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Pulmonary Symptoms (pulmonary + symptom)
Selected AbstractsSurveillance of Infectious Disease Occurrences in the Community: An Analysis of Symptom Presentation in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 7 2003Joe Suyama MD Objectives: To determine the effectiveness of a simulated emergency department (ED)-based surveillance system to detect infectious disease (ID) occurrences in the community. Methods: Medical records of patients presenting to an urban ED between January 1, 1999, and December 31, 2000, were retrospectively reviewed for ICD-9 codes related to ID symptomatology. ICD-9 codes, categorized into viral, gastrointestinal, skin, fever, central nervous system (CNS), or pulmonary symptom clusters, were correlated with reportable infectious diseases identified by the local health department (HD). These reportable infectious diseases are designated class A diseases (CADs) by the Ohio Department of Health. Cross-correlation functions (CCFs) tested the temporal relationship between ED symptom presentation and HD identification of CADs. The 95% confidence interval for lack of trend correlation was 0.0 ± 0.074; thus CCFs > 0.074 were considered significant for trend correlation. Further cross-correlation analysis was performed after chronic and non-community-acquirable infectious diseases were removed from the HD database as a model for bioterrorism surveillance. Results: Fifteen thousand five hundred sixty-nine ED patients and 6,489 HD patients were identified. Six thousand two hundred eight occurrences of true CADs were identified. Only 87 (1.33%) HD cases were processed on weekends. During the study period, increased ED symptom presentation preceded increased HD identification of respective CADs by 24 hours for all symptom clusters combined (CCF = 0.112), gastrointestinal symptoms (CCF = 0.084), pulmonary symptoms (CCF = 0.110), and CNS symptoms (CCF = 0.125). The bioterrorism surveillance model revealed increased ED symptom presentation continued to precede increased HD identification of the respective CADs by 24 hours for all symptom clusters combined (CCF = 0.080), pulmonary symptoms (CCF = 0.100), and CNS symptoms (CCF = 0.120). Conclusions: Surveillance of ED symptom presentation has the potential to identify clinically important ID occurrences in the community 24 hours prior to HD identification. Lack of weekend HD data collection suggests that the ED is a more appropriate setting for real-time ID surveillance. [source] Metastatic pulmonary calcification in a dialysis patient: Case report and a reviewHEMODIALYSIS INTERNATIONAL, Issue S2 2006Christoph H. EGGERT Abstract A 19-year-old male presented with chest pain and dyspnea. He was anephric following nephrectomy for focal segmental glomerulosclerosis, had a subsequent failed transplant, and had been dialysis dependent for 3 years. Workup revealed hyperparathyroidism and an abnormal chest X-ray and computed tomography scan, significant for massive extra-skeletal pulmonary calcification. A markedly abnormal Technitium99 methylene diphosphonate (Tc99m-MDP) bone scan confirmed the clinical suspicion of metastatic pulmonary calcification. Metastatic pulmonary calcification (MPC) is common, occurring in 60% to 80% of dialysis patients on autopsy and bone scan series. It may lead to impaired oxygenation and restrictive lung disease. Typically, the calcium crystal is whitlockite rather than hydroxyapatite, which occurs in vascular calcification. Four major predisposing factors may contribute to MPC in dialysis patients. First, chronic acidosis leaches calcium from bone. Second, intermittent alkalosis favors deposition of calcium salts. Third, hyperparathyroidism tends to cause bone resorption and intracellular hypercalcemia. Finally, low glomerular filtration rate can cause hyperphosphatemia and an elevated calcium-phosphorus product. There may be other factors. Some authors suggest that the incidence of MPC in recent years may be lower due to improved dialysis techniques. The diagnosis is confirmed by biopsy, but can be suspected by typical findings on a Tc99m-MDP bone scan. Therapy is limited to ensuring adequate dialysis, correcting calcium-phosphorus product, and hyperparathyroidism; discontinuing vitamin D analogues may help. Conflicting reports show that transplantation may either improve or worsen the situation. MPC should be considered in dialysis patients who have characteristic abnormal chest radiography and/or pulmonary symptoms. [source] Value of fractional exhaled nitric oxide (FENO) for the diagnosis of pulmonary involvement due to inflammatory bowel diseaseINFLAMMATORY BOWEL DISEASES, Issue 4 2010Ezgi Ozyilmaz MD Abstract Background: Pulmonary involvement due to inflammatory bowel disease (IBD) is frequent when evaluating a patient with IBD and pulmonary involvement remains complicated. Most of the patients are asymptomatic and the methods used are mostly invasive or expensive procedures. The aim of this prospective study is to evaluate the value of the fractional exhaled nitric oxide (FENO) level for the diagnosis of pulmonary involvement due to IBD and to investigate any correlation between FENO level and disease activity. Methods: Thirty-three nonsmoker patients with IBD (25 ulcerative colitis [UC] and 8 Crohn's Disease [CD]) who were free of corticosteroid treatment and 25 healthy subjects as a control group were enrolled in this study. All patients with IBD were investigated for pulmonary involvement with medical history, physical examination, chest roentgenogram, oxygen saturation, blood eosinophil levels, pulmonary function tests (PFTs), high-resolution computed tomography (HRCT), and FENO level. Results: Pulmonary involvement was established in 15 patients (45.5%) with IBD. The FENO level was higher in patients with pulmonary involvement than without pulmonary involvement and healthy controls independent from the pulmonary symptoms, eosinophil count, duration of disease, activity of disease, and surgery history (FENO: 32 ± 20; 24 ± 8; 14 ± 8 ppb, respectively) (P < 0.05). In addition, diffusion capacity (DLCO) was found to be significantly lower in patients with CD compared with UC (P < 0.05). Conclusions: This study showed that an increased FENO level may be used for identifying patients with IBD who need further pulmonary evaluation. Inflamm Bowel Dis 2009 [source] Lobectomy for Pulmonary Vein Occlusion Secondary to Radiofrequency AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2010MATTHEW A. STELIGA M.D. Pulmonary Vein Occlusion After RF Ablation., Pulmonary vein stenosis, a recognized complication of transcatheter radiofrequency ablation in the left atrium, is often asymptomatic. Significant stenosis is commonly treated with percutaneous balloon dilation with or without stenting. We encountered a case of complete pulmonary vein occlusion that caused lobar thrombosis, pleuritic pain, and persistent cough. Imaging studies revealed virtually no perfusion to the affected lobe. A lobectomy was performed, resolving the persistent cough and pain. Pulmonary vein occlusion should be suspected in patients who present with pulmonary symptoms after having undergone ablative procedures for atrial fibrillation. This condition may necessitate surgical intervention if interventions such as balloon dilation or stenting are not possible or are ineffective.,(J Cardiovasc Electrophysiol, Vol. 21, pp. 1055-1058, September 2010) [source] Evolution of hypoxemia in patients with severe cirrhosisJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 10 2002Isabelle Colle Abstract Background and Aim: Hypoxemia is common in patients with cirrhosis but the natural history of this syndrome is unknown. The aim of this study was to follow a series of patients with cirrhosis and to compare patients with and without hypoxemia to determine their risk of complications and survival rate. Methods: Fifty-eight consecutive Child,Pugh C patients with cirrhosis were included and followed up for 1,18 months. Blood gas measurements and plasma endothelin levels were measured in all patients. Blood gas measurements were repeated in 34 patients. Results: Hypoxemia was present in 35 patients (60%) (alveolar-arterial oxygen (AaO2) gradient > 20 mmHg) but none had pulmonary symptoms. There was no significant difference in liver tests and plasma endothelin levels between hypoxemic and non-hypoxemic patients. The occurrence of variceal bleeding and survival rate was not significantly different between the two groups. The AaO2 gradient worsened in nine patients and normalized in six of the hypoxemic patients. The AaO2 gradient increased to more than 20 mmHg in seven non-hypoxemic patients. There was no relationship between AaO2 gradient changes and Child,Pugh score grade changes. Conclusion: Asymptomatic hypoxemia is common in patients with severe cirrhosis but it is not a predictive factor of short-term complications or mortality. These results should be considered when deciding on liver transplantation. [source] Treatment of allergic bronchopulmonary aspergillosis (ABPA) in CF with anti-IgE antibody (omalizumab)PEDIATRIC PULMONOLOGY, Issue 12 2008Adaobi Kanu MD Abstract Allergic bronchopulmonary aspergillosis (ABPA) results from IgE induced pulmonary response to aspergillus species. Recognition and management of ABPA is challenging in cystic fibrosis (CF) patients because changes in symptoms, lung function and chest radiograph are similar to that seen in CF related pulmonary infection. Standard therapy for ABPA includes systemic steroids and adjunctive use of antifungal agents. Little has been published regarding the use of monoclonal anti-IgE antibody in those with ABPA. We report a CF patient with her third exacerbation of ABPA who was treated with monoclonal anti-IgE (omalizumab) antibody; she had unfavorable side effects with prednisone therapy. This therapy resulted in improvement of pulmonary symptoms and lung function not achieved with antibiotics or prednisone alone. Pediatr. Pulmonol. 2008; 43:1249,1251. © 2008 Wiley-Liss, Inc. [source] Respiratory effects of exposure to low levels of concrete dust containing crystalline silicaAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2001E. Meijer MD Abstract Background Dusts containing crystalline silica are generated in mining, construction, glass, granite and concrete production industries. The association between exposure to low levels of concrete dust containing crystalline silica and reduction in lung function, was evaluated in a cross-sectional study. Methods The study was carried out among 144 concrete workers, from two factories, with exposure assessment of respirable dust and silica by personal samplers. Results of respiratory questionnaires and standardized measurements of lung function were compared with the results in a control population. Multiple linear regression analysis was used in selecting factors that predict (age and standing height standardized residual) lung function. Results The average concentration of respirable dust in both factories was 0.8 mg/m3 and 0.06 mg/m3 for respirable silica. The average silica content of the dust was 9%. The average cumulative dust exposure was 7.0 mg/m3 year and cumulative silica exposure was 0.6 mg/m3 year. Significant associations between exposure to concrete dust and a small lung function (FEV1/FVC ratio, MMEF) loss were found, independent of smoking habits and of a history of allergy. Conclusions Our results indicate that, concrete workers with chronic obstructive pulmonary symptoms and/or work-related lower respiratory symptoms are at risk of having a reduction in lung function (FEV&1/FVC ratio) outside the 5th percentile of the external reference population, and therefore, of mild chronic obstructive pulmonary disease, at respirable concrete dust levels below 1 mg/m3 with a respirable crystalline silica content of 10% (TWA, 8 hr). Am. J. Ind. Med. 40:133,140, 2001. © 2001 Wiley-Liss, Inc. [source] Occupational tuberculosis following extremely short exposureTHE CLINICAL RESPIRATORY JOURNAL, Issue 1 2009Zaza Kamper-Jørgensen Abstract Introduction:, Transmission of Mycobacterium tuberculosis (MT) in most cases requires extended exposure. Objectives:, To document that MT transmission may occur even after very short exposure. Material and Methods:, All first-time culture-confirmed tuberculosis (TB) cases in Denmark have since 1992 been subjected to genotyping, using the IS6110 -Restriction Fragment Length Polymorphism (RFLP) technique. A young nurse with no risk factors developed pulmonary TB: the DNA pattern of her MT strain was compared to The Danish TB Subtyping Database, comprising >6000 DNA patterns from TB patients nationwide. Results:, Only one single MT DNA pattern matched the DNA profile of the isolate from the nurse. The pattern originated from a patient shortly admitted to the department where she worked at the time. MT transmission had occurred in spite of very short exposure. Conclusion:, By adding modern molecular epidemiological methods to traditional epidemiological surveys, a more detailed picture of MT-transmission pathways can be obtained, showing that MT transmission can occur even after extremely short exposure. This stresses the necessity for adequate respiratory protection among hospital staff taking care of patients with pulmonary symptoms suspected for TB. Please cite this paper as: Kamper-Jørgensen Z, Lillebaek T and Andersen ÅB. Occupational tuberculosis following extremely short exposure. The Clinical Respiratory Journal 2009; 3: 55,57. [source] Severe strongyloidiasis in corticosteroid-treated patientsCLINICAL MICROBIOLOGY AND INFECTION, Issue 10 2006L. Fardet Abstract Severe strongyloidiasis, caused by Strongyloides stercoralis, is a preventable life-threatening disease that can occur in any corticosteroid-treated patient who has travelled to a country with infested soil, even if the contact occurred up to 30 years previously. This diagnosis should be considered in corticosteroid-treated patients who experience either unusual gastrointestinal or pulmonary symptoms, or who suffer from unexplained sepsis caused by Gram-negative bacilli. Peripheral eosinophilia is not observed systematically and, even if present, is moderate in most cases. Ivermectine is the best prophylactic and therapeutic option, and thiabendazole should no longer be used. However, guidelines for the prevention and management of S. stercoralis infection in such patients have not yet been established. [source] | ||||||||||