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

An orbitozygomatic infratemporal approach for the removal of large neoplasms involving the lateral skull base is described. This approach, involves a unilateral frontotemporal incision extended inferiorly to the neck, a lateral facial flap reflected anteriorly. Transection of the zygoma is followed by its reflection inferolaterally with the temporalis muscle. This exposure provides excellent visualization of both the intradural and extradural aspects of the anterior portion of the cavernous sinus, allowing an aggressive resection of neoplasms in this region. Experience with this procedure in the management of 15 patients is reported here. There was one postoperative death due to pneumonia and septicemia. The morbidities included wound infection, meningitis, CSF leakage and cranial nerve palsy. All the surviving patients, are living independently and have returned to their previous occupations.
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PMID:Orbitozygomatic infratemporal approach to lateral skull base tumors. 839 73

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

Recently the incidence of infectious diseases caused by penicillin-resistant Streptococcus pneumoniae (PRSP) is increasing. Patients with meningitis caused by PRSP have been reported with high mortality especially in the field of pediatrics, and it is crucial to treat with accurate and precise choice of antibiotics. We report the first adult case of bacterial meningitis caused by PRSP in Japan. A 32-year-old male without immunological abnormalities developed acute pneumococcal meningitis. Empiric therapy with ampicillin and cefotaxime was not effective and the S. pneumonia from CSF showed resistance to multiple antibiotics such as penicillin and cefotaxime. He was treated successfully with the combination of panipenem/betamipron, vancomycin, and chloramphenicol. We assume that panipenem/betamipron is recommended to be added to empiric therapy of bacterial meningitis, considering an increasing incidence of PRSP infection.
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PMID:[An adult case of bacterial meningitis caused by penicillin-resistant Streptococcus pneumoniae]. 856 45

CRP level was determined in the cerebrospinal fluid in 40 cases of bacterial meningitis. Similar determination in serum was done in 32 of these patients. Aetiological verification was possible in 90% of cases. Meningitis caused by Str. pneumonia and Neisseria meningitides prevailed (52.5% and 27.5% respectively). The control group comprised 20 subjects. For CRP demonstration immunochemical and turbidimetric methods were used. CRP in CSF was raised in 62.5% of the study cases while in the serum it was raised in all of them. CRP detection in serum in acute phase of central nervous system infection is diagnostically important since CRP increase suggests a purulent process.
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PMID:[C-reactive protein (CRP) and its significance in purulent meningitis]. 858 95

We studied the effects of inhibiting and augmenting neutrophil function by using an immunocompetent rat model of infectious and hyperoxic lung injury. After intrabronchial Escherichia coli challenge at all fractional inspired O2 (FIO2) values studied (FIO2 = 0.21, 0.60, and 0.95) and after lethal O2 exposure alone (FIO2 = 0.90), lung injury, as measured by histological and physiological changes, was reduced by a CD11b/CD18-directed monoclonal antibody (MAb 1B6, P < 0.05 vs. controls) but was increased by recombinant granulocyte colony-stimulating factor (rG-CSF; P < 0.05 vs. control; MAb 1B6 vs. rG-CSF, P < 0.004). Pulmonary neutrophil counts were reduced by MAb 1B6 (P < 0.04) and increased by rG-CSF (P < 0.0004) compared with control animals. However, despite antibiotics, MAb 1B6 and rG-CSF both significantly increased the relative risk of death, independent of O2 concentration, during E. coli pneumonia (1.74 [symbol: see text] 1.20 and 2.39 [symbol: see text] 1.19, respectively, each P < 0.01). During lethal hyperoxia, MAb 1B6 increased the relative risk of death (1.76 [symbol: see text] 1.28, P < 0.16), whereas rG-CSF had no effect on survival (0.97 [symbol: see text] 1.28, P = 0.89). Thus inhibition of neutrophil function attenuated and enhancement worsened lung injury in response to infectious and hyperoxic challenges, supporting a pathophysiological role of the neutrophil in these processes. However, it is problematic that MAb 1B6 therapy, despite preventing lung damage, ultimately worsened host defenses and survival. Furthermore, rG-CSF also adversely affected survival during infectious lung injury, demonstrating the inherent risks of inhibiting or augmenting neutrophil function in an immunocompetent host during infection.
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PMID:Controlled trials of rG-CSF and CD11b-directed MAb during hyperoxia and E. coli pneumonia in rats. 880 15

In order to assess the efficacy and safety of recombinant human granulocyte-macrophage colony-stimulating factor (rHuGM-CSF) in the treatment of HIV-associated leukopenia, 35 subjects suffering from severe leukopenia/neutropenia (24 with a previous diagnosis of AIDS, 11 with AIDS-related complex), received rHuGM-CSF at 0.5-3 micrograms/Kg/day subcutaneously for a mean period of 9.7 +/- 12.5 weeks (range 2-43 weeks). Five patients have been treated continuously for more than 6 months. rHuGM-CSF administration led to a significant (at least two-fold; P < .001) increase in total leukocyte, neutrophil and monocyte count by the second week of treatment, subsequently maintained through the entire course of therapy. No considerable effects on other hematological, immunological and virological parameters have been detected. Patients treated with rHuGM-CSF did not suffer from novel opportunistic diseases, while bacterial infections occurred in only 3 cases (pneumonia in 2, otitis/mastoiditis in 1). Long-term treatment with rHuGM-CSF allowed continuation or resumption of potentially myelotoxic drugs in 22 patients out of 35. A self-limited flu-like syndrome represented the most common adverse event (observed in 15 patients), while no other significant clinical or laboratory abnormalities were found. In conclusion, long-term rHuGM-CSF therapy showed a good efficacy and safety profile in the treatment of HIV-related leukopenia, also increasing tolerability to potentially myelosuppressive drugs, and leading to a significant reduction in morbidity due to secondary infections.
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PMID:Recombinant human granulocyte-macrophage colony-stimulating factor (rHuGM-CSF) in leukopenic patients with advanced HIV disease. 880 19

This study describes bronchoalveolar lavage (BAL), histological and immunohistochemical features in a series of 10 patients with cryptogenic organizing pneumonia (COP). The histological diagnosis was performed by transbronchial biopsy in seven cases and by open lung biopsy in three cases. All patients showed a marked increase in lymphocytes and a mild increase in neutrophils and eosinophils in BAL fluid. The number of T-lymphocytes expressing human leucocyte antigen-DR (HLA-DR) surface antigen was increased (p < 0.002). The majority of lymphocytes expressed the CD8 phenotype, so that the CD4/CD8 ratio was markedly decreased. Masson bodies were present in the lung specimens of all patients. Most of the epithelial cells surrounding the Masson bodies were immunoreactive with an anti-granulocyte/macrophage colony-stimulating factor (GM-CSF) monoclonal antibody. The great majority of mononuclear cells in the lung specimens showed immunoreactivity with anti-CD3, anti-CD8 and anti-CD45R0 monoclonal antibodies. In the Masson bodies, spindle cells were immunoreactive with anti-alpha smooth muscle (alpha-sm) actin monoclonal antibody. Glucocorticoid treatment (the therapy of choice in COP) downregulated GM-CSF messenger ribonucleic acid (mRNA) expression in lung epithelial cell lines. These findings indicate that the combination of bronchoalveolar lavage cell profile with histological evidence is a valuable means of corroborating a clinical diagnosis of cryptogenic organizing pneumonia, and that granulocyte/macrophage colony-stimulating factor may be one of the cytokines involved in the pathogenesis.
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PMID:Bronchoalveolar lavage, histological and immunohistochemical features in cryptogenic organizing pneumonia. 890 12

A newborn with symptoms of congenital cytomegalovirus infection (interuterine dystrophy, thrombocytopenia, leukopenia, hepatosplenomegaly, chronic pneumonia, pleocytosis in CSF) is described in whom tests for specific anti- CMV-IgM antibodies were negative. Changes typical for cytomegaloviral infection were found on autopsy. The authors discuss the difficulties in interpreting various serologic tests (CFT, anti-CMV IgM) in congenital infections, suggesting the necessity of introducing new diagnostic methods for better diagnosis and treatment.
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PMID:[Suppression of immunological response in a newborn with congenital cytomegalovirus infection: diagnostic difficulties]. 897 25

Adenovirus infections are very common diseases, especially upper respiratory infections and diarrhea in infants. Moreover, adenoviruses can occasionally produce CNS infections. The common causative adenovirus is type 7 for them, and they have been associated with pneumonia and epidemics of adenovirus in family outbreaks. Reye-like syndrome has rarely been reported. As AIDS and other immunocompromised patients have increased, new reports of adenovirus CNS infections have also increased. Of course the immunosuppressed conditions have included lymphoma, transplant etc. In the near future, long term care for immunocompromised patients will have a crisis of adenovirus CNS infection. On the other hand, adenovirus CNS infections are difficult to diagnose precisely without special facilities, due to the need for adenovirus cultivation from CSF. In addition, the diagnosis may have limitations due to the many subtypes of adenovirus. Despite the benefits of PCR methods, standard laboratory testing procedures are still not established for diagnosis.
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PMID:[Adenovirus CNS infections]. 910 87

The surveillance of pneumococcal resistance in nasopharyngeal isolates is a practical way to determine the prevalence of resistant strains and is a reasonable predictor of resistance in systemic isolates. The increasing prevalence of resistance is shifting the distribution of invasive pneumococcal serotypes toward those included in conjugate vaccines. If these vaccines reduce carriage, they may eliminate or greatly reduce the prevalence of resistant strains. Meningitis is the most important infection caused by PRP for which penicillin or ampicillin therapy is inappropriate. Although the extended spectrum cephalosporins will be effective for most cases of PRP meningitis, it is clear that such therapy is not foolproof. It is important for the laboratory to test CSF isolates not only for penicillin resistance but also for resistance to the cephalosporins. beta-Lactam antibiotics can still be considered appropriate empiric therapy for otitis media, pneumonia, or sepsis. However, occasional treatment failures with these agents may necessitate use of alternative therapeutic strategies.
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PMID:Antibiotic-resistant pneumococci in pediatric disease. 915 79


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