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

Whole shaken cultures of 20 random, unidentified actinomycetes were extracted with n-butanol at pH 4.5, 7.0 and 8.5, respectively. Residues of butanol-extractable materials (BXM) were reconstituted (100X) in buffers and freeze-dried. BXM were surprisingly well tolerated in animals and were screened against influenza A viral pneumonia in mice. One culture yielded BXM-80 which suppressed both chemical (LPS) and viral (NDV) pneumonia in mice as well as inhibited rat foot pad edema induced by carrageenin. Aspirin, Butazolidin, hydrocortisone, indomethacin, and prednisolone, which are known to inhibit carrageenin-induced rat foot pad edema were tested against chemical (LPS) and viral (NDV) pneumonia in mice. Only hydrocortisone and prednisolone suppressed LPS pneumonia. All of these 5 compounds failed to inhibit NDV pneumonia. Microbial products are suggested as a source for new and unique anti-inflammatory agents.
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PMID:Experiences in the search for anti-inflammatory agents of microbial origin. 41 20

Incidence and type of postoperative complications were prospectively analyzed in 2280 patients undergoing gastrointestinal surgery. 6.6% had one or more pulmonary complications requiring therapeutic intervention (2.3% pneumonia, 1.6% drained pleural effusions, 1.2% atelectases). Based on univariate and logistic regression analyses, the following parameters constitute high-risk patients with regard to pulmonary complications: Elective surgery (4.3%, 61/1428): anemia (7.2% pulmonary complications), pathological blood gas analysis (9.8%), preoperative hospitalization greater than 1 week (6.3%), blood loss under operations greater than 1000 ml (10.5%), length of the operation greater than 3 h (9.7%); emergency surgery (10.4%, 89/852): upper gastrointestinal operation (16.2%), age greater than 75 (19.9%), ASA IV/V (28%), anemia (19.6%), chronic bronchitis (19%), pathological blood gas analysis (26.6%), diabetes (16.5%), heart failure (18.2%), blood loss under operation greater than 1000 ml (24.3%), length of the operation greater than 2 h (15.4%). These results allow to distinguish between different levels of pulmonary risk.
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PMID:[Pulmonary complications following surgical abdominal interventions. Identification of various risk groups]. 150 62

The patients received thoracotomy usually suffered from significant severe pain postoperatively, which accompanied with impaired pulmonary function or increased incidences of atelectasis and pneumonia. So adequate analgesia for those patients is indicated. The purpose of this study is to investigate the efficiency of patient-controlled analgesia (PCA) and determine whether it is better than conventional analgesia or not. Twenty-six patients, ASA physical status class I and II, were randomized into two groups: PCA and intramuscular (IM). The effect on pain relief was assessed by a visual analogue pain scale (VAPS) q 4 h postoperatively for two days. Forced vital capacity (FVC) and the questionnaire of nocturnal sleep disturbance by pain were evaluated preoperatively, the first, second postoperative mornings. As result of this study, the patients of PCA group get less pain than IM group after the first and second days of surgery. VAPS values are 3.7 +/- 1.1, 2.8 +/- 0.8 and 6.1 +/- 0.9, 5.3 +/- 1.1 respectively pertaining to PCA and IM groups (p less than 0.05). The patients of IM group get more disturbance of nocturnal sleep than PCA group at initial two nights of postoperation as well (p less than 0.05). It is manifest to look out the significant difference between these two groups in accordance with FVC ratio records of post-surgery vs presurgery at initial two days after surgery on the subject of respiratory function recovery. PCA group are 46.46 +/- 7.29%, 52.25 +/- 8.32% in a condition of more progress on lung function recovery than IM group of 38.13 +/- 10.25%, 42.15 +/- 7.82% (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Efficiency of patient-controlled analgesia versus conventional analgesia in patients after thoracotomy]. 175 53

Sixteen risk factors for nosocomial pneumonia were prospectively studied in 582 intubated patients in a surgical intensive care unit (ICU) to identify patients at particularly high risk. Overall, pneumonias developed in 94 of the patients (16%). Significant risk factors for pneumonia were mechanical ventilation for more than 72 h, impaired consciousness or co-operation, specific therapeutic interventions as a marker of severe underlying diseases (dopamine/dobutamine greater than or equal to 5 micrograms/kg.min, barbiturate therapy for treatment of elevated intracranial pressure, continuous i.v. antiarrhythmic or antihypertensive drugs), and pre-existing pulmonary abnormalities (P less than 0.001). The acquisition of postoperative pneumonia was further associated with male sex, ASA class IV and a history of smoking, but statistical significance was lost after stepwise logistic regression. Longer operative procedures, thoracic or upper abdominal surgery, longer preoperative hospital stay, low serum albumin concentration on admission, prior antibiotics, old age, obesity, low weight, malignant disease, and steroid treatment did not influence the incidence of pneumonia. In this study we were able to identify a subpopulation of intensive care patients at particularly high risk for pneumonia.
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PMID:[Risk factors in nosocomial pneumonia in intensive care patients. A prospective study to identify high-risk patients]. 195 43

The admissions to Vancouver General Hospital from its Surgical Day Care Centre were reviewed for the period 1977 to 1987. The overall mean rate of admission for the period was 0.28 per cent, for surgically-related admissions 0.22 per cent and for anaesthesia-related admissions 0.07 per cent. The principal reasons for surgery-related admissions were postoperative bleeding, complications, the need for further surgery, the requirement for prolonged postoperative care, and pain. Urology had a particularly high percentage of admissions compared with its workload, because of the diagnostic nature of much of the work. Anaesthesia-related admissions included "syncope," lack of an accompanying adult, aspiration pneumonitis and coincident acute disease. Twelve of the 14 patients admitted with syncope had surgery in the afternoon and had received less than ideal amounts of intravenous fluid. Seven of the 12 ASA physical status II patients admitted had an admission diagnosis related to the coincident disease.
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PMID:Hospital admissions from the Surgical Day Care Centre of Vancouver General Hospital 1977-1987. 220 46

A 29-yr-old white woman presented with chronic pneumonia in the left lower lobe and with left pleural effusion. She was known to have inflammatory bowel disease, but she was asymptomatic under maintenance treatment with 5-ASA. She received numerous antibiotic regimens according to susceptibility testing of microorganisms cultured from sputum and bronchial lavage and on an empiric basis was also given antituberculosis treatment, but there was no clinical improvement or change in the chest radiographic findings. Sputum was repeatedly examined and yielded, among other organisms, Clostridium inocuum, Enterobacter, Klebsiella pneumoniae, Proteus mirabilis, and Staphylococcus aureus. On one microscopic examination of sputum, the presence of feculent material was suspected. A subsequent gastrografin enema revealed a cologastric and colobronchial fistula between the splenic flexture of the colon and the greater curve of the stomach and the bronchial system. Segmental resection of the colon and resection of the lower lobe of the left lung were performed. Histologic findings of the resected colon were consistent with Crohn's disease. After a long period of postoperative recovery, the patient returned to good general health and well-being. To our knowledge, a colobronchial fistula caused by Crohn's colitis has not been previously reported.
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PMID:Colobronchial fistula: a rare complication of Crohn's colitis. 224 Aug 49

Children undergoing general anesthesia are at increased risk of severe aspiration pneumonitis. Cimetidine and ranitidine, specific histamine (H2-receptor) antagonists, when given 1-3 h preoperatively markedly reduce the acidity and volume of gastric content. A newer compound, famotidine, is a more specific antagonist with no inhibitory effect on the drug metabolizing microsomal enzyme systems of the liver (cytochrome P-450), in contrast to cimetidine. An additional clinical advantage is a possible longer duration of action. In order to evaluate these potential advantages we studied the effects of preanesthetic oral famotidine on gastric fluid pH and volume in 4 groups in a random manner. METHODS. With parental consent, 107 infants and children (ASA I status, 4 months to 14 years old, NPO for at least 6 h) received either no famotidine (n = 29) or 0.15 mg/kg (n = 27), 0.3 mg/kg (n = 25) or 0.6 mg/kg (n = 26) famotidine at 7.00 a.m. Following induction by mask with nitrous oxide/oxygen (N2O/O2) and enflurane (E) or i.v. thiopental, intubation was performed in all patients. Anesthesia was maintained with N2O/O2 and E. A orogastric double-lumen tube was passed into the stomach, and the gastric content was aspirated in a uniform manner. Gastric volume was recorded and pH values were measured with pH paper. RESULTS. In the control group, 28 of 29 patients (97%) had a pH less than 2.5, 18/29 (62%) had a gastric volume greater than 0.4 ml/kg and 17/29 (59%) had a pH less than 2.5 and gastric volume greater than 0.4 ml/kg, meaning an increased risk of pneumonitis if the child aspirates the gastric content. Famotidine administration was effective between 1.5 and 6 h after oral administration. Preoperative famotidine application produces pH values of gastric contents higher than 2.5 in all dosage groups (84%, 94%, 75%), and these differences were highly significant (P less than 0.001), whereas the gastric volume reduction with these doses was not significant. The incidence of pH less than 2.5 and volume of gastric contents exceeding 0.4 ml/kg did not vary with the different doses of famotidine. As there were no measurable differences in the effect of famotidine, we recommend that children at high risk of pulmonary aspiration receive 0.15 mg/kg famotidine orally at least 1.5 h but not later than 6 h before induction.
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PMID:[Famotidine dosage in children. The effect of different doses on the pH and volume of the gastric juice]. 228 7

In an attempt to explain the discrepancy between the high number of patients said to be at risk of aspiration pneumonitis and the low reported incidence of this anaesthetic complication, 100 ASA physical status I-II elective surgical patients were studied. The volume of fluid present in the stomach at the time of induction of anaesthesia was correlated with gastroesophageal reflux (GER) detected by visual inspection of the pharynx and by continuous measurement of upper oesophageal pH. Mean gastric volume was 30 +/- 28 ml (range 0-210 ml). Gastric fluid volume greater than or equal to 0.4 ml.kg-1 at pH less than or equal to 2.5 was present in 46 patients. No GER was detected during induction of anaesthesia in our sample of 100 patients. Furthermore, patient age, duration of preoperative fasting, body mass index, cigarette smoking, alcohol consumption, preoperative anxiety, and a history of preoperative GER were not correlated with significant modifications of gastric volume or pH. We conclude that the low incidence of aspiration pneumonitis in elective surgical patients may be explained in part by the very low risk of GER, despite gastric fluid volumes of more than 0.4 ml.kg-1 in a high proportion of this patient population.
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PMID:Occurrence of gastroesophageal reflux on induction of anaesthesia does not correlate with the volume of gastric contents. 237 55

One hundred and eleven patients over 65 years of age underwent a major abdominal surgery between March 1986 and February 1987. The cardiorespiratory (CR) complications found were: cardiovascular (CV) failure 36%, post-operative myocardial infarction 5%, respiratory (R) failure 24%, pneumonia 11%. The overall mortality rate was 36%. The factors related with CV failure were: age over 75 years, ischemic cardiopathy, Goldman 3 and over, ASA III and over, cardiac failure, transoperatory hypotension and over 4 hours duration surgery. The ones related with myocardial infarction were: age over 75 years, Goldman 3 and over, ASA III and over, over 4 hours duration surgery and vital capacity (VC) less than 60%. For pneumonia the only related factor was VC less than 60%. For mortality, the factors found were Goldman 3 and over, ASA III and over and VC less than 60%. The mortality rate in patients without CR failure was 9%, with CV failure 35% (p less than 0.01), with R failure 33% and CR failure 90% (p less than 0.001).
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PMID:[Cardio-respiratory complications after major abdominal surgery in elderly patients. Risk factors and prognosis]. 281 95

The effects on gastric pH and volume of intravenous administration of cimetidine and metoclopramide before induction of anesthesia were studied. Sixty ASA Class I patients scheduled for elective surgery were randomly divided into four groups of 15 each, and the study was double-blinded. Group I received normal saline only; Group II received 4 mg/kg of cimetidine only; Group III received 0.15 mg/kg of metoclopramide only; and Group IV received 4 mg/kg of cimetidine and 0.15 mg/kg of metoclopramide. All drugs were given intravenously 30 min before induction of anesthesia. Gastric aspirates were collected during anesthesia, 30 min and 60 min after administration of the drugs. Metoclopramide reduced gastric volume significantly when administered alone (P = 0.0001), but cimetidine did not (P = 0.10). Cimetidine increased the gastric fluid pH significantly (P = 0.0001) as did metoclopramide (P = 0.0023). The effects of cimetidine and metoclopramide on gastric fluid pH were additive when administered together. The combination of cimetidine and metoclopramide when given intravenously before anesthesia provides greater protection against aspiration pneumonitis in patients at risk than does either drug alone.
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PMID:The effects of intravenous cimetidine and metoclopramide on gastric volume and pH. 673 79


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