RESUMEN
Adrenal insufficiency is believed to occur frequently in severe sepsis and septic shock. The aim of the present study was to determine whether adrenal function is also related to the severity of community-acquired pneumonia (CAP). In total, 64 Japanese patients with CAP were consecutively enrolled in the present study, which was carried out during 2005-2006. Serum adrenocorticotropic hormone (ACTH) and cortisol were measured in each subject, as was the response of cortisol secretion when 250 mug of cosyntropin was administered. Analyses were performed comparing these values with the score calculated according to the Pneumonia Patient Outcomes Research Team (PORT) cohort study, the number of in-hospital deaths and the length of hospital stay. As the PORT score increased, serum ACTH and cortisol also increased, while the response of cortisol secretion to the administration of cosyntropin decreased. In the analysis by receiver operating characteristic curves, adrenal dysfunction was related significantly to both the number of in-hospital deaths and the length of hospital stay. Adrenal dysfunction was shown to correlate with the Pneumonia Patient Outcomes Research Team score and the clinical outcomes, while adrenal insufficiency defined by the cosyntropin stimulation test was rare in the present study.
Asunto(s)
Hidrocortisona , Sistema Hipotálamo-Hipofisario/fisiopatología , Sistema Hipófiso-Suprarrenal/fisiopatología , Neumonía Bacteriana/fisiopatología , Corticoesteroides/uso terapéutico , Hormona Adrenocorticotrópica/sangre , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/fisiopatología , Femenino , Humanos , Hidrocortisona/sangre , Tiempo de Internación , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/inmunología , Curva ROC , Índice de Severidad de la Enfermedad , Análisis de SupervivenciaRESUMEN
Left pleural effusion was found in a 60-year-old woman in whom chest radiography performed during a physical check up revealed no abnormality. Abdominal CT scanning revealed an abscess in the left psoas muscle. The psoas abscess was eliminated temporarily by drainage under ultrasonographic guidance and by the administration of antibiotics, but recurred one month later. A stag-horn renal stone considered to have caused the psoas abscess by formation of a perirenal abscess was eliminated by left nephrectomy. It is suggested tentatively that the psoas abscess might have been the cause of the pleural effusion.
Asunto(s)
Absceso/complicaciones , Cálculos Renales/complicaciones , Enfermedades Renales/complicaciones , Derrame Pleural/etiología , Absceso del Psoas/diagnóstico por imagen , Absceso/cirugía , Femenino , Humanos , Cálculos Renales/cirugía , Enfermedades Renales/cirugía , Persona de Mediana Edad , Nefrectomía , Derrame Pleural/diagnóstico por imagen , Absceso del Psoas/etiología , Recurrencia , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Ataque Isquémico Transitorio/patología , Lóbulo Occipital/irrigación sanguínea , Resultado Fatal , Femenino , Estudios de Seguimiento , Humanos , Ataque Isquémico Transitorio/diagnóstico por imagen , Persona de Mediana Edad , Lóbulo Occipital/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Three familial cases of psittacosis are reported. The first case was a 46-year-old woman, the second case, her 18-year-old daughter. Both of them often visited the house of the third case, a 49-year-old women, who was the elder sister of case 1 and who took care of the chick of a budgerigar which she kept in the house. Case 1 came to our hospital with abrupt onset of fever, headache, nausea and general malaise. Because she was suspected to have meningitis, she was admitted to the Department of Neurology. On admission, her chest X-ray film showed bilateral ground glass shadows. She also had hypoxemia and liver dysfunction. On learning of her history of contact with the chick, psittacosis was suspected. Case 2 suffered from fever and headache. Her chest X-ray film revealed opaque infiltration in the right lower lung field. Case 3 complained of fever, headache and vomiting. Her chest X-ray film showed fan-shaped faint shadows in the left upper, middle and lower lung fields. We interpreted these findings as showing psittacosis based on anamnesis. The result of the complement fixation (CF) antibody titer against chlamydia was 1:32 in cases 2 and 3, enabling a serological diagnosis of psittacosis. The corresponding result was 1:16 in case 1. Although the CF antibody titer showed no increase, we diagnosed the case clinically as psittacosis. It is difficult to correctly diagnose psittacosis only from the physical findings and chest X-ray films. Detailed anamnesis, in particular taking a history of exposure to birds, is an important clue for diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Anticuerpos Antibacterianos/análisis , Psitacosis/transmisión , Adolescente , Chlamydophila psittaci/inmunología , Pruebas de Fijación del Complemento , Brotes de Enfermedades , Familia , Humanos , Masculino , Persona de Mediana Edad , Minociclina/uso terapéutico , Psitacosis/tratamiento farmacológico , Radiografía TorácicaRESUMEN
Clinical comparison of SLX with other tumor-associated antigens such as CA19-9, CA125, and CEA, was made in benign respiratory diseases including diffuse panbronchiolitis (DPB), bronchiectasis (BE), bronchial asthma (BA), and pulmonary emphysema (PE). Sensitivities of each marker (greater than 38.0 U/ml) on DPB were 79.4% in SLX, 68.0% in CA19-1, 46.7% in CA125, and 35.7% in CEA. Serum levels of SLX in DPB and BE were significantly higher than those in BA and PE. There seemed to be no relationship between serum levels of SLX and CRP, ESR, and the volume of sputum. Immunohistochemical studies showed positive staining on the surface of respiratory bronchioles and alveolar walls in DPB and these findings were not observed in normal lung tissues. We consider that the high value of serum levels of SLX in DPB can be explained by these findings.