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

Discovering the cause of poor performance in racehorses can often represent a considerable challenge eluding the more common diagnostic techniques available at the racetrack. Application of sports medicine techniques to these problem cases can aid in the diagnosis of poor performance. Central to the development of this capability has been the use of highspeed treadmills, allowing the racehorse to be evaluated in the controlled laboratory setting, at exercise intensities equivalent to those of racing. Video and cinematographic gait analysis can be used in the diagnosis of subtle lameness conditions. Evaluating hoof balance at high speed has also become an important technique for both lameness diagnosis and prevention. Correcting hoof imbalance normalizes the applied stresses on joints, ligaments, and tendons. Abnormal upper airway function resulting in increased resistance to airflow is major cause of poor racing performance. Often this cause of upper airway dysfunction is difficult to evaluate at rest or after exercise. A definitive diagnosis can be made in these cases using treadmill endoscopy to visualize upper airway function during peak exercise. Lower airway function can also affect performance capability. Radiographic and scintigraphic imaging modalities can be used to evaluate both global and regional lung function in cases of suspected pneumonia, EIPH, COPD, or emphysema. Reduced metabolic fitness can be a primary cause of poor performance due to inherent differences in capability, pathologic changes in the major body systems involved in exercise, or inadequate training. Metabolic stress testing can be used to evaluate the level of fitness in these cases. Orthopedic imaging has also become a valuable diagnostic technique for evaluating musculoskeletal injuries. Scintigraphic evaluation of soft tissue and bone and CT scanning are used to localize the source of lameness and to grade the severity of various orthopedic conditions such as arthritis and stress-induced bone disease that are often difficult to categorize with conventional radiography.
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PMID:The use of sports medicine techniques in evaluating the problem equine athlete. 218 71

The experience of the intensive respiratory care in 930 cases treated from 1983 for 4 years and in 404 cases over the next 2 years is reported. The background operational problems are stressed. Those between age 10 and 50 years did significantly better (p less than 0.05). The survival over the first 4 years in IPPR cases was 16.3% and in non IPPR group 71.8%; over the next 2 years, the former group, survival was 32.4 and 36.3%. The survival in asthmatic patients was high (76%). In cases with organophosphorus poisoning (without IPPR), survival was 81% while in IPPR group it was 29%. In 1988, the results in this group were better due to more aggressive management. In autopsy data on 85 cases, infection was not a major feature in those dying within 24 hours. The survival in COPD cases showed significant relation to age (p less than 0.05), initial arterial pO2 below 60 mm (p less than 0.01) and arterial pH below 7.3 (p less than 0.01). In cases with pneumonia (also asthma) younger cases did better (p less than 0.05) as also those with pneumonia and initial pO2 above 60 mm (p less than 0.01) and pH above 7.3 (p less than 0.001). When pneumonia was community acquired, survival (64.8%) was better than when it was hospital acquired (24%; p less than 0.01). Only the need for IPPR affected survival in trauma group. The major cause of death was infection with Klebsiella, Pseudomonas, Staphylococci and other gram--ve organisms. It is concluded that with proper planning and training, the IRCU does provide a useful mode of treatment in selected patients with respiratory problems.
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PMID:Bombay experience in intensive respiratory care over 6 years. 269 98

We report seven elderly patients with COPD who developed serious infectious complications during prolonged treatment with high doses of corticosteroids. Infections included invasive pulmonary aspergillosis, Herpes simplex stomatitis and esophagitis, cytomegalovirus pneumonia, bacterial sepsis, fungemia and meningitis due to Cryptococcus neoformans. Each of the three patients who developed invasive aspergillus pneumonia died. The efficacy of prolonged therapy with high doses of corticosteroids in patients with COPD is not proven. These cases illustrate the potential for serious infections in patients with COPD treated with corticosteroids.
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PMID:Serious infectious complications of corticosteroid therapy for COPD. 272 Dec 49

Terlipressin (Glypressin) is a "pro-hormone"; after intravenous injection the glycyl radicals are slowly cleaved by enzymatic action, liberating vasopressin. We have assessed the efficacy of terlipressin in the treatment of severe hemoptysis. The study was performed on 20 patients: in 5 cases there was very copious hemoptysis and in 15 cases there was repeated hemoptysis of lesser volume. The cause was distributed as follows: 6 cases of neoplasms, 5 were sequelae of tuberculosis, bronchial dilatation 2 cases, pneumonia with abscess 2 cases, chronic airflow obstruction (COPD) 2 cases and 3 cases of silicosis. The treatment consisted of a slow intravenous injection of 2 mgm 4 times per day (9 patients), then in 11 patients an injection of 2 mgm at the time of acute episodes followed by 1 mgm every 6 hours. The patients received an average of between 15 and 20 mgm of the product for a treatment lasting over 5 days at the maximum. The results were as follows: total success 12 cases; partial success (a reduction to at least one-third of the initial hemoptysis): 5 cases; failure: 3 cases. The failures were linked in two cases to neoplastic disease and in one case there was an intolerance to the drug which did not allow the treatment to be pursued.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Treatment of severe hemoptysis with terlipressin. Study of the efficacy and tolerance of this product]. 279 45

There is not as yet a specific marker for lung cancer. We tested the specificity of six serum markers using radio-immunological assays (CA-50, CA-19.9, CA-125, CA-15.3, Enolase, CEA) in 60 patients with non-neoplastic diseases of the lung (COPD: 28 patients, acute pneumonia: 23 patients, allery: 9 patients). No correlation was found between the percentage of false positivities on the one hand, and sex, age and smoking habits on the other. CA-125 proved to be positive in 74% of acute pneumonia cases. The rate of false positive values is low with CEA (3.3%), Enolase (6.7%) and CA-15.3 (5%) and therefore the cut-off value we chose for these markers was adequate. This is not the case with CA-50, CA-19.9 and CA-125, for which we observed a high rate of false positive values (33.3%, 13.3% and 53.3% respectively) and for which higher cut-off values must be adopted.
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PMID:Serum levels of CA-50, CA-19.9, CA-125, CA-15.3, enolase and carcino-embryonic antigen in non neoplastic diseases of the lung. 317 58

Previous studies have suggested that oxygen uptake (VO2) may be dependent on oxygen delivery (QO2) at most levels of QO2 in patients with the adult respiratory distress syndrome (ARDS); however, the adequacy of substrate delivery in patients with non-ARDS respiratory failure is unclear. The purpose of the present study was to examine the relationship between VO2 and QO2 in a group of critically ill patients (n = 10) with non-ARDS respiratory failure (ie, cardiac pulmonary edema, chronic obstructive pulmonary disease [COPD], or pneumonia). For comparison, these relationships were also examined in a group of patients (n = 6) with ARDS. The data indicate that VO2 is dependent on QO2 in both patients with ARDS and non-ARDS respiratory failure. In contrast, regional venous oxygen tension differences varied considerably between the two groups of patients, indicating differences in local adaptations to critical reductions in QO2. Finally, over a similar range of QO2, oxygen extraction was greater in patients with ARDS compared to patients with non-ARDS respiratory failure (r = -0.67 and slope = -0.62 vs r = -0.45 and slope = -0.35; p less than 0.05). These data suggest that a linear relationship between VO2 and QO2 is not unique to patients with ARDS and may not predict regional adaptations to critical reductions in substrate availability.
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PMID:Relationships of oxygen uptake and oxygen delivery in respiratory failure not due to the adult respiratory distress syndrome. 328 13

The recognition of aspergillus in all its clinical disguises remains a challenge to clinicians in all fields of medicine. Fortunately, aspergillus has low pathogenicity for humans and requires very heavy inoculum of spores (aspergillary pneumonitis) in order to infect those whose pulmonary defense mechanisms, inherent structure, and physiology are intact. Patients with problems from aspergillus may be seen in either inpatient or outpatient clinical practice. The patient with fibrotic or cavitary lung disease finds himself at risk to be colonized and develop an aspergilloma (fungus ball). Conservative therapy (that is, antibiotics, pulmonary hygiene) or simple observation is often all that is required. With significant hemoptysis, surgical removal could be definitive treatment; but these patients often have such compromised pulmonary function that alternative therapies like infusion of antifungal agents locally are tempting. Part of the problem of the patient with asthma or COPD may actually be secondary to hypersensitivity to aspergillus (ABPA), which exacerbates bronchospasm and adds "pulmonary infiltrates" to the underlying disease. The recognition of this entity and then the judicious use of corticosteroids to control the symptoms will stabilize the clinical course of the disease. The immunocompromised patient may be relatively free of pulmonary disease.; but aspergillus, waiting until cytotoxic agents, corticosteroids, granulocytopenia, broad-spectrum antibiotics, and previous pneumonias destroy the local lung defense mechanisms, will then attack with a vengeance. The resultant invasive pulmonary aspergillosis requires treatment with amphotericin B, along with its own inherent toxicity.
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PMID:The many faces of pulmonary aspergillosis. 389 65

Nephrotoxicity frequently complicates the use of aminoglycosides in severely compromised acute care patients. Therefore, we initiated an open clinical trial to determine if cefmenoxime alone is useful for serious Gram-negative pneumonias in this population. Thirty consecutive patients were studied. Average age was 66 years. Most were malnourished at entry, with serum albumin averaging 2.8 g/dl and prognostic nutritional index values over 70% (normal less than 40%). One-half of the patients had severe COPD and 67.9% were on ventilators. Fifty-seven per cent suffered concomitant cardiac disease, and 78.6% had been previously treated with antibiotics. Pneumonia was proven by new infiltrates on chest X-ray, new fever, elevated WBC count and Gram-negative rods on Gram's stain and in cultures of tracheal aspirate or sputum. Patients were given cefmenoxime 1-2 g every 6 h for an average of 12 days. Cefmenoxime peak (1 h) and trough concentrations were measured by HPLC and averaged 58 and 7 mg/l respectively. Gram-positive organisms, Escherichia coli, Klebsiella spp. and Haemophilus influenzae were usually eradicated. Persistence was noted for Enterobacter, Pseudomonas and Acinetobacter spp. Persistence in patients with good clinical response was considered colonization rather than superinfection. Overall, satisfactory clinical response rate was noted in 78.6%, while four patients responded satisfactorily with recurrence, and two treatments were unsatisfactory. No serious adverse effects were observed. Cefmenoxime is a promising agent for treatment of susceptible pneumonias in critical care patients.
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PMID:Cefmenoxime in the treatment of nosocomial pneumonias in critical care patients. 609 Mar 80

We followed the course of 36 consecutive patients hospitalized with chronic obstructive pulmonary disease and acute respiratory failure due to exacerbation of chronic bronchitis in order to clarify the prognosis in this common group of patients. All of the patients had spirometric evidence of severe, poorly reversible airflow limitation and all had a similar cause of acute respiratory failure. In addition, all received similar treatment during hospitalization and follow-up. Patients wtih asthma and pneumonia were excluded by clinical, spirometric, and roentgenographic criteria. Hospital survival was 94 percent, and only one patient required intubation. Two-year survival was 72 percent, and none of the patients died during a readmission for acute respiratory failure. This prognosis is much better than commonly recognized and compares favorably to that of stable outpatients with similar degrees of airflow limitation. An episode of acute respiratory failure, triggered by an exacerbation of chronic bronchitis, does not necessarily alter the prognosis of patients with COPD.
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PMID:The prognosis of patients with chronic obstructive pulmonary disease after hospitalization for acute respiratory failure. 710 57

Pentoxifylline has been reported previously in an unblinded study to improve oxygen saturation, treadmill walk time, and resting diffusion of carbon monoxide (Dco) in patients with COPD. We recruited 12 patients with moderate to severe COPD whose exercise capacity was limited by ventilation or who developed hypoxemia with exercise. Patients were randomized to receive pentoxifylline or placebo, each for a 12-week period in a prospective, double-blind, crossover design study, to assess the effects of pentoxifylline on oxygenation, resting Dco, and exercise tolerance using arterial blood gas analysis. Eleven patients with a mean FEV1 of 0.94 L and a mean Dco of 9.85 mL/min/mm Hg completed the study. One patient withdrew from the study after developing pneumonia. There were no significant differences in resting oxygenation, resting Dco, or spirometry after 12 weeks of pentoxifylline relative to placebo. The 12-min walk test and dyspnea index for activities of daily living were also not significantly different while taking pentoxifylline. Finally, at maximal exercise, there were no differences in workload attained, exercise duration, oxygen consumption, carbon dioxide production, minute ventilation, oxygen saturation, PO2, alveolar-arterial oxygen pressure difference, or Borg score while taking pentoxifylline relative to placebo. We conclude that pentoxifylline does not improve oxygenation, resting Dco, exercise tolerance, or dyspnea in patients with moderate to severe COPD.
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PMID:The effects of pentoxifylline on oxygenation, diffusion of carbon monoxide, and exercise tolerance in patients with COPD. 749 61


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