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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Herpesviruses cause various acute, subacute, and chronic disorders of the central (CNS) and peripheral (PNS) nervous systems in adults and children. Both immunocompetent and immunocompromised individuals may be affected. Zoster (shingles), a result of reactivation of varicella zoster virus (VZV), is the most frequent neurologic complication. Other neurological complications include encephalitis produced by type I herpes simplex virus (HSV-1), and less frequently HSV-2, as well as by VZV and cytomegalovirus (CMV). Acute meningitis is seen with VZV and HSV-2, and benign recurrent meningitis with HSV-2. Combinations of meningitis/ encephalitis and myelitis/radiculitis are associated with Epstein Barr Virus (EBV); myelitis with VZV, CMV, EBV, and HSV-2; and ventriculitis/encephalitis with VZV and CMV. Brainstem encephalitis due to HSV and VZV, and polymyeloradiculitis due to CMV are well documented. HHV-6 produces childhood exanthem subitum (roseola) and febrile convulsions. Immunocompetent and immunocompromised hosts manifest different incidences and patterns of herpesvirus infections. For example, stroke due to VZV-mediated large vessel disease (herpes zoster ophthalmicus) occurs predominantly in immunocompetent hosts, while small vessel disease (leukoencephalitis) and ventriculitis develop almost exclusively in immunocompromised patients. EBV-associated primary CNS lymphomas also are restricted to immunosuppressed individuals. Recent large CSF PCR studies have shown that VZV, EBV, and CMV more frequently produce meningitis, encephalitis, or encephalopathy in immunocompetent hosts than was formerly realized. We review herpesvirus infections of the nervous system and illustrate the expanding spectrum of disease by including examples of a 75-year-old male on steroid treatment for chronic lung disease with fatal HSV-2 meningitis and an 81-year-old male with myasthenia gravis, long-term azathioprine use, and an EBV-associated primary CNS lymphoma.
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PMID:The expanding spectrum of herpesvirus infections of the nervous system. 1155 90

Patients referred to pulmonary rehabilitation usually have advanced chronic obstructive lung disease (COPD). This disease is a common cause of death in developed countries, ranking fourth as a cause of death in the United States, behind heart disease, cancer, and stroke. The three-year survival following outpatient pulmonary rehabilitation is approximately 80%. Clearly, markers of disease severity such as the degree of airways obstruction, arterial blood gas abnormality, degree of pulmonary hypertension, and the need for hospitalizations predict mortality in this disease. However, because of substantial co-morbidity, patients with COPD often die with their disease rather than from their disease. Thus, only 45 to 63% of deaths in patients with advanced lung disease are directly due to the disease itself. Factors other than primary disease severity that predict mortality in COPD include nutritional depletion, exercise endurance, functional performance, and even social factors such as marital status. Thus, once the chronic lung disease progresses to the point where referral is made to pulmonary rehabilitation, non-pulmonary factors are also important predictors of survival. This underscores the importance of a holistic approach to the patient with advanced lung disease, and the need for a comprehensive severity grading system that includes more than the forced expiratory volume in 1 sec (FEV1).
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PMID:Non-pulmonary factors affecting survival in patients completing pulmonary rehabilitation. 1177 Feb 16

The Japanese Respiratory Society has recently formulated practice guidelines for the management of adult patients with community-acquired pneumonia. The guidelines recommend the use of various oral antibiotics at individual physicians' discretion. We compared the cost-effectiveness of amoxicillin/clavulanate (AMPC/CVA), azithromycin (AZM), clarithromycin (CAM), cefdinir (CFDN), levofloxacin (LVFX), and minocycline (MINO), when used on an ambulatory basis. We performed a formal cost-effectiveness analysis from the perspective of direct cost payers in the framework of the Japanese medical system. Outcomes considered were quality-adjusted life days (QALD), costs per patient, and incremental costs per quality-adjusted life year (QALY) gained. Under baseline conditions, the effectiveness of MINO, AZM, CAM, and LVFX were on a par and higher than that of AMPC/CVA or CFDN by 125-290.5 QALD. The least expensive antibiotic was MINO (55,070 to 59,208 yen), followed by AZM (56,049 to 60,188 yen), CAM (56,171 to 60,309 yen), LVFX (61,988 to 66,127 yen). AMPC/CVA (122,432 to 133,797 yen), and CFDN (123,375 to 134,649 yen). Thus, MINO, AZM, and CAM were cost-effective antibiotics for adults with community-acquired pneumonia. Sensitivity analyses revealed that the initial success rate of each antibiotic was crucial in determining cost-effectiveness. When the number of times antibiotics are taken in a day and the period of therapy were taken into account, AZM was most beneficial with 917,179-1,152,694 yen (US$ 7,643-9,606) per additional QALY over MINO in patients without comorbidity. This result, however, was not applicable to patients with chronic lung disease. MINO was the least expensive and the most cost-effective in empirically treating adult patients with community-acquired pneumonia on an ambulatory basis. AZM provides a higher quality of life for adults without comorbidity with generally acceptable marginal cost.
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PMID:[Cost-effectiveness analysis of ambulatory treatment for adult patients with community-acquired pneumonia: according to Japanese Respiratory Society guidelines]. 1192 12

Mortality rates in Russia are very high as compared to those in other developed countries, particularly among men. A series of hypotheses associating heavy drinking and social and economic stresses of the transition period with drastic increases in mortality rates in Russia in the mid-1990s have been generated. However, the hypotheses are under analytical study on an individual level. A case control study was carried out to investigate the association of mortality due to smoking, alcoholic consumption, and a variety of socioeconomic indices. A total of 13,079 individuals who died in 1990-1999 were identified during a populational survey of 90,147 families in four Russian cities: Barnaul, Tomsk, Tyumen, and Vladivostok. Data on lifestyle habits, such as smoking, alcohol consumption, and some socioeconomic characteristics of the deceased were obtained from questionnaire surveys with proxy respondents (wives, husbands, etc.). Proportional mortality analyses were carried out. Controls were selected from those who died from non-smoking-related causes. A statistically significant association was established between smoking and the risk of death due to cancers of the lung, mouth, pharynx, larynx, esophagus, stomach, and urinary bladder. There was also a dose-response relationship of the numbers of cigarettes smoked to the risk of cancers at these sites. Smokers were found to be at a statistically significantly increased risk for coronary heart disease and stroke. There was a close and statistically significant association between smoking and chronic obstructive lung diseases, respiratory tuberculosis, and other respiratory infections. There was also a close dose-response relationship of the number of cigarettes consumed per day to the risk of respiratory tuberculosis and obstructive lung disease.
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PMID:[Smoking: the main cause of high mortality rate among Russian population]. 1238 Feb 85

In patients with obstructive sleep apnoea syndrome (OSAS), pulmonary haemodynamics can show both transient perturbations during sleep and permanent alterations. During sleep, repeated fluctuations in pulmonary artery pressure and pulmonary wedge pressure, coincident with apnoeas, can be observed. Calculation of transmural pressure values is preferable to intravascular pressures in OSAS, due to the marked swings in intrathoracic pressure associated with obstructive apnoeas. Pulmonary artery pressure may progressively increase during sleep, particularly in close sequences of highly desaturating apnoeas. Apnoea-induced hypoxia appears as the most important determinant of this pulmonary artery pressure behaviour. Stroke volume and cardiac output during obstructive apnoeas show changes mainly related to intrathoracic pressure variations. Permanent precapillary pulmonary hypertension at rest is observed in <50% OSAS patients, and is poorly reversible after OSAS treatment. It correlates best with diurnal respiratory function parameters. However, the finding of pulmonary hypertension in some patients with near normal diurnal lung function led to suggest that sleep respiratory disorders may contribute to permanent pulmonary haemodynamic impairment in predisposed subjects. Knowledge on right ventricle hypertrophy in OSAS is inconsistent. As to right ventricle failure, it is clinically evident in subjects with associated lung disease or morbid obesity, while it may be detected instrumentally in subjects without such alterations, presumably as effect of apnoeas themselves. Besides, it appears more fully reversible after long-term OSAS treatment than pulmonary hypertension.
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PMID:Pulmonary haemodynamics in obstructive sleep apnoea. 1253 Nov 20

This paper explores the extent to which changes in medication use during the 1990s are linked to improvements in functioning among Americans before they reach retirement age. Using two cross-sections from a survey of Americans ages 51-61, we examined changes between 1992 and 1998 in the prevalence of functional limitations and medication use associated with five chronic conditions: hypertension, diabetes, lung disease, stroke, and arthritis. We found no evidence linking increases in medication use to improvements in functioning. Instead, increases in educational attainment offset the negative effects of increases in obesity and arthritis over this period. Findings underscore the need for caution in projecting forward improvements in old-age functioning when considering the future of Medicare, Medicaid, and other programs that serve the elderly with disabilities.
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PMID:Trends in medication use and functioning before retirement age: are they linked? 1288 63

In contrast to surgical patients, prevention of acute pulmonary thromboembolism has been less well studied in hospitalized medical patients even in Western countries. But some data apparently showed the high prevalence of venous thromboembolism in medical patients. The combination of mechanical prophylactic measures should be indicated for medical patients with risk factors including stroke, cancer, prolonged bedrest, heart failure and severe lung disease. Prospective studies to evaluate the frequency of venous thromboembolism in medical patients with risk factors and the efficacy and safety of each prophylactic measure, especially of pharmacological prophylaxis are necessary to establish the guidelines for prevention of pulmonary thromboembolism for Japanese people.
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PMID:[Prevention of pulmonary thromboembolism in medical patients]. 1457 7

This paper uses the Assets and Health Dynamics of the Oldest Old (AHEAD) data set to examine the influence of nativity on the health status, measured by self-reported presence of chronic diseases, of the elderly US-resident population. In particular, age at time of migration is used to examine the potential lingering influence of self-selection for good health among immigrants who entered the USA as adults. Bivariate analyses and logistic regression models are presented. The results of these analyses show that the influence of positive selection for health varies depending on the disease studied. Self-selection for good health is maintained for cancer, heart disease, stroke, and lung disease. This self-selection effect is seen after controlling for socioeconomic factors and health behaviors. While these latter factors are more influential, this study indicates that good health in a population at young ages is maintained throughout the lifespan.
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PMID:Do health selection effects last? A comparison of morbidity rates for elderly adult immigrants and US-born elderly persons. 1461 23

Controlled mechanical ventilation (CMV) may contribute to impaired hemodynamics in patients with respiratory failure. It is rational to assume that hybrid modalities of mechanical ventilation have fewer hemodynamic side-effects when spontaneous respiratory activity is allowed during the application of positive airway pressure. Partial liquid ventilation (PLV) has been shown to improve gas exchange in subjects with severe alveolar lung disease. We have shown that spontaneous respiratory efforts during proportional assist ventilation (PAV) is possible in experimental animals without lung disease whose lungs are partially filled with perfluorocarbons. In another series of experiments we demonstrated that PLV improves oxygenation and lung compliance in adult rabbits with severe surfactant deficiency, and in rabbits with meconium aspiration. In animals with meconium aspiration mortality, work of breathing and the degree of lung injury, as assessed by histological analysis, were reduced. In another two series of animals with and without surfactant deficiency spontaneous breathing supported by PAV was associated with increased cardiac output, stroke volume and oxygen transport, as compared to CMV after pharmacologically induced muscle paralysis. An increased arterial and venous pH in animals with surfactant deficiency during spontaneous breathing supported by PAV suggests improved tissue perfusion. Furthermore, gas exchange was improved during spontaneous breathing supported by PAV as compared to CMV and muscle paralysis.
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PMID:[Preserved spontaneous breathing during partial liquid ventilation. Results of experimental animal studies and their clinical implications]. 1469 30

The aim of this study is to contribute to the emerging field of quantification of Health Impact Assessment (HIA), by analysing how different relative risks affect the burden of disease for various socio-economic groups (SES). Risk analysis, utilising attributable and impact fraction, raises several methodological considerations. The present study illustrates this by measuring the impact of changed distribution levels of smoking on lung cancer, ischemic heart disease (IHD), chronic obstructive lung disorder (COLD) and stroke for the highest and lowest socio-economic groups measured in disability adjusted life years (DALY). The material is based on relative risks obtained from various international studies, smoking prevalence (SP) data and the number of DALY based on data available for Sweden. The results show that if smoking would have been eliminated (attributable fraction, AF), the inequality between the highest and lowest socio-economic groups may decrease by 75% or increase by 21% depending on the size of the relative risk. Assuming the same smoking prevalence for the lowest socio-economic group as for the highest (impact fraction), then the inequality may decrease by 7-26%. Consequently, the size of the relative risk used may have a significant impact, leading to substantial biases and therefore should be taken into serious consideration in HIA.
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PMID:Using risk analysis in Health Impact Assessment: the impact of different relative risks for men and women in different socio-economic groups. 1472 Jun 39


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