DEPICTION CONTROL: ECG Prognostic significance of ECG changes in acute pneumonia A total of 293 patients with acute pneumonia

were examined for the relationship between ECG changes and the gravity and immediate outcomes of disease. The pneumonia gravity was determined by the mathematic method based on the computation of the prognostic index of pneumonia (Z. K. Trushinsky et al., 1978). It was established that the overload of the right atrium, malfunction of automatism, excitability and conduction, depression of the ST segment and T wave inversion were in a good agreement with the gravity of pneumonia. In patients with severe and medium-severe disease, the above alterations were more demonstrable than in patients with mild pneumonia. Atrial fibrillation and intraventricular blockades, hypertrophy of the left ventricle and changes in the end part of the ventricular complex were observed more frequently in patients discharged from the hospital with residual phenomena as compared to the recovered patients. This indicates a prognostically unfavourable importance of the ECG signs while evaluating the immediate prognosis. In patients with associated acute pneumonia and coronary heart disease, the ECG changes (arrhythmias, displacement of the ST segment and T wave inversion) were more pronounced and steadier, which was linked with the development of more profound dystrophic lesions of the myocardium. Using the ECG to identify pulmonary embolism ecause pulmonary embolism (PE) is a master at imitating many conditions, including acute myocardial infarction (MI), it's frequently unrecognized in postoperative and medical patients. In this article, I'll describe how you can use electrocardiogram (ECG) clues to recognize PE and intervene promptly. A common complication of deep vein thrombosis (DVT), PE is the third most common cardiovascular disorder in the United States and one of the major causes of complications and death among hospitalized patients. About 50,000 Americans die of PE or DVT each year, yet it's easily missed or misdiagnosed. The signs and symptoms of PE-including tachypnea and dyspnea--can mimic those of other problems, such as heart failure and pneumonia. Without treatment, about 11% of patients with PE die within an hour of the embolic event; the mortality rate is 30% for those who survive longer than an hour. But if PE is identified and treated early, the mortality rate drops to 8%@ .Because PE can masquerade as many conditions, it's easier to prevent than to diagnose. The most significant risk factors for PE are known as Virchow's triad: * Venous stasis is typically caused by activity restrictions but may also be caused by conditions such as MI, heart failure, obesity, and atrial arrhythmias. which decrease heart contractility. Hypercoagulation can be caused by pregnancy, parturition, malignancy, sepsis, or dehydration and is more common in patients over age 40.

Slow-resolution pneumonia: radiologic and tomodensitometric features To assess the radiologic findings of unresolving pneumonias (radiologic signs not normalized at the end of the fourth week of antibiotic therapy), the radiologic (192) and CT examinations (33) of 50 patients were reviewed, for a total of 64 pulmonary parenchymal lesions. These lesions presented as masses (3; 4.6%), parenchymal thickenings with aerial bronchogram (41; 63.7%), sometimes escavated (4; 10%), alveolar ground glass alterations (4; 6.2%), more frequent on the right side (49; 73%), mostly in the upper lobe (21; 32.8%). Pleural effusion was demonstrated in 16 patients (32%) and lymphadenopathies were shown in 8 patients (8%). When possible, the responsible germ was isolated with microbiological expectoration test (14; 35.3%), bronchoscopy associated with bronchoalveolar lavage (7; 37.5%) and needle biopsy in the mass (2; 5%). The germs were Candida (9), haemophilus influentiae (1), Klebsiella (1), pneumococcus (1), Pseudomonas (3), Staphylococcus aureus (4), streptococcus alpha hemoliticus (6). There are no typical radiologic and CT findings for the described lesions in different-patients and different germs can produce the same changes. Therefore, pulmonary inflammations must be followed to their complete resolution, to rule out the chance of a neoplastic process (obstructive pneumonia). The first radiologic control must be made at least 15 days after the beginning of therapy for the anatomo-pathologic processes of recovery to show radiographically. CT can be fundamental in the differential diagnosis with neoplasm, in unresolving pneumonia, to study the tracheobronchial tree, to study lymphadenopathies and to guide needle biopsy.

Quantitative comparison of idiopathic interstitial pneumonias on highresolution computed tomographic findings

To analyze the high-resolution computed tomographic (HRCT) findings of IPF (interstitial pulmonary fibrosis), NSIP (nonspecific interstitial pneumonia) and COP (cryptogenic organizing pneumonia) retrospectively through quantification methods and to explore their distinguishing features.
METHODS: Observers with no prior knowledge of the diagnosis evaluated the frequency, extent and distribution of various thin-section CT findings in 29 males and 17 females. The mean age was 50 10 years old (range: 25 - 76). They had a histological diagnosis of IPF (n = 19), nonspecific interstitial pneumonia (NSIP) (n = 14) and cryptogenic organizing pneumonia (COP) (n = 13). RESULTS:

Ground-glass opacity, thickening of bronchovascular bundles and interlobular septal thickening were frequent features of IPF and NSIP. The frequency and extent of honeycombing and bronchiolectasis were more found in IPF than in NSIP and COP (P < 0.05). The frequency and extent of air space consolidation were more found in COP than IPF (P < 0.05). There were more number of segments with traction bronchiectasis and less extent of air space consolidation in IPF

than NSIP and COP. The number of segments with traction bronchiectasis was less in NSIP than that of IPF and COP.
CONCLUSION:

The various subtypes of idiopathic interstitial pneumonias often have the distinguishing characteristics easily identified on HRCT. Bronchiolectasis and honeycombing are valuable features for IPF; air space consolidation is a valuable feature for COP. The features of NSIP are also found in both IPF and COP so that additional features are required for both.

Chest computed tomographic findings and clinical features of legionella pneumonia

To describe the chest radiographic and computed tomographic (CT) findings of legionella pneumonia.
METHODS:

Serial chest radiographs and CT scans obtained in 12 patients with serologically proven Legionella pneumophila pneumonia were retrospectively reviewed. Chest CT findings were analyzed with regard to patterns and distributions of pulmonary abnormalities.
RESULTS:

Nine of the 12 patients were in an immunocompromised state, that is, steroid therapy (n = 8) and myelodysplastic syndrome (n = 1), and 6 of the 8 steroid users were on high-dose steroid. All patients showed multilobar or multisegmental pulmonary infiltrates on CT scans. The CT findings were categorizable as; predominantly airspace consolidations (n = 6), mixed lesions with lobular consolidation and ground-glass opacity (GGO) (n = 3), and pure GGO lesions (n = 2). Five of the 6 patients on high-dose steroid therapy had lobar consolidations with (n = 4) or without a cavity (n = 1), and 1 patient had a mixed lesion.
CONCLUSIONS:

The most common CT findings in legionella pneumonia were multilobar or multisegmental consolidation and GGO. Cavitary lobar consolidation occurred commonly in patients on highdose steroid therapy.

MRI of the lung parenchyma

by recent technical advances, thus leading to a significantly improved image quality in MRI of the lungs. Compared to helical CT good results have been demonstrated using a cardiac and respiratory triggered T2 weighted turbo spin echo sequence which should be included in every imaging protocol. Recent studies have proven that MRI is comparable or even better than the gold-standard helical CT regarding the staging of bronchogenic cancer and follow-up examinations of pneumonia and lung metastases. For other indications like the assessment of pulmonary nodules and the early diagnosis of pneumonia MRI has shown promising results; however these results need to be confirmed in larger patient groups. In patients with chronic infiltrative lung disease, CT scanning remains the superior imaging modality due to the inferior spatial resolution of MRI. In conclusion MRI is a reliable alternative imaging method to helical CT for many indications; in some cases it may be a promising additional examination method. ENDOSCOPIC CONTROL Objective Aspiration pneumonia is a significant cause of morbidity and mortality in both acute and long-term care settings. While there are many reasons for patients to develop aspiration pneumonia, there exists a strong association between difficulty swallowing, or dysphagia, and the development of aspiration pneumonia. The modified barium swallow test (MBS) and endoscopic evaluations of swallowing are considered to be the most comprehensive tests used to evaluate and manage patients with dysphagia in an effort to reduce the incidence of pneumonia. The purpose of this study was to provide an initial investigation of whether flexible endoscopic evaluation of swallowing with sensory testing (FEESST) or MBS is superior as the diagnostic test for evaluating and guiding the behavioral and dietary management of outpatients with dysphagia. FEESST combines the standard endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal sensory discrimination thresholds by endoscopically delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve. Study Design Randomized, prospective cohort outcome study in a hospital-based outpatient setting. Methods One hundred twenty-six outpatients with dysphagia were randomly assigned to either FEESST or MBS as the diagnostic test used to guide dietary and behavioral management (postural changes, small bites and sips, throat clearing). The outcome variables were pneumonia incidence and pneumonia-free interval. The patients were enrolled for 1 year and followed for 1 year. Results Seventy-eight MBS examinations were performed in 76 patients with 14 patients (18.4%) developing pneumonia; 61 FEESST examinations were performed in 50 patients with 6 patients (12.0%) developing pneumonia. These differences were not statistically significant (2 = 0.93, P = .33). In the MBS group the median pneumonia-free interval was 47 days; in the FEESST group the median pneumonia-free interval was 39 days. Based on Wilcoxon's signedrank test, this difference was not statistically significant (z = 0.04, P = .96).

Conclusion Whether dysphagic outpatients have their dietary and behavioral management guided by the results of MBS or of FEESST, their outcomes with respect to pneumonia incidence and pneumonia-free interval are essentially the same.