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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The chest roentgenograms of 142 neonates who survived mechanical ventilation for respiratory distress syndrome (N = 99) and prolonged apnea (N = 43) were reviewed. Thirty-seven infants had bronchopulmonary dysplasia (BPD) and 17 of these developed lobar hyperinflation of the right lower lobe and collapse of the right upper lobe. Regional lung function was measured with a xenon 133 technique in three of these infants and in five other patients who either died or were lost to follow-up. All had BPD with right lower lobe overinflation. Ventilation was less in the lower regions than the upper regions bilaterally (P less than .001), indicating that the hyperinflation of the lower lobes was not compensatory for upper lobe collapse but was due to emphysema. Mean regional perfusion was equal in the upper and lower regions of the chest. This preferential distribution of lobaremphysema and ipsilateral atelectasis in BPD tended to present and regress simultaneously, but in many infants it lasted as long as eight weeks. Only one infant with persistent atelectasis developed pneumonia. The best mode of therapy appears to be supportive.
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PMID:Preferential distribution of lobar emphysema and atelectasis in bronchopulmonary dysplasia. 37 67

In February 1979 a 51 year old man fell will in Munich, displaying symptoms of an influenza-like illness which developed into pneumonia. The patient died eight days later of circulatory collapse which failed to respond to treatment, accompanied by high temperature, leucopenia and agranulocytosis. Typical rods detected in the lung tissue and histological sections by immunofluorescence indicated the possibility of a Legionella pneumophila infection. The pathogen isolated from the lung tissue on CYE agar was identified as L. pneumophila, serogroup I. The diagnosis was confirmed by the CDC, Atlanta. This is the first time this organism has been isolated in Central Europe from a case with a fatal outcome.
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PMID:[Legionnaires' disease in Germany (author's transl)]. 47 55

In an intensive care unit an important role is assigned to respiratory physiotherapy. Its principal task is efficacious toilet of the bronchi by fluidifying the secretions, promoting their ungluing from the respiratory tree and facilitating their evacuation by cough or by aspiration with a catheter or bronchoscope. The technique comprises the inhalation of a secretolytic (e.g. Bisolvon, NaCl 9%) and, in the case of asthma, bronchospasmolytic (e.g. Ventoline) aerosol followed by breathing exercises. The other objectives of physiotherapy are to ensure a better distribution of inspired air, increase failing ventilation, ameliorate disturbed gas exchange, relax the contracted respiratory muscles and prevent bronchiolar collapse in emphysema during expiration. The field of application of respiratory physiotherapy is large; its purpose is prophylactic and therapeutic. The method is prophylactic in all patients confined to bed, where there is a risk of bronchial obstruction or ventilatory failure, especially in those with severe operation, traumatism or consciousness disorder. Physiotherapy has a therapeutic role in several, principally broncho-pulmonary diseases, such as asthma, obstructive emphysema, pneumonia, bronchiectasis, pulmonary abscess, atelectasis, and pulmonary and pleural fibrosis. Myocardial infarction and pulmonary embolism in the acute state, acute pulmonary edema, pneumothorax and pulmonary hemorrhage are contraindications for physiotherapy. If the method is to be effective the intensive care unit should have a specialized physiotherapist attached to it working there on a daily basis.
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PMID:[The role of respiratory physiotherapy in an intensive care unit]. 52 99

Here are the most important pathomorphological findings recorded from 14 calves or heads of young cattle following whole-body X-ray treatment (170 R and u50 R median-line dosage): 1. Damage was caused to the haematopoietic system, with the most severe effects on granulopoiesis, thrombocytopoiesis, and lymphopoiesis, but less conspicuous lesion of erythropoiesis. 2. Haemorrhagic diathesis developed together with pneumonia in 86 per cent of all cases, manifested in most of them as severe fibrinous pneumonia and pleuropneumonia (in 75 per cent of the cases) and progressing pericarditis. 3. Liver degeneration occurred to all animals, usually in the form of centrobular liver cell necrobiosis (86 per cent), with most of the cases accompanied by diffuse degenerative hepatoparenchymal damage (80 per cent) as well as by granular degeneration of the myocardium and acute fubulonephrosis, the latter two processes obviously developing only short time before death. 4. Catarrhal as well as fibrinous and circumscribed diphtheroid enteritis developed in 43 per cent of all animals, those which had received a median-line dosage of 170 R. 5. Deficiency in supply was recorded, too, with severe damage to the haematopoietic organs being in the focus of the pathological process. That damage actually was the cause of the haematologically established granulocytopenia or agranulocytosis, thrombocytopenia, and lymphopenia. That was the background against which radiation syndrome of calf could be accompanied by activation of latent or subclinical infection of respiratory organs and the development of severe pneumonia as well as by changes in the intestinal flora leading to the outbreak of enteritis. The collapse of cellular defence mechanisms obviously caused intestinal induction of resorption of bacterial toxins and decomposed tissue products, with the pneumonia-damaged lungs being involved. The results eventually were intoxication with haemodynamic disorders, increase in vascular permeability, and degenerative damage to the parenchyma. Haemorrhagic diathesis was the result of thrombocytopenia and, possibly, endotoxic or toxic damage to the coagulation and blood vessel system. Further pathogenetic aspects relating to the radiation syndrome in calf and young cattle are discussed.
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PMID:[Pathomorphology and pathogenesis of radiation sickness in calves and young cattle following whole body roentgen irradiation]. 72 76

The role chest radiography plays in intensive care units (ICU) is unlike its role elsewhere because in the ICU a patient's underlying disease is usually known. Furthermore, additional diseases that develop in the ICU-such as pneumonia, hemorrhage, edema, lung collapse and effusion-often are radiographically indistinguishable. Nevertheless, an ICU radiograph of the chest is valuable, mainly in identifying such complications as malpositioned intravenous catheters, Swan-Ganz catheters, pacemakers, nasogastric tubes, endotracheal tubes, chest tubes, and mediastinal tubes, and ectopic gas related to mechanical ventilation. Understanding the limitations of the portable ICU chest film in the diagnosis of specific diseases and being alert to possible iatrogenic complications will increase the usefulness of ICU chest radiography.
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PMID:Chest radiography in intensive care units. 73 45

Three cases of life-endangering airway obstruction by fibrin membranes are reviewed which developed in a 17-year-old girl with virus pneumonia, in a 21-year-old girl with a history of thrombopathy after general anaesthesia with naso-tracheal intubation and in a 23-year-old woman after short anaesthesia with orotracheal intubation. Possible causal factors, the clinical symptoms and the therapeutic measures taken by the anaesthetist are discussed. Since these cases are generally in a state of severe respiratory collapse by the time treatment is initiated general anaesthesia with muscle relaxation should be attempted only if the anaesthesist is certain that he can effectively ventilate the patient before and during the operation. Otherwise it is better to apply assisted ventilation with oxygen and halothane via a mask until a clear air passage has been restored. Administration of anticholine drugs and control of shock are essential.
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PMID:[Anaesthesia for the relief of dyspnoea caused by fibrin membranes in the larynx and trachea (author's transl)]. 88 57

A 6-week-old infant born prematurely had severe hyponatremia and other features of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). This disturbance was believed to be secondary to extensive bilateral pneumonia with collapse of the right upper lobe. Although this association has been recognized in adults, this is the first report of its occurrence in an infant. SIADH must be considered in the differential diagnosis of hyponatremia in association with pneumonia in an infant.
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PMID:Bilateral pneumonia and inappropriate secretion of antidiuretic hormone in a premature infant. 94 22

Lung biopsy remains the essential cornerstone in the diagnosis of pneumocystis pneumonia. Whatever technique can establish this diagnosis safely and early in order to get treatment started quickly should be used. Open lung biopsy remains a candidate for the diagnostic method of choice because if offers some advantages over percutaneous needle biopsy. There is a greater supply of competent thoracic surgeons in most hospitals than of physicians who are proficient with needle biopsy. The direct vision afforded by thoracotomy enables selective biopsy of grossly involved lung that can be appreciated by direct vision and palpation; needle biopsy is random and blind in its sampling. A more generous tissue specimen can be obtained for pathologic examination; the pathologic diagnosis of an "unsatisfactory specimen" is unlikely to result from open biopsy. Open lung biopsy achieves a higher diagnostic yield earlier in the pneumonitis when pneumocystis pneumonia is confined to the perihilar regions inaccessible to percutaneous needle biopsy. Better control of hemostasis is achieved by direct vision and ligature in a group of patients characteristically at high risk for bleeding tendencies, and pneumothorax is controlled in open biopsy; thoracostomy prevents the later, uncontroled collapse of the lung when the patient returns to the ward where there may be some diagnostic and therapeutic delay in the treatment of pneumothorax in a patient who can tolerate little further respiratory compromise.
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PMID:Open lung biopsy in the diagnosis of Pneumocystis carinii pneumonia. 108 51

The clinical and autopsy findings in a patient with the severe form of leukocyte adhesion deficiency are presented. An 18-month-old Hispanic female had a history of delayed umbilical cord separation, recurrent necrotizing skin lesions, and gingivitis. Her neutrophils were found to lack detectable CD11/CD18 adhesion glycoproteins and were deficient in adhesion-dependent functions. She succumbed to necrotizing enterocolitis, peritonitis, and pneumonia following sudden cardiorespiratory collapse. Postmortem examination revealed multiple regions of mucosal ulceration and bacterial and fungal overgrowth with complete lack of an acute inflammatory response. Impaired neutrophil emigration from blood vessels into injured tissue appears to have been the basis of this patient's disease. Some of the many foci of bronchopneumonia, in contrast, contained numerous neutrophils. Lymphoid tissue, including the thymus, was severely depleted of lymphocytes. These findings support the concepts that neutrophils can emigrate in response to certain stimuli via CD18-independent mechanisms and that severe deficiency of CD18 is associated with compromised function of lymphocytes in vivo.
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PMID:Leukocyte adhesion deficiency: clinical and postmortem observations. 134 81

This review covers the papers that we believe represent the most interesting and innovative developments in hilar and mediastinal imaging over the past year. One of the most exciting of these is the expanded role for sonography in imaging extracardiac mediastinal pathology. A number of reports highlight its use in directing mediastinal biopsy, for tissue characterization, and for staging lymphoma. The comparative merits of CT and MR imaging in staging bronchogenic carcinoma have been further clarified. The past year has also seen further attempts to characterize tumor versus postobstructive pneumonitis or collapse using MR imaging and CT. Other useful clinical work includes the documentation of signs distinguishing paramediastinal lung masses from primary mediastinal pathology. References are also made to clinically relevant aspects of MR scanning and advances in imaging of the airway, particularly cine and high-resolution CT of the trachea.
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PMID:Imaging of the mediastinum and hila. 152 80


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