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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Concomitant pneumonia and influenza constitute the leading infectious cause of death in the elderly and the fourth most common cause of death overall. The presence of concomitant illness and delays in diagnosis contribute to significant mortality from this disease in the elderly; senescence of the immune system seems less important in predisposition to pneumonia than the presence of concomitant illness. Delay in diagnosis is frequently secondary to the atypical presentations of pneumonia in the elderly. The usual symptoms of fever, chills, rigors, and sputum production that are present in young adults all may be absent; confusion may be the only presenting symptom. Tachypnea is frequent, but the physical examination, in addition to often being technically difficult, is not sufficiently sensitive in making a diagnosis. Leukocytosis is common, but by no means specific. Chest roentgenograms frequently show incomplete consolidation and findings are difficult to distinguish from other diseases of the elderly, such as congestive heart failure, atelectasis, pulmonary embolism, and malignancy. Therefore, clinical diagnosis requires a high index of suspicion despite atypical clinical manifestations.
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PMID:Clinical features of pneumonia in the elderly. 209 72

Transudative pleural effusions usually result from systemic disorders such as congestive heart failure, hypoproteinaemic states and pneumonia. We report a patient who illustrates a rarely considered local mechanism of transudate formation.
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PMID:An unusual pleural effusion. 210 45

We developed disease-specific measures of sickness at admission based on medical record data to study mortality of Medicare patients with one of five conditions (congestive heart failure, acute myocardial infarction, cerebrovascular accident, pneumonia, and hip fracture). We collected an average of 73 sickness variables per disease, but our final sickness-at-admission scales use, on average, 19 variables. These scales are publicly available, and explain 25% of the variance in 30-day postadmission mortality for patients with acute myocardial infarction, pneumonia, or cerebrovascular accident. Sickness at admission increased following the introduction of the prospective payment system (PPS). For our five diseases combined, the 30-day mortality to be expected because of sickness at admission was 1.0% higher in the 1985-1986 period than in the 1981-1982 period (16.4% vs 15.4%), and the expected 180-day mortality was 1.6% higher (30.1% vs 28.5%). Studies of the effects of PPS on mortality must take this increase in sickness at admission into account.
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PMID:Changes in sickness at admission following the introduction of the prospective payment system. 212 Apr 79

We developed explicit process criteria and scales for Medicare patients hospitalized with congestive heart failure, myocardial infarction, pneumonia, cerebrovascular accident, and hip fracture. We applied the process scales to a nationally representative sample of 14,012 patients hospitalized before and after the implementation of the diagnosis related group-based prospective payment system. For the four medical diseases, a better process of care resulted in lower mortality rates 30 days after admission. Patients in the upper quartile of process scores had a 30-day mortality rate 5% lower than that of patients in the lower quartile. The process of care improved after the introduction of the prospective payment system; eg, better nursing care after the introduction of the prospective payment system was associated with an expected decrease in 30-day mortality rates in pneumonia patients of 0.8 percentage points, and better physician cognitive performance was associated with an expected decrease in 30-day mortality rates of 0.4 percentage points. Overall, process improvements across all four medical conditions were associated with a 1 percentage point reduction in 30-day mortality rates after the introduction of the prospective payment system.
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PMID:Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system. 212 Apr 79

To determine the magnitude, duration, and associated factors of perioperative changes in pulmonary function, we retrospectively reviewed the medical records of 145 patients who required preoperative mechanical ventilation for acute respiratory failure before undergoing 200 surgical procedures. Patients were grouped into five pulmonary diagnostic categories: (1) adult respiratory distress syndrome (ARDS) (n = 49); (2) pneumonia (n = 20); (3) atelectasis (n = 65); (4) congestive heart failure (n = 11); and (5) acute ventilatory failure (n = 55). Sixty patients underwent intra-abdominal surgery, 135 patients required surgery on the periphery, and five patients had a thoracotomy. For all patients, PaO2/FIO2 declined significantly from 321 mm Hg (mean) preoperatively to 258 mm Hg intraoperatively, and shunt fraction (Qs/QT) increased from 0.16 to 0.23 without a significant change in PaCO2. The magnitude of the increase in Qs/QT did not differ among pulmonary diagnostic groups. Preoperatively, patients undergoing laparotomy had lower PaO2/FIO2 (278 vs 340) and higher Qs/QT (0.19 vs 0.14) than patients requiring surgery on the periphery. Intraoperatively, Qs/QT increased more during abdominal procedures than during peripheral procedures. Intraoperative hypoxemia (PaO2/FIO2 less than 80 mm Hg) occurred during 13 procedures. Hypoxemic patients had a mean increase in Qs/QT of 0.20 (0.25 preoperatively to 0.45 intraoperatively), and a significant increase in PaCO2 from 38 mm Hg to 45 mm Hg intraoperatively). In general, these patients had ARDS (n = 10), sepsis (n = 10), a laparotomy (n = 9), and intraoperative mechanical ventilation via the Ohio Anesthesia ventilator (n = 8), a commonly used operating room ventilator. Their preoperative peak airway pressure (54 cm H2O) and minute ventilation (20 L/min) requirements exceeded the capabilities of the Ohio Anesthesia ventilator and likely contributed to impaired gas exchange intraoperatively. Within the first several hours postoperatively, PaO2/FIO2 recovered to preoperative levels in all patients, even in those who had severe intraoperative hypoxemia develop and who underwent laparotomy. We conclude that most patients with acute respiratory failure receiving preoperative mechanical ventilation experienced mild-to-moderate deterioration in intraoperative pulmonary oxygen exchange that rapidly returned to preoperative levels after surgery. We recommend that necessary surgery not be postponed by concern that pulmonary function will be worsened by surgery and anesthesia.
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PMID:Factors affecting perioperative pulmonary function in acute respiratory failure. 212 51

The study comprised 40 children of both sexes aged from 2 to 12 years, 22 suffering from bronchial asthma and 18 suffering from atopic dermatitis. Twenty healthy children of comparable age and sex to the patients were studied as controls. All the children were subjected to full history including dietetic questionnaire, thorough examination, and to estimation of serum IgE, serum ceruloplasmin, and zinc and copper levels in both serum and hairs. The mean concentrations of zinc in serum and hairs were respectively 70.3 +/- 13.2 micrograms/100 ml and 167.5 +/- 23.0 micrograms/gm in asthmatic cases and 65.9 +/- 11.7 micrograms/100 ml and 164.8 +/- 23.6 micrograms/gm in those with atopic dermatitis. These levels were significantly (p less than 0.001) decreased in comparison to the control values (88.4 +/- 11.0 micrograms/100 ml and 194.5 +/- 18.6 micrograms/gm). On the other hand, a significant (p less than 0.001) increase in serum and hairs copper was demonstrated in both allergic groups compared to the controls. Mean copper values were respectively 79.5 +/- 8.06 micrograms/100 ml and 18.7 +/- 1.9 micrograms/gm in the asthmatic cases and 81.4 +/- 8.4 micrograms/100 ml and 17.8 +/- 2.08 micrograms/gm in cases with atopic dermatitis. The control mean concentrations were 67.95 +/- 6.37 micrograms/100 ml and 14.5 +/- 2.53 micrograms/gm respectively. Significant (p less than 0.001) higher levels of serum ceruloplasmin were observed in the allergic patients compared to the controls and were correlated with the hypercupremia. The results were discussed and a good dietetic intake of high biological value protein and zinc supplement was recommended to these patients in order to correct their disturbances especially the hypozincemia which could lead to exaggeration of their allergic conditions. The field of trace elements metabolism has grown rapidly over the past few years, particularly after the development of novel techniques as the atomic absorption spectrophotometry which had allowed the reliable measurements of several trace elements in tissues and so had opened a new field for many researches (Henkin, 1976). Zinc and copper are involved in cell and tissue growth. Zinc plays an important role in DNA and protein synthesis and is intimately involved with copper as cofactors in several important enzyme systems. The effects of many pathological conditions as congestive heart failure, pneumonia, rheumatic heart diseases, bronchitis, recurrent infection, hemolytic anemia, psoriasis, and malnutrition on the levels of serum zinc, copper, and other trace elements have been of interest to investigators for a number of years (Sinha and Gabrieli, 1970; David et al., 1984).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Zinc and copper status in children with bronchial asthma and atopic dermatitis. 213

Two hundred and eighty four patients with Down Syndrome (DS) were seen between 1951-1989. One-hundred and fourteen (40.1%) had a [corrected] cardiac murmur at presentation. A definitive cardiac diagnosis was established in 47 (41%) patients, of which 38 had long term follow-up. Fifteen (33%) patients had atrioventricular canals. There were 21 males and 17 females, with a mean age of 5.3 years. Fifteen (39%) patients were in functional class (FC) I, 16 (42%) in FC II, six (15%) in FC III, and one patient in FC IV at the time of presentation. There were 18 survivors (13 in the surgical group and five in the nonsurgical group) and 20 nonsurvivors (four in the surgical group and 16 in the nonsurgical group). Causes of death in the nonsurgical group included congestive heart failure, pneumonia, and pulmonary vascular disease, and occurred at a mean age of 8.4 years. Post-operative complications accounted for deaths in three of the four surgical patients. The survivors in the surgical group are presently in FC I/II. In the nonsurgical group, there was increased mortality, especially in those who presented in an earlier era, and a deterioration in functional class on follow-up due to the development of pulmonary vascular disease. Our data suggest that a) patients with Down syndrome and heart disease are helped by cardiac surgery with stabilization and improvement of their functional class; b) deterioration in functional class is seen in patients with Down syndrome with cardiac lesions who are managed nonsurgically [corrected] and c) mortality remains high in such patients treated nonsurgically due to development of pulmonary vascular disease and congestive heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term follow-up of children with Down syndrome with cardiac lesions. 214 3

Plasma atrial natriuretic peptide (ANP) Levels were measured by radioimmunoassay both in 38 infants with pneumonia and 20 infants with pneumonia associated with congestive heart failure (CHF). 10 of the 20 infants with CHF were examined with echocardiography during CHF and recovery period. The plasma ANP Levels in the pneumonia group was 424.3 +/- 214.4 pg/ml (mean +/- SD). Which was significantly higher than that of the control group (P less than 0.01). The plasma ANP levels in pneumonia with CHF group was 684.4 +/- 366.9 pg/ml, which was significantly higher than that in the group of pneumonia without CHF (P less than 0.01). Positive linear correlation was found between the mean pulmonary artery pressure and plasma ANP content (r = 0.717, P less than 0.05). The results of this study suggest that plasma ANP concentration may give useful information on the indication of using vasodilators in infant with pneumonia. It may also be taken as a practical diagnostic indicator in pneumonia associated with CHF.
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PMID:[Plasma atrial natriuretic peptide levels and their clinical importance in infant with pneumonia associated with congestive heart failure]. 216 35

Diffuse pulmonary infiltrates in the immunocompromised host in the majority represent an opportunistic infection. However, in about 25 to 30%, they represent complications of an adverse drug reaction, recurrence of the underlying disease such as leukemia or lymphoma involving the lung, or an idiopathic "fibrosis," and in a small percentage are attributable to an "unrelated" process such as congestive heart failure, pulmonary emboli, community-acquired pneumonia, and so on. In 10 to 20% of the patients, two or more of these processes occur. A pulmonary process in the immunocompromised patient is almost always fatal unless the clinician intervenes with the proper diagnosis and/or effective empiric therapy.
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PMID:Diffuse pulmonary infiltrates in the immunocompromised host. 218 78

Five cases of bacteremic infections due to Haemophilus influenzae type f in adults are described, and previous reports of type f disease in nonpediatric patients are reviewed. Respiratory tract infections were most common in our series (two cases of pneumonia, one of epiglottitis, and one of nosocomial septicemia probably resulting from aspiration pneumonitis). All of these patients had factors predisposing them to respiratory tract infections, e.g., neurologic disease, congestive heart failure, or cigarette smoking. A fifth patient, who was bacteremic without an apparent primary focus, had dysgammaglobulinemia. Six episodes of bacteremia occurred in five patients; 11 of 13 cultures of blood obtained before parenteral antibiotic therapy were positive. All isolates were biotype I and susceptible to ampicillin. Antibiotic therapy was curative in cases of proved respiratory tract infection but failed in the setting of nosocomial septicemia, perhaps because of delayed initiation. The brevity of antibiotic treatment of the cryptogenic bacteremia permitted infection of a prosthetic vascular graft and recurrent bacteremia. Graft removal and repeated antibiotic therapy were curative.
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PMID:Bacteremic disease due to Haemophilus influenzae capsular type f in adults: report of five cases and review. 220 Oct 66


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