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

Pertinent historical, clinical, and laboratory findings were recorded for 37 consecutive patients who presented to the emergency room complaining of shortness of breath and chest pain but without evidence of coronary insufficiency, pneumonia, or musculoskeletal injury. 13 had pulmonary embolism suggested by lung scan with or without pulmonary angiogram, or, in 2 cases, by right heart catheterization. As a group, these patients in whom embolism was judged probable approached fairly closely the profiles of previous studies of patients with documented pulmonary emboli. Nonetheless, they differed very little, and in no clinically useful way short of lung scans and invasive studies, from the remaining 24 patients in whom embolism was judged unlikely. In the population served by this emergency room, which has a high morbidity from chest diseases and putative predisposing conditions to pulmonary embolism, screening patients for high and low probability groups for this diagnosis cannot be done on clinical grounds alone. Six-projection ventilation-perfusion lung scanning may be the only acceptable screening examination, and should be available directly from the emergency room in hospitals with an active emergency service.
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PMID:Accuracy of screening for pulmonary embolism in the emergency room. 45 63

In this retrospective study of 115 cases of histoplasmids, there were 66 male and 49 female patients ranging in age from 2 months to 79 years. The most common presenting symptoms were cough, chest pain, wheezing, weight loss, hemoptysis, and shortness of breath. Thirty-five patients (30%) were asymptomatic. Two patients had manifestations of obstruction of the superior vena cava. Radiologic findings simulated carcinoma, tuberculosis, pneumonia, and viral infections. Sixty-five patients had various operative proceudres, such as lung biopsy, wedge resection, lobectomy, pneumonectomy, resection of lymph node, and bypass of superior vena cava, for diagnosis and treatment. There were two deaths and two postoperative complications. A total of 15 patients received intravenous amphotericin B. Four patients with pneumonic infiltrates developed disseminated histoplasmosis.
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PMID:Histoplasmosis: clinical manifestations and surgical management. 47 35

A farmer who had no prior history of pulmonary disease developed tightness in the chest of rapid onset, shortness of breath, fever, and pulmonary infiltration while farming. The symptoms of his disease worsened with repeated exposure to the dusty farm field but remitted after each of five hospitalizations. Provocative challenge with inhalation of a water-soluble extract of dust from the field reproduced both asthmatic and pneumonitic features of the disease, while administration of corticosteroids clinically controlled the entire process. The data suggest a common cause for asthma and pneumonitis in this patient.
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PMID:Hypersensitivity pneumonitis and extrinsic asthma. An unusual association. 66 46

An 18-year-old woman with stage IIIB Hodgkin's disease presented with minimal shortness of breath and progressed to fatal pulmonary insufficiency in five days. Biopsy and necropsy lung tissue specimens established the diagnosis of acute radiation pneumonitis. The diagnosis of radiation pneumonitis should be considered in the presence of a nonproductive cough, dyspnea, mixed interstitial and alveolar infiltrates on chest roentgenogram, negative cultures, and the characteristic findings on lung biopsy of macrophage accumulation and alveolar fibrin deposition in the face of minimal cellular infiltrate. A trial of steroid treatment may be warranted.
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PMID:Acute febrile illness associated with bilateral pulmonary infiltrates after irradiation in a patient with Hodgkin's disease. 84 87

Gold lung, a gold-induced pneumonitis, is considered to be caused by hypersensitivity reaction to gold. We performed lymphocyte stimulation test (LST) to determine the response to gold, using lymphocytes obtained by bronchoalveolar lavage (BAL) from a patient with gold lung. A 57-year-old man was admitted with progressive shortness of breath following a skin eruption. He had been receiving weekly sodium gold thiomalate (Shiosol) for rheumatoid arthritis, with a cumulative dose of 485 mg. Chest roentgenogram showed diffuse interstitial infiltrates. LST for the response to gold, using peripheral lymphocytes, was positive. T cell lymphocytosis was observed in BAL, and transbronchial lung biopsy showed lymphocytic alveolitis and granulation tissue in alveolar ducts. From these findings, we diagnosed gold lung. Prednisolone (PSL) was started with an initial dose of 30 mg/day and resulted in a rapid improvement. As the dose of PSL was tapered, the patient's condition deteriorated and he was treated with a maintenance dose of 10 mg PSL. The second BAL revealed persistent lymphocytosis, and LST using bronchoalveolar lymphocytes for response to gold was positive. LST using peripheral lymphocytes was also positive, but was weaker than that using bronchoalveolar lymphocytes. This is the first report in Japan of a positive LST for response to gold, using bronchoalveolar lymphocytes from a patient with gold lung. This case suggests that the presence of activated lymphocytes against gold in the lung is cumulative, and that cell-mediated hypersensitivity is related to gold lung.
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PMID:[A case of gold lung with positive lymphocyte stimulation test to gold, using bronchoalveolar lymphocytes]. 156 28

Toxoplasma pneumonia is being recognized with increased frequency, especially in patients with AIDS. We reviewed the English-, French-, and Spanish-language literature from January 1966 through February 1991 to identify cases of postnatally acquired pneumonia associated with Toxoplasma gondii. We identified two distinct clinical syndromes, one in immunocompetent patients and one in patients with defects in cell-mediated immunity. Shortness of breath and cough were the most common symptoms and fever and rales the most common signs in both groups of patients. Lymphadenopathy and hepatosplenomegaly were reported more frequently for immunocompetent patients. Chest roentgenographs usually revealed bilateral interstitial infiltrates, but a variety of other roentgenographic findings were reported. Serological findings were suggestive of active toxoplasmosis in immunocompetent but not in immunosuppressed patients. In early reports, identification of T. gondii as the etiologic agent of pneumonia was based on serology or autopsy findings. In more recent reports, open lung biopsy and especially bronchoalveolar lavage were used for diagnosis. Mortality among patients with toxoplasma pneumonia was 55%. However, in cases of T. gondii pneumonia diagnosed during life, mortality was 0 for immunocompetent patients and 40% for immunosuppressed patients. In immunosuppressed patients, improvement was associated with specific antitoxoplasma drug therapy. Unfortunately, relapses were common. We also reviewed data on series of patients with disseminated toxoplasmosis manifested predominantly in extrapulmonary sites and found that 33% of these patients had evidence of subclinical pulmonary involvement even though pneumonia had not been diagnosed clinically.
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PMID:Pulmonary toxoplasmosis: a review. 157 81

Thirty-eight patients were treated with high dose rate endobronchial brachytherapy to palliate symptoms (cough, hemoptysis, fever, and/or shortness of breath) caused by endobronchial of previously irradiated (greater than or equal to 5000 cGy) bronchogenic carcinoma. The dose per fraction was 600 cGy at a radius of 1 cm from the center of the linear path of the source, and each patient received three fraction, each fraction separated by a 1-week interval. Twenty-nine patients (76%) had symptomatic improvement, 16 with complete and 13 with partial relief of symptoms. The likelihood of symptom relief was greater in those patients who had extra-bronchial tumor measuring less than 5 cm (15/15) compared to those with extra-bronchial tumor measuring greater than or equal to 5 cm (2/8). The median duration of symptom relief was 7.5 months. Repeat bronchoscopy done 3 months after brachytherapy revealed that 41% (11/27) had complete tumor regression and another 41% (11/27) had partial regression. Nine of 14 patients with post-obstructive atelectasis/pneumonitis had radiographic improvement. Twelve patients (32%) died from massive hemoptysis occurring 2-56 weeks (median 10 weeks) after brachytherapy. Location of the recurrence was the most important predictor of pulmonary hemorrhage. It occurred only in patients with recurrence in the right upper lobe, right mainstem, or left upper lobe bronchus. Whether this high rate of fatal pulmonary hemorrhage was a real phenomenon or a statistical fluke of small numbers remains an unanswered question.
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PMID:The use of high dose rate endobronchial brachytherapy to palliate symptomatic endobronchial recurrence of previously irradiated bronchogenic carcinoma. 172 25

We have presented the case of a 45-year-old HIV-positive man who had a 2-week history of shortness of breath and fever and who was found to have pneumonia due to an acid-fast bacillus. Despite treatment with isoniazid, rifampin, ethambutol, and clofazimine, he died of the infection. Culture results obtained after his death showed the organism to be Mycobacterium kansasii. Mycobacterial infections are common in patients with AIDS, but are usually due to M tuberculosis or M avium complex. Of the 35 patients with AIDS and M kansasii infection mentioned in the literature, only eight of these were described; and of the four patients (including our patient) who received therapy considered appropriate for this infection, only two survived.
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PMID:Mycobacterium kansasii infection in a patient with AIDS. 174 88

A 56-year-old man was admitted with hemiparesis and shortness of breath. He was positive to human immunodeficiency virus (HIV) antibody and was diagnosed as acquired immunodeficiency syndrome (AIDS) with Kaposi's sarcoma and pneumocystis carinii pneumonia. He developed chronic photosensitivity and vitiligo preceding the onset of the AIDS-related complex (ARC). Association of the two skin lesions with HIV infection is very rare. Although the role of HIV infection in these skin lesions is not significant, the immunological responses in the early course of HIV infection may have contributed to the development of both of these skin lesions.
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PMID:Vitiligo and chronic photosensitivity in human immunodeficiency virus infection. 192 Sep 68

A 63-year-old white woman with a history of hypertension and chronic obstructive pulmonary disease presented to the emergency room with worsening shortness of breath, anorexia, coughing, increased thirst, and leg edema of two weeks' duration. Medications included lisinopril 10 mg/d, which had been started six weeks earlier, sustained-release theophylline 300 mg q12h, and an albuterol inhaler. The lisinopril was discontinued on admission. Serum sodium concentration was 109 mmol/L; the osmolality of the blood and of the urine were 253 mOsmol and 438 mOsmol, respectively, with a specific gravity of 1.025 and a urine sodium of 17 mmol/L. The hyponatremia initially was considered to be the syndrome of inappropriate antidiuretic hormone secretion in response to the patient's suspected pneumonia. Due to worsening blood pressure, lisinopril was restarted and the serum sodium concentration dropped from 134 to 126 mmol/L. Evaluation of the patient's hyponatremia included assessment of thyroid, adrenal, hepatic, and cardiac function that were within normal limits. The patient was discharged on the following medications: sustained-release theophylline 300 mg tid, prednisone 10 mg/d, albuterol inhaler 2 puffs q6h, and sustained-release verapamil 240 mg/d for blood pressure control. Her serum sodium concentration has remained between 135 and 140 mmol/L during hospitalizations for exacerbations of chronic obstructive pulmonary disease and for pneumonias 10 and 12 months after discharge.
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PMID:Severe hyponatremia: an association with lisinopril? 165 42


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