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

It has been shown that patients with COPD require as long as 20 min for equilibration of oxygen tension to occur after changing the fraction of inspired oxygen (FIO2). To date, there have been no studies to determine the equilibration time for the PaO2 in mechanically ventilated patients with diffuse pneumonia. We studied seven patients (five males, two females) with radiographic evidence of diffuse pneumonia. All patients required mechanical ventilation. After introducing a change in FIO2, arterial blood gas values were measured at 5-min intervals for 30 min. Four patients achieved maximal change in PaO2 after 5 min, while four patients required 10 min. These results are similar to those found in patients with left ventricular failure who experience equilibration rapidly; however, patients with COPD experience it at a much slower pace. These observations have clinical importance when managing unstable patients where time is a critical element.
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PMID:Rate of decay or increment of PaO2 following a change in supplemental oxygen in mechanically ventilated patients with diffuse pneumonia. 818 94

Measuring of the rate of radioactivity decrease of inhaled 99mTc-DTPA aerosol may detect disorders of alveocapillary membrane integrity. The study included 21 patients (11 non-smokers and 10 smokers) suffering from different pulmonary diseases (pulmonary embolism - PE; chronic obstructive pulmonary disease - COPD; pneumonia - PN; occupational diseases - OD) in order to detect disorders of pulmonary epithelial permeability (PEP) and 2 healthy individuals (non-smokers) with normal findings (NF). DTPA was labelled using the standard procedure with 1480 MBq 99mTc in 1 ml of physiologic saline. Patients with nasal obstruction inhaled aerosol for 2.5 min. particle size 0.8 micron produced in a nebulizer connected to O2. After that gamma scintillation camera and computer were used for data acquiring in dynamic mode. After that ventilation and perfusion scintigraphy of the lungs was performed in four standard projections. Data processing was conducted with ROI drawing after both lungs on the added image. Clearance value was expressed in T1/2 (min), while the curves had monoexponential shape in all patients. In the non-smoking group mean clearance value for both lungs in patients suffering from PE, COPD and PN did not differ from NF. Clearance in the part of the lungs affected with disease (pneumonia, embolism) was faster than in healthy pulmonary tissue. In sick smokers, however, mean pulmonary clearance value was higher than in non-smokers, irrespective of the type of disease. Pulmonary clearance in individuals suffering from occupational diseases was also accelerated, irrespective of the fact whether the patients smoked or not.
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PMID:Application of 99mTc-DTPA aerosol in evaluation of pulmonary epithelial permeability. 856 98

The aim of this ecological study was to investigate the effect of outdoor air pollution on the mortality risk of metropolitan inhabitants in Santiago de Chile. Cause-specific deaths by the day for the years 1988-1991 in Santiago de Chile were extracted from mortality data tapes of the National Center for Statistics. Deaths from accidents were excluded. Total and some specific respiratory diseases deaths were compared calculating the risk of death by municipality and month of the year using age-adjusted standardized mortality ratios (SMRs) controlling for socioeconomic level. Daily counts of deaths were regressed using a Poisson model on the total and fine suspended particles, SO2, CO and ozone on the preceding day, controlling for temperature and humidity. A clear pattern in the geographical distribution of risk of death, both for general mortality and specific respiratory causes (pneumonia, COPD and asthma) was found using SMR, with higher values in the most polluted areas regardless of socioeconomic and living conditions. A highly significant positive association was found between total mortality and both fine suspended particles and CO level. The association remained significant for those days with fine suspended particles levels below 150 micrograms/dl suggesting a no-threshold effect for the total number of deaths. These results are in agreement with previously reported associations, and they add to the body of evidence showing that particulate pollution is associated with increases daily mortality.
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PMID:The effect of outdoor air pollution on mortality risk: an ecological study from Santiago, Chile. 858 29

Adenovirus pneumonia is endemic among infants and children. We report an adult case of adenovirus pneumonia causing respiratory failure and infection in the patient's spouse. The case in the spouse presented as an exacerbation of COPD.
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PMID:The spectrum of adult adenovirus pneumonia. 876 29

Aspiration of microorganisms colonizing the oropharynx is the main route of bacterial entry to lower airways in mechanically ventilated patients. Examination of the microbial flora involved in ventilator-associated pneumonia shows that only few species, among the many oropharynx microorganisms, are responsible for the majority of lower respiratory tract colonizations and infections in intubated patients. Underlying disease, length of intubation, and type and duration of prior antibiotic therapy are the most important factors related with the causative flora of respiratory infections in these patients. Except in certain populations (eg, chronic obstructive pulmonary disease [COPD] patients who may be colonized by Pseudomonas aeruginosa), methicillin-sensitive Staphylococcus aureus, Streptococcus pneumoniae, and unencapsulated Hemophilus influenzae are the predominant respiratory pathogens within the first week of intubation in critically ill patients. These microorganisms are subsequently replaced by multiresistant flora, such as Pseudomonas aeruginosa, methicillin-resistant staphylococci or Acinetobacter baumanii. This change of flora takes place as a consequence of prior antibiotic therapy among other factors. Fungi have to be taken in account particularly in the presence of severe immunodepression. All of these multiresistant pathogens (particularly P aeruginosa) are responsible for most of the deaths directly related to pneumonia; therefore, the early recognition of causative agents and appropriate antibiotic therapy are of great importance determining outcome. This strategy represents the most efficient approach to managing patients with ventilator-associated pneumonia.
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PMID:Microbial causes of ventilator-associated pneumonia. 888 60

Previous studies have indicated that disorders producing crackling lung sounds may be different in terms of the waveform of the crackles or their timing in a respiratory cycle. In this study, we evaluated whether two-dimensional discriminant analysis of crackles has a better ability to separate pulmonary disorders than does a single-dimensional analysis. Cracking sounds of patients with cryptogenic fibrosing alveolitis (n = 10), bronchiectasis (n = 10), COPD (n = 10), heart failure (n = 10) and acute pneumonia (n = 11) and of those recovering from pneumonia (n = 9) have been studied. Variables indicating the timing of crackles during inspiration (beginning and endpoint of crackling) and their waveform (initial deflection width (IDW), two cycle duration (2CD) and largest deflection width (LDW)), were used for the analysis. The discrimination properties of one- and two-dimensional analyses with these variables were compared. The two-dimensional distances between the patient groups were the largest by combining IDW and the end-point of crackling. Cryptogenic fibrosing alveolitis was distinguished from bronchiectasis, COPD, heart failure and acute pneumonia without overlap. The differences between the diseases were illustrated two-dimensionally with ellipses. The two-dimensional analysis resulted in better separation between the groups than the use of single characteristics alone. This type of analysis can enhance the diagnostic power of acoustic pulmonary studies. It is also an informative visual way to find differences among pulmonary disorders.
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PMID:Separation of pulmonary disorders with two-dimensional discriminant analysis of crackles. 896 34

Particles with diameters ranging from less than 0.02 to more than 100 microns and in concentration up to 120 micrograms/m3 daily average TSP (total suspended particles) are measurable in the air of Swiss cities and responsible for the decrease of visibility on the Swiss Plateau and south of the Alps. The particle size shows a typical distribution: the coarse particles (> 2.5 microns mass median diameter) are mostly of natural origin (plants, pollen, earth particles) and are deposited in the upper airways. The fine particles (PM2.5 < 2.5 microns) are predominantly deposited into the alveolar space. These fine and ultrafine particles (< 0.02 microns) are produced by the burning of fossil fuels or by photochemical reactions. By bypassing the mucociliary and cellular defense mechanisms, fine particles can invade the lung parenchyma and cause an inflammatory response. The additional chemical layering of a carbon core by nitrates, sulfates and other organic materials and metals such as iron cause greater local oxidative and/or carcinogenic damage than in the vaporized state. In comparing worldwide epidemiological studies, there seems to be a cohesive and consistent relationship between increases of particle concentration and the increase of mortality (mostly among patients over 65 with concomitant lung and heart diseases and among smokers) and morbidity (bronchitis, pneumonia, COPD, and, less convincingly, asthma). An increase in daily average PM10 (particles < 10 microns) is correlated with an increase in mortality not related to accidents and suicides of 1.0% for the same and/or the following days. In Switzerland, mean annual concentrations of 14-53 micrograms/m3 TSP or 10-33 micrograms/m3 PM10, well below the national standard (annual mean TSP 70 micrograms/m3) have been measured in rural and urban areas. Even at these concentrations an increase in respiratory symptoms and a decrease in lung function, without evidence for a "safe" threshold, have been observed in the Swiss study of air pollution and lung diseases in adults (SAPALDIA). Although the noxious effects of the particles cannot be clearly separated from the effect of other pollutants (e.g. NOx, SO2, ozone) in complex pollutant mixtures, the emission standards and national standards for ambient air should be revised, in particular by adding a standard for fine particles (e.g. PM10 or PM2.5).
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PMID:[Are inhaled dust particles harmful for our lungs?]. 900 26

Pasteurella multocida, a gram-negative coccobacillus which colonizes the nasopharynx and gastrointestinal tract of many animals, is a well known cause of soft tissue infection after animal bites. Human infection can also occur after non-bite animal exposure, usually via inhalation of contaminated secretions. The respiratory tract is the second most common site of Pasteurella infection after soft tissue infection. Most patients with Pasteurella pulmonary infection are elderly with underlying lung disease, either COPD, bronchiectasis, or malignancy. The spectrum of disease includes pneumonia, tracheobronchitis, lung abscess, and empyema. Clinical features of Pasteurella respiratory tract infections are indistinguishable from other pathogens. A history of cat or dog exposure should alert the clinician to consider Pasteurella as a potential pulmonary pathogen in an elderly patient with chronic lung disease. The preferred drug for the treatment of Pasteurella infections is penicillin. Alternately, doxycycline is highly effective against P multocida.
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PMID:Pasteurella multocida pneumonia. 909 78

Airways represent a serial and parallel branched system, through which the alveoli are connected with the external air. They participate in the mechanical and immune defense against noxious agents, regional flow regulation to optimize the perfusion/ventilation ratio and provide lung mechanical support. Functional exploration of central airways is based on resistance measurement, flow-volume curve or spirometry, while peripheral airways influence parameters as the upstream resistance, the slope of phase III nitrogen washout and the residual volume. Bronchodynamic tests supply important information on airway reversibility and nonspecific reactivity. Anatomopathologic alterations of obstructive chronic bronchitis, pulmonary emphysema and bronchial asthma account for their specific functional and bronchodynamic alterations. There is a growing interest for bronchiolitis in the clinical, radiologic and functional field. This type of lesion, always present in COPD, asthma and interstitial disease, becomes relevant when isolated or predominant. The most useful anatomofunctional classification separates the "constrictive" forms, the cause of obstruction and hyperinflation, from "proliferative" forms where an intraluminal proliferation more or less extended to alveolar air spaces as in BOOP (bronchiolitis obliterans organizing pneumonia) results in restrictive dysfunction. Constrictive bronchiolitis obliterans represents a severe and frequent complication of lung and bone marrow transplantation. Idiopathic BOOP may occur with cough or flue-like symptoms. In other cases, constrictive and proliferative forms may have a toxic (gases or drugs), postinfective or immune etiology (rheumatoid arthritis, LES, etc). Respiratory bronchiolitis or smokers' bronchiolitis, an often asymptomatic lesion, rarely associated to an interstitial lung disease, should be considered separately. The relationships between respiratory bronchiolitis, COPD and initial centriacinar emphysema is still to be elucidated. The diagnostic combination of the more sensitive functional tests with HRCT will allow a better understanding of the natural history of the various forms of bronchiolitis.
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PMID:Airway disease: anatomopathologic patterns and functional correlations. 914 18

The effect of fiberoptic bronchoscopy and bronchoalveolar lavage on the functioning of the respiratory system was studied in 72 patients (42 males and 30 females). The bronchoscopy was performed in the sitting position. Supplemental oxygen was not given to all the evaluated patients. The group included 24 patients with lung cancer, 9 with sarcoidosis, 12 with tuberculosis, 1 with farmer's lung and 10 with other lung diseases (pneumonia, COPD). A control group consisted of 16 patients who were undergoing routine diagnostic endoscopy but who were seen to be without lung disease. Group BF (39 individuals) received only a bronchoscopic examination, group BF+BAL (33 persons) received a bronchoscopy followed by BAL using 140 ml. of normal saline solution as a lavage fluid. After the bronchoscopic examination there were significant differences in all spirometric measurements, except MEF25. The bronchoscopy and bronchoalveolar lavage caused a transient fall in FEV1, VC, MEF50, MEF75 (7.7-9.4%) which was similar in both groups. These measurements returned to normal after 24 hours. The testing of pulmonary functioning before the bronchoscopy was seen to be clinically important for safety of the patient undergoing this procedure.
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PMID:[The effect of fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) on results of spirometric measurements]. 919 Feb 46


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