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

"Environmental tobacco smoke" (ETS) is the term used to characterize tobacco combustion products inhaled by nonsmokers in the proximity of burning tobacco. Over 3800 compounds are in tobacco smoke, many of which are known carcinogens. Most ETS exposure is from sidestream smoke emitted from the burning tip of the cigarette. Sidestream smoke is hazardous because it contains high concentrations of ammonia, benzene, nicotine, carbon monoxide, and many carcinogens. Nonsmokers chronically exposed to ETS are believed to assume health risks similar to those of a light smoker. Children of parents who smoke have more respiratory infections, more hospitalizations for bronchitis and pneumonia, and a smaller rate of increase in lung function compared to children of parents who do not smoke, particularly during the first year of life. Among adults with preexisting health conditions such as allergies, chronic lung conditions, and angina, the symptoms of these conditions are exacerbated by exposure to ETS. The acute health effects among healthy adults include headaches, nausea, and irritation of the eyes and nasal mucous membranes. The evidence for a relationship between ETS and cancer at sites other than lung is insufficient to draw any positive conclusions. For lung cancer, studies have consistently shown an excess risk between 10% and 300%, with a summary relative risk of 1.3 (95% confidence interval = 1.1-1.5). A dose-response relation is suggested but difficult to assess completely. Histologic types of lung cancer are generally similar to those most closely associated with active smoking, although other histologic types have also been found. Both excess relative risks and the dose responses are underestimates of the true excess risk and of the range of dose-response effect. Although the temporal relationship between exposure and disease occurrence is established, many questions are unanswered. The findings are consistent with many known biologic effects of active smoking and are partially analogous to the biologic effects of direct smoke inhalation. As many as 5000 nonsmokers are estimated to die annually from lung cancer as a result of exposure to ETS. There is great potential for prevention of these premature deaths. The two major preventive actions are (a) eliminating the source by reducing the amount of direct smoking and (b) limiting the level of exposure by restricting where tobacco can be smoked. Specific preventive actions include smoking cessation, smoking prevention, restriction of advertising, increased taxation on tobacco, and adoption of stringent nonsmoking policies in the workplace, schools, and public places.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Health hazards of passive smoking. 328 40

One hundred consecutive patients 80 years of age or older consented to and subsequently underwent open-heart operations at our institution between July 1976 and May 1987. Fifty of the patients had aortic valvular disease (28 with coexisting coronary artery disease), and 41 had isolated coronary artery disease. Eight patients had mitral valvular disease, and one had a dissecting aortic aneurysm. Ninety had Class IV disease that was functional, ischemic, or both. The most compelling indications for operation in 85 patients were unstable or postinfarction angina, syncope, acute pulmonary edema, or cardiogenic shock. Twenty-nine patients died soon after operation (within 90 days). New York Heart Association Class IV disease, previous myocardial infarction, cachexia, and emergency operation were preoperative variables associated with early death. Forty-three patients had no complications except for atrial arrhythmias and were discharged from the hospital a mean (+/- SD) of 11.5 +/- 3.7 days after operation. Low cardiac output, acute myocardial infarction, reoperation for bleeding, renal insufficiency, pneumonia, and prolonged endotracheal intubation were the most common serious postoperative complications. Twenty-eight patients who survived postoperative complications were discharged 24.9 +/- 19.6 days after operation. Seventeen patients died 2 to 104 months after discharge from the hospital. Actuarial calculation predicts the survival of 59 percent of patients at three years and 54 percent at five years. Of the 54 patients still alive at this writing, 53 have disease within New York Heart Association and Canadian Cardiovascular Society Classes I or II. For selected octogenarians with unmanageable cardiac symptoms, operation may be an effective therapeutic option.
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PMID:Open-heart surgery in octogenarians. 338 92

Encouraging results of the combination of upper hemibody irradiation (UHBI) and local chest irradiation (LCI) combined withh standard-dose chemotherapy in patients with extensive small cell bronchogenic carcinoma led us to a second pilot study utilizing the same radiation program combined wit high-dose induction chemotherapy. Fourteen patients with small cell bronchogenic carcinoma, five with extensive disease and nine with localized disease, were treated with cyclophosphamide (1.5 g/m2 iv, Days 1 and 22), lomustine (70 mg/m2 orally, Day 1), and methotrexate (15 mg/m2 twice weekly during Weeks 2, 3, 5, and 6). UHBI (600 rads) was given during Week 6 in a single dose and LCI was given during Week 7 (2000 rads/five fractions) to the tumor and mediastinum. Maintenance chemotherapy began in Week 12 with cyclophosphamide (700 mg/m2 iv every 3 weeks) and lomustine (70 mg/m2 orally every 6 weeks). Twelve patients were evaluable for response and toxicity (eight with limited disease). There were three complete response and seven partial responses after induction chemotherapy. After completion of the consolidation radiation therapy, all 12 patients had a response: six complete responses and six partial responses. Acute toxic effects included nausea and vomiting in eight patients, fever in five, and hypotension and angina in one. Subacute toxic effects included nausea, vomiting, and dehydration in two patients who required hospitalization, prolonged aplasia in one, reversible radiation esophagitis in three. Three patients had radiation pneumonitis including one with bilateral diffuse disease that led to death from respiratory failure. Only two of 12 patients received their maintenance therapy on schedule. Treatment failures occurred within the LCI field in seven patients and in distant metastatic sites in six. The median time to first relapse was 7 months and the median survival was 9 months. Because of toxicity, treatment delays, and poor survival in this group of patients, we cannot recommend this combined modality approach.
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PMID:Upper hemibody and local chest irradiation as consolidation following response to high-dose induction chemotherapy for small cell bronchogenic carcinoma--a pilot study. 628 19

During the past 3 years, 51 cases of pulmonary lesions associated with the use of amiodarone, an effective anti-arrhythmic and anti-angina drug, have been reported in 17 publications. Durations of treatment, daily doses and total dosage were extremely varied. Clinical symptoms as well as radiological findings, respiratory function studies and laboratory data suggested hypersensitivity pneumonia. However, the histopathological substrate remains ill-defined, and while some data suggest a toxic effect, others are in favour of an immune reaction ending in diffuse pulmonary fibrosis. Five of the 11 deaths reported seem to be directly related to the drug. It would appear that long-term treatment with amiodarone requires regular periodical examination of the respiratory system.
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PMID:[The amiodarone lung]. 637 47

Nitroglycerin (Ng) is a potent and short-acting coronary and systemic vasodilator, widely used in anginal pain treatment. When given to patients with pneumonia or chronic lung disease, Ng was found to cause a further decrease in arterial oxygen tension (PaO2) by increased perfusion of poorly ventilated territories in the lungs. In order to investigate the potential hazard in Ng decreasing the PaO2 in ischemic heart disease patients, who develop acute pneumonia, we administered 0.4 mg Ng sublingually to 11 patients who suffered concomitantly from ischemic heart disease and acute pneumonia. Arterial blood gases were monitored before, 2, 5 and 10 min following Ng administration, as well as a standard 12-lead electrocardiogram that was monitored as the same time. 8 out of the 11 patients showed a decrease in PaO2 which was mild to moderate, during the study period of time, none of them showed an increase, and there was tendency for the lower (less than 60 mm Hg) initial PaO2 to show a lesser decrease in the PaO2 in comparison to the higher (greater than 60 mm Hg) initial PaO2. There was no statistical significant correlation between the decrease in PaO2 and patients' age, sex, coexisting chronic obstructive lung disease and severity of systemic heart failure. Our conclusion is that the hazard in lowering PaO2 by Ng in ischemic heart disease patients who develop acute pneumonia is minimal, but the drug should be used with caution.
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PMID:Arterial hypoxemia following the administration of sublingual nitroglycerin in patients with ischemic heart disease and pneumonia. 679 69

The platelet aggregation test was used to detect circulating immune complexes (CIC) in 567 patients admitted to a general hospital. One hundred and fourteen or 20.1% had positive tests compared to seven or 5.4% of 129 normal controls. When the hospitalized population was analyzed by disease group, significantly elevated CIC levels were found in 27 disease categories, including several common conditions not generally considered to be immunologically mediated, such as angina pectoris, myocardial infarction, congestive heart failure, pneumonia, pulmonary emboli, diabetes mellitus, infarction of the bowel, and carcinoma of the lung. These results indicated that an important problem in the interpretation of CIC levels in a particular condition may be the presence of complexes caused by common diseases coexisting with the condition being studied.
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PMID:Circulating immune complexes in unselected patients admitted to the medical service of a general hospital. 706 76

This study explored the prevalence of comorbid conditions in hospitalized patients with multiple sclerosis (MS) who were 65 years of age or older. Using 1989 data from the Quality of Care Medicare Provider Analysis and Review (MEDPAR) file, hospitalized MS patients were compared with respect to discharge diagnoses to an age- and sex-matched group of hospitalized patients without MS. As expected, the following discharge diagnoses were more common (P < 0.05) for MS patients: urinary tract infection, pneumonia, septicemia and cellulitus. In contrast, MS patients were less likely (P < 0.05) to have discharge diagnoses of acute myocardial infarction, heart failure, hypertension, angina pectoris, cerebrovascular disease, diabetes mellitus and chronic obstructive pulmonary disease. Possible explanations include under-reporting of certain comorbid conditions on discharge records of MS patients, a protective effect of MS or its treatment, reduced prevalence of risk factors, disproportionate mortality in younger MS patients with comorbidity and the benefits of medical surveillance.
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PMID:Patterns of comorbidity in elderly patients with multiple sclerosis. 772 46

To predict hospital costs after coronary artery bypass grafting (CABG) from preoperative characteristics and postoperative complications, 4 analyses of the data were used: (1) a univariate analysis of each preoperative and postoperative variable, (2) a multivariate analysis of the preoperative variables (model 1), (3) a multivariate analysis of the postoperative variables (model 2), and (4) a multivariate analysis of pre- and postoperative variables (model 3). Eight-hundred seven patients who underwent a first-time CABG at Emory University during 1990 were analyzed in this study. Using model 1, the determinants of costs were higher angina grade (p = 0.0006), previous myocardial infarction (p = 0.0133), older age (p = 0.0001), congestive heart failure (p = 0.0001), and a higher number of diseased vessels (p = 0.0001). For model 2, the determinants of costs were adult respiratory distress syndrome (p = 0.0073), intraaortic balloon pumping (p < 0.0001), pneumonia (p < 0.0001), septicemia p < 0.0001), major arrhythmia (p < 0.0001), reexploration for bleeding (p < 0.0001), wound infection (p = 0.0632), neurologic event (p = 0.0013), fluid overload (p = 0.0516), and absence of pericarditis (p = 0.0588). For univariate analysis, the determinants of increased costs were similar to those from models 1 and 2. Although there is considerable variance in hospital costs for any number of complications, utilized resources (costs) increase inexorably as patients have more complications after coronary surgery. The mean cost to the hospital for the 382 patients who underwent CABG and experienced no complications was $16,776.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Predicting hospital costs for first-time coronary artery bypass grafting from preoperative and postoperative variables. 794 47

Rate adaptive ventricular pacemakers using central venous oxygen saturation (O2Sat) to control the pacing rate have been implanted in 14 patients (mean age 71 years), with a mean follow-up period of 44 months (range 2-63 months). In eight patients the pacemakers were replaced due to signs of battery depletion after an implant duration of 39-58 months. During bicycle exercise testing the O2Sat decreased on average from 61% +/- 4% at rest to 36% +/- 4% (P < 0.0001) at peak exercise, and the maximum pacing rate was 122 +/- 5 beats/min. The time delay until the O2Sat had dropped 10%, 65%, and 90% of the total reduction during exercise was 4.8 +/- 0.9 seconds, 39.8 +/- 3.8 seconds, and 71.3 +/- 7.5 seconds, respectively. The O2Sat decreased 9.4% +/- 2% (P < 0.005) from resting supine to resting sitting. Oxygen breathing increased the telemetered O2Sat from the pacemaker by 8.4% +/- 1% (P < 0.001). During follow-up the O2Sats were relatively stable in 50% of the patients, but demonstrated significant fluctuations in the others. At 1-year invasive follow-up O2Sat measured by the pacemaker decreased 22% +/- 2%, and in blood samples from the right ventricle 22% +/- 2% from rest to 3 minutes exercise at 25 watts. There was a significant correlation between O2Sat measured by the pacemaker and in blood samples from right ventricle (n = 105; r = 0.73; P < 0.001). In two patients the O2Sat dropped significantly during pneumonia. In another patient episodes of angina pectoris was associated with low O2Sat and a concomitant fast pacing rate.
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PMID:Long-term clinical performance of a central venous oxygen saturation sensor for rate adaptive cardiac pacing. 797 97

The problems of an etiotropic approach to the choice of antibiotics in the treatment of infants remain actual and require their solution which is evident from the example of some usual affections: intrahospital pneumonia of newborns, pneumonia of infant outpatients, purulent meningitis, etc. The practice of irrational therapy of some children infections such as streptococcal angina and scarlet fever, whooping cough, intestinal infections, otitis media purulenta, sinusitis is rather common. Attention should be paid to the organization of the bacteriological services and the increase of the physicians qualification in the field of antibiotic therapy and clinical microbiology. It is advisable that chemotherapeutists be included in the staff of certain general hospitals.
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PMID:[Use of antibiotics in pediatrics]. 803 80


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