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

Tietze's syndrome is characterized by pain due to a self-limiting, localized, non-suppurative swelling of the costochondral or sternoclavicular junction of unknown etiology. The case of a woman is presented here who was submitted to the hospital under the suspicion of a pathological fracture. After extensive investigations the diagnosis of Tietze's syndrome was made by exclusion, and the patient was successfully treated with local injection of an anaesthetic. Possible differential diagnoses of Tietze's syndrome include myocardial infarction, pneumonia, and others. This report emphasizes the importance of a thorough clinical investigation and the need for the exclusion of severe and lifethreatening diseases.
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PMID:Tietze's syndrome--a chameleon under the thoracic abdominal pain syndrome. 323 63

Actinomycosis is an uncommon infection. The regions mostly involved are the cervico fascial area, the thorax and the abdomen. The thoracic variety accounts for approximately 15% of the cases. Clinical pictures of pulmonary neoplasm, abscess, and empyema have been described. Misleading symptoms often delay the right diagnosis. The present study describes a case of actinomycosis with pleuro-pulmonary involvement. A 48-year woman had been well until two and a half years previously, when she developed symptoms suggestive of pneumonia. When referred to a medical clinic with thoracic pain and tiredness, pulmonary embolism was suspected. Inhalation and perfusion scintigraphy showed several perfusion defects. There were several relapses, with clinical pictures suggestive of pulmonary embolism, before an abscess in the left axilla appeared. Drained pus showed no growth of Actinomycetes. Correct diagnosis of the true cause was only possible by direct microscopy. Possible symptoms and the diagnostic difficulties when Actinomycetes is involved are discussed.
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PMID:Thoraco-pleural actinomycosis presenting like diffuse pulmonary embolism. 323 66

One hundred and four children who were hospitalized for documented or suspected non-CNS bacterial infections (56 males/48 females, 22 days to 15 years old) were treated with intravenous imipenem/cilastatin for 9.4 days (range 3 to 28 days). Children up to three years of age received 100 mg/kg/day and older children 60 mg/kg/day, administered in four divided doses. Bacterial pathogens were isolated before therapy in 85%. Diagnoses in the 74 evaluable patients included bronchopneumonia with or without empyema (20%), peritonitis complicating appendicitis (16%), skin/soft tissue abscesses (14%), septicemia (11%) and miscellaneous other infections (39%). Among evaluable patients, 95% were clinically cured or improved. One patients, a marasmic child with pneumonitis due to pseudomonas, died during therapy. One evaluable patient each with shigellosis, Klebsiella pneumoniae empyema and streptococcal pneumonia had bacteriologic eradication or suppression but, due partly to noninfectious complications, had no overall clinical improvement. Most bacterial isolates (101/108) were eradicated, including many gram-negative and gram-positive aerobes and anaerobes; three pathogens persisted (one Proteus mirabilis and one Salmonella typhi, one Staphylococcus aureus); and one Escherichia coli pyelonephritis recurred after therapy ended too early. Imipenem/cilastatin was well tolerated by 91% of children. Clinical adverse experiences (AEs), none serious except for the one death, occurred in 19%; 12% were judged possibly related to imipenem/cilastatin, but none probably or definitely related. No serious laboratory AEs occurred; the most common AEs were eosinophilia (11%), urine discoloration, and infusion site pain. Imipenem/cilastatin is well tolerated and has excellent clinical efficacy in a wide variety of pediatric infections.
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PMID:Imipenem/cilastatin for pediatric infections in hospitalized patients. 333 Oct 43

A 47-year-old woman presented with the chief complaint of gait disturbance and pain of bilateral lower limbs. She was diagnosed as having necrotizing myelitis because myelography was normal and incidentally bilateral adrenal tumor was recognized by ultrasonography and computed tomography. Left adrenalectomy was performed under the diagnosis of bilateral non-functioning adrenal tumor or metastasis to the adrenal glands with unknown origin. The tumor was 10 x 6 x 3 cm in size and 175 g in weight. The pathological diagnosis was non-Hodgkin lymphoma (diffuse large cell type). After combination chemotherapy of vincristine, cyclophosphamide, prednisolone and adriamycin, residual right adrenal mass showed a remarkable reduction, but unfortunately she died 5 months later postoperatively because of complications of lung edema and pneumonitis.
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PMID:[A case of bilateral adrenal non-Hodgkin lymphoma]. 337 94

The extraperitoneal approach is not usually used for reconstruction of the abdominal aorta; however, herein we have made an attempt to influence vascular surgeons to modify this practice. The results in 200 patients approached extraperitoneally have been compared with those of 70 patients explored by the traditional transperitoneal route. The expeditious technique of extraperitoneal exploration described results in significantly less postoperative morbidity due to the pulmonary complications of atelectasis and pneumonia. Intestinal ileus is uniformly brief, and rarely requires nasogastric suction. Patients explored extraperitoneally have demonstrably less pain and were discharged from the hospital sooner. Furthermore, prosthetic graft patency and mortality were comparable in both groups. Thus, the retroperitoneal approach should be the preferred method of aortoiliac reconstruction since the postoperative convalescence period is smoother and shorter.
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PMID:Extraperitoneal approach for aortoiliac reconstruction of the abdominal aorta. 351 14

A randomized, open, prospective study including 45 patients with either soft tissue infections (29 cases) or pneumonia (15 cases) after surgical intervention and one case having both indications was carried out with ofloxacin. The standard dose was 200 mg ofloxacin b. i. d. In most cases, clinical symptoms, such as fever, rubor, swelling and pain in soft tissue infections, as well as fever, dyspnoea, physical and radiological signs for pneumonia, subsided within two to seven days. Laboratory data (blood analyses, liver enzymes) remained in the normal range. The overall tolerability was good. Bacteriological controls have proven that ofloxacin is able to eradicate a broad range of pathogens, including persister pathogens and also certain bacteria like Clostridium perfringens and Erysipelothrix rhusiopathiae. In our study, Streptococcus faecalis was of intermediate sensitivity in one case and resistant in another. Ofloxacin has proven to be effective in soft tissue infections and pneumonia after surgical intervention.
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PMID:Treatment of surgical infections with a modern quinolone: therapy of soft tissue infections and pneumonia with ofloxacin. 354 48

A previously healthy 27 year-old male plumber presented with six days of fever, nausea, vomiting, malaise and headache. The subsequent development of cough, dyspnoea and pleuritic pain coincided with the simultaneous development of progressive bilateral cavitary pneumonia with pleural effusion. Leucocytosis, thrombocytopenia, hyponatraemia, hypoalbuminaemia, hypophosphataemia and hypoxaemia were the main laboratory abnormalities. Clinical suspicion of Legionnaires' disease was confirmed by the presence of serum antibody to Legionella pneumophila (titre 1:512) by an indirect fluorescent antibody test. Treatment with erythromycin and rifampicin resulted in clinical recovery with minimal residual bilateral pleural effusion six months after presentation. This patient is the first to acquire Legionnaires' disease in Singapore.
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PMID:Legionnaires' disease--report of Singapore's first local case. 355 84

In order to estimate the incidence and significance of aspiration during anaesthesia, a study of cases in which this complication had occurred was made at the Karolinska Hospital. With the aid of the anaesthetic recordkeeping system of the Department of Anaesthesia and the computer-based register of diagnoses of in-patients at the hospital, all cases in which aspiration was recorded were retrieved. Eighty-three cases of aspiration were retrieved from the file of anaesthetic records and four from the in-patient register. This constitutes an incidence of 4.7 aspirations in 10 000 anaesthetics, or 1 in 2131. The patients most often affected were children and the elderly. In 83% of the cases there were one or more preoperative factors indicating an increased risk for aspiration, such as emergency operation (38 cases, 43%), upper abdominal or emergency abdominal surgery (14 cases, 16%), a history indicating delayed gastric emptying (e.g. peptic ulcer/gastritis, pregnancy, obesity, unusual stress or pain, elevated intracranial pressure, 54 cases, 61%). In 29 cases (33%) there was a history indicating an increased risk of regurgitation, e.g. nasogastric tube, oesophageal disease or pregnancy. In 15 cases of elective surgery, no history of increased risk for aspiration could be found. In 67% of those cases the aspiration was preceded by difficulties involving the airways or intubation. The incidence of aspiration was more than sixfold higher during the night than during regular daytime working hours. In 41 cases (47%) the aspiration led to aspiration pneumonitis confirmed by x-ray. Fifteen patients (17%) needed mechanical ventilation, and four died.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Aspiration during anaesthesia: a computer-aided study of 185,358 anaesthetics. 375 72

The authors report their 2-year experience of esophageal endoscopic sclerotherapy for prevention of recurrent variceal bleeding in patients with liver cirrhosis. Sixty-three alcoholic cirrhotics underwent sclerotherapy 10 +/- 6 days (SD) after hospital admission for variceal bleeding. Varices were successfully eradicated in 43 patients (68 p. 100), with an average of 3 injection sessions, over a mean period of 5 weeks. Unsuccessful treatment was due to abbreviated course of treatment because of early rebleeding and early mortality. Early rebleeding episodes after therapy occurred in 19 patients (30 p. 100): 10 in whom the esophageal varices were eradicated, 9 in whom sclerotherapy had failed. Recurrent hemorrhage was the cause of death in 6 patients. After variceal eradication had been achieved, new varices were observed in 7 p. 100 of patients after a mean follow-up of 8 months. The risk of further variceal bleeding was 0.008 hemorrhage/patient/month. Minor complications (thoracic pain, dysphagia, esophageal ulcers, pleural effusion) occurred in 60 p. 100 of patients. An esophageal stricture developed in 13 out of the 43 successfully treated patients (30 p. 100). Major complications occurred in 5 patients and was the cause of death in 4: mediastinitis, esophageal perforation, bronchoesophageal fistulae, cardiogenic shock and aspiration pneumonitis. The survival curve, assessed by cumulative life analysis, showed a 60 p. 100 survival rate after 12 months and 56 p. 100 after 18 months. It was significantly different (p less than 0.001) between groups of cirrhosis classified according to Child-Pugh's criteria (95, 52 and 9 p. 100 at 12 months for groups A, B and C respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Evaluation of 2 years' experience with elective endoscopic sclerotherapy of hemorrhagic esophageal varices in cirrhotic patients]. 387 11

Pulmonary problems are common in systemic lupus erythematosus, and may be the presenting feature of this multi-system disease. The clinical spectrum ranges from mild, self-limited, pleuritic chest pain to fulminant and rapidly fatal, diffuse, pulmonary hemorrhage. Accordingly, treatment must be individually tailored to the clinical features of each patient. Non-steroidal-anti-inflammatory drugs may be adequate therapy for pleuritic pain. High dose corticosteroids may be indicated in more severe cases of pleurisy with effusion, lupus pneumonitis, and diffuse interstitial lung disease. Immunosuppressive drugs such as azathioprine and cyclophosphamide should be considered in cases of lupus pneumonitis or interstitial lung disease unresponsive to steroids. Combined therapy with corticosteroids, immunosuppressives and plasmapheresis should be considered for fulminant cases of diffuse pulmonary hemorrhage attributed to lupus. There is no definitive therapy for pulmonary hypertension at this time. Decisions regarding treatment in each instance must be made with the recognition that there is little strong clinical evidence to support the use of any of these therapies. Finally, no pulmonary process should be attributed to lupus until infection has been rigorously excluded in these patients.
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PMID:Pulmonary disease in systemic lupus erythematosus. 390 99


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