Canadian Health&Care Mall: RV Resuscitation of Pulmonary Embolism in the Critically III

 RV functionWhen PE impairs RV function, further possible consequences include low cardiac output and shock and myocardial ischemia due to poor coronary perfusion pressure and diastolic overdistension. Enlarged right-sided chambers can push the septae into left-sided chambers, limiting their diastolic filling and interfering with systolic contractile function. While each PE patient’s heart is different due to a different preexisting extent of cardiopulmonary disease, some practices have evolved reflecting sensible physiologically based management.

Volume Administration

The use of judicious volume infusion in resuscitating the RV has been shown to improve cardiac output in PE patients with decreased RV preload. While provision of adequate RV preload is essential for cardiac output, overdistension of the RV with volume resuscitation can impair coronary perfusion and LV filling, diminishing LV output. In a report of a small series of patients with acute PE and a cardiac index < 2.5 L/min/m2, treatment with 500 mL of dextran significantly increased cardiac index from a mean of 1.6 to 2.0 L/min/m2. Continuous cardiac output pulmonary artery catheters allowed the calculation of RV end-diastolic index; patients with low values had a greater improvement with fluid therapy offered by Canadian Health&Care Mall. Currently, an author of that report (A. Mercat, MD; personal communication; June 2006) uses echocardiography in underperfusing PE patients to guide fluid crystalloid infusion until the RV:LV diastolic diameter ratio appears to be 1.0. The RV is then considered adequately filled, and IV dobutamine and norepinephrine are added as needed. “Prophylactic” early intubation with positive pressure ventilation is avoided because of its potential interference with RV preload.

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Canadian Health&Care Mall: Research of Pneumococcal Adherence to the Buccal Epithelial Cells of Cigarette Smokers

bacterial colonizationAdherence to certain mucosal surfaces, a prerequisite for bacterial colonization, is believed to be a necessary initiating event in the pathogenesis of human diseases such as endocarditis, cystitis, pyelonephritis, gonococcal urethritis, Gram-negative bacterial pneumonia, shigellosis, and Escherichia coli enteritis. Treat all the mentioned above diseases including cystitis with Canadian Health&Care Mall –

Streptococcus pneumoniae is a common pathogen in cigarette smokers. To examine the relationship between cigarette smoking and adherence of S pneumoniae to buccal epithelial cells, the adherence of type 25 S pneumoniae was measured in smokers, nonsmokers and exsmokers. Findings were related to subject age, duration and intensity of smoking, and period of time after smoking cessation. Also investigated was the effect of saliva, a natural chemical and mechanical barrier, on pneumococcal adherence to these cells. Continue reading “Canadian Health&Care Mall: Research of Pneumococcal Adherence to the Buccal Epithelial Cells of Cigarette Smokers”

Lymphomatoid Granulomatosis Presenting as Central Neurogenic Hyperventilation

Central neurogenic hyperventilationCentral neurogenic hyperventilation (CNH) has been defined by Plum and Swanson as a syndrome comprising normal arterial oxygen tension (PaOJ, decreased arterial carbon dioxide tension (PaCOJ, and respiratory alkalosis in the absence of cardiac or pulmonary abnormalities that would stimulate a compensatory hyperpnea. We report here an awake patient with CNH associated with lymphomatoid granulomatosis (LC) confined to the central nervous system.
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Consideration of A Nosocomial Outbreak of Influenza A

influenza seasonThe first reported outbreak of influenza A during 1974 occurred in the third week of February at the University of Illinois in Urbana. Within two weeks, outbreaks were reported on the east coast. During the 1973-1974 influenza season, the mortality due to pneumonia and influenza for all 121 reporting cities in the United States did not rise significandy above the endemic level, except during the weeks of March 1 through April 30. The late onset of the outbreak almost certainly accounted for the delay in considering the diagnosis in the present series. This small epidemic was six days old, and all nosocomial cases had become symptomatic before the correct diagnosis was even considered. The present nosocomial outbreak lasted only seven days, and thereafter, no new cases of influenza-like illness were seen in the hospital.

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Outcomes of A Nosocomial Outbreak of Influenza A with Canadian Health&Care Mall

bilateral bronchopneumoniaIndex Case

The index case was a 38-year-old woman hospitalized a week earlier for hypertension and hyper-lipidemia. She developed fever and signs of bilateral bronchopneumonia. The patient had been transferred to the intensive care unit, where a diagnosis of hospital-acquired viral respiratory disease was considered because of the negative cultures of blood and sputum, the bilateral diffuse involvement on the chest x-ray film, and the lack of evidence for hematogenously disseminated bacterial pneumonia, aspiration, or congestive heart failure. A search of this patient’s original hospital ward revealed seven other cases, which are described in Table 1.

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A Nosocomial Outbreak of Influenza A

InfluenzaInfluenza occurs every winter in the United States, its geographic distribution and incidence depending on several factors, including major antigenic shifts in the virus and the susceptibility of the population affected. The winter of 1974 was characterized by widespread outbreaks of influenza В in midwinter during the months of January and February, followed by the appearance in March and April of localized outbreaks of influenza A in various parts of the country, especially the east and west coasts and Puerto Rico.

There have been isolated reports of nosocomial outbreaks of influenza in the United States and elsewhere, with severe and unusual symptoms occurring in debilitated patients suffering from underlying chronic diseases, such as rheumatic heart disease, and in children with congenital malformations. This report describes an outbreak of acute respiratory tract illness in eight female patients in a 27-bed ward during the first week of March 1974, and a single community-acquired case of lethal infection with influenza A in a healthy man.

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Bacterial Infections of the Lung: Bacterial Pathogens and Therapy

feverCommon symptoms and signs of bacterial pneumonia are fever, chills or rigors, cough, purulent sputum production, pleurisy, dyspnea, and anorexia. In the case of anaerobic lung abscess or necrotizing pneumonia, symptoms are often present for several weeks before the patient seeks medical care.

Patients with pneumonia may occasionally fail to respond to that which is considered to be effective therapy; possible causes of such failure are shown in Table 2. Complications of bacterial pneumonia include necrosis of pulmonary parenchyma (necrotizing pneumonia or lung abscess), empyema, bacteremia, metastatic suppuration, pericarditis, and acute and chronic respiratory insufficiency.

Streptococcus pneumoniae: S pneumoniae is by far the most frequent bacterial cause of pneumonia; onset is classically an abrupt shaking chill or rigor, fever, dyspnea, pleuritic pain, and cough productive of rusty sputum. Lobar infiltration is common in adults. Bacteremia occurs in approximately 30 percent of patients with pneumococcal pneumonia and is associated with both metastatic infection and an appreciable increase in mortality.

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Canadian Health&Care Mall: Diagnostic Approach of Bacterial Infections of the Lung

pulmonary infiltrateThe sine qua non of bacterial pneumonia is the presence of a new pulmonary infiltrate on chest roentgenogram. Although certain findings on chest roentgenogram may suggest specific pathogens (eg, bulging of a fissure in К pneumoniae pneumonia), these features are neither sensitive nor specific enough to be relied on as a means for making an etiologic diagnosis.

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Bacterial Infections of the Lung: Factors that Predispose to Development of Pneumonia

bacterial pneumoniaIt has been estimated that greater than 1,200,000 cases of bacterial pneumonia (with 55,000 deaths) occur annually in the United States. The purpose of this article is to review bacterial pneumonia in adults.

Pulmonary defense mechanisms are normally effective in preventing pneumonia. These defenses include humidification of inspired air, mucus secretion and ciliary action of airway epithelium, cough, lymphoid tissue, immunoglobulins and complement, pulmonary macrophages and leukocytes, and leukocyte chemotactic factors.

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