Cases reported "Pneumonia"

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1/8. Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography.

    PURPOSE: To obtain statistical data on the use of high-resolution computed tomography (HRCT) for early detection of pneumonia in febrile neutropenic patients with unknown focus of infection. MATERIALS AND methods: One hundred eighty-eight HRCT studies were performed prospectively in 112 neutropenic patients with fever of unknown origin persisting for more than 48 hours despite empiric antibiotic treatment. Fifty-four of these studies were performed in transplant recipients. All patients had normal chest roentgenograms. If pneumonia was detected by HRCT, guided bronchoalveolar lavage was recommended. Evidence of pneumonia on chest roentgenograms during follow-up and micro-organisms detected during follow-up were regarded as documentation of pneumonia. RESULTS: Of the 188 HRCT studies, 112 (60%) showed pneumonia and 76 were normal. documentation of pneumonia was possible in 61 cases by chest roentgenography or micro-organism detection (54%) (P < 10(-6)). Sensitivity of HRCT was 87% (88% in transplant recipients), specificity was 57% (67%), and the negative predictive value was 88% (97%). A time gain of 5 days was achieved by the additional use of HRCT compared to an exclusive use of chest roentgenography. CONCLUSION: The high frequency of inflammatory pulmonary disease after a suspicious HRCT scan (> 50%) proves that pneumonia is not excluded by a normal chest roentgenogram. Given the significantly longer duration of febrile episodes in transplant recipients, HRCT findings are particularly relevant in this subgroup. patients with normal HRCT scans, particularly transplant recipients, have a low risk of pneumonia during follow-up. All neutropenic patients with fever of unknown origin and normal chest roentgenograms should undergo HRCT.
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ranking = 1
keywords = specificity
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2/8. Diagnostic value of lung uptake of indium-111 oxine-labeled white blood cells.

    One hundred sixty-two white-blood-cell scans were retrospectively reviewed to determine the sensitivity and specificity of the test for pulmonary and pleural infection. All scans were performed 18-24 hr after injection of indium-111 oxine-labeled autologous or donor cells. Pulmonary activity was graded on a scale of 0-4: 0 = equal to soft tissue; 1 = greater than soft tissue but less than rib; 2 = equal or greater than rib but less than liver; 3 = equal or greater than liver but less than spleen; 4 = equal to spleen. Activity was also characterized as being focal or diffuse. The white-blood-cell scan findings were correlated with the clinical diagnosis on the basis of physical examination, laboratory results, chest radiographs, clinical course, and pathologic studies when available. As pulmonary activity increased from grade 1 to 4, sensitivity declined from 93% to 14% and specificity increased from 64% to 100%. The sensitivity and specificity of focal uptake were 31% and 89% vs 62% and 74% for diffuse pulmonary activity. Making a distinction between focal and diffuse activity did not improve the specificity of low grades of pulmonary activity. The white-blood-cell scan can be very sensitive or very specific for pulmonary or pleural infection, depending on the criteria selected for a positive scan.
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ranking = 4
keywords = specificity
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3/8. lung perforation complicating tube thoracostomy: pathologic description of three cases.

    Insertion of a chest tube into the pleural space is standard therapy for a variety of pleural abnormalities. Three cases are described of lung perforation secondary to this procedure. In all three cases the tube had been inserted with the use of a trocar, and in two there were pleural adhesions in the vicinity of the puncture; in none was the perforation suspected clinically or considered to contribute to patient death. Pathologic features included one or two pleural holes continuous with a parenchymal tract of variable length. In one case, there was early epithelialization of the inner surface of the tract, suggesting that some of these may remain patent and be seen as incidental findings long after their formation. Two of the cases were identified among 18 patients who had had chest tubes inserted and came to autopsy over a similar period, implying that the incidence of the complication is greater than is generally appreciated. Reasons for this under appreciation are the lack or nonspecificity of clinical and radiographic findings and the ease with which perforation can be overlooked at autopsy.
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keywords = specificity
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4/8. Serologic diagnosis of focal pneumonia caused by cryptococcus neoformans.

    Cryptococcal antigen was detected in the serum of 3 patients with biopsy-proved cryptococcus neoformans pneumonitis. It is possible that the specificity of this antigen test will allow the serologic diagnosis of cryptococcal pneumonia and obviate the need for invasive procedures.
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ranking = 1
keywords = specificity
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5/8. legionnaires' disease in non-Legionnaires. A report of five cases.

    Seventeen patients with illness resembling legionnaires' disease were evaluated for antibodies to the Legionnaires' bacillus. Three patients were Legionnaires who developed pneumonia after attending the July 1976 convention. All three were seropositive (titers greater than or equal to 1:128) to the Legionnaires' bacillus. None of the remaining 14 patients were Legionnaires. Five were seropositive and nine, seronegative (titers less than or equal to 1:32). The seropositive patients had illnesses best explained by legionnaires' disease, whereas the seronegative patients had illnesses better explained by other diagnoses. This correlation between serology and clinical findings supports the specificity of the antibody test for legionnaires' disease. Of the five non-Legionnaire seropositive cases, two occurred before, and one 3 months after, the convention. The case histories of these five patients are presented. Disease generally involved the lungs, kidneys, and the central nervous system. Although the pathogenesis of this multiple organ involvement is unclear, a possible explanation is the production of a toxin by the Legionnaires' bacillus.
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ranking = 1
keywords = specificity
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6/8. An "occupational miliary" due to nitrous gases.

    The authors report the case of a patient suffering from chemical pneumonia due to nitrous gases of occupational origin which was mistakenly taken for military tuberculosis. Anamnestic, clinical and anatomopathological aspects of this disease, which successively analysed, often make the diagnosis difficult due to their complexity and lack of specificity.
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ranking = 1
keywords = specificity
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7/8. mycoplasma pneumoniae infection complicated by paroxysmal cold hemoglobinuria with anti-P specificity of biphasic hemolysin.

    A 7-year-old boy with mycoplasma pneumoniae infection complicated by transitory paroxysmal cold haemoglobinuria (PCH) is described. The Donath-Landsteiner-antibody exhibited anti-P specificity; hemolytic activity was partially inhibited against papainized erythrocytes at 0 degrees C incubation temperature and increased from 8 degrees C upwards. The association of mycoplasma pneumoniae infection with PCH has been described 4 times only and in one instance where specificity was stated it was anti-I.
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ranking = 6
keywords = specificity
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8/8. Evaluation of malignant and benign lung lesions with 99Tcm-tetrofosmin.

    99Tcm-tetrofosmin planar imaging was performed in 30 patients with malignant and benign lung lesions. There were 21 cases of primary lung cancer (10 squamous cell, 5 small cell, 4 adenocarcinoma and 2 large cell) and 9 benign lung lesions (4 pneumonia, 3 tuberculosis, 1 infected bronchiectasis and 1 bronchiectasis obliterans). Anterior and posterior planar thorax images were obtained 30 min after the intravenous injection of 740 MBq (20 mCi) of 99Tcm-tetrofosmin. Visual and quantitative evaluations were performed. For the quantitative evaluation, regions of interest were drawn over the lesioned area (L) and over the contralateral non-lesioned area (N). Of 21 malignant primary lesions; 19 (90%) showed 99Tcm-tetrofosmin accumulation. Four (44%) of the nine benign lung lesions (3 cases of pneumonia and the one case of active tuberculosis) showed uptake. The mean L/N ratios for the malignant and benign lesions were 1.63 /- 0.29 and 1.64 /- 0.19, respectively. There were no significant differences (P > 0.05) in the L/N ratios of the malignant and benign lesions or the various histological types of cancer. In conclusion, 99Tcm-tetrofosmin was highly sensitive (90%) in detecting malignant lung lesions, but it had poor specificity (55%).
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ranking = 1
keywords = specificity
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