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

In 28 patients with hematologic malignancy, the clinical effect and the safety of sulbactam/cefoperazone (SBT/CPZ) were studied on 45 episodes during granulocytopenic stage after antineoplastic chemotherapy. The overall efficacy rate obtained with SBT/CPZ in combination with other drugs was 62%. The rates for sepsis, suspected sepsis and pneumonia were 67%, 94% and 38%, respectively. The efficacy in those cases that showed granulocyte count less than 300/microliters during the course of administration of SBT/CPZ was 53%, and in those cases that showed granulocyte counts recovery to more than 300/microliters was 73%. Prior antimicrobiological treatments had no influence on the efficacy of SBT/CPZ. SBT/CPZ showed an activity spectrum covering frequently isolated microorganism including Acinetobacter calcoaceticus, Pseudomonas aeruginosa, Enterobacter cloacae and Staphylococcus aureus. Mild adverse effect were observed in 4 episodes (8.8%). These result suggested that SBT/CPZ was thought to be a useful drug for empirical therapy in granulocytopenic patients with hematologic malignancies.
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PMID:[Clinical evaluation of sulbactam/cefoperazone for infections during the chemotherapy of hematologic malignancy]. 799 Feb 60

Four patients with hematological malignancies, following bone marrow transplantation, who developed documented gram-negative [Klebsiella pneumoniae (2), Pseudomonas aeruginosa or Acinetobacter calcoaceticus] pneumonia during absolute neutropenia, were treated with a combination of antimicrobial therapy, granulocyte transfusions, and high-dose intravenous immunoglobulin. The patients recovered following this regimen, including 2 who had septic shock and respiratory failure, necessitating intubation and mechanical ventilation. These data suggest that therapy combining antimicrobial agents, granulocyte transfusions and opsonins may be effective in neutropenic patients who develop gram-negative pneumonia.
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PMID:Combined therapy of granulocyte transfusions, intravenous opsonins and antibiotics for gram-negative pneumonia in neutropenic cancer patients. 817 36

Considerable data suggest that very high doses of acute total body radiation destroy most hematopoietic stem cells and that recovery is possible only after a bone marrow transplant. We review data from a radiation accident victim exposed to about 10-Gy or more acute total body radiation. Total dose and uniformity of distribution were confirmed by physical measurements (paramagnetic resonance), computer simulation, and biologic dosimetry (granulocyte kinetics and cytogenetic abnormalities). Treatment consisted of supportive measures, transfusions, and hematopoietic growth factors (granulocyte-macrophage colony-stimulating factor and interleukin-3). Hematopoietic recovery occurred slowly. Granulocytes were detectable throughout the postexposure period, exceeding 0.5 x 10(9)/L by day 37. There was slower and incomplete recovery of red blood cells and platelets. Increases in blood cell production were paralleled by morphologic changes in bone marrow biopsies. Gastrointestinal toxicity was moderate. Death from a probable radiation pneumonitis infection occurred on day 130. These data indicate the possibility of hematopoietic recovery after approximately 10 Gy or more acute total body radiation without a transplant. They also suggest that lung rather than gastrointestinal toxicity may be dose-limiting under these circumstances.
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PMID:Hematopoietic recovery after 10-Gy acute total body radiation. 828 54

Fever of unknown origin (FUO) has been defined as an elevation in temperature (38 degrees C) for at least 2-3 weeks despite intensive investigation. The value of immunoscintigraphy with the technetium-99m-labelled anti-granulocyte antibody anti-NCA-95 (BW 250/183, IgG1) was studied retrospectively in 34 consecutive patients with FUO. Every effort was made to confirm a diagnosis, including methods such as ultrasonography, computed tomography, magnetic resonance imaging, bacteriological tests, surgical intervention and clinical follow-up. In 58.8% of the patients, an infectious cause for the fever was found, in 30.2% of the patients, a benign or malignant haematological disease, pancreatitis or thyrotoxicosis was found. No cause for fever could be found in 11%. The overall diagnostic sensitivity and specificity of immunoscintigraphy for infection were 40% and 92% respectively. The positive predictive value was calculated to be 88% and the negative predictive value was calculated to be 52%. False-negative scans were especially noted in patients with endocarditis, pneumonia and small brain abscesses, where the lesions did not exceed a diameter of 0.5 cm. If patients with endocarditis were excluded, the imaging sensitivity and specificity were increased to 57% and 95%. This study demonstrates that 99mTc-anti-NCA-95 scanning is able to localize infectious causes of FUO, other than endocarditis.
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PMID:Use of immunoscintigraphy in the diagnosis of fever of unknown origin. 828 76

Many of the pulmonary complications that we have described have a nonspecific radiographic appearance. The most crucial information for proper interpretation of the chest radiographs is the chronologic onset of radiographic abnormalities after transplantation. Before and immediately after engraftment, local peripheral opacities accompanied by a surrounding rim of edema are regarded as fungal infections, and therapy with granulocyte transfusions and amphotericin B is initiated. Diffuse interstitial thickening is likely to represent edema, pulmonary hemorrhage, bacterial infection, or ARDS rather than CMV or P. carinii pneumonia in the neutropenic host. After engraftment, diffuse interstitial processes become the predominant lung abnormalities. In allogeneic transplant patients who are serologically positive for CMV or who receive serologically positive donor marrow for CMV, pneumonitis caused by this virus is perhaps the most common treatable lung infection. Idiopathic interstitial pneumonias present in a similar fashion to CMV pneumonia; however, the response to corticosteroid therapy is only occasionally gratifying. The onset of nodular opacities in this period may be due to a number of disorders, such as opportunistic infection, BOOP, PTLPD or recurrent tumor. Open lung biopsy usually is required for definitive diagnosis.
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PMID:Pulmonary complications after bone marrow transplantation. 853 56

The value of immunoscintigraphy with technetium-99m (99Tcm) labelled anti-granulocyte monoclonal antibody (BW250/183) was studied prospectively in human immunodeficiency virus (HIV-1) antibody-positive patients presenting with fever without localizing symptoms or signs. Twenty-three studies were performed in 23 patients and the results of 99Tcm-anti-granulocyte imaging were compared with the definitive microbiological or cytological diagnosis. Twenty-one patients had an infective cause of pyrexia, one patient had disseminated lymphoma and one Kaposi sarcoma. 99Tcm-anti-granulocyte antibody imaging correctly identified the sites of infection in only five (24%) patients, four of whom had infective colitis (one also had bacterial pneumonia) and one of whom had cellulitis. Sixteen foci of infection were not localized by 99Tcm-anti-granulocyte immunoscintigraphy (false-negative scans). Six of these patients had Pneumocystis carinii pneumonia; other diagnoses in this group included bacterial or fungal pneumonia and bacteraemia secondary to line infections. 99Tcm-anti-granulocyte antibody did not accumulate in the patients with disseminated lymphoma and Kaposi sarcoma (true-negative scans). 99Tcm-anti-granulocyte imaging, therefore, appears useful in identifying extrathoracic infection in HIV-1 positive patients. Its lack of sensitivity for the identification of pulmonary infection means that its role in the investigation of HIV-1 antibody-positive patients with fever without localizing symptoms or signs is limited.
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PMID:Immunoscintigraphy with a 99Tcm-labelled anti-granulocyte monoclonal antibody in patients with human immunodeficiency virus infection and AIDS. 857 Jan 14

Peripheral blood precursor cells (PBPCs) are used with increasing frequency for hematopoietic transplants and have more or less replaced autologous bone marrow transplants. First clinical and experimental reports document the feasibility of PBPCs as a source for allogeneic transplants. Few data exist on the optimal procedure and the ideal number of cells for the transplant. We have previously shown in rabbits that PBPCs can be used for transplants even across a major histocompatibility barrier. We used this model to test whether the number of transplanted precursor cells would influence graft outcome. Adult outbred Red Burgundy rabbits were used as donors, New Zealand White rabbits of the opposite sex as recipients. One individual donor was taken for one individual recipient. Conditioning consisted of single-dose total body irradiation of 10 Gy followed by a short course of cyclosporine to enhance engraftment. Donor animals were treated with recombinant human granulocyte-colony-stimulating factor, 10 micrograms/kg subcutaneously daily from day -2 until day +9. PBPCs were obtained from the artery of the donor animal by repetitive centrifugation of 2 x 40 ml heparinized blood on each day of donation, i.e. days 0, +2, +3, +6, +8, and +10 and infused without further manipulation. Eight animals underwent transplantation. Seven took the grafts, six died of graft-versus-host disease and pneumonia between days 12 and 55 (median survival of all animals: 34 days). One animal was still alive after 120 days. Transplanted nucleated cells varied from 7.3 to 15.4 x 10(8)/ kg (median 9.2 x 10(8)/kg) and CFU-GM from 12.3 to 176.8 x 10(4)/kg (median 42 x 10(4)/kg). Survival tended to increase with more CFU-GM) r = 0.716, p = 0.0704). These data confirm that allogeneic PBPCs can engraft across a major histocompatibility barrier and suggest that a higher number of CFU-GM might be advantageous.
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PMID:Peripheral blood pressure cells transplants across a major histocompatibility barrier in rabbits: positive effects of a higher number of precursor cells? 867 39

A 74-year-old female developed pneumonia following herpes simplex encephalitis. Her white blood cell counts reached 28,400/microliters, about 90% of which consisted of granulocytes. The polymorphonuclear (PMN) elastase/alpha 1-antitrypsin complex levels increased and reached the maximum of 5,019 ng/ml, indicating the release of a large amount of elastase derived from the granulocytes. The mechanism of PMN elastase release was most likely to be granulocyte destruction associated with phagocytosis. The cleavage of fibrinogen and fibrin by PMN elastase, independent of plasmin, was indicated by the presence of the fragments in immunoprecipitated plasma from the patient corresponding to elastase-induced FDP D and DD fragments and the absence of fragments corresponding to plasmin-induced FDP D and DD fragments on SDS-PAGE. These findings suggested that the large amount of PMN elastase released from the excessive numbers of granulocytes in this patient with herpes simplex encephalitis and pneumonia, induced the cleavage of fibrinogen and fibrin without the participation of plasmin.
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PMID:An alternative elastase-mediated degradation of fibrinogen and fibrin observed in a patient with herpes simplex encephalitis and pneumonia. 886 27

Underlying diseases, complications, clinical findings, and laboratory findings were evaluated in 158 cases of septicaemia admitted to Jikei University Hospital from 1975 to 1994, in order to conjectured factors that prescribe for the prognosis. 50% of the patients had underlying diseases. Malignancy including leukaemia (31 cases, 39.2%) was the most common underlying disease, followed by low birth weight infant (17 cases, 21.5%), aplastic anemia (9 case, 11.4%), and congenital heart disease (7 cases, 8.9%). The death rate for patients with underlying disease (27.8%) was significantly greater than the mortality for normal patients with septicaemia (8.9%) (p < 0.05). Meningitis (24.7%) was the most common complication, followed by DIC (19.6%), shock (15.2%), and pneumonia (10.8%). The mortality rate of septicaemia complicated by shock was 66.7% (p < 0.01), and that complicated by DIC was 45.2% (p < 0.01). The mortality rate for patients with the clinical findings of respiratory distress, cough, abdominal distention, cyanosis, splenomegaly, or peripheral coldness was more than 40% and significantly greater (p < 0.01). Mortality rate in patients with granulocyte counts of < 4.000/mm3, platelet counts of < 5 x 10(4)/ mm3, total protein of < 5.0 g/dl, or ESR of < 20 mm/hr were significantly greater (p < 0.01) than those in patients with normal laboratory findings. Coincidence rate of blood and stool cultures was 57.9% for E. coli, and 28.6% for Klebsiella sp., and that of blood and throat cultures was more than 30% for Pseudomonas sp., Haemophilus influenzae, and Staphylococcus aureus. In the study of antimicrobial susceptibility for microorganisms isolated, the number of drug resistant S. aureus had increased in the last 10 years.
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PMID:[Study on septicaemia in infants and children in the past 20 years. Part 2. An analysis of factors that prescribe for the prognosis]. 889 May 45

This study describes bronchoalveolar lavage (BAL), histological and immunohistochemical features in a series of 10 patients with cryptogenic organizing pneumonia (COP). The histological diagnosis was performed by transbronchial biopsy in seven cases and by open lung biopsy in three cases. All patients showed a marked increase in lymphocytes and a mild increase in neutrophils and eosinophils in BAL fluid. The number of T-lymphocytes expressing human leucocyte antigen-DR (HLA-DR) surface antigen was increased (p < 0.002). The majority of lymphocytes expressed the CD8 phenotype, so that the CD4/CD8 ratio was markedly decreased. Masson bodies were present in the lung specimens of all patients. Most of the epithelial cells surrounding the Masson bodies were immunoreactive with an anti-granulocyte/macrophage colony-stimulating factor (GM-CSF) monoclonal antibody. The great majority of mononuclear cells in the lung specimens showed immunoreactivity with anti-CD3, anti-CD8 and anti-CD45R0 monoclonal antibodies. In the Masson bodies, spindle cells were immunoreactive with anti-alpha smooth muscle (alpha-sm) actin monoclonal antibody. Glucocorticoid treatment (the therapy of choice in COP) downregulated GM-CSF messenger ribonucleic acid (mRNA) expression in lung epithelial cell lines. These findings indicate that the combination of bronchoalveolar lavage cell profile with histological evidence is a valuable means of corroborating a clinical diagnosis of cryptogenic organizing pneumonia, and that granulocyte/macrophage colony-stimulating factor may be one of the cytokines involved in the pathogenesis.
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PMID:Bronchoalveolar lavage, histological and immunohistochemical features in cryptogenic organizing pneumonia. 890 12


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