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

The case history of seven children aged 1 5/12 to 5 9/12 years with non tuberculous bacterial pericarditis, observed in the last 8 years at the University children's hospitals of Basle, Berne and Zurich is reported. The history showed febrile illness of 3--14 days duration, which led to an admission diagnosis of pneumonia, angina or pseudocroup. From the signs of heart failure and cardiomegaly on chest X-ray the differential diagnosis of myocardial disease or pericardial effusion was made. The ECG-changes were uncharacteristic, and a friction rub and pulsus paradoxus was encountered once only. The effusion diagnosis should preferably be substantiated by a non-invasive method (scintigram, echocardiogram) as diagnostic pericardiocentesis does often not allow to aspirate the thick pus through the needle. Diagnostic and therapeutic surgical pericardiotomy with consecutive drainage is therefore mandatory. Halothane should be avoided as an anesthetic for this procedure of hemodynamic reasons. With surgery and antibiotics the recovery rate in our series was 100%, and no pericardial constriction was observed on follow-up 1 to 8 years later.
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PMID:Pericarditis purulenta in children. 61 70

Symptomatic myocardial infarction without chest pain was identified in 26 of 102 patients (25.5%) admitted to the hospital with acute myocardial infarction. As a group, these patients had a significantly lesser prevalence of a history of angina (P less than 0.05) and cigarette smoking (P less than 0.01). Their mean age was 69.1 years compared with 58.7 years for patients with chest pain (P less than 0.001). The group had a significantly greater median delay between the onset of symptoms and (1) arrival at the hospital (P less than 0.05), (2) examination by a physician in the emergency room (P less than 0.05), (3) diagnosis of possible myocardial infarction (P less than 0.001), and (4) transfer from the emergency room to the intensive care unit (P less than 0.001). They had significantly higher admission values for mean heart rate, respiratory rate, temperature and white blood cell count and more frequent in-hospital complications of pneumonia (P less than 0.001) and cardiogenic shock (P less than 0.05). Mortality in the group was 50% compared with 18% in the group with chest pain (P less than 0.05). Discriminant function analysis identified an at-risk population with 80% reliability.
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PMID:Symptomatic myocardial infarction without chest pain: prevalence and clinical course. 91 Jul 14

This study seeks to assist in setting priorities for assessing medical practices and technologies when assessment resources are scarce. It develops an objective index of expected gain from technology assessment, using modified DRG-level data on hospitalizations in NY State. The index uses standard economic concepts to combine measures of resource use, the coefficient of variation in use rates across regions, and the rate at which the incremental value of a medical intervention changes as its rate of use changes, providing a dollar-valued welfare loss from variations. For the entire US in 1987, the highest index occurred for coronary artery bypass graft ($0.95 billion per year), but most of the high-index interventions were nonsurgical, including hospitalizations for psychosis ($0.74 billion per year), cardiac catheterization ($0.62 billion per year), chronic obstructive lung disease ($0.55 billion per year), angina pectoris ($0.46 billion per year), adult gastroenteritis ($0.38 billion per year), adult pneumonia ($0.32 billion per year) and medical back problems ($0.28 billion per year). The top 25 interventions create an annual welfare loss of exceeding $7 billion. The present value of convincingly assessing the correct way to use these interventions sums many years of annual gains from eliminating these welfare losses. The gains from eliminating unexplained variation in medical practices appear greatly larger than costs of necessary studies.
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PMID:Priority setting in medical technology and medical practice assessment. 164 Jul 69

From April 1988 to April 1989, nine patients (seven men and two women) with coronary three-vessel disease and disabling angina underwent elective myocardial revascularization. None of the patients had available veins because of previous bypass procedures (three) or extensive varicosis (six). On standard cardiopulmonary bypass and cardioplegic arrest the right and the left mammary arteries (RIMA, LIMA) and the right gastroepiploic artery (RGEA) were anastomosed each to a major coronary branch (none of them as free graft) in each patient. All patients survived the operation but one, who died 2 weeks after the operation of a bilateral pneumonia. Autopsy revealed patent anastomoses. One patient had to be reexplored for bleeding. Two patients required temporary inotropic support. There was no perioperative myocardial infarction. All survivors were discharged home in an average of 18.7 days after the operation, are free from angina, and all have negative stress tests (mean follow-up 7.7 months) but one with severe coronary atherosclerosis who experiences slight exertional angina despite good patency of the grafts. Five patients were recatheterized after a mean interval of 5.4 months after operation revealing in all cases patent anastomoses. Total revascularization of the heart with arterial grafts is feasible, safe, and it could become the method of choice if patency persists in the long run.
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PMID:Total arterial revascularization of the heart using both mammary arteries and the right gastroepiploic artery. 213 62

A retrospective study of 44 patients who were involved in combination with chronic sinusitis and bronchiectasis provided better understanding of the etiology in the relationship between upper air ways tract and lower air way tract. The incidence of bronchictasis was found in 5%, 3 out of 60 cases with chronic sinusitis and that of chronic sinusitis in 45%, 44 out of 98 cases with idiopathic bronchiectasis. Both side involvements of the paranasal sinus and the lung were statistically high in sinobronchiectasis compared to chronic sinusitis or bronchiectasis involved alone. The past history of the patients with sinobronchiectasis showed high occurrence of bronchial asthma or allergic rhinitis, habitual angina of the throat, acute otitis media and pneumonia. A chest X. Ray evaluation of 70 patients with chronic sinusitis alone revealed relatively high incidence of abnormal fibro-nodular shadow in the lung compared to 70 patients without chronic sinusitis. It was thought that weakness of air-way tract to infection in the patients with sinobronchiectasis might play some role on break down of sino-bronchial syndrome, a combination disease of chronic sinusitis and chronic bronchitis.
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PMID:[Correlation between upper airway tract and lower airway tract in the break down of sinobronchiectasis]. 229 49

Over a period of 18 months, 313 patients (mean age 52 years) undergoing elective cardiovascular surgery were included in the autologous transfusion program involving two different Transfusion Centres. A further 10 patients were excluded because of anaemia (haemoglobin levels less than 11 g.dl-1) (n = 3), angina pectoris less than 8 days before (n = 3), patient refusal (n = 2), pneumonia (n = 1), and severe aortic insufficiency (n = 1). A maximum of 5 ml.kg-1 of blood was obtained during the 3 to 4 weeks prior to surgery, one donation being taken a week. In one Transfusion Centre, the blood was taken without tourniquet, and without any fluid replacement. Diuretics and converting enzyme inhibitors were stopped. In the opposite, in the other Centre, blood was taken using a tourniquet, and replaced by a gelatin solution (Plasmion). All the patients were given iron. The blood units were kept by the Transfusion Centres under the same conditions as homologous blood, but in a separate circuit. The 313 patients predeposited a mean of 2.71 units of blood: 4 units where obtained in 59 patients, 3 in 113, 2 in 133 and only 1 in 8. Mean haemoglobin level on starting the program was 14.49 g.dl-1. Neither homologous red cells nor plasma was administered in 176 patients (56.23%); among the 172 patients who predeposited 3 or 4 units, 123 (71.5%) were given their own blood only. Intraoperative blood salvage was used in 189 out of 313 patients (60.4%), and intraoperative haemodilution with albumin was used in 173 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Tolerance and efficacy of delayed autologous transfusion in cardiovascular surgery]. 233 Oct 83

A study of 60 patients suffering chronic lympholeukemia indicates disorders of the functional adequacy of neutrophils that shows further deterioration with association of infection (pneumonia, angina, abscesses and other infections). By the content of cationic protein of the neutrophils it becomes possible to evaluate the state of unspecific defense of the body and severity of the pathological process. The cationic lysosomal test may be recommended for the diagnosis of infectious complications in hemoblastoses.
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PMID:[A decrease in the activity of granulocyte cationic protein in patients with chronic lympholeukemia]. 262 72

The length of hospital stay after coronary surgery was studied in 4,683 patients undergoing cardiac catheterization followed by coronary surgery at Emory University Hospital or Crawford Long Hospital between the years 1981 and 1986. Length of stay after coronary surgery had a median and modal value of 7 days. There was, however, a long statistical tail of patients with a prolonged length of stay extending out to more than 180 days. Prolonged length of stay (greater than 10 days) could be correlated with preprocedural variables such as age, elective versus emergency status, angina class, ejection fraction, and gender. Length of stay increased from a mean of 6.9 +/- 1.4 days under the age of 40 years to 10.9 +/- 12.1 days over the age of 70 years (p less than 0.0001). Length of stay was correlated with the periprocedural variables of wound infection, neurologic event, arrhythmias, pneumonia, postoperative myocardial infarction, mortality, and pericarditis. Length of stay increased from 8.8 +/- 9.6 days without a neurologic event to 21.1 +/- 17.9 days with a neurologic event (p less than 0.0001). Similarly, without a wound infection, the average stay was 8.7 +/- 8.9 days; with a wound infection, the average stay was 32.2 +/- 25.8 days (p less than 0.0001). The correlates of prolonged stay were tested in another population comprising 781 patients undergoing cardiac catheterization followed by coronary artery bypass grafting in 1987. The predictors of prolonged stay in the 1987 population were wound infection, pneumonia, arrhythmias, age, neurologic events, postoperative infarction, and ejection fraction. Thus, length of hospital stay after coronary surgery may be predicted by multiple preprocedural and periprocedural variables.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Determinants of prolonged length of hospital stay after coronary bypass surgery. 278 9

Serum gamma-glutamyltranspeptidase (GGTP) and alpha-amylase clearance were determined in a total group of 90 patients of whom 60 with renal diseases and 30 with extrarenal diseases. The renal patients were distributed, according to diagnosis in the following groups: acute glomerulonephritis, chronic glomerulonephritis, acute pyelonephritis, chronic pyelonephritis, nephrotic syndrome and manifest chronic renal failure. The 30 controls were hospitalized for different extrarenal diseases such as: pneumonia, gastroduodenal ulcer, arterial hypertension stage I and angina pectoris. Serum GGTP assay was performed in 60 patients (40 renal patients and 20 controls) using Boehringer monotest kits and in 30 patients (20 renal patients and 10 controls) using Romanian kits (I.C.C.F.). No changes suggesting a particular type of nephropathy were observed. The results obtained by using the two types of kits for the serum GGTP assay have proved to be very close. Alpha-amylase clearance was determined in all the patients with Spofa (R.S.C.) tablets concomitantly with the urea and creatinine clearance. Important decreases of alpha-amylase clearance in concordance with decreases of urea and creatinine clearances were observed in all the patients with severe renal failure. More moderate decreases of alpha-amylase clearance were observed in the patients with acute and chronic glomerulonephritis. The utility of this clearance as a test of glomerular filtration and sometimes as a prognostic test, is discussed.
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PMID:Preliminary clinical and methodologic observations on the determination of serum gamma-glutamyltranspeptidase and of the alpha-amylase clearance in nephropathies. 286 37

A 59-yr-old man was given over a 30-month period a cumulative dose of 36 g of propranolol for treatment of angina pectoris. He then presented with respiratory disease, having all the clinical, radiologic, and functional characteristics of interstitial pneumonitis. No other cause of pneumonitis was found. Bronchoalveolar lavage (BAL) showed a lymphocytic alveolitis with lymphocyte subset inverted ratio. After a 9-wk period of drug withdrawal, clinical and radiologic improvement was observed along with resolution of BAL abnormalities. Propranolol therapy was resumed for 6 wk and induced the recurrence of BAL abnormalities. Propranolol treatment was finally stopped, and 15 wk later, clinical symptoms abated, chest roentgenogram and pulmonary function tests were improved, and BAL data returned to normal. This observation seems to exemplify the possible diagnostic value of coupling provocation test with BAL cell data in some hypersensitivity pneumonitis induced by drugs. In addition, these data support the role of a cell-mediated immunologic mechanism in the pathogenesis of propranolol-induced pneumonitis.
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PMID:Provocation test coupled with bronchoalveolar lavage in diagnosis of propranolol-induced hypersensitivity pneumonitis. 291 46


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