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

Ventilation perfusion scanning fails to diagnose pulmonary embolism in matched defects. In 61 patients (19 with pulmonary embolism proved by angiography, 32 with chronic obstructive lung disease and 10 with acute bacterial pneumonia) we computed the ventilation perfusion ratio (V/Q) in these matched defects, using Krypton 81 m. This analysis demonstrated that the diagnosis of pulmonary embolism could be made with a specificity of 100% when the V/Q ratio was greater than 1.2 in the matched defects. Pulmonary embolism was characterized by a perfusion defect with a high V/Q ratio, even in Laennec infarction. In contrast, the analysis excluded the diagnosis of pulmonary embolism and suggested another disease when the V/Q was less than 0.95 with a specificity of 95%. Perfusion defects in acute pneumonia always had a V/Q less than 1. The diagnosis remained difficult in chronic obstructive lung disease when pulmonary embolism was suspected on subsegmental defects. Nevertheless this could be solved in about 50% of the cases by quantitative analysis. We feel, therefore, that ventilation perfusion scanning should be quantified by V/Q analysis to improve the diagnosis of pulmonary embolism.
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PMID:[Calculation of the ventilation-perfusion ratio in the scintigraphic diagnosis of pulmonary embolism]. 295 94

Mean values for serum angiotensin-I-converting enzyme (SACE), determined spectrophotometrically in 648 subjects, using the synthetic substrate hippuryl-L-histidyl-L-leucine, and expressed in units per milliliter, were: controls, 11.11 +/- 3.97 (n = 89); lung cancer, 6.50 +/- 3.26 (n = 87); tuberculosis of the lung, 8.93 +/- 4.60 (n = 68); pulmonary sarcoidosis, 21.18 +/- 14.93 (n = 48); pneumonia, 9.81 +/- 6.83 (n = 52); fibrosis, 11.18 +/- 8.26 (n = 34); diabetes mellitus, 10.90 +/- 7.51 (n = 29); ischemic heart disease, 8.98 +/- 6.19 (n = 42); pulmonary embolism, 13.20 +/- 3.91 (n = 5); and lymphomas, 11.66 +/- 5.44 (n = 36). The lowest values for SACE (5.92 +/- 1.95) were observed in 7 patients with pulmonary metastases. No relationship could be found between SACE and other laboratory parameters, nor between the enzyme activity in men and women. Evidence suggests that low SACE activity is often associated with extrapulmonary cancers of various organs. Levels were significantly decreased in cancer of the lung and pulmonary metastases and significantly (p less than 0.001) increased in sarcoidosis compared with other diseases, suggesting that SACE activity may be of value in the diagnosis and prognosis of cancer of the lung.
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PMID:The value of angiotensin-I-converting enzyme determinations in malignant and other diseases. 299 Jul 99

Reported in this paper is experience obtained since 1978 from surgical removal of the tracheal bifurcation in combination with pneumonectomy in 38 cases. Squamous cell carcinoma centrally growing from the upper lobe was recorded from 24 patients to whom 36 interventions had been applied for bronchial carcinoma. 50 per cent of all operations in conjunction with pneumonectomy were performed on patients in the pT3NOMO stage. The cumulated 3-year survival rate amounted to 37 per cent. Mortality in hospital accounted for 18.4 per cent and was thus clearly higher than what had been recordable from standard techniques in carcinoma surgery. Causes of postoperative deaths included insufficient sutures in three cases, pulmonary embolism in 2, and pneumonia in the contralateral residual lung in another 2. Standardised surgical and anaesthesiological techniques were used. Modifications of resections are discussed.
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PMID:[Bifurcated resection in the surgical treatment of central non-small cell T3 carcinoma]. 302 Aug 40

Prophylactic and elective operations have the same risk. They require detailed and extensive information of the patient and documentation thorough medical reasoning. Without preoperative planning prophylactic operations are justified in severe conditions. Simultaneous operations increase the risk in case they represent major procedures or in septic interventions. Simultaneous surgical interventions of the stomach and the biliary tract imply a high morbidity (13% pulmonary embolism and pneumonia) and a high lethality (15%). In simultaneous operations the fastest of the skilled surgeons is the one who is most successful.
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PMID:[Preventive and simultaneous operations of the abdomen]. 302 70

Pulmonary embolism (PE) is often unrecognized or misdiagnosed because of the lack of specificity of clinical signs and symptoms. PE shares many of the clinical features of pneumonia and is therefore often unrecognized in elderly patients who present with low-grade fever, modest leukocytosis, and pulmonary infiltrates. Assessment of clinical risk factors increases the usefulness of diagnostic tests. The accuracy of diagnosis is improved if specific tests are performed. Ventilation-perfusion lung scans, noninvasive or contrast venography, and pulmonary angiography increase the likelihood of correct diagnosis. Since pulmonary angiography is a relatively low-risk procedure, it should be performed in most patients suspected of having PE who have nondiagnostic lung scans and negative lower extremity venous studies.
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PMID:Diagnosis of pulmonary embolism. 305 12

Clinical and echocardiographic data of 11 patients with tricuspid valve endocarditis (TE) were analysed to determine diagnostic criteria and to study the outcome of this condition. The study population comprised 6 men and 5 women (average age 38.4 +/- 18 years). TE was the only lesion in 9 cases; there was 1 case of associated pulmonary and aortic valve endocarditis, and in the other patient mitral and aortic valve endocarditis was also present. Five patients were heroin addicts. In 5 cases, the causative organism was Staphylococcus aureus. The clinical presentation was usually atypical with a systolic murmur rarely characteristic in 9 patients and signs of right ventricular failure in only 3 patients. On the other hand, 8 patients had one or more episodes of acute pneumonia or typical pulmonary embolism. The diagnosis was established by echocardiography which demonstrated the valvular vegetations. The outcome was favourable in 10 patients, only one of whom required surgical intervention. Two dimensional echocardiography provided valuable information about the evolution of the valvular vegetations, frequently showing regression after medical therapy.
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PMID:[Tricuspid endocarditis. Value of echocardiography. Developmental data. Apropos of 11 cases]. 308 18

Infectious complications increase the risk of postoperative thromboembolism. In order to assess the risk of deep vein thrombosis (DVT) in acute infections not associated with surgery, 36 patients with acute pneumonia or pyelonephritis were evaluated regarding development of DVT with the 125I-fibrinogen uptake test with confirmative phlebography. 1/15 patients with pyelonephritis and 1/21 patients with pneumonia developed DVT. No fatal pulmonary embolism was seen. The frequency of DVT was thus 6%. This low figure may be due to early mobilization of the patients and does not motivate routine anticoagulant prophylaxis against thromboembolic complications in patients with acute infections.
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PMID:Frequency of thromboembolic complications in patients with acute pneumonia and pyelonephritis. 319 14

Actinomycosis is an uncommon infection. The regions mostly involved are the cervico fascial area, the thorax and the abdomen. The thoracic variety accounts for approximately 15% of the cases. Clinical pictures of pulmonary neoplasm, abscess, and empyema have been described. Misleading symptoms often delay the right diagnosis. The present study describes a case of actinomycosis with pleuro-pulmonary involvement. A 48-year woman had been well until two and a half years previously, when she developed symptoms suggestive of pneumonia. When referred to a medical clinic with thoracic pain and tiredness, pulmonary embolism was suspected. Inhalation and perfusion scintigraphy showed several perfusion defects. There were several relapses, with clinical pictures suggestive of pulmonary embolism, before an abscess in the left axilla appeared. Drained pus showed no growth of Actinomycetes. Correct diagnosis of the true cause was only possible by direct microscopy. Possible symptoms and the diagnostic difficulties when Actinomycetes is involved are discussed.
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PMID:Thoraco-pleural actinomycosis presenting like diffuse pulmonary embolism. 323 66

From 1966 through 1985, a total of 640 patients received 739 renal transplants at a single center transplantation program. Of 245 total deaths, a slide and chart review of all 116 autopsied cases (47%) identified the major causes of death as pneumonia (n = 43), sepsis (n = 32), hemorrhage (n = 15), peritonitis (n = 11), meningitis (n = 7), and pulmonary embolism (n = 5). Eighty-five (73.3%) of these patients died of complications directly associated with immunosuppression, almost all (n = 82) as a result of infection. Organisms most frequently identified at death were gram-negative bacilli (n = 72), Candida species (n = 23), cytomegalovirus (n = 17), enterococcus (n = 14), Staphylococcus aureus (n = 11), Aspergillus species (n = 10), Pneumocystis carinii (n = 5), and mycobacteria (n = 5). Significant associations were found between bolus steroid antirejection therapy and infection with Aspergillus cytomegalovirus. Diabetics had a higher incidence of fungal infections and bowel perforation than nondiabetics. During this 20-year period, overall one-year actual patient survival rates for the four respective five-year intervals increased dramatically (69.9%, 68.2%, 83.3%, and 91.8%), but the normalized death rate showed a smaller decrease for infectious vs noninfectious causes.
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PMID:Causes of death in renal transplant recipients. A review of autopsy findings from 1966 through 1985. 330 85

Autopsies are performed much less frequently in the elderly than in younger patients. Little information exists as to causes of death in the institutionalized elderly. The clinical diagnostic error rate documented by autopsy studies ranges from 6% to 68%. We analyzed the clinical and autopsy records of 234 patients who died during a 14 1/2-year period at our chronic care institution to determine the accuracy of clinical cause of death in addition to the pathologic cause of death. The most common causes of death included bronchopneumonia (33%), congestive heart failure (15%), metastatic carcinoma (14%), pulmonary embolism (8%), myocardial infarction (7%), cerebrovascular accident (6%), unknown cause of death (8%), and a miscellaneous group (9%). The highest diagnostic error rate was in the underdiagnosis of pulmonary embolism (39% antemortem accuracy rate). The most accurately diagnosed condition was cerebrovascular accident (92% antemortem accuracy rate). Pneumonia was correctly diagnosed antemortem in 73% of the patients studied. These data suggest that serious and potentially treatable illnesses are underdiagnosed in the elderly institutionalized patient and that there is valuable information to be learned by performing autopsies in the elderly population.
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PMID:Autopsy study of the elderly institutionalized patient. Review of 234 autopsies. 333 92


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