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

The etiology of recurrent aspiration pneumonitis after the successful repair of esophageal atresia has not been defined. In order to explain this occurrence, we performed esophageal manometric examinations on eight patients who had undergone repair of EA and tracheoesophageal fistula. Two patients who had had recurrent pneumonia had subnormal pressure of the lower esophageal sphincter; they also had a history of severe regurgitation, and a barium esophagram demonstrated free gastroesophageal reflux. The LES incompetence in these patients was apparently corrected by administration of bethanechol.
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PMID:Role of lower esophageal sphincter incompetence in recurrent pneumonia after repair of esophageal atresia. 90 73

Acute toxic epidermal necrolysis (Lyell's syndrome) ended fatally in a 48-year-old patient with chronic recurrent bronchial pneumonia. A marked haemorrhagic diathesis had developed, with signs of severe clotting and platelet abnormalities, indicating that the clotting disorder was, in the first instance, the result of "toxic" liver and bone-marrow damage (in connection with the recurrent pneumonia and its previous drug treatment), and not disseminated intravascular coagulation. The clotting abnormalities in this patient were probably less the result of "necrolysis" of the epidermis than an accompanying effect of the generatized intoxication of multiple aetiologies of the entire organism, which probably also precipitated the fulminating course of the Lyell's syndrome. An important part, of course, was the preceding protracted administration of chloramphenicol for the recurrent bronchial pneumonia.
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PMID:[Clotting abnormalities in the Lyell's syndrome (acute toxic epidermal necrolysis) (author's transl)]. 118 36

Recurrent pneumonia is defined as two or (usually) more separate episodes of lower respiratory tract infection that generally are accompanied by fever, leucocytosis, and purulent sputum production. These episodes are separated by an asymptomatic interval of at least 1 month or clearing of the chest visible by radiograph. Clinical improvement and radiological clearing should result after appropriate antimicrobial therapy. Chronic pneumonia is an illness that lasts at least 6 weeks and is caused by a microorganism. The chest radiograph usually shows diffuse or focal shadows. The incidence of either chronic or recurrent chest infections is unknown. Neither condition is common, but when present, they frequently present a difficult diagnostic challenge. Chronic pneumonias are usually caused by slow-growing organisms, such as fungi or mycobacteria. Occasionally, chronic pneumonias cannot be diagnosed, even when lung biopsy specimens are cultured or studied histopathologically. When a patient presents with recurrent pulmonary parenchymal infections, the clinician needs to identify the likely etiologies. Possible etiologies are structural abnormalities, underlying medical conditions, and immunological abnormalities, including infection by the human immunodeficiency virus (HIV).
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PMID:Chronic and recurrent pneumonia. 130 31

One hundred and forty-two flexible fiberoptic bronchoscopies were carried out in 1 year, under local anaesthesia, in 123 children aged between 15 days and 17 years. Indications were tuberculosis (n = 26), persistent pneumonia (n = 20), suspected foreign body or control after extraction (n = 18), asthma (n = 17), atelectasis (n = 14), recurrent pneumonia (n = 13), opportunistic pneumonia (n = 11), permanent bronchial obstruction (n = 10), miscellaneous disease (n = 13). Fiberoptic bronchoscopy was abnormal in 101 patients (80%) and led to a change in the treatment in 84 cases (68%). True complications (n = 5) were all transient and were followed by complete recovery. Flexible fiberoptic bronchoscopy under local anaesthesia is a simple and safe procedure. It is an essential diagnostic and therapeutic tool in the management of pediatric respiratory disorders.
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PMID:[Endoscopic bronchial exploration under local anesthesia in children]. 133 30

We report on a 67-year-old man with Felty's syndrome (FS) complicated by recurrent pneumonia and an infected wound, which was not healing in spite of maximal antibiotic and local therapy. Encouraged by previous experience, we treated him with granulocyte-macrophage colony-stimulating factor (GM-CSF). His total leukocyte count rose, but the patient's pneumonia deteriorated. In addition, a previously known chronic obstructive lung disease (COLD) was exacerbated acutely. These complications finally led to his death. Postmortem examination revealed widespread pneumonia with invasive aspergillosis and a peripheral adenocarcinoma in his left lung.
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PMID:Treatment of neutropenia in Felty's syndrome with granulocyte-macrophage colony-stimulating factor--hematological response accompanied by pulmonary complications with lethal outcome. 145 82

Forcible administration of rendered animal fat to infants is a tradition in south western Saudi Arabia. Accidental inhalation may result in a resistant form of lipoid pneumonia. A series of 24 cases of lipoid pneumonia, 22 of which were diagnosed by bronchoscopy with bronchial lavage and microscopic examination of the aspirate, are reported. The technique is described briefly and the results analysed. A high index of suspicion together with bronchoscopy and bronchial lavage of all cases of resistant or recurrent pneumonia is essential in areas such as ours for diagnosis of this condition.
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PMID:Bronchoscopy in lipoid pneumonia. 147 91

Very recently, the concept of artificial intracorporeal oxygenation of blood for patients suffering from respiratory failure has been introduced into clinical practice through development of a totally implantable intravascular oxygenator (IVOX). We report on the use of such a device in a patient who developed severe respiratory insufficiency secondary to prolonged hypovolaemic shock and pneumonia following successful repair of a ruptured abdominal aortic aneurysm in September, 1990. Postoperatively, severe hypoxaemia occurred (AaDO2 548-602 torr) despite extensive mechanical ventilatory support. There was no obvious chance to overcome this situation by conventional therapeutic measures and the decision was made to institute IVOX therapy. Hypoxaemia was resolved immediately and both FiO2 and tidal volume could be reduced within hours. The patient's respiratory condition continued to improve over the next days leading to termination of IVOX therapy after 71 hours. However, the necessity of long-term ventilatory support secondary to recurrent pneumonia and sepsis, multiple abdominal reoperations for ischemic colitis and retroperitoneal abscess prolonged his recovery. He was discharged from the hospital after four months and is alive and well now 14 months after his operation. He is the first long-term survivor after IVOX therapy in Europe. IVOX may be successfully used in selected patients while the indications and it's potential role in the therapy of severe respiratory failure still need to be defined.
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PMID:[Artificial intravascular oxygenation (IVOX). Application to the treatment of postoperative respiratory failure]. 148 73

Recurrent pneumonia is still an important problem. In this retrospective study we reviewed the records of 90 patients with a history of 3 or more episodes of acute pneumonia. The 90 patients accounted for altogether 347 episodes of acute pneumonia, treated at the Department of Infectious Diseases, Lund. 12 patients died while being treated for pneumonia at the department. Pneumonia alone caused the death in 7 of these 12 patients. In all, 51 of the patients died during the 11-year study period. Death certificates, stating the cause of death, were available in 38 cases, and pneumonia was the direct cause of death in 15 patients. Most of the infections were community-acquired, only 47 were nosocomial, 20/90 patients suffered from disorders associated with immune deficiency, and 70 patients had other predisposing illnesses. We found a larger number of underlying immunoglobulin deficiencies (11 patients of 38 investigated) than previously reported. Of 13 patients without other known, predisposing conditions, hypogammaglobulinemia was found in 3 patients. We suggest that patients with recurrent pneumonia should be thoroughly investigated, in order to find previously unrecognized immune deficiency.
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PMID:Recurrent pneumonia: a review of 90 adult patients. 158 28

Anti-reflux procedures have been advocated in children with profound neurologic disability referred for feeding gastrostomy when gastroesophageal reflux is present. Facilitation of care, reduction in pneumonia and vomiting, and improvement in the general health and survival of these children have been major goals of fundoplication and gastrostomy. In large pediatric series, these procedures have been reported to have low risk and negligible mortality rates. Recent reports, however, document an increased incidence of sequelae of fundoplication in children with profound neurologic disability. This paper retrospectively reviews a series of 35 nonverbal, nonambulatory pediatric patients undergoing a total of 39 fundoplications (37 Nissen, 1 Thal, and 1 Belsey) over an 11-year period. Neurologic impairment of 17 (49%) patients was acquired, 13 (37%) congenital, and 5 (14%) due to a syndrome. Perioperative complications occurred in six (17%). Three additional complications led to early postoperative death. A fourth early death was unexplained. Fourteen (40%) had recurrent pneumonia, 11 (31%) recurrent vomiting, 8 (23%) choking-gagging-retching complex, and 3 (9%) bowel obstruction requiring laparotomy. Recurrent gastroesophageal reflux was documented in seven (20%) patients. A second ARP was performed in six (17%). There were 14 (40%) late deaths. Although the major goals of anti-reflux procedure are clearly achieved in many severely impaired children with gastroesophageal reflux, the use of Nissen fundoplication to resolve the complications of swallowing disorders and improve outcome with an acceptably low risk in this complex set of patients does not appear to be established.
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PMID:Nissen fundoplication in children with profound neurologic disability. High risks and unmet goals. 163 87

Rhodococcus equi is a primarily pathogen in animals and it has only rarely been seen in immunocompromised humans. We describe our experience with an HIV-negative patient with a functioning renal graft under cyclosporin-azathioprine-prednisone therapy. The patient died after a two months recurrent multifocal pneumonia. The cultures from sputum and blood were negatives but R. equi was isolated from lungs in the necropsy. Most of the 41 cases we had found in the literature had AIDS or HIV infection. Six cases had a kidney graft under azathioprine-prednisone therapy. Rhodococcus equi infection may be missed in some instances due to incomplete or improper identification of the organism, that grows well in aerobic media but is usually regarded as a component of normal flora or as a contaminant. The ability of R. equi to persist in and eventually to destroy macrophages is the basis of its pathogenicity. It also explains the clinical resistance to antibiotics without intracellular activity. Rhodococcus equi infection must be suspected in immunocompromised patients with recurrent pneumonia. Correct identification and combined therapy with lipophilic antibiotics that penetrate the macrophages are necessary to prevent the high mortality of this infection.
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PMID:[Pulmonary infection caused by Rhodococcus equi in a renal transplant recipient]. 163 9


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