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

In a randomized prospective study, two different regimens of antibiotic prophylaxis have been tested: four-day cefazolin prophylaxis (Kefzol 0.5 gr every 6 h) compared with two-day cefuroxime administration (Zinacef 1.5 gr every 12 h). A total of 569 patients in the two groups were studied in a 10 month period. Haematological, liver function, serum creatinine and urea measurement were made preoperatively and repeated daily for the first four days and after one week. At least five chest X-rays were taken during the hospitalisation. Body temperature was measured regularly every two hours in the ICU and a least twice a day thereafter. The wounds were examined daily and the patients were carefully observed for other infections. Bacteriological examinations of the tips of all inserted catheters and pacemaker wires were undertaken on removal in the first four months of the trial. Swabs of any tracheal or wound secretion or pus taken for bacteriological examinations as also blood cultures in any suspected septicaemia. Of the 569 patients three had to be withdrawn from the study. Of the assessable ones 285 received cefuroxime and 281 were given cefazolin. Seven patients (1.2%) died postoperatively. The total infection rate was 5.5%: 5.7% in the cefazolin group and 5.3% in the cefuroxime group. The overall wound infection rate was 1.8%: 2.5% in the cefazolin group and 1.1% in the cefuroxime group. Septicaemia occurred in 0.5% of the cases. Pneumonia occurred in 11 (1.9%) patients; 1.5% in the cefazolin and 2.5% in the cefuroxime group. Seven patients (1.2%) developed a urinary tract infection; 1.4% in the cefazolin group and 1.1% in the cefuroxime group.(ABSTRACT TRUNCATED AT 250 WORDS)
J Cardiovasc Surg (Torino)
PMID:Perioperative antimicrobial prophylaxis in cardiovascular surgery. A prospective randomized trial comparing two day cefuroxime prophylaxis with four day cefazolin prophylaxis. 351 30

Air leakage and necrotic degeneration may occur after bronchial anastomosis and can lead to death from secondary pneumothorax and pneumonia. We studied the ability of a new tissue adhesive (N-butyl-cyanoacrylate monomer) to enforce the bronchial suture line. The left main bronchus in each of five pigs in Group A was completely transected and closed by four stitches and tissue adhesive. The transected left main bronchus in each of the other five pigs in Group B was connected with 11 to 14 interrupted polyglycolic acid 3-0 sutures. The time required for reconstruction was 10 +/- 3.6 minutes in Group A and 25.0 +/- 6.5 minutes in Group B. No symptoms of a constricted airway were apparent in Group A. All pigs were examined at an interval of from 5 to 8 weeks after operation. Evidence of infection at the bronchus appeared in three animals: two in Group A and one in Group B. One instance of air leakage at the anastomosis occurred in Group B. We measured the maximum tensile strength of the bronchial suture line by means of an electromechanical testing machine comparing the tensile strength of the treated left bronchus with that of the control right bronchus. The maximum tension of the treated bronchus in Group A was 10.3 +/- 1.52 (pounds) and that of control was 8.0 +/- 1.56 (pounds) (p less than 0.05). The maximum tension of Group B was 7.93 +/- 0.29 (pounds) on the treated side and 6.78 +/- 0.32 (pounds) on the control side (p less than 0.05). The suture line with tissue adhesive was enforced sufficiently to act as a stable connective tissue. Histologic studies in Group A revealed that the suture line was completely healed without tissue damage and was strengthened by the tissue adhesive.
J Thorac Cardiovasc Surg 1987 Mar
PMID:Bronchial anastomosis with a tissue adhesive. 354 55

The diagnostic features and operative results of six patients with spontaneous aorto-caval fistula associated with abdominal aortic aneurysm were analyzed. Abdominal pain, pulsatile abdominal mass and haematuria were constant preoperative findings in all patients. Radiological signs of congestive heart failure of various degrees were present in five, abdominal bruit in four and preoperative renal failure in three patients. As preoperative diagnostic examinations i.v. pyelography was done in two patients and ultrasound scanning and angiography of the abdominal aorta in a further two patients. In one ultrasound scanning a dilated inferior vena cava and hepatic veins were seen as an indirect sign of ACF, while in both angiograms the ACF was seen. In these two cases the diagnosis of ACF was made preoperatively, while in four other cases the diagnosis was made during the operation. Three patients survived the operation and were still alive after eight months, four years and six years respectively. Postoperative complications developed in two patients: postoperative ileus in one and deep venous thrombosis and pneumonia in another. Because of its rarity aorto-caval fistula is difficult to diagnose. The presence of haematuria in a patient suffering from abdominal aortic aneurysm should strongly suggest the diagnosis of an aorto-caval fistula.
J Cardiovasc Surg (Torino)
PMID:Diagnosis and treatment of spontaneous aorto-caval fistula. 355 68

Rheumatic mitral valve stenosis is an important nonobstetric complication of pregnancy in an African country. Between January 1965 and September 1985 41 closed mitral valvotomies with a Tubbs dilator were performed in 39 pregnant women (two first trimester, 22 second trimester, and 17 third trimester). All patients experienced symptomatic improvement from New York Heart Association Class 3.01 (average) preoperatively to 1.22 postoperatively. There were no deaths related to the operation and delivery. Fetal deaths were due to postoperative spontaneous abortion in two cases (4.9%) or premature labour in three cases (7.3%), for an overall survival of 36 babies (87.8%). Fetal morbidity was due to prematurity or dismaturity in three infants, all of whom survived. Thirty-three normal infants were delivered at term. Nine patients needed subsequent surgical procedures for mitral valve restenosis 5 to 17 years (mean 10.2 years) after the initial closed valvotomy: Repeat closed valvotomy was performed in three patients after 5, 8, and 10 years (the first two during subsequent pregnancies), an open procedure was performed in one after 6 years, and five patients underwent subsequent mitral valve replacement after 11 (two), 12 (two), and 17 (one) years. Two late deaths occurred; one after 10 years, as a result of pneumonia and meningitis, and the other after 12 years, before a mitral valve replacement for restenosis could be performed. None of the remaining patients has required further surgical procedures, but two have moderate symptoms. Closed mitral valvotomy gives satisfactory results in pregnant patients with severe mitral stenosis. When indicated during pregnancy, it should be performed at any stage of the pregnancy.
J Thorac Cardiovasc Surg 1987 May
PMID:The feasibility of closed mitral valvotomy in pregnancy. 357 80

An experimental model for empyema thoracis in the Duncan-Harley guinea pig is introduced. Empyema thoracis development and early death (less than 14 days after bacterial inoculation) were noted after various concentrations and species were inoculated into the pleural space with a piece of umbilical tape, which was used as a cofactor. The effect of concomitant hemothorax was also tested. Group I (N = 90) had intrapleural inoculation of umbilical tape and various concentrations (10(4), 10(6), 10(8) organisms/ml) of various bacterial species, which included Staphylococcus aureus (N = 30), Escherichia coli (N = 30), and Bacteroides fragilis (N = 30). Group II (N = 90) had intrapleural inoculation of umbilical tape, 1 ml of autologous blood, and the same varying concentrations and species of bacteria as Group I. The observation period was 14 days, during which time early deaths were noted. Fifty-eight percent of the staphylococcal group of animals, 37% of the E. coli group of animals, and none of the B. fragilis group of animals developed empyema. Animals with empyema developed significant weight loss (p less than 0.05) and roentgenographic evidence of empyema, which was supported by postmortem pleural reaction and pneumonia scores (p less than 0.05). Higher concentrations of inoculated bacteria produced a higher incidence of empyema in the S. aureus and E. coli groups (p less than 0.05), but concomitant hemothorax did not increase the already high incidence of empyema and early death in the E. coli group. Empyema caused by B. fragilis did not develop, even with cofactors of umbilical tape and blood. Anaerobic infections in this model may require the presence of other aerobic or facultative organisms, the presence of necrotic lung, prior malnutrition, or a combination thereof.
J Thorac Cardiovasc Surg 1985 Jan
PMID:Effect of hemothorax on experimental empyema thoracis in the guinea pig. 388 Aug 47

Over a period of 12 1/2 years, 476 patients underwent thoracotomy for lung cancer at two affiliated hospitals. Hospital mortality for all patients was 5.25% and for those undergoing pulmonary resection, 5.67%. Hospital mortality is more indicative of true risk than is the 30 day mortality figure, which we regard as arbitrary and misleadingly low. Thirty-seven preoperative risk factors were analyzed for their effects on both morbidity and mortality, and 12 classes of postoperative complications were analyzed for their effect on mortality. All preoperative risk factors together accounted only for 12% of the risk of mortality (R2 by multiple regression analysis). Only three of these factors bore a significant association with mortality: patient age 60 years or over (p less than 0.05), need for pneumonectomy (p less than 0.005), and premature ventricular contractions on the admission electrocardiogram (p less than 0.05). All the listed postoperative complications together accounted for only 28% of the risk of mortality. Of these complications, four showed a significant association with postoperative death: infectious complications (pneumonia and empyema) and cardiovascular accidents (pulmonary embolism and myocardial infarction). In both analyses, the remainder of the risk of death must be attributed either to factors not considered or to purely random factors. It follows that much the greater part of the risk of death from surgical treatment of lung cancer could not be predicted from the preoperative status of the patients.
J Thorac Cardiovasc Surg 1986 Apr
PMID:Random versus predictable risks of mortality after thoracotomy for lung cancer. 395 74

Seventy adult patients with thoracic empyema were treated at the University of Michigan Medical Center between 1978 and 1982. Twenty-two (31%) of the empyemas were associated with pneumonia, 23 (33%) occurred as postoperative complications, and seven (10%) were iatrogenic. When used as the initial mode of drainage, repeat thoracentesis was successful in only four of 11 cases (36%). Similarly, closed tube thoracostomy, as initial treatment, was successful in only 14 of 40 cases (35%). Rib resection, however, provided cure or control in 10 of 11 patients (91%) when employed as the first treatment method. Eight of 12 patients (67%) with parapneumonic empyemas were treated successfully with closed tube thoracostomy, in contrast to only two of 17 patients (12%) with postoperative empyemas so treated. Eventual control or cure of empyema was achieved in 57 patients (81%), whereas 13 (19%) died (five from their empyema and eight with empyema as an active problem at the time of death). All of the five empyema-caused deaths occurred in patients who underwent chest tube drainage as the most invasive treatment modality. The mortality rate for immunosuppressed patients was 40% (four of 10 patients). This analysis of a large recent series of adult empyemas suggests that chest tube drainage is often inadequate and more aggressive management is likely to result in fewer treatment failures and fewer total procedures. Early rib resection, especially for postoperative empyemas and those in immunocompromised patients, is recommended.
J Thorac Cardiovasc Surg 1985 Dec
PMID:Modern management of adult thoracic empyema. 406 34

A prospective investigation was undertaken in adults to assess the specificity and sensitivity of fever (greater than 38 degrees C) and leucocytosis (greater than 10 000/microliters) for the diagnosis of infection after operations with cardiopulmonary bypass. A log-linear model analysis of a multiway frequency table was used for statistical evaluation. The model parameters were separately evaluated for 2 periods: the early one until the 6th day, the late period from the 7th postoperative day until discharge. Seven out of 115 patients suffered infections during their hospital stay: Bacteremia occurred in 3, pneumonia in 2, and deep sternal wound infection in 2 patients, and a superficial wound infection in one. No significant interactions between fever, leucocytosis and/or infection were found in the first period, except an inverse relation between fever and elevated WBC (p = 0.0197). After the 6th postoperative day the model parameters did show significant interactions, fever and leucocytosis being more frequent in infected patients. However, the specificity was low: only 15% of the patients with fever or elevated WBC had an infection. The risk of in-hospital infection was significantly higher after a long duration of cardiopulmonary bypass (p = 0.009), and after transfusion of more than 2500 ml of blood on the day of operation (p = 0.001).
Thorac Cardiovasc Surg 1984 Feb
PMID:Fever, leucocytosis and infection after open heart surgery. A log-linear regression analysis of 115 cases. 619 74

The acquired immune deficiency syndrome is characterized by the development of multiple recurrent opportunistic infections or unusual neoplasms in individuals with no prior history of immune suppression. This report summarizes the thoracic diseases encountered in such patients before after death and the role of diagnostic techniques currently used in the evaluation of thoracic disease in 15 patients with this syndrome. Efficacy of treatment was determined by correlation with postmortem findings in all patients. Pulmonary disease was present in all 15 patients and necessitated 23 transbronchial biopsies in 11 patients. Pneumocystis carinii pneumonia and cytomegalovirus pneumonia were the most common findings. Nine open lung biopsies in eight patients disclosed either Pneumocystis carinii pneumonia or Kaposi's sarcoma. Esophageal disease was present in four patients, and endoscopic evaluation demonstrated Candida esophagitis (two), esophageal Kaposi's sarcoma (one), and cytomegalovirus esophagitis and Kaposi's sarcoma (one). Mean time to death from diagnosis of acquired immune deficiency syndrome was 7.7 months, with respiratory insufficiency being the most common cause of death (9/15, 60%). Pneumocystis carinii pneumonia was successfully eradicated in 70% of the patients. Candida esophagitis was ameliorated in both patients with the disease. Unsuspected pulmonary Kaposi's sarcoma, cytomegalovirus pneumonitis, and other infectious pathogens were documented at autopsy. These data reveal that Pneumocystis carinii pneumonia and Candida esophagitis can be managed successfully in patients with acquired immune deficiency syndrome if appropriately diagnosed. The major cause of death in this series was pulmonary insufficiency, often the result of severe cytomegalovirus infection. Thoracic surgeons must continue to play an aggressive and important role in the early diagnosis and management of potentially treatable pulmonary and esophageal disease in these patients.
J Thorac Cardiovasc Surg 1984 Nov
PMID:Thoracic manifestations of the acquired immune deficiency syndrome. 633 56

Computed tomographic scans of the chest were utilized to stage mediastinal disease in 148 instances of bronchogenic carcinoma considered for resection in 146 patients. Nodes greater than or equal to 1.5 cm in diameter were interpreted as abnormal. All nodes positive by computed tomography were evaluated by mediastinoscopy, anterior mediastinotomy, or thoracotomy. All patients with negative computed tomographic findings underwent thoracotomy without prior surgical staging. Patients undergoing thoracotomy were divided into two groups. In Group I (first 51 instances) routine mediastinal exploration was not carried out; in Group II (last 97 instances) the mediastinum was explored in every patient and nodes were submitted for histopathological study. The computed tomographic and pathological findings on the mediastinal lymph nodes were compared. The sensitivity, specificity, and accuracy of computed tomography in Group I were 88%, 94%, and 92%, respectively, in Group II 75%, 89%, and 86%, and in the combined group, 80%, 91%, and 88%. The positive predictive index in Group I, Group II, and in the combined group was 88%, 69%, and 77%, respectively. It was lower for central than peripheral lesions (74% versus 88%) and was lowest for lesions in the right upper and left lower lobes. The negative predictive index was greater than 90% for all groups and all tumor sites except the left upper lobe, where it was 89%. Ten patients had false-positive scans, three with old mediastinitis and seven with postobstructive pneumonia; nine of the 10 had central lesions, and seven of these lesions were located in the right upper lobe. Eight patients had false-negative scans; six had para-aortic, subaortic, or postsubcarinal nodes. These nodes would not have been accessible to mediastinoscopy. In only one patient with false-negative nodes would routine mediastinoscopy have prevented thoracotomy and resection. Computed tomographic staging of mediastinal disease is indicated for all patients with lung cancer in whom operation is contemplated. Computed tomography directs the most appropriate staging procedure for patients with positive findings and obviates invasive staging for patients with negative findings.
J Thorac Cardiovasc Surg 1984 Oct
PMID:Computed tomography. An effective technique for mediastinal staging in lung cancer. 648 85


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