). Sixty-four percent of the patients had a syndrome or chromosomal abnormality, respiratory disease, or neuromuscular disorder. The barium contrast upper-gastrointestinal radiographic series, performed in all patients, identified structural [gastric outlet obstruction (2%), esophageal stricture (11%), erosive esophagitis (9%)], and functional abnormalities [gastroesophageal reflux (90%), barium aspiration (8%), esophageal hypoperistalsis (30%), delayed gastric emptying (4%)]. Barium contrast upper gastrointestinal radiographic series identified gastroesophageal reflux with a sensitivity of 90% (compared to history), was 50% sensitive and 92% specific for erosive esophagitis (compared to biopsy), was 59% sensitive and 74% specific for esophageal dysmotility (compared to esophageal manometry), and there was a significant (p less than 0.01) association between barium aspiration and prior evidence of aspiration pneumonitis. Esophageal manometry demonstrated a significantly (p less than 0.001) lower esophageal sphincter pressure in patients compared with controls, but no significant correlation with failure to thrive, aspiration pneumonia, biopsy evidence of esophagitis, or parameters of the 24-hour esophageal pH study. Twenty-four hour pH monitoring showed significantly (p less than 0.05) more reflux episodes than in asymptomatic controls and there was significant (p less than 0.05) correlation between the percentage of time pH was less than 4 and the presence of hypoalbuminemia, and biopsy-proven erosive esophagitis or Barrett's esophagus. Endoscopic appearance was 91% sensitive and 60% specific for esophagitis when compared to biopsy. Nissen fundoplication was completely effective at resolving gastroesophageal reflux in 83%, and associated with marked improvement in 15%. No patient died as a result of fundoplication. Major complications included: recurrence of symptoms requiring reoperation (2%), subsequent mechanical bowel obstruction (8%), wound infection or pneumonia (12%).
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PMID:Investigation and outcome of 121 infants and children requiring Nissen fundoplication for the management of gastroesophageal reflux. 227 17

We report the cases of 35 patients with complex benign esophageal disease who required radical surgical reconstruction. These patients had undergone 63 previous esophageal operations. Twenty-seven patients required esophagogastrectomy, four had esophageal exclusion before colon interposition, two had cardioplasty, and two without stricture did not require resection. Reconstruction was achieved by esophagogastrostomy in six patients, colon interposition in eight, and acid suppression and alkaline diversion in 21. One patient died of pneumonia 2 weeks after esophagogastrostomy. The overall rate of postoperative improvement was 70%, but the condition of 86% of patients was improved after the acid-suppression and alkaline-diversion procedure, which is the reconstructive procedure we prefer in properly selected patients with complex benign esophageal disease.
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PMID:Esophageal reconstruction for complex benign esophageal disease. 229 56

IORT may be a potentially useful adjunctive treatment combined with surgery and/or external beam irradiation in treating locally advanced lung and esophageal tumors. To begin investigation of this modality, the tolerance of intact mediastinal structures to IORT was studied using adult American Foxhounds (wt. 25-30 kg). Groups of six animals received IORT to doses of 20, 30, or 40 Gy to two separate intrathoracic ports, using 9 MeV electrons to treat a portion of the collapsed right upper lobe, and 12 MeV electrons to treat the mediastinal structures. A group of three dogs received thoracotomy with sham irradiation. Two dogs from each treatment dose group, as well as one sham-irradiated control, were sacrificed electively at 1, 3, and 12 months following IORT. There were no acute nor late IORT related mortalities. Post-operative weight loss was minimal (average 4.5% of pre-operative weight) for all dogs. Serial esophagrams showed no inflammation or ulceration. No cardiac nor pulmonary changes were noted clinically. At autopsy, the irradiated lung showed evidence of acute pneumonitis at 1 month with progressive fibrosis at 3 months and 1 year. Esophageal reactions were minimal, with only two dogs (one 30 Gy and one 40 Gy) demonstrating histologically confirmed esophagitis at 1 month. Tracheal changes were minimal. Cardiac damage was evident in the right atrial tissues. In several dogs, this cardiac damage ranged from myocardial vascular changes to frank ischemic necrosis noted at 1 and 3 months, and dense fibrosis at 1 year. The phrenic nerves showed normal function, but had evidence of perineural fibrosis. The large vessels demonstrated only mild histologic evidence of irradiation. The results of this large animal study suggest that intact mediastinal structures will tolerate small volume IORT to doses of 20 Gy without significant clinical sequellae. Although the histologic changes in the right atrium and contralateral lung are worrisome, no cardiac nor pulmonary problems arose over the 1 year follow-up. Irradiation of the contralateral lung and other sensitive structures can be reduced by careful selection of electron beam energy and use of custom lead shielding.
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PMID:Response of the mediastinal and thoracic viscera of the dog to intraoperative radiation therapy (IORT). 310 47

Continuous monitoring of distal oesophageal pH and oesophagoscopy were performed in 28 children aged 15 days to 12 years (mean: 14 months) intubated and ventilated for bronchiolitis (7), pneumonia (8), epiglotitis (2), neurological distress (8), whooping cough (2) or recurrent apneic spells (1). Esophageal pH was studied 2-8 days (mean: 2 days) after intubation; its duration was 12-23 h 50 min (M: 22 h). An abnormal gastroesophageal reflux was presumed when the percent of total monitoring time during which the esophageal pH fell below 4.0 was above 5.2%. The esophagoscopy was carried out on the day following the pH monitoring. All children were in the supine position and fed a pH 7 diet infused continuously with a nasogastric tube; 15 children were under pancuronium. An abnormal gastroesophageal reflux was found in 4 children, associated with a benign esophagitis in 2. A benign esophagitis without gastroesophageal reflux was found in 3 cases. One child had a peptic ulcer of the bulb without gastroesophageal reflux nor oesophagitis. 21 children had no abnormality. Only one of the 15 children under pancuronium had an abnormal gastroesophageal reflux. We conclude that in intubated children fed continuously with a nasogastric tube, gastroesophageal reflux is unfrequent and, when present, appears to have little consequences.
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PMID:[Acid gastroesophageal reflux in the child with intubation, artificial respiration and continuous nutrition. Apropos of 28 cases]. 314 99

A 64-year-old man presented with mediastinal and bilateral hilar adenopathy, and a biopsy of a scalene node revealed non-Hodgkin's lymphoma. One week after a cycle of combination chemotherapy, he developed an esophagobronchial fistula. Following a resolution of pneumonia by antibiotics, a cervical esophagostomy was made and, after the improvement of his general condition with parenteral hyperalimentation, he was given one course of combination chemotherapy which was continued until the mediastinal lymph node shadow completely disappeared. A subcutaneous bypass operation was performed on the stomach. After receiving one more cycle of intensification chemotherapy, he was discharged. Three months later, a bronchoscopy showed healing of the fistula. Nine months postoperatively, there is no evidence of the lymphoma or the esophagobronchial fistula recurring. Esophageal involvement is rare in malignant lymphoma and this is only the sixth reported case of esophageal fistula of the respiratory tract in association with lymphoma, and just the second to be treated successfully.
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PMID:Mediastinal malignant lymphoma complicated with esophagobronchial fistula: successfully treated case. 369 29

In order to estimate the incidence and significance of aspiration during anaesthesia, a study of cases in which this complication had occurred was made at the Karolinska Hospital. With the aid of the anaesthetic recordkeeping system of the Department of Anaesthesia and the computer-based register of diagnoses of in-patients at the hospital, all cases in which aspiration was recorded were retrieved. Eighty-three cases of aspiration were retrieved from the file of anaesthetic records and four from the in-patient register. This constitutes an incidence of 4.7 aspirations in 10 000 anaesthetics, or 1 in 2131. The patients most often affected were children and the elderly. In 83% of the cases there were one or more preoperative factors indicating an increased risk for aspiration, such as emergency operation (38 cases, 43%), upper abdominal or emergency abdominal surgery (14 cases, 16%), a history indicating delayed gastric emptying (e.g. peptic ulcer/gastritis, pregnancy, obesity, unusual stress or pain, elevated intracranial pressure, 54 cases, 61%). In 29 cases (33%) there was a history indicating an increased risk of regurgitation, e.g. nasogastric tube, oesophageal disease or pregnancy. In 15 cases of elective surgery, no history of increased risk for aspiration could be found. In 67% of those cases the aspiration was preceded by difficulties involving the airways or intubation. The incidence of aspiration was more than sixfold higher during the night than during regular daytime working hours. In 41 cases (47%) the aspiration led to aspiration pneumonitis confirmed by x-ray. Fifteen patients (17%) needed mechanical ventilation, and four died.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Aspiration during anaesthesia: a computer-aided study of 185,358 anaesthetics. 375 72


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