PIGEON BREEDER'S LUNG IN CHILDREN

PEDIATRICS ◽  
1967 ◽  
Vol 39 (6) ◽  
pp. 904-915
Author(s):  
E. Richard Stiehm ◽  
Charles E. Reed ◽  
William H. Tooley
Keyword(s):  
Interstitial Pneumonitis ◽  
Prolonged Exposure ◽  
Elevated Serum ◽  
Cell Formation ◽  
Acute Onset ◽  
X Rays ◽  
Diffusion Technique ◽  
Round Cell Infiltration ◽  
Gradual Onset ◽  
Severity Of The Disease

Diffuse interstitial pneumonitis associated with the prolonged exposure to pigeons is described in five boys ages 7 to 15. The clinical characteristics include a gradual onset of cough, shortness of breath, and weight loss; in three cases, acute onset of fever, chills, cough, and muscle aches occurred within 12 hours after heavy exposure. Physical findings consisted only of occasional rales and wheezes. The chest x-rays in four cases showed a diffuse interstitial pneumonitis. A lung biopsy in one case disclosed interstitial inflammation, round cell infiltration, and giant cell formation. The patients improved when the birds were removed. One severely ill boy was treated successfully with steroids. Pulmonary function studies disclosed diminished vital capacity, absent or minimal airway obstruction, and a variable defect in diffusing capacity. Their sera contained normal or elevated complement levels, increased γG and γA globulin, and precipitating antibody to extracts of pigeon feathers, droppings, and plasma. Levels of precipitating antibody, measured by a new radial diffusion technique, tended to correlate with the severity of the disease and the degree of exposure to pigeons. Antibody levels fell progressively when pigeons were removed from the environment. Except that the specific antigens differ, pigeons breeder's lung, Farmer's lung, bagassosis, maple bark stripper's disease and other similar syndromes are identical. They all differ sharply from allergic bronchial asthma in the symptoms and the mechanisms of the hypersensitivity. The histopathology of the biopsy, the elevated serum complement, and the absence of disease in some exposed individuals who have precipitins favor the interpretation that the pathogenesis of this illness is a delayed hypersensitivity to the inhaled antigens; but participation of an Arthus-type reaction cannot be excluded.

Diagnostic Criteria for Influenza B-Associated Reye's Syndrome: Clinical vs. Pathologic Criteria

PEDIATRICS ◽  
1977 ◽  
Vol 60 (5) ◽  
pp. 702-708
Author(s):  
Lawrence Corey ◽  
Robert J. Rubin ◽  
Dennis Bregman ◽  
Michael B. Gregg
Keyword(s):  
Disease Control ◽  
Diagnostic Criteria ◽  
Hepatic Dysfunction ◽  
Elevated Serum ◽  
Acute Onset ◽  
Demographic Characteristics ◽  
Influenza B ◽  
Elevated Blood ◽  
Blood Ammonia ◽  
Reye's Syndrome

Between December 15, 1973, and June 30, 1974, a total of 379 cases of Reye's syndrome was reported to the Center for Disease Control. One hundred forty-seven (40%) were confirmed by either autopsy or biopsy, while 232 were diagnosed by clinical and laboratory parameters. Comparisons of the epidemiologic and demographic characteristics, the hospital course, the outcome, and the laboratory abnormalities of the clinically diagnosed and the pathologically confirmed cases revealed no significant differences. In the epidemiologic setting of influenza B outbreaks, children who have the acute onset of noninflammatory encephalopathy associated with elevated serum transaminase levels, hypoprothrombinemia, and elevated blood ammonia levels should be considered to have Reye's syndrome. Further evaluation of diagnostic criteria is needed, however, for sporadically occurring, nonepidemic cases of noninflammatory encephalopathy associated with hepatic dysfunction.

Abstract WP428: Cardiopulmonary Response to Ischemic Stroke Varies by Stroke Location

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
John Probasco ◽  
Tiffany Chang ◽  
David Victor ◽  
Paul Nyquist
Keyword(s):  
Ischemic Stroke ◽  
Pulmonary Edema ◽  
Basilar Artery ◽  
Cardiac Dysfunction ◽  
Medical Center ◽  
Elevated Serum ◽  
Acute Pulmonary Edema ◽  
Stunned Myocardium ◽  
X Rays ◽  
Qtc Prolongation

Introduction: Ischemic stroke is associated with electrocardiographic and cardiac enzyme changes indicative of stunned myocardium. It is unknown if acute pulmonary edema occurs independent of cardiac dysfunction in ischemic stroke or in association with particular vascular distributions. Hypothesis: Ischemic strokes in the posterior fossa are associated with acute pulmonary edema independent of stroke related cardiac dysfunction. Methods: This is a retrospective study of ischemic stroke patients treated over two years at a tertiary medical center, including patients with basilar artery stroke (N=18), RMCA (N=31) and LMCA (N=27) distribution strokes involving the insula, and TIA controls (N=67). Of the 143 patients, 53% were female, 45% were black, 40% had a history of stroke or TIA, and 73% had hypertension. Discharge diagnosis, brain imaging, and review of chest x-rays (by two blinded reviewers) were used to determine the proportion of patients within each group with evidence of pulmonary edema. Cardiac variables including ejection fraction, serum troponin levels (>0.06 ng/mL), non-specific ST segment changes and QTc prolongation (>460ms) were compared between groups. Results: Patients with basilar artery occlusions and associated ischemic stroke developed pulmonary edema during their hospitalization more frequently than control patients (0.67 vs. 0.01, P<0.0001). There were no signs of stunned myocardium or CHF as indicated by elevated troponin, altered echocardiography, or QTc prolongation for the basilar group. None of the patients in the basilar group with pulmonary edema had altered echocardiography. Patients with RMCA and LMCA distribution strokes were noted to have a higher frequency of pulmonary edema compared to the controls (0.23, P=0.0012; 0.41, P=0.002), at a proportion less than the basilar group (for RMCA, P=0.005; LMCA, P=0.13,). The proportions of patients with elevated serum troponin and QTc prolongation were significantly greater for RMCA (0.41 vs. 0.05, P=0.0008; 0.40 vs.0.16, P=0.017) and LMCA (0.33 vs. 0.05, P=0.008; 0.36 vs. 0.16, P=0.046) patients relative to controls. Conclusion: Pulmonary edema occurs independently of cardiac stunning or dysfunction in patients with basilar artery occlusions.

Septic epiphysitis and sequestrum formation in the glenoid of the scapula in a five-month-old foal diagnosed by computed tomography

2019 ◽  
Vol 7 (3) ◽  
pp. e000837
Author(s):  
Peter E Clements ◽  
Becky Jones ◽  
Richard Coomer
Keyword(s):  
Poor Prognosis ◽  
Serum Amyloid A ◽  
Proximal Humerus ◽  
Treatment Options ◽  
Elevated Serum ◽  
Acute Onset ◽  
Subchondral Bone Plate ◽  
Large Defect ◽  
Amyloid A ◽  
Bony Fragment

A five-month-old Connemara foal presented for acute-onset, severe left forelimb lameness with fever, neutrophilia and an elevated serum amyloid A concentration. Radiographs were suspicious of septic physitis of the proximal humerus. CT identified a large defect involving the central portion of the subchondral bone plate of the glenoid and a sequestered bony fragment within the defect, which were not seen radiographically. CT findings were consistent with septic epiphysitis and sequestrum formation, which had significant implications on available treatment options. The foal was given a poor prognosis for returning to soundness so was subject to humane euthanasia.

scholarly journals Case Report: Acute Spinal Cord Myelopathy in Patients With COVID-19

2020 ◽  
Vol 11 ◽  
Author(s):  
Eman M. Khedr ◽  
Ahmed A. Karim ◽  
Radwa K. Soliman
Keyword(s):  
Spinal Cord ◽  
Elevated Serum ◽  
Transverse Myelitis ◽  
Artery Occlusion ◽  
Acute Onset ◽  
Nasopharyngeal Swab ◽  
University Hospitals ◽  
Thoracic Myelopathy ◽  
Mri Scan ◽  
Polymerase Chain

COVID-19 is typically associated with fever and severe respiratory symptoms including dry cough and dyspnea. However, COVID-19 may also affect both central and peripheral nervous systems. To date, the incidence rate of spinal cord involvement in COVID-19 is not known and the pathogenesis is still not fully understood. We report here two female patients admitted to Assiut University Hospitals/Egypt during the period from first of July to August 10, 2020. Both presented with a positive SARS-CoV-2 polymerase chain reaction (PCR) nasopharyngeal swab, elevated serum d-dimer and ferritin levels, and bilateral ground glass appearance in a CT chest scan. The first was a 60-year-old female with acute onset of flaccid paraplegia 10 days after flu-like symptoms, in whom MRI revealed transverse myelitis. The second was a 21-year-old female with symptoms of acute quadriplegia, fever, headache, and anosmia in whom an MRI scan revealed long cervico-thoracic myelopathy. Anterior spinal artery occlusion and possibly transverse myelitis were considered as differential diagnosis of long segment myelopathy.

Dementia of acute onset in the Canadian Study of Health and Aging

2005 ◽  
Vol 17 (3) ◽  
pp. 451-459 ◽  
Author(s):  
Paige King ◽  
Pratima Devichand ◽  
Kenneth Rockwood
Keyword(s):  
Risk Factors ◽  
Acute Onset ◽  
Vascular Risk Factors ◽  
Adverse Outcomes ◽  
Vascular Risk ◽  
Canadian Study ◽  
People With Dementia ◽  
Gradual Onset ◽  
Insidious Onset ◽  
Onset Group

Background: Although most people with dementia experience an insidious onset of symptoms, in some cases onset can be acute. The importance of acute onset is unclear. Some reports suggest that it portends a worse course.Methods: We performed a secondary analysis of the clinical examination cohort (n=2914) of the Canadian Study of Health and Aging (CSHA). We defined “acute onset of dementia” from the Cambridge Examination for Mental Disorders in the Elderly (CAMDEX) questionnaire, conducted with an informant. People with dementia of acute onset were compared to those with dementia of insidious onset for development of adverse outcomes of death and institutionalization over 5years.Results: Of the 1132 people who had dementia, 130 (11.5%) met criteria for acute onset. Compared with gradual-onset dementia patients, those with acute-onset dementia were more often men (42% vs. 30%, p<0.05), resided in nursing homes (75% vs. 63%, p<0.05), had vascular risk factors (72% vs. 47%, p<0.05), and a Hachinski Ischemia Scale (HIS) score ≥7 (64% vs. 19%, p<0.05). More patients with dementia of acute onset than gradual onset were diagnosed with vascular dementia (55% vs. 13%; p<0.05). Adjusted hazard ratios (HRs) for survival and institutionalization in the acute-onset group were 0.93 [95% confidence interval (CI) 0.7–1.2] and 0.76 (95% CI 0.4–1.3), respectively, compared with the gradual-onset group.Conclusions: People with acute-onset dementia had more vascular risk factors than those with gradual-onset dementia across all dementia diagnoses, and lower risks of institutionalization but worse survival. Routine inquiry about the onset of dementia might help to better clarify prognoses in patients with dementia.

scholarly journals Amiodarone-Induced Pulmonary Toxicity – A Frequently Missed Complication

2016 ◽  
Vol 9 ◽  
pp. CCRep.S39809 ◽  
Author(s):  
Alexander J. Sweidan ◽  
Navneet K. Singh ◽  
Natasha Dang ◽  
Vinh Lam ◽  
Jyoti Datta
Keyword(s):  
Coronary Artery ◽  
Lung Disease ◽  
Interstitial Pneumonitis ◽  
Pulmonary Toxicity ◽  
Pulmonary Nodules ◽  
Ground Glass ◽  
X Rays ◽  
X Ray ◽  
Chest X Ray ◽  
New Onset

Introduction Amiodarone is often used in the suppression of tachyarrhythmias. One of the more serious adverse effects includes amiodarone pulmonary toxicity (APT). Several pulmonary diseases can manifest including interstitial pneumonitis, organizing pneumonia, acute respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary nodules or masses, and pleural effusion. Incidence of APT varies from 5–15% and is correlated to dosage, age of the patient, and preexisting lung disease. Description A 56-year-old male with a past medical history of coronary artery disease and chronic obstructive pulmonary disease was admitted for a coronary artery bypass graft. Post-operatively, the patient was admitted to the ICU for ventilator management and continued to receive his home dose of amiodarone 400 mg orally twice daily, which he had been taking for the past 3 months. The patient was found to be hypoxemic with a PaO2 52 mmHg and bilateral infiltrates on chest x-ray. Patient also complained of new onset dyspnea. Physical exam found bilateral rhonchi with bibasilar crackles and subcutaneous emphysema along the left anterior chest wall. Daily chest x-rays showed worsening of bilateral interstitial infiltrates and pleural effusions. A chest high-resolution computed tomography on post-operative day 3 showed extensive and severe bilateral ground glass opacities. APT was suspected and amiodarone was discontinued. A course of oral prednisone without antibiotics was initiated, and after one week of treatment the chest film cleared, the PaO2 value normalized and dyspnea resolved. Discussion APT occurs via cytotoxic T cells and indirectly by immunological reaction. Typically the lungs manifest a diffuse interstitial pneumonitis with varying degrees of fibrosis. Infiltrates with a ‘ground-glass’ appearance appreciated on HRCT are more definitive than chest x-ray. Pulmonary nodules can be seen, frequently in the upper lobes. These are postulated to be accumulations of amiodarone in areas of previous inflammation. Those undergoing major cardiothoracic surgery are known to be predisposed to APT. Some elements require consideration: a baseline pulmonary function test (PFT) did not exist prior. APT would manifest a restrictive pattern of PFTs. In APT diffusing capacity (DLCO) is generally >20 percent from baseline. A DLCO was not done in this patient. Therefore, not every type of interstitial lung disease could be ruled out. Key features support a clinical diagnosis: (1) new dyspnea, (2) exclusion of lung infection, (3) exclusion of heart failure, (4) new radiographic features, (5) improvement with withdrawal of amiodarone. Our case illustrates consideration of APT in patients who have extensive use of amiodarone and new onset dyspnea.

Long-Term Phenothiazine Treatment does not Cause Pituitary Tumours

1984 ◽  
Vol 144 (4) ◽  
pp. 421-424 ◽  
Author(s):  
Victoria A. Lilford ◽  
R. J. Lilford ◽  
Janet E. Dacie ◽  
Lesley A. Rees ◽  
T. Chard
Keyword(s):  
Prolonged Exposure ◽  
Average Duration ◽  
Serum Prolactin ◽  
X Rays ◽  
Pituitary Tumours ◽  
Duration Of Treatment ◽  
Pituitary Fossa

SummaryIn order to explore the possibility that prolactinomas may be caused by prolonged under-inhibition of prolactin-secreting cells we examined the pituitary fossa in 69 patients on long-term phenothiazine treatment. The average duration of treatment was 12.5 years and 55 (80 per cent) of the patients had persistently raised serum prolactin levels. The incidence of radiologically detectable pituitary fossa abnormalities was not significantly different to that in control populations. In 62 per cent of patients the skull x-rays from an earlier admission were available. Comparison of these with earlier films did not show a higher incidence of pituitary fossa abnormalities after prolonged exposure to phenothiazines.

scholarly journals The Use of Antibiotics in Diverticulitis: An Update in Non-operative Management

2021 ◽  
Author(s):  
Mariana Morales-Cruz ◽  
Paulina Moctezuma Velázquez
Keyword(s):  
Acute Diverticulitis ◽  
The Elderly ◽  
Operative Management ◽  
Acute Onset ◽  
Common Disease ◽  
Severity Of The Disease ◽  
Non Operative Management ◽  
Developed Nations ◽  
Case Basis ◽  
Common Manifestation

Diverticulosis is a common disease among Western and developed nations. Approximately 20% of patients with diverticulosis will become symptomatic. Acute diverticulitis is a common manifestation of diverticular disease. Different classifications exist to try to categorize it but, it is generally considered as complicated or uncomplicated. Eighty-five percent of patients with an acute onset of diverticulitis will have an uncomplicated presentation. The best way to assess the degree and severity of the disease is a CT scan along with some biochemical parameters like CRP. Recent guidelines from associations all over the world accept non-antibiotic therapy as a valid strategy of treatment for the non-complicated diverticulitis. Antibiotics are still compulsory in immune-compromised patients, the elderly, those with comorbidities, and those with signs of sepsis. Recommendations should be made on a case-by-case basis.

scholarly journals A Case Report on the Child with Two Coins Ingested Foreign Bodies in the Esophagus During the Lockdown in COVID 19 Pandemic

2020 ◽  
Vol 2 (4) ◽  
pp. 1-2
Author(s):  
Rabia Arora ◽  
◽  
Satinder Pal Singh ◽  
Arvinder Singh ◽  
◽  
...  
Keyword(s):  
Foreign Bodies ◽  
Pediatric Population ◽  
Age Groups ◽  
Acute Onset ◽  
Endoscopic Examination ◽  
Lateral View ◽  
X Rays ◽  
Cervical Oesophagus ◽  
X Ray ◽  
Low Threshold

A 4-year-old child presented to the emergency department with an acute onset of dysphagia and vomiting. A plain X-ray soft tissue neck lateral view revealed a double circular opacity in the cervical oesophagus consistent with an ingestion of multiple foreign bodies. Preoperative planning and SARS-CoV2 testing is of particular importance for the pediatric population and if testing cannot be performed, patients in all age groups should be handled as though they are positive for COVID-19, and appropriate precautions should be taken. The child was taken to the theatre for rigid pharyngo-oesophagoscopy and removal of the coins. After the first coin was removed subsequent endoscopic examination revealed a second coin at the same location. This extremely rare case of two ingested coins becoming impacted with perfect radiological alignment, we would therefore advocate having a low threshold for performing a ‘second look’ endoscopy after removal of the first foreign body with postoperative X-rays.

scholarly journals Unusual cause of acute low-back pain: sudden annulus fibrosus rupture

2012 ◽  
Vol 4 (2) ◽  
pp. 22 ◽  
Author(s):  
Ali Fahir Ozer ◽  
Tunc Oktenoglu ◽  
Mehdi Sasani ◽  
Tuncay Kaner ◽  
Omur Ercelen ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Annulus Fibrosus ◽  
Acute Onset ◽  
Low Back ◽  
X Rays ◽  
Disc Disease ◽  
Acute Low Back Pain ◽  
Magnetic Resonance Imaging Mri ◽  
Provocative Discography

Low-back pain is a common problem in neurosurgery practice, and an algorithm has been developed for assessing these cases. However, one subgroup of these patients shares several clinical features and these individuals are not easy to categorize and diagnose. We present our observations for 8 of these patients, individuals with low-back pain caused by atypical annulus fibrosus rupture (AAR). The aim of this study is to show the consequences of overlooked annular tears on acute onset of low back pain. Eight patients with acute-onset severe low-back pain were admitted. Physical examinations were normal and each individual was examined neurologically and assessed with neuroradiologic studies [plain x-rays, magnetic resonance imaging (MRI), discography and computed tomography (CT) discography]. AAR was ultimately diagnosed with provocative discography. In all cases, MRI showed a healthy disc or mild degeneration, whereas discography and CT discography demonstrated disc disease. Anterior interbody cage implantation was performed in 3 of the 8 cases and posterior dynamic stabilization was carried out in 3 cases. The other 2 individuals refused surgery, and we were informed that one of them developed disc herniation at the affected level 1 year after our diagnosis. Clinical and radiological outcomes were evaluated. In cases where AAR is suspected, MRI, discography, and CT discography should be performed in addition to routine neuroradiologic studies.

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