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

Success in lung transplantation has been hindered by airway complications, usually as a result of anastomotic ischemia and stenosis. We report our experience with expanding metal stents in managing airway stenoses after lung transplantation. From April 1984 through November 1993, 46 single lung, 5 double lung, and 154 heart-lung transplantations were performed at Papworth Hospital. All patients received immunosuppression with azathioprine, cyclosporine, methylprednisolone, and induction antithymocyte globulin. Fourteen patients (nine single lung, two double lung, and three heart-lung) had an airway stenosis requiring a stent. The most common features were shortness of breath, wheezing or stridor, and a fall in pulmonary function tests (11 patients). Three patients had pneumonia. Airway stenosis was diagnosed on bronchoscopy an average of 61 days after transplantation (range 3 to 245 days). Stent placement occurred an average of 18 days after the diagnosis (range 2 to 84 days). One heart-lung transplant recipient received a silicone rubber stent. All other patients received expanding metal stents. Six patients required multiple stent placements. After stent placement the average increase in the forced expiratory volume in 1 second was 117%. Infection complicated the stenoses in 12 patients. Pseudomonas aeruginosa and Aspergillus fumigatus were the most common pathogens, each occurring in six cases. Multiple pathogens were isolated in seven cases. Three patients died as a direct consequence of their airway problems. Two died of pneumonia despite stenting, and a third died of acute occlusion of the silicone rubber stent. Expanding metal stents are an effective treatment of airway stenoses in lung transplant recipients. Patients with suspected airway problems should be referred for early bronchoscopy with the potential for stent placement.
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PMID:Airway stenoses after lung transplantation: management with expanding metal stents. 780 17

Lower respiratory disease is a major source of morbidity in military recruits, with hospitalization rates for pneumonia more than 30 times that of the non-recruit population. The etiologic agent remains unknown in over 75% of cases. This study prospectively examined the etiology of pneumonia among recruits at Naval Training Center, San Diego, California. Recruits presenting with cough, fever, or shortness of breath and pulmonary infiltrates on chest X-ray were eligible for enrollment. A standardized scoring form and focused physical exam were completed on each subject. Sputum specimens were obtained for Gram's stain and culture, DNA probing for Legionella and Mycoplasma species, and direct fluorescent antibody staining for Legionella. Acute and convalescent serologies were performed for adenovirus, influenza A and B, Mycoplasma pneumoniae, Chlamydia group, and respiratory syncytial virus. Of 110 eligible patients, 100 consented to enrollment and 75 patients completed the study. Etiologic diagnoses were obtained in 40 of the patients (53%). M. pneumoniae, Haemophilus influenzae, and viruses accounted for the majority of infections. Mixed infections were seen in six patients. Forty-seven percent of patients had no diagnosis established. Pneumonia in this series of military recruits was frequently caused by M. pneumoniae and H. influenzae. Fifty percent of cases were undiagnosed with routinely available laboratory methods. Further studies are warranted to more clearly define the etiologic agents of recruit pneumonia and the utility of prophylactic measures.
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PMID:Pneumonia in military recruits. 787 Mar 17

Side reactions following ivermectin treatment were evaluated in sixty males with high density bancroftian microfilaremia (GM 1388/ml). Following a single oral dose of ivermectin of different strengths (20, 50, 100 or 200 micrograms/kg), microfilariae clearance and side reactions were monitored in a double blind fashion. Microfilaria levels fell rapidly after ivermectin administration in all dosage groups and 98% of pretreatment microfilariae was cleared after 12 h of treatment. The rate of microfilaria (mf) clearance was slower with 20 micrograms/kg than with the highest dose (200 micrograms/kg) administered. Forty-six patients (77%) became amicrofilaraemic within 2 weeks of treatment. Side reactions were noted in 97% of cases. The most common reactions were fever, headache, weakness, myalgia and cough which appeared by 12 h and subsided by 72 h following treatment. The frequency and intensity of side reactions were related to pretreatment mf densities and were independent of the dose administered. Unusual side reactions were noted in a few patients with high density microfilaraemia. These included intense cough, shortness of breath, blood tinged mucoid expectoration associated with patchy pneumonitis of the lung. Itchy rashes, lymphatic nodules and raised alkaline phosphatase level were also observed in some patients. These side reactions were transient, self limiting and were not serious enough to warrant any treatment. These exaggerated unusual reactions were possibly due to allergic response of the susceptible host to rapid killing of large number of microfilariae.
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PMID:Side reactions following ivermectin therapy in high density bancroftian microfilaraemics. 790 35

We conducted a nested case-control study utilizing cases of clinical pneumonia identified in a community-based prospective surveillance study of children under 3 years of age in order to test the validity of a survey questionnaire. Three types of sex- and age-matched concurrent controls were selected from the surveillance population: acute respiratory infection (ARI) clinic controls. ARI community controls and healthy community controls. Survey interviews were scheduled at random for any of four consecutive 7-day periods after the diagnosis of the case. The questionnaire covered a 30-day recall period. The combination of cough with fast breathing or shortness of breath, and with fever, provided the highest positive predictive value for pneumonia. The sensitivity of some questions dropped when the interview took place more than 15 days after the diagnosis of the case. However, the utilization of a 15-day recall period did not increase the positive predictive value of the survey. We conclude that in this trained population under surveillance, a survey questionnaire utilizing a 30-day recall period and using the combination of cough, fast breathing or shortness of breath and fever to define episodes with a high likelihood of pneumonia, offers an acceptable tool for the monitoring and evaluation of respiratory control programmes. This questionnaire needs further evaluation in an untrained population and in other regions before it can be adopted for use in ARI control programmes.
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PMID:Validity of a respiratory questionnaire to identify pneumonia in children in Lima, Peru. 800 98

Effects of indoor environmental factors on children's respiratory system and pulmonary function tests were investigated in this study. A total of 617 primary school children aged between 9-12 years were included. A standard questionnaire, which includes questions about respiratory symptoms and illness, indoor environmental determinants, family history of respiratory diseases, and smoking habits of the parents, was sent to homes of all children and information was obtained from parents. Children with a family history of asthma, bronchitis, or other chest troubles suffered morning and day/night coughs, shortness of breath, wheezing and asthma, bronchitis, or pneumonia more frequently. Children whose mothers smoked complained of blocked-runny nose and sinusitis more frequently. Pulmonary function levels were diminished in passive smokers and in children whose houses were heated by a wood-burning stove. As a result, passive smoking, using a wood-burning stove for heating, and family history of respiratory diseases are to be considered risk factors for the respiratory system.
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PMID:Effects of indoor environmental factors on respiratory systems of children. 801 25

Endobronchial hamartomas are a tenth as frequent as the usually asymptomatic intrapulmonary hamartomas. We report on 7 patients. 2 men and 3 women had an endobronchial hamartoma. In one patient multiple endobronchial hamartomas were found in the left upper lobe. In a 56-year-old patient with an 8-year history of shortness of breath, cough and several episodes of pneumonia and acute onset of respiratory failure, a tracheal hamartoma was diagnosed. Frequently, endobronchial hamartomas can be resected without loss of lung tissue. Laser resection is often possible and may be the treatment of choice in elderly or inoperable patients. Because of lower risk, laser resection is frequently preferred to conventional operative resection in patients with tracheal hamartomas.
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PMID:[Diagnosis and therapy of endobronchial and tracheal hamartomas]. 821 Oct 33

An 81-year-old man being treated with weekly low dose methotrexate (MTX) for psoriasis was admitted with a 2-month history of cough, shortness of breath and 7% eosinophilia in the peripheral blood. Chest roentgenogram revealed bilateral alveolar and interstitial infiltrates. Although the clinical presentation suggested MTX pneumonitis, a transbronchial lung biopsy established a diagnosis of pulmonary cryptococcosis. Pulmonary cryptococcosis should be included in the list of infectious processes that can mimic MTX pneumonitis.
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PMID:Pulmonary cryptococcosis mimicking methotrexate pneumonitis. 833 16

We report the history of a 38-year-old male native of Sri Lanka admitted to the emergency ward because of chest pain and shortness of breath. On physical and radiographic examination a bilateral predominantly right-sided pneumonia was found. The patient was admitted to the medical ICU and an antibiotic regimen with amoxicillin/clavulanic acid and erythromycin was initiated. Shortly afterwards septic shock developed. The patient was intubated and received high doses of catecholamines. He died 30 hours after admission to the hospital. Cultures from sputum, tracheal aspirate and blood grew Acinetobacter baumanni. Acinetobacter is an ubiquitous gram-negative rod with coccobacillary appearance in clinical specimens, that may appear gram-positive due to poor discoloration on Gram-stain. It is a well known causative agent of nosocomial infections, particularly in intensive care units. Community-acquired pneumonias, however, are quite rare. Sporadic cases have been reported from the US, Papua-New Guinea and Australia. Interestingly, these pneumonias are fulminant and have a high mortality. Chronic obstructive lung disease, diabetes, and tobacco and alcohol consumption appear to be predisposing factors. Due to the rapid course and poor prognosis, prompt diagnosis and adequate antibiotic treatment are indicated. Antibiotics use for community-acquired pneumonias, such as amoxicillin/clavulanic acid or macrolides, are not sufficient. Appropriate antibiotics for the initial treatment of suspected Acinetobacter infections include imipenem and carboxy- and ureidopenicillins combined with an aminoglycoside.
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PMID:[Community-acquired Acinetobacter pneumonia]. 837 43

The radiographic findings in two children with acute "recall" pneumonitis, associated with administration of Adriamycin (doxorubicin hydrochloride) and actinomycin D at variable intervals after local radiation therapy, were presented to emphasize the unique radiographic appearance and clinical course. A 10-year-old girl underwent radiation therapy 9 weeks after completing an initial cycle of chemotherapy. Within hours of the resumption of chemotherapy, she was in clinical respiratory distress. Chest radiography showed a well-defined area of alveolar consolidation in the periphery of the right lung corresponding to the area of radiation. Shortness of breath and right chest rales developed in a 15-year-old boy within 12 hours of the resumption of chemotherapy 6 weeks after radiation therapy was completed. Chest radiography showed an alveolar infiltrate extending from the apex to the base of the right lung corresponding to the area of radiation. Symptoms may be confused with an infectious pathogenesis; thus, knowledge of the history of radiation therapy and the radiation port is important in initiating treatment with steroids rather than antibiotics.
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PMID:"Recall" pneumonitis: adriamycin potentiation of radiation pneumonitis in two children. 847 91

Lung toxicity associated with 5-aminosalicylate (5-ASA) agents is a rare entity. We report the case of a 32-yr-old woman with ulcerative colitis who developed progressive shortness of breath while taking one of the 5-ASA drugs, oral mesalamine. Bilateral pulmonary infiltrates, peripheral eosinophilia, and histological findings consistent with acute pneumonitis characterized the lung injury. Although the differential diagnosis is broad, mesalamine-induced lung damage must be considered in patients who develop unexplained respiratory symptoms while taking this agent.
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PMID:Mesalamine-induced lung toxicity. 863 48


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