Importance of clinical and echocardiographic hemodynamic assessment in chronic pulmonary embolism.

J Cardiovasc Ultrasound. 2011 Dec;19(4):224-7

Authors: Choe WS, Kang DY, Yoon JH, Lee MH, Cha MJ, Kim HK, Kim YJ, Cho GY, Sohn DW

Abstract
We describe a 42-year-old man presenting to the emergency department with cardiogenic shock. He had a prior history of acute pulmonary embolism (PE), and had been on anticoagulation for 2 years. Although computed tomographic pulmonary angiography performed at the emergency department showed no change in the extent of PE and did not support a role of surgical treatment, pulmonary embolectomy was recommended by attending physician based on clinical and echocardiographic hemodynamic findings like unstable vital sign and markedly enlarged right ventricle with severely depressed systolic function. Surgery confirmed the presence of fresh thrombi. After surgery, hemodynamic status was progressively improved, but the patient died due to pneumonia and pulmonary hemorrhage.

PMID: 22259670 [PubMed - in process]

Changes in epidemiology, clinical features and severity of influenza A (H1N1) 2009 pneumonia in the first post-pandemic influenza season.

Clin Microbiol Infect. 2011 Dec 8;

Authors: Viasus D, Cordero E, Rodríguez-Baño J, Oteo JA, Fernández-Navarro A, Ortega L, Gracia-Ahufinger I, Fariñas MC, García-Almodovar E, Payeras A, Paño-Pardo JR, Muñez-Rubio E, Carratalà J,

Abstract
Clin Microbiol Infect ABSTRACT: Although the influenza A (H1N1) 2009 virus is expected to circulate as a seasonal virus for some years after the pandemic period, its behaviour cannot be predicted. We analysed a prospective cohort study of hospitalized adults with influenza A (H1N1) 2009 pneumonia at 14 teaching hospitals in Spain to compare the epidemiology, clinical features and outcomes of influenza A (H1N1) 2009 pneumonia between the pandemic period and the first post-pandemic influenza season. A total of 348 patients were included: 234 during the pandemic period and 114 during the first post-pandemic influenza season. Patients during the post-pandemic period were older and more likely to have chronic obstructive pulmonary disease, chronic kidney disease and cancer than the others. Septic shock, altered mental status and respiratory failure on arrival at hospital were significantly more common during the post-pandemic period. Time from illness onset to receipt of antiviral therapy was also longer during this period. Early antiviral therapy was less frequently administered to patients during the post-pandemic period (22.9% versus 10.9%; p 0.009). In addition, length of stay was longer, and need for mechanical ventilation and intensive-care unit admission were significantly higher during the post-pandemic period. In-hospital mortality (5.1% versus 21.2%; p <0.001) was also greater during this period. In conclusion, significant epidemiological changes and an increased severity of influenza A (H1N1) 2009 pneumonia were found in the first post-pandemic influenza season. Physicians should consider influenza A (H1N1) 2009 when selecting microbiological testing and treatment in patients with pneumonia in the upcoming influenza season.

PMID: 22264321 [PubMed - as supplied by publisher]

Community-Acquired pneumonia in outpatients: etiology and outcomes.

Eur Respir J. 2012 Jan 20;

Authors: Cillóniz C, Ewig S, Polverino E, Marcos MA, Prina E, Sellares J, Ferrer M, Ortega M, Gabarrús A, Mensa J, Torres A

Abstract
The purpose of this study was to establish the microbial etiology and outcomes of patients with community-acquired pneumonia (CAP) treated as outpatients after presenting to a hospital emergency care unit.Prospective observational study carried out in the Hospital Clinic of Barcelona Spain. All consecutive cases of CAP treated as outpatients were included.568 adult outpatients with CAP were studied, mean ±SD age of 47.2±17.6 years; 110 (19.4%) were aged ≥65 years. Etiologic diagnoses were established in 188 cases (33.1%). Streptococcus pneumoniae was the most frequent pathogen followed by Mycoplasma pneumoniae and respiratory viruses. Legionella was detected in 2.3% (n=13). More than one causative agent was found in 17 (9.0%) patients.The mortality was low (3; 0.5%), and other adverse events were rare (complications (30, 5.3%), readmission (13, 2.3%), treatment failure (13, 2.3%). Complications were mostly related to pleural effusion and empyema and readmissions and treatment failures to comorbidities.Outpatients with CAP have a characteristic microbial pattern. Regular anti-pneumococcal coverage remains mandatory. Treatment failures and readmissions are rare and may be reduced by increased attention to patients requiring short term observation in the emergency care unit and in the presence of pleural effusion and comorbidities.

PMID: 22267760 [PubMed - as supplied by publisher]

Focal Organizing Pneumonia Mimicking Lung Cancer: A Surgeon's View.

Am Surg. 2012 Jan;78(1):133-7

Authors: Zheng Z, Pan Y, Song C, Wei H, Wu S, Wei X, Pan T, Li J

Abstract
Focal organizing pneumonia is a unique form of organizing pneumonia. Little is known regarding its clinical and radiological feature, diagnosis, management, and outcome. Twenty patients with focal organizing pneumonia were investigated and compared with 40 patients with bronchogenic carcinoma. There were 38 men (63.3%) and 22 women (36.7%). The mean age was 55 ± 9.9 years. No specific feature in clinical and radiological manifestation was found to distinguish between focal organizing pneumonia and bronchogenic carcinoma. In patients with focal organizing pneumonia, wedge resection was performed in 12 cases and lobectomy in eight cases. Follow-up was complete with a median period of 26 months (range, 6 to 104 months). All patients were free from recurrence of organizing pneumonia. Clinical and radiologic findings of focal organizing pneumonia are nonspecific, and this unique form of organizing pneumonia is difficult to differentiate from lung cancer. Surgical resection allows both diagnosis and cure. However, considering the benign nature of this disease, major pulmonary resections should be avoided.

PMID: 22273330 [PubMed - in process]