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

Detection of latent tuberculosis infection is an important step in the control of tuberculosis. The tuberculin skin test is the only proven method for identifying tuberculosis infection in patients who do not have tuberculosis disease. The prevalence of tuberculosis infection among hospitalized patients in a pneumological department of an inner-city hospital was evaluated, using the intradermal tuberculin skin test (Mantoux technique). Interpretation of the Mantoux test was based on the size of induration in millimeters and the individual risk profile of the patients, according to the guidelines of the American Thoracic Society and the Centers for Disease Control, revised in 1989. Of 697 tested patients, 252 showed test results consistent with tuberculosis infection (36.2%). 55 of these 697 patients had active tuberculosis disease or a prior history of tuberculosis (7.9%). A positive tuberculin skin test was found in 197 of 642 patients (30.7%) with a diagnosis different from tuberculosis (COPD, pneumonia, cancer and others). In our study, the sensitivity of the tuberculin skin test for active tuberculosis infection was 95%. The present study revealed a high prevalence of tuberculosis infection among hospitalized patients in a pneumological department. Further studies are needed to assess the usefulness of routine tuberculin skin testing in hospitalized populations.
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PMID:[Intracutaneous tuberculin test using the Mendel-Mantoux technique. Tuberculin reactivity among inpatients in a pneumology department]. 1108 93

Lipomas are rare endobronchial tumors that may cause severe parenchymal damage due to bronchus obstruction and subsequent pneumonia. Therefore, accurate diagnosis and radical treatment are essential. We describe three cases of endobronchial lipoma. One patient presented with hemoptysis, two patients were initially diagnosed as COPD. They were all treated by electrocautery which achieved complete removal. We recommend electrocautery as an easy and cost-effective alternative for removal of intraluminal tumors including lipoma.
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PMID:Endobronchial lipoma: a series of three cases and the role of electrocautery. 1112 55

Pneumonia acquired in Community (CAP) may be a primary disease occurring in healthy individuals or secondary to predisposing factors or comorbidity. Prevalence of CAP is 2.6 to 5% for all ages, in USA 12%, for over 65 years 30%. Streptococcus pneumoniae is the commonest pathogen 30-50%, H. influenzae in COPD, the atypical pneumonia Mycoplasma pn., M. catharralis, Legionella pn., Enterobacteria, anaerobics often in hospital survey. In children is different RSV, Parainfluenzae type 3, Rhinovirus in the first 2 years old. Others are S. pneumoniae, H. influenzae, Chlamydia sp., etc. Appropriate empiric antibiotic therapy choices are based in guidelines. The most common pathogen is S. pneumoniae, isolates raised resistance rates to Penicillin to 20-50%, 40% in our country and also to Macrolides, with potential clinical failure (21-40%). Specially in elderly people and with the comorbidity are recommended the 23 valent polysaccharide vaccine, effective in bacteremic pneumonia 70-80%. Is not effective in children under 2 years, for that is important conjugated vaccine Hib (toxoids T, D, CRM197, OMP Nm) to prevent carriers, otitis media and reduce exacerbation of these respiratory infections.
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PMID:[Current interest of antipneumococcal vaccination]. 1120 55

The respiratory failure in polytrauma patients and respiratory failure of different origin (COPD, pneumonia, pulmonary edema). In the first case invasive ventilation seems to be preferable and so the tracheal intubation, in emergency, with its more important guidelines. In the second case there are important physiopathological elements to consider NIMV the best first approach for ventilatory support.
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PMID:[Mechanical ventilation in the emergency room]. 1123 49

Indices of atmospheric particulate matter (PM) have been reported to be associated with daily mortality and morbidity in a large number of recent time-series studies. However, the question remains as to which components of PM are responsible for the reported associations. Multiple PM components rarely are measured simultaneously. To investigate PM effects on mortality and morbidity, we used the multiple PM components measured in Windsor, Ontario, at a site only a few miles from downtown Detroit, Michigan. This study focused primarily on two study periods in which multiple PM components were measured in Windsor: 1985 to 1990, when levels of total suspended particles (TSP), sulfate from TSP (TSP-SO4(2-)), PM less than 10 microns in diameter (PM10), and nonthoracic TSP (TSP-PM10) were measured throughout the year; and 1992 to 1994, when data on PM10, PM2.5 (PM less than 2.5 microns in diameter), PM10-2.5 (PM10 minus PM2.5), particle acidity (H+), and artifact-free sulfates (SO4(2-)) were available for mostly summer months. Mortality data were analyzed for the 1985 to 1990 study period, and data on both mortality and hospital admissions of elderly patients were analyzed for the 1992 through 1994 period. Poisson regressions were used to estimate the effects of these PM components and gaseous criteria pollutants on mortality (nonaccidental, circulatory, respiratory, and nonaccidental without circulatory and respiratory) and on hospital admissions of elderly patients (for pneumonia, chronic obstructive pulmonary disease [COPD], ischemic heart disease, dysrhythmias, heart failure, and stroke), adjusting for temperature and humidity, trends and seasonal cycles, and day of the week. Both PM10 and TSP were associated significantly with respiratory mortality for the 1985 to 1990 period, with similar relative risk (RR) estimates for PM10 (RR = 1.123; 95% confidence interval [CI] 1.0361-1.218) and TSP (RR = 1.109; 95% CI 1.028-1.197), per 5th to 95th percentile increment. The effect-size estimates for TSP-SO4(2-) and TSP-PM10 were smaller and less significant. In two-pollutant models, simultaneous inclusion of gaseous pollutants with PM10 or TSP reduced PM coefficients by 0 to 34%. The effect-size estimates for total mortality, circulatory mortality, and total minus circulatory and respiratory mortality were less than those for respiratory mortality. Ozone (O3) and nitrogen dioxide (NO2) also were associated significantly with total and circulatory mortality, but a simultaneous consideration of these pollutants with PM10 reduced PM10 coefficients only slightly, or even increased them. In these results, pollution coefficients often were positive at multiple lag days (0-day through 3-day lags were examined), but for PM indices, 1-day lag coefficients were most significant. However, when all combinations of multiple-day average exposures were examined, for cases in which multiple lag days were positive, the choice of single-day or multiple-day average exposure did not appreciably change the estimated effect sizes. An examination of temporal correlation showed that the order of spatial uniformity as expressed by the median site-to-site correlation was O3 (0.83), PM10 (0.78), TSP (0.71), NO2 (0.70), carbon monoxide (CO) (0.50), and sulfur dioxide (SO2) (0.49), which suggests less exposure error for O3 and PM10 than for the other measured pollutants. Thus, these results suggest that spatially homogeneous pollution indices show higher associations with measured health outcomes.
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PMID:Association of particulate matter components with daily mortality and morbidity in urban populations. 1124 87

Chlamydophila (Chlamydia) pneumoniae infection is increasingly reported worldwide nowadays. We studied twelve Thai adults presenting with the clinical symptoms and signs of community-acquired pneumonia (CAP) due to C. pneumoniae (TWAR) at Pramongkutklao Hospital in Bangkok, Thailand. Their mean age was 38 (range 21-73) years. Six patients lived in Bangkok. Seven patients had comorbid diseases (four cases with allergic asthma, one each with diabetes mellitus, chronic obstructive pulmonary disease and coronary artery disease). C. pneumoniae pneumonia presented as subacute pneumonia in 6 patients. The clinical manifestations were mild (IDSA risk class I-III) except in 4 patients who had preexisting allergic asthma, COPD and coronary heart disease. The diagnosis of C. pneumoniae pneumonia was based on microimmunofluorescence (MIF) antibody technique (IgM titer > or = 1:16, IgG > or = 1:512, IgA > or = 1:256 with or without fourfold rises). The clinical conditions were consistent with the primary infection (IgM titer of 1:16 or higher) in 6 patients and reinfection (IgG titer of 1:512, IgA titer of 1:256 or higher without rises of IgM titer) in the other 6 patients. Minimal bilateral pleural effusion was detected in only one patient. Coinfection was demonstrated in 2 patients (one each with S. pneumoniae and K. pneumoniae). All patients markedly improved after a 2-week course of macrolide, doxycycline or newest fluoroquinolone therapy. All patients had done well at one year of follow-up. C. pneumoniae infection has been recently recognized and a high seroprevalence (37%) in Thai school children and 100 per cent in young male Thai military conscripts has been reported. This report suggests that this infection, C. pneumoniae, may be a common pathogen of CAP in Thailand.
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PMID:Chlamydophila (Chlamydia) pneumoniae as a cause of community-acquired pneumonia in Thailand. 1146 Sep 48

Convincing evidence now exists that particulate air pollution exacerbates heart and lung disease, leading to increased morbidity and mortality. The populations particularly susceptible to these exposures are still unclear. Recent work on potential mechanisms of action of particulate air pollution point to pathways also influenced by diabetes. We examined whether diabetes modified the effect of airborne particles by looking at the association of PM(10) with hospital admissions for heart and lung disease in persons with or without diabetes as a comorbidity. In addition we stratified by age within persons with and without diabetes. We used Medicare data for Cook County, Illinois for the years 1988-1994, and found that a 10 microg/m(3) increase in PM(10) was associated with a 2.01% (95% CI 1.40-2.62%) increase in admissions for heart disease with diabetes, but only a 0.94% (95% CI 0.61-1.28%) increase in persons without diabetes. Similar effect modification was not seen for lung diseases. When analyzing by age we found twice the PM(10)-associated risk for heart disease in diabetics than nondiabetics in both age groups. We found for pneumonia admissions that diabetes is an effect modifier in the younger age group, and for COPD in the older age group. We conclude that persons with diabetes are a susceptible population.
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PMID:Are diabetics more susceptible to the health effects of airborne particles? 1154 41

Acute exacerbation of chronic bronchitis (AECB) is a very common condition, which presents with deteriorating sputum production and dyspnoea in a patient with pre-existing COPD or chronic bronchitis. As these symptoms are relatively non-specific and also the presenting feature of a wide range of other conditions, the physician should carefully consider the differential diagnosis before deciding on whether or not a patient indeed has AECB. The differential diagnosis can be summarised as pneumonia, pneumothorax, cardiac failure/cor pulmonale, bronchiectasis, asthma, tuberculosis, sinusitis and other forms of upper respiratory tract sepsis, diffuse panbronchiolitis, lung cancer, gastro-oesophageal reflux, the presence of a foreign body in the airway, melioidosis, and lung abscess. This article aims to discuss these conditions, with brief presentation of clinical cases, in the evaluation of differential diagnosis of AECB.
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PMID:Solutions for difficult diagnostic cases of acute exacerbations of chronic bronchitis. 1158 3

In a 59-year-old male patient, chronic dry cough and dyspnoea on exertion preexisting for several years became rapidly progressive within a few weeks prior to hospitalisation. He died one month after admission from respiratory failure. Three months before admission, history, pulmonary function tests, and computed tomography (CT) of the chest revealed no evidence of asthma, COPD, or any other lung disease. Clinical examination showed no clubbing, but end-inspiratory velcro-rales were audible over both lungs. Inhaled steroids and diuretics did not bring clinical amelioration. On admission there were basal consolidations, bronchiectases, and predominant fibrotic changes with honeycombing and subpleural thickening over both lungs, in the absence of any ground-glass pattern in the CT. At the same time lymphocytosis predominated in bronchoalveolar lavage (BAL). The search for pneumonia, viral infection, tumour, vasculitis, or a drug-related disorder remained negative. Pathological examination at autopsy showed nonuniform fibrosing alveolitis.
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PMID:[Rapidly progressing respiratory insufficiency of uncertain etiology]. 1168 68

Exacerbations of COPD are a major source of morbidity and mortality, resulting in tremendous increases in healthcare costs. Spirometric testing of at-risk persons can help identify patients early in the disease course who may benefit from early intervention to slow the disease process. Avoidance of irritants, smoking cessation, and use of pharmacologic agents aimed at decreasing airflow obstruction are strategies for reducing the frequency and severity of exacerbations. Patients should be educated about modifiable risk factors, such as cigarette smoking, environmental exposures, improper inhaler technique, influenza and pneumonia vaccination, pulmonary rehabilitation, and use of supplemental oxygen. Early, aggressive interventions are necessary to improve quality of life, decrease hospital admissions, improve morbidity and mortality, and reduce overall healthcare costs.
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PMID:Treatment of COPD exacerbations. Pharmacologic options and modification of risk factors. 1208 21


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