Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 24-year-old Chinese woman presented with cough, chest pain, weight loss, low grade fever and bronchial breath sounds on auscultation. The diagnosis of chronic eosinophilic pneumonia was made on characteristic systemic and pulmonary clinical manifestations, blood eosinophilia and the striking chest radiographic appearance. This rare, idiopathic but benign condition responds well to corticosteroid treatment and the long term prognosis is excellent. The typical chest radiographic pattern of 'photographic negative of pulmonary oedema' in this condition is emphasised.
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PMID:Clinics in diagnostic imaging (17). Chronic eosinophilic pneumonia (CEP). 904 11

This study analyzes patient demand in a regional public health pulmonology practice. The following data were recorded for all first-visit patients for a period of two years: age, sex, referral source, initial diagnosis by the referring physician, final diagnosis by the pulmonologist, and destination. The service studied 1,486 patients (men/women: 1.5). Most (71%) were between 40 and 80 years old. Referrals were from the family doctor (60%), health center (9%), emergency service (10%), hospital (12%), other specialists (6%), and others (3%). The most frequent reasons for remission were upper airway disease (UAD) (36%), specifically chronic obstructive pulmonary disease (COPD) and asthma, and the presentation of symptoms (28%) such as dyspnea, cough, hemoptysis and chest pain. Analysis of the final diagnoses for the patients presenting with symptoms showed that no disease could be detected in one third of those with dyspnea and hemoptysis or in half of those who complained of chest pain; acute respiratory infection was diagnosed in 45% of those complaining of persistent cough. UAD was the most frequent cause of symptoms. The index of doctor's visit/inhabitant was 0.97% for patients referred by family doctors and 0.38% for those from health centers, but the initial and final diagnosis profiles of these patients were not statistically different. Patients referred by emergency services had significantly more (p < 0.001) in number of radiological findings and hemoptysis. Those sent from hospitals more often suffered pneumonia. In conclusion, this profile of a regional public health pulmonology practice shows that: 1) UAD and clinical symptoms are the most frequent reasons for patient remission; 2) family doctors generate three times mor demand for services than do health centers, and 3) 14% of patients can be considered normal.
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PMID:[Profile of a pneumology regional health service]. 906 82

Occult infections during sickle cell pain crisis can be associated with significant morbidity. It has been suggested that empiric workup for pneumonia and urinary tract infection (UTI) is required. A study was undertaken to determine whether clinical criteria can be used to exclude such infections as precipitants of pain crisis in adults. This retrospective, observational clinical study was conducted in an inner-city teaching hospital emergency department (ED) with 95,000 visits/year. Patients 18 years of age or older presenting to the ED with sickle cell pain crisis who had not used antipyretics within 6 hours before presentation were eligible. Ninety-four visits were evaluated. During initial evaluation the treating physician completed a questionnaire addressing systemic, pulmonary, and urinary tract signs and symptoms. Temperature and physical examination were recorded on an ED memo. Treatment modalities were at the discretion of the treating physician. All patients had a complete blood count, reticulocyte count, urinalysis, and chest radiograph. If the urinalysis was positive (>2 white blood cells) or the patient had clinical evidence of a UTI, a urine culture was obtained. UTI was confirmed through a urine culture with >100,000 colony-forming units/mL. Chest X-rays were reviewed by a staff radiologist. Definitive diagnosis of pneumonia was made by the presence of an infiltrate and a positive clinical response to antibiotic therapy. Thirty-eight patients totalling 94 visits to the ED were studied during an 18-month period. Six diagnoses of pneumonia and 3 diagnoses of UTI were made. All six patients with pneumonia had at least 4 of the signs and symptoms including fever, chills, cough, shortness of breath, sputum production, chest pain, hemoptysis, abnormal pulmonary examination, and temperature of >37.8 degrees C. Of the three patients with UTI, two had signs and symptoms inconsistent with UTI (asymptomatic bacteriuria). In patients with sickle cell pain crisis, medical history and physical examination can be useful to predict the absence of pneumonia, but may not be as beneficial in predicting the absence of UTI. These results suggest that empiric chest x-ray may be unnecessary to exclude pneumonia; however, routine urinalysis may be indicated. Because of the low incidence of these infections, larger studies are required to confirm these findings.
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PMID:Diagnostic evaluation for infectious etiology of sickle cell pain crisis. 914 90

Pulmonary hemorrhage is a rare cause of death in patients with acute leukemia. Within a 3-month period we observed three such cases, all of which were associated with the gram-negative opportunistic pathogen Stenotrophomonas maltophilia. Since fatal lung bleeding had previously not been observed in conjunction with this organism, we collected the data from all patients with documented S. maltophilia infections or colonizations of the past year and analyzed the risk factors for a lethal outcome. A total of eight patients were identified. In the three patients with fatal hemorrhage, the interval between first complaints (chest pain, cough, fever) and death from lung bleeding was 36-72 h. A fourth patient with acute leukemia died of nonhemorrhagic respiratory failure 9 days after developing S. maltophilia-associated pneumonia. All four patients had received intensive chemotherapy and were severely neutropenic and thrombocytopenic. Such a combination of predisposing factors was not observed in the four patients with nonfatal infections or colonizations. Pulsed-field gel electrophoresis demonstrated that the infections were unrelated. S. maltophilia was also isolated from a faucet in a patient's room, but the strain isolated was genetically different from the strain causing the patient's pneumonia. Our data suggest that severe bone marrow aplasia and a recent history of intensive chemotherapy are predisposing factors for the development of fulminant hemorrhagic S. maltophilia pneumonia. Since some of the infections and colonizations developed despite prophylactic administration of antibacterial agents with documented in vitro activity against the pathogen and none was controlled by such agents, it is clear an efficient treatment strategy needs to be developed.
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PMID:Fatal pulmonary hemorrhage in patients with acute leukemia and fulminant pneumonia caused by Stenotrophomonas maltophilia. 917 42

Ascariasis and hookworm (ancylostomiasis) remain the most common intestinal nematodes in the world with significant economic, social, and medical impact. An understanding of the transmission and pathogenesis of ascariasis and hookworm are necessary to recognize their clinical manifestations and to manage the pulmonary sequelae of infection. Transmission occurs predominantly in the tropics and rural areas where there is suboptimal sanitation, personal hygiene, and education regarding these parasites. Ascariasis generally occurs through hand-to-mouth ingestion of agricultural products or food contaminated with parasite eggs. Hookworm is transmitted through larval penetration of the skin. Larval pulmonary migration generally is asymptomatic. However, symptomatic pulmonary disease may occur with fever, cough, chest pain, hemoptysis, dyspnea, and wheezing due to (1) Loffler's syndrome, (2) the effects of larval tissue migration, (3) airway reactivity or bronchospasm, (4) infectious bacterial complications from parasitic migration and associated aspiration, and rarely (5) chronic eosinophilic pneumonia, transdiaphragmatic penetration, or symptoms of upper airway obstruction. Clinical evaluation shows pulmonary opacities on chest radiograph, peripheral blood eosinophilia, and larvae in respiratory or gastric secretions. Symptomatic treatment may be necessary with bronchodilators and systemic steroids or antibiotics for bacterial complications. The drug of choice is mebendazole (Vermox) 100 mg twice a day for 3 days. Alternatives include a single dose of pyrantel pamoate (Antiminth) 11 mg/kg (maximum dose, 1 g) or albendazole (Zentel) 400 mg orally once. Invermectin (Mectizan) is available through the World Health Organization, and, in the United States, through the manufacturer on a compassionate-use basis. Ivermectin is as effective as currently available drugs against Ascaris but shows only partial efficacy against hookworms, which infest humans. Preventive measures, improvement of sanitary facilities, education, and school screening may be important in the endemic areas to control these parasitic infections.
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PMID:Ascariasis and hookworm. 919 78

Esophageal achalasia (EA) has been historically treated by esophageal dilatation or myotomy with or without fundoplication. Botulinum toxin (Botox-Allergan) use in pediatric EA has not been previously described. The authors' objective was to observe the efficacy of botulinum toxin injection into the lower esophageal sphincter (LES) for EA. An 11-year-old boy presented with a 9-month history of frequent pneumonia, productive cough, and a 1-year history of chest discomfort and odynophagia. Chest radiograph showed changes compatible with aspiration. Upper gastrointestinal (UGI) series showed typical narrowing of the LES, and 24-hour pH study showed no reflux. Esophageal manometry showed classic findings of achalasia. An upper gastrointestinal endoscopy was performed showing a huge volume of retained food. A direct four-quadrant injection was performed with a total of 100 U of botulinum toxin into the LES. UGI series showed improvement in esophageal emptying. Esophageal manometry showed impressive improvement in LES pressure (preinjection, 44.1 mm Hg to postinjection mean of 16.6 mm Hg), percent relaxation (preinjection, 30% to postinjection, 58.8%), and duration of relaxation (preinjection, 1.9 seconds to postinjection, 11 seconds). The patient has not had any further respiratory symptoms, chest pain, or odynophagia in 8 months of follow-up. Botulinum toxin injection is simple and effective for EA and merits its study in a prospective manner in the pediatric population.
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PMID:Botulinum toxin use in pediatric esophageal achalasia: a case report. 920 Jan

Children acquire blastomycosis, with rare exceptions, through the respiratory route. Nearly half of those who are infected may be asymptomatic. Cough is the most common symptom and is usually without sputum production, and hemoptysis is not noted. Other symptoms are chest pain (described as tightness or pain when breathing), weight loss, night sweats, and loss of appetite. The severity of illness is variable and may simulate an upper respiratory infection, bronchitis, pleuritis, or pneumonia. As in adults, an overwhelming infection may cause respiratory failure even in immunocompetent children and in immunocompromised children who live in or travel to endemic areas are susceptible to infection. Some reports based on consecutive cases note extrapulmonary dissemination commonly in children, whereas dissemination is rarely noted in outbreak cases. Chronicity of the disease favors extrapulmonary dissemination. Chest radiograph patterns are alveolar infiltrates, consolidation, and nodule(s), and these may be accompanied by cavitation. Diagnosis is suspected when the symptoms that mimic common respiratory infections persist for more than 2 weeks and by a history of residence or travel to an endemic area. Chest radiographic findings of nodule(s) or cavitation further increase the suspicion. Confirmation of diagnosis is by microscopic examination and culture of sputum. When expectorated sputum is unavailable, bronchoscopy with lavage and biopsy or percutaneous needle biopsy of lung is the appropriate next step. Disease that is progressive or severe or disseminated to other organs should be treated. Amphotericin B is effective and results in excellent cure rates. Experience using oral azoles is limited in children.
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PMID:Blastomycosis in children. 931 95

Chest pain is the initial symptom of many life-threatening disease processes. Pain may arise from any structure located in the thoracic cavity. Cardiac causes of chest pain usually have anginal symptoms. Noncardiac causes have a variety of chest pain characteristics. Diseases that require immediate attention and intervention are myocardial infarction/unstable angina, dissecting aortic aneurysm, pericarditis, pulmonary embolism, pneumothorax, pneumonia, and acute chest syndrome. In order to evaluate a patient with the complaint of chest pain, the advanced practice nurse must be familiar with the differential diagnosis approach to acute chest pain.
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PMID:Acute chest pain. 931 75

We reviewed the case records of 10 Oriental patients with systemic lupus erythematosus (SLE) who developed pulmonary haemorrhage (PH) between 1987 and 1996 to determine their clinical presentation and outcome. All the patients had clinical evidence of PH including a sudden onset of dyspnoea, tachycardia, fall in haemoglobin (at least 1.5 gm%) and bilateral diffuse alveolar infiltrates on chest radiographs. At the time of PH, nine patients had a disease duration of 2 years or less and all the patients had clinical and/or laboratory evidence of active lupus disease. Fever and lung crepitations were present in 90% of patients while haemoptysis and chest pain occurred in only three and two patients, respectively. All the patients were treated with high dose intravenous corticosteroids and in addition seven had a combination of pulse methylprednisolone and cyclophosphamide, and four had received plasmapheresis. Four patients died as a result of PH. One patient died of pneumonia three years after recovering from PH while the remaining five had no recurrence of PH after a median follow-up of 22 months. Our study suggests that PH in Oriental lupus patients often occurs early in the disease, rarely presents with haemoptysis and has a high mortality despite aggressive immunosuppressive therapy.
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PMID:Pulmonary haemorrhage in Oriental patients with systemic lupus erythematosus. 941 86

The most common diagnoses of elderly patients in the emergency department (ED) were compared among three age subgroups: 65 to 74, 75 to 84, and 85 and older. The computerized billing records for patient visits to 10 northern New Jersey hospital EDs for the years 1985 to 1991 were retrospectively analyzed. The most frequently occurring ICD-9-CM codes for elderly patients were compared among the three age subgroups. Elderly persons comprised 174, 146 (14% of the total) patient visits. The 176,146 patient visits were assigned 259,440 ICD-9-CM codes. The most common ICD-9-CM codes for medical diagnoses included chest pain, cardiac dysrhythmias, congestive heart failure, syncope, abdominal pain, and dyspnea. Fractures, particularly of the lower limb and upper limb; contusions; open wounds, particularly of the head, neck, and trunk; and falls were among the most common trauma diagnoses. The proportions in the three age subgroups of each diagnosis were statistically significantly different, except for cardiac arrest and contusions of the trunk and of multiple sites. The diagnoses with clinically significant higher relative risks in older age subgroups were atrial fibrillation, congestive heart failure, syncope, hypovolemia/dehydration, gastrointestinal hemorrhage, dyspnea, pneumonia, pulmonary edema, cerebrovascular accident, septicemia, urinary tract infection, fractures, and open wounds of the head, neck, trunk, particularly the scalp, and falls. Clinically significant lower relative risks were found in older age subgroups for chest pain, acute myocardial infarction, hypertension, angina, chronic airway obstruction not elsewhere classified, epistaxis, contusions of the upper limb, and open wounds of the finger.
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PMID:Age-related differences in diagnoses within the elderly population. 945 12


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