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

Many rehabilitation methods are directed at prevention during the acute management of the trauma patient. Their success is measured by the absence of secondary disabilities. Their cost in relation to health care can be estimated. Figures from 1972 showing cost estimates for treatment of common complications are as follows: Decubitus ulcers $7,000, Urinary tract infection 5,000, Kidney stones 5,000, Thrombophlebitis with pulmonary embolism 4,000, Pneumonia 3,000, Contractual deformities 2,000. Current inflation would revise the above costs at least 25%. It is also important to note that the cost of such complications to the individual is immeasurable in time and energy and quality of life.
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PMID:Rehabilitation of the trauma patient. 43 19

Our experience with 101 consecutive T.H.A.'s in 91 patients was examined in an attempt to identify preoperative risk factors for postoperative medical complications, especially pulmonary embolism and thrombophlebitis. Six per cent of patients developed postoperative clinical thrombophlebitis, and 8% a pulmonary embolism. Advancing age and previous venous thrombosis served as predictors for pulmonary embolism and thrombophlebitis, respectively (p less than 0.01), but obesity, venous varicosities, diabetes mellitus, cigarette smoking, previous pulmonary embolism, and length of surgery did not, for either. Fifty per cent of the patients with preoperative abnormal kidney function developed some form of medical complication postoperatively, a significant increase in risk (p less than 0.05) over patients with normal kidney function. We were unable to identify an increase in postoperative atelectasis or pneumonia associated with smoking or obesity in these patients. No consistent decrease in post-operative medical morbidity could be assigned to preoperative medical consultations, suggesting that we have not yet identified all significant risk factors. A thorough preoperative preparation and improvement in intra- and postoperative techniques and management may account for differences found in this study from traditionally held risk factors.
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PMID:Risk factor assessment in 101 total hip arthroplasties: a medical perspective. 47 24

To assess the usefulness of plasma deoxyribonucleic acid (DNA) detection in the diagnosis of pulmonary embolism (PE), we prospectively studied the frequency and duration of the occurrence of free plasma DNA in 23 patients with PE and in 49 patients with pneumonia, myocardial infarction, thrombophlebitis, or normal lung scans. Plasma DNA was detected in 19 of the 23 patients (83 per cent) with PE and in none of the 49 patients with other diagnoses. Eighteen of the 19 PE patients with free DNA had persistence of DNA on all subsequent sampling for up to 5 days. In this series, plasma DNA had a sensitivity of 83 per cent in the diagnosis of PE and was extremely specific for PE. Thus, detection of free plasma DNA may be useful as a rapid, noninvasive test to aid in the diagnois of PE.
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PMID:A prospective study of plasma DNA in the diagnosis of pulmonary embolism. 70 76

In a retrospective review of 53 patients, 58 episodes of infection due to Acinetobacter calcoaceticus var. anitratus (Herellea vaginicola) were studied. Although the organism is widely distributed in nature, it is of relatively low virulence since colonization is more frequently noted than infection and since most infections occur in patients subjected to the epidemiologic pressures common to nosocomial, gram-negative bacillary infection: prior antibiotic therapy; instrumentation and manipulation (e.g., endotracheal intubation, urinary bladder catheterization, arterial and venous cannulation); surgery; hospitalization, especially with residence in an intensive care unit; severe underlying disease, either systemic (e.g., chronic obstructive pulmonary disease, malignancy) or localized to the infected area (e.g., prior bacterial or aspirational pneumonia, trauma). Pneumonia was the most common infection due to A. calcoaceticus, and occurred only in patients with a tracheostomy or endotracheal tube in place. In over half the 25 patients, more than one lobe was involved and bronchopneumonia was the usual roentgenographic appearance. Cavitation (2 patients) and empyema formation (3 patients) were uncommon. The severity of acinetobacter pneumonia is reflected in the high mortality rate (44% overall, with a 36% mortality rate due primarily to infection). Tracheobronchitis due to A. calcoaceticus was less severe than pneumonia since no patients died primarily as a result of the infection. Urinary tract infections occurred in five patients, none of whom were ill and none of whom died. Urinary bladder catheterization was thought to be responsible for infection in three patients, and in at least four of the five patients infection was restricted to the lower tract. Wound infections were noted in six patients who had undergone surgery and were related to the presence of foreign bodies in the operative site in five of the patients. Surgical debridement and/or drainage of the infected area was the primary therapeutic measure employed in most cases. Only one patient died and this was a result of noninfectious causes. Skin infection due to A. calcoaceticus was seen in two patients, one of whom exhibited fulminant, fatal cellulitis and septicemia in the setting of pancytopenia. All nine patients with acinetobacter septicemia had received antecedent antibiotic therapy, and in all cases intravenous catheters were in place at the time bacteremia occurred. Clinically, seven of the nine patients were in shock. The mortality rate was 44% overall, with a 22% mortality rate due to infection. Although septicemia was thought to be "line-related" in five of the nine patients, serious post-bacteremic complications developed in three patients: prosthetic valve endocarditis, suppurative thrombophlebitis and subhepatic abscess.
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PMID:Infections with Acinetobacter calcoaceticus (Herellea vaginicola): clinical and laboratory studies. 84 90

A recent U.S. Public Health Service report compared the incidence of complications with 3 methods of midtrimester abortion. The comparison was based on a 4-year study of abortions done in 32 institutions. Major complications were least frequent with cervical dilatation followed by curettage or suction evacuation, more frequent with hypertensive saline injected into the amniotic sac, and most frequent with instillation of prostaglandin F2. By the second trimester, dilatation and evacuation is a difficult procedure. Major complications considered were: fever for 3 or more days; pelvic infections; pneumonia; thrombophlebitis; hemorrhage requiring transfusions; psychiatric hospitalization; hypernatremia; injury to bladder, ureter, or intestines; wound disruption; unintended major surgery; pulmonary embolism; convulsions; endotoxic shock; cardiac arrest; and death. The report is difficult to evaluate. Most medical letter consultants prefer intraamniotic administration of prostaglandin F2 or saline for midtrimester abortions.
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PMID:Phenformin. 84 55

The clinical features of 101 Melanesian patients with Staphylococcus aureus bacteraemia observed during two 2-year periods (1977-1979 and 1985-1987) in a university teaching hospital in Papua New Guinea are reviewed. The age of the patients ranged from 12 to 70 years. There were 69 males and 32 females. Diabetes mellitus, found in 15 patients, was the most common predisposing factor. Most of the patients (87%) had community-acquired infection. Soft-tissue infection, pneumonia, arthritis, osteomyelitis, intravenous-site thrombophlebitis, cerebral abscess, endocarditis and cavernous sinus thrombosis were among the clinical entities observed. Soft tissues and lungs were the most common sites of primary and secondary foci of infection, respectively. All but 1 of the 101 blood isolates were resistant to penicillin G and none was resistant to methicillin. The overall case fatality rate was 24%. These data demonstrate that staphylococcal bacteraemia in adult Papua New Guineans is mostly community acquired and has a high mortality. Skin and soft tissues are the major primary foci of infection leading to staphylococcal bacteraemia.
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PMID:The clinical spectrum of staphylococcal bacteraemia: a review of 101 Melanesian patients from Papua New Guinea. 208 Jun 75

A series of 63 cases of fatal acute pulmonary thromboembolism (PTE) with available necropsy study was evaluated The diagnosis was established ante mortem in 20 cases (predictive index 31%). The diagnosis was only suspected in 2 of the 16 patients in whom PTE was associated with pneumonia (predictive index 12.5%, p less than 0.01), in 3 of the 26 cases if PTE associated with neoplasia (predictive index 11.5% p less than 0.01) and in 8 of the 41 cases with terminal disease (predictive index 19.5%, p less than 0.01). On the contrary, thrombophlebitis and relapsing PTE had a significative facilitation effect on the diagnosis (predictive indexes 53.3% and 52.6%, respectively; p less than 0.01). It was concluded that the presence of neoplasia, pneumonia or terminal illness make the diagnosis of pulmonary thromboembolism difficult.
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PMID:[What factors make the diagnosis of pulmonary thromboembolism difficult?]. 219 3

The enterococcus has been relegated to a position of unimportance in the pathogenesis of surgical infections. However the increasing prevalence and virulence of these bacteria prompt reconsideration of this view, particularly because the surgical patient has become increasingly vulnerable to infectious morbidity due to debility, immunosuppression, and therapy with increasingly potent antibiotics. The enterococcus is a versatile opportunistic nosocomial pathogen, causing such diverse infections as wound, intra-abdominal, and urinary tract infections; catheter-associated infection; suppurative thrombophlebitis; endocarditis; and pneumonia. Although surgical drainage remains the cornerstone of therapy for enterococcal infections involving a discrete focus, in the circumstances typified by the compromised surgical patient, specific antibacterial therapy directed against the enterococcus is warranted. Recent evidence indicates that parenteral antibiotic therapy for enterococcal bacteremia is mandatory and that appropriate therapy clearly reduces the number of deaths.
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PMID:Pathogenicity of the enterococcus in surgical infections. 219

Mycotic aneurysms as defined in this study include only those naturally occurring aortic aneurysms that result from or are secondarily infected by bacteria arising in a distant site of infection. Of the 2,585 patients treated for aortic aneurysm during the past 8 1/2 years, 22 patients had disease conforming to this definition. The aneurysms were located in the ascending aorta in 2 patients, ascending aorta and arch in 5, arch and descending aorta in 1, descending thoracic aorta in 1, separate descending and abdominal aorta in 1, thoracoabdominal aorta in 5, upper abdominal aorta in 6, and infrarenal abdominal aorta in 1. The primary source of infection was the urinary tract in 2 patients, salmonellosis in 4, pneumonia in 3, sub-acute bacterial endocarditis in 2, ear, nose, and throat in 2, cellulitis of the hand in 1, chronic wounds in 2, dental extraction in 1, lumbar disc space infection in 1, septic thrombophlebitis in 1, and generalized febrile illness in 3. The duration of febrile illness ranged from 2 weeks to 1 year. All patients were treated with antibiotics and operation was performed within 24 hours after admission in 11 patients and within one to eight days after admission in 11. Treatment consisted of in situ graft replacement. Appropriate antibiotics were given intravenously for 4 to 6 weeks in patients with positive cultures and continued orally for the rest of the patients' lives. Of the 22 patients, 19 (86%) were early survivors, and all are still alive 3 months to 8 years postoperatively. Only 1 had a recurrent infection, which involved the intervertebral disc space.
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PMID:In situ prosthetic graft replacement for mycotic aneurysm of the aorta. 291 1

Teicoplanin was evaluated in 47 patients with severe infections, including 14 patients with bone infections, 11 patients with soft-tissue infections, 7 patients with endocarditis, 5 patients with pneumonia, 3 patients with septic thrombophlebitis, 3 patients with septicemia of unknown origin, and 4 patients with miscellaneous infections. Overall, bacteremia was documented in 24 patients. The pathogens isolated were 35 strains of Staphylococcus aureus (including 8 methicillin-resistant strains), 4 strains of Staphylococcus epidermidis, 4 strains of Streptococcus faecalis, 2 strains of Streptococcus pneumoniae, 5 strains of other streptococci, and 1 Micrococcus luteus strain. A total of 22 patients (46.8%) were clinically cured, 8 patients (17.0%) improved, 2 patients (4.3%) had relapses after initial improvement, and 15 patients (31.9%) failed to respond. The results were better in nonbacteremic patients (19 of 23 patients [82.6%] were cured or improved) than in patients with bacteremia (12 of 24 patients [50%] were cured or improved). Bacteriological cure occurred in 25 patients (53.2%), and superinfections were documented in 6 patients (12.8%). No major adverse effects were observed. We conclude that teicoplanin is a potentially effective and well-tolerated antimicrobial agent for therapy of nonbacteremic infections caused by gram-positive bacteria.
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PMID:Clinical evaluation of teicoplanin for therapy of severe infections caused by gram-positive bacteria. 294


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