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

Aged or immuno-compromised patients were mostly affected, by pneumonia caused by infection of MRSA, and more than half of the cases were superinfected with glucose-nonfermentative Gram-negative rods including Pseudomonas aeruginosa. These patients were treated with a monotherapy of arbekacin (ABK) by intravenous drip administration or with a combination of ABK and imipenem/cilastatin, ceftazidime or antifungals. The clinical efficiencies were 55.6% in 11 monotherapy cases and 83.3% in combined therapy. MRSA was eradicated in 31.9% of the patients. These results are comparable with, or superior to the vancomycin therapy in the treatment of MRSA pneumonia. When MRSA is isolated from sputum of pneumonia patients, the discrimination between colonization and infection is important, but the diagnosis is very difficult in many clinical cases before the initiation of chemotherapy. The number of bacteria and the grade of inflammation should be carefully scored before starting a chemotherapy.
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PMID:[Clinical analysis of MRSA pneumonia. Niigata Research Group of MRSA.ABK]. 807 82

Gastric emptying of a liquid test meal was studied in an experimental model of chemical pneumonitis. In the first phase, 160 microliters of a hydrocarbon mixture was injected iv into 10 young adult rats, and the same volume of saline solution was injected into 10 controls. Arterial blood gases and lung dry and wet weight were determined. In the second phase, gastric emptying of a 5% (w/v) glucose solution marked with phenol red (6 mg/dl) was studied 5, 10, 20 and 30 min after orogastric infusion of the test meal. Gastric retention was determined by measuring the concentration of the marker in the residual test meal recovered from the stomach after killing the animal. Thirty-two experimental and 32 control animals were paired and eight pairs were used at each time. The wet weight and external volume of the lungs were determined in all animals and 20 experimental animals were analyzed histopathologically. The animals of the experimental group developed intense macro- and microscopic pulmonary alterations. PaO2 values (mean +/- SD) at the first (70.7 +/- 5.9 mmHg) and fifth hour (71.1 +/- 8.5 mmHg) were significantly lower than the respective values obtained for the control group (109.5 +/- 13.5 and 113.9 +/- 11.2 mmHg). Gastric retention at 5, 10, 20 and 30 min was significantly higher in animals with pneumonitis (median: 59.1%, 55.4%, 45.3%, 27.2%) when compared to respective values for the control group (median: 47.5%, 46.6%, 24.1%, 19.3%). These results indicate a delay in the gastric emptying of liquids in serious pulmonary disorders.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Gastric emptying of a liquid meal in experimental chemical pneumonitis. 825 51

Correlates of the size of infarcts, the time from stroke to death, and the mechanisms of death were studied in 77 consecutive patients who died from infarction in the middle cerebral artery territory. The area of infarcts was assessed by planimetry on schemas of representative brain levels and the results were expressed as a ratio of infarcted area on the whole MCA territory. No clear relationship was found between the size of infarcts in the MCA territory, and any of the characteristics of the patients, but extensive infarcts were more frequent when the internal carotid artery was occluded. No evidence was found of an adverse effect of age, diabetes or initial hyperglycemia on the size of infarcts. The mechanisms of death were not linked to sex, age, high blood pressure, diabetes, blood glucose level at admission, presence and location of an arterial occlusion, or etiology of the infarct. On the contrary, they varied as a function of interval from stroke to death. Transtentorial herniation, the main cerebral cause of death, occurred mainly in the first week and was related to the large size of infarcts. Rare recurrences of stroke and frequent extracerebral mechanisms of death (mainly pneumonia, pulmonary embolism and cardiopathy) occurred later on.
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PMID:Infarcts in the middle cerebral artery territory. Pathological study of the mechanisms of death. 833 39

A 59-year-old Japanese man with RA was referred to us with arthralgia and pulmonary infiltration. Chest roentgenogram showed migratory infiltration and pleural effusion, the glucose levels of the pleural fluid were not reduced. Transbronchial lung biopsy showed granulation tissue plugging the alveolar ducts, indicating organizing pneumonia and interstitial inflammation. These pathological findings were identical with those for cryptogenic organizing pneumonitis (COP). There was a good clinical and roentgenographic response and the pleural effusion responded well to corticosteroids. The characteristic migratory infiltration in rheumatoid lung disease responds well to corticosteroids.
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PMID:A case of steroid-responsive organizing pneumonia in a patient with rheumatoid arthritis showing migratory infiltration and normal glucose levels in pleural effusions. 836 98

An insulin-deficient 51-year-old man was put on dietary therapy and sulfonylurea (SU). Although there was good glycemic control for 2 years, the fasting blood glucose (FBG) level increased gradually over the subsequent 4-year period, and there was a marked increase in body weight. Secondary failure of SU therapy 20 years after the initial diagnosis led to insulin therapy. The FBG became unstable, and the C-peptide response disappeared. The patient died of nonketotic hyperosmolar coma and pneumonia at the age of 87. At autopsy, the pancreas showed marked atrophy (32 g) with extensive fatty degeneration. Islets replaced by islet amyloid polypeptide (IAPP)-positive amyloid (IAPP-AM) amounted to 77% in the tail, 74% in the body, and 73% in the head of the pancreas. All islets were positive for IAPP-AM throughout the pancreas, except for a pancreatic polypeptide-rich lobe, where none were positive. IAPP-AM-positive islets had also undergone fatty change of the surrounding pancreatic acinar cells. beta-Cells decreased remarkably in number and were displaced to the periphery of the islets by the IAPP-AM deposits. These findings suggest that IAPP-related diabetes could have a progressive course, with secondary oral hypoglycemic agent failure and the subsequent development of severe insulin deficiency similar to that seen in insulin-dependent diabetes mellitus.
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PMID:Marked islet amyloid polypeptide-positive amyloid deposition: a possible cause of severely insulin-deficient diabetes mellitus with atrophied exocrine pancreas. 848 72

Infections due to nontuberculous mycobacteria (NTM) are especially common in patients with AIDS. Meningitis due to NTM, however, is rare. A search for CSF cultures positive for NTM over the past 11 years at our hospital yielded 16 cases. Of these, 15 were caused by Mycobacterium avium-intracellular (MAI), and one was caused by M fortuitum. All patients with MAI infection had widespread dissemination and at least one risk factor for AIDS. Clinical features included weight loss, altered mentation, and seizures. Analysis of cerebrospinal fluid revealed a mildly elevated leukocyte count with lymphocyte predominance and normal protein and glucose values. All direct smears were negative for acid-fast bacilli. In-hospital mortality was 67%. The patient with infection due to M fortuitum had a preexisting diagnosis of AIDS and had a right upper lobe pneumonia and headaches. Cranial CT showed an enlarged infundibulum of the pituitary gland. Results of CSF analysis were essentially normal, and direct smears were negative. He left the hospital against medical advice. Our study indicates that the finding of MAI in the CSF in patients with AIDS is associated with an in-house mortality of 67% indicating a very poor prognosis.
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PMID:Nontuberculous mycobacterial infection of the central nervous system in patients with AIDS. 850 83

The purpose of this study was to determine whether the clinical and microbiological characteristics of parapneumonic effusions in patients with community-acquired pneumonia (CAP) infected with the human immunodeficiency virus (HIV) were different from those observed in patients without HIV infection. One hundred and thirty seven patients with parapneumonic effusions were included and divided into two groups depending on whether they had HIV infection or not. The parapneumonic effusion rate was significantly higher in HIV-positive than in noninfected patients (21 vs 13%). Their clinical course was more severe, presenting a higher rate of bacteraemias (58 vs 18%). Pleural fluid in patients infected with HIV had significantly lower glucose levels than that of patients without HIV infection. Chest tube drainage was more frequent in parapneumonic effusions of patients infected with HIV than in those without HIV infection (71 vs 44%). Staphylococcus aureus was the most common microorganism found in the bacteriological samples of patients with CAP infected with HIV (53 vs 12%). We conclude that patients with community-acquired pneumonia and HIV infection have a higher rate of parapneumonic effusions and a more severe clinical course than non-HIV patients, and that Staphylococcus aureus predominates in their bacteriological samples.
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PMID:Parapneumonic effusions secondary to community-acquired bacterial pneumonia in human immunodeficiency virus-infected patients. 862 Sep 65

We have isolated two phenotypically distinct nonfastidious Francisella strains (Fx1 and Fx2) from the blood of compromised patients with pneumonia and compared them with eight other Francisella strains, including Francisella tularensis biovar tularensis, F. tularensis biovar novicida, and F. philomiragia. Our isolates grew well on sheep blood agar, chocolate agar, modified Thayer-Martin agar, and Trypticase soy agar. Fx1 and Fx2 were determined to be within the Francisella genus by cellular fatty acid analysis and by the utilization of glucose, production of H2S and catalase, and lack of motility, oxidase, nitrate reductase, and gelatinase. They were additionally shown to belong to the species F. tularensis by sequencing of two variable regions comprising approximately 500 nucleotides of the 16S rRNA gene. Also, RNA probe hybridization confirmed their belonging to the species F. tularensis. However, the new strains, which are not identical, are distinguished from other F. tularensis strains by growth characteristics, repetitive extragenic palindromic PCR fragment pattern, and some biochemical tests. Key biochemical differences included the findings that Fx1 was positive for beta-galactosidase and arabinose hydrolysis and that both strains were citrulline ureidase positive and glycerol negative. Commercial F. tularensis antiserum agglutinated stock F. tularensis strains but not Fx1, Fx2, F. tularensis biovar novicida, or F. philomiragia; serum from either patient failed to agglutinate or only weakly agglutinated commercial antigen but showed agglutination when tested against each patient's respective isolate. Fx1 and Fx2 produced beta-lactamase. Because of their good growth, negative serology, and biochemical profile, the organisms could be misidentified in the clinical laboratory if standard strategies or commercial identification systems are used.
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PMID:Characterization of two unusual clinically significant Francisella strains. 881 97

A dietary algorithm for management of persistent diarrhea in developing countries, using locally available foods, is yet to be standardized. We identified factors related to poor outcome among 75 malnourished hospitalized male patients aged 3-48 months with persistent diarrhea (> or = 14 days) treated on soy and cereal-based diet (Diet I). The 28 patients with stool output > 60 g/k body weight on the sixth or the seventh treatment day were considered diarrhea treatment failures on Diet I. In the univariate analysis, breast feeding (p < 0.001), carbohydrate malabsorption based on low stool pH or reducing substances > 0.5% (p = 0.03), initial 24-h purge rate (p = 0.001), pneumonia (p = 0.003), or probable septicemia (p = 0.03) were associated with diarrhea treatment failures. Although 16 of these 28 patients responded to systemic antibiotics without dietary modification, all but one of the remaining recovered on a chicken puree, glucose, and oil formulation. Twenty-six children had weight loss after 7 days on Diet I as compared with the postrehydration weight. These children had lower mean age (p = 0.05), lower food intake in the first 24 h (p = 0.05) and during the initial 7 days (p < 0.01), and a higher initial excretion of enteroaggregative Escherichia coli (32 vs. 8%; p = 0.01). In the logistic regression model, significant risk factors for diarrhea treatment failures were initial purge rates, carbohydrate malabsorption, and intercurrent systemic infection; only low food intake was associated with significant risk for weight loss. The significant association of diarrhea treatment failures with carbohydrate malabsorption suggests that in the initial diet itself, part of polysaccharide be substituted with sucrose or glucose to obtain the right balance between osmolarity and energy density. Our data suggest that prompt identification and treatment of systemic infection is critical, as its eradication achieved recovery in more than half of the treatment failures without a dietary change.
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PMID:Prognostic factors in hospitalized children with persistent diarrhea: implications for diet therapy. 885 82

A veal calf with chronic pneumonia was characterized by reduced weight gain, feed intake and increased feed/gain ratio. Concentrations of hemoglobin, packed cell volume, red blood cell number and blood plasma levels of iron, albumin, urea, glucose, insulin, insulin-like growth factor-I and triiodothyronine were decreased, while plasma levels of total protein, immunoglobulin G and nonesterified fatty acids were increased. White blood cell number, blood plasma concentrations of triglycerides, growth hormone, cortisol and tumor necrosis factor-alpha were not changed. Hematological, metabolic and endocrine changes were interpreted as expressions of reduced energy and protein intake and of nutrient partitioning which contributed to reduced growth performance.
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PMID:Endocrine, metabolic and hematological changes associated with reduced growth performance during chronic pneumonia in calves: a case study. 892 69


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