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

Important in the pathogenesis of pneumonia in the elderly patient are chronic diseases, including diabetes mellitus, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and cerebrovascular disease. Also vital are the changes that take place in the immune system and mucociliary clearance mechanisms of the lung. The clinician should be aware of these risk factors, especially since the mortality rate of lower respiratory infections approaches 40% in these elderly patients. Treatment guidelines are included.
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PMID:Pneumonia syndromes: a clinical approach in the elderly. 221 Mar 94

We measured quality of care before and after implementation of the prospective payment system. We developed a structured implicit review form and applied it to a sample of 1366 Medicare patients with congestive heart failure, acute myocardial infarction, pneumonia, cerebrovascular accident, or hip fracture who were hospitalized in 1981-1982 or 1985-1986. Very poor quality of care was associated with increased death rates 30 days after admission (17% with very good care died vs 30% with very poor care). The quality of medical care improved between 1981-1982 and 1985-1986 (from 25% receiving poor or very poor care to 12%), although more patients were judged to have been discharged too soon and in unstable condition (7% vs 4%). Except for discharge planning processes, the quality of hospital care has continued to improve for Medicare patients despite, or because of, the introduction of the prospective payment system with its accompanying professional review organization review.
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PMID:Changes in quality of care for five diseases measured by implicit review, 1981 to 1986. 212 Apr 79

Late results in 139 patients undergoing open repair of tetralogy of Fallot from 1965 to December 1975 were analyzed. Their ages ranged from 1 year to 35 years. All patients were repaired through a right ventricular approach. One hundred two patients had infundibulectomy alone (non-patch group) and 14 required right ventricular outflow patch (RV-patch group) and 23 trans-annular patch. The hospital mortality rate was 18.7% (26 cases) and 103 patients were discharged and have been followed until death or for 13-24 years. Cardiac catheterizations were performed in 80 patients an average of 1.8 years after correction. Right ventricular systolic pressure was 49.8 +/- 22.4 mmHg in non-patch group, 41 +/- 16.5 mmHg in RV-patch group and 54.5 +/- 14.2 mmHg in PA-patch group. Seven in 11 patients of PA-patch group had over an 8 mmHg of right ventricular end diastolic pressure. Six patients died during the follow up: four deaths in the first 5 years, 2 between 5 and 15 years. The causes of death were congestive heart failure (3), sudden (1), pneumonia (1) and accidental (1). Late complications were 3 arrhythmias and 2 reoperations. Event free rate at 24 years was 74.8 +/- 3.8%.
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PMID:[Late results after open repair of tetralogy of Fallot: a 13-24 year follow-up]. 221 54

We studied the effect, in a university teaching hospital, of the prospective payment system (PPS) on utilization of physical therapy (PT), a non-reimbursable service; subjects were hospitalized patients aged 75 or older with non-PT-related diagnoses (myocardial infarction, pneumonia, congestive heart failure, and colectomy) and PT-related diagnoses (cerebrovascular accident and hip fracture). The proportion of patients referred for PT increased from 68 percent pre-PPS to 85 percent post-PPS for those with PT-related diagnoses and from 13 percent pre-PPS to 19 percent post-PPS for those with non-PT-related diagnoses. The mean number of sessions of PT decreased slightly for both groups: from 8.5 to 7.6 sessions for those with PT-related diagnoses and from 5.2 to 4.5 for those with non-PT-related diagnoses. In patients with PT-related diagnoses whose ambulatory status worsened during hospitalization, referrals for PT increased from 76 percent pre-PPS to 98 percent post-PPS. Referrals of comparable patients with non-PT-related diagnoses did not increase. Changes in provider education and efforts to reduce length of stay may account for these findings.
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PMID:Prospective payment and the utilization of physical therapy service in the hospitalized elderly. 224 Mar 37

The mechanism of hyponatremia associated with pneumonia has been debated. In particular, the responsibility of inappropriate antidiuretic hormone secretion has been questioned. We have shown that inappropriate antidiuretic hormone secretion is a nearly constant finding during pneumonia and is roughly proportional to the extent of pneumonia. Nevertheless, it must be emphasized that extracellular fluid volume may be increased, diminished or normal during pneumonia, depending on the underlying condition (congestive heart failure, cirrhosis) or on the importance of extrarenal losses (sweats, fever). Careful clinical and laboratory assessment of extracellular fluid volume should enable adequate therapy.
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PMID:[Hyponatremia of acute pulmonary infections]. 226 57

Amiodarone pneumonitis is a serious complication that may lead to fatal lung fibrosis. In an attempt to diagnose this condition as early as possible, the technetium-99m-labelled diethylene triamine penta-acetic acid (99mTc-DTPA) aerosol washout rates of 10 non-smoking normal volunteers (group 1), 10 non-smoking patients on a long-term amiodarone regimen with dilated cardiomyopathy but no congestive heart failure (group II) and 10 patients with amiodarone pneumonitis (group III) were compared. Spirometric measurements, as percentage predicted, were higher in group I than in group III (P less than 0.05). The global mean effective half-lives of 99mTc-DTPA aerosol for both lungs together in minutes were 65 +/- 14, 55 +/- 16 and 27 +/- 4 for groups I, II and III, respectively. Group III values were significantly lower than those of groups I and II (P less than 0.05). Our results demonstrated that amiodarone pneumonitis alters the alveolar-capillary membrane permeability to hydrophilic molecules. The pulmonary clearance of 99mTc-DTPA aerosol is a useful test in the differentiation of patients on a long-term amiodarone regimen without side effects from patients with amiodarone pneumonitis. The test is rapid, easy to perform and has the potential for playing an important role in deciding which patients should discontinue therapy.
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PMID:Pulmonary clearance of technetium 99m diethylene triamine penta-acetic acid aerosol in patients with amiodarone pneumonitis. 228 6

Patients with asthma who have incomplete control of their symptoms or require regular systemic steroidal therapy are said to have recalcitrant asthma. A systematic approach may significantly improve quality of life. Factors that should be evaluated include living with an antigen, occupational exposure, use of beta-adrenoreceptor blockers, use of nonsteroidal anti-inflammatory agents, sensitivity to dietary chemicals, endocrinopathies, gastroesophageal reflux, sinusitis, bronchopulmonary aspergillosis, and noncompliance. Other diseases may mimic asthma or exacerbate nonspecific bronchial hyperreactivity. These include congestive heart failure, chronic infectious bronchitis resulting from cystic fibrosis, ciliary dysfunction syndrome, and immunodeficiency syndromes, upper airway obstruction, pertussis syndrome, psychogenic coughs, bronchiolitis obliterans, chronic eosinophilic pneumonia, and vasculitides. A systematic approach to the evaluation of coexisting factors and potential exacerbating diseases is presented.
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PMID:Recalcitrant asthma: an allergist's approach. 229 75

The authors reviewed the initial presentation of seven infants with acute myocarditis. All patients presented with respiratory distress including tachypnea (respiratory rate greater than or equal to 40) and intercostal retractions. Other findings included tachycardia (heart rate greater than or equal to 120) (7/7) and grunting (6/7). Lungs were clear to auscultation in six out of the seven patients. Cardiomegaly was seen in five of the initial chest roentgenograms. Each initial electrocardiogram had abnormal findings. Initial diagnoses were sepsis and shock in three patients, pneumonia and asthma in two, and congestive heart failure in two. Six patients required tracheal intubation. All required admission to the Pediatric Intensive Care Unit (ICU). Two patients died. Myocarditis should be suspected in a child presenting with severe respiratory distress, tachycardia, cardiomegaly, and/or an abnormal electrocardiogram. Prompt stabilization and admission to a pediatric intensive care unit for further evaluation and treatment is essential.
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PMID:Acute myocarditis in infants. Initial presentation. 230 4

Since April 1988 we have used the Hemopump device, a new means of circulatory support, to successfully treat three orthotopic heart transplant recipients with biventricular failure refractory to conventional therapy. The Hemopump device is a 21F catheter-mounted, transvalvular, intraaortic axial flow pump. Power to the pump is percutaneously transmitted from an external electromechanical drive console by a flexible drive cable. We first used the pump in a 61-year-old man in whom severe steroid-resistant rejection developed 28 days after heart transplant, resulting in cardiogenic shock (cardiac index less than 2.0 L/min/m2) despite maximal inotropic support. In the second case a 49-year-old man with no evidence of pulmonary hypertension sustained cardiac arrest 2 hours after heart transplant, necessitating open chest massage and emergency cardiopulmonary bypass. The third patient was a 9-year-old boy in whom rejection developed 5 months after heart transplant, resulting in congestive heart failure that was unresponsive to maximal medical therapy. The device was implanted by way of the femoral artery approach in the first case, the ascending aorta in the second, and the distal abdominal aorta in the third. Duration of support was 46 hours, 65 hours, and 6 days, respectively. Increased blood flow provided by the pump ranged from 2 to 4 L/min. No device-related complications, such as hemolysis, infection, or thromboembolic events, occurred. All patients recovered normal heart function and were weaned from the device. The first patient is well after 12 months. The second patient died of metastatic lymphoma at 2 months, and the third died of Pseudomonas pneumonia after 2 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment of cardiac allograft failure by use of an intraaortic axial flow pump. 239 37

Mortality and hospitalization rates for pneumonia have increased among older Americans during recent years (1979-86), despite a national commitment to the reduction of premature deaths from pneumonia. A prospective study of deaths and hospitalizations attributable to pneumonia was conducted among 5,474 subjects ages 55 and older who participated in the NHANES I Epidemiologic Followup Study. Prevalent chronic conditions, health behaviors, and nutritional status indicators, measured at baseline, were examined in relation to pneumonia hospitalization and death during 12 years of followup. Mortality and hospitalization rates for pneumonia were higher among men than women, and higher among those ages 65 and older than among those 55-64 of both sexes. Risk of pneumonia death was higher among subjects with a history of congestive heart failure, stroke, cancer, or diabetes. Risk of pneumonia hospitalization was higher among subjects with a history of chronic obstructive pulmonary disease and among men who were current smokers. Daily alcohol consumption did not increase risk of pneumonia in this study population. Four measures of nutritional status were examined taking age, prevalent chronic conditions, and cigarette smoking into account: body mass index, arm muscle area, and serum albumin and hemoglobin levels. Risk of pneumonia death was 2.6 times higher in men in the lowest quartile, compared with men in the highest quartile, of body mass index. Similarly, the risk was 4.5 times higher among men in the lowest quartile of arm muscle area. Risk of death from pneumonia was 3.6 times higher among women in the lowest quartile of serum albumin levels compared with women in the highest quartile. Relative risks for these nutritional status indicators remained elevated after adjusting for age and the medical history risk factors. These risk factors should be taken into account when designing and evaluating pneumonia vaccination trials and community prevention programs.
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PMID:Prospective study of pneumonia hospitalizations and mortality of U.S. older people: the role of chronic conditions, health behaviors, and nutritional status. 250 6


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