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

We reviewed 69 patients with documented carcinoid tumors, 67 of whom had resectable disease. Operations included nine pneumonectomies, 31 lobectomies, 12 bilobectomies, five segmental resections, and 10 sleeve resections. Follow-up on 65 patients reveals 40 surviving beyond 5 years and 13 beyond 20 years since resection. There were no operative deaths and only one recurrence (local) that was subsequently successfully resected. Twenty patients had had recurrent unifocal pneumonitis or hemoptysis for up to 5 years prior to diagnosis. Two patients had the carcinoid syndrome. Biopsy was performed on 23 tumors and resulted in "moderate-to-severe" hemorrhage in six cases. Lymphatic spread was present in seven cases. All seven are alive and free of disease, six of whom have been followed from 5 to 24 years. Diseased resection margins were present in two cases, with both surviving 20 years after resection. All 10 sleeve resections were performed more than 5 years ago. We conclude that carcinoid tumors carry a favorable prognosis upon resection, even when intrathoracic lymphatic metastases are present and are resected. Lung-sparing resections including sleeve resections should be utilized. Recurrent pneumonia or hemoptysis or both requires diligent investigation. Biopsy of the tumors may be performed with care.
J Thorac Cardiovasc Surg 1980 Apr
PMID:Bronchial carcinoid tumors: twenty years' experience. 735 32

Twenty-four aortic coarctation patients with minimal collaterals were operated on. Left-side bypass was used in 18 cases, internal shunt in 4, while a jump graft ws inserted in 2 cases. These methods were applied when the distal aortic pressure fell below 50 mmHg systolic during test clamping. The coarctation was corrected with isthmusplasty in 12 cases, resection and end-to-end anastomosis in 5 cases, resection with prosthetic replacement in 5 cases and jump graft in 2 cases. The operative mortality was 2 patients (8.3%). One patient died of complications of a post-perfusion bleeding tendency; the other, who had concomitant aortic insufficiency, died of cerebral infarction and pneumonia. At follow-up examination, the blood pressure difference between the upper and lower extremities had disappeared in all cases. The blood pressure was still over 150 mmHg systolic in 9 patients, 8 of whom received anti-hypertensive medication. One patient died during the follow-up period, while waiting for an operation for aortic insufficiency.
Scand J Thorac Cardiovasc Surg 1980
PMID:Surgical treatment of coarctation of the aorta with minimal collateral circulation. 743 42

Aortic prosthetic valve endocarditis is frequently associated with a perivalvular ring abscess which destroys the normal annulus, so that it is difficult to seat a new prosthesis. Between November, 1974, and January, 1980, we treated four patients with aortic prosthetic endocarditis by translocation of the aortic valve, closure of the native coronary artery ostia, and placement of saphenous vein bypass grafts to the coronary arteries. In each case operation was undertaken because of progressive congestive heart failure resulting from aortic regurgitation; two patients had systemic emboli, and two patients had uncontrolled infection. Infection was due to Enterococcus in three instances and to an unknown organism in one. Total ischemic times averaged 2 hours, 15 minutes; a 25 mm Dacron graft containing a porcine valve was used to replace the ascending aorta and aortic valve, and two or three saphenous vein grafts were placed to distal coronary arteries. One patient died 40 days postoperatively of renal failure and Pseudomonas pneumonia with an intact repair. The other three patients were hospital survivors, with one doing well until dying of chronic active hepatitis 12 months postoperatively. The other two patients are alive at 4 months and 18 months with satisfactory hemodynamic function and are free of infection. Translocation of the aortic valve for prosthetic valve endocarditis is a useful alternative when conventional replacement techniques cannot be utilized.
J Thorac Cardiovasc Surg 1981 Feb
PMID:Translocation of the aortic valve for prosthetic valve endocarditis. 745 30

While transcatheter embolization of the spleen has shown promise in the treatment of a wide spectrum of disorders, the incidence of serious complications with this technique has limited its use as an alternative to operative splenectomy. In our institution 41 patients were treated with a modified technique involving partial splenic embolization, careful antibiotic prophylaxis, and adequate pain control. There was no mortality and only few instances of clinically significant complications: a splenic abscess in one patient, pancreatitis in one patient, severe pleural effusions in two patients, and pneumonia in five patients.
Cardiovasc Intervent Radiol 1980
PMID:Splenic embolization. 745 22

Patients with cystic fibrosis pose particular challenges for lung transplant surgeons. Earlier reports from North American centers suggested that patients with cystic fibrosis were at greater risk for heart-lung or isolated lung transplantation than other patients with end-stage pulmonary disease. During a 3 1/2 year period, 44 patients with end-stage lung disease resulting from cystic fibrosis underwent double lung transplantation at this institution. During the same interval, 18 patients with cystic fibrosis died while waiting for lung transplantation. The ages of the recipients ranged from 8 to 45 years, and mean forced expiratory volume in 1 second was 21% predicted. Seven patients had Pseudomonas cepacia bacteria before transplantation. Bilateral sequential implantation with omentopexy was used in all patients. There were no operative deaths, although two patients required urgent retransplantation because of graft failure. Cardiopulmonary bypass was necessary in six procedures in five patients and was associated with an increased blood transfusion requirement, longer postoperative ventilation, and longer hospital stay. Actuarial survival was 85% at 1 year and 67% at 2 years. Infection was the most common cause of death within 6 months of transplantation (Pseudomonas cepacia pneumonia was the cause of death in two patients), and bronchiolitis obliterans was the most common cause of death after 6 months. Actuarial freedom from development of clinically significant bronchiolitis obliterans was 59% at 2 years. Results of pulmonary function tests improved substantially in survivors, with forced expiratory volume in 1 second averaging 78% predicted 2 years after transplantation. Double lung transplantation can be accomplished with acceptable morbidity and mortality in patients with cystic fibrosis.
J Thorac Cardiovasc Surg 1995 Feb
PMID:Improved results of lung transplantation for patients with cystic fibrosis. 753 96

Renal fusion or ectopia can present formidable challenges during aortic surgery. To evaluate morbidity and define optimal management, the clinical histories of 20 patients with renal fusion or ectopia who underwent 21 aortic procedures at the authors' institution over a 37-year period were reviewed. Indications for surgery included aortic aneurysm in 16 patients (infrarenal in 15 and thoracoabdominal in one) and aortoiliac occlusive disease in five (with renovascular hypertension in two). The abnormal kidney was detected before surgery in 13 patients (65%) by excretory urography, arteriography, computed tomography, or ultrasonography. Arteriography revealed multiple and/or anomalous renal arteries in nine of 12 patients studied. At surgery, 15 patients (75%) were found to have multiple or anomalous renal arteries. Six required renal revascularization (reimplantation four, endarterectomy one, aortorenal bypass one). The renal symphysis was divided in two patients. There were no operative deaths. Six major complications included bleeding requiring reoperation, renal failure requiring short-term dialysis, pancreatitis, gastrointestinal bleeding, pneumonia and thrombophlebitis. Preoperative aortography is recommended in patients with renal fusion or ectopia because of the high incidence of associated renal artery anomalies. The surgeon must be prepared to preserve or revascularize these anomalous renal arteries. Division of the renal symphysis is rarely required. Although perioperative morbidity is raised, aortic reconstruction in patients with renal fusion or ectopia can be safely performed without increased mortality.
Cardiovasc Surg 1995 Aug
PMID:Renal artery anomalies in patients with horseshoe or ectopic kidneys: the challenge of aortic reconstruction. 758 97

While elective repair of abdominal aortic aneurysms and aortoiliac occlusive disease is associated with an acceptable (3%) mortality rate, combined aortic and renal revascularization has usually been reported to have a higher perioperative mortality. Over the past 5 years, 785 elective aortic procedures have been performed at the authors' medical center. During the same period, 77 renal artery reconstructions have been performed in 73 patients in conjunction with aortic procedures. All were done using the retroperitoneal approach to the aorta and renal arteries. Indication for concomitant renal artery revascularization included 79% (61 of 77 patients) for either significant stenosis or anatomic involvement, 18% for renovascular hypertension (14 of 73) and 3% (two of 73) for renal impairment. The demographics and risk factors were similar in both groups. Operative mortality rate was 2.9% (23 of 785) in the aortic group and 3% (two of 73) in the combined group. Complications in the combined group were one stroke (1.4%), one re-exploration for bleeding (1.4%), two pulmonary pneumonia (2.7%) and five patients had elevated serum creatinine (> 350 mumol/l) after operation. Of these patients two died, one had an occluded graft and two eventually improved. There was one early graft thrombosis and one late thrombosis. In the authors' experience, concomitant aortic bypass and renal artery revascularization can be performed with an acceptable mortality and morbidity using the retroperitoneal approach.
Cardiovasc Surg 1995 Aug
PMID:Does concomitant aortic bypass and renal artery revascularization using the retroperitoneal approach increase perioperative risk? 758 98

To determine the effect of a prior internal mammary artery graft on coronary artery bypass reoperation, experience with 189 consecutive patients who underwent such surgery was reviewed. Some 147 patients (group I) received only saphenous vein grafts at the primary coronary bypass surgery (CABG) and 42 (group II) received at least one IMA graft at the primary CABG. There were no differences in preoperative patient characteristics or operative data between the groups. Significantly more redo CABG 0-5 years after the initial operation was seen in group II compared with that in group I, indicating inadequate first operation or technical difficulties. In group II a larger proportion of the patients had patent grafts at redo (52.4% versus 34.7%). There were no entry injuries to the grafts or the heart in either group. No operative mortality was encountered in group II, while seven patients in group I died (P < 0.05). Group II had more pneumonia (P < 0.01) and re-exploration for bleeding (P < 0.001) than group I. However, the overall postoperative morbidity in group II patients was less than in group I, though not statistically significant. When comparing patients with an occluded internal mammary artery graft at redo (group A) with those who had a patent internal mammary artery graft (group B) there were no statistically significant differences in patient characteristics and preoperative patient profile, even though group B patients showed a trend towards a better preoperative cardiac profile. A mean of 2.4 grafts/patient were performed in group B compared with 4.0 in group A (P < 0.01). Other operative parameters did not differ between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Cardiovasc Surg 1995 Apr
PMID:Risks, benefits and results of reoperative coronary surgery with internal mammary grafts. 760

The critical care environment contributes to the development of respiratory infections. The mortality rate of nosocomial pneumonia is as high as 50% to 70%, and approximately half of the deaths are directly attributable to the presence of lung infection. Altered host defenses, emergence of bacterial resistance, and technological advances that result in various therapeutic interventions contribute to pneumonia and its associated mortality in the critically ill population. Nasogastric intubation, elevated gastric pH, large gastric volumes, and endotracheal intubation may all promote exposure of the lungs to large numbers of bacteria. An understanding of the pathogenesis of this serious illness could allow us to devise methods for curbing the incidence and severity of the disease. The clinical setting in which pneumonia develops can be a guide to the organisms responsible, and an understanding of this relationship is helpful in developing a treatment plan. The diagnosis of nosocomial pneumonia is not always accurate, and empiric therapy with appropriately selected antibiotics can be potentially life-saving.
Semin Thorac Cardiovasc Surg 1995 Apr
PMID:New approaches to prevention and treatment of nosocomial pneumonia. 761 58

Pneumonia in the immunocompromised patient remains a significant cause of morbidity and mortality. These patients are susceptible to a wide variety of organisms, but specific infections tend to occur in well defined settings. The type of infection can be predicted based on the nature and severity of the immune defect, past patient exposures, chemotherapy given, radiographic presentation, and acuteness of illness. New treatments, including growth factors, the oral antifungal agents, and antiviral drugs, such as ganciclovir and acyclovir, have improved management and prognosis in some cases. However, some problems have increased with a significant risk of spontaneous pneumothorax now seen with Pneumocystis carinii infection. Bronchoscopy with bronchoalveolar lavage plays a major role in diagnosis, particularly for P carinii and cytomegalovirus infection. However, open lung biopsy remains essential for diagnosis in some settings. Surgical resection for control of hemoptysis and for removal of residual foci of disease also are an integral part of management of pulmonary fungal infections in the immunosuppressed patient.
Semin Thorac Cardiovasc Surg 1995 Apr
PMID:Pulmonary infection in the immunocompromised patient. 761 59


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