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

Malnutrition is a serious threat to patients with neuromuscular disease and marginally-compensated respiratory muscle weakness. It causes atrophy of inspiratory muscles, further weakening them. It reduces respiratory drive, potentially aggravating respiratory failure, either directly or indirectly, by promoting atelectasis and pneumonia, and it contributes strongly to such patients' risk of infection, their most common cause of death. In treating such patients, it must be remembered that abrupt increases in nutritional support, particularly with high percentages of carbohydrates, will increase CO2 production, potentially worsening ventilatory failure. Certain selected neuromuscular disease patients benefit from specific nutritional treatments (carnitine for carnitine deficient patients, high-calorie diets for muscular dystrophy and acid-maltase deficiency). Finally, the amino acid, fat, and nucleic acid content of the diet affects the immune response in beneficial or harmful ways, that are just now being elucidate. The potential for useful nutritional interventions in patients with neuromuscular diseases has never looked better, but is not yet fully realized. The challenges for the future will be to work out the beneficial and harmful effects of the various nutrients in the various diseases, to find ways to rapidly identify patients who will benefit, and to determine the safest, least uncomfortable, and most effective methods of delivery of the required nutrients.
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PMID:Nutritional factors in the pathogenesis and therapy of respiratory insufficiency in neuromuscular diseases. 825 75

A 32-year-old woman in the 26th week of pregnancy became ill, 6 days after returning from a trip to Indonesia, with a fever up to 42 degrees C, haemolytic anaemia (haemoglobin 7.6 g/dl) and thrombocytopenia (7,000/microliters). She had not been on any malaria prophylaxis. Chloroquine, quinine and pyrimethamine, administered after macrogametocytes of Plasmodium falciparum had been found in the blood smear, eliminated the parasites from the peripheral blood, but respiratory failure and treatment-resistant pneumonia occurred, leading to the adult respiratory distress syndrome (Morel stage 4). Because of threatened intrauterine death (resulting from premature placental separation during artificial ventilation) the child was delivered by an emergency section. Despite extensive conventional therapeutic measures the mother's respiratory state progressively deteriorated so that extracorporeal membrane CO2 elimination was instituted on the 17th day. First signs of improvement in respiratory functions were noted after six days. The extracorporeal CO2 elimination was discontinued after twelve days, because artificial ventilation could now be adequately controlled. The woman was gradually weaned from the ventilator and discharged home without symptoms after a total of 11 weeks in hospital. Her child has not shown any neurological symptoms.
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PMID:[Acute respiratory failure in tropical malaria during pregnancy. Successful treatment using extracorporeal CO2 elimination]. 818 19

The predictive value of serial versus isolated measurements of transfer factor for carbon monoxide (TLCO) in the diagnosis of pneumocystis carinii pneumonia (PCP) in a cohort of 474 HIV-1 seropositive patients, with all stages of HIV disease, was evaluated. Two groups of patients were studied, one group with serial lung function measurements (Group 1) and another with only a single set of measurements (Group 2). During the study period 118 patients performing serial tests developed a respiratory illness of which 58 were performing monthly and 60 three monthly measurements of lung function (Group 1). In 36 patients from Group 1, where PCP was diagnosed, monthly lung function tests showed a decrease in TLCO from 68% (+/- 3.2) (SEM), (8 weeks prior to illness), to 44% (+/- 2.5) predicted normal at presentation, whereas in 22 patients who did not have PCP, TLCO fell from 71% (+/- 4.5) to 57% (+/- 3.1). TLCO was thus reduced to lower values in these with PCP than in those without PCP (p < 0.05). A fall of TLCO of 5% from initial values when used as predictive for presence of PCP had a sensitivity of 75% and a specificty of 28% (positive predictive value 56%; negative predictive value 48%). TLCO was < 70% predicted in 72/78 patients with PCP who performed only single lung function tests (Group 2), which gave a sensitivity of 92% and a specificity of 71% as a diagnostic test for PCP when compared with the cohort as a whole. The positive predictive value was 34%, negative predictive value was 98%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Serial pulmonary function tests in the diagnosis of P. carinii pneumonia. 833 1

The intravascular oxygenator (IVOX) is a new device which is implanted in the vena cava sup. and inf. where it oxygenates the blood and removes CO2. We report on its successful use in a young patient with severe pneumonia. This 21-year-old female was admitted to hospital with acute respiratory distress due to pneumococcal pneumonia and sepsis following chickenpox. Considering the rapidly progressive course with severe hypoxia and shock, PaO2/PaCO2 values of 6.5/6.4 kPa on mechanical ventilation with an FiO2 of 1.0 and a PEEP of 13 mbar, we decided to implant an intravascular oxygenator. Besides rapid improvement of oxygenation, we observed remarkable recovery of cardiovascular function such as an increase in mean arterial pressure and mixed-venous saturation, while the dose of vasopressors could be decreased. The intravascular oxygenator was removed without problems after 29 days of continuous use, when pulmonary function allowed an FiO2 of 0.45. The patient was discharged from the intensive care unit after 99 days in a good neurological and stable cardiovascular state.
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PMID:[Hemodynamic improvement during therapy using the intravascular oxygenator (IVOX)]. 847 57

Myxedema coma is characterized by severe lack of thyroid hormones, unconsciousness and serious restriction of vital functions. The mortality rate still ranges between 50 and 80%. In patients with inapparent hypothyroidism myxedema coma occasionally follows surgery, anesthesia or severe infection. A case of myxedema coma following surgery is reported. CASE REPORT. A 46-year-old woman was anesthesized for hip replacement. The intraoperative cardiovascular situation was characterized by hypotension and tachycardia. On the first postoperative day, unexpectedly a cardiac arrest occurred. Resuscitation with high doses of epinephrine was successful. There was no evidence of myocardial infarction, hypoxia and pulmonary embolism as causative factors for cardiac arrest. A pulmonary artery catheter was inserted and showed low cardiac output. Catecholamines and intravascular fluids were administered without hemodynamic improvement. In the next 5 days pneumonia was followed by ARDS and acute renal failure. After successful treatment of these complications the patient remained in deep coma. An intracerebral disease could be excluded by computerized tomography. Evaluation showed low thyroid hormones (T3; T4) and elevated TSH. The diagnosis of a myxedema coma was assumed. After failure of oral therapy with L-thyroxine (0.025-0.05 mg/day) for 10 days, intravenous therapy with 0.5 mg L-thyroxine was performed. Thirty-six hours later the patient regained consciousness, without cardiac complications. The patient progressed uneventfully under oral therapy with 0.1 mg L-thyroxine and was discharged from the hospital 6 weeks later. DISCUSSION. Pathophysiology and symptomatology of a case of postoperative myxedema coma are described (Tables 1-4). In this patient, the following symptoms occurred: low thyroid hormones (T3; T4), elevated TSH, deep coma, decreased ventilatory response to CO2, diminished myocardial contractility under catecholamine stimulation, impaired renal water excretion. After failure of oral substitution of L-thyroxine, intravenous therapy had to be performed in spite of the high risk of further cardiac complications in this patient. This led to complete recovery with normal neuropsychological and cardiopulmonary parameters. CONCLUSION. Myxedema coma is a rare complication in postoperative care, but in cases of inexplicable unconsciousness thyroid failure should be excluded. If myxedema coma is evident, intravenous therapy with L-thyroxine should be performed under the conditions of extended monitoring.
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PMID:[Myxedema coma as a rare postoperative complication]. 848 Sep 6

This report describes the radiologic appearance of the intravenous oxygenator (IVOX), an intracorporeal CO2-O2 exchanger for use in patients with severe respiratory deficiency, and the extensive radiographic and sonographic support required for its use. Six patients aged 19-39 years who had severe adult respiratory distress syndrome (ARDS) and who were not expected to survive were selected for IVOX placement; ARDS was caused by trauma (four patients), severe pneumonia (one patient), or a fat embolus from a tibial fracture (one patient). Before insertion of the IVOX, all patients underwent evaluation of their right internal jugular vein, right common femoral vein, and inferior vena cava with real-time ultrasound (US) to ascertain vascular size. The IVOX improved oxygenation in all patients; because of such improvement, one patient survived. Use of the IVOX may become common; hence, radiologists should understand how the IVOX functions and its appropriate placement, be able to identify it on chest and abdominal radiographs, and appreciate the importance of US in placement of this device and follow-up.
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PMID:Radiologic evaluation of the intravenous oxygenator. 849 30

We retrospectively reviewed 304 episodes of pneumococcal bacteremia in 293 adults to compare the clinical features, prognostic factors, and case-fatality rate associated with this illness to those in previous studies. We studied patients at an inner-city university hospital who had pneumococcal bacteremia from January 1980 through December 1993. We analyzed patient demographics, risk factors for pneumococcal infection, pneumococcal vaccination status, initial vital signs, findings on chest roentgenograms, arterial blood gases, and laboratory values. Ninety-six percent of our study population was African American and 61% were male; pneumococcal vaccination was documented for 2%. The case-fatality rate in our study was 36%. Older age, lower mean arterial pressure, lower mean temperature, higher respiratory rate, multilobar pneumonia, leukopenia, low platelet count, hypoalbuminemia, low arterial pH, low arterial oxygen tension, and high arterial carbon dioxide tension were associated with higher mortality. Our study suggests that mortality due to pneumococcal bacteremia has not changed significantly in the last 6 decades, that the number of patients in high-risk groups who are receiving pneumococcal vaccine is insufficient, and that higher mortality can be predicted from the history, vital signs, and laboratory values at initial presentation.
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PMID:Pneumococcal bacteremia in adults: a 14-year experience in an inner-city university hospital. 856 43

A Pasteurella haemolytica A1 broth was injected intratracheally in eight calves and measurements of pulmonary function values (PFV) were made once before and hourly post inoculation (p.i.). Changes in PFVs, included increased respiratory rate and minute ventilation (up to 158% of baseline 2 h p.i.) and decreased tidal volume and lung dynamic compliance (up to 33% of baseline 3 h p.i.). Total pulmonary resistance was not affected. At and after 3 h p.i. there was a progressive impairement of gas exchange, as judged from arterial O2 tension which decreased up to 65% of baseline. In contrast, arterial CO2 tension was not affected. Pulmonary hypertension was observed during the 3 last h of the study and was attributable to an increased pulmonary vascular resistance. Severe neutropenia was observed at 3 h p.i. and post-mortem histological findings were consistent with an acute fibrinohemorragic bronchopneumonia. In conclusion, P. haemolytica airway challenge unequiovocally resulted in acute pneumonia, providing a reproducible pathophysiological model for investigations regarding new therapeutic strategies.
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PMID:Pulmonary ventilation, mechanics, gas exchange and haemodynamics in calves following intratracheal inoculation of Pasteurella haemolytica. 859 99

We evaluated the efficacy of noninvasive mechanical ventilation (NIMV) in alleviating distress and avoiding intubation in patients with de novo acute respiratory failure complicating primary medical disorders. Eleven consecutive patients with severe respiratory distress were entered. In all patients a decision to intubate on an urgent basis had been made, but NIMV could be initiated within minutes. The patients suffered from acute pulmonary edema (five), sepsis/ARDS (two), status asthmaticus (two), and severe pneumonia (two). Dyspnea score (max=10) was (+/- SD) 8.4 +.- 1.6, scale for accessory muscle use (max=5) was 4.2 +/- 0.7, and respiratory rate was 37.6 +/- 3.8 min -1. Pa CO2, pH, and base excess (BE) were 48 +/- 18 mm Hg, 7.27 +/- 0.13, and -5.5 +/- 7.4, respectively, with five patients showing severe metabolic acidosis (BE < - 10). NIMV was applied using proportional assist ventilation. There were three early failures. These included the two patients with sepsis/ARDS who did not tolerate the mask. One patient failed because Pa CO2 and pH deteriorated despite subjective improvement. The remaining eight patients demonstrated progressive improvement, and none required intubation. The duration of NIMV was 3 h to 2 d. We conclude that when NIMV is made available on a "few minutes" basis, selected patients with severe de novo respiratory distress/failure caused by reversible medical disorders, who would otherwise have been intubated, can be given substantial relief and be spared intubation.
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PMID:Noninvasive positive-pressure ventilation in acute respiratory distress without prior chronic respiratory failure. 863 May 38

Exposure to the toxic gases carbon monoxide and nitrogen dioxide (NO2) in indoor ice arenas occasionally occurs and may result in severe symptoms. The gases are produced by ice resurfacing machines operating on hydrocarbons, and in certain conditions toxic levels accumulate. The damage to lung tissues caused by NO2 may not be evident until after a latency time of 1/2-2 days. The role of corticosteroids in the treatment is controversial, but there are clinical experiences as well as experimental data supporting their use. We report two cases of toxic pneumonitis, with delayed onset, due to NO2 exposure during an ice hockey game in an indoor arena. Signs and symptoms were cough, dyspnoea, haemoptysis, hypoxaemia and reduced peak expiratory flow. Chest radiographs showed parenchymatous infiltrative lesions and alveolar consolidation. Both patients were treated with high doses of corticosteroids by inhalation and orally or intravenously. Their condition rapidly improved and pulmonary function was restored.
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PMID:Nitrogen dioxide pneumonitis in ice hockey players. 864 38


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