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

Aerosolized pentamidine prophylaxis for Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS) may predispose these patients to recurrent apical Pneumocystis infection. Bullous changes and pulmonary cysts develop in the lung apices due to repeated episodes of inflammation and cytotoxic effects of HIV on pulmonary macrophages. These changes progress despite prophylaxis against recurrent Pneumocystis infection with aerosolized pentamidine, increasing the risk of spontaneous pneumothorax. Two cases are presented of bilateral pneumothoraces in patients with AIDS and recurrent P carinii pneumonia despite aerosolized pentamidine prophylaxis. Patients receiving aerosolized pentamidine prophylaxis for Pneumocystis pneumonia appear to have an increased risk of pneumothorax due to recurrent apical infections with P carinii.
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PMID:Spontaneous pneumothorax in AIDS patients with recurrent Pneumocystis carinii pneumonia despite aerosolized pentamidine prophylaxis. 198 19

The objective of our study was to determine the safety of transbronchial biopsy (TBB) in nonhospitalized patients. The design was a prospective study of the consecutive cases from July 1987 until September 1988 in the setting of a university hospital of the third level with 1,800 beds. The patients were a consecutive sample of 169 patients who had 184 procedures of fiberoptic bronchoscopy (FOB) with TBB performed. They suffered from different diseases: lung nodules or masses, diffuse interstitial disease, alveolar condensation, etc. An FOB with TBB was performed in immunocompetent outpatients, who were kept under observation for four hours and then had a chest roentgenogram taken afterwards. We contacted them again after 72 hours to rule out delayed complications. In three cases, more than 100 ml of blood were obtained during the FOB, without significant hemoptysis being recorded in those patients during the observation period; chest pain occurred in 15 patients during the TBB; pneumothorax occurred in two patients (1 percent), one of whom required admission to the hospital, without requiring chest tube drainage. Other complications are reported (bronchospasm, parenchymal hemorrhage, and pneumonia). In conclusion, we consider the TBB to be a technique with a low incidence of complications for outpatients, so therefore we do not believe that admission to the hospital is mandatory for this type of patient, although we do recommend a longer observation period.
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PMID:Safety of the transbronchial biopsy in outpatients. 199 9

Since the introduction of aerosolised pentamidine for prophylaxis against Pneumocystis carinii pneumonia (PCP) in HIV-seropositive persons and patients with AIDS, an increasing number of cases of atypical manifestations of infection with Pneumocystis carinii have been reported in the United States, viz. upper lobe pneumonia, extrapulmonary Pneumocystis carinii infection and spontaneous pneumothorax. An association between these atypical manifestations of Pneumocystis carinii infection and the use of aerosolised pentamidine seems likely. This report is the first description in the Netherlands of an atypical Pneumocystis carinii infection in an AIDS patient while using aerosolised pentamidine for prophylaxis against PCP. Since aerosolised pentamidine for prophylaxis against PCP is increasingly being used in the Netherlands, a rise in incidence of atypical manifestations of Pneumocystis carinii infection can be expected.
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PMID:[Pneumocystis carinii infection during prophylaxis with nebulized pentamidine in a patient with AIDS]. 202 Mar 15

307 patients with chest injuries were treated in an outpatient clinic during a three month period. Ten patients developed complications such as hemothorax, pneumothorax and lung contusion, or late complications such as atelectases and pneumonia. 21 patients were hospitalized after initial evaluation. Two patients died. Pain was a symptom in 306 of the 307 patients. Other symptoms were coughing, hempoptysis, fever, nausea. Complications increased in 40 patients, with other symptoms or signs in addition to pain. These other symptoms had a 40% positive and 95% negative predictive value as regards complications. 45 out of 114 patients had a pathological chest x-ray. Positive chest x-ray had a 40% positive and 94% negative predictive value as regards complications. In four patients (1.3%) complicating injuries were not identified initially. Five of 24 patients (21%) were hospitalized unnecessarily. Chest x-ray should be performed in patients with additional symptoms and signs. Patients with no signs in addition to chest wall tenderness can be observed at home.
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PMID:[Ambulatory evaluation and treatment of blunt thoracic injuries]. 204 51

Spontaneous pneumothorax can be a complication of several pulmonary diseases, such as pulmonary emphysema, chronic bronchitis and interstitial pulmonary disease. Nevertheless, it is a rare complication of any pneumonia, there is no description of necrosis or abscess caused by Pneumocystis Carinii pneumonia. We present a case of spontaneous pneumothorax (which was not resolved), being a reason for admission, of a patient with AIDS who developed Pneumocystis Carinii pneumonia during the stay in hospital. We think that spontaneous pneumothorax can register bad evolution in patients with AIDS and pulmonary symptoms.
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PMID:[Pneumothorax, Pneumocystis carinii, and AIDS]. 210 85

Ten of our AIDS patients developed a unilateral or bilateral spontaneous pneumothorax. Four patients previously had pneumocystis carinii pneumonia and one had pulmonary tuberculosis. In six patients the pneumothorax occurred during the acute period of pneumocystis carinii pneumonia. Five patients were admitted to hospital because of the pneumothorax. The radiological findings varied from a small pneumothorax to almost total pulmonary collapse. Five of the ten patients were discharged after successful treatment of the pneumothorax but, in two, cystic lung segments had to be removed surgically.
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PMID:[Spontaneous pneumothorax in AIDS. Observations in 10 patients]. 217 62

Cytotoxic agents may cause interstitial or eosinophilic pneumonitis, alveolar proteinosis, pulmonary venous occlusive disease, pulmonary fibrosis, pneumothorax, or pulmonary oedema. These agents may also potentiate lung injury caused by radiotherapy or high oxygen fractions in inspired air. Clinical and roentgenological features of lung damage induced by cytotoxic drugs are usually non-specific, and differential diagnoses include progression of the malignant disease and a plethora of opportunistic infections. Monitoring of blood gases and carbon monoxide transfer factor may facilitate early detection of drug induced lung injury. Fiberoptic bronchoscopy, bronchoalveolar lavage, transbronchial biopsy, or open lung biopsy may be necessary for reliable diagnosis. Early detection of lung damage and immediate withdrawal of the responsible agent(s) are essential. Steroids may be of therapeutic value in some patients.
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PMID:Pulmonary toxicity of cytotoxic and immunosuppressive agents. A review. 218 2

The authors present a pilot study in which 20 patients with simple rib fractures were randomized prospectively into two treatment groups. One group received ibuprofen and the other group ibuprofen plus a rib belt for analgesia. There were no statistically significant differences observed in pulmonary function testing between the groups at initial visit, 48 hours, or 5 days. Atelectasis developed in four patients, two in each treatment group; there were no cases of pneumonitis. Patients with displaced rib fractures experienced a higher rate of hemo- or pneumothorax than did those with nondisplaced fractures (5/10 v 1/10). Patients with displaced fractures who used rib belts experienced a higher rate of hemothorax than those using oral analgesia alone (4/6 v 1/4). Patients using rib belts uniformly reported a significant amount of additional pain relief. The clinician can use a rib belt to provide additional comfort to the patient with fractured ribs without apparent additional compromise to respiratory parameters. A further study stratifying displaced and nondisplaced fractures has been initiated to clarify the possible contributing roles of displaced rib fractures and the rib belt in patients with displaced fractures.
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PMID:A randomized clinical trial of rib belts for simple fractures. 219 66

The incidence of systemic side effects under aerosolized pentamidine treatment or prophylaxis for pneumocystis carinii pneumonia is low when compared to intravenous application. Erythema, hypotension, hypoglycemia, renal failure are infrequently seen. Local side effects--cough, bronchial spasm, metallic taste--are frequent complications of aerosolized pentamidine treatment. Cystic lung disease, pneumothorax, and atypical pneumonia may be a late sequelae of pneumocystis carinii pneumonia, and not a primary effect of pentamidine. Poor apical ventilation due to suboptimal inhalation technique etc. and decreased deposition of pentamidine in these areas may be of some consequence for the development of these unusual complications. Extrapulmonary pneumocystis infections under preventive pentamidine aerosol treatment for pneumocystis carinii pneumonia have been seen in single cases, a causal relationship to pentamidine application is not yet established.
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PMID:[Unwanted drug side effects with pentamidine inhalation]. 219 33

A constellation of adverse effects and complications may be associated with mechanical ventilation, although in many instances the causal role of the ventilator itself has not been established. Complications occur with greater frequency than is generally appreciated, and tend to be under-reported in the medical literature. Among the potential adverse physiologic effects of positive-pressure ventilation are decreased cardiac output, unintended respiratory alkalosis, increased intracranial pressure, gastric distension, and impairment of hepatic and renal function. Failure of the ventilator to cycle, of safety alarms to function properly, and of inspired gas to be properly heated or humidified are examples of equipment-related complications. Perhaps most feared among medical complications occurring during mechanical ventilation are pneumothorax, bronchopleural fistula, and the development of nosocomial pneumonia; these entities may owe as much to the impairment of host defenses and normal tissue integrity as to the presence of the ventilator per se. Finally, a variety of avoidable "misadventures," due primarily to lapses of understanding and communication among the physicians, nurses, and respiratory care practitioners managing the ventilated patient, can adversely affect comfort, morbidity, and ultimate outcome.
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PMID:Complications associated with mechanical ventilation. 219 2


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