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

Twenty-six white male subjects, who worked with plutonium (239Pu) during World War II at Los Alamos, have been given medical examinations periodically over a period of 42 y to identify potential health effects. Inhalation was the primary mode of Pu exposures. The latest examinations, including urine bioassay and in-vivo measurements for radioactivity, were performed in late 1986 and 1987. The average age of the 22 living subjects in 1986 was 66 y. The diseases and physical changes noted in these persons are characteristic of a male population in their 60s. Estimates of individual Pu depositions, including lung burdens, as of 1987 or at time of death range from 52 to 3180 Bq (1.4 to 86 nCi) with a median value of 500 Bq (13.5 nCi). Four persons from the original group had died as of 1987. The causes of death were lung cancer, myocardial infarction, accidental injury, and respiratory failure due to pneumonia/congestive heart failure. Expected deaths based on U.S. death rates of white males, adjusted for age and calendar year, are 9.2 based on U.S. rates (standardized mortality ratio = 0.41). Subsequent to 1987, three additional deaths occurred from atherosclerotic heart disease, lung cancer, and osteogenic sarcoma. The bone sarcoma case is discussed in terms of Pu exposure, the natural incidence of this disease, anatomical location of the tumor, and bone tumors observed in Pu-exposed dogs. Plutonium deposition in this man is estimated to have been below current radiation protection guidelines.
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PMID:A 42-y medical follow-up of Manhattan Project plutonium workers. 185 80

Two hundred and thirty-seven children have died who were seen in the Division of Neurology, Kanagawa Children's Medical Center from 1975 to 1989. They corresponded to about 11% of the total death in the hospital. A total of 128 cases of 237 deaths (54.0%) were suffering from epilepsies, most of whom were also complicated with other CNS disorders. The causes of death were pneumonia, respiratory failure and suffocation in 60%, whereas status epilepticus or convulsions only in 14%. About 40% of victims died at home or in an emergency room without effective resuscitation. Mortality was considered high in infantile spasms (16 out of 146, 11%) and in severe myoclonic epilepsy in infancy (4 out of 8, 50%). It was note worthy that 3 cases of severe myoclonic epilepsy in infancy died of status epilepticus and 2 died at home. Sixteen cases whose chief problems were partial epilepsies and severe myoclonic epilepsy in infancy, died of status epilepticus in 10 cases, convulsions after tonsillectomy, etc. Causes of death of these 16 cases were related to convulsions except in two cases whose causes were pneumonia in one and unknown in the other. About a half of them (7 cases) died at home. Adequate managements appeared necessary to prevent accidental deaths of children with epilepsies.
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PMID:[Mortality patterns of children with epilepsies in a children's medical center]. 187 50

It is important to evaluate the development of neonates submitted to assisted ventilation since it is one of the most commonly used procedures in patients with respiratory failure. A group of 50 neonates who had been submitted to assisted ventilation were studied and compared to another group of 50 children with the same inclusion criteria, except for the fact that they had not needed ventilation. They were each evaluated since birth and thereafter every two months during their first year of life and every three months in the second year. The Amiel Tison Neurological Assessment was used to evaluate the children during the first year while the Mayo Clinic General Neurological Exploration adapted for nursing children was applied during the following year. In assessing psychomotor development, the Brunette Lezine Scale, standardized for Mexican children, was used. For practical purposes, a sample of the results obtained during the second year are presented while some pertinent variables are commented on. For those included in the ventilated group, results show a higher frequency of hyaline membrane disease (27 cases), intraventricular hemorrhage (19), pneumonia (18), and arterious duct persistence (13). The control group showed the following frequencies, respectively: 0, 4, 5, and 4 cases. The ventilation group was found to have a statistically significant higher relative risk rate (P less than 0.05) and a higher risk for neurologic sequelae (P less than 0.001) when compared to the control group. Asphyxia and hemorrhaging were factors associated and present in the ventilated group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The neurological and psychomotor evolution at 2 years of age of newborn infants who underwent assisted ventilation]. 187 56

The value of continuous positive airway pressure (CPAP) ventilation via a tight fitting face mask was assessed in eight HIV-1 antibody-positive patients with Pneumocystis carinii pneumonia who were in hypoxaemic respiratory failure. All patients were conscious, able to protect their airway and not hypercapnic. Treatment was effective in seven patients. Prior to CPAP, mean (range) arterial oxygen tension was 6.7 (4.7-10.5) kPa in seven patients breathing oxygen via a face mask (FiO2 = 0.6), 6.1 kPa in one patient breathing room air and rose to 9.9 (6.8-12.8) kPa with CPAP (FiO2 = 0.6 and PEEP = 1.3 kPa in six patients and 2.6 kPa in one patient); the mean increase in PaO2 was 3.1 kPa (P less than 0.02). These seven patients experienced a rapid reduction in dyspnoea and their respiratory rate fell from a mean of 40 breaths min-1 to 32 breaths min-1 (P less than 0.001). One patient deteriorated rapidly on CPAP and died: no other complications were seen with this technique. CPAP was continued for a mean of 4.5 days and the seven responders all survived the episode of P. carinii pneumonia. We conclude that mask CPAP provides an effective means of improving oxygenation in severely hypoxaemic patients with P. carinii pneumonia.
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PMID:Continuous positive airway pressure ventilation for respiratory failure associated with Pneumocystis carinii pneumonia. 188 30

In a prospective study of community-acquired pneumonias, 30 patients were diagnosed with Legionnaires' disease in 15 months. Clinical, laboratory and radiologic features of these patients are reviewed and compared with those who have pneumococcal pneumonia. Alcoholism, history of smoking, previous antimicrobial therapy, gastrointestinal and neurologic manifestations, elevations of serum transaminases, alkaline phosphatase and creatinine levels were more frequent in pneumonia due to Legionella pneumophila than in pneumococcal pneumonia. The presence of respiratory failure and radiologic progression were common findings that suggested L pneumophila as the etiologic agent of a community-acquired pneumonia. Development of respiratory failure was associated with involvement of several lobes and isolation of L pneumophila in any specimen. In 21 of 30 patients with Legionnaires' disease, L pneumophila was isolated from respiratory specimens. Overall mortality was 10 percent, but it increased to 27 percent in patients not treated with erythromycin initially.
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PMID:Legionella pneumophila. A cause of severe community-acquired pneumonia. 191 47

Most patients with adult respiratory distress syndrome (ARDS) survive the initial insult which caused respiratory failure only to succumb later to sepsis caused by nosocomial pneumonia or to pulmonary fibrosis. Clinical criteria and analysis of the tracheal aspirate are notoriously inadequate for establishing a diagnosis of ventilator-associated pneumonia. We implemented a comprehensive diagnostic protocol to determine the cause of sepsis in ARDS patients who had been ventilated for more than three days and who had no bronchoscopic evidence of pneumonia. Nine patients with late ARDS who had fever (89 percent), leukocytosis (89 percent), a new localized infiltrate (78 percent), purulent tracheal secretions (89 percent), low systemic vascular resistance (50 percent), and marked uptake of gallium in the lungs (100 percent) had no source of infection identified. Open-lung biopsy specimens from seven patients showed the fibroproliferative phase of diffuse alveolar damage and confirmed absence of pneumonia. Treatment with prolonged high doses of corticosteroids was associated with a marked and rapid improvement in lung injury score (p less than 0.003 at five days). Our findings indicate that the fibroproliferative process occurring in the lungs of patients with late ARDS gives rise to clinical manifestations identical to those of pneumonia and is potentially responsive to steroid treatment.
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PMID:Fibroproliferative phase of ARDS. Clinical findings and effects of corticosteroids. 191

Twenty-five pediatric orthotopic liver transplantations (OLTs) performed in 22 patients at Sainte-Justine Hospital were reviewed for infections complications. One patient died within 12 hours posttransplantation and is excluded. The patients had an average age of 6.1 years (range, 1.25 to 19 years) and an average weight of 20.4 kg (range, 11 to 55 kg). Two patients (9%) were cytomegalovirus (CMV) seropositive and 9 of 19 patients (48%) were Epstein-Barr virus (EBV) seropositive preoperatively. Five of the donors (20%) were CMV seropositive. The most common indications for OLT were biliary atresia (8) and tyrosinemia (7). There were 4 deaths, for an overall mortality rate of 19%. In 3 patients, deaths were related to infection (CMV hepatitis and duodenitis with aortoduodenal fistula, adult respiratory distress syndrome [ARDS] with Streptococcus viridans pneumonia, Escherichia coli cholangitis with progressive hepatic failure). Fifteen patients (72%) had 41 major infections, most of them bacterial, during the first month posttransplantation. These include pneumonia (25%), line sepsis (17%), cholangitis (14%), and tracheitis (14%). There was only one major viral infection, a CMV hepatitis that occurred in the first month posttransplantation. Three patients had fungal infections (8%) associated with hepatic artery thrombosis and recurrent cholangitis. All three patients required retransplantation. There was only one protozoal infection (Pneumocystis carinii pneumonia) causing life-threatening respiratory failure, from which patient recovered without sequelae. Infection still remains a serious complication of OLT. Bacterial infection is common and is usually associated with technical complications. The low rate of CMV infection is related to low incidence of CMV in the donor pool and the minimal use of strong immunosuppressants.
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PMID:Infectious complications of pediatric liver transplantation. 191 82

Spinal cord injury increases the risk of many life-threatening medical problems, including respiratory failure, pulmonary embolism, and renal failure. Respiratory failure results from paralysis of muscles of inspiration (which impairs oxygen transport to alveoli) and of expiration (which impairs cough and predisposes to pneumonia and atelectasis). Respiratory failure in patients with spinal cord injury can be prevented by proper positioning of the patient, training of ventilatory muscles, pulmonary toilet, and aggressive use of antibiotics and bronchodilators. When respiratory failure occurs, it can be managed by administration of oxygen, intubation, and mechanical ventilation, and in instances of paralysis of the diaphragm, by diaphragmatic pacing. The risk of deep vein thrombosis and pulmonary embolism in acute spinal cord disease is increased by the immobilization of the patient and abnormalities in clotting factors. Thrombotic disease in spinal cord disease can be prevented by intermittent calf compression and heparinization. If pulmonary embolism develops, the patient should be started on a regimen of warfarin for at least 3 months. If anticoagulation is contraindicated, a Greenfield filter can be placed. However, concurrent use of quad cough places the patient at increased risk for complications from the Greenfield filter. Chronic pyelonephritis and systemic amyloidosis are the most common causes of renal failure in the patient with spinal cord disease. Renal failure can be prevented by maintaining a low postvoid residual volume, avoidance of indwelling catheters, use of medications that are not nephrotoxic, and rapid treatment of infection. Hemodialysis and peritoneal dialysis can extend the life of the patient with spinal cord disease in whom renal failure develops, and successful use of renal transplantation has recently been reported.
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PMID:Medical complications of spinal cord disease. 192 58

Postoperative mortality and morbidity of diabetic versus nondiabetic patients undergoing primary coronary artery bypass grafting (CABG) were analyzed. In 1988, 711 patients had CABG procedures, of which 565 were nondiabetic and 146 diabetic. The two groups of patients were statistically similar in regard to age, weight, tobacco and ethanol use, and preoperative levels of cholesterol, triglycerides, blood urea nitrogen (BUN), and creatinine. Preoperative serum glucose levels were significantly elevated in diabetic patients (182 vs. 106, P less than .001). Cardiac output, ejection fraction, and bypass, crossclamp time, and total operating room times were not different for the two groups. Emergent and urgent procedures had a significantly higher mortality rate than elective cases (11.3% and 6.6% vs. 1.7%, respectively; P less than 0.05), but this was independent of the patient's diabetic status. Women had a higher mortality rate than men (6.5% vs. 2.9%; P = 0.05) although within each gender group, there were no differences between diabetics and nondiabetics. There were 27 patients with complications in the diabetic group (18.5%) and 47 in the nondiabetic group (8.3%; P less than .001). The types of complications within the two groups differed in that wound infections (7.5%), postoperative arrhythmias (4.8%), respiratory failure (4.1%), and intra-aortic balloon pump use (4.1%) were significantly greater (P less than .05) in the diabetic patients compared to the nondiabetic (0.9%, 1.8%, 0.4%, and 1.4%, respectively). Occurrences of postoperative pneumothorax, reoperation, myocardial infarction, stroke, urinary tract infection, and pneumonia were similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Complications of coronary artery surgery in diabetic patients. 192 97

Ten patients with severe hematologic malignancies (four with acute leukemia, three with multiple myeloma, one with prolymphocytic leukemia, one with malignant lymphoma and one with blastic crisis of chronic myelogenous leukemia) developed respiratory failure during the period between April 1986 and May 1990. Clinically, the patients manifested high-fever, dyspnea refractory to oxygen therapy, diffuse pulmonary rales and severe hypoxemia without evidence of cardiogenic pulmonary edema. Chest roentgenograms displayed diffuse alveolar infiltrates. Respiratory failure occurred as early as 48 hours and as late as 66 days after the administration of intensive anti-neoplastic chemotherapy. At that time leukocyte count was between 100/microliters and 54,900/microliters. Marked leukocytosis was observed in two patients with AML and PLL. Respiratory failure was preceded by sepsis in one patient with AML and by pneumonia in nine patients. DIC was diagnosed in four patients. All patients treated with high dose methyl prednisolone (mPSL) within 12 hours after the onset of respiratory failure. Only one patient required assisted ventilation. High dose mPSL had significant effect on seven of ten patients. But three patients died from progressive respiratory failure, sepsis, pneumonia and multi-organ failure.
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PMID:[Clinical investigation on acute respiratory failure in patients with severe hematologic malignancy]. 194 22


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