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

Experimental studies have shown that the surfactant system of the lung is affected shortly after irradiation. It is unclear, however, whether surfactant plays a role in the pathogenesis of radiation pneumonitis. In the present study surfactant components (saturated phosphatidylcholine, surfactant protein A, phosphatidylglycerol, and phosphatidylinositol) and other phospholipids of bronchoalveolar lavage fluid (BAL) were studied in four patients with pleural mesothelioma before and during hemithorax irradiation (70 Gy) as well as zero, 1, 2, 3, and 4 months following irradiation. The concentrations of these same components and of soluble proteins were also estimated in the epithelial lining fluid (ELF) using urea as a marker of dilution. After radiotherapy, the concentrations of the surfactant components in ELF decreased to 12 to 55% of the control values before radiation, whereas the concentration of sphingomyelin in ELF increased ninefold. There were small changes in the other phospholipids. The concentration of soluble protein in ELF increased sevenfold. The minimum surface activity of crude BAL increased from 12 +/- 4 to 32 +/- 6 mN/m, and that of the sediment fraction of BAL increased from 7 +/- 4 to 22 +/- 6 mN/m, p less than 0.001. The protein-rich supernatant fraction of BAL from irradiated lung had a inhibitory effect on normal surfactant. There were significant correlations between the increasing severity of the radiologic changes on the one hand and, on the other, the saturated phosphatidylcholine/sphingomyelin ratio (p less than 0.001), the concentrations of soluble protein (p less than 0.001), and the concentrations of the surfactant components (p less than 0.02-0.001) in ELF.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Changes in surfactant in bronchoalveolar lavage fluid after hemithorax irradiation in patients with mesothelioma. 232 59

We determined ciprofloxacin levels in plasma, saliva, bronchial secretions, lavage fluid, and alveolar macrophages in 9 patients five hours following the last administration of the drug (2 x 750 mg ciprofloxacin daily over a period of at least 3 days). The ciprofloxacin concentration in the alveolar film was determined using urea as internal marker for the lavage. On average it was 2.51 micrograms/ml (= 186% of the plasma level), and clearly exceeded the minimal inhibition concentrations for the facultative pathogenic organism. This means that, in the alveolar film--which represents the barrier to descending pneumonia--an effective accumulation of the quinolone takes place.
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PMID:[Bronchopulmonary penetration of ciprofloxacin]. 236 2

Of 47 patients with Klebsiella pneumoniae bacteraemia admitted to the Hillbrow Hospital, Johannesburg during a period of 18 months, 31 were males and 16 were females. Features predisposing to illness were found in 89.4% patients, chronic alcoholism, neoplastic disease and diabetes mellitus being the most common. Twenty-five infections were acquired in hospital and 22 in the community. Most patients (59.6%) had pneumonia. All isolates of K. pneumoniae were resistant to ampicillin (100%); several (42.6%) were resistant to other antibiotics also. The overall mortality rate was 55.3%. A higher mean initial blood pressure and lower concentrations of serum urea and bilirubin were found in survivors. None of the 28 patients, surviving more than 48 h who received combined therapy with an aminoglycoside and a beta-lactam antibiotic (to which the organism was susceptible) died. Among the remaining patients treated with either an appropriate beta-lactam agent alone, an appropriate aminoglycoside alone or ciprofloxacin the combined mortality rate was 83.3% (P = 0.007).
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PMID:Klebsiella pneumoniae bacteraemia at an urban general hospital. 240 58

Although a rare form of nonresolving pulmonary infiltrate, exogenous lipoid pneumonia is a great mimicker. It often is mistaken for bacterial pneumonia or cancer. Many cases have been diagnosed only by open lung biopsy or other invasive procedures. Depending on the type of lipid ingested and the degree of inflammation that occurs, damage to the lung can be little to none or can fulminate to necrosis and hemorrhage. Symptoms may range from none to respiratory failure. In the case presented, the patient was ingesting Vaseline Intensive Care Lotion and baby oil as laxatives. This information was elicited only after diagnosis was made by open lung biopsy.
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PMID:Exogenous lipoid pneumonia. 274 81

A prospective study during 44 months has been carried out in order to establish the incidence of pneumonia due to Legionella sp. in our hospital's intensive care unit (ICU). Thirty cases of legionellosis were diagnosed (22.2% of the studied pneumonias) two of them were acquired in the ICU and 76.6% were caused by L. pneumophila serotype. The most evident symptomatology was intense dyspnea, neurological disorders, acute respiratory and renal failure. The biochemical alterations, most commonly encountered were increased liver enzymes, hypoxemia, hypoalbuminemia, increased urea, creatinine and hematuria. As a consequence of this severe disease, the mortality rate was high (13 out of 30 cases).
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PMID:[Legionellosis at intensive care units: study of 30 cases]. 277 93

Serum gamma-glutamyltranspeptidase (GGTP) and alpha-amylase clearance were determined in a total group of 90 patients of whom 60 with renal diseases and 30 with extrarenal diseases. The renal patients were distributed, according to diagnosis in the following groups: acute glomerulonephritis, chronic glomerulonephritis, acute pyelonephritis, chronic pyelonephritis, nephrotic syndrome and manifest chronic renal failure. The 30 controls were hospitalized for different extrarenal diseases such as: pneumonia, gastroduodenal ulcer, arterial hypertension stage I and angina pectoris. Serum GGTP assay was performed in 60 patients (40 renal patients and 20 controls) using Boehringer monotest kits and in 30 patients (20 renal patients and 10 controls) using Romanian kits (I.C.C.F.). No changes suggesting a particular type of nephropathy were observed. The results obtained by using the two types of kits for the serum GGTP assay have proved to be very close. Alpha-amylase clearance was determined in all the patients with Spofa (R.S.C.) tablets concomitantly with the urea and creatinine clearance. Important decreases of alpha-amylase clearance in concordance with decreases of urea and creatinine clearances were observed in all the patients with severe renal failure. More moderate decreases of alpha-amylase clearance were observed in the patients with acute and chronic glomerulonephritis. The utility of this clearance as a test of glomerular filtration and sometimes as a prognostic test, is discussed.
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PMID:Preliminary clinical and methodologic observations on the determination of serum gamma-glutamyltranspeptidase and of the alpha-amylase clearance in nephropathies. 286 37

Four hundred and fifty-three adults in 25 British hospitals entered a prospective study of community-acquired pneumonia. A microbiological diagnosis was established in 67 per cent; Streptococcus pneumoniae (34 per cent). Mycoplasma pneumoniae (18 per cent) and Influenza A virus (7 per cent) were the commonest microorganisms. Our observations support the view that most of those in the microbiologically negative group (33 per cent) had S. pneumoniae infection. In addition to cultures of blood and sputum the most useful initial tests were for sputum pneumococcal antigen and serum mycoplasma specific IgM. Twenty-six patients (5.7 per cent) died, seven within 48 h of admission. Multivariate analyses showed age, absence of chest pain, absence of vomiting, previous treatment with digoxin, tachypnoea, diastolic hypotension, confusion, leucopenia, leucocytosis, and raised blood urea levels were significantly correlated with death. Patients had a 21-fold increased risk of death if they had two of the following: admission respiratory rate greater than or equal to 30/min, admission diastolic BP less than or equal to 60 mmHg, urea greater than 7 mmol/l during admission. Mortality was not related to aetiology except that all three patients with combined Influenza A virus and Staphylococcus aureus infection died. Nine patients had legionella pneumonia; none died. No patients who died from pneumococcal pneumonia, mycoplasma pneumonia or staphylococcal pneumonia had received an appropriate antibiotic before admission. Such deaths are possibly preventable. Assisted ventilation was used in 22 patients of whom 14 survived. Hospital stay in survivors averaged 10.8 days; after six weeks 79 per cent were fit for normal activities, and 55 per cent showed resolution of radiographic signs of pneumonia. We recommend that antibiotics should be given as early as possible and chosen always to cover S. pneumoniae, and in addition M. pneumoniae during outbreaks, and S. aureus during influenza epidemics.
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PMID:Community-acquired pneumonia in adults in British hospitals in 1982-1983: a survey of aetiology, mortality, prognostic factors and outcome. The British Thoracic Society and the Public Health Laboratory Service. 311 95

The field of research bronchoalveolar lavage has grown exponentially in the past decade. Despite this growth, the clinical role of lavage is uncertain. The authors review the clinical areas in which lavage has made its greatest impact as a diagnostic test (e.g. eosinophilic pneumonia, eosinophilic granuloma, alveolar proteinosis, infection, and neoplasia). The importance of the test early in the evaluation of undiagnosed diffuse alveolar diseases is considered. Finally we discuss the possibility that urea marks the recovered lining fluid volume and thus serves as a standard denominator. Results from our laboratory indicate that it does not. We feel that lavage is clinically useful and should be employed in the evaluation of undiagnosed diseases. Although it has provided data about the pathogenesis of chronic inflammatory diseases, its role in the longitudinal evaluation of these illnesses remains to be proven.
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PMID:Bronchoalveolar lavage: clinical role and quantitative assessment. 323 3

Between January 1984 and December 1985, 183 adult patients, subsequently shown to have pneumococcal bacteraemia, were admitted. Of these infections, nine were caused by penicillin-resistant strains, and three of these were resistant to other antibiotics. The organisms from 150 patients were serotyped/grouped. The primary site of infection was lung in 90 per cent of patients. Among the patients with pneumonia, those with serovar 3 strains accounted for most intensive care unit admissions, most cases requiring inotropic drugs, and mechanical ventilation and had the highest complication rate and mortality. Findings which predicted the need for intensive care included higher age, elevated concentrations of serum urea, creatinine, and phosphate and lower levels of total serum protein, albumin and calcium. Twenty-four patients died of whom 23 had pneumonia. The case fatality rate among all of the patients admitted to the intensive care unit was 60 per cent and among those not admitted to the unit, 9.2 per cent. Of the patients who died, 41.7 per cent did so within the first five days of admission. The prophylactic use of polyvalent pneumococcal vaccine in industrial workers from low socio-economic groups should be carefully considered.
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PMID:Pneumococcal bacteraemia in adults in a low socio-economic urban population. 327 83

Although various complications such as electrolyte imbalance and urinary infection are known to be induced by ureterosigmoidostomy, it is still a surgical technique difficult to ignore since it allows patients to lead an almost normal life without the encumbrance of external urinary devices. At our hospital, we performed eighteen ureterosigmoidostomy operations between 1976 and 1985. Herein, we review the postoperative conditions of electrolyte, renal function and other complications. The patients (16 male, 2 female) were between 53 and 72 years old, the mean age being 61.5 years. The primary diseases were bladder tumor (14 patients), prostatic cancer (2), carcinoma of the female urethral diverticulum (1) and urethral stricture (1). As to the electrolytes, both serum Na and serum K values fluctuated within the normal range. Hyperchloremia was detected in 4 cases (22.2%), but it was only slightly above the normal range and the conditions were more or less stabilized a year after the operation. Although blood urea nitrogen had a tendency to elevate one or two years after the operation, serum creatinine fluctuated within the normal range. During the observation period, only 7 of the 18 cases (38.9%) showed complications, the major complication being pyelonephritis (3 cases). Postoperative excretory urogram revealed slight to medium hydronephrosis two months after the operation in 9 of the 18 cases (50%), but most of these conditions were normalized within a year. Four patients died after leaving hospital; 3 due to the recurrence of cancer and one due to pneumonia. The 14 other outpatients are enjoying a normal life without the use of any external urinary device.
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PMID:[Ureterosigmoidostomy--clinical review of 18 cases]. 344 31


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