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

Pneumonia apparently resulting from aspiration became clinically apparent in an elderly man two days after admission to a private room on a general medical ward. Pneumonia developed in a patient in an adjacent room three days later. Both patients had group B Neisseria meningitidis isolated from a percutaneous transtracheal aspirate. A prevalence survey failed to identify meningococcal carriers among other ward patients. The index patient required frequent nasotracheal suctioning during the first two hospital days prior to penicillin G potassium therapy. The second patient was simultaneously receiving continuous oxygen therapy administered by nasal cannula. Events suggested that the organism may have been transmitted by direct contact, probably on the hands of hospital personnel.
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PMID:Meningococcal pneumonia. A source of nosocomial infection. 678 86

In 26 patients with culture-proved pulmonary coccidioidomycosis, cytologic preparations of respiratory secretions were significantly more sensitive (38.5%) than potassium hydroxide (KOH) preparations (15.4%) in identifying spherules of Coccidioides immitis. Those patients able to produce sputum or having multiple-lobe pneumonitis on chest roentgenogram appeared to be more likely to have spherules identified in the sputum by either technique. In the absence of sputum production or multiple-lobe pneumonitis, neither cytologic nor KOH preparations were likely to disclose spherules. Because of its greater sensitivity, a cytologic preparation should be examined in addition to a KOH preparation when pulmonary coccidioidomycosis is a clinical consideration.
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PMID:Rapid diagnosis of pulmonary coccidioidomycosis. Cytologic v potassium hydroxide preparations. 683 94

In normal children of the first 6 months of life the erythrocyte membrane stability assessed from the characteristics of its passive K+-permeability depends on the feeding pattern. The greater stability is observed upon natural feeding while the least upon feeding by means of cow's milk dilution. Apparently, varying stability of cell membranes lies at the basis of appreciable disorders of membranes permeability during acute pneumonia in children kept on irrational feeding (with simple mixtures). Thus, in this group of the patients, there are higher indicators of passive K+-permeability of the erythrocyte membrane and the most significant changes in some of the characteristics of bioenergetic processes (intracellular content of potassium, ATP, transmembranous potassium distribution ratio).
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PMID:[Passive K+-permeability of the erythrocyte membrane in healthy infants and those with pneumonia in the 1st months of life on different feeding regimens]. 712 94

In September 1990, a 55-year-old female with erythroleukemia was treated with enocitabine, mitoxantrone, vincristine, and etoposide. Despite prophylaxis of infectious diseases by oral administration of 2,400 mg/day amphotericin B (AMPH), 600 mg/day ofloxacin, and 1,500 mg/day kanamycin, pneumonia with refractory pyrexia appeared and developed cystic lesions with air crescent signs thereafter. Finally, the cystic one formed fungus balls. The pneumonia was diagnosed as aspergillus pneumonia by fungus growth in the tissue in the transbronchial lung biopsy specimens and by an elevation of serum anti-Aspergillus antibody. The patient had continuously been administered with AMPH for 16 days, increasing the drug doses every 2 days. The maximum plasma level of AMPH rose up to 0.78 micrograms/ml, the total amount up to 166 mg. The fungus balls disappeared completely without adverse effects except a transient decrease of plasma potassium level. Pharmacological studies had been reported that tissue AMPH levels elevated more than twice as much as that of the plasma. Although the maximum plasma level was less than that of MIC for Aspergillus, the lung tissue drug level was suspected to have been maintained higher by continuous drip infusion. These findings indicate that continuous drip infusion of AMPH is one of the useful treatment for lung aspergillosis.
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PMID:[A case of erythroleukemia associated with lung aspergilloma successfully treated with continuous drip infusion of amphotericin B]. 760 95

Recently, renal osteodystrophy is a remarkable problem in patients on long-term hemodialysis (HD). In this retrospective study, we evaluated the perioperative management of 21 patients receiving orthopedic surgery between January 1990 and December 1992. These patients had been maintained on HD for an average of 8.6 years (range, 18 months-20 years). The primary causes of orthopedic surgery were amyloidosis, diabetic gangrene, rheumatoid arthritis and fractures. Laminectomy, replacement of arthropathy, osteosynthesis and amputation of the lower extremity were undertaken. General anesthesia was performed on six patients. Vecuronium was given to all of these patients. Isoflurane was used in 5 patients and sevoflurane in 1 patient. Regional anesthesia was used in 15 patients. During anesthesia, the average infusion rate of intravenous fluids was 2.7 ml.kg-1.h-1, and the intraoperative complications included hypertension in 16, hypotension in 12, arrhythmia in 4 and prolonged sedation in 2 patients. Postoperative complications included hyperkalemia in 2, pneumonia in 2, psychological disorder in 3, clotting fistula in 1 and delayed wound healing in 7 patients. One early death in a diabetic patient following amputation occurred on the 13th postoperative day. Preoperative HD was performed within 24 hours and postoperative HD within 72 hours of the operation. Nafamostat mesilate was used as an anticoagulant. Excessive removal of potassium must be avoided during preoperative HD to prevent arrhythmia. The well-managed elective patients gave a good result. However, extreme care in nutrition and infection control should be taken, especially in diabetic patients.
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PMID:[Perioperative management of dialysed patients for orthopedic surgery]. 777 29

Although various complications such as electrolyte imbalance and urinary infections are known to be induced, ureterosigmoidostomy may still prove to be useful on selected patients who desire a continent form of internal diversion. At our hospital, we performed nineteen ureterosigmoidostomy operations in the seven years between 1981 and 1987. Herein, we have reviewed the postoperative conditions of electrolytes, renal function and other complications. The patients (17 male, 2 female) were between 43 and 75 years old, the mean being 60.3 years. The primary disease was bladder tumor with histopathological findings of transitional cell carcinoma (17) and squamous cell carcinoma (2). Post-operative fluctuations in electrolyte values of Serum Na and Serum K were within the normal value. Hyperchloremia was initially detected in four cases (21.0%), but these were only slightly above the normal range and a year after the operations the conditions were stabilized. Although blood urea nitrogen had a tendency to elevate one or two years after the operation serum creatinine fluctuated within the normal range. After the operations, we administered 10% sodium potassium citrate solution to all patients to prevent hyperchloremic acidosis. During the observation period, only four out of nineteen cases (21.0%) exhibited pyelonephritis. No other complications were observed. Postoperative excretory urograms revealed slight to medium hydronephrosis two months after the operation in four out of nineteen cases but most of these conditions were normalized within a year. Nine patients died after leaving the hospital; seven due to the recurrence of cancer and two due to pneumonia. The ten remaining patients are enjoying normal lives without the use of any external urinary device.
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PMID:[Clinical evaluation on long-term complications of ureterosigmoidostomy]. 807 55

A 52-year-old man was admitted to our hospital because of oliguric renal failure. The patient was well until four weeks earlier, when he developed nausea and anorexia. The urea nitrogen was 179 mg/dl, creatinine 29.2 mg/dl, uric acid 19.0 mg/dl and potassium 8.6 mEq/1. Hemodialysis was started immediately after admission. Bone marrow aspiration showed atypical plasma cell infiltration consistent with multiple myeloma. The immunoelectrophoresis revealed urinary lambda -type Bence Jones protein and serum IgD- lambda -type M protein. The findings of renal biopsy study were consistent with myeloma kidney. On the fourth hospital day, administration of prednisolone 40 mg and melphalan 2 mg was started. The patient also underwent double filtration plasma-pheresis (DFPP). Serum IgD level was decreased from 950 to 113 mg/dl. After a course of chemotherapy, however, he developed severe leukopenia and was complicated with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. This complication was successfully treated with imipenem/cilastation and vancomycin combined with granulocyte colony stimulating factor (G-CSF). The patient was discharged and returned to work on maintenance hemodialysis. Fifteen months after the presentation, he manifested progressive peripheral nerve disturbances. Three months later, the patient died--not from renal failure, but from ventricular arrhythmia. The application of maintenance dialysis therapy to myelomatosis has until now been questioned. The present case, however, suggests that aggressive treatment consisting of chronic dialysis therapy as well as chemotherapy and plasma exchange should be administered even in patients with established renal failure.
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PMID:[Maintenance hemodialysis in IgD- lambda -type multiple myeloma associated with severe renal failure]. 813 51

Normothermic retrograde continuous cardioplegia is a revolutionary development for myocardial preservation in cardiac surgery. Despite excellent reports regarding this technique, the surgical community has expressed concern over technical problems encountered. The method of normothermic retrograde continuous cardioplegia in current use requires both large total crystalloid volumes and large potassium loads to deliver adequate cardioplegia. We have developed a technique that eliminates these problems. The heart is stopped by an initial infusion of normothermic cardioplegic solution through a coronary sinus catheter. The infusate is then converted to normothermic pump blood. Small boluses of potassium chloride are added intermittently to maintain cardiac arrest. We applied this technique to 35 patients undergoing cardiac valve surgery. The average volume of crystalloid cardioplegia required was 125 mL (range, 40 to 155 mL), and the average total potassium load was 52 mEq (range, 2 to 100 mEq). Clinically significant sequelae were noted in 4 patients (11%), and 1 (3%) died of pneumonia on the 28th postoperative day. The method we describe is a safe and effective alternative to the current technique of normothermic retrograde continuous cardioplegia and offers both physiologic and technical advantages to patients undergoing cardiac valve procedures.
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PMID:Normothermic retrograde continuous cardioplegia for myocardial protection during cardiopulmonary bypass. A modified technique. 833 71

We present the case of a patient with a history of asthma who developed cough and hemoptysis that were unresponsive to antituberculous therapy. Chest roentgenography demonstrated right-sided collapse with consolidation and a pleural effusion. Bronchial biopsy revealed fungal hyphae, and cultures later yielded Bipolaris spicifera. In addition, weight loss and intractable hypotension in association with hyponatremia and elevated potassium levels suggested addisonian crisis, which was confirmed by measurement of serum ACTH and cortisol levels. Computed tomography of the abdomen revealed bilateral adrenal involvement. Tissue obtained on biopsy of the adrenal glands yielded B. spicifera. The patient responded to treatment with 2 g of iv amphotericin B; the adrenal masses and pneumonia resolved, and he remained well until last seen in July 1992. However, he requires replacement therapy with prednisone and fludrocortisone. On review of the available literature, we were unable to find a previously reported case.
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PMID:Disseminated bipolaris infection in an asthmatic patient: case report. 839 76

A total of 235 cases of sudden unexpected death syndrome (SUDS) among apparently healthy male Thai migrant workers in Singapore were reported between 1982 and 1990. Most of the deaths occurred during sleep and 13% were not sleep-related. The median age at the time of death was 33 years and the median interval between arrival and death was 8 months. These deaths occurred singly and sporadically throughout the year. Post-mortem examination revealed few abnormal findings except for haemorrhagic congestion or oedema of the lungs. There were moderate to severe intra-alveolar haemorrhages with some evidence of myocarditis or pneumonitis. Preliminary findings of serial sections of the hearts indicate evidence of anomalies in the cardiac conduction system. Epidemiological investigations showed that a family history of similar deaths and serological evidence of current or recent infection with Pseudomonas pseudomallei were significantly associated with SUDS. Extensive biochemical and toxicological investigations were inconclusive. There was no evidence of chronic deficiency in thiamine or potassium among the healthy Thai workers living and working in the same conditions as the cases, and no significant abnormalities were detected on electrocardiographic examination. As these migrant workers experienced various psychosocial problems which could stem from maladjustment to an urban environment, separation from the family, burden of debts and long hours of work, stress could be a precipitating factor for SUDS.
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PMID:Epidemiology of sudden unexpected death syndrome among Thai migrant workers in Singapore. 844 52


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