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)

About 120,000 infants are born each year with sickle cell disease (SCD) in Africa. The majority have Hb SS, but Hb SC and Hb S/beta+ thalassaemia are common in west Africa. The development of Plasmodium falciparum and P. malariae is partially inhibited in the Hb SS red cells, but malaria precipitates both haemolytic and infarctive crises, and is the commonest and most important cause of morbidity and mortality. The pneumococcus is likely to be the second major infectious cause of sickness and death. In one rural community, there were less than 2% of the expected number of subjects with SCD surviving beyond 5 years of age. Genetic factors improving prognosis include (1) the Senegal beta chain haplotype, which is linked to a high level of Hb F, and (2) alpha+ thalassaemia. Of environmental factors improving prognosis, the family is of first importance. The commonest age of presentation is 1-3 years. Children present with anaemic crises (malaria, splenic sequestration, folate deficiency, and possibly aplastic), infarctive crises (hand-foot syndrome, bone-pain, pulmonary and abdominal) or acute infections (malaria, pneumonia, septicaemia, meningitis, osteomyelitis). Tragically, many patients in central Africa have been infected by the human immunodeficiency virus (HIV) through blood transfusions; they present with generalised lymphadenopathy and other features of the acquired immunodeficiency syndrome (AIDS). The principles of management are (1) to ensure freedom from malaria, (2) to continue folic acid supplements, (3) to give blood transfusions only when anaemia endangers life, (4) to control pain, (5) to restore hydration, and (6) to prescribe broad spectrum antibiotics in large dosage and without delay, but only when there are definite indications, such as fever (greater than 39 degrees C), acute pulmonary disease, meningitis, and acute osteomyelitis. The advent of HIV and AIDS makes the control of SCD of even greater importance. Principles of control are (1) early diagnosis through appropriate laboratory techniques and selective screening, (2) education of parents, patients, health professionals and public, and (3) the maintenance of health at sickle cell clinics; measures must include antimalarial prophylaxis. SCD programmes should be integrated with primary health care and AIDS control programmes.
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PMID:The presentation, management and prevention of crisis in sickle cell disease in Africa. 265 Jul 73

Twelve patients with a bronchial carcinoid tumor seen over the past 10 years, were retrospectively analyzed. The age, symptoms, smoking habit, previous respiratory conditions, X-ray and extension of the tumor, bronchial endoscopy, treatment and survival were studied. The mean age of these patients was 42.5 years with a male predominance of 2:1. More than half of the patients were smokers (58.3%). The most common symptoms were hemoptysis, costal pain, pneumonia and fever. Two of the patients were asymptomatic (16.6%) and their tumor was detected in a routine health control. Almost half of the patients (41.6%) complained of respiratory symptoms for 3 years previous to diagnosis (mean 7.8 years with a range of 3 to 11 years). 75% of the cases were centrally located. The left lung was most frequently affected (75%). Fiberbronchoscopy was carried out in nine patients; in eight of them the tumor was localized and information was obtained about the segment involved. However, the biopsy was positive in only one case (14.2%). Two patients presented endocrine symptoms with a syndrome similar to the carcinoid. The disease was disseminated with adrenal metastasis in two cases, one of which had also bone and liver metastasis. An immunohistochemical study was performed in eight cases with a positive result for ACTH and calcitonin in one patient. Ten patients were treated with surgery; one with chemotherapy and the other was treated with palliation. Two patients were lost in the follow up period.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Carcinoid tumor of the bronchi. An infrequent tumor. Clinical study of 12 cases]. 267 62

A case is presented of a 17-year-old with leukemia, pneumonia and chest-wall pain. Inadequate treatment of the patient's pain led to behavioral changes similar to those seen with idiopathic opioid psychologic dependence (addiction). The term pseudoaddiction is introduced to describe the iatrogenic syndrome of abnormal behavior developing as a direct consequence of inadequate pain management. The natural history of pseudoaddiction includes progression through 3 characteristic phases including: (1) inadequate prescription of analgesics to meet the primary pain stimulus, (2) escalation of analgesic demands by the patient associated with behavioral changes to convince others of the pain's severity, and (3) a crisis of mistrust between the patient and the health care team. Treatment strategies include establishing trust between the patient and the health care team and providing appropriate and timely analgesics to control the patient's level of pain.
Pain 1989 Mar
PMID:Opioid pseudoaddiction--an iatrogenic syndrome. 271 May 65

A pneumothorax occurred in a 29-year-old HIV-positive woman with rapidly progressive dyspnoea at rest and left-thoracic pain, dry cough and fever. Sputum test revealed Pneumocystis carinii pneumonia. Treatment was started with 20 mg/kg trimethoprim and 100 mg/kg sulfamethoxazole, but was poorly tolerated and changed for pentamidine, 4 mg/kg i.v. from the fifth day onwards. A chest drain was inserted, but pleurodesis became necessary after two further lung collapses. After three weeks secondary prophylaxis of the Pn. carinii pneumonia was started with pentamidine inhalations (60 mg every two weeks). The patient gradually improved under this regimen. Pneumothorax is a rare complication of Pn. carinii pneumonia, but should be considered in patients with rapid respiratory deterioration. In addition, Pn. carinii pneumonia should be considered in HIV-positive patients with pneumothorax.
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PMID:[Pneumothorax as a complication of Pneumocystis carinii pneumonia]. 280 85

From 1985 to 1987, we had 4 patients with infected emphysematous bulla, three males and one female ranging from 18 to 61 years of age. The male patients had been suffering from emphysematous bullae and had complications stemming from the resulting infection. In the female case, the infection occurred at the pneumatocele which had grown at pneumonia was caught during steroid therapy for SLE. While all cases were medicated with antibiotics intravenously, they were drained with a small caliber tube percutaneously, then were washed using a cytocidal agent (dilute povidone iodine). In two cases, an infected emphysematous bulla and an infected pneumatocele cleared, then shrank and closed. In the remaining cases, the infected emphysematous bullae also cleared and shrank, then the patients underwent operations. All patients then healed. The therapeutic combination of percutaneous drainage with a small caliber tube and washing of infected emphysematous bulla is available for therapy or preoperative treatment for the following reasons: First of all, especially in patients who have remarkably disturbed pulmonary function, it can be performed safely and pt's symptoms and the general condition of the patient improves rapidly. The second reason is that, in some particular cases, it achieves the remarkable shrinkage and closure of infected emphysematous bulla. The third reason is that, the patients experience minimum pain with the use of a small caliber drainage tube.
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PMID:[Treatment of the infected emphysematous bulla]. 280 13

At our institution, the TAH has been identified as a valuable support to a select subgroup of individuals with end-stage heart disease as a bridge to transplantation. Length of implantation has varied from 1 to 48 days in the PUH series. Management of the care of the TAH-implanted patient requires a collaborative effort by nurses, physicians, and biomedical engineers. Nurses caring for the patient must have extensive knowledge of postoperative care of the high-risk cardiac surgical patient that is supplemented by the specialized knowledge of TAH function and monitoring. We have identified specialized components to the nursing care of the patient following TAH implantation. Monitoring for hemorrhage is important in the immediate postoperative period; anticoagulation and assessment of possible embolic events are later considerations. Knowledge of the relationship between TAH function and changing preload and afterload enhances the nurses' interpretation of COMDU and hemodynamic monitoring parameters, and is essential when applied to other nursing interventions, such as patient positioning and mobilization. Nursing-care measures to prevent atelectasis or consolidation are essential to prevention of pneumonia. Prevention of infection is crucial to facilitate transplantation. Practice of aseptic technique with particular care to drive-line insertion sites is necessary. Pain management, as well as nutritional and psychologic support, are important to promote patient well-being (a nursing-care plan is outlined in Table 1). The goals of all nursing-care measures are an improved perfusion state as offered by the TAH, prevention of possible complications associated with TAH implantation, and prevention of possible complications of critical illness and immobility. The desired outcome is a patient with a stabilized or improving condition prior to cardiac transplantation. It has been exciting to participate in the development of nursing-care guidelines for a patient population that has little precedent. The TAH creates a symbiotic relationship between man and machine, and nursing-care responsibilities have grown to encompass the mechanical aspects of this relationship. Satisfaction has increased as well, as the nurse is able to provide a specialized service in the provision of a life-saving therapy and be a vital element in the successful implementation of an artificial-heart program. As advances are made in the development of mechanical devices that assist or replace the human heart, ongoing evaluation and refinement of nursing care guidelines are essential.
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PMID:Nursing considerations for the patient with a total artificial heart. 281 89

Most forms of barotrauma related to mechanical ventilation are known to occur in both adult and pediatric patients. The pressure-driven transfer of gas from the alveolar compartment to the systemic circulation, a devastating complication of ventilatory support in infants, is not generally recognized as a consequence of ventilatory support in adults. Two young adult patients who received ventilatory support with high levels of positive pressure for pneumonia and the adult respiratory distress syndrome developed massive sub-pleural air cysts, interstitial emphysema, and tension pneumothoraces. Despite receiving appropriate treatment for these problems, the patients had recurrent episodes of cerebral infarction, myocardial injury, and a characteristic pattern of livedo reticularis. This distinctive triad of findings, otherwise unexplained and occurring in the setting of cystic barotrauma, is highly suggestive of systemic gas embolism. Although our patients presented with dramatic clinical features, we believe that patients with ventilator-related gas embolism may present more commonly with subtler signs, such as puzzling disturbances in heart rhythm or mental status, seizure activity, hypotension, localized pain, or other embolic manifestations readily ascribed to other causes in critically ill patients.
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PMID:Systemic gas embolism complicating mechanical ventilation in the adult respiratory distress syndrome. 293 Jan 7

The chemistry, spectrum of activity, mechanism of action, pharmacokinetics, adverse effects, and dosage and administration of pentamidine are reviewed, and the role of the drug in treating Pneumocystis carinii infections in immunocompromised patients is discussed. Pentamidine isethionate, an aromatic diamidine compound, is active against certain protozoan organisms. Used extensively in the tropics in the treatment of Trypanosoma and Leishmania infections, its value in the management of Pneumocystis carinii infections has been demonstrated in infected immunosuppressed children and adults. Recently, interest in pentamidine has increased with the rising number of patients with acquired immunodeficiency syndrome (AIDS) who have P. carinii pneumonia. Pentamidine's mechanism of action and pharmacokinetic profile are not completely understood. Pentamidine is distributed extensively after i.v. or i.m. administration, with a volume of distribution of 3 L/kg. Appreciable quantities of pentamidine concentrate in the urine, and drug levels are detectable for up to six to eight weeks after cessation of therapy. After aerosol administration, the drug is almost exclusively recovered from the lung, with little extrapulmonary distribution. Available data suggest that approximately 50% of patients who receive the drug by the i.v. or i.m. route will experience some drug toxicity (local pain, sterile abscesses at the intramuscular injection site, hypoglycemia, hypotension, or azotemia), while adverse effects after aerosol therapy include bronchial irritation but little systemic toxicity. Regardless of the route of administration, pentamidine has emerged as a mainstay of therapy in the management of P. carinii pneumonitis in AIDS patients, especially in those who are allergic to the sulfa component of trimethoprim-sulfamethoxazole.
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PMID:Update on pentamidine for the treatment of Pneumocystis carinii pneumonia. 304 30

The increasing number of beta-lactam antibiotic-resistant infections has led to the development of an alternative treatment: the combination of a beta-lactam antibiotic with an irreversible, suicide-type, beta-lactamase inhibitor. Such a combination, sulbactam/ampicillin, was used in clinical trials at 4 European and 1 American centres to treat severely ill patients with lower respiratory tract infections including bronchiectasis, pneumonia and purulent tracheobronchitis. The sulbactam/ampicillin combination was assessed for safety, efficacy and tolerance in a total of 91 patients. Investigators from all 5 centres reported satisfactory bacteriological and clinical results. The combination agent either cured or improved the condition of virtually all patients who were evaluated. The few side effects reported mainly involved pain at the injection site. A review of these studies indicates that therapy with sulbactam/ampicillin effectively treats lower respiratory tract infections in severely ill patients without causing serious adverse reactions.
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PMID:Sulbactam/ampicillin in the treatment of lower respiratory infections. 306 54

An unusual case of post-irradiation aneurysm of extracranial internal carotid artery is presented. A 70-year-old man, complaining of left cervical throbbing mass with focal pain, was admitted on February 8, 1985. It was noted, from his past history, that he had had surgery of the removal of cervical lymph-nodes and that unknown dosage of irradiation had been added to the cervical region 30 years before. Left carotid angiography (on admission) demonstrated a giant aneurysm in the cervical portion of internal carotid artery. Right carotid angiography with compression of left carotid artery revealed good cross filling through anterior communicating artery. Computed tomography with contrast media showed a ring like enhanced mass, which was thought to showed a ring like enhanced mass, which was thought to suggest that a large part of the aneurysm was filled with intraluminal thrombosis. During 30 days of evaluation, the aneurysm grew larger and his cervical pain became untolerable. Operation, the resection of the aneurysm and the reconstruction (of circulation) with vein graft, was challenged n March 12. It was so difficult with meticulous work that the ligation of left common carotid artery was performed after all. Seven days after the operation, he suffered from the gastrointestinal bleeding, which was enough to lead him to hypovolemic shock. Thereafter, right hemiparesis and aphasia were brought about. Two months later, he die of pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of radiation induced aneurysm of extracranial carotid artery]. 320 68


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