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

To evaluate the efficacy of continuous administration of 50% nitrous oxide in oxygen for reducing pain during flexible fiberoptic bronchoscopy 32 children aged 3-60 months were randomly assigned to an experimental or a control group. Indications for endoscopy included persistent atelectasis (6), wheezing (10) cystic fibrosis (2) pneumonia (11) persistent cough (3). All patients received Midazolam (0.3 mg/kg) atropine (20 mcg/kg) intra rectaly 20 minutes before the procedure. The flexible fiberoptic bronchoscope (Olympus BF3C4) was inserted transnasally through a face mask. Topical anesthesia with 1% lidocaine hydrochloride (3 mg/kg) was applied to the nose, larynx, trachea and bronchial tree over 15 minutes through the suction chanel of the bronchoscope. All patients were monitored with a pulse oximeter and a cardiac monitor. The experimental group (n = 16) received 50% nitrous oxide in oxygen prior (3 minutes) and during flexible fiberoptic bronchoscopy, the control group (n = 16) received only oxygen. We measured pain of the children by a behavioral observation scale (Children's Hospital of Eastern Ontario Pain Scale: CHEOPS) at each phase of topical anesthesia during bronchoscopy in the two groups. At the end of bronchoscopy physician's satisfaction was scored by a visual analogue scale (VAS 0-100) in which 0 corresponded to absence of satisfaction. Nitrous oxide was associated with lesser pain scores than those with oxygen. Physician significantly preferred these procedure compared with oxygen. No complication occurred during procedure. Combined with local anesthesia midazolam and atropin the administration of 50% nitrous oxide in oxygen seems a better choice for flexible fiberoptic bronchoscopy in children and should be used routinely.
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PMID:[Bronchial endoscopy under local anesthesia and pain in children. The value of a nitrous oxide-oxygen combination]. 960 88

A 67-year-old female was admitted to our hospital because of pneumonia-like shadow on chest roentgenogram with persistent cough and sputum of 4 months duration. Diagnosis as lung cancer was delayed more than 4 months. She showed fever and inflammatory reactions. Antibiotics were effective to inflammatory reactions, but not effective to pneumonia-like shadow. Transbronchial lung biopsy was useful for the diagnosis. Right lower lobectomy was performed. In this case, tumor extents were limited within one lobe. Tumor cells did not invade blood and lymphatic vessels, and extrathoracic metastases were not detected. The prognosis of bronchiolo-alveolar cell carcinoma was determined by intra-pulmonary tumor extent. Based on a comparison with the outcome of unresected cases, bronchiolo-alveolar cell carcinoma limited within one lobe should be surgically resected.
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PMID:[A resected case of a bronchiolo-alveolar cell carcinoma of the lung accompanying pneumonia-like shadow on chest roentgenogram]. 975 49

Small cell lung cancer (SCLC) accounts for 20% to 25% of cases of bronchogenic carcinoma and results in pronounced morbidity and mortality in the United States. More than 90% of cases of SCLC are caused by cigarette smoking. Common pulmonary manifestations are dyspnea, persistent cough, hemoptysis, and postobstructive pneumonia. At the time of diagnosis, patients usually have extensive disease. To date, therapeutic approaches have made only modest advances in outcome. Combined modality approaches, such as radiotherapy administered concomitantly with the initiation of chemotherapy, induction chemotherapy followed by radiotherapy administered during the subsequent courses of chemotherapy, sequential chemotherapy and radiotherapy, and courses of radiotherapy split between cycles of chemotherapy, are important for improving survival in patients with SCLC.
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PMID:Current guidelines for the management of small cell lung cancer. 1047 59

Jessica, a 14-year-old girl with a history of asthma, went to her pediatrician's office because of a persistent cough. She had been coughing for at least 3 months with occasional cough-free periods of less than a few days. The cough was nonproductive and was not accompanied by fever, rhinorrhea, or facial or chest pain. Jessica and her mother observed that the cough increased with exercise and typically was not present during sleep. She has used two metered-dose inhalers--albuterol and cromolyn--without any change in the cough pattern. For the past 5 years, Jessica has had mild asthma responsive to albuterol. She enjoys running on the cross-country team, soccer, and dancing. She is an average student and denies any change in academic performance. She has never been hospitalized or had an emergency department visit for asthma or pneumonia. There has been no recent travel or exposure to a person with a chronic productive cough, tobacco smoke, or a live-in pet. Jessica lives with her mother and younger sister in a 10-year-old, carpeted apartment without any evidence of mold or recent renovation. In the process of taking the history, the pediatrician noticed that Jessica coughed intermittently, with two or three coughs during each episode. At times, the cough was harsh; at other times, it was a quiet cough, as if she were clearing her throat. She was cooperative, without overt anxiety or respiratory distress. After a complete physical examination with normal findings, the pediatrician interviewed Jessica and her mother alone. Jessica's parents had been divorced for the past 6 years. She lived with her mother but visited her father, and his new family with two young children, every weekend. She spoke about this arrangement comfortably and said that she loved her father and mother but didn't like the tension she experienced at her father's home. "I don't like adults arguing when kids are around." When asked why she thought the cough persisted so long, she commented in a neutral tone, "I don't know. It's never been like this before." Jessica's pediatrician prescribed an inhaled steroid with the albuterol. When the cough did not respond after 1 week, he ordered a chest radiograph (normal) and a tuberculin skin test (purified protein derivative-negative), and he added montelukast (a leukotriene inhibitor) and monitored airway resistance with a peak flow meter. The cough persisted, and the peak flow recording showed normal airway resistance. At this time, Jessica's pediatrician suspected a conversion reaction and contemplated the next best therapeutic strategy.
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PMID:Persistent cough in an adolescent. 1060 74

A 65-year-old woman was admitted because of dyspnea and persistent cough. Her chest radiograph and CT films revealed multiple nodular and patchy shadows in bilateral lungs, indicating bronchiolitis obliterans organizing pneumonia (BOOP)-like shadows. Autoimmune hemolytic anemia was diagnosed because peripheral blood cell analysis revealed anemia (hemoglobin, 5.5 g/dl) with increased reticulocytes (253/1000), and positive direct and indirect Coomb's tests. In addition, decreased diffusion capacity and mild hypoxemia (PaO2, 71 Torr) were recognized. Bronchoalveolar lavage fluid (BALF) showed the increased number of total cells and lymphocytes, and a decreased CD4(helper)/CD8(suppressor) ratio (= 0.65). Histopathological features of transbronchial lung biopsy showed an infiltration of lymphocytes in the alveolar walls and spaces, and thickening of the alveolar walls. A discrepancy was apparent among roentgenogram, histopathological findings and BALF results. Open lung biopsy had not been performed because of severe hemolytic anemia and lack of informed consent. In addition, the patient suffered from chronic thyroiditis with positive thyroid autoantibody. After oral administration of prednisolone, both pulmonary shadows and anemia improved. We concluded that autoimmune hemolytic anemia may be associated with steroid-sensitive interstitial lung lesions in some cases. Further immunologic studies are necessary to elucidate the relationship between autoimmune hemolytic anemia and interstitial lung shadows.
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PMID:[Multiple nodular and patchy shadows in chest radiograph in a patient with autoimmune hemolytic anemia associated with chronic thyroiditis]. 1082 1

To evaluate the WHO (World Health Organization) algorithm for management of respiratory tract infection (RTI) in HIV-1-infected adults and determine risk factors associated with RTI, we enrolled a cohort of 380 HIV-1-seropositive adults prospectively followed for incident RTI at an outpatient clinic in Nairobi, Kenya. RTI was diagnosed when patients presented with history of worsening or persistent cough. Patients were treated with ampicillin, or antituberculosis therapy when clinically indicated, as first-line therapy and with trimethoprim/sulfamethoxazole as second-line therapy. Five hundred ninety-seven episodes of RTI were diagnosed: 177 of pneumonia and 420 of bronchitis. The WHO RTI algorithm was used for 401 (95%) episodes of bronchitis and 151 (85%) episodes of pneumonia (p <.001). Three percent of bronchitis cases versus 32% of pneumonia cases failed to respond to first-or second-line treatment (p <.0001). Being widowed (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI]: 1.0-4.4), less than 8 years of education (adjusted OR = 2.5, CI: 1.5 - 4.1), and CD4 count < 200 cells/microl (adjusted OR = 2.4, CI: 1.4-3.9) were risk factors for pneumonia. A high percentage of patients (32%) with pneumonia required a change in treatment from that recommended by the WHO guidelines. Randomized trials should be performed to determine more appropriate treatment strategies in HIV-1-infected individuals.
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PMID:Respiratory tract infection in HIV-1-infected adults in Nairobi, Kenya: evaluation of risk factors and the world health organization treatment algorithm. 1146 24

A 59-yr-old man developed fevers, shortness of breath, persistent cough and weight loss, shortly after initiation of therapy with interferon-alpha 2a and cytosine arabinoside for treatment of chronic myelogenous leukemia. Radiologic pulmonary infiltrates and lung tissue biopsy were consistent with bronchiolitis obliterans organizing pneumonia (BOOP). After discontinuation of the chemotherapeutic drugs, the pneumonic symptoms and chest roentgenogram infiltrates resolved. This report suggests that treatment with interferon-alpha, in combination with cytosine arabinoside, may produce the rare complication of BOOP.
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PMID:Bronchiolitis obliterans organizing pneumonia in a patient with chronic myelogenous leukemia developing after initiation of interferon and cytosine arabinoside. 1187 80

A 64-year-old Japanese woman with a two-week history of polyarthralgia and persistent cough was diagnosed as seropositive polyarthritis and fulfilled the criteria of early rheumatoid arthritis (RA). In addition, inflammatory pitting edema of the distal extremities was apparent, suggestive of the remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. A number of investigations including hand MRI, bone scintigraphy and HLA typing supported a diagnosis of RS3PE syndrome rather than RA. Chest computed tomography revealed concomitant evidence of bronchiolitis obliterans organizing pneumonia (BOOP). Treatment with 30 mg of prednisolone daily immediately ameliorated the polyarthritis and the BOOP. Seropositive polyarthritis with distal pitting edema may be categorized as both RA and the RS3PE syndrome.
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PMID:An abrupt onset of seropositive polyarthritis with prominent distal tenosynovitis concomitant with bronochiolitis obliterans organizing pneumonia (BOOP): consideration of the relationship with RS3PE syndrome. 1500 59

A case of self-limiting pneumonia due to Chlamydia pneumoniae is described. A 39-year-old male visited our hospital complaining of a persistent cough. No antibiotics were administered to this patient because of the absence of fever and a mild positive inflammatory response, but an infiltrate on a chest radiograph improved. Finally, a diagnosis of C. pneumoniae pneumonia was made by seroconversion of the C. pneumoniae-specific antibody and detection of the C. pneumoniae gene in bronchoalveolar lavage fluid. Self-limiting C. pneumoniae pneumonia is rarely encountered, although self-limiting upper respiratory tract infections due to C. pneumoniae are common. Thus, most self-limiting C. pneumoniae pneumonia may be missed when symptoms are minimal.
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PMID:Self-limiting pneumonia due to Chlamydia pneumoniae. 1615 90

Microbiological analysis allows us to identify the etiology of pneumonia and its in vitro susceptibility pattern. Antibiotic treatment directed against a known pathogen enables us to narrow antibacterial spectrum of action, and to reduce costs, drug adverse effects risk and antibiotic resistance. However it is unnecessary to perform extended microbiological studies in all patients with community acquired pneumonia (CAP). Etiological studies must be based in pneumonia severity, epidemiological risk factors and clinical response to empirical treatment. Routine microbiological analysis for ambulatory patients is not recommended. In patients with persistent cough and worsening in their general conditions, a sputum sample must be obtained to perform an acid-fast smear and Mycobacterium culture. The risk of complications and death of patients hospitalized with CAP justifies basic microbiological exploration (sputum Gram staining and culture, blood cultures, pleural fluid culture) intending to obtain a more accurate etiology of pulmonary infection and to guide specific antibiotic treatment. Paired serum samples obtained to document atypical pathogen infections (Mycoplasma pneumoniae, Chlamydia pneumoniae) and urine sample to detect Legionella pneumophila antigenuria are recommended in all CAP severely ill patients that are admitted to ICU, in those not responding to betalactamic drug treatment and in selected patients with specific epidemiological risks. A microbiological study would be useful in management of patients with severe CAP pneumonia outbreaks with clinical-epidemiological particular characteristics, and in-patients with empirical antimicrobial treatment failure.
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PMID:[Microbiologic diagnosis of community-acquired pneumonia in adults]. 1616 17


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