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

The diagnostic features and operative results of six patients with spontaneous aorto-caval fistula associated with abdominal aortic aneurysm were analyzed. Abdominal pain, pulsatile abdominal mass and haematuria were constant preoperative findings in all patients. Radiological signs of congestive heart failure of various degrees were present in five, abdominal bruit in four and preoperative renal failure in three patients. As preoperative diagnostic examinations i.v. pyelography was done in two patients and ultrasound scanning and angiography of the abdominal aorta in a further two patients. In one ultrasound scanning a dilated inferior vena cava and hepatic veins were seen as an indirect sign of ACF, while in both angiograms the ACF was seen. In these two cases the diagnosis of ACF was made preoperatively, while in four other cases the diagnosis was made during the operation. Three patients survived the operation and were still alive after eight months, four years and six years respectively. Postoperative complications developed in two patients: postoperative ileus in one and deep venous thrombosis and pneumonia in another. Because of its rarity aorto-caval fistula is difficult to diagnose. The presence of haematuria in a patient suffering from abdominal aortic aneurysm should strongly suggest the diagnosis of an aorto-caval fistula.
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PMID:Diagnosis and treatment of spontaneous aorto-caval fistula. 355 68

The spread of influenza virus through a community typically causes large increases in medical visits for febrile respiratory disease. Increased school absenteeism occurs early in the epidemic, and school children appear to be important for disseminating the virus. Industrial absenteeism, hospitalizations of adults and infants for pneumonia, and deaths due to pneumonia-influenza all tend to peak later in the epidemic. Although influenza infection rates are highest in persons of school age, hospitalizations and deaths occur primarily in infants and in the elderly, particularly among those with pulmonary, cardiovascular, or other debilitating disorders. Influenza viruses can be spread by aerosol or contact. The primary target cells are those of the respiratory epithelium. In healthy adults, the typical influenza syndrome includes fever, cough, and general aches for three to seven days, but lassitude, cough, and evidence of small-airways disease may persist for weeks. Laryngotracheobronchitis, pneumonia, and unexplained fever are prominent manifestations of influenza that lead to hospitalization of young children. Adults are more likely to have complications of bacterial pneumonia and worsening of chronic pulmonary disease or congestive heart failure. Less frequent complications include myositis, various neurologic disorders, and Reye's syndrome. These consequences of influenza clearly justify strenuous efforts at prevention and control.
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PMID:Clinical manifestations and consequences of influenza. 359 13

To select topics for quality assurance activities focusing on older patients, we convened a 14-member panel of physicians and experts in quality assurance. In two rounds of ratings, panelists rated 42 medical conditions (eg, pneumonia) in terms of their effects on patient outcomes, the availability of beneficial interventions, and the health benefits from improving current quality. They rated 27 health services (eg, adult day-care) on similar dimensions. The feasibility of doing quality assurance work on each condition and service also was rated. Using the ratings, the conditions selected for quality assurance work were congestive heart failure, hypertension, pneumonia, breast cancer, adverse effects of drugs, incontinence, and depression. Health care services selected were hospital discharge planning, acute inpatient care for the frail elderly, long-term-care facilities (intermediate-care facilities and skilled nursing facilities), home health care services, and case management.
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PMID:Assuring the quality of health care for older persons. An expert panel's priorities. 365

A patient with congestive heart failure and pneumonia was begun on a nitroprusside infusion for cardiac afterload reduction. Urine output declined sharply and azotemia ensued despite little change in arterial pressure. Further evaluation supported a prerenal mechanism with dramatic recovery related to tapering and discontinuation of the nitroprusside. The mechanism of renal deterioration is possibly related to a 'steal' syndrome due to preferential dilation of vascular beds other than the renal.
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PMID:Nitroprusside-induced acute azotemia. 368 44

Restriction to systemic blood flow at the atrial level in total anomalous pulmonary venous connection (TAPVC) may play a role in the early development of congestive heart failure in some patients. Over a 4-year period, 21 patients with TAPVC without extracardiac obstruction presented from 1 day to 10 months of age (mean 2.6 months). Of 21 patients, 17 (81%) presented after 1 month of age with moderate to severe congestive heart failure. In the first week after birth 4 patients presented with minimal symptoms of congestive heart failure. A small patent foramen ovale (3 mm or less in diameter) was found in 19 of 21 patients (90%) by 2-dimensional echocardiography or angiography. Balloon or blade and balloon atrial septostomy was performed in these 19 patients and resulted in significant decreases in mean right to left atrial pressure gradient (from 2.8 to 0.25 mm Hg, p less than 0.001), systolic pulmonary to femoral artery pressure ratio (from 0.80 to 0.60, p less than 0.001), and systemic arterial oxygen saturation (from 84% to 79%, p less than 0.01). One patient had nonfatal complications. Surgery was performed in 19 patients from 2 weeks to 29 months (mean 12 months) after catheterization, with 1 operative death (5% mortality). Four patients required early total correction because of persistent heart failure; 15 had elective surgical repair. One of 2 unoperated patients died of pneumonia at 2.5 years of age. A restrictive interatrial communication develops after the first month of extrauterine life in most patients with TAPVC. Atrial septostomy results in improved hemodynamic conditions and clinical palliation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Restrictive interatrial communication in total anomalous pulmonary venous connection. 370 65

The predictive values of several clinical variables for the presence or absence of pneumonia in adults with acute respiratory complaints were studied. Patients with congestive heart failure were excluded. Of 464 patients who received a chest roentgenogram, 129 (27.8%) had pneumonia. None of the symptoms, signs, or laboratory findings evaluated could reliably predict the presence of pneumonia. The absence of abnormal auscultatory findings on lung examination, however, excluded pneumonia with greater than 95% certainty. Among the 106 patients who presented with acute asthma, only two (1.9%) had pneumonia. Among the 33 patients with underlying organic brain syndrome, 25 (75.8%) had pneumonia. Incorporating these findings into a diagnostic strategy for ordering chest roentgenograms could have reduced the number of roentgenograms obtained by 54% and spared 72% of patients without pneumonia unnecessary radiation exposure.
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PMID:The need for chest roentgenograms in adults with acute respiratory illness. Clinical predictors. 371 28

A gamma-camera and computer were used to measure pulmonary accumulation of technetium-99m human serum albumin in 15 patients who met the criteria for adult respiratory distress syndrome (ARDS), and in ten asymptomatic patients. The ratio of lung to blood-pool activity increased in ARDS patients, but did not change in nonARDS patients. Lung to heart measurements by a portable probe with scaler correlated well with those obtained simultaneously with the gamma-camera and computer: probe measurements over 60 min increased significantly (p less than .0001) more in ten ARDS patients than in the nonARDS patients or in five postARDS patients, three with pneumonia and two with congestive heart failure. We conclude that the probe with scaler is sensitive enough to detect abnormal pulmonary accumulation of albumin in ARDS patients.
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PMID:Diagnosis of adult respiratory distress syndrome with Tc-99m human serum albumin and portable probe. 372 Mar 23

Transient hypoxemia is not uncommon after major cardiac or thoracic surgery. The differential diagnosis includes atelectasis, pulmonary embolus, pneumonitis, congestive heart failure and several other diverse cardiovascular and pulmonary problems. Less well recognized is transient right to left intracardiac shunting through a patient foramen ovale or previously unsuspected atrial septal defect. Three cases of clinically important hypoxemia associated with right to left shunting after aortocoronary bypass surgery are presented. The right to left shunting was documented with contrast-enhanced echocardiography, which is a simple, inexpensive and accurate means of screening patients for intracardiac right to left shunts and may play a valuable role in the postoperative management of patients.
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PMID:Atrial level right to left intracardiac shunt associated with postoperative hypoxemia: demonstration with contrast two-dimensional echocardiography. 387 42

During the course of one year, 47 critical care patients with gram-negative bacillary pneumonia at Millard Fillmore Hospital were randomly assigned to aztreonam or tobramycin therapy (two to one). Of these, 40 were fully evaluable for microbiologic and clinical response. All evaluable patients had gram-negative organisms in tracheal aspirate culture specimens and confirmed susceptibility of the organism to both study drugs. There was no difference between the two groups with respect to the percentage of patients who received concurrent antibiotics for gram-positive organisms. More than 60 percent of the patients received mechanical ventilation. Essentially, all had new lung infiltrates as shown by chest radiography, leukocytosis, recent onset of fever, and increased volume of purulent secretions. Half had multilobar pulmonary infiltrates. Their mean age was 73 years, with none under age 50. Most had chronic obstructive pulmonary disease, congestive heart failure, or both. By the prognostic nutritional index criteria, over 70 percent were nutritionally deficient at entry. The majority of infections were caused by Pseudomonas, Enterobacter, Klebsiella, and Escherichia coli. Aztreonam eradicated 92 percent of the causative gram-negative organisms, compared with 57 percent for tobramycin (p less than 0.05). Aztreonam produced a favorable clinical response (cure or improvement) in 93 percent of patients, compared with 50 percent for tobramycin (p less than 0.05). There were no differences in the minor adverse effects observed in the two treatment groups. Overall, aztreonam was superior to tobramycin for treatment of pneumonia due to susceptible gram-negative bacteria in these critical care patients.
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PMID:Treatment with aztreonam or tobramycin in critical care patients with nosocomial gram-negative pneumonia. 388 47

Serratia marcescens (SM) produced a prolonged outbreak in a neonatal intensive care unit of high level gastrointestinal colonization (10(9) SM/g feces) which in the early part of the outbreak predisposed to respiratory infection. The early outbreak featured a strain of SM carrying a 54 X 10(6) dalton conjugative plasmid which mediated resistance to gentamicin, tobramycin and beta-lactam agents. The second part of the outbreak involved primarily gastrointestinal colonization with SM strains that were plasmid-free. Acquisition of SM was related to very low birth weight (less than 1500 g). Among very low birth weight neonates, SM colonization was associated with pneumonia, patent ductus arteriosus, congestive heart failure and septicemia. Among neonates greater than 1500 g, SM colonization was associated with bronchopulmonary dysplasia, use of a respirator, patent ductus arteriosus and congestive heart failure. Respirator contamination, respiratory tract colonization and consequent pneumonia were reduced by more frequent changing of respirator tubing. Colonized sinks remained chronically colonized with multiresistant SM.
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PMID:Endemic Serratia marcescens infection in a neonatal intensive care nursery associated with gastrointestinal colonization. 388 79


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