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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A new Pulmonary Medicine-Thoracic Surgery service was established in a community hospital in July 1974. This report details the experience of 409 bronchoscopies performed from July 1, 1974 through Dec 31, 1976. There were no deaths and four complications--one aspiration and three pneumothoraces resulting from transbronchial lung biopsy. Final diagnoses for which bronchoscopy was done were as follows: cancer--141; infectious disease--97; interstitial disease--33; obstructive lung disease--58; hemoptysis--35; miscellaneous--45. In the cancer group, a cytohistologic diagnosis was made in 82 patients by bronchoscopy alone, 31 additional diagnoses were made by scalene node biopsy or mediastinoscopy, and the remainder by surgical exploration and/or resection. In 268 patients with benign disease, bronchoscopy established the diagnosis in 87% of the cases. Pulmonary Medicine tended not to repeat nondiagnostic bronchoscopy but rather to refer immediately for a definitive surgical procedure. Thoracic Surgery tended not to reduplicate bronchoscopy for the purpose of "confirmation." A conjoint medical-surgical approach to bronchial disease, at the community level and based on a mutual understanding of capability and limitation, is feasible, productive, and economical.
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PMID:Bronchoscopy in the community hospital. 62 19

Because of its communicable nature and because there are many state laws specific to the control of tuberculosis (TB), TB is managed differently than other airborne infectious diseases [corrected]. Many of these laws predate the current public health recommendations for the prevention and control of TB. In 1989, CDC published A Strategic Plan for the Elimination of Tuberculosis in the United States that was developed by the Advisory Committee (now Council) for the Elimination of Tuberculosis (ACET). The Plan called for the establishment of a national goal of TB elimination (i.e., achieving a case rate of < 1 per million population) by the year 2010. One of the methods for improving disease containment in the Plan was for the use of quarantine measures for nonadherent patients. The Plan called for revision of state and local laws to "facilitate the cure of persons with infectious tuberculosis". The issue of outdated state TB laws was also identified as a problem in the National Action Plan to Combat Multidrug-resistant Tuberculosis. In response to this issue, CDC conducted a survey of state TB control laws and ACET developed recommendations to address discrepancies between previously published recommendations and guidelines for the control of TB and state TB control laws. In order to address these discrepancies, states updating TB control laws should incorporate current recommendations and guidelines from CDC, ACET, and the American Thoracic Society. State laws should permit policies and practices to be rapidly reviewed and amended as new data becomes available and new recommendations and guidelines are published.
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PMID:Tuberculosis control laws--United States, 1993. Recommendations of the Advisory Council for the Elimination of Tuberculosis (ACET) 814 7

There are 2 parts to this article. Part 1 is a preamble, jointly prepared by Immigration and Overseas Health Services, Medical Services Branch and the Bureau of Communicable Disease Epidemiology, LCDC, Department of National Health and Welfare, to provide background information regarding the medical assessment of immigrants prior to landing in Canada. Part 2 is a set of guidelines for the investigation of individuals who were placed under surveillance for tuberculosis post-landing in Canada. It was jointly prepared by the Canadian Thoracic Society, the Tuberculosis Directors of Canada and the Department of National Health and Welfare in consultation with the provincial and territorial epidemiologists and has been approved by the Canadian Lung Association and the Canadian Thoracic Society.
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PMID:Guidelines for the investigation of individuals who were place under surveillance for tuberculosis post-landing in Canada. Canadian Thoracic Society, the Tuberculosis Directors of Canada and the Department of National Health and Welfare. 850 32

We reported a case of a thoracic empyema due to M. chelonae (Atypical Mycobacterium, group IV) after thoracic surgery. A 49-year-old male underwent right middle lobectomy for pulmonary metastasis of esophageal cancer. Postoperative course was complicated for intractable air leakage, and several procedures were tried before successful re-thoractomy. Seven days after re-thoractomy, mycobacterium was proved in pleural effusion. And later on M. chelonae was identified by DNA hybridization method. Therefore, open window thoracotomy was performed at once. M. chelonae disappeared 7 days after operation and the patient discharged on 40 postoperative days. Thoracic empyema by M. chelonae is rare, and only one case was reported in Japan so far. Present case was not combined with infectious pulmonary disease by some mycobacterium. Therefore it is most reasonable to suppose this intrathoracic infection developed through the thoracic drain. In conclusion, because of the M. chelonae toleranced for almost all anti-biotics including anti-tuberculous agents, except clarithromycin, the timing of surgical approach is important for the treatment of this infectious disease.
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PMID:[A case of a patient with post-operative empyema due to Mycobacterium chelonae]. 872 63

Infection with HIV depresses cell-mediated immunity by selectively depleting the CD4 T cells. That process increases the HIV-infected individual's susceptibility to other infections such as Myco tuberculosis. The World Health Organization estimates that more than 4 million people worldwide have been infected with HIV and Myco tuberculosis. 35 patients newly diagnosed with pulmonary tuberculosis (TB) at the Government Thiruvotteswarar Hospital of Thoracic Medicine in Madras and 77 at the Institute of Thoracic Medicine were tested for infection with HIV using particle agglutination, ELISA, and Western blot. 19 were HIV positive, 12 were acid-fast bacillus smear positive, 12 were tuberculin skin test positive, and 15 were culture positive. As the incidence of HIV infection increases in India, so does the number of patients coinfected with HIV and TB. Health personnel need to recognize such dual infection and take the proper steps to manage the epidemic.
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PMID:Detection of HIV infection in pulmonary tuberculosis patients. 901 77

This seminar reviews the aetiology, clinical presentation, approach to diagnosis, and management of immunocompetent adults with community-acquired pneumonia (CAP). Pneumonia is a common clinical entity, particularly among the elderly. A thorough understanding of the epidemiology and microbiology of CAP is essential for appropriate diagnosis and management. Although the microbiology of CAP has remained relatively stable over the last decade, there is new information on the incidence of atypical pathogens, particularly in patients not admitted to hospital, and new information on the incidence of pathogens in cases of severe CAP and in CAP in the elderly. Recent studies have provided new data on risk factors for mortality in CAP, which can assist the clinician in decisions about the need for hospital admission. The emergence of antimicrobial resistance in Streptococcus pneumoniae, the organism responsible for most cases of CAP, has greatly affected the approach to therapy, especially in those patients who are treated empirically. Guidelines for the therapy of CAP have been published by the American Thoracic Society, the British Thoracic Society, and, most recently, the Infectious Diseases Society of America. These guidelines differ in their emphasis on empirical versus pathogenic-specific management.
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PMID:Community-acquired pneumonia. 1023 45

The Infectious Diseases Society of America (IDSA) has published guidelines for the treatment of community-acquired pneumonia (CAP). Although Streptococcus pneumoniae remains the most common etiologic agent, Chlamydia pneumoniae and Legionella pneumophila are also important causes. For all suspected CAP patients, particularly those requiring hospitalization, chest radiographs are strongly recommended to confirm the diagnosis. The IDSA guidelines, in contrast to those published by the American Thoracic Society, emphasize the use of sputum Gram's stain and culture in all patients, whenever possible, to establish etiology. This information can be used not only to guide therapy but also to track trends in the etiologic pathogens for CAP and their antibiotic susceptibility. In light of the better outcomes with the earliest possible interventions, the IDSA recommends initial empiric antimicrobial therapy until laboratory results can be obtained to guide more specific therapy. Macrolides, doxycycline, and fluoroquinolones are suggested for primary empiric therapy, since each has activity against common bacterial pathogens and atypical agents. Detailed antibiotic recommendations are made for various pathogens. For inpatients, attempts should be made to cover Legionella and other common pathogenic bacteria. Alternative antibiotics are recommended for patients with structural diseases of the lung, penicillin allergy, or suspected aspiration pneumonia. Switch to an appropriate oral antibiotic is recommended as soon as the patient's condition is stable and he or she can tolerate oral therapy, often within 72 h.
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PMID:Treatment of community-acquired pneumonia--IDSA guidelines. Infectious Diseases Society of America. 1008 53

Relatively simple objective criteria are now available to predict which patients are at risk for bad outcomes from community-acquired pneumonia. In general, these include older patients and those with certain coexisting illnesses (especially neoplastic disease) or findings of altered mental status, hypotension, severe tachycardia, tachypnea, fever, acidemia, azotemia, hypoxemia, hyperglycemia, anemia, or hyponatremia. The major causes of severe pneumonia are S pneumoniae, H influenzae, and L pneumophila. Less common causes include mixed aerobic and anaerobic mouth flora, as well as M pneumoniae, C pneumoniae, gram-negative bacilli, and S aureus. Specific diagnosis is hampered by a lack of reliable diagnostic tests, but Gram's stain of expectorated sputum and cultures of sputum and blood may occasionally be helpful. Many empirical treatment regimens have been recommended, including those of the American Thoracic Society and the Infectious Diseases Society of America, which are reviewed here. It is hoped that better diagnostic tools will permit future targeting of microbes with narrow-spectrum therapy to diminish the risk of selection of resistant strains with empirical regimens.
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PMID:Severe pneumonia. When and why to hospitalize. 1022 91

This article takes a broad perspective of community-acquired pneumonia (CAP). The arguments and data that support or refute the current approaches to initial antimicrobial treatment of CAP as outlined in the American Thoracic Society and Infectious Disease Society of America documents are provided. The complex issues involved in the decision of how to properly treat CAP are addressed.
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PMID:Antibiotic therapy for community-acquired pneumonia. 1051 6

In this paper we present a synopsis of the recommendations of three Consensus Conferences (from the American Thoracic Society and the American Society of Infectious Diseases) for the empirical antibiotic treatment of severe community and hospital acquired pneumonia. Several groups are defined according to the existence of specific risk factors, severity of the disease and timing of the onset of pneumonia (in the case of nosocomial pneumonia). Each group has more likely pathogens and several antimicrobial agents are proposed. However the option must always rely on the local microbiological sensitivity pattern.
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PMID:[Various criteria for the choice of the empirical antibiotic treatment of pneumonia in intensive care]. 1089 43


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