Observational study to analyze patterns of treatment of breakthrough dyspnea in cancer patients in clinical practice.

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Cabezón-Gutiérrez, Luis; Delgado-Mingorance, Ignacio; Nabal-Vicuña, María; Jiménez-López, Antonio Javier; Cabezón-Álvarez, Ana; Soler-López, Begoña

2018-06-12

Although breakthrough dyspnea is very frequent in cancer patients, there are no precise recommendations for treating it. The main objective of this study was to analyze what treatments are used in clinical practice for the management of breakthrough dyspnea in cancer patients in Spain and the secondary objectives were to describe the characteristics of cancer patients with breakthrough dyspnea and the attributes of the disorder. Cancer patients over 18 years of age, with breakthrough dyspnea and a Karnofsky performance score of ≥30, who were treated at departments of oncology in institutes across Spain were included in this cross-sectional observational study. The characteristics of breakthrough dyspnea, history of treatment, anthropometric variables, Mahler dyspnea index, Borg scale, Edmonton Symptoms Assessment Scale, and patient satisfaction with current breakthrough dyspnea treatment were assessed. The mean age of the 149 included patients was 66 years (95% confidence interval: 64.3 to 67.9), and 53 were females (35.6%). The mean breakthrough dyspnea intensity was 5.85 (95% confidence interval 5.48 to 6.22, Borg scale). A total of 55.1% of the first-choice treatments consisted of opioids, followed by oxygen (17.3%). A total of 119 patients (79.9%) received monotherapy for breakthrough dyspnea. Patients presenting with basal dyspnea received oxygen in a greater proportion of cases (21.1% vs 7.4%; p = 0.07). Patients with predictable dyspnea received a greater proportion of opioids (70.9% vs 44.4%; p = 0.01). Opioids constitute first-line therapy for breakthrough dyspnea in routine clinical practice, though the scientific evidence supporting their use is scarce. Further information derived from controlled clinical trials is needed regarding the comparative efficacy of the different treatments in order to justify their use.

Aggravation of dyspnea in stage I non-small cell lung cancer patients following stereotactic body radiotherapy

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Paludan, Merete; Traberg Hansen, Anders; Petersen, Jørgen

2006-01-01

the association of dose-volume histogram parameters with changes in dyspnea. The study concerns 28 medically inoperable stage I NSCLC patients that received SBRT at our department between 2000 and 2003. A central dose of 45 Gy/3 fractions was delivered in 5-8 days. WHO toxicity scoring of dyspnea...... consistent temporal variations of dyspnea after SBRT. We identified COPD as the factor showing the closest association with aggravation of dyspnea. The observed aggravation of dyspnea following SBRT reflects habitual exacerbations of COPD rather than treatment-related toxicity. Concern about pulmonary...

Use of post-exercise laryngoscopy to evaluate exercise induced dyspnea.

LENUS (Irish Health Repository)

McNally, P

2010-10-01

We present the case of a child with asthma who continued to have marked exercise induced dyspnea despite appropriate treatment, and in the face of adequate control of all other asthma symptoms. Spirometry showed a marked truncation of inspiratory flow, and laryngoscopy performed immediately after exercise showed laryngomalacia with dynamic, partial inspiratory obstruction. Exercise induced laryngomalacia (EIL) is a rare cause of exercise induced dyspnea which is diagnosed by post exercise flexible laryngoscopy and may require supraglottoplasty.

Assessment of dyspnea in terminally III cancer patients. Role of the thoracic surgeon as a palliative care physician

International Nuclear Information System (INIS)

Yoshino, Kazuo; Nishiumi, Noboru; Masuda, Ryota; Iwazaki, Masayuki; Saito, Yuki; Tokuda, Yutaka

2011-01-01

Many cancer patients suffer from rapidly-progressing dyspnea that is difficult to relieve. The subjects were 26 patients who had dyspnea that was difficult to relieve. The Numeric Rating Scale was used to evaluate their dyspnea. For all patients, the cause of the dyspnea was investigated by CT and x-rays. The principal causes of the dyspnea were pleural effusion that increased daily, complications from pneumonia, massive ascites, multiple metastatic lung tumors and atelectasis, recurrent laryngeal nerve paralysis and narrowing secondary airway compression. Dyspnea was caused by a variety of conditions that overlapped over time, intensifying patients' discomfort. Among 14 patients for whom we recommended treatment with sedation, only 8 of them consented. Among the patients who were treated with sedation, the median interval between the exacerbation of dyspnea and death was 16 days; among non-sedated patients it was 18 days. Palliative care physicians who specialize in the respiratory system can, to some extent, predict the occurrence of rapidly progressive dyspnea in cancer patients. It is important to explain the methods of relieving dyspnea to the patient, the patient's family, and the oncologist early, so that decisions on how to manage dyspnea can be made in advance. (author)

[Exercise laryngoscopy: a new method for the differential diagnosis of dyspnea on exertion].

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Tervonen, Hanna; Iljukov, Sergei; Niskanen, Minna-Liisa; Vilkman, Erkki; Sovijärvi, Anssi; Aaltonen, Leena-Maija

2011-01-01

Exertional dyspnea originating from the laryngeal level can be established with certainty only if the paradoxical vocal cord adduction is observed during dyspnea. We have developed a novel diagnostic method, exercise laryngoscopy, which involves observation of the larynx with a flexible endoscope applied via the nose during a bicycle ergometry test. It has been our aim to improve the differential diagnosis of dyspnea on exertion and thus also reduce unnecessary antiasthmatic medication. Exercise laryngoscopy allows examination in the out-patient clinics because the method is well tolerated.

Bedside Ultrasonography versus Brain Natriuretic Peptide in Detecting Cardiogenic Causes of Acute Dyspnea

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Keihan Golshani

2016-04-01

Full Text Available Acute dyspnea is a common cause of hospitalization in emergency departments (ED.Distinguishing the cardiac causes of acute dyspnea from pulmonary ones is a major challenge for responsible physicians in EDs. This study compares the characteristics of bedside ultrasonography with serum level of blood natriuretic peptide (BNP in this regard. Methods: This diagnostic accuracy study compares bedside ultrasonography with serum BNP levels in differentiating cardiogenic causes of acute respiratory distress. Echocardiography was considered as the reference test. A checklist including demographic data (age and sex, vital signs, medical history, underlying diseases, serum level of BNP, as well as findings of chest radiography, chest ultrasonography, and echocardiography was filled for all patients with acute onset of dyspnea. Screening characteristics of the two studied methods were calculated and compared using SPSS software, version 20. Results: 48 patients with acute respiratory distress were evaluated (50% female. The mean age of participants was 66.94 ± 16.33 (28-94 years. Based on the results of echocardiography and final diagnosis, the cause of dyspnea was cardiogenic in 20 (41.6% cases. Bedside ultrasonography revealed the cardiogenic cause of acute dyspnea in 18 cases (0 false positive and BNP in 44 cases (24 false positives. The area under the ROC curve for bedside ultrasonography and BNP for differentiating the cardiogenic cause of dyspnea were 86.4 (95% CI: 74.6-98.3 and 66.3 (95% CI: 49.8-89.2, respectively (p = 0.0021. Conclusion: It seems that bedside ultrasonography could be considered as a helpful and accurate method in differentiating cardiogenic causes of acute dyspnea in emergency settings. Nevertheless, more study is needed to make a runaway algorithm to evaluate patients with respiratory distress using bedside ultrasonography, which leads to rapid therapeutic decisions in a short time.

Impact of Blunted Perception of Dyspnea on Medical Care Use and Expenditure, and Mortality in Elderly People

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Satoru eEbihara

2012-07-01

Full Text Available Dyspnea is an alarming symptom responsible for millions of patient visits each year. Poor perception of dyspnea might be reasonably attributed to an inappropriately low level of fear and inadequate earlier medical treatment for both patients and physicians, resulting in subsequent intensive care. This study was conducted to evaluate medical care use and cost, and mortality according to the perception of dyspnea in community-dwelling elderly people. We analyzed baseline data from a community-based Comprehensive Geriatric Assessment (CGA in 2002. The perception of dyspnea in 479 Japanese community-dwelling elderly people with normal lung function was measured in August 2002. The sensation of dyspnea during breathing with a linear inspiratory resistance of 10, 20 and 30 cmH2O/L/s was rated using the Borg scale. According to the perception of dyspnea, we divided the elderly into tertiles and compared all hospitalizations, out-patient visits, costs and death through computerized linkage with National Health Insurance (NHI beneficiaries claims history files between August 2002 and March 2008. In-patient hospitalization days and medical care costs significantly increased with the blunted perception of dyspnea, resulting in an increase in total medical-costs with blunted perception of dyspnea. With low perception group as reference, the hazard ratios of all cause mortality were 0.65 (95%CI 0.23-1.89 for intermediate perception group and 0.31(0.10-0.97 for high perception group, indicating the mortality rate also significantly increased with the blunted perception of dyspnea after multivariates adjustment (p=0.04. The blunted perception of dyspnea is related to hospitalization, large medical costs and all-cause mortality in community-dwelling elderly people. These findings provide a rational for preventing serious illness with careful monitoring of objective conditions in the elderly.

McArdle's Disease Presenting as Unexplained Dyspnea in a Young Woman

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Nha Voduc

2004-01-01

Full Text Available McArdle's disease is a rare, inherited deficiency of myophosphorylase, an enzyme required for the utilization of glycogen. Patients with myophosphorylase deficiency classically present with exercise intolerance, leg pain and muscle fatigue. The case of a young woman with exertional dyspnea and leg cramps is described. Exercise testing confirmed the presence of exercise intolerance and demonstrated an accelerated heart rate response, despite the absence of an anaerobic threshold and a respiratory exchange ratio of less than 1.0. Subsequent ischemic forearm testing and muscle biopsy confirmed the diagnosis of myophosphorylase deficiency. Evaluation of lung mechanics with esophageal pressure measurements demonstrated the presence of respiratory muscle weakness and early fatiguability, suggesting that the patient's dyspnea might have been attributable to an increased respiratory effort. Dyspnea is not a classic symptom associated with myophosphorylase deficiency, although subclinical respiratory muscle impairment may be present. No previous studies have evaluated respiratory muscle function during exercise in patients with myophosphorylase deficiency.

Correlation of chest computed tomography findings with dyspnea and lung functions in post-tubercular sequelae

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Ananya Panda

2016-01-01

Full Text Available Aims: To study the correlation between dyspnea, radiological findings, and pulmonary function tests (PFTs in patients with sequelae of pulmonary tuberculosis (TB. Materials and Methods: Clinical history, chest computed tomography (CT, and PFT of patients with post-TB sequelae were recorded. Dyspnea was graded according to the Modified Medical Research Council (mMRC scale. CT scans were analyzed for fibrosis, cavitation, bronchiectasis, consolidation, nodules, and aspergilloma. Semi-quantitative analysis was done for these abnormalities. Scores were added to obtain a total morphological score (TMS. The lungs were also divided into three zones and scores added to obtain the total lung score (TLS. Spirometry was done for forced vital capacity (FVC, forced expiratory volume in 1 s (FEV1, and FEV1/FVC. Results: Dyspnea was present in 58/101 patients. A total of 22/58 patients had mMRC Grade 1, and 17/58 patients had Grades 2 and 3 dyspnea each. There was a significant difference in median fibrosis, bronchiectasis, nodules (P < 0.01 scores, TMS, and TLS (P < 0.0001 between dyspnea and nondyspnea groups. Significant correlations were obtained between grades of dyspnea and fibrosis (r = 0.34, P = 0.006, bronchiectasis (r = 0.35, P = 0.004, nodule (r = 0.24, P = 0.016 scores, TMS (r = 0.398, P = 0.000, and TLS (r = 0.35, P = 0.0003. PFTs were impaired in 78/101 (77.2% patients. Restrictive defect was most common in 39.6% followed by mixed in 34.7%. There was a negative but statistically insignificant trend between PFT and fibrosis, bronchiectasis, nodule scores, TMS, and TLS. However, there were significant differences in median fibrosis, cavitation, and bronchiectasis scores in patients with normal, mild to moderate, and severe respiratory defects. No difference was seen in TMS and TLS according to the severity of the respiratory defect. Conclusion: Both fibrosis and bronchiectasis correlated with dyspnea and with PFT. However, this correlation was not

Right sided arcus aorta as a cause of dyspnea and chronic cough

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Ozkaya Sevket

2012-10-01

Full Text Available Abstract Background Right sided arcus aorta (RSAA is a rare condition that is usually asymptomatic. Patients may present with exertional dyspnea and chronic cough. A recent article suggested that RSAA should be included in the differential diagnosis of asthma, especially in patients with intractable exertional dyspnea. We aimed to present the clinical, radiologic and spirometric features of thirteen patients with RSAA observed in four years at the Rize Education and Research Hospital and Samsun Chest Diseases and Thoracic Surgery Hospital. Methods The characteristics of patients with RSAA, including age, gender, symptoms, radiologic and spirometric findings, were retrospectively evaluated. Results A total of thirteen patients were diagnosed with RSAA. Their ages ranged from 17 to 86 years and the male to female ratio was 11:2. Seven of the patients (54% were symptomatic. The most common symptoms were exertional dyspnea, dysphagia and chronic cough. Five patients had received treatment for asthma with bronchodilators. Spirometry showed intrathoracic tracheal obstruction in five patients. Conclusions The RSAA anomaly occurs more frequently than might be estimated from the number of patients who are detected. Patients with intractable exertional dyspnea and chronic cough should be evaluated for the RSAA anomaly by thoracic CT.

Cervical Hyperostosis Leading to Dyspnea, Aspiration and Dysphagia: Strategies to Improve Patient Management

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Georgios Psychogios

2018-04-01

Full Text Available Diffuse idiopathic skeletal hyperostosis (DISH is a rare but well known cause of dysphagia. In very few cases aspiration and dyspnea are described as a clinical manifestation. An 82-year-old man presented himself in our clinic with severe dyspnea, aspiration, and pneumonia. After performing a microlaryngoscopy an emergency tracheotomy became necessary.In laryngoscopy a severe bulging of the posterior oropharyngeal and hypopharyngeal wall was detected. The glottis area was not observable and immobilisation of the right vocal cord could be detected. The CT showed anterior osteophytes and ossification of the anterior longitudinal ligament from C2–C7. We performed a panendoscopy in order to explore the upper aerodigestive area. Postoperatively an emergency tracheotomy was needed due to the development of laryngeal edema. The osteophytes were removed in cooperation with the department of orthopaedics. Three months postoperative the patient had no dyspnea or dysphagia, so the tracheotomy could be closed.Cervical hyperostosis is commonly described in elderly patients and usually presenting without symptoms, therefore a surgical treatment is usually not necessary. Nevertheless it can lead to severe morbidity and dyspnea with airway obstruction. Therefore it is essential that cervical hyperostosis is recognized early enough and appropriate treatment is initiated. Flexible endoscopy should be preferred over direct panendoscopy because it could lead to life-threatening edema and a prophylactic tracheostomy should be strongly considered in patients that present with severe dyspnea,

Relationship between anxiety and dyspnea on exertion in patients with chronic obstructive pulmonary disease

NARCIS (Netherlands)

de Voogd, J.N.; Sanderman, R.; Postema, K.; van Sonderen, E.; Wempe, J.B.

2011-01-01

Dyspnea limits exercise in patients with chronic obstructive pulmonary disease (COPD) and is known to induce anxiety. Little is known whether anxiety contributes to exercise-induced dyspnea, which in turn might influence the outcome of diagnostic tests. The aim of the present study was to examine

Continuous subcutaneous infusion of compound oxycodone for the relief of dyspnea in patients with terminally ill cancer: a retrospective study.

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Kawabata, Masahiro; Kaneishi, Keisuke

2013-05-01

Pain and dyspnea are the most prevalent and distressing symptoms in patients with terminally ill cancer. Evidences have accumulated for the effects of morphine on dyspnea, whereas little is known about the effects of oxycodone on dyspnea. We investigated the effectiveness of oxycodone for dyspnea in patients with terminally ill cancer. The injectable form of compound oxycodone (iOC) containing hydrocotarnine was administered continuously via subcutaneous route. We administered iOC to 136 patients. The effect on dyspnea was less conspicuous than pain, yet iOC was effective for dyspnea with varying degrees. None of the adverse effects observed were serious. These results suggest that continuous subcutaneous administration of oxycodone could be one of the reasonable alternatives in the management of dyspnea in patients with terminally ill cancer.

Psycho-Physiological Associates of Dyspnea in Hospitalized Patients with Interstitial Lung Diseases: A Cross-Sectional Study.

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Zhou, Yan Hua; Mak, Yim Wah

2017-10-24

Dyspnea has been found to be an independent predictor of mortality among patients with respiratory diseases and is often regarded as a difficult symptom to control in patients with interstitial lung diseases (ILDs). Previous studies have found an association of psychological and physiological factors with dyspnea among patients with chronic obstructive airway diseases. However, symptom management of hospitalized patients with ILDs has been hampered by difficulty in priority, since they are often admitted with multiple psycho-physiological needs. This study examined the prevalence of dyspnea and the psycho-physiological factors associated with it among hospitalized Chinese patients with ILDs. We studied 165 hospitalized patients with ILDs recruited consecutively over three months in a public hospital in Guangzhou, China. Dyspnea and common psycho-physiological factors, including cough symptoms, activity capacity, lung function, physical and mental health status, and anxiety and depression symptoms, were measured. By ordered logistic regression, level of dyspnea statistically significantly affected performance in a six-minute walk test and physical functioning in work or other regular daily activities in hospitalized patients with ILDs. Respiratory rehabilitation with an appropriate intensity of exercise training or other strategies for enhancing the physical functioning of this population with moderate and severe levels of dyspnea should be prioritized.

Point-of-Care Ultrasonography for Evaluation of Acute Dyspnea in the ED.

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Zanobetti, Maurizio; Scorpiniti, Margherita; Gigli, Chiara; Nazerian, Peiman; Vanni, Simone; Innocenti, Francesca; Stefanone, Valerio T; Savinelli, Caterina; Coppa, Alessandro; Bigiarini, Sofia; Caldi, Francesca; Tassinari, Irene; Conti, Alberto; Grifoni, Stefano; Pini, Riccardo

2017-06-01

Acute dyspnea is a common symptom in the ED. The standard approach to dyspnea often relies on radiologic and laboratory results, causing excessive delay before adequate therapy is started. Use of an integrated point-of-care ultrasonography (PoCUS) approach can shorten the time needed to formulate a diagnosis, while maintaining an acceptable safety profile. Consecutive adult patients presenting with dyspnea and admitted after ED evaluation were prospectively enrolled. The gold standard was the final diagnosis assessed by two expert reviewers. Two physicians independently evaluated the patient; a sonographer performed an ultrasound evaluation of the lung, heart, and inferior vena cava, while the treating physician requested traditional tests as needed. Time needed to formulate the ultrasound and the ED diagnoses was recorded and compared. Accuracy and concordance of the ultrasound and the ED diagnoses were calculated. A total of 2,683 patients were enrolled. The average time needed to formulate the ultrasound diagnosis was significantly lower than that required for ED diagnosis (24 ± 10 min vs 186 ± 72 min; P = .025). The ultrasound and the ED diagnoses showed good overall concordance (κ = 0.71). There were no statistically significant differences in the accuracy of PoCUS and the standard ED evaluation for the diagnosis of acute coronary syndrome, pneumonia, pleural effusion, pericardial effusion, pneumothorax, and dyspnea from other causes. PoCUS was significantly more sensitive for the diagnosis of heart failure, whereas a standard ED evaluation performed better in the diagnosis of COPD/asthma and pulmonary embolism. PoCUS represents a feasible and reliable diagnostic approach to the patient with dyspnea, allowing a reduction in time to diagnosis. This protocol could help to stratify patients who should undergo a more detailed evaluation. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Exercise-induced dyspnea is a problem among the general adolescent population.

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Johansson, H; Norlander, K; Hedenström, H; Janson, C; Nordang, L; Nordvall, L; Emtner, M

2014-06-01

Respiratory symptoms during exercise are common and might limit adolescents' ability to take part in physical activity. To estimate the prevalence, determinants and consequences of exercise-induced dyspnea (EID) on daily life in a general population of 12-13 year old adolescents. A letter was sent to the parents of all 12-13 year old adolescents in the city of Uppsala (n = 3838). Parents were asked to complete a questionnaire together with their child on EID, asthma and allergy, consequences for daily life (wheeze, day time- and nocturnal dyspnea) and physical activity. The response rate was 60% (n = 2309). Fourteen percent (n = 330) reported EID, i.e. had experienced an attack of shortness of breath that occurred after strenuous activity within the last 12 months. Female gender, ever-asthma and rhinitis were independently associated with an increased risk of EID. Ever-asthma was reported by 14.6% (n = 338), and 5.4% (n = 128) had both EID and ever-asthma. Sixty-one percent (n = 202) of the participants with EID did not have a diagnosis of asthma. In addition to rhinitis, participants with EID reported current wheeze and day-time as well as nocturnal dyspnea more often than the group without EID. No difference was found in the level of physical activity between participants with and without EID. Adolescents with undiagnosed exercise-induced dyspnea have respiratory symptoms and are affected in daily life but have the same level of physical activity as adolescents without exercise-induced respiratory symptoms. Copyright © 2014 Elsevier Ltd. All rights reserved.

Perception of dyspnea in childhood asthma crisis by the patients and those in charge of them.

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Parente, Ana Alice Amaral Ibiapina; March, Maria Fátima Pombo; Evangelista, Lucia Araujo; Cunha, Antonio Ledo

2011-01-01

To evaluate the correlation between perception of dyspnea during a mild to moderate asthma attack using the Modified Borg Scale (MBS) and peak expiratory flow rate (PEFR). This was a cross-sectional study conducted with children and adolescents who sought a pediatric emergency service due to an asthma attack. Data were collected from July 2005 to June 2006. Demographic data were recorded. Patients and those in charge of them were requested to grade, individually, the patient's dyspnea using the MBS; afterwards, the peak expiratory flow rate was measured. 181 asthmatic patients were evaluated, with a mean age of 7.2 (± 2.4) years (range, 4-12). The mother sought medical aid in 83.4% of the cases (151/181). Patient symptoms included coughing in 68.5% (124/181), dyspnea in 47.0% (85/181), and wheezing in 12.7% (23/181). Thirty-six percent (65/181) had a mild attack, and 64.1% (116/181) a moderate one. A significant negative correlation was found between the patients' and accompanying adults' perceptions of patient's dyspnea and the PEFR (% predicted; rs = -0.240 and rs = -0.385, respectively). Both the patients and those looking after them had a poor perception of the severity of the patient's dyspnea. This emphasizes the need to monitor objective measures such as the PEFR and to develop better ways of evaluating dyspnea.

Gender and perception of dyspnea: The role of the variation in the forced expiratory volume in one second

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Carlos A. Nigro

2010-08-01

Full Text Available During bronchoconstriction women perceive more breathlessness than men. The aims of study were 1 to evaluate if quality of dyspnea in bronchoconstriction was different in women and men 2 to assess if gender difference in the perception of dyspnea could be related to the level of bronchoconstriction. 457 subjects (257 women inhaled methacholine to a 20% decrease in FEV1, or 32 mg/ml. Dyspnea was evaluated using the modified Borg scale and a list of expressions of dyspnea. Borg scores were recorded immediately before the challenge test baseline and at the maximum FEV1 decrease. The prevalence of descriptors of dyspnea reported by women and men was similar. Dyspnea was related to the level of FEV1 (ΔFEV1: OR 1.05, 95%CI 1.01-1.09, p 0.0095, females (OR 2.90, 95%CI 1.33-6.33, p 0.0072, younger subjects (OR 0.93, 95%CI 0.89- 0.97, p 0.0013 and body mass index (BMI (OR 1.11, 95%CI 1.01-1.23, p 0.023. As the FEV1 fell less than 20% from baseline, only the ΔFEV1 was significantly associated with dyspnea (ΔFEV1:OR 1.15, 95%CI 1.07- 1.24, p 0.0002. Instead, if the FEV1 fell higher ≥ 20%, the presence of dyspnea was related to the degree of bronchoconstriction (ΔFEV1: OR 1.04, 95%CI 1.01-1.09, p 0.0187, females (OR 3.02, 95%CI 1.36-6.72, p 0.0067, younger subjects (OR 0.92, 95%CI 0.88-0.96, p 0.0007 and BMI (OR 1.12, 95%CI 1.01-1.23, p 0.023. The quality of dyspnea during the bronchoconstriction was similar in women and men; women showed a higher perception of dyspnea than men only when the FEV1 fell more than 20% from baseline.

Dyspnea: when the preliminary imaging is unconvincing

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Angelica Moretti

2015-05-01

Full Text Available A 73-year-old man was admitted to the Emergency Room (ER for dyspnea and cough from several months. In ER were performed blood sampling, chest X-ray, electrocardiogram, echocardiogram and arterial blood gas. A thoracic ultrasound (US revealed in the left side an abundant pleural effusion and a lung consolidation area of about 5 cm without air bronchogram. A thoracentesis showed the presence of hemorrhagic effusion. Chest computed tomography (CT revealed micro-pulmonary embolism, abundant left pleural effusion with atelectasis of the lower ipsilateral lobe. Meanwhile the chest CT revised by the pulmonologist appeared suspicious for the presence of cancer, the cytological examination of pleural fluid revealed the presence of an adenocarcinoma. While the patient was waiting for the bronchoscopy he had a stroke and died in a few days. In conclusion, we believe that thoracic US has to be considered an extension of the physical examination, it is a bedside tool and it represents a valid diagnostic and therapeutic method. Therefore thoracic US, if closely linked to the physician’s activity, can directly affect the decision-making process and management of the patient with dyspnea.

The origin of dyspnea and its role in the reduction of exercise endurance in patients with rheumatoid arthritis

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Mikhail Vasil'evich Sheyanov

2010-01-01

Results. Dyspnea during exercise was reported by 54 (52% patients with RA and 9 (9% control patients (p < 0.001. Dyspnea was more frequently detected and more significant in RA patients with other symptoms of respiratory organ lesions (cough, sputum discharge, chest pain on breathing and coughing, anemia, and emotional disorders of the anxious-depressive type. The degree of dyspnea correlated with DAS 28 scores (r = 0.33; p < 0.01. No correlation was found between lung function parameters and blood gas composition. Pulmonary MSCT in RA patients with dyspnea more frequently revealed signs of bronchiolitis and lesion of the lung as its interstitial fibrotic type. Conclusion. Dyspnea is a common symptom and an important factor in reducing EE and QL in patients with RA. Dyspnea in these patients has a multifactorial origin. Of importance in its occurrence are the involvement of the lung and bronchi in the pathological process irrespective of the lung function, as well as RA-associated factors (including anemia, and nosogenic emotional disorders (anxiety and/or depression.

Discriminating between cardiac and pulmonary dysfunction in the general population with dyspnea by plasma pro-B-type natriuretic peptide

DEFF Research Database (Denmark)

Mogelvang, R; Goetze, JP; Schnohr, P

2007-01-01

OBJECTIVES: This study was designed to determine whether measurement of plasma pro-B-type natriuretic peptide (proBNP) could be used in discriminating between cardiac and pulmonary dyspnea in the general population. BACKGROUND: Natriuretic peptides are useful markers in ruling out acute cardiac d......% to 17%). CONCLUSIONS: In the general population with dyspnea, plasma proBNP concentrations are increased in left ventricular dilatation, hypertrophy, systolic dysfunction, or diastolic dysfunction, but are unaffected by pulmonary dysfunction.......OBJECTIVES: This study was designed to determine whether measurement of plasma pro-B-type natriuretic peptide (proBNP) could be used in discriminating between cardiac and pulmonary dyspnea in the general population. BACKGROUND: Natriuretic peptides are useful markers in ruling out acute cardiac...... dyspnea in the emergency department, but their diagnostic significance in evaluating chronic dyspnea in the general population is unknown. METHODS: Within the Copenhagen City Heart Study, a large, community-based population study, dyspnea was evaluated by spirometry, oxygen saturation, echocardiography...

[Dyspnea in the terminal stage].

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Binsack, T

2001-10-01

From all symptoms in palliative medicine those concerning respiration are most excruciating and most difficult to treat. No other symptom is more dependent on psychosocial circumstances and on the atmosphere around the patient. Therefore the relief of respiratory problems is as important as the therapy of pain. A consequent therapy comprises besides drug therapy (adrenocortical steroids, brochodilators, opioids, sedatives and sometimes antibiotics) also physiotherapy and in special cases oncological treatment and radiotherapy. A team present twenty-four hours a day, the training of relatives and friends, the frank dealing with the patient's anxiety of suffocation are the basis of all therapeutic measures. Dyspnea often is the reason for a longer stay in a palliative care unit.

Comparing dynamic hyperinflation and associated dyspnea induced by metronome-paced tachypnea versus incremental exercise.

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Calligaro, Gregory L; Raine, Richard I; Bateman, Mary E; Bateman, Eric D; Cooper, Christopher B

2014-02-01

Dynamic hyperinflation (DH) during exercise is associated with both dyspnea and exercise limitation in COPD. Metronome-paced tachypnoea (MPT) is a simple alternative for studying DH. We compared MPT with exercise testing (XT) as methods of provoking DH, and assessed their relationship with dyspnea. We studied 24 patients with moderate COPD (FEV1 59 ± 9% predicted) after inhalation of ipratropium/salbutamol combination or placebo in a double-blind, crossover design. Inspiratory capacity (IC) was measured at baseline and after 30 seconds of MPT with breathing frequencies (fR) of 20, 30 and 40 breaths/min and metronome-defined I:E ratios of 1:1 and 1:2, in random sequence, followed by incremental cycle ergometry with interval determinations of IC. DH was defined as a decline in IC from baseline (∆IC) for both methods. Dyspnea was assessed using a Borg CR-10 scale. ∆IC during MPT was greater with higher fR and I:E ratio of 1:1 versus 1:2, and less when patients were treated with bronchodilator rather than placebo (P = 0.032). DH occurred during 19 (40%) XTs, and during 35 (73%) tests using MPT. Eleven of 18 (61%) non-congruent XTs (where DH occurred on MPT but not XT) terminated before fR of 40 breaths/min was reached. Although greater during XT, the intensity of dyspnea bore no relationship to DH during either MPT and XT. MPT at 40 breaths/min and I:E of 1:1 elicits the greatest ∆IC, and is a more sensitive method for demonstrating DH. The relationship between DH and dyspnea is complex and not determined by DH alone.

A case of vogt-koyanagi-harada syndrome with persistent dyspnea secondary to laryngeal edema.

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Mantopoulos, Dimosthenis; deSilva, Brad W; Cebulla, Colleen M

2014-01-01

We report a case of laryngeal edema associated with the Vogt-Koyanagi-Harada (VKH) syndrome. A 32-year-old African-American female presented with a 12-day prodrome, including headache, tinnitus and shortness of breath, which preceded sudden photophobia and bilateral visual loss. Examination and clinical testing were most consistent with VKH, and the patient improved with intravenous methylprednisolone therapy. The patient had persistent dyspnea, which was out of proportion to chest CT findings and which was exacerbated during a recurrence of VKH. Flexible fiberoptic laryngoscopy with stroboscopy revealed diffuse laryngeal edema. Symptoms were alleviated with breathing exercises. Several autoimmune diseases may cause diffuse laryngeal edema. In this case, VKH was associated with the patient's glottic edema and dyspnea. We recommend that laryngeal edema be considered in the differential diagnosis for patients with dyspnea and VKH.

Greater dyspnea is associated with lower health-related quality of life among European patients with COPD

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Gruenberger JB

2017-03-01

Full Text Available Jean-Bernard Gruenberger,1 Jeffrey Vietri,2 Dorothy L Keininger,1 Donald A Mahler3 1Health Economics and Outcomes Research, Novartis Pharma AG, Basel, Basel-Stadt, Switzerland; 2Health Outcomes Practice, Kantar Health, Horsham, PA, 3Geisel School of Medicine at Dartmouth, Hanover, NH, USA Objective: Dyspnea is a defining symptom in the classification and treatment of chronic obstructive pulmonary disease (COPD. However, the degree of variation in burden among symptomatic COPD patients and the possible correlates of burden remain unclear. This study was conducted to characterize patients in Europe currently being treated for COPD according to the level of dyspnea in terms of sociodemographics, health-related quality of life, work productivity impairment, and health care resource use assessed by patient reports.Methods: Data were derived from the 5-EU 2013 National Health and Wellness Survey (N=62,000. Respondents aged ≥40 years who reported currently using a prescription for COPD were grouped according to their level of dyspnea as per the Global Initiative for Chronic Obstructive Lung Disease guidelines and compared on health status (revised Short Form 36 [SF-36]v2, work impairment (Work Productivity and Activity Impairment questionnaire, and number of health care visits in the past 6 months using generalized linear models with appropriate distributions and link functions.Results: Of the 768 respondents who met the inclusion criteria, 245 (32% were considered to have higher dyspnea (equivalent to modified Medical Research Council score ≥2. Higher dyspnea was associated with decrements ranging from 3.9 to 8.2 points in all eight domains of the SF-36 health profile after adjustment for sociodemographics, general health characteristics, and length of COPD diagnosis; mental component summary scores and Short Form-6D health utility scores were lower by 3.5 and 0.06 points, respectively. Adjusted mean activity impairment (55% vs 37%, P<0.001 and

Anterior cervical osteophytes causing dysphagia and dyspnea: an uncommon entity revisited.

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Giger, Roland; Dulguerov, Pavel; Payer, Michael

2006-10-01

Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis (DISH). We present the case of an 83-year-old patient with progressive dysphagia and acute dyspnea, necessitating emergency tracheotomy. Voluminous anterior cervical osteophytes extending from C3 to C7 and narrowing the pharyngoesophageal segment by external compression and bilateral vocal fold immobility were diagnosed radiologically and by fiberoptic laryngoscopy. Surgical removal of all osteophytes led to the resolution of symptoms. Dyspnea with or without dysphagia caused by hypertrophic anterior cervical osteophytes is an uncommon entity. The exhaustive diagnostic workup proposed in the literature could be simplified by using fiberoptic laryngoscopy and dynamic videofluoroscopy. The causes, treatment, and outcome are discussed.

A Case of Vogt-Koyanagi-Harada Syndrome with Persistent Dyspnea Secondary to Laryngeal Edema

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Dimosthenis Mantopoulos

2014-11-01

Full Text Available Purpose: We report a case of laryngeal edema associated with the Vogt-Koyanagi-Harada (VKH syndrome. Patient and Methods: A 32-year-old African-American female presented with a 12-day prodrome, including headache, tinnitus and shortness of breath, which preceded sudden photophobia and bilateral visual loss. Examination and clinical testing were most consistent with VKH, and the patient improved with intravenous methylprednisolone therapy. Results: The patient had persistent dyspnea, which was out of proportion to chest CT findings and which was exacerbated during a recurrence of VKH. Flexible fiberoptic laryngoscopy with stroboscopy revealed diffuse laryngeal edema. Symptoms were alleviated with breathing exercises. Conclusions: Several autoimmune diseases may cause diffuse laryngeal edema. In this case, VKH was associated with the patient's glottic edema and dyspnea. We recommend that laryngeal edema be considered in the differential diagnosis for patients with dyspnea and VKH.

Severe dyspnea due to a giant antrochoanal polyp

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Coloma-Milano M; Gil-Carcedo-Sañudo E; Gil-Carcedo-García LM.; Martín-Batista S; Madrigal-Revuelta M; Vallejo-Valdezate LA

2012-01-01

SummaryIntroduction: The antrochoanal polyp is a prevalent pathology in teenagers and young adults. It usually presents with nasal obstruction.Patient and method: Case report: An 80-year-old male with alcoholic encephalopathy, chronic bronchial disease of unknown etiology and polypoid chronic rhinosinusitis came to the emergency service with severe dyspnea without laryngeal features.Anterior rhinoscopy showed a polypoid mass in left nostril that prevented the visualization with nasal endoscop...

Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis.

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Samad, Idris; Akst, Lee; Karatayli-Özgürsoy, Selmin; Teets, Kristine; Simpson, Marissa; Sharma, Ashwyn; Best, Simon R A; Hillel, Alexander T

2016-11-01

Endoscopic airway surgery is a frequently used procedure in the management of laryngotracheal stenosis (LTS); however, no established outcome measures are available to assess treatment response. To assess acoustics and aerodynamic measures and voice- and dyspnea-related quality of life (QOL) in adult patients with LTS who undergo endoscopic airway surgery. This case series compared preoperative measures and postoperative outcomes among adult patients who underwent endoscopic airway surgery for LTS from September 1, 2013, to September 30, 2015, at the tertiary care Johns Hopkins Voice Center. Patients were excluded if they did not undergo balloon dilation or if they had multilevel or glottic stenosis. The Phonatory Aerodynamic System was used to quantify laryngotracheal aerodynamic changes after surgery. Final follow-up was completed 2 to 6 weeks after surgery. The voice-related QOL instrument (V-RQOL), Dyspnea Index, and Clinical Chronic Obstructive Pulmonary Disease Questionnaire were completed before and after endoscopic surgery. Consensus auditory perceptual evaluation of voice, acoustic measurements, and aerodynamic outcomes were also assessed. Fourteen patients (1 man and 13 women; mean [SD] age, 45.4 [4.3] years) were enrolled. The mean postoperative V-RQOL scores (n = 14) increased from 74.3 to 85.5 (mean of difference, 11.3; 95% CI, 2.2 to 20.3). The mean postoperative Dyspnea Index (n = 14) decreased from 26.9 to 6.6 (mean of difference, -20.3; 95% CI, -27.9 to -12.7); the mean postoperative Clinical Chronic Obstructive Pulmonary Disease Questionnaire scores (n = 9) decreased from 3.2 to 1.0 (mean of difference, -2.2; 95% CI, -3.4 to -0.9). Postoperative mean vital capacity (n = 14) increased from 2.5 to 3.1 L (mean of difference, 0.6 L; 95% CI, 0.3-1.0 L), whereas mean laryngeal resistance (n = 14) decreased from 73.9 to 46.4 cm H2O/L/s (mean of difference, -27.5 cm H2O/L/s; 95% CI, -44.8 to -10.3 cm H2O/L/s) postoperatively. Patients

Dyspnea in the ambulance - etiology, mortality, and point-of-care diagnostics

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Bøtker, Morten Thingemann

2016-01-01

dyspnea in the ambulance requires identification of high-risk groups and early correct treatment. Bringing forward simplified versions of advanced diagnostic modalities known from the hospital as point-of-care diagnostics already in the ambulance may aid the discrimination of underlying conditions causing......, we included all patients dialing the emergency number (1-1-2) due to a medical emergency in three of five Danish regions. For identification of highrisk patients and evaluation of electrocardiogram-based triage, we compared short-term mortality between patients included in the first study based...... that are highly prioritized in emergency medical services – including chest pain and trauma. Whether this increased mortality can be ascribed to an older age and comorbidity among patients suffering dyspnea, or if modifiable risk factors are also present, is unsettled. Improving outcome for patients suffering...

Dyspnea descriptors developed in Brazil: application in obese patients and in patients with cardiorespiratory diseases.

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Teixeira, Christiane Aires; Rodrigues Júnior, Antonio Luiz; Straccia, Luciana Cristina; Vianna, Elcio Dos Santos Oliveira; Silva, Geruza Alves da; Martinez, José Antônio Baddini

2011-01-01

To develop a set of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors) for use in Brazil and to investigate the usefulness of these descriptors in four distinct clinical conditions that can be accompanied by dyspnea. We collected 111 dyspnea descriptors from 67 patients and 10 health professionals. These descriptors were analyzed and reduced to 15 based on their frequency of use, similarity of meaning, and potential pathophysiological value. Those 15 descriptors were applied in 50 asthma patients, 50 COPD patients, 30 patients with heart failure, and 50 patients with class II or III obesity. The three best descriptors, as selected by the patients, were studied by cluster analysis. Potential associations between the identified clusters and the four clinical conditions were also investigated. The use of this set of descriptors led to a solution with seven clusters, designated sufoco (suffocating), aperto (tight), rápido (rapid), fadiga (fatigue), abafado (stuffy), trabalho/inspiração (work/inhalation), and falta de ar (shortness of breath). Overlapping of descriptors was quite common among the patients, regardless of their clinical condition. Asthma was significantly associated with the sufoco and trabalho/inspiração clusters, whereas COPD and heart failure were associated with the sufoco, trabalho/inspiração, and falta de ar clusters. Obesity was associated only with the falta de ar cluster. In Brazil, patients who are accustomed to perceiving dyspnea employ various descriptors in order to describe the symptom, and these descriptors can be grouped into similar clusters. In our study sample, such clusters showed no usefulness in differentiating among the four clinical conditions evaluated.

An adult cystic fibrosis patient presenting with persistent dyspnea: case report

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Farinet Catherine L

2006-05-01

Full Text Available Abstract Background Persistent dyspnea is a common finding in the cystic fibrosis patient that typically leads to further work up of an alternative pulmonary etiology. Adult cystic fibrosis patients; however, are growing in numbers and they are living into the ages in which coronary artery disease becomes prevalent. Coronary disease should be included in the consideration of diagnostic possibilities. Case presentation A 52-year-old white male with cystic fibrosis was evaluated for exertional dyspnea associated with vague chest discomfort. Diagnostic testing revealed normal white blood cell, hemoglobin and platelet count, basic metabolic panel, fasting lipid profile, HbA1c, with chest radiograph confirming chronic cystic findings unchanged from prior radiographs and an electrocardiogram that revealed sinus rhythm with left anterior fascicular block. Stress thallium testing demonstrated a reversible anteroseptal perfusion defect with a 55% left ventricular ejection fraction. Heart catheterization found a 99% occlusion of the left anterior descending artery extending into the two diagonal branches, with 100% obstruction of the left anterior descending artery at the trifurcation and 70% lesion affecting the first posterior lateral branch of the circumflex artery. Conclusion This case report represents the first description in the medical literature of a cystic fibrosis patient diagnosed with symptomatic coronary artery disease. Applying a standard clinical practice guide proved useful toward evaluating a differential diagnosis for a cystic fibrosis patient presenting with dyspnea and chest discomfort.

Physiological mechanisms of dyspnea during exercise with external thoracic restriction: Role of increased neural respiratory drive

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Mendonca, Cassandra T.; Schaeffer, Michele R.; Riley, Patrick

2013-01-01

We tested the hypothesis that neuromechanical uncoupling of the respiratory system forms the mechanistic basis of dyspnea during exercise in the setting of “abnormal” restrictive constraints on ventilation (VE). To this end, we examined the effect of chest wall strapping (CWS) sufficient to mimic a “mild” restrictive lung deficit on the interrelationships between VE, breathing pattern, dynamic operating lung volumes, esophageal electrode-balloon catheter-derived measures of the diaphragm electromyogram (EMGdi) and the transdiaphragmatic pressure time product (PTPdi), and sensory intensity and unpleasantness ratings of dyspnea during exercise. Twenty healthy men aged 25.7 ± 1.1 years (means ± SE) completed symptom-limited incremental cycle exercise tests under two randomized conditions: unrestricted control and CWS to reduce vital capacity (VC) by 21.6 ± 0.5%. Compared with control, exercise with CWS was associated with 1) an exaggerated EMGdi and PTPdi response; 2) no change in the relationship between EMGdi and each of tidal volume (expressed as a percentage of VC), inspiratory reserve volume, and PTPdi, thus indicating relative preservation of neuromechanical coupling; 3) increased sensory intensity and unpleasantness ratings of dyspnea; and 4) no change in the relationship between increasing EMGdi and each of the intensity and unpleasantness of dyspnea. In conclusion, the increased intensity and unpleasantness of dyspnea during exercise with CWS could not be readily explained by increased neuromechanical uncoupling but likely reflected the awareness of increased neural respiratory drive (EMGdi) needed to achieve any given VE during exercise in the setting of “abnormal” restrictive constraints on tidal volume expansion. PMID:24356524

Gender effect on the use of modified borg and visual analog scales in the evaluation of dyspnea in chronic obstructive pulmonary disease

International Nuclear Information System (INIS)

Ilgin, D.; Ozalevli, S.; Karaali, H.K.; Cimrin, A.H.; Ucan, E.S.

2010-01-01

To investigate the gender effect on the use of Modified Borg Scale (MBS) and Visual Analog Scale (VAS) for the effort dyspnea evaluation in Chronic Obstructive Pulmonary Disease (COPD) patients. Fifty-two patients with severe COPD were included in this study. Pulmonary function (spirometry), quality of life (Chronic Respiratory Disease Questionnaire-CRDQ), exercise capacity (6-minute walking test), and dyspnea severity (Modified Borg and Visual Analog Scales) were evaluated. The dyspnea severity scores were higher and walking distance was shorter in women (p<0.05). The scores of the both scales were correlated with each other in both genders (p<0.05). In men, the dyspnea scores obtained by MBS and VAS scales were significantly correlated with 6-minute walking distance (p=0.001) and total score of CRDQ (p=0.001). On the other hand, the dyspnea severity score of the women obtained by MBS was correlated with only the total score of CRDQ (p<0.05). The results of our study show that gender has an effect on dyspnea perception obtained by MBS and VAS. We suggest that MBS and VAS should be used for men whereas MBS may be more convenient for women in the evaluation of dyspnea in severe COPD. (author)

[When the cause of dyspnea is on larynx. Asthma of difficult control, resistant to treatment? Vocal cords dysfunction? or Both?].

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Sacre Hazouri, José Antonio

2006-01-01

Dyspnea is a symptom whose diagnosis requires the exclusion of other diseases with which it can be confused, such as asthma and a variety of pulmonary and heart diseases. Dyspnea originated in the larynx may occur due to obstruction by a tumor or other affections in situ, interfering the airway, such as: edema by infections or inflammatory processes, a traumatism, an abnormal movement of the larynx structures, such as the inappropriate or absent of the vocal cords or the laryngospasm. Severity of larynx dyspnea may be to mild to acute, risking the life. This paper reviews the normal laryngeal function and the anatomic, obstructive, and functional disorders that can lead to dyspnea. Some suggestions are also made to determine the cause and treat these diseases.

Relationship Among Pulmonary Hypertension, Autoimmunity, Thyroid Hormones and Dyspnea in Patients With Hyperthyroidism.

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Zuhur, Sayid Shafi; Baykiz, Derya; Kara, Sonat Pinar; Sahin, Ertan; Kuzu, Idris; Elbuken, Gulsah

2017-04-01

Previous studies have reported conflicting results regarding the mechanisms underlying the pathophysiology of pulmonary hypertension (PHT) in patients with hyperthyroidism. Therefore, in this study, we investigated the association between PHT and thyroid-stimulating hormone (TSH) receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3, fT4 and dyspnea during daily activities in a large population of patients with hyperthyroidism. A total of 129 consecutive patients with hyperthyroidism, 37 with hypothyroidism and 38 euthyroid controls were enrolled in this study. The modified medical research council scale was used for the assessment of dyspnea in daily activities. All the patients and euthyroid controls underwent transthoracic echocardiography for the assessment of PHT. Mild PHT was present in 35%, 36%, 13.5% and 5% of the patients with Graves׳ disease, toxic multinodular goiter, hypothyroidism and euthyroid controls, respectively. Pulmonary vascular resistance (PVR) was higher in hyperthyroid patients with PHT than in those without PHT. Moreover, a significant positive correlation was found between modified medical research council scale and pulmonary artery systolic pressure as well as PVR in patients with hyperthyroidism. No association was found between PHT and serum TSH receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3 and fT4 levels. Mild PHT is present in a significant proportion of patients with hyperthyroidism, regardless of etiology. PVR appears to be the main cause of PHT in patients with hyperthyroidism, and neither autoimmunity nor thyroid hormones are associated with PHT in these patients. Mild dyspnea during daily activities in patients with hyperthyroidism may be related to PHT; however, severe dyspnea requires further evaluation. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Analysis of Depression and Anxiety Levels in Patients with Dyspnea

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Servet Kayhan

2013-07-01

Full Text Available Aim: The aim of the study was to assess the frequency of anxiety and depression in a sample of elderly patients with chronic respiratory failure and the relationships between these comorbidities and the severity of dyspnea. Material and Method: Sixty-four consecutive inpatients with asthma and chronic obstructive disease were evaluated in a chest disease hospital. A questionnaire including sociodemographic features was applied to patients and healthy control group. Anxiety was assessed by Spielberg state and trait anxiety scale, and depression by Beck depression inventory. Spirometric tests, respiratory symptoms and severity of dyspnea were evaluated in the study group. Results: The mean age of study group was 67.28±9.13 (range between 50-88 years. Of those 22 (34.4% were females and 42 (65.6% were males. The mean Beck depression inventory scores of the group was 18.42±10.00 (range between 5-47, the mean Spielberg’s state anxiety score was 40.20±8.13 and the mean Spielberg’s trait score was 44.70±7.94 these results were close to control group. Depression with Beck depression inventory scores was diagnosed in 24 (37.5%, absent or mild depression in 40 (62.5%, moderate depression in 13 (20.3% and severe depression in 11 (17.2% patients. There was a relation between age and depression scores (p=0.022. Depression scores, Spielberg’s state and trait inventory scores were found statistically related with each other. Discussion: The results of the present study support that anxiety and depressive disorders are found with a high incidence in patients with respiratory impairments but the severity of dyspnea measures does not affect the scores of depression and anxiety.

Acute laryngeal dyspnea as first presentation of granulomatosis with polyangiitis.

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Pajor, Anna Maria; Kwiatkowska, Sylwia; Kroczyńska-Bednarek, Jadwiga; Piotrowski, Wojciech J

2015-01-01

Granulomatosis with polyangiitis (GPA) is a multi-organ disease which mostly affects lungs, kidney, and head and neck region. We report a rare case of acute laryngeal dyspnea and rapidly progressive pulmonary changes as first manifestations of disease. A 53 year-old woman presented with symptoms of two-week dyspnea, which aggravated rapidly in the preceding hours. Laryngological examination revealed subglottic infiltrations and vocal fold oedema which required urgent tracheotomy. During few days she developed gingival ulcerations and pulmonary infiltration with negative serum c-ANCA titers. The histopathological examination of subglottic and gingival biopsies and the clinical picture established the diagnosis of GPA. She was treated with prednisone and cyclophosphamide with recovery; however, during over 3 years of follow-up, pulmonary symptoms relapsed and subglottic stenosis persisted. The difficulties in diagnosis and treatment in this unusual presentation of GPA are outlined with conclusion that in patients with subglottic infiltration, which develops rapidly, even when this is a sole presentation of the disease, and when c-ANCA are negative, GPA should always be considered.

Evaluation of the Appropriate Washout Period Following Fan Therapy for Dyspnea in Patients With Advanced Cancer: A Pilot Study.

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Kako, Jun; Morita, Tatsuya; Yamaguchi, Takuhiro; Sekimoto, Asuko; Kobayashi, Masamitsu; Kinoshita, Hiroya; Ogawa, Asao; Zenda, Sadamoto; Uchitomi, Yosuke; Inoguchi, Hironobu; Matsushima, Eisuke

2018-02-01

To clarify the duration required for dyspnea to return to baseline severity after fan therapy, to evaluate whether fan-to-legs therapy or no fan therapy would be a suitable control therapy, and to investigate changes in patients' face surface temperature after fan therapy. In this pilot study, all participants received 3 interventions in the following order: no fan, fan to legs, and fan to face. Participants used a fan for 5 minutes, and they scored their dyspnea at 10-minute intervals for 60 minutes or until the score had returned to its baseline value, whichever occurred first. Nine patients with advanced cancer admitted to a palliative care unit were included; they had dyspnea at rest and rated its severity as at least 3 points on a 0- to 10-point numerical rating scale. Descriptive statistics and the Wilcoxon signed rank test were used to analyze the data. All patients completed the study. Of the 9 participants, 6 experienced a clinical benefit from using a fan to their faces. Of these patients, only 2 participants' (2 of 6) dyspnea scores returned to baseline by the end of the 60-minute assessment period after exposure to fan-to-face therapy. In fan-to-legs and no fan settings, there was no change in the dyspnea scores. There were significant differences between the baseline face surface temperature and that after fan-to-face and fan-to-legs settings. When using a crossover design to investigate the effect of fan therapy on dyspnea, 1 hour is an insufficient washout period.

Diagnostic accuracy and reproducibility of pleural and lung ultrasound in discriminating cardiogenic causes of acute dyspnea in the emergency department.

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Cibinel, Gian Alfonso; Casoli, Giovanna; Elia, Fabrizio; Padoan, Monica; Pivetta, Emanuele; Lupia, Enrico; Goffi, Alberto

2012-02-01

Dyspnea is a common symptom in patients admitted to the Emergency Department (ED), and discriminating between cardiogenic and non-cardiogenic dyspnea is often a clinical dilemma. The initial diagnostic work-up may be inaccurate in defining the etiology and the underlying pathophysiology. The aim of this study was to evaluate the diagnostic accuracy and reproducibility of pleural and lung ultrasound (PLUS), performed by emergency physicians at the time of a patient's initial evaluation in the ED, in identifying cardiac causes of acute dyspnea. Between February and July 2007, 56 patients presenting to the ED with acute dyspnea were prospectively enrolled in this study. In all patients, PLUS was performed by emergency physicians with the purpose of identifying the presence of diffuse alveolar-interstitial syndrome (AIS) or pleural effusion. All scans were later reviewed by two other emergency physicians, expert in PLUS and blinded to clinical parameters, who were the ultimate judges of positivity for diffuse AIS and pleural effusion. A random set of 80 recorded scannings were also reviewed by two inexperienced observers to assess inter-observer variability. The entire medical record was independently reviewed by two expert physicians (an emergency medicine physician and a cardiologist) blinded to the ultrasound (US) results, in order to determine whether, for each patient, dyspnea was due to heart failure, or not. Sensitivity, specificity, and positive/negative predictive values were obtained; likelihood ratio (LR) test was used. Cohen's kappa was used to assess inter-observer agreement. The presence of diffuse AIS was highly predictive for cardiogenic dyspnea (sensitivity 93.6%, specificity 84%, positive predictive value 87.9%, negative predictive value 91.3%). On the contrary, US detection of pleural effusion was not helpful in the differential diagnosis (sensitivity 83.9%, specificity 52%, positive predictive value 68.4%, negative predictive value 72.2%). Finally

Evaluation of a combination of low-dose ketamine and low-dose midazolam in terminal dyspnea-attenuation of "double-effect"

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Abhijit Kanti Dam

2008-01-01

Full Text Available Aim: Of all symptoms in palliative medicine those concerning respiration are most excruciating and difficult to treat. Reticence about the use of morphine for palliation of dyspnea is common, especially in nonmalignant diseases, as there is a fear of causing respiratory depression, particularly where Chronic Obstructive Pulmonary Disease (COPD exists. This factor is also compounded by the lack of availability of morphine in parts of developing countries. Ketamine has excellent anesthetic and analgesic effects in addition to being easily available. It produces bronchodilatation and does not produce respiratory or cardiovascular depression. The author seeks to evaluate the role of low-dose (0.2 mg/kg ketamine and midazolam (0.02 mg/kg in the attenuation of terminal dyspnea. Methods: Sixteen patients with terminal dyspnea, admitted to the Critical Care Unit (CCU with cancer and other noncancer diagnoses were recruited. The subjective component of dyspnea was assessed using the Graphic Rating Scale (GRS, which has values from 0 - 10, 10 being maximum dyspnea. Each patient received a low-dose of ketamine and midazolam for relief of dyspnea. All the patients received low-flow (2 L/min. oxygen therapy via nasal cannula. Immediately after admission, all the patients were reassured and nursed in a decubitus position of their choice. The GRS was recorded at the point of admission, 10 minutes after starting oxygen therapy, and ten minutes after administration of low-dose ketamine and midazolam. Hemodynamic parameters were also recorded at these three points. Result: All the patients who enrolled in our study had significant dyspnea at admission, as was evident from the GRS scores of 8.250 (SD 0.91, respiratory rate of 28.56 (SD 5.0, mean arterial blood pressure (MABP of 102.7 (SD 14.63, pulse rate of 115.62 (SD 23.3, and SpO2 of 92.43 (SD 2.38. All the patients benefited from the combination of ketamine and midazolam, as evidenced by the statistically

Progressive dyspnea due to pulmonary carcinoid tumorlets

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Anastasios Kallianos

2017-01-01

Full Text Available This is a case description of a female patient, 77 years-old, who presented with progressive dyspnea and cough. She had a mild hypoxemia in the arterial blood gases (PaO2 72 mmHg and normal spirometry. The chest computer tomography revealed diffuse “ground glass” opacities, segmental alveolitis, bronchiectasis, fibrotic lesions and numerous micronodules. A thoracoscopy was performed and the obtained biopsy showed carcinoid tumorlets, with positive CK8/18, CD56, TTF-1 and synaptophysin immunohistochemical markers. Pulmonary carcinoid tumorlets are rare, benign lesions and individuals with tumorlets are typically asymptomatic. Our report presents a symptomatic clinical case of carcinoid tumorlet.

[Development of an activity of daily living scale for patients with COPD: the Activity of Daily Living Dyspnea scale].

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Yoza, Yoshiyasu; Ariyoshi, Koya; Honda, Sumihisa; Taniguchi, Hiroyuki; Senjyu, Hideaki

2009-10-01

Patients with COPD often experience restriction in their activities of daily living (ADL) due to dyspnea. This type of restriction is unique to patients with COPD and cannot be adequately evaluated by the generic ADL scales. This study developed an ADL scale (the Activity of Daily Living Dyspnea scale [ADL-D scale]) for patients with COPD and investigated its validity and internal consistency. Patients with stable COPD were recruited and completed a pilot 26-item questionnaire. Patients also performed the Incremental Shuttle Walk Test (ISWT), and completed the St George's Respiratory Questionnaire (SGRQ), and Medical Research Council (MRC) dyspnea grade. There were 83 male participants who completed the pilot questionnaire. Following the pilot, 8 items that were not undertaken by the majority of subjects, and 3 items judged to be of low clinical importance by physical therapists were removed from the pilot questionnaire. The final ADL-D scale contained 15 items. Scores obtained with the ADL-D scale were significantly correlated with the MRC dyspnea grades, distance walked on the ISWT and SGRQ scores. The ADL-D scores were significantly different across the five grades of the MRC dyspnea grade. The ADL-D scale showed high consistency (Chronbach's alpha coefficient of 0.96). The ADL-D scale is a useful scale for assessing impairments in ADL in Japanese male patients with COPD.

[A case of laryngeal papilloma with sudden dyspnea].

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Pabiszczak, Maciej; Wierzbicka, Małgorzata; Borucki, Lukasz; Iwanik, Katarzyna

2005-01-01

Laryngeal papilloma is one of the most common non-malignant tumors of the larynx. In adult they are included to pre-cancerous diseases. In morphological examination, it is a solid tumor. Often it is possible to cure them during one surgical procedure. The disease is mostly localized on the anterior commissurae region, vocal fold, ventricules, and on the laryngeal surface of the epiglottis. If the malignant transformation is suspected, a large excision with margin has to be performed, completed by a histological evaluation. A case of a huge laryngeal papilloma with dyspnea is presented.

Benefits of short inspiratory muscle training on exercise capacity, dyspnea, and inspiratory fraction in COPD patients

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Barakat Shahin

2008-10-01

Full Text Available Barakat Shahin1, Michele Germain2, Alzahouri Kazem3, Guy Annat41Department of Physiology, University of Claude Bernard Lyon I, Lyon, France; 2Chef of the Service of EFR, Hospital of the Croix-Rousse at Lyon, France; 3Department of Medical Informatics, Hospital of St. Julien, Nancy, France; 4Department of Physiology, UFR Médecine Lyon Grange-Blanche Université Claude Bernard Lyon I, INSERM ESPRI ERI 22, Lyon, FranceAbstract: Static lung hyperinflation has important clinical consequences in patients with chronic obstructive pulmonary disease (COPD. Given that most of these patients have respiratory and peripheral muscle weakness, dyspnea and functional exercise capacity may improve as a result of inspiratory muscle training (IMT. The present study is designed to investigate the benefits of a short outpatient program of IMT on inspiratory muscle performance, exercise capacity, perception of dyspnea, and the inspiratory fraction (IF. Thirty patients (24 males, 6 females with significant COPD (forced expiratory volume in one second [FEV1] = 46.21% ± 6.7% predicted, FEV1 = 33.6% ± 8.04% predicted were recruited for this study and had 3 months of IMT (30 minutes/day for 6 days/week in an outpatient clinic. Following IMT, there was a statistically significant increase in inspiratory muscle performance (an increase of the maximal inspiratory pressure from 59% ± 19.1% to 79% ± 21.85% predicted; p = 0.0342, a decrease in dyspnea (from 5.8 ± 0.78 to 1.9 ± 0.57; p = 0.0001, an increase in the distance walked during the 6 minute walk test, from 245 ± 52.37 m to 302 ± 41.30 m, and finally an increase in the IF (the new prognostic factor in COPD from 27.6 ± 9.7% to 31.4% ± 9.8%. The present study concludes that in patients with significant COPD, IMT results in improvement in performance, exercise capacity, sensation of dyspnea, and moreover an improvement in the IF prognostic factor.Keywords: inspiratory muscle training, dyspnea, inspiratory

Perspectives of patients, family caregivers and physicians about the use of opioids for refractory dyspnea in advanced chronic obstructive pulmonary disease.

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Rocker, Graeme; Young, Joanne; Donahue, Margaret; Farquhar, Morag; Simpson, Catherine

2012-06-12

A recent national practice guideline recommends the use of opioids for the treatment of refractory dyspnea in patients with advanced chronic obstructive pulmonary disease (COPD). We conducted two qualitative studies to explore the experiences of patients and family caregivers with opioids for refractory COPD-related dyspnea and the perspectives and attitudes of physicians toward opioids in this context. Patients (n = 8; 5 men, 3 women), their caregivers (n = 12; 5 men, 7 women) and physicians (n = 28, 17 men, 11 women) in Nova Scotia participated in the studies. Semistructured interviews were recorded, transcribed verbatim, coded conceptually and analyzed for emergent themes using interpretive description methodology. Patients reported that opioids provided a sense of calm and relief from severe dyspnea. Family caregivers felt that opioids helped patients to breathe more "normally," observed improvements in patients' symptoms of anxiety and depression, and experienced reductions in their own stress. Patients reported substantial improvements in their quality of life. All patients and family caregivers wanted opioid therapy to continue. Most physicians were reluctant to prescribe opioids for refractory dyspnea, describing a lack of related knowledge and experience, and fears related to the potential adverse effects and legal censure. Discrepancies between the positive experiences of patients and family caregivers with opioids and the reluctance of physicians to prescribe opioids for refractory dyspnea constitute an important gap in care. Bridging this gap will require initiatives to improve the uptake of practice guidelines and to increase confidence in prescribing opioids for dyspnea refractory to conventional treatment.

[Unexpected treatable dyspnea caused by intratracheal granuloma in an amyotrophic lateral sclerosis patient with mechanical ventilation].

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Ishida, Shimon; Kimura, Fumiharu; Hosokawa, Takafumi; Satoh, Toshihiko; Furutama, Daisuke; Sugino, Masakazu

2007-09-01

Respiratory insufficiency is a problem that develops in nearly all people diagnosed with amyotrophic lateral sclerosis (ALS). A 46-year-old man with ALS, who had been in a bedridden state with tracheal ventilation support, complained of faintness and dyspnea. The airway pressure of the ventilator had increased, and bleeding from the trachea had occurred several times. A fiberoptic bronchoscopy showed granulation located on the anterior wall of the trachea and severe airway obstruction of the tracheostomy tube. Although a long tracheostomy tube had been intubated for the initial management of the tracheal granulation, a tumor on the posterior tracheal wall had relapsed and occluded the tracheal lumen. A self-expandable metallic airway stent was placed into the tracheal stenosis. After stenting, his symptoms of dyspnea and syncope imploved, and the increased airway pressure of the ventilator was normalized. We speculated that the tracheal granuloma had occurred due to a tracheal mucosal injury related to endotracheal suctioning. We should pay attention to complaints of dyspnea in ALS patients with tracheostomy and make a careful consideration to airway care including suction management.

[Nasal flaring as a predictor of mortality in patients with severe dyspnea].

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Zorrilla Riveiro, José Gregorio; Arnau Bartés, Anna; García Pérez, Dolors; Rafat Sellarés, Ramón; Mas Serra, Arantxa; Fernández Fernández, Rafael

2015-02-01

To determine whether the presence of nasal flaring is a clinical sign of severity and a predictor of hospital mortality in emergency patients with dyspnea. Prospective, observational, single-center study. We enrolled patients older than 15 years of age who required attention for dyspnea categorized as level II or III emergencies according to the Andorran Medical Triage system. Two observers evaluated the presence of nasal flaring. We recorded demographic and clinical variables, including respiratory effort, vital signs, arterial blood gases, and clinical course (hospital admission and mortality). Bivariable analysis was performed and multivariable logistic regression models were constructed. We enrolled 246 patients with a mean (SD) age of 77 (13) years; 52% were female. Nasal flaring was present in 19.5%. Patients with nasal flaring had triage levels indicating greater severity and they had more severe tachypnea, worse oxygenation, and greater acidosis and hypercapnia. Bivariable analysis detected that the following variables were associated with mortality: age (odds ratio [OR], 1.05; 95% CI, 1.01-1.10), prehospital care from the emergency medical service (OR, 3.97; 95% CI, 1.39-11.39), triage level II (OR, 4.19; 95% CI, 1.63-10.78), signs of respiratory effort such as nasal flaring (OR, 3.79; 95% CI, 1.65-8.69), presence of acidosis (OR, 7.09; 95% CI, 2.97-16.94), and hypercapnia (OR, 2.67; 95% CI, 1,11-6,45). The factors that remained independent predictors of mortality in the multivariable analysis were age, severity (triage level), and nasal flaring. In patients requiring emergency care for dyspnea, nasal flaring is a clinical sign of severity and a predictor of mortality.

The role of voice therapy in the treatment of dyspnea and dysphonia in a patient with a vagal nerve stimulation device.

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Gillespie, Amanda I; Helou, Leah B; Ingle, John W; Baldwin, Maria; Rosen, Clark A

2014-01-01

Vagal nerve stimulators (VNS) are implanted to treat medically refractory epilepsy and depression. The VNS stimulates the vagus nerve in the left neck. Laryngeal side effects are common and include dysphagia, dysphonia, and dyspnea. The current case study represents a patient with severe dyspnea and dysphonia, persisting even with VNS deactivation. The case demonstrates the use of voice and respiratory retraining therapy for the treatment of VNS-induced dysphonia and dyspnea. It also highlights the importance of a multidisciplinary approach, including laryngology, neurology, and speech-language pathology, in the treatment of these challenging patients. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Impact of exercise capacity on dyspnea and health-related quality of life in patients with chronic obstructive pulmonary disease

DEFF Research Database (Denmark)

Jacobsen, Ramune; Frølich, Anne; Godtfredsen, Nina S

2012-01-01

To assess the impact of the amount of exercise training during pulmonary rehabilitation (PR) program for improvements in dyspnea and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD).......To assess the impact of the amount of exercise training during pulmonary rehabilitation (PR) program for improvements in dyspnea and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD)....

Acupuncture Treatment for Dyspnea due to Combined Pulmonary Fibrosis and Emphysema: A Case Report.

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Matsumoto-Miyazaki, Jun; Miyazaki, Nagisa; Nishiwaki, Ayuko; Endo, Junki; Ushikoshi, Hiroaki; Ohno, Yasushi; Minatoguchi, Shinya

2015-12-01

Combined idiopathic pulmonary fibrosis with pulmonary emphysema (CPFE) is a syndrome with a characteristic presentation of upper lobe emphysema and lower lobe fibrosis. Dyspnea on exertion (DOE) is a major symptom of CPFE. We report a patient with DOE due to CPFE who was successfully treated with acupuncture. Case report. A 72-year-old Japanese man with a 4-year history of DOE was diagnosed with CPFE 2 years previously in another hospital. He received standard Western medicine treatment, which included bronchodilators. However, his DOE did not improve. Consequently, he visited our hospital for acupuncture treatment and received acupuncture treatment once a week for 1 year. After 10 weeks of acupuncture treatment, the results of the 6-minute walk test (6-minute walking distance, 379 m; lowest oxygen saturation, 86%; modified Borg dyspnea scale score: 2 units) were better than those at baseline (352 m, 84%, 4 units, respectively). These values were sustained at both 30 weeks (470 m, 88%, 1 unit) and 60 weeks (473 m, 85%, 2 units). Serum interstitial biomarkers, Krebs von den Lungen and surfactant protein-D, decreased after commencement of acupuncture therapy. A patient with CPFE showed improvements in dyspnea scores, exercise tolerance, and serum biomarkers during a 1-year course of acupuncture treatment. Use of acupuncture might be an effective adjunct therapy in relieving DOE due to CPFE. A large, well-designed cohort study that includes patients with CPFE treated with acupuncture should be conducted.

Intrathoracic Caecal Perforation Presenting as Dyspnea

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Vincent Granier

2010-01-01

Full Text Available Introduction. Bochdalek hernia is a congenital defect of the diaphragm that is usually diagnosed in the neonatal period and incidentally in asymptomatic adults. Small bowel incarceration in a right-sided Bochdalek hernia is exceptional for an adult. Case Presentation. A 54-year-old woman was admitted for acute dyspnea, tachycardia, hypotension, and fever. Five days before, she had been experiencing an episode of diffuse abdominal pain. The admission chest X-ray was interpreted as right pleural effusion and pneumothorax with left mediastinal shift. Chest tube drainage was purulent. The thoracoabdominal CT examination suspected an intestinal incarceration through a right diaphragmatic defect. At laparotomy, a right-sided Bochdalek hernia was confirmed with a complete necrosis of the incarcerated caecum. Ileocaecal resection was performed, but the patient died from delayed septic complications. Conclusion. Intrathoracic perforation of the caecum is a rare occurrence; delayed diagnosis due to misleading initial symptoms may lead to severe complications and poor prognosis.

Anterior Cervical Osteophytes Causing Dysphagia and Dyspnea: An Uncommon Entity Revisited

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Giger, Roland; Dulguerov, Pavel; Payer, Michael

2007-01-01

Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis (DISH). We present the case of an 83-year-old patient with progressive dysphagia and acute dyspnea, necessitating emergency tracheotomy. Voluminous anterior cervical osteophytes extending from C3 to C7 and narrowing the pharyngoesophageal segment by external compression and bilateral vocal fold immobility were diagnosed radiologically and by fiberoptic laryngoscop...

Prevalence of diastolic dysfunction as a possible cause of dyspnea in the elderly

DEFF Research Database (Denmark)

Pedersen, Frants; Raymond, Ilan; Mehlsen, Jesper

2005-01-01

Symptoms in patients with heart failure and preserved left ventricular ejection fraction may be caused by isolated diastolic dysfunction. The purpose of this study was to assess the prevalence of diastolic dysfunction as a potential cause of dyspnea in a sample of elderly subjects, as well as of ...

Nasal flaring as a clinical sign of respiratory acidosis in patients with dyspnea.

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Zorrilla-Riveiro, José Gregorio; Arnau-Bartés, Anna; Rafat-Sellarés, Ramón; García-Pérez, Dolors; Mas-Serra, Arantxa; Fernández-Fernández, Rafael

2017-04-01

To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea. Single-center, prospective, observational study of patients aged over 15 requiring urgent attention for dyspnea, classified as level II or III according to the Andorran Triage Program and who underwent arterial blood gas test on arrival at the emergency department. The presence of nasal flaring was evaluated by two observers. Demographic and clinical variables, signs of respiratory difficulty, vital signs, arterial blood gases and clinical outcome (hospitalization and mortality) were recorded. Bivariate and multivariate analyses were performed using logistic regression models. The sample comprised 212 patients, mean age 78years (SD=12.8), of whom 49.5% were women. Acidosis was recorded in 21.2%. Factors significantly associated with the presence of acidosis in the bivariate analysis were the need for pre-hospital medical care, triage level II, signs of respiratory distress, presence of nasal flaring, poor oxygenation, hypercapnia, low bicarbonates and greater need for noninvasive ventilation. Nasal flaring had a positive likelihood ratio for acidosis of 4.6 (95% CI 2.9-7.4). In the multivariate analysis, triage level II (aOR 5.16; 95% CI: 1.91 to 13.98), the need for oxygen therapy (aOR 2.60; 95% CI: 1.13-5.96) and presence of nasal flaring (aOR 6.32; 95% CI: 2.78-14.41) were maintained as factors independently associated with acidosis. Nasal flaring is a clinical sign of severity in patients requiring urgent care for acute dyspnea, which has a strong association with acidosis and hypercapnia. Copyright © 2016 Elsevier Inc. All rights reserved.

Three-minute constant rate step test for detecting exertional dyspnea relief after bronchodilation in COPD

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Borel B

2016-11-01

Full Text Available Benoit Borel,1,2 Courtney A Wilkinson-Maitland,3 Alan Hamilton,4 Jean Bourbeau,5 Hélène Perrault,6 Dennis Jensen,3,5,7 François Maltais2 1Laboratoire HAVAE, Université de Limoges, Limoges, France; 2Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, 3Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC, 4Boehringer Ingelheim (Canada Limited, Burlington, ON, 5Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Center, Montreal, QC, 6Faculty of Health Sciences, University of Ottawa, Ottawa, ON, 7Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada Background: The aim of this study was to evaluate the responsiveness of the 3-minute constant rate step test (3-MST to detect the relief of exertional dyspnea (respiratory discomfort after acute bronchodilation in COPD patients. Patients and methods: A total of 40 patients with moderate-to-severe COPD (mean forced expiratory volume in 1 second: 45.7 (±14.7, % predicted performed four 3-MSTs at randomly assigned stepping rates of 14, 16, 20 and 24 steps/min after inhalation of nebulized ipratropium bromide (500 µg/salbutamol (2.5 mg and saline placebo, which were randomized to order. Patients rated their intensity of perceived dyspnea at the end of each 3-MST using Borg 0–10 category ratio scale. Results: A total of 37 (92.5%, 36 (90%, 34 (85% and 27 (67.5% patients completed all 3 minutes of exercise at 14, 16, 20 and 24 steps/min under both treatment conditions, respectively. Compared with placebo, ipratropium bromide/salbutamol significantly decreased dyspnea at the end of the third minute of exercise at 14 steps/min (by 0.6±1.0 Borg 0–10 scale units, P<0.01 and 16 steps/min (by 0.7±1.3 Borg 0–10 scale

A 26-year-old man with dyspnea and chest pain

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Saurabh Mittal

2017-01-01

Full Text Available A 26-year-old smoker male presented with a history of sudden onset dyspnea and right-sided chest pain. Chest radiograph revealed large right-sided pneumothorax which was managed with tube thoracostomy. High-resolution computed tomography thorax revealed multiple lung cysts, and for a definite diagnosis, a video-assisted thoracoscopic surgery-guided lung biopsy was performed followed by pleurodesis. This clinicopathologic conference discusses the clinical and radiological differential diagnoses, utility of lung biopsy, and management options for patients with such a clinical presentation.

Laryngeal schwannoma in an 8-year-old boy with inspiratory dyspnea.

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Rognone, Elisa; Rossi, Andrea; Conte, Massimo; Nozza, Paolo; Tarantino, Vincenzo; Fibbi, Antonio; Saetti, Roberto; Cutrone, Cesare; Tortori-Donati, Paolo

2007-10-01

Schwannomas of the larynx are rare lesions in the pediatric age group. In this article, we report on the neuroimaging features of a schwannoma arising from the left aryepiglottic fold in an 8-year-old boy with a 6-month history of inspiratory dyspnea. Neuroimaging showed a well-defined, avoid mass originating from the left aryepiglottic fold. The lesion was removed endoscopically. Complete removal of laryngeal schwannomas is curative, and adjuvant treatment is not required.

A 68-Year-Old Man With Dyspnea on Exertion and Cough.

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Agrawal, Abhinav; Sikachi, Rutuja R; Koenig, Seth; Khanijo, Sameer

2018-06-01

A 68-year-old man with a history of chronic lymphocytic leukemia well controlled on ibrutinib, hypertension, obesity, and a remote history of smoking (10 pack-years) presented with increasing dyspnea on exertion and cough. He had previously finished two courses of oral antibiotics for his symptoms without significant improvement. On presentation, he had no fevers or sputum production. Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

A Case of Frequent Arousal Following Nocturnal Dyspnea Caused by Gastroesophageal Reflux Disease

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Dae Wui Yoon

2013-06-01

Full Text Available Gastroesophageal reflux disease (GERD is a common disorder that is associated with many esophageal syndromes and complications. Most cases of reflux event occur during the day, but reflux during sleep can cause not only esophageal problems, but also sleep problems, such as arousal and poor sleep quality. We report the case of a 17-year-old man who had been referred to us with frequent arousal following sudden dyspnea. On polysomnography, no respiratory disturbances and periodic limb movements were found during the sleep study, but frequent events of arousal were reported (arousal index: 12.3/h. On a 24-hr esophageal pH monitoring test, his DeMeester score was 176.43 and the total reflux time was 1120.9 min (76.9%, indicating the presence of significant acid reflux. After treatment with a proton-pump inhibitor, the arousals following nocturnal dyspnea and fatigue in the morning disappeared in the patient. GERD should be considered as a cause of spontaneous arousal or awakening not accompanying respiratory disturbances.

Quantification of Emphysema with a Three-Dimensional Chest CT Scan: Correlation with the Visual Emphysema Scoring on Chest CT, Pulmonary Function Tests and Dyspnea Severity

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Park, Hyun Jeong; Hwang, Jung Hwa [Dept. of Radiology, Soonchunhyang University Seoul Hospital, Seoul (Korea, Republic of)

2011-09-15

We wanted to prospectively evaluate the correlation between the quantification of emphysema using 3D CT densitometry with the visual emphysema score, pulmonary function tests (PFT) and the dyspnea score in patients with chronic obstructive pulmonary disease (COPD). Non-enhanced chest CT with 3D reconstruction was performed in 28 men with COPD (age 54-88 years). With histogram analysis, the total lung volume, mean lung density and proportion of low attenuation lung volume below predetermined thresholds were measured. The CT parameters were compared with the visual emphysema score, the PFT and the dyspnea score. A low attenuation lung volume below -950 HU was well correlated with the DLco and FEV{sub 1}/FVC. A Low attenuation lung volume below -950 HU and -930 HU was correlated with visual the emphysema score. A low attenuation lung volume below -950 HU was correlated with the dyspnea score, although the correlations between the other CT parameters and the dyspnea score were not significant. Objective quantification of emphysema using 3D CT densitometry was correlated with the visual emphysema score. A low attenuation lung volume below -950 HU was correlated with the DLco, the FEV{sub 1}/FVC and the dyspnea score.

Quantification of Emphysema with a Three-Dimensional Chest CT Scan: Correlation with the Visual Emphysema Scoring on Chest CT, Pulmonary Function Tests and Dyspnea Severity

International Nuclear Information System (INIS)

Park, Hyun Jeong; Hwang, Jung Hwa

2011-01-01

We wanted to prospectively evaluate the correlation between the quantification of emphysema using 3D CT densitometry with the visual emphysema score, pulmonary function tests (PFT) and the dyspnea score in patients with chronic obstructive pulmonary disease (COPD). Non-enhanced chest CT with 3D reconstruction was performed in 28 men with COPD (age 54-88 years). With histogram analysis, the total lung volume, mean lung density and proportion of low attenuation lung volume below predetermined thresholds were measured. The CT parameters were compared with the visual emphysema score, the PFT and the dyspnea score. A low attenuation lung volume below -950 HU was well correlated with the DLco and FEV 1 /FVC. A Low attenuation lung volume below -950 HU and -930 HU was correlated with visual the emphysema score. A low attenuation lung volume below -950 HU was correlated with the dyspnea score, although the correlations between the other CT parameters and the dyspnea score were not significant. Objective quantification of emphysema using 3D CT densitometry was correlated with the visual emphysema score. A low attenuation lung volume below -950 HU was correlated with the DLco, the FEV 1 /FVC and the dyspnea score.

Dyspnea, pulmonary function and exercise capacity in adult Saudi patients with sickle cell disease

International Nuclear Information System (INIS)

Alameri, Hatem F.; Alem, A.; Al-Momen, A.; Kardas, W.; Owais, M.; Jehangir, A.

2008-01-01

Objective was to examine pulmonary function, dyspnea, and exercise capacity in adult Saudi patients with sickle cell disease (SCD) patients. The patients were recruited from the hematology clinic at King Khalid University Hospital in Riyadh from January to December 2005. The study involved 39 patients with stable SCD 20 women and 19 men, with a mean age of 22.7+/- 7.1 years, hemoglobin level of 95.5+/-14.6g/L and hemoglobin F level of 13.7+/08.6. Patients underwent pulmonary function tests PFT forced expiratory volume in first second [FEV1], forced vital capacity [FVC], and diffusion capacity of carbon monoxide [DLco] data are presented as a percentage of the normal prediction, a 6- minute walk test 6MWT and echocardiography. Dyspnea was assessed using the Borg score. The 6MWT data were compared to body mass index matched healthy controls. Forty-one percent of SCD patients had mild dyspnea at rest and this increased to 61% at the end of the 6MWT. Pulmonary function tests were abnormal in 51%, 36% of patients had a restrictive pattern, 10% had isolated decrease in DLco and 5% had a mixed restrictive-obstrutive pattern. The 6MWD was shorter in SCD patients compared to the controls 368+/-67 versus 407+/-47m, p=0.005. No hematological variables correlated with outcome variables. Chronic pulmonary complications in adult Saudi SCD patients are relatively mild but common. Pulmonary function in these patients differs from that published for African-origin SCD patients. The difference may reflect a different natural history of SCD in the 2 populations. (author)

Diagnostic performance of multi-organ ultrasound with pocket-sized device in the management of acute dyspnea.

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Sforza, Alfonso; Mancusi, Costantino; Carlino, Maria Viviana; Buonauro, Agostino; Barozzi, Marco; Romano, Giuseppe; Serra, Sossio; de Simone, Giovanni

2017-06-19

The availability of ultra-miniaturized pocket ultrasound devices (PUD) adds diagnostic power to the clinical examination. Information on accuracy of ultrasound with handheld units in immediate differential diagnosis in emergency department (ED) is poor. The aim of this study is to test the usefulness and accuracy of lung ultrasound (LUS) alone or combined with ultrasound of the heart and inferior vena cava (IVC) using a PUD for the differential diagnosis of acute dyspnea (AD). We included 68 patients presenting to the ED of "Maurizio Bufalini" Hospital in Cesena (Italy) for AD. All patients underwent integrated ultrasound examination (IUE) of lung-heart-IVC, using PUD. The series was divided into patients with dyspnea of cardiac or non-cardiac origin. We used 2 × 2 contingency tables to analyze sensitivity, specificity, positive predictive value and negative predictive value of the three ultrasonic methods and their various combinations for the diagnosis of cardiogenic dyspnea (CD), comparing with the final diagnosis made by an independent emergency physician. LUS alone exhibited a good sensitivity (92.6%) and specificity (80.5%). The highest accuracy (90%) for the diagnosis of CD was obtained with the combination of LUS and one of the other two methods (heart or IVC). The IUE with PUD is a useful extension of the clinical examination, can be readily available at the bedside or in ambulance, requires few minutes and has a reliable diagnostic discriminant ability in the setting of AD.

Daily functioning of dyspnea, self-esteem and physical self in patients with moderate COPD before, during and after a first inpatient rehabilitation program.

Science.gov (United States)

Ninot, Gregory; Moullec, Gregory; Desplan, Jacques; Prefaut, Christian; Varray, Alain

2007-11-30

Inpatient rehabilitation improves dyspnea and increases self-esteem between admission and discharge in patients with moderate chronic obstructive pulmonary disease (COPD). Some researchers nevertheless argue that the changes may be due to nursing effects and thus that scores will decrease quickly at home after discharge. This study assessed the change in dyspnea, self-esteem and physical self mean scores and stability in patients with moderate COPD during three consecutive four-week periods: at home, during an inpatient rehabilitation program, and again at home post-discharge. Twenty-three consecutive patients [63.9 years (SD 6.6)] with moderate COPD [FEV1 = 55.8% (SD 13.2)] were included. The participants responded to the Physical Self Inventory and rated dyspnea using a visual analogue scale twice a day. Exercise tolerance was assessed with the six-minute walk test (6MWT) at admission and discharge. 6MWT performance improved between admission and discharge [452.3 m. (SD 74.0) vs. 503.3 m. (SD 80.4), p self-esteem and physical self scores between the two home periods (p self-worth at home post-discharge compared to pre-admission (p self-esteem, the perceptions of physical condition and attractive body were all significant. After rehabilitation, the coefficients between dyspnea, and perceived physical condition, physical strength and sport competence were significant (p self scores in patients with moderate COPD and decreases their instability; the program also improves dyspnea. However, the impact of rehabilitation was greater on specific perceptions of physical abilities than on the global self-esteem. Randomized controlled trials are needed to confirm these changes, which were probably due to rehabilitation program.

Pulmonary rehabilitation improves exercise capacity and dyspnea in air pollution-related respiratory disease.

Science.gov (United States)

Miyamoto, Naomi; Senjyu, Hideaki; Tanaka, Takako; Asai, Masaharu; Yanagita, Yorihide; Yano, Yudai; Nishinakagawa, Tsuyoshi; Kotaki, Kenji; Kitagawa, Chika; Rikitomi, Naoto; Kozu, Ryo; Honda, Sumihisa

2014-01-01

Air pollution in Japan caused respiratory disease, such as chronic bronchitis and asthma, in many individuals in the 1960s. Although air pollution has decreased, many victims of air pollution-related respiratory disease are limited in their activities of daily living because of respiratory symptoms. The purpose of this study was to evaluate the efficacy of pulmonary rehabilitation in victims of air pollution-related chronic bronchitis or asthma. Subjects were enrolled in a 12-week (2-week inpatient followed by 10-week outpatient) pulmonary rehabilitation program. The program comprised conditioning, strength training, endurance training, and patient education. We assessed the Modified Medical Research Council (MMRC) dyspnea grade, pulmonary function, peripheral muscle force, incremental shuttle walk distance (ISWD), and physical activity at baseline and immediately after the program. Twenty-nine subjects (mean age 74.2 ± 10.1 years, 11 males) completed the program, including 11 subjects with COPD and 18 subjects with asthma. Following rehabilitation, the participants (n = 29) showed significant improvements in MMRC dyspnea grade, vital capacity % predicted, quadriceps force and ISWD (all P pollution-related asthma. In conclusion, we recommend that patients with chronic bronchitis or asthma, resulting from exposure to air pollution, are referred for pulmonary rehabilitation.

Severe dyspnea in a patient with neurofibromatosis type 1

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P.B. Poble

2017-01-01

Full Text Available Neurofibromatosis type 1 (NF1 is a genetic disease in which pulmonary complications are rare, but severe, especially pulmonary hypertension (PH. The mechanisms underlying the onset of PH in patients with NF1 are unclear and might be multifactorial. In particular, the frequent presence of pulmonary parenchymal lesions makes etiological diagnosis of PH difficult. We describe here the case of a patient with NF1 admitted to our clinic with dyspnea and right heart failure revealing severe pre-capillary PH. Parenchymal lesions were mild and PH was attributed to pulmonary vascular involvement. Clinical and hemodynamic conditions of the patient improved under pulmonary arterial hypertension-specific combination therapy. This case suggests that treatment of PH due to pulmonary vascular involvement in NF1 may be aligned with recommendations for PAH treatment.

The O-C2 angle established at occipito-cervical fusion dictates the patient's destiny in terms of postoperative dyspnea and/or dysphagia.

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Izeki, Masanori; Neo, Masashi; Takemoto, Mitsuru; Fujibayashi, Shunsuke; Ito, Hiromu; Nagai, Koutatsu; Matsuda, Shuichi

2014-02-01

We have revealed that the cause of postoperative dyspnea and/or dysphagia after occipito-cervical (O-C) fusion is mechanical stenosis of the oropharyngeal space and the O-C2 alignment, rather than total or subaxial alignment, is the key to the development of dyspnea and/or dysphagia. The purpose of this study was to confirm the impact of occipito-C2 angle (O-C2A) on the oropharyngeal space and to investigate the chronological impact of a fixed O-C2A on the oropharyngeal space and dyspnea and/or dysphagia after O-C fusion. We reviewed 13 patients who had undergone O-C2 fusion, while retaining subaxial segmental motion (OC2 group) and 20 who had subaxial fusion without O-C2 fusion (SA group). The O-C2A, C2-C6 angle and the narrowest oropharyngeal airway space were measured on lateral dynamic X-rays preoperatively, when dynamic X-rays were taken for the first time postoperatively, and at the final follow-up. We also recorded the current dyspnea and/or dysphagia status at the final follow-up of patients who presented with it immediately after the O-C2 fusion. There was no significant difference in the mean preoperative values of the O-C2A (13.0 ± 7.5 in group OC2 and 20.1 ± 10.5 in group SA, Unpaired t test, P = 0.051) and the narrowest oropharyngeal airway space (17.8 ± 6.0 in group OC2 and 14.9 ± 3.9 in group SA, Unpaired t test, P = 0.105). In the OC2 group, the narrowest oropharyngeal airway space changed according to the cervical position preoperatively, but became constant postoperatively. In contrast, in the SA group, the narrowest oropharyngeal airway space changed according to the cervical position at any time point. Three patients who presented with dyspnea and/or dysphagia immediately after O-C2 fusion had not resolved completely at the final follow-up. The narrowest oropharyngeal airway space and postoperative dyspnea and/or dysphagia did not change with time once the O-C2A had been established at O-C fusion. The O-C2A established at O

Unexplained dyspnea in a patient of chronic arsenicosis: A diagnostic challenge and learning curve for physicians

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Amitabha Sengupta

2015-01-01

Full Text Available Chronic arsenic exposure causes cutaneous effects like hyperkeratosis, peripheral vascular disease, hypertension, ischemic heart disease, non-cirrhotic portal hypertension, hepatomegaly, peripheral neuropathy, respiratory involvement, bad obstetrical outcome, hematological disturbances, and diabetes mellitus. Here we present a case of a 24-year-old lady, with chronic exposure to arsenic, presenting to us with progressive dyspnea. We found pulmonary arterial hypertension (PAH as a cause of her dyspnea. PAH can occur in arsenicosis, secondary to arsenic-induced chronic obstructive pulmonary disease (COPD, lung fibrosis, and portal hypertension, which we excluded by appropriate investigations in our case. We also excluded a familial or heritable form of PAH. Thus, with the exclusion of all these secondary causes of PAH, as well as a hereditary cause, we came to a conclusion that this PAH might be due to chronic arsenic exposure. To the best of our knowledge, no case of PAH in chronic arsenicosis has been reported to date.

Acromegaly presented as a cause of laryngeal dyspnea.

Science.gov (United States)

Saussez, S; Mahillon, V; Chantrain, G; Thill, M P; Lequeux, T

2007-12-01

Acromegalic patients can develop obstructive sleep apnea syndrome or upper airflow obstruction. The development of dyspnea is unusual and the fixation of both vocal cords is exceptional. We report the case of a patient with bilateral vocal cord paralysis. Fiberoptic laryngoscopy and computed tomography (CT) of the neck showed a supra-glottic stenosis due to a swelling of the soft tissue. A tracheostomy was first performed. Thereafter, micro-laryngoscopy using laser vaporisation of the supra-glottic soft tissue was attempted but failed to remove the tracheostomy canula. Finally, blood tests and cerebral MRI revealed an acromegaly. The patient underwent a trans-sphenoidal resection of the pituitary adenoma. Fifteen months later, fiberoptic laryngoscopy showed bilateral restoration of vocal cord mobility and the tracheostomy canula was successfully removed after 18 months. Vocal cord fixation is probably due to hypopharyngeal and laryngeal soft tissue swelling and can be reversible after successful treatment of the adenoma.

Dyspnea with anemia turned out to be a case of hereditary hemorrhagic telangiectasia

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Amitabha Sengupta

2013-01-01

Full Text Available Hereditary hemorrhagic telangiectasia (HHT is a rare autosomal dominant inherited disorder of the vascular system. It can be asymptomatic but when symptomatic most common presentation being epistaxis. It can involve any organs of the body like lungs, skin, liver brain, GI mucosa etc. We are reporting a case of HHT presented to us with dyspnea and severe anemia. He had arteriovenous malformations of different visceral organs and telangiectasia of skin along with presence of similar history in first-degree relatives.

A Case of Vogt-Koyanagi-Harada Syndrome with Persistent Dyspnea Secondary to Laryngeal Edema

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Dimosthenis Mantopoulos; Brad W. deSilva; Colleen M. Cebulla

2014-01-01

Purpose: We report a case of laryngeal edema associated with the Vogt-Koyanagi-Harada (VKH) syndrome. Patient and Methods: A 32-year-old African-American female presented with a 12-day prodrome, including headache, tinnitus and shortness of breath, which preceded sudden photophobia and bilateral visual loss. Examination and clinical testing were most consistent with VKH, and the patient improved with intravenous methylprednisolone therapy. Results: The patient had persistent dyspnea, which wa...

An uncommon case of dyspnea with unilateral laryngeal paralysis in acromegaly.

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Lerat, Justine; Lacoste, Marie; Prechoux, Jean-Marc; Aubry, Karine; Nadalon, Sylvie; Ly, Kim Heang; Bessede, Jean-Pierre

2016-02-01

A 61-year-old man with obstructive sleep apnea syndrome and normal BMI complained of dyspnea. Nasofibroscopy revealed a global and major oedema of the glottis and supraglottis and also a paralysis of the left vocal fold. CT-scan pointed out a spontaneous hyperdensity of the left arytenoid cartilage. A tracheostomy was performed. Clinical examination revealed large hands and macroglossy with high IGF1 rate. MRI confirmed a supracentimetric pituitary adenoma. To our knowledge, this is the first description of a case of acute respiratory distress due to unilateral larynx paralysis leading to acromegaly diagnosis. This is due to submucosal hypertrophy and vocal cord immobility. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Patients with end-stage interstitial lung disease may have more problems with dyspnea than end-stage lung cancer patients

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Ryo Matsunuma

2016-01-01

Full Text Available Introduction: Patients with end-stage interstitial  lung disease (ILD do not appear to receive adequate palliative care despite apparent suffering before death. The aim of this study was to evaluate their signs, symptoms, and treatment received before death. Methods: Patients with ILD and lung cancer (LC who were hospitalized and died in our hospital were enrolled retrospectively. Signs and symptoms and treatments at 7 days, 3 days, and 1 day before death were evaluated and compared between the two groups of patients. Results: A total of 23 patients with ILD and 59 patients with LC group were eligible for participation. Significantly more LC patients had loss of consciousness than ILD patients on 7 days (ILD: LC = 1 [5.6%]:24 [41%], P = 0.013, 3 days (1 [5.6%]:33 [56%], P < 0.001. Significantly more ILD patients had dyspnea than LC patients on 3 days (16 [89%]:38 [64%], P = 0.047 1 day before death (21 [91%]:33 [56%], P = 0.001. On 1 day before death, significantly more LC patients received morphine than ILD patients (2 [8.7%]: 14 [24%], P = 0.015. More ILD patients received sedation (11 [48%]: 11 [19%], P = 0.007. Conclusions: End-stage ILD patients may experience dyspnea more frequently than terminal LC patients, and they need sedation. Morphine should be administered to ILD patients who have dyspnea. Additional prospective studies are needed.

Perception of urge-to-cough and dyspnea in healthy smokers with decreased cough reflex sensitivity

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Kanezaki, Masashi; Ebihara, Satoru; Nikkuni, Etsuhiro; Gui, Peijun; Suda, Chihiro; Ebihara, Takae; Yamasaki, Miyako; Kohzuki, Masahiro

2010-01-01

Background Although cigarette smoking has been implicated as an important risk factor for the development of respiratory symptoms, the perceptional aspects of two symptoms in smokers have not been fully elucidated. Therefore, we simultaneously evaluated the cough reflex sensitivity, the cognition of urge-to-cough and perception of dyspnea in both healthy smokers and non-smokers. Methods Fourteen male healthy never-smokers and 14 age-matched male healthy current-smokers were recruited via publ...

The NT-ProBNP Test in Subjects with End-Stage Renal Disease on Hemodialysis Presenting with Acute Dyspnea: Is Knowing Worth the Cost?

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Shaffer R. S. Mok

2013-01-01

Full Text Available Background. The NT-ProBNP/BNP test has been validated as a marker for determining the etiology of acute dyspnea. In the setting of end-stage renal disease on hemodialysis (ESRD on HD, the utility of the NT-ProBNP/BNP test has not been validated. This study examines the clinical utility of the NT-ProBNP test in the setting of ESRD on HD patients presenting with acute dyspnea. Methods. A retrospective case series of 250 subjects were admitted to Cooper University Hospital, 07/2010-03/2011, with ESRD and HD presenting with dyspnea. The incidences of echocardiography, cardiology consultation, and NT-ProBNP elevated and normal were examined. Correlation coefficients were calculated for NT-ProBNP with age (years, estimated dry weight (kg, amount of fluid removed (L, and ejection fraction (EF in % among other echocardiography parameters. Results. Of the total sample 235 patients had NT-ProBNP levels performed. Cardiology consults were placed in 68.8% and 58% who underwent echocardiography. Of those for whom an echocardiography was performed estimated mean EFs of 54.6%, 50.8%, and 61.7% were observed among the NT-ProBNP elevated group, normal group, and no NT-ProBNP group, respectively. No differences were detected in all other echocardiography measurements. No correlation was observed between NT-ProBNP and age (, baseline EDW (, amount of fluid removed (, or EF (. Conclusion. In the setting of ESRD on HD, the NT-ProBNP test has no clinical utility in determining the etiology of acute dyspnea. This can be demonstrated through echocardiographic and therapeutic parameters measured in this study.

Dyspnea and dysphagia associated to hypopharyngeal fibrolipoma: A case report

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Marco A. Mendez Saenz, MD

2017-04-01

Full Text Available Fibrolipomas are benign lesions conformed by fat and connective tissue, classified as histologic variants of lipomas. They are rarely located in the head and neck and represent less than 0.6% of the benign tumors of the larynx and hypopharynx. Their clinical presentation depends on its location and size. We present the case of a 51-year-old male patient who reported progressive dyspnea, dysphagia and obstructive sleep symptoms with a duration of 3 months, without apparent cause. A pharyngolaryngeal fiberoptic endoscopy showed a smooth, rounded mass in the posterior wall of the hypopharynx, partially obstructing the laryngeal vestibule, creating a valve effect. Complete trans-cervical resection of the lesion was performed after the airway was secured by means of a tracheotomy. The final histopathology report was fibrolipoma. He is currently asymptomatic and without evidence of relapse one year after the procedure.

Ranolazine versus placebo in patients with ischemic cardiomyopathy and persistent chest pain or dyspnea despite optimal medical and revascularization therapy: randomized, double-blind crossover pilot study

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Shammas NW

2015-03-01

Full Text Available Nicolas W Shammas,1 Gail A Shammas,1 Kathleen Keyes,2 Shawna Duske,1 Ryan Kelly,1 Michael Jerin3 1Midwest Cardiovascular Research Foundation, 2Cardiovascular Medicine, Private Corporation, 3St Ambrose University, Davenport, IA, USA Background: Patients with ischemic cardiomyopathy (ICM may continue to experience persistent chest pain and/or dyspnea despite pharmacologic therapy and revascularization. We hypothesized that ranolazine would reduce anginal symptoms or dyspnea in optimally treated ICM patients.Methods: In this randomized, double-blind, crossover-design pilot study, 28 patients with ICM (ejection fraction less or equal 40% were included after providing informed consent. A total of 24 patients completed both placebo and ranolazine treatments and were analyzed. All patients were on treatment with a beta blocker, an angiotensin-converting enzyme inhibitor (or angiotensin receptor blocker, and at least one additional antianginal drug. After randomization, patients received up to 1,000 mg ranolazine orally twice a day, as tolerated, versus placebo. The primary end point was change in angina as assessed by the Seattle Angina Questionnaire (SAQ, or in dyspnea as assessed by the Rose Dyspnea Scale (RDS. Change in the RDS and SAQ score from baseline was compared, for ranolazine and placebo, using the Wilcoxon signed rank test or paired t-test.Results: Patients had the following demographic and clinical variables: mean age of 71.5 years; male (82.1%; prior coronary bypass surgery (67.9%; prior coronary percutaneous intervention (85.7%; prior myocardial infarction (82.1%; diabetes (67.9%; and mean ejection fraction of 33.1%. No statistical difference was seen between baseline RDS score and that after placebo or ranolazine (n=20 (P≥0.05. There was however, an improvement in anginal frequency (8/10 patients (P=0.058, quality of life (8/10 patients (P=0.048, and mean score of all components of the SAQ questionnaire (n=10 (P=0.047 with ranolazine

Defining the minimal important difference for the visual analogue scale assessing dyspnea in patients with malignant pleural effusions.

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Eleanor K Mishra

Full Text Available The minimal important difference (MID is essential for interpreting the results of randomised controlled trials (RCTs. Despite a number of RCTs in patients with malignant pleural effusions (MPEs which use the visual analogue scale for dyspnea (VASD as an outcome measure, the MID has not been established.Patients with suspected MPE undergoing a pleural procedure recorded their baseline VASD and their post-procedure VASD (24 hours after the pleural drainage, and in parallel assessed their breathlessness on a 7 point Likert scale.The mean decrease in VASD in patients with a MPE reporting a 'small but just worthwhile decrease' in their dyspnea (i.e. equivalent to the MID was 19mm (95% CI 14-24mm. The mean drainage volume required to produce a change in VASD of 19mm was 760ml.The mean MID for the VASD in patients with a MPE undergoing a pleural procedure is 19mm (95% CI 14-24mm. Thus choosing an improvement of 19mm in the VASD would be justifiable in the design and analysis of future MPE studies.

Diaphragmatic mobility: relationship with lung function, respiratory muscle strength, dyspnea, and physical activity in daily life in patients with COPD.

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Rocha, Flávia Roberta; Brüggemann, Ana Karla Vieira; Francisco, Davi de Souza; Medeiros, Caroline Semprebom de; Rosal, Danielle; Paulin, Elaine

2017-01-01

To evaluate diaphragmatic mobility in relation to lung function, respiratory muscle strength, dyspnea, and physical activity in daily life (PADL) in patients with COPD. We included 25 patients with COPD, classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria, and 25 healthy individuals. For all of the participants, the following were evaluated: anthropometric variables, spirometric parameters, respiratory muscle strength, diaphragmatic mobility (by X-ray), PADL, and the perception of dyspnea. In the COPD group, diaphragmatic mobility was found to correlate with lung function variables, inspiratory muscle strength, and the perception of dyspnea, whereas it did not correlate with expiratory muscle strength or PADL. In patients with COPD, diaphragmatic mobility seems to be associated with airway obstruction and lung hyperinflation, as well as with ventilatory capacity and the perception of dyspnea, although not with PADL. Avaliar a relação da mobilidade diafragmática com a função pulmonar, força muscular respiratória, dispneia e atividade física de vida diária (AFVD) em pacientes com DPOC. Foram avaliados 25 pacientes com diagnóstico de DPOC, classificados de acordo com critérios da Global Initiative for Chronic Obstructive Lung Disease, e 25 indivíduos saudáveis. Todos foram submetidos às seguintes avaliações: mensuração antropométrica, espirometria, força muscular respiratória, mobilidade diafragmática (por radiografia), AFVD e percepção de dispneia. No grupo DPOC, houve correlações da mobilidade diafragmática com variáveis de função pulmonar, força muscular inspiratória e percepção de dispneia. Não houve correlações da mobilidade diafragmática com força muscular expiratória e AFVD. A mobilidade diafragmática parece estar associada tanto com a obstrução das vias aéreas quanto com a hiperinsuflação pulmonar em pacientes com DPOC, assim como com a capacidade ventilatória e percep

[Effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life for patients with chronic lung disease].

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Lee, Chang Kwan

2007-04-01

The purpose of this study was to examine the effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life in inpatients with chronic lung disease. This quasi experimental study was designed with a nonequivalent control group pre-post test time series. Twenty three patients were assigned to the experimental group and nineteen to the control group. The inpatient pulmonary rehabilitation program was composed of upper and lower extremity exercise, breathing retraining, inspiratory muscle training, education, relaxation and telephone contacts. This program consisted of 4 sessions with inpatients and 4 weeks at home after discharge. The control group was given a home based pulmonary rehabilitation program at the time of discharge. The outcomes were measured by the Borg score, 6MWD and the Chronic Respiratory Disease Questionnaire(CRQ). There was a statistically significant difference in dyspnea between the experimental group and control group, but not among time sequence, or interaction between groups and time sequence. Also significant improvements in exercise capacity and health related quality of life were found only in the experimental group. An Inpatient pulmonary rehabilitation program may be a useful intervention to reduce dyspnea, and increase exercise capacity and health related quality of life for chronic lung disease patients.

Dyspnea in a case of shoulder dislocation – to beware of this rare life-threatening symptom

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Joshi Satyen Praful

2016-01-01

Full Text Available Shoulder dislocation is a common injury in orthopedic practice. In an acute presentation, closed reduction of the shoulder joint leads to an uneventful recovery. However, in the developing world neglected shoulder dislocation and treatments from quacks are not uncommon. Improper treatment and neglect can rarely become life threatening. We present one such case, emphasizing the need to investigate the symptom of dyspnea in a patient with history of shoulder dislocation.

Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: A randomized controlled trial

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Rajashree Ranjita

2016-07-01

Conclusions: Findings indicate that IAYT benefits coal miners with COPD, reducing dyspnea; fatigue and PR, and improving functional performance and peripheral capillary SpO2%. Yoga can now be included as an adjunct to conventional therapy for pulmonary rehabilitation programs for COPD patients.

Intensive symptom control of opioid-refractory dyspnea in congestive heart failure: Role of milrinone in the palliative care unit.

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Silvestre, Julio; Montoya, Maria; Bruera, Eduardo; Elsayem, Ahmed

2015-12-01

We describe an exemplary case of congestive heart failure (CHF) symptoms controlled with milrinone. We also analyze the benefits and risks of milrinone administration in an unmonitored setting. We describe the case of a patient with refractory leukemia and end-stage CHF who developed severe dyspnea after discontinuation of milrinone. At that point, despite starting opioids, she had been severely dyspneic and anxious, requiring admission to the palliative care unit (PCU) for symptom control. After negotiation with hospital administrators, milrinone was administered in an unmonitored setting such as the PCU. A multidisciplinary team approach was also provided. Milrinone produced a dramatic improvement in the patient's symptom scores and performance status. The patient was eventually discharged to home hospice on a milrinone infusion with excellent symptom control. This case suggests that milrinone may be of benefit for short-term inpatient administration for dyspnea management, even in unmonitored settings and consequently during hospice in do-not-resuscitate (DNR) patients. This strategy may reduce costs and readmissions to the hospital related to end-stage CHF.

Analyse of the prevalence rate and risk factors of pulmonary embolism in the patients with dyspnea

International Nuclear Information System (INIS)

Cao Yanxia; Su Jian; Wang Bingsheng; Wu Songhong; Dai Ruiting; Cao Caixia

2005-01-01

Objective: To analyse the prevalence rate and risk factors of pulmonary embolism (PE) in patients with dyspnea and to explore the predisposing causes and its early clinical manifestations. Methods: Retrospective analysis was done in 461 patients with dyspnea performed 99 Tc m -macroaggregated albumin (MAA) lung perfusion imaging and 99 Tc m -DTPA ventilation imaging or 99 Tc m -MAA perfusion imaging and chest X-ray examination. Among them, 48 cases without apparent disease were considered as control group, whereas the remaining patients with other underlying illnesses as patients group. PEMS statistics software package was used for estimation of prevalence rate, χ 2 test and PE risk factor analysis. Results: There were 251 PE patients among 461 patients, the prevalence rate [ (π)=95% confidence interval (CI) ] was: lower extremity thrombosis and varicosity (80.79-95.47 ), post cesarean section (55.64-87.12), lower extremity bone surgery or fracture (52.76-87.27 ), cancer operation (52.19-78.19), atrial fibrillation or heart failure (53.30-74.88), obesity (23.14-50.20), post abdominal surgery (20.23-59.43), diabetes (19.12-63.95), chronic bronchitis (1.80-23.06), normal control group (3.47-22.66). Except chronic bronchitis, PE prevalence rate between patients group and control group had significant difference (P 99 Tc m -MAA and DTPA lung imaging should be done as early as possible. (authors)

A 29-Year-Old Man With Nonproductive Cough, Exertional Dyspnea, and Chest Discomfort.

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Halpenny, Darragh; Suh, James; Garofano, Suzette; Alpert, Jeffrey

2015-09-01

A 29-year-old man presented with a 5-month history of worsening dry cough, exertional dyspnea, chest tightness, and palpitations. He had been treated by his primary care physician with trials of guaifenesin/codeine, azithromycin, albuterol, and omeprazole without improvement. He denied wheezing, fever, sweats, anorexia, joint pain, swelling, or rash. He had no past medical history. He denied a history of tobacco smoking or IV drug use. He kept no pets, worked as a manager in an office environment, and had no history of occupational inhalational exposure. He reported using aerosolized insect spray to eradicate bed bugs in his house shortly before the cough began but did not report any acute symptoms when using the spray.

Accuracy of point-of-care lung ultrasonography for the diagnosis of cardiogenic pulmonary edema in dogs and cats with acute dyspnea.

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Ward, Jessica L; Lisciandro, Gregory R; Keene, Bruce W; Tou, Sandra P; DeFrancesco, Teresa C

2017-03-15

OBJECTIVE To determine the accuracy of a point-of-care lung ultrasonography (LUS) protocol designed to diagnose cardiogenic pulmonary edema (CPE) in dyspneic dogs and cats. DESIGN Diagnostic test evaluation. ANIMALS 76 dogs and 24 cats evaluated for dyspnea. PROCEDURES Dogs and cats were evaluated by LUS; B lines were counted at 4 anatomic sites on each hemithorax. A site was scored as positive when > 3 B lines were identified. Animals with ≥ 2 positive sites identified on each hemithorax were considered positive for CPE. Medical records were evaluated to obtain a final diagnosis (reference standard) for calculation of the sensitivity and specificity of LUS and thoracic radiography for the diagnosis of CPE. RESULTS Dogs and cats with a final diagnosis of CPE had a higher number of positive LUS sites than did those with noncardiac causes of dyspnea. Overall sensitivity and specificity of LUS for the diagnosis of CPE were 84% and 74%, respectively, and these values were similar to those of thoracic radiography (85% and 87%, respectively). Use of LUS generally led to the misdiagnosis of CPE (ie, a false-positive result) in animals with diffuse interstitial or alveolar disease. Interobserver agreement on LUS results was high (κ > 0.85). CONCLUSIONS AND CLINICAL RELEVANCE LUS was useful for predicting CPE as the cause of dyspnea in dogs and cats, although this technique could not be used to differentiate CPE from other causes of diffuse interstitial or alveolar disease. Point-of-care LUS has promise as a diagnostic tool for dyspneic dogs and cats.

Dyspnea in a nonagenarian: The usual suspects, an unexpected culprit.

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Madeira, Sérgio; Raposo, Luís; David, Raquel; Marques, Alexandre; Andrade Gomes, José; Cardim, Nuno; Anjos, Rui

2015-09-01

Platypnea-orthodeoxia syndrome (POS) is an uncommon syndrome characterized by dyspnea and hypoxemia triggered by orthostatism and relieved by recumbency. It is often associated with an interatrial shunt through a patent foramen ovale (PFO). We report the case of a 92-year-old woman initially admitted in the setting of a traumatic femoral neck fracture (successfully treated with hip replacement surgery) in whom a reversible decline in transcutaneous oxygen saturation from 98% (in the supine position) to 84% (in the upright position) was noted early post-operatively. Thoracic multislice computed tomography excluded pulmonary embolism and severe parenchymal lung disease. The diagnosis of POS was confirmed by tilt-table contrast transesophageal echocardiography, which demonstrated a dynamic and position-dependent right-to-left shunt (torrential when semi-upright and minimal in the supine position) through a PFO. The patient underwent percutaneous closure of the PFO with an Amplatzer device, which led to prompt symptom relief and full functional recovery. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

SHORT TERM EFFECT OF ACUPUNCTURE-TENS ON LUNG FUNCTIONS AND DYSPNEA FOR SUBJECTS WITH MODERATE COPD

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Vinod Babu. K

2015-10-01

Full Text Available Background: Acupuncture TENS is used to improve pain instead of invasive acupuncture. Acupuncture shown to improve dyspnoea and lung functions in COPD (Chronic Obstructive Pulmonary Disease patients. The purpose of the study is to determine Short term effectiveness of Acupuncture-TENS in reducing dyspnea and improving lung functions for subjects with moderate COPD. Method: An experimental study design, selected 30 geriatric subjects with COPD randomized 15 subjects into each Study and Control group. Study group received Acu-TENS for 45 minutes for total 5 sessions, while control group received placebo TENS. Outcome measurements such as breathlessness using Modified Borg Scale (MBS, Lung functions using Pulmonary Function Test (PFT was measured before and after intervention. Results: Analysis from pre-intervention to post-intervention within study group found that there is statistically significant change in means of MBS, FEV1, FEV1/FVC ratio and within control group there is a statistically significant change in means of MBS, but there is no statistically significant change in means of FEV1, FVC and FEV1/FVC ratio. When post-intervention means were compared between the groups there is no statistically significant difference in means of MBS and FEV1, FVC and FEV1/FVC ratio. Conclusion: It is concluded that one week of Acu-TENS on EXL1 point found no significant effect on improving dyspnea and lung functions in subjects with moderate COPD in geriatric populations.

Effect of body mass index on diagnostic and prognostic usefulness of amino-terminal pro-brain natriuretic peptide in patients with acute dyspnea

NARCIS (Netherlands)

Bayes-Genis, Antoni; Lloyd-Jones, Donald M.; van Kimmenade, Roland R. J.; Lainchbury, John G.; Richards, A. Mark; Ordoñez-Llanos, Jordi; Santaló, Miquel; Pinto, Yigal M.; Januzzi, James L.

2007-01-01

BACKGROUND: Amino (N)-terminal pro-brain natriuretic peptide (NT-proBNP) testing is useful for diagnostic and prognostic evaluation in patients with dyspnea. An inverse relationship between body mass index (BMI); (calculated as weight in kilograms divided by height in meters squared) and NT-proBNP

[Is BNP assay useful for the diagnosis of acute dyspnea in emergencies departments?].

Science.gov (United States)

Lakhdhar, Rim; Hamouda, Chokri; Ben Ammar, Lotfi; Majed, Kamel; Moncef, Fekih; Kaabachi, Naziha; Drissa, Habiba; Borsali Falfoul, Nebiha

2013-01-01

It would be interesting to the emergency doctor to have at his disposal a helpful diagnostic tool like brain natriuretic peptide (BNP). Such assay is simple, available and reliable. To report our experience on the role of BNP in the etiological diagnosis of acute dyspnea (AD) in emergency room (ER) and to assess the cost-effectiveness ratio of such diagnosis strategy. A prospective study conducted in the ER of Rabta university teaching hospital of Tunis, from March 1st to June 20th 2010, involving 30 consecutive patients presenting to the emergency for AD. All patients underwent echocardiography in their acute phase and benefited from the dosage of BNP during the first 4 hours. The echocardiography parameters were collected by a single operator who was unaware of the results of the BNP dosage. The mean age of patients was 72.8years with a sex ratio of 1.5. AD was of orthopnea type in 9 cases and stage III NYHA dyspnea in the other patients. Clinical and radiological signs of left heart failure were noted in 30% of cases. Ultrasound data have objectified systolic dysfunction in 4 cases, diastolic in 3 cases and systolic plus diastolic in 10 cases. The BNP levels were below 100 pg/ml in 10 cases with pulmonary origin of the AD. A BNP level between 100 and 400 pg/ml was noted in 3 cases. In our study, the clinical probability of AHF prior to performing the test was estimated at 53% and estimated at 100% after the BNP assay. The BNP assay has reduced the length of stay in the emergency department 4 to 5 days and saved nearly 50% of the cost of care per patient. The BNP assay, has allowed us to confirm the AHF all cases. Given the prognostic value and economic benefit of this test we recommend its use in ER of our country.

MRC chronic Dyspnea Scale: Relationships with cardiopulmonary exercise testing and 6-minute walk test in idiopathic pulmonary fibrosis patients: a prospective study

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Roussos Charis

2010-05-01

Full Text Available Abstract Background Exertional dyspnea is the most prominent and disabling feature in idiopathic pulmonary fibrosis (IPF. The Medical Research Chronic (MRC chronic dyspnea score as well as physiological measurements obtained during cardiopulmonary exercise testing (CPET and the 6-minute walk test (6MWT are shown to provide information on the severity and survival of disease. Methods We prospectively recruited IPF patients and examined the relationship between the MRC score and either CPET or 6MWT parameters known to reflect physiologic derangements limiting exercise capacity in IPF patients Results Twenty-five patients with IPF were included in the study. Significant correlations were found between the MRC score and the distance (r = -.781, p 2 at the initiation and the end (r = -.542, p = 0.005 and r = -.713, p VO2 peak/kg (r = -.731, p 2 at peak exercise (r = -. 682, p 2 slope (r = .731, p 2 at AT (r = .630, p = 0.002 and the Borg scale at peak exercise (r = .50, p = 0.01 for the CPET. In multiple logistic regression analysis, the only variable independently related to the MRC is the distance walked at the 6MWT. Conclusion In this population of IPF patients a good correlation was found between the MRC chronic dyspnoea score and physiological parameters obtained during maximal and submaximal exercise testing known to reflect ventilatory impairment and exercise limitation as well as disease severity and survival. This finding is described for the first time in the literature in this group of patients as far as we know and could explain why a simple chronic dyspnea score provides reliable prognostic information on IPF.

Dyspnea, Tachycardia, and New Onset Seizure as a Presentation of Wilms Tumor: A Case Report

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Linda Li

2014-01-01

Full Text Available Wilms tumor is found in 1 in 10,000 children and most commonly presents in asymptomatic toddlers whose care givers notice a nontender abdominal mass in the right upper quadrant. This case of Wilms tumor presented as a critically ill eleven-year old with significant tachypnea, dyspnea, vague abdominal pain, intermittent emesis, new onset seizure, metabolic acidosis, and hypoxemia. This is the first case in the literature of Wilms Tumor with cavoatrial involvement and seizure and pulmonary embolism resulting in aggressive resuscitation and treatment. Treatment included anticoagulation, chemotherapy, nephrectomy, and surgical resection of thrombi, followed by adjunctive chemotherapy with pulmonary radiation.

An unusual cause of severe dyspnea: A laryngeal live leech: Case report.

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Anajar, Said; Ansari, Rachid; Hassnaoui, Jawad; Abada, Reda; Roubal, Mohammed; Mahtar, Mohammed

2017-01-01

Foreign bodies in the upper airways are one of the most challenging otolaryngology emergencies, leeches present a very rare cause of airway foreign bodies around the world. A 6-year-old girl was referred to our otolaryngology department at a tertiary university hospital with a severe dyspnea and hemoptysis. Nasofibroscopy revealed a dark living leech in the supraglottic area which extends to the glottis. The patient was urgently admitted to the operating room, the leech was grasped and removed with a foreign body forceps with a full length of more than 6cm. All symptoms were relieved post operatively and she was discharged one day later. Leeches should be suspected as an airway foreign body in patients with a recent history of drinking from stream water. Prevention remains the best treatment for such cases based simply on hygiene measures like not drinking stream water directly and filtering drinking water before it is used. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Discriminating between cardiac and pulmonary dysfunction in the general population with dyspnea by plasma pro-B-type natriuretic peptide

DEFF Research Database (Denmark)

Mogelvang, R; Goetze, JP; Schnohr, P

2007-01-01

OBJECTIVES: This study was designed to determine whether measurement of plasma pro-B-type natriuretic peptide (proBNP) could be used in discriminating between cardiac and pulmonary dyspnea in the general population. BACKGROUND: Natriuretic peptides are useful markers in ruling out acute cardiac...... the expected concentration of plasma proBNP based on age and gender was established for dyspneic subjects: an actual plasma proBNP concentration below half of the expected value ruled out left ventricular systolic and diastolic dysfunction (sensitivity 100%, 95% CI 100% to 100%; specificity 15%, 95% CI 12...

Relationships between respiratory and airway resistances and activity-related dyspnea in patients with chronic obstructive pulmonary disease

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Plantier L

2012-03-01

Full Text Available Bruno Mahut1,2, Aurore Caumont-Prim3,4, Laurent Plantier1,5, Karine Gillet-Juvin1,6, Etienne Callens1, Olivier Sanchez5,6, Brigitte Chevalier-Bidaud3, Plamen Bokov1, Christophe Delclaux1,5,71Assistance Publique – Hôpitaux de Paris (AP-HP, Hôpital Européen Georges Pompidou, Service de Physiologie – Clinique de la Dyspnée, F-75015 Paris, France; 2Cabinet La Berma, 4 avenue de la Providence; F-92160 Antony, France; 3AP-HP, Hôpital Européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, F-75015 Paris, France; 4INSERM, Centre d'Investigation Épidémiologique 4, F-75015 Paris, France; 5Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, F-75015 Paris, France; 6AP-HP, Hôpital Européen Georges Pompidou, Service de Pneumologie; F-75015 Paris, France; 7CIC 9201 Plurithématique, Hôpital Européen Georges Pompidou, F-75015 Paris, FranceBackground: The aims of the study were: (1 to compare numerical parameters of specific airway resistance (total, sRawtot, effective, sRaweff and at 0.5 L • s-1, sRaw0.5 and indices obtained from the forced oscillation technique (FOT: resistance extrapolated at 0 Hz [Rrs0 Hz], mean resistance [Rrsmean], and resistance/frequency slope [Rrsslope] and (2 to assess their relationships with dyspnea in chronic obstructive pulmonary disease (COPD.Methods: A specific statistical approach, principal component analysis that also allows graphic representation of all correlations between functional parameters was used. A total of 108 patients (mean ± SD age: 65 ± 9 years, 31 women; GOLD stages: I, 14; II, 47; III, 39 and IV, 8 underwent spirometry, body plethysmography, FOT, and Medical Research Council (MRC scale assessments.Results: Principal component analysis determined that the functional parameters were described by three independent dimensions (airway caliber, lung volumes and their combination, specific resistance and that resistance parameters of the two techniques

Addition of non-invasive ventilatory support to combined aerobic and resistance training improves dyspnea and quality of life in heart failure patients: a randomized controlled trial.

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Bittencourt, Hugo Souza; Cruz, Cristiano Gonçalves; David, Bruno Costa; Rodrigues, Erenaldo; Abade, Camille Magalhães; Junior, Roque Aras; Carvalho, Vitor Oliveira; Dos Reis, Francisco Borges Faria; Gomes Neto, Mansueto

2017-11-01

To test the hypothesis that combined aerobic and resistance training and non-invasive ventilatory support result in additional benefits compared with combined aerobic and resistance training alone in heart failure patients. A randomized, single-blind, controlled study. Cardiac rehabilitation center. A total of 46 patients with New York Heart Association class II/III heart failure were randomly assigned to a 10-week program of combined aerobic and resistance training, plus non-invasive ventilatory support ( n = 23) or combined aerobic and resistance training alone ( n = 23). Before and after intervention, results for the following were obtained: 6-minute walk test, forced vital capacity, forced expiratory volume at one second, maximal inspiratory muscle pressure, and maximal expiratory muscle pressure, with evaluation of dyspnea by the London Chest Activity of Daily Living scale, and quality of life with the Minnesota Living With Heart Failure questionnaire. Of the 46 included patients, 40 completed the protocol. The combined aerobic and resistance training plus non-invasive ventilatory support, as compared with combined aerobic and resistance training alone, resulted in significantly greater benefit for dyspnea (mean change: 4.8 vs. 1.3, p = 0.004), and quality of life (mean change: 19.3 vs. 6.8, p = 0.017 ). In both groups, the 6-minute walk test improved significantly (mean change: 45.7 vs. 44.1, p = 0.924), but without a statistically significant difference. Non-invasive ventilatory support combined with combined aerobic and resistance training provides additional benefits for dyspnea and quality of life in moderate heart failure patients. ClinicalTrials.gov identifier: NCT02384798. Registered 03 April 2015.

The five-point Likert scale for dyspnea can properly assess the degree of pulmonary congestion and predict adverse events in heart failure outpatients

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Cristina K. Weber

2014-01-01

Full Text Available OBJECTIVES: Proper assessment of dyspnea is important in patients with heart failure. Our aim was to evaluate the use of the 5-point Likert scale for dyspnea to assess the degree of pulmonary congestion and to determine the prognostic value of this scale for predicting adverse events in heart failure outpatients. METHODS: We undertook a prospective study of outpatients with moderate to severe heart failure. The 5-point Likert scale was applied during regular outpatient visits, along with clinical assessments. Lung ultrasound with ≥15 B-lines and an amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP level >1000 pg/mL were used as a reference for pulmonary congestion. The patients were then assessed every 30 days during follow-up to identify adverse clinical outcomes. RESULTS: We included 58 patients (65.5% male, age 43.5±11 years with a mean left ventricular ejection fraction of 27±6%. In total, 29.3% of these patients had heart failure with ischemic etiology. Additionally, pulmonary congestion, as diagnosed by lung ultrasound, was present in 58% of patients. A higher degree of dyspnea (3 or 4 points on the 5-point Likert scale was significantly correlated with a higher number of B-lines (p = 0.016. Patients stratified into Likert = 3-4 were at increased risk of admission compared with those in class 1-2 after adjusting for age, left ventricular ejection fraction, New York Heart Association functional class and levels of NT-proBNP >1000 pg/mL (HR = 4.9, 95% CI 1.33-18.64, p = 0.017. CONCLUSION: In our series, higher baseline scores on the 5-point Likert scale were related to pulmonary congestion and were independently associated with adverse events during follow-up. This simple clinical tool can help to identify patients who are more likely to decompensate and whose treatment should be intensified.

An Elderly Female with Dyspnea and Abdominal Pain

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Jon Van Heukelom

2017-01-01

Full Text Available History of Present Illness: A 55-year-old female presented via transfer from a referring hospital with 48 hours of abdominal pain, vomiting and dyspnea. She was found to be in severe distress. Her temperature was 37.5° C (99.5° F, heart rate 130 beats per minute, respiratory rate 47 breaths per minute, blood pressure 80/48, and oxygen saturation of 95% on a non-rebreather mask. She had distended neck veins, diminished breath sounds on the left hemi-thorax, and a distended abdomen. A chest x-ray that had been obtained at the referring hospital was immediately reviewed. The decision was made to intubate the patient. Following intubation, a nasogastric tube was placed with marked improvement in her hemodynamics. An abdomen-pelvis CT was obtained which showed a para-esophageal hernia with the majority of the stomach located in the left hemi-thorax and evidence of a bowel obstruction. Significant findings: Radiography shows a dilated, gas-filled structure that fills nearly the entire left hemi-thorax. Lung markings are visible in the uppermost portion of the left hemi-thorax. There is mediastinal shift to the right. In the visualized portion of the abdomen, dilated loops of bowel are also visualized. This constellation of findings is consistent with a tension gastrothorax. Discussion: Tension gastrothorax is a rare complication of blunt trauma, diaphragmatic hernias, and certain surgical procedures.1,2 Clinically, a tension gastrothorax may mimic that of a tension pneumothorax, making it difficult to diagnose.3,4 Stabilizing treatment includes decompressing the stomach by means of a nasogastric (NG tube.2 Placement may be difficult due the intra-thoracic position of the stomach leading to kinking of the tube. The attempt to place an NG tube can lead to hyperventilation and air swallowing, which can aggravate gastric distention.4 Failure to decompress the stomach, however, may lead to patient decompensation and cardiac arrest.5 Definitive treatment

Stethoscope versus point-of-care ultrasound in the differential diagnosis of dyspnea: a randomized trial.

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Özkan, Behzat; Ünlüer, Erden E; Akyol, Pinar Y; Karagöz, Arif; Bayata, Mehmet S; Akoğlu, Haldun; Oyar, Orhan; Dalli, Ayşe; Topal, Fatih E

2015-12-01

We aimed to determine the accuracies of point-of-care ultrasound (PoCUS) and stethoscopes as part of the physical examinations of patients with dyspnea. Three emergency medicine specialists in each of two groups of ultrasound and stethoscope performers underwent didactic and hands-on training on PoCUS and stethoscope usage. All the patients enrolled were randomized to one of two predetermined PoCUS or stethoscope groups. The diagnostic performance of ultrasonography was higher than that of the stethoscope in the diagnoses of heart failure (90 vs. 86%, 1.00 vs. 0.89, and 5.00 vs. 4.92, respectively) and pneumonia (90 vs. 86.7%, 0.75 vs. 0.73, and 16.50 vs. 13.82, respectively). No significant differences were observed in the utility parameters of these modalities in these diagnoses. Although some authors argue that it is time to abandon the 'archaic tools' of past centuries, we believe that it is too early to discontinue the use of the stethoscope.

Nontraumatic head and neck emergencies: a clinical approach. Part 1: cervicofacial swelling, dysphagia, and dyspnea.

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Brea Álvarez, B; Tuñón Gómez, M; Esteban García, L; García Hidalgo, C Y; Ruiz Peralbo, R M

2016-01-01

Nontraumatic emergencies of the head and neck represent a challenge in the field of neuroradiology for two reasons: first, they affect an area where the thorax joins the cranial cavity and can thus compromise both structures; second, they are uncommon, so they are not well known. Various publications focus on nontraumatic emergencies of the head and neck from the viewpoints of anatomic location or of particular diseases. However, these are not the most helpful viewpoints for dealing with patients in the emergency department, who present with particular signs and symptoms. We propose an analysis starting from the four most common clinical presentations of patients who come to the emergency department for nontraumatic head and neck emergencies: cervical swelling, dysphagia, dyspnea, and loss of vision. Starting from these entities, we develop an approach to the radiologic management and diagnosis of these patients. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Gender and perception of dyspnea: The role of the variation in the forced expiratory volume in one second Género y percepción de disnea: el rol de la variación del volumen espiratorio forzado en un segundo

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Carlos A. Nigro

2010-08-01

Full Text Available During bronchoconstriction women perceive more breathlessness than men. The aims of study were 1 to evaluate if quality of dyspnea in bronchoconstriction was different in women and men 2 to assess if gender difference in the perception of dyspnea could be related to the level of bronchoconstriction. 457 subjects (257 women inhaled methacholine to a 20% decrease in FEV1, or 32 mg/ml. Dyspnea was evaluated using the modified Borg scale and a list of expressions of dyspnea. Borg scores were recorded immediately before the challenge test baseline and at the maximum FEV1 decrease. The prevalence of descriptors of dyspnea reported by women and men was similar. Dyspnea was related to the level of FEV1 (ΔFEV1: OR 1.05, 95%CI 1.01-1.09, p 0.0095, females (OR 2.90, 95%CI 1.33-6.33, p 0.0072, younger subjects (OR 0.93, 95%CI 0.89- 0.97, p 0.0013 and body mass index (BMI (OR 1.11, 95%CI 1.01-1.23, p 0.023. As the FEV1 fell less than 20% from baseline, only the ΔFEV1 was significantly associated with dyspnea (ΔFEV1:OR 1.15, 95%CI 1.07- 1.24, p 0.0002. Instead, if the FEV1 fell higher ≥ 20%, the presence of dyspnea was related to the degree of bronchoconstriction (ΔFEV1: OR 1.04, 95%CI 1.01-1.09, p 0.0187, females (OR 3.02, 95%CI 1.36-6.72, p 0.0067, younger subjects (OR 0.92, 95%CI 0.88-0.96, p 0.0007 and BMI (OR 1.12, 95%CI 1.01-1.23, p 0.023. The quality of dyspnea during the bronchoconstriction was similar in women and men; women showed a higher perception of dyspnea than men only when the FEV1 fell more than 20% from baseline.Durante la broncoconstricción las mujeres perciben más disnea que los hombres. Los objetivos del estudio fueron evaluar: 1 si la calidad de la disnea durante la broncoconstricción fue diferente en mujeres y hombres, 2 si la diferencia entre sexos en la percepción de disnea podría relacionarse al nivel de broncoconstricción. 457 sujetos (257 mujeres inhalaron metacolina hasta un descenso del FEV1 ≥ 20% o 32 mg/ml. La

Belching, regurgitation, chest tightness and dyspnea: not gastroesophageal reflux disease but asthma.

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Zhang, Jing-Xi; Zhan, Xian-Bao; Bai, Chong; Li, Qiang

2015-02-07

Belching is a common symptom of gastroesophageal reflux disease. If the symptoms are not relieved after anti-reflux treatment, another etiology should be considered. Here, we report a case of a 43-year-old man who presented with belching, regurgitation, chest tightness and dyspnea for 18 mo, which became gradually more severe. Gastroscopic examination suggested superficial gastritis. Twenty-four-hour esophageal pH monitoring showed that the Demeester score was 11.4, in the normal range. High-resolution manometry showed that integrated relaxation pressure and intrabolus pressure were higher than normal (20 mmHg and 22.4 mmHg, respectively), indicating gastroesophageal junction outflow tract obstruction. Pulmonary function test showed severe obstructive ventilation dysfunction [forced expiratory volume in 1 second (FEV1)/forced vital capacity 32%, FEV1 was 1.21 L, occupying 35% predicted value after salbuterol inhalation], and positive bronchial dilation test (∆FEV1 260 mL, ∆FEV1% 27%). Skin prick test showed Dermatophagoides farinae (++), house dust mite (++++), and shrimp protein (++). Fractional exhaled nitric oxide measurement was 76 ppb. All the symptoms were alleviated completely and pulmonary function increased after combination therapy with corticosteroids and long-acting β2-agonist. Bronchial asthma was eventually diagnosed by laboratory tests and the effect of anti-asthmatic treatment, therefore, physicians, especially the Gastrointestinal physicians, should pay attention to the belching symptoms of asthma.

Aerobic exercise training without weight loss reduces dyspnea on exertion in obese women

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Bernhardt, Vipa; Stickford, Jonathon L.; Bhammar, Dharini M.; Babb, Tony G.

2015-01-01

Dyspnea on exertion (DOE) is a common symptom in obesity. We investigated whether aerobic exercise training without weight loss could reduce DOE. Twenty-two otherwise healthy obese women participated in a 12-week supervised aerobic exercise training program, exercising 30 min/day at 70–80% heart rate reserve, 4 days/week. Subjects were grouped based on their Ratings of Perceived Breathlessness (RPB) during constant load 60W cycling: +DOE (n = 12, RPB ≥ 4, 37 ± 7 years, 34 ± 4kg/m2) and −DOE (n = 10, RPB ≤ 2, 32 ± 6 years, 33 ± 3kg/m2). No significant differences between the groups in body composition, pulmonary function, or cardiorespiratory fitness were observed pre-training. Post-training, peak was improved significantly in both groups (+DOE: 12 ± 7, −DOE: 14 ± 8%). RPB was significantly decreased in the + DOE (4.7 ± 1.0–2.5 ± 1.0) and remained low in the −DOE group (1.2 ± 0.6–1.3 ± 1.0) (interaction p exercise training improved cardiorespiratory fitness and DOE and thus appears to be an effective treatment for DOE in obese women. PMID:26593640

A very rare cause of dyspnea with a unique presentation on a computed tomography scan of the chest: macrophage activation syndrome

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Brandao-Neto, Rodrigo Antonio; Santana, Alfredo Nicodemos Cruz; Danilovic, Debora Lucia Seguro; Mendonca, Berenice Bilharinho de; Bernardi, Fabiola Del Carlo; Barbas, Carmen Silvia Valente

2008-01-01

Macrophage activation syndrome is a rare and potentially life-threatening disease. It occurs due to immune dysregulation manifested as excessive macrophage proliferation, typically causing hepatosplenomegaly, pancytopenia and hepatic dysfunction. Here, we report an unusual case of macrophage activation syndrome presenting as dyspnea, as well as (reported here for the first time) high resolution computed tomography findings of an excavated nodule, diffuse ground glass opacities and consolidations (mimicking severe pneumonia or alveolar hemorrhage). The patient was successfully treated with human immunoglobulin. We recommend that macrophage activation syndrome be considered in the differential diagnosis of respiratory failure. Rapid diagnosis and treatment are essential to achieving favorable outcomes in patients with this syndrome. (author)

Urinothorax—An Underdiagnosed Cause of Acute Dyspnea: Report of a Bilateral and of an Ipsilateral Urinothorax Case

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Leonidas Laskaridis

2012-01-01

Full Text Available Urinothorax (UT is a rare and often undiagnosed condition, defined as the presence of urine in the pleural cavity due to the retroperitoneal leakage of urine accumulation, known as urinoma, into the pleural space. UT usually is a transudative pleural effusion that presents in patients with obstructive uropathy and it may occur following surgical procedures in the ureter or kidney such as ESWL, PCNL, and URS. Its diagnosis requires a high degree of clinical suspicion since the respiratory symptoms tend to be absent or mild and the urological signs tend to dominate. However, UT may rarely present with severe and acute dyspnea as well. The objectives of this study are to describe two new cases of this rare entity, a bilateral case and an ipsilateral case focusing on the side that occurs according to the affected renal insult, and to alert the physicians to include UT in their differential diagnosis of pleural effusions especially in patients with recent urinary tract disorders.

Prognostic validation of the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index in inoperable non-small-cell lung cancer.

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Denehy, Linda; Hornsby, Whitney E; Herndon, James E; Thomas, Samantha; Ready, Neal E; Granger, Catherine L; Valera, Lauren; Kenjale, Aarti A; Eves, Neil D; Jones, Lee W

2013-12-01

To investigate the prognostic utility of the body mass index, severity of airflow obstruction, measures of exertional dyspnea, and exercise capacity (BODE) index in patients with inoperable non-small-cell lung cancer (NSCLC). One hundred consecutive patients with inoperable NSCLC and performance status 0 to 3 completed pulmonary function testing, the modified Medical Research Council dyspnea scale, a 6-minute walk test, and body mass index-the multidimensional 10-point BODE index. Cox proportional models were used to estimate the risk of all-cause mortality according to the BODE index with or without adjustment for traditional prognostic factors. Median follow-up was 31.5 months; 61 deaths (61%) were reported during this period. There was a significant univariate association between the BODE index score and mortality (adjusted p(trend) = 0.027). Compared with patients with a BODE index of 0, the adjusted hazard ratio for risk of death was 1.37 (95% confidence interval [CI], 0.74-2.55) for a BODE index of 1, 1.22 (95% CI, 0.45-3.25) for a BODE index of 2, and 2.44 (95% CI, 1.19-4.99) for a BODE index more than 2. The BODE index provided incremental prognostic information beyond that provided traditional markers of prognosis (adjusted p(trend) = 0.051). Every one-point increase in the BODE index, the risk of death increased by 25% (hazard ratio = 1.25; 95% CI, 1.27-4.64). The BODE index is a strong independent predictor of survival in inoperable NSCLC beyond traditional risk factors. Use of this multidimensional tool may improve risk stratification and prognostication in NSCLC.

Dyspnea and choking as presenting symptoms in primary medulla oblongata germinoma.

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Yip, Chi-Man; Tseng, Hui-Hwa; Hsu, Shu-Shong; Liao, Wei-Chuan; Chen, Jun-Yih; Chen, Chih-Hao; Chang, Chia-Yuan

2014-01-01

The medulla oblongata is the lower half of the brainstem. It contains the cardiac, respiratory, vomiting, and vasomotor centers and deals with autonomic functions such as breathing, heartbeat, and blood pressure. Primary medulla oblongata germinoma is very rare and less than 20 cases have been reported in the English literature. A 22-year-old female without any particular past medical history presented to us in October 2012 with the chief complaint of dyspnea and frequent choking for 1 month. Neurological examination revealed lower cranial nerve palsies and nystagmus. Her brain computed tomography (CT) and brain magnetic resonance imaging (MRI) demonstrated a mass lesion at the dorsal surface of medulla oblongata with extension into the inferior fourth ventricle and foramen magnum. She underwent bilateral suboccipital craniotomy and C1 laminoplasty with the grossly total resection of the tumor. The histological examination of the tumor proved germinoma. Postoperative adjuvant radiotherapy was arranged. The latest brain MRI and whole spine MRI done 1 year after surgery showed neither residual nor recurrent tumor in the whole axis. She is regularly followed-up at our outpatient department and is doing well except having left vocal cord palsy, which occurred before surgery. Medulloblastoma, ependymoma, glioma, hemangioblastoma, and cavernous angioma are common intraaxial tumors in the medulla oblongata and fourth ventricle. Intracranial germ cell tumors originate from extragonadal seminal cells and have been found in 0.4-3.4% of patients with primary central nervous system (CNS) tumors in Western countries, while the incidence is reported to be 5-8 times greater in Japan and the Far East. Although germinoma of medulla oblongata is rare and difficult to diagnose preoperatively, it should be included in the differential diagnosis of medulla masses with fourth ventricle extension, especially in Asian population.

Validation of the dyspnea index in adolescents with exercise-induced paradoxical vocal fold motion.

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De Guzman, Vanessa; Ballif, Catherine L; Maurer, Rie; Hartnick, Christopher J; Raol, Nikhila

2014-09-01

Paradoxical vocal fold motion (PVFM) affects almost 1 million adolescents in the United States. However, to date, no disease-specific objective measure exists to assess symptom severity and response to treatment in adolescents with exercise-induced PVFM. To validate the Dyspnea Index (DI) quality-of-life instrument (previously validated for adults with breathing disorders) in children aged 12 to 18 years with exercise-induced PVFM and to determine the minimum significant DI change corresponding to patient-reported or caregiver-reported improvement or worsening of symptoms. A longitudinal study of 56 patients (age range, 12-18 years) diagnosed as having exercise-induced PVFM and their caregivers from February 1, 2013, to September 30, 2013, in an outpatient pediatric otolaryngology office practice. The DI was administered to patients and caregivers, with items modified to reflect the perspective of caregivers. Appropriate DI change was measured to reflect improvement or worsening of symptoms. Test-retest reliability was accomplished by having a subset of patients and caregivers complete the instrument twice within 2 weeks before therapy. Internal consistency was assessed by calculation of Cronbach α. Discriminant validity and convergent validity were determined by comparing DIs with assessment of global change in symptoms. The patient and caregiver mean (SD) DI changes were -12.9 (9.6) and -14.7 (9.3), respectively (P therapy.

Observational Study on Safety of Prehospital BLS CPAP in Dyspnea.

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Sahu, Novneet; Matthews, Patrick; Groner, Kathryn; Papas, Mia A; Megargel, Ross

2017-12-01

with appropriate training. Sahu N , Matthews P , Groner K , Papas MA , Megargel R . Observational study on safety of prehospital BLS CPAP in dyspnea. Prehosp Disaster Med. 2017;32(6):610-614.

Uso de descritores de dispneia desenvolvidos no Brasil em pacientes com doenças cardiorrespiratórias ou obesidade Dyspnea descriptors developed in Brazil: application in obese patients and in patients with cardiorespiratory diseases

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Christiane Aires Teixeira

2011-08-01

Full Text Available OBJETIVO: Desenvolver um conjunto de termos descritores de dispneia para uso no Brasil. Investigar a utilidade desses descritores em quatro condições distintas que cursam com dispneia. MÉTODOS: Um conjunto de 111 frases descritivas da sensação de falta de ar foi coletado a partir das informações de 67 pacientes e de 10 profissionais da saúde. Tais frases foram analisadas e reduzidas a 15 expressões, em função de sua frequência de citação, similaridade de significados e potencial importância fisiopatológica. O conjunto de expressões foi aplicado a 50 pacientes com asma, 50 com DPOC, 30 com insuficiência cardíaca e 50 com obesidade graus II ou III. Os três melhores termos selecionados pelos pacientes foram estudados por análise de agrupamentos. Também foram investigadas as possíveis associações entre os agrupamentos encontrados e as quatro condições clínicas incluídas. RESULTADOS: O emprego dessa lista de descritores levou a uma solução com sete agrupamentos, denominados sufoco, aperto, rápido, fadiga, abafado, trabalho/inspiração e falta de ar. Houve grande superposição no uso de descritores pelos pacientes com as quatro condições clínicas. A asma mostrou associações expressivas com sufoco e trabalho/inspiração, enquanto DPOC e insuficiência cardíaca, com sufoco, trabalho/inspiração e falta de ar; e obesidade, com falta de ar apenas. CONCLUSÕES: Pacientes no Brasil habituados a sentir dispneia utilizam diferentes termos para descrever seu sintoma, e tais descrições podem ser agrupadas em conjuntos por similaridade. Tais agrupamentos não mostraram utilidade na distinção diagnóstica entre os grupos avaliados neste estudo.OBJECTIVE: To develop a set of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors for use in Brazil and to investigate the usefulness of these descriptors in four distinct clinical conditions that can be accompanied by dyspnea. METHODS: We collected 111

Laryngeal dyspnea in relation to an interaction between acenocoumarol and topical econazole lotion.

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Wey, Pierre-François; Petitjeans, Fabrice; Lions, Christophe; Ould-Ahmed, Mehdi; Escarment, Jacques

2008-08-01

Bleeding is the most serious complication of oral anticoagulant therapy used for the prevention of thromboembolic complications. Drug-drug interactions are an important concern, as they may increase drug toxicity and, in the case of anticoagulant therapies, increase the risk of hemorrhage. An 84-year-old woman presented to the emergency department with a bilateral cervical hematoma and symptoms of upper-airway obstruction that had been increasing for 72 hours, with dyspnea and difficulty speaking developing in the previous 24 hours. Transnasal fiberoptic laryngoscopy revealed a significant laryngeal hematoma, as well as a hematoma on the floor of the mouth and in the tonsil area. Laboratory abnormalities included a prothrombin time 120 seconds. The patient had been receiving acenocoumarol 4 mg/d for 10 years for episodes of atrial fibrillation and recurrent deep venous thrombosis. Seventeen days earlier, she had received a prescription for topical econazole lotion 1% to be applied 3 times daily for 1 month to treat a dermatitis affecting 12% of the body surface. The patient was admitted to the intensive care unit for treatment of respiratory failure, where oxygen was delivered by face mask. The coagulation disorders were treated with prothrombin complex concentrate 30 IU/kg IV and vitamin K1 10 mg IV, and values normalized within 36 hours. Surgical evacuation of the laryngeal hematoma was not necessary. After 48 hours, improvement in the patient's respiratory symptoms allowed transfer to the ear, nose, and throat unit, where daily endoscopic examination was performed. Aspirin was substituted for acenocoumarol, and the patient returned home after 10 days without sequelae. Based on a Naranjo score of 7, this episode was probably related to an interaction between acenocoumarol and econazole. This report describes a case of a probable interaction between topical econazole lotion 1% and acenocoumarol that resulted in overanticoagulation and a life-threatening laryngeal

Uso de descritores de dispneia traduzidos da língua inglesa em pacientes com doenças cardiorrespiratórias ou obesidade Dyspnea descriptors translated from English to Portuguese: application in obese patients and in patients with cardiorespiratory diseases

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Christiane Aires Teixeira

2011-08-01

Full Text Available OBJETIVO: Investigar a utilidade de descritores de dispneia, desenvolvidos em língua inglesa e traduzidos para o português falado no Brasil, em pacientes com quatro condições distintas que cursam com dispneia. MÉTODOS: Uma lista de 15 descritores de dispneia construída em um estudo nos EUA foi traduzida para o português. Esse conjunto de descritores foi aplicado a 50 pacientes com asma, 50 com DPOC, 30 com insuficiência cardíaca e 50 com obesidade graus II ou III. Os termos selecionados como os três melhores para descrever a sensação de dispneia pelos pacientes foram estudados por análise de agrupamentos. Também foram investigadas as possíveis associações entre os agrupamentos encontrados e as quatro condições clínicas incluídas. RESULTADOS: O emprego dessa lista levou a uma solução com nove agrupamentos, denominados expiração, fome de ar, sufoco, superficial, rápido, aperto, falta de ar, trabalho e inspiração. Houve acentuada superposição no uso de descritores pelos pacientes com as quatro condições clínicas. Asma, DPOC e insuficiência cardíaca mostraram associações relevantes com inspiração. Insuficiência cardíaca mostrou associação adicional com trabalho, enquanto nenhum agrupamento se associou de maneira expressiva com obesidade. CONCLUSÕES: O uso de descritores de dispneia traduzidos da língua inglesa por pacientes no Brasil levou a identificação de agrupamentos distintos, os quais guardaram semelhança com aqueles obtidos em um estudo nos EUA. Esses descritores traduzidos foram menos úteis do que um grupo de descritores desenvolvido no Brasil no que se refere à capacidade de gerar associações significativas com as condições clínicas investigadas.OBJECTIVE: To investigate the usefulness of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors that were developed in English and translated to Brazilian Portuguese in patients with four distinct clinical conditions that

Patients with collagen vascular disease and dyspnea. The value of gallium scanning and bronchoalveolar lavage in predicting response to steroid therapy and clinical outcome

International Nuclear Information System (INIS)

Greene, N.B.; Solinger, A.M.; Baughman, R.P.

1987-01-01

Patients with collagen vascular disease with or without pulmonary symptoms were studied to determine the value of gallium scan and bronchoalveolar lavage (BAL) in predicting clinical outcome and response to steroid therapy. Thirty-six subjects, 20 with progressive dyspnea, were studied. Gallium uptake was seen in the lung in 17 of the 20 progressively dyspneic patient's and none of the 16 nonprogressive patients. The BAL fluid in the progressive patients had a higher percentage of neutrophils (13.4 percent +/- 2.88) and lymphocytes (16.1 percent +/- 2.75) than in the nonprogressive patients (neutrophils = 3.3 +/- 1.30 percent; lymphocytes = 5.6 +/- 1.57 percent. Of the 19 progressive patients who were treated with steroids or cyclophosphamide, six had only increased neutrophils in their BAL fluid and all died. The remaining 13 treated progressive patients had increased lymphocytes or a normal BAL (two patients): six had improvement in their vital capacity, six have had stable function, and one died. We found gallium scan and BAL useful in assessing progressive pulmonary fibrosis in collagen vascular disease

Dyspnea during Advanced Cancer

Science.gov (United States)

... Data Conducting Clinical Trials Statistical Tools and Data Terminology Resources NCI Data Catalog Cryo-EM NCI's Role ... cava syndrome in a child is a serious medical emergency because the child's windpipe can become blocked. ...

The time-course of cortico-limbic neural responses to air hunger

OpenAIRE

Binks, Andrew P.; Evans, Karleyton C.; Reed, Jeffrey D.; Moosavi, Shakeeb H.; Banzett, Robert B.

2014-01-01

Several studies have mapped brain regions associated with acute dyspnea perception. However, the time-course of brain activity during sustained dyspnea is unknown. Our objective was to determine the time-course of neural activity when dyspnea is sustained. Eight healthy subjects underwent brain blood oxygen level dependent functional magnetic imaging (BOLD-fMRI) during mechanical ventilation with constant mild hypercapnia (~45 mmHg). Subjects rated dyspnea (air hunger) via visual analog scale...

Respuesta al entrenamiento en EPOC: Diferencia entre limitación por fatiga muscular y por disnea Training response in COPD: Differences between fatigue-limited and dyspnea-limited patients

Directory of Open Access Journals (Sweden)

Martín Sívori

2011-04-01

Full Text Available Este estudio comparó la respuesta post entrenamiento al ejercicio en pacientes limitados por fatiga muscular (LF vs. disnea (LD. Se incluyeron pacientes con EPOC moderada y grave (definición GOLD, clasificándolos en LF si la respuesta a cicloergometría máxima tenía ≥ 2 puntos en la escala de Borg para fatiga muscular vs. disnea; LD a la inversa. Se realizaron ergometría submáxima, 6 minutos y pruebas de calidad de vida mediante cuestionario. Fueron entrenados 3 veces/semana, 90 min/sesión con ejercicios de fuerza y aeróbicos por 8 semanas, evaluándolos de la misma manera. Fueron estudiados 14 pacientes del grupo LF y 11 del LD. El promedio de edad fue 69 y 66 años respectivamente. Presentaban grave obstrucción bronquial (FEV1: 49%. No existían diferencias basales entre ambos grupos, excepto en el índice masa-corporal (IMC, menor en los LF. Luego del entrenamiento, ambos grupos mejoraron significativamente en variables de ejercicio y calidad de vida, excepto carga máxima en los LD. Comparando ambos grupos, se observó mejor respuesta en los LF en carga máxima (48.7 ± 9.2 vs. 40.04 ± 15.48 watts, p = 0.033, prueba de 6 minutos (505.42 ± 50.75 vs. 454.9 ± 64.3 metros, p = 0.048 y ergometría submáxima (14.57 ± 9.55 vs. 6.71 ± 4.18min, p = 0.025, respectivamente. Como conclusión, los pacientes LF tuvieron mayor respuesta al entrenamiento en ejercicios submáximos y carga máxima, presentando menor IMC. Posiblemente, deberían instrumentarse diferentes estrategias de entrenamiento para diferentes fenotipos de pacientes con EPOC.Our objective was to study the post-training response to exercise, comparing fatigue-limited (FL vs. dyspnea-limited (DL COPD patients. Moderate and severe COPD patients (GOLD definition were included. They were classified as FL if Borg score of fatigue at maximal exercise testing was ≥ 2 points vs. dyspnea; and DL if it was the reverse. Also, each patient was evaluated with submaximal

[Acute dyspnea in malignant melanoma].

Science.gov (United States)

Franzen, A M; Günzel, T

2011-09-01

Metastases to the larynx are rare. The current article presents the case of a 75-year-old patient with a history of shortness of breath due to a supraglottic exophytic lesion that was identified as a metastasis of a cutaneous melanoma treated 2.5 years previously. As a result of our medline analysis we found approximately 30 cases of metastatic melanoma to the larynx published to date. Primary tumors are always cutaneous in origin and spread over the whole integument of trunk and extremities. The time interval between diagnosis of the primary and the laryngeal metastasis is often several years. In most reports a supraglottic exophytic, red coloured lesion is described. Diagnosis can only be proven by histological examination. Laryngeal metastasis is usually an indication of tumor dissemination and always has a fatal prognosis.

Quantitative CT assessment in chronic obstructive pulmonary disease patients: Comparison of the patients with and without consistent clinical symptoms and pulmonary function results

International Nuclear Information System (INIS)

Nam, Boda; Hwang, Jung Hwa; Lee, Young Mok; Park, Jai Soung; Jou, Sung Shick; Kim, Young Bae

2015-01-01

We compared the clinical and quantitative CT measurement parameters between chronic obstructive pulmonary disease (COPD) patients with and without consistent clinical symptoms and pulmonary function results. This study included 60 patients having a clinical diagnosis of COPD, who underwent chest CT scan and pulmonary function tests. These 60 patients were classified into typical and atypical groups, which were further sub-classified into 4 groups, based on their dyspnea score and the result of pulmonary function tests [typical 1: mild dyspnea and pulmonary function impairment (PFI); typical 2: severe dyspnea and PFI; atypical 1: mild dyspnea and severe PFI; atypical 2: severe dyspnea and mild PFI]. Quantitative measurements of the CT data for emphysema, bronchial wall thickness and air-trapping were performed using software analysis. Comparative statistical analysis was performed between the groups. The CT emphysema index correlated well with the results of the pulmonary functional test (typical 1 vs. atypical 1, p = 0.032), and the bronchial wall area ratio correlated with the dyspnea score (typical 1 vs. atypical 2, p = 0.033). CT air-trapping index also correlated with the results of the pulmonary function test (typical 1 vs. atypical 1, p = 0.012) and dyspnea score (typical 1 vs. atypical 2, p = 0.000), and was found to be the most significant parameter between the typical and atypical groups. Quantitative CT measurements for emphysema and airways correlated well with the dyspnea score and pulmonary function results in patients with COPD. Air-trapping was the most significant parameter between the typical vs. atypical group of COPD patients

Quantitative CT assessment in chronic obstructive pulmonary disease patients: Comparison of the patients with and without consistent clinical symptoms and pulmonary function results

Energy Technology Data Exchange (ETDEWEB)

Nam, Boda; Hwang, Jung Hwa [Dept. of Radiology, Soonchunhyang University Hospital, Seoul (Korea, Republic of); Lee, Young Mok [Bangbae GF Allergy Clinic, Seoul (Korea, Republic of); Park, Jai Soung [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Jou, Sung Shick [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of); Kim, Young Bae [Dept. of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan (Korea, Republic of)

2015-09-15

We compared the clinical and quantitative CT measurement parameters between chronic obstructive pulmonary disease (COPD) patients with and without consistent clinical symptoms and pulmonary function results. This study included 60 patients having a clinical diagnosis of COPD, who underwent chest CT scan and pulmonary function tests. These 60 patients were classified into typical and atypical groups, which were further sub-classified into 4 groups, based on their dyspnea score and the result of pulmonary function tests [typical 1: mild dyspnea and pulmonary function impairment (PFI); typical 2: severe dyspnea and PFI; atypical 1: mild dyspnea and severe PFI; atypical 2: severe dyspnea and mild PFI]. Quantitative measurements of the CT data for emphysema, bronchial wall thickness and air-trapping were performed using software analysis. Comparative statistical analysis was performed between the groups. The CT emphysema index correlated well with the results of the pulmonary functional test (typical 1 vs. atypical 1, p = 0.032), and the bronchial wall area ratio correlated with the dyspnea score (typical 1 vs. atypical 2, p = 0.033). CT air-trapping index also correlated with the results of the pulmonary function test (typical 1 vs. atypical 1, p = 0.012) and dyspnea score (typical 1 vs. atypical 2, p = 0.000), and was found to be the most significant parameter between the typical and atypical groups. Quantitative CT measurements for emphysema and airways correlated well with the dyspnea score and pulmonary function results in patients with COPD. Air-trapping was the most significant parameter between the typical vs. atypical group of COPD patients.

The time-course of cortico-limbic neural responses to air hunger.

Science.gov (United States)

Binks, Andrew P; Evans, Karleyton C; Reed, Jeffrey D; Moosavi, Shakeeb H; Banzett, Robert B

2014-12-01

Several studies have mapped brain regions associated with acute dyspnea perception. However, the time-course of brain activity during sustained dyspnea is unknown. Our objective was to determine the time-course of neural activity when dyspnea is sustained. Eight healthy subjects underwent brain blood oxygen level dependent functional magnetic imaging (BOLD-fMRI) during mechanical ventilation with constant mild hypercapnia (∼ 45 mm Hg). Subjects rated dyspnea (air hunger) via visual analog scale (VAS). Tidal volume (V(T)) was alternated every 90 s between high VT (0.96 ± 0.23 L) that provided respiratory comfort (12 ± 6% full scale) and low V(T) (0.48 ± 0.08 L) which evoked air hunger (56 ± 11% full scale). BOLD signal was extracted from a priori brain regions and combined with VAS data to determine air hunger related neural time-course. Air hunger onset was associated with BOLD signal increases that followed two distinct temporal profiles within sub-regions of the anterior insula, anterior cingulate and prefrontal cortices (cortico-limbic circuitry): (1) fast, BOLD signal peak 40s. BOLD signal during air hunger offset followed fast and slow temporal profiles symmetrical, but inverse (signal decreases) to the time-courses of air hunger onset. We conclude that differential cortico-limbic circuit elements have unique contributions to dyspnea sensation over time. We suggest that previously unidentified sub-regions are responsible for either the acute awareness or maintenance of dyspnea. These data enhance interpretation of previous studies and inform hypotheses for future dyspnea research. Copyright © 2014 Elsevier B.V. All rights reserved.

Laser Posterior Cordotomy: Is it a Good Choice in Treating Bilateral Vocal Fold Abductor Paralysis?

Directory of Open Access Journals (Sweden)

Mahmoud A. Khalil

2014-01-01

Full Text Available Background Bilateral abductor vocal fold paralysis can lead to respiratory distress and dyspnea. Objectives To assess the efficacy of CO 2 laser unilateral posterior cordotomy in cases with bilateral abductor paralysis as regards improvement of dyspnea with preservation of satisfactory voice and swallowing after the operation. Methods A prospective study was done on 18 patients with bilateral abductor vocal fold paralysis (10 females and 8 males from November 2010 to December 2012 with their ages ranging from 32 to 64 years. Results All patients showed improvement of dyspnea after the operation, most of the patients suffered from mild to moderate dyspnea in the immediate post-operative period, and two patients needed another intervention to solve it. All the patients had satisfactory results of their voice after the operation, and one patient only suffered from temporary aspiration. Conclusion Unilateral CO 2 laser posterior cordotomy is an easy and effective procedure to solve the dyspnea after bilateral vocal fold abductor paralysis without aspiration or significant voice alteration.

Psychogenic Dyspnea and Therapeutic Chest Radiograph

Science.gov (United States)

Kaufman, Kenneth R.; Endres, Jennifer K.; Kaufman, Nathaniel D.

2007-01-01

Conversion disorders, the physical expression of unresolved psychological pain, can be associated with mourning. This case report is third in a series of articles by the authors on childhood mourning reflecting the effects of multiple losses (K. R. Kaufman & N. D. Kaufman, 2005; K. R. Kaufman & N. D. Kaufman, 2006). In this case report, perception…

Dyspnea in Pregnancy: An Unusual Cause

African Journals Online (AJOL)

outcome. REFERENCES. 1. Calvinho P, Bastos C, Bernardo JE, Eugénio L, Antunes MJ. Diaphragmmatic eventration: Long‑term follow‑up and results of open‑chest plicature. Eur J Cardiothorac Surg 2009;36:883‑7. 2. Townsend CM, Beauchamp RD, Evers BM, Kenneth LM. Pediatric surgery. Sabiston Textbook of Surgery ...

A retrospective study of 155 adult equids and 21 foals with tetanus from Western, Northern and Central Europe (2000-2014). Part 2

DEFF Research Database (Denmark)

van Galen, Gaby; Rijckaert, Joke; Mair, Tim

2017-01-01

on admission, longer diagnosis time, treatment and hospitalization delay, and mild severity grade. Variables associated with death included: anorexia, dysphagia, dyspnea, low blood potassium concentration on admission, moderate and severe disease grading, development of dysphagia, dyspnea, recumbency...

Clinical utility of measures of breathlessness.

Science.gov (United States)

Cullen, Deborah L; Rodak, Bernadette

2002-09-01

The clinical utility of measures of dyspnea has been debated in the health care community. Although breathlessness can be evaluated with various instruments, the most effective dyspnea measurement tool for patients with chronic lung disease or for measuring treatment effectiveness remains uncertain. Understanding the evidence for the validity and reliability of these instruments may provide a basis for appropriate clinical application. Evaluate instruments designed to measure breathlessness, either as single-symptom or multidimensional instruments, based on psychometrics foundations such as validity, reliability, and discriminative and evaluative properties. Classification of each dyspnea measurement instrument will recommend clinical application in terms of exercise, benchmarking patients, activities of daily living, patient outcomes, clinical trials, and responsiveness to treatment. Eleven dyspnea measurement instruments were selected. Each instrument was assessed as discriminative or evaluative and then analyzed as to its psychometric properties and purpose of design. Descriptive data from all studies were described according to their primary patient application (ie, chronic obstructive pulmonary disease, asthma, or other patient populations). The Borg Scale and the Visual Analogue Scale are applicable to exertion and thus can be applied to any cardiopulmonary patient to determine dyspnea. All other measures were determined appropriate for chronic obstructive pulmonary disease, whereas the Shortness of Breath Questionnaire can be applied to cystic fibrosis and lung transplant patients. The most appropriate utility for all instruments was measuring the effects on activities of daily living and for benchmarking patient progress. Instruments that quantify function and health-related quality of life have great utility for documenting outcomes but may be limited as to documenting treatment responsiveness in terms of clinically important changes. The dyspnea

PERCEPTION OF AIRWAY-OBSTRUCTION IN A RANDOM-POPULATION SAMPLE - RELATIONSHIP TO AIRWAY HYPERRESPONSIVENESS IN THE ABSENCE OF RESPIRATORY SYMPTOMS

NARCIS (Netherlands)

BRAND, PLP; RIJCKEN, B; SCHOUTEN, JP; KOETER, GH; WEISS, ST; POSTMA, DS

Subjects with asymptomatic airway hyperresponsiveness in epidemiologic studies may have variable airway obstruction that is not perceived as dyspnea. We tested the hypothesis that such subjects are less likely to report an increase in dyspnea during histamine-induced bronchoconstriction than

Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction

DEFF Research Database (Denmark)

Walsted, Emil Schwarz; Faisal, Azmy; Jolley, Caroline J

2017-01-01

Rationale: Exercise induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly...

77 FR 20873 - Qualification of Drivers; Application for Exemptions; Implantable Cardioverter Defibrillators

Science.gov (United States)

2012-04-06

..., please include a self-addressed, stamped envelope or postcard or print the acknowledgement page that... variety known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure. FMCSA..., collapse or congestive cardiac failure; and/or (2) which is likely to cause syncope, dyspnea, collapse, or...

A 62-year-old man with dyspnea

Directory of Open Access Journals (Sweden)

Misbah Baqir

2016-01-01

Full Text Available We describe the case of a 62-year-old man who presented with shortness of breath that had progressed over several years. He had a history of a paralyzed right hemidiaphragm for at least the previous 10 years. He also reported weakness in his proximal legs and daytime sleepiness. On examination, he was found to have thoracoabdominal paradox when in supine position. Pulmonary function testing revealed severe restriction; arterial blood gas showed chronic respiratory acidosis. Electromyography showed chronic phrenic neuropathy bilaterally, with mild proximal myopathy. Serum aldolase level was mildly elevated, but serologic tests for connective tissue disorders were within reference range. After extensive clinical investigations, the patient was found to have severely reduced acid α-glucosidase. Genetic analysis confirmed the diagnosis of adult-onset Pompe disease. The patient started treatment with bilevel positive airway pressure titrated during polysomnography, and acid α-glucosidase enzyme replacement was recommended.

Resection and Primary Closure of Edematous Glossoepiglottic Mucosa in a Dog Causing Laryngeal Obstruction.

Science.gov (United States)

Schabbing, Kevin J; Seaman, Jeffrey A

An approximately 22 mo old male neutered English bulldog was evaluated for acute onset of dyspnea with suspected brachycephalic obstructive airway syndrome (BOAS). Laryngoscopic exam revealed diffuse, severe edema and static displacement of redundant glossoepiglottic (GE) mucosa causing complete obstruction of the larynx and epiglottic entrapment. Static displacement of the GE mucosa was observed and determined to be the overriding component of dyspnea in this patient with BOAS. Resection and primary closure with two separate, simple continuous sutures of the GE mucosa were performed. Resection and primary closure of the GE mucosa resolved the acute onset of dyspnea in this patient. Surgical correction of the stenotic nares, elongated soft palate, and everted laryngeal saccules were performed under the same anesthetic procedure. Static displacement of the GE mucosa may occur in patients with BOAS. Surgical resection and closure of the GE mucosa resolved this patient's dyspnea and is recommended in airway obstruction. It remains to be determined if primary closure and subsequent tensioning or scar tissue of the GE mucosa results in further complications related to restricted epiglottic movement.

A comprehensive scoring system in correlation with perioperative airway management for neonatal Pierre Robin Sequence.

Directory of Open Access Journals (Sweden)

Ning Yin

Full Text Available To evaluate a comprehensive scoring system which combines clinical manifestations of Pierre Robin Sequence (PRS including severity of breathing difficulties, body weight and preoperative Cormack-Lehane grade, for its correlation with perioperative PRS airway management decision.Forty PRS children were retrospectively recruited after surgery. Specialists examined all subjects and scored for clinical manifestations (1´ - 4´, weight gain (1´- 4´, dyspnea scores (1´- 4´, and Cormack-Lehane grade (1´- 4´. The correlation of the integrated scores and the necessity of endotracheal intubation or laryngeal mask application were analyzed. In addition, the score correlation with postoperative dyspnea and/or low pulse oxygen saturation (SPO2 levels after extubation was determined.In our study every individual patient had a score from 0´ to 16´, while the higher in the numbers represented higher risk of breathing difficulty. All patients with comprehensive scores 13 points required a laryngeal mask assisted airway management and were considered to have difficult airways. Dyspnea after extubation and postoperative low SPO2 occurred among patients who scored over 10 points.In PRS patients, preoperative weight gaining status and severity of dyspnea in combination with Cormack-Lehane classification provide a scoring system that could help to optimize airway management decisions such as endotracheal intubation or laryngeal mask airway placement and has the potential to predict postoperative dyspnea or low SPO2 levels.

The effect of inhaled menthol on upper airway resistance in humans: A randomized controlled crossover study

Directory of Open Access Journals (Sweden)

Effie J Pereira

2013-01-01

Full Text Available BACKGROUND: Menthol (l-menthol is a naturally-occurring cold receptor agonist commonly used to provide symptomatic relief for upper airway congestion. Menthol can also reduce the sensation of dyspnea. It is unclear whether the physiological action of menthol in dyspnea reduction is through its cold receptor agonist effect or whether associated mechanical changes occur in the upper airway.

[Recurrent laryngeal papillomatosis complicated by decompensated respiratory failure in two children].

Science.gov (United States)

Aurégan, C; Thierry, B; Blanchard, M; Chéron, G

2015-11-01

Laryngeal papillomatosis is a rare, potentially severe cause of recurrent laryngeal dyspnea. It should be known as a cause of laryngeal dyspnea resistant to the usual treatments. We report on two pediatric cases of severe laryngeal papillomatosis with respiratory distress and failure. These observations illustrate the importance of early adequate treatment. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Pathogen-Reduced, Extended Platelet Storage in Platelet Additive Solution (PAS)

Science.gov (United States)

2016-10-01

Research Subjects. XI. STUDY PROCEDURES Screening An abbreviated version of blood donor screening will be performed including completion of a study...carefully monitored for adverse reactions ; i.e., fever, chills, dyspnea, urticaria or pain (infusion site, chest pain or other). Any adverse reactions ...During apheresis collection and infusion of platelets, the subject will be carefully monitored for adverse reactions ; e.g., fever, chills, dyspnea

Systemic effects of chronic obstructive pulmonary disease in young-old adults’ life-space mobility

Directory of Open Access Journals (Sweden)

Garcia IFF

2017-09-01

Full Text Available Isabel Fialho Fontenele Garcia,1 Carina Tiemi Tiuganji,1 Maria do Socorro Morais Pereira Simões,2 Ilka Lopes Santoro,3 Adriana Claudia Lunardi1,2 1Master’s and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, 2Department of Physical Therapy, School of Medicine, University of Sao Paulo, 3Respiratory Division, Pulmonary Rehabilitation Center, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil Purpose: The objective was to assess whether dyspnea, peripheral muscle strength and the level of physical activity are correlated with life-space mobility of older adults with COPD.Patients and methods: Sixty patients over 60 years of age (40 in the COPD group and 20 in the control group were included. All patients were evaluated for lung function (spirometry, life-space mobility (University of Alabama at Birmingham Study of Aging Life-Space Assessment, dyspnea severity (Modified Dyspnea Index, peripheral muscle strength (handgrip dynamometer, level of physical activity and number of daily steps (accelerometry. Groups were compared using unpaired t-test. Pearson’s correlation was used to test the association between variables.Results: Life-space mobility (60.41±16.93 vs 71.07±16.28 points, dyspnea (8 [7–9] vs 11 [10–11] points, peripheral muscle strength (75.16±14.89 vs 75.50±15.13 mmHg, number of daily steps (4,865.4±2,193.3 vs 6,146.8±2,376.4 steps, and time spent in moderate to vigorous activity (197.27±146.47 vs 280.05±168.95 minutes were lower among COPD group compared to control group (p<0.05. The difference was associated with the lower mobility of COPD group in the neighborhood.Conclusion: Life-space mobility is decreased in young-old adults with COPD, especially at the neighborhood level. This impairment is associated to higher dyspnea, peripheral muscle weakness and the reduced level of physical activity. Keywords: COPD, elderly, mobility limitation, dyspnea, muscular

A Systematic Review of Resistance Training Versus Endurance Training in COPD

DEFF Research Database (Denmark)

Iepsen, Ulrik Winning; Jørgensen, Karsten Juhl; Ringbaek, Thomas

2015-01-01

PURPOSE:: Endurance training (ET) as part of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) has been shown to improve exercise capacity and health-related quality of life, but dyspnea limits the exercise intensity. Therefore, resistance training (RT), which...... may cause less dyspnea, could be an alternative. The purpose of this review was to formulate evidence-based recommendations on the use of RT in pulmonary rehabilitation of patients with COPD. Our primary outcomes were health-related quality of life, activities of daily living, dyspnea, possible harm......, and total mortality. Our secondary outcomes were walking distance, lean body mass, muscle strength, and exercise capacity. METHODS:: We identified randomized controlled trials through a systematic multidatabase search. One author checked titles and abstracts for relevance using broad inclusion criteria...

Pathogen-Reduced, Platelet Additive Solution, Extended Stored Platelets (PREPS)

Science.gov (United States)

2015-10-01

abbreviated version of blood donor screening will be performed including completion of a study specific health history questionnaire, check of vital signs... adverse reactions ; i.e., fever, chills, dyspnea, urticaria or pain (infusion site, chest pain or other). Any adverse reactions will be recorded and... adverse reactions ; e.g., fever, chills, dyspnea, urticaria, or pain (infusion site, chest pain or other). Adverse reactions will be recorded in the

DYSFUNCTION OF THE VOCAL CORDS IN CHILDREN AND ADOLESCENTS. CASE REPORT

OpenAIRE

Navazo-Eguía AI; Arias-Tobalina H; Suárez-Muñiz E; Mata-Franco G

2011-01-01

INTRODUCTIONThe vocal cord dysfunction (VCD) or laryngeal asthma is characterized by paroxysmal episodes of adduction of the vocal cords during inspiration and / or expiration, leading to episodes of dyspnea and stridor.CASE REPORT A 13 year old female with a history of exercise-related asthma is admitted to Hospital with a episode of stridor and dyspnea. Pulmonary function curve showed flattening of inspiratory and expiratory curve. Fiberoptic laryngoscopy: adducion of both vocal cords duri...

Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED: A SIMEU Multicenter Study.

Science.gov (United States)

Pivetta, Emanuele; Goffi, Alberto; Lupia, Enrico; Tizzani, Maria; Porrino, Giulio; Ferreri, Enrico; Volpicelli, Giovanni; Balzaretti, Paolo; Banderali, Alessandra; Iacobucci, Antonello; Locatelli, Stefania; Casoli, Giovanna; Stone, Michael B; Maule, Milena M; Baldi, Ileana; Merletti, Franco; Cibinel, Gian Alfonso; Baron, Paolo; Battista, Stefania; Buonafede, Giuseppina; Busso, Valeria; Conterno, Andrea; Del Rizzo, Paola; Ferrera, Patrizia; Pecetto, Paolo Fascio; Moiraghi, Corrado; Morello, Fulvio; Steri, Fabio; Ciccone, Giovannino; Calasso, Cosimo; Caserta, Mimma A; Civita, Marina; Condo', Carmen; D'Alessandro, Vittorio; Del Colle, Sara; Ferrero, Stefania; Griot, Giulietta; Laurita, Emanuela; Lazzero, Alberto; Lo Curto, Francesca; Michelazzo, Marianna; Nicosia, Vincenza; Palmari, Nicola; Ricchiardi, Alberto; Rolfo, Andrea; Rostagno, Roberto; Bar, Fabrizio; Boero, Enrico; Frascisco, Mauro; Micossi, Ilaria; Mussa, Alessandro; Stefanone, Valerio; Agricola, Renzo; Cordero, Gabriele; Corradi, Federica; Runzo, Cristina; Soragna, Aldo; Sciullo, Daniela; Vercillo, Domenico; Allione, Attilio; Artana, Nicoletta; Corsini, Fabrizio; Dutto, Luca; Lauria, Giuseppe; Morgillo, Teresa; Tartaglino, Bruno; Bergandi, Daniela; Cassetta, Ilaria; Masera, Clotilde; Garrone, Mario; Ghiselli, Gianluca; Ausiello, Livia; Barutta, Letizia; Bernardi, Emanuele; Bono, Alessia; Forno, Daniela; Lamorte, Alessandro; Lison, Davide; Lorenzati, Bartolomeo; Maggio, Elena; Masi, Ilaria; Maggiorotto, Matteo; Novelli, Giulia; Panero, Francesco; Perotto, Massimo; Ravazzoli, Marco; Saglio, Elisa; Soardo, Flavia; Tizzani, Alessandra; Tizzani, Pietro; Tullio, Mattia; Ulla, Marco; Romagnoli, Elisa

2015-07-01

Lung ultrasonography (LUS) has emerged as a noninvasive tool for the differential diagnosis of pulmonary diseases. However, its use for the diagnosis of acute decompensated heart failure (ADHF) still raises some concerns. We tested the hypothesis that an integrated approach implementing LUS with clinical assessment would have higher diagnostic accuracy than a standard workup in differentiating ADHF from noncardiogenic dyspnea in the ED. We conducted a multicenter, prospective cohort study in seven Italian EDs. For patients presenting with acute dyspnea, the emergency physician was asked to categorize the diagnosis as ADHF or noncardiogenic dyspnea after (1) the initial clinical assessment and (2) after performing LUS ("LUS-implemented" diagnosis). All patients also underwent chest radiography. After discharge, the cause of each patient's dyspnea was determined by independent review of the entire medical record. The diagnostic accuracy of the different approaches was then compared. The study enrolled 1,005 patients. The LUS-implemented approach had a significantly higher accuracy (sensitivity, 97% [95% CI, 95%-98.3%]; specificity, 97.4% [95% CI, 95.7%-98.6%]) in differentiating ADHF from noncardiac causes of acute dyspnea than the initial clinical workup (sensitivity, 85.3% [95% CI, 81.8%-88.4%]; specificity, 90% [95% CI, 87.2%-92.4%]), chest radiography alone (sensitivity, 69.5% [95% CI, 65.1%-73.7%]; specificity, 82.1% [95% CI, 78.6%-85.2%]), and natriuretic peptides (sensitivity, 85% [95% CI, 80.3%-89%]; specificity, 61.7% [95% CI, 54.6%-68.3%]; n = 486). Net reclassification index of the LUS-implemented approach compared with standard workup was 19.1%. The implementation of LUS with the clinical evaluation may improve accuracy of ADHF diagnosis in patients presenting to the ED. Clinicaltrials.gov; No.: NCT01287429; URL: www.clinicaltrials.gov.

Physiologic effects of an ambulatory ventilation system in chronic obstructive pulmonary disease.

Science.gov (United States)

Porszasz, Janos; Cao, Robert; Morishige, Richard; van Eykern, Leo A; Stenzler, Alex; Casaburi, Richard

2013-08-01

Exercise intolerance limits the ability of patients with chronic obstructive pulmonary disease (COPD) to perform daily living activities. Noninvasive ventilation reduces dyspnea and improves exercise performance, but current systems are unsuitable for ambulatory use. In patients with COPD experiencing exercise-induced desaturation, we evaluated improvements in exercise tolerance facilitated by a wearable, 1-lb, noninvasive open ventilation (NIOV) system featuring a nasal pillow interface during constant work rate (CWR) cycle ergometer exercise and associated effects on dyspnea, respiratory muscle activation, and pulmonary gas exchange efficiency. Fifteen men with COPD (FEV₁ = 32.2 ± 12.0% predicted; FEV₁/FVC = 31.6 ± 7.1%; exercise oxygen saturation as measured by pulse oximetry [Spo₂] = 86.5 ± 2.9%) participated. After incremental testing establishing peak work rate, subjects completed three visits in which they performed CWR exercise to tolerance at 80% peak work rate: (1) unencumbered breathing room air, (2) using NIOV+compressed air, (3) using NIOV+compressed O₂, or (4) using O₂ via nasal cannula. Assessments included exercise duration, surface inspiratory muscle EMG, Spo₂, transcutaneous Pco₂, and Borg dyspnea scores. Exercise endurance was 17.6 ± 5.7 minutes using NIOV+O₂, greatly prolonged compared with unencumbered (5.6 ± 1.9 min), nasal O₂ (11.4 ± 6.8 min), and NIOV+Air (6.3 ± 4.1 min). Isotime Spo₂ was higher and intercostal, scalene, and diaphragmatic EMG activity was reduced using NIOV+O₂ compared with unencumbered, nasal O₂, and NIOV+Air, signifying respiratory muscle unloading. Isotime dyspnea reduction correlated with isotime EMG reduction (r = 0.42, P = 0.0053). There were no significant differences in isotime VD/VT or transcutaneous Pco₂ among treatments. NIOV+O₂ yielded substantial exercise endurance improvements accompanied by respiratory muscle unloading and dyspnea reductions in patients with severe hypoxemic

The Impact of Listening to Music During a High-Intensity Exercise Endurance Test in People With COPD.

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Lee, Annemarie L; Dolmage, Thomas E; Rhim, Matthew; Goldstein, Roger S; Brooks, Dina

2018-05-01

In people with COPD, dyspnea is the primary symptom limiting exercise tolerance. One approach to reducing dyspnea during exercise is through music listening. A constant speed endurance test reflects a high-intensity aerobic exercise training session, but whether listening to music affects endurance time is unknown. This study aimed to determine the effects of listening to music during a constant speed endurance test in COPD. Participants with COPD completed two endurance walk tests, one with and one without listening to self-selected music throughout the test. The primary outcome was the difference in endurance time between the two conditions. Heart rate, percutaneous oxygen saturation, dyspnea, and rate of perceived exertion were measured before and after each test. Nineteen participants (mean [SD]: age, 71 [8] years; FEV 1 , 47 [19] % predicted) completed the study. Endurance time was greater (1.10 [95% CI, 0.41-1.78] min) while listening to music (7.0 [3.1] min) than without (5.9 [2.6] min), and reduced end-test dyspnea (1.0 [95% CI, -2.80 to -1.80] units) (with music, 4.6 [1.7] units; vs without music, 5.6 [1.4] units, respectively). There was not a significant difference in heart rate, percutaneous oxygen saturation, or leg fatigue. There were no adverse events under either condition. In COPD, dyspnea was less while listening to music and was accompanied by an increased tolerance of high-intensity exercise demonstrated by greater endurance time. Practically, the effect was modest but may represent an aid for exercise training of these patients. Australian New Zealand Clinical Trials Registry; No. ACTRN12617001217392. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

March 2014 pulmonary case of the month: the cure may be worse than the disease

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Penupolu S

2014-03-01

Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: A 51 year old woman was seen with a chief complaint of gradually increasing shortness of breath. She was at baseline five months prior to presentation but noticed dyspnea on minimal exertion initially at a higher altitude, gradually progressing to dyspnea at rest. She was tried on 2 courses of antibiotics with no significant improvement. In addition to the dyspnea, she has some non productive cough but no fevers. PMH, SH, FH: She had a renal transplant in 1997 for IgA disease and has a history of type II diabetes and hypertension. She is a life long nonsmoker and has only occasional alcohol use. She is employed as a utility designer and has no exposure to any dusts, fumes or exotic animals. Family history is noncontributory. Medications: Atenolol, Lasix, Prednisone 2 mg q daily, Rosuvastatin, Sirolimus 2 mg po q daily ...

Long-Term Mortality of Emergency Medical Services Patients

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Bøtker, Morten T; Terkelsen, Christian J; Sørensen, Jan Nørtved

2017-01-01

, and vital status data from 3 of 5 geographic regions in Denmark. We included events from July 1, 2011, to December 31, 2012. We classified EMS events according to primary dispatch category (unconsciousness/cardiac arrest, accidents/trauma, chest pain, dyspnea, neurologic symptoms, and other EMS patients......). The primary outcome was 1-year mortality adjusted for age, sex, and Charlson comorbidity index. RESULTS: Among 142,125 EMS events, primary dispatch categories were unconsciousness or cardiac arrest 5,563 (3.9%), accidents or trauma 40,784 (28.7%), chest pain 20,945 (14.7%), dyspnea 9,607 (6.8%), neurologic...... symptoms 17,804 (12.5%), and other EMS patients 47,422 (33.4%). One-year mortality rates were unconscious or cardiac arrest 54.7% (95% confidence interval [CI] 53.4% to 56.1%), accidents or trauma 7.8 (95% CI 7.5% to 8.1%), chest pain 8.5% (95% CI 8.1% to 9.0%), dyspnea 27.7% (95% CI 26.7% to 28...

Successful hyperbaric oxygen therapy for laryngeal radionecrosis after chemoradiotherapy for mesopharyngeal cancer. Case report and literature review

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Abe, Madoka; Terashima, Kotaro; Matsuo, Mioko; Uehara, Satoru; Shioyama, Yoshiyuki; Hara, Iwao

2012-01-01

Laryngeal radionecrosis is one of the most troublesome late complications of radiotherapy, because it is frequently resistant to treatment and laryngectomy is required in the worst case. Here, we report a case of laryngeal radionecrosis, successfully treated by use of hyperbaric oxygen (HBO) therapy, in which laryngectomy was avoided. A 67-year-old male received radical chemoradiotherapy (CRT) for mesopharyngeal cancer, which included radiotherapy with a total dose of 71.4 Gy/38 Fr and chemotherapy with CDDP + S-1. He developed dyspnea and throat pain 9 months after completion of CRT. Laryngoscopy revealed vocal cord impairment because of severe laryngeal edema. He was diagnosed as having laryngeal radionecrosis and initially received conservative therapy combined with antibiotics, steroids, and prostaglandins. Because his dyspnea was persistent despite this treatment, HBO therapy was administered 20 times, and resulted in complete remission of the dyspnea. HBO therapy, therefore, is regarded as an effective conservative therapeutic option for laryngeal radionecrosis. (author)

Awareness of breathing: the structure of language descriptors of respiratory sensations.

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Petersen, Sibylle; Orth, Bernhard; Ritz, Thomas

2008-01-01

Recent research suggests that dyspnea is not a single sensation but a multidimensional construct reflected in different verbal descriptors that can provide useful diagnostic information. In this study superordinated clusters of dyspnea were investigated in combination with a dimensional approach. We examined the use of 20 respiratory symptom descriptors by healthy volunteers who completed a protocol of seven experimental conditions: Quiet breathing, breath holding, paced breathing, climbing stairs, resistive load breathing, voluntary hyperinflation, and voluntary hyperventilation. We analyzed the ratings of these descriptors with multidimensional scaling (MDS) and cluster analysis. While similarities with prior studies were found on a lower fusion level, we were able to demonstrate the usefulness of interpreting higher fusion levels with four clusters related to work of breathing, coordination, suffocation, and struggling for air, merging into two superordinated clusters, effort and air hunger that are compatible with widely accepted primary components of dyspnea. MDS results also suggested that future studies should consider further breathing sensations related to cognitive control of breathing.

CT pulmonay angiography features of a hepatopulmonary syndrome

International Nuclear Information System (INIS)

Chawla, Ashish; Gaikwad, Vishai; Dubey, Niraj; Bosco, Jerome

2015-01-01

A 59-year-old man presented a six-month history of worsening dyspnea and dry cough, and not responding to medication. There was no history of fever, hematemesis, loss of appetite, or chest pain. Physical examination revealed peripheral cyanosis and clubbing. Bibasilar crepitations were present but no murmur was auscultated. Platypnea (worsening of dyspnea in a standing position) was present. Arterial gas analysis showed a PaO2 of 52 mm when breathing ambient room air. Laboratory findings were significant for a mildly abnormal liver function test

CT pulmonay angiography features of a hepatopulmonary syndrome

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Chawla, Ashish; Gaikwad, Vishai; Dubey, Niraj; Bosco, Jerome [Dept. of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore (Singapore)

2015-08-15

A 59-year-old man presented a six-month history of worsening dyspnea and dry cough, and not responding to medication. There was no history of fever, hematemesis, loss of appetite, or chest pain. Physical examination revealed peripheral cyanosis and clubbing. Bibasilar crepitations were present but no murmur was auscultated. Platypnea (worsening of dyspnea in a standing position) was present. Arterial gas analysis showed a PaO2 of 52 mm when breathing ambient room air. Laboratory findings were significant for a mildly abnormal liver function test.

Personality and Lung Function in Older Adults.

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Terracciano, Antonio; Stephan, Yannick; Luchetti, Martina; Gonzalez-Rothi, Ricardo; Sutin, Angelina R

2017-10-01

Lung disease is a leading cause of disability and death among older adults. We examine whether personality traits are associated with lung function and shortness of breath (dyspnea) in a national cohort with and without chronic obstructive pulmonary disease (COPD). Participants (N = 12,670) from the Health and Retirement Study were tested for peak expiratory flow (PEF) and completed measures of personality, health behaviors, and a medical history. High neuroticism and low extraversion, openness, agreeableness, and conscientiousness were associated with lower PEF, and higher likelihood of COPD and dyspnea. Conscientiousness had the strongest and most consistent associations, including lower risk of PEF less than 80% of the predicted value (OR = 0.67; 0.62-0.73) and dyspnea (OR = 0.52; 0.47-0.57). Although attenuated, the associations remained significant when accounting for smoking, physical activity, and chronic diseases including cardiovascular and psychiatric disorders. The associations between personality and PEF or dyspnea were similar among those with or without COPD, suggesting that psychological links to lung function are not disease dependent. In longitudinal analyses, high neuroticism (β = -0.019) and low conscientiousness (β = 0.027) predicted steeper declines in PEF. A vulnerable personality profile is common among individuals with limited lung function and COPD, predicts shortness of breath and worsening lung function. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Clinical outcomes according to symptom presentation in patients with acute myocardial infarction: Results from the FAST-MI 2010 registry.

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Puymirat, Etienne; Aissaoui, Nadia; Bonello, Laurent; Cayla, Guillaume; Labèque, Jean-Noel; Nallet, Olivier; Motreff, Pascal; Varenne, Olivier; Schiele, François; Ferrières, Jean; Simon, Tabassome; Danchin, Nicolas

2017-12-01

Atypical clinical presentation in acute myocardial infarction (AMI) patients is not uncommon; most studies suggest that it is associated with unfavorable prognosis. Long-term clinical impact differs according to predominant symptom presentation (typical chest pain, atypical chest pain, syncope, cardiac arrest, or dyspnea) in AMI patients. FAST-MI 2010, a nationwide French registry, included 4169 patients with AMI in 213 centers at the end of 2010 (76% of active centers). Demographics, medical history, hospital management, and outcomes were compared according to predominant symptom presentation. Typical chest pain with no other symptom was reported in 3020 patients (68% in STEMI patients, 76% in NSTEMI patients). Atypical chest pain, dyspnea, syncope, and cardiac arrest were reported in 11%, 11%, 5%, and 1%, respectively. Patients with atypical clinical presentation had a higher cardiovascular risk profile and received fewer medications and a less invasive strategy. Using Cox multivariate analysis, atypical chest pain was not associated with higher death rate at 3 years (HR: 0.96, 95% CI: 0.69-1.33, P = 0.78), whereas cardiac arrest (HR: 2.44, 95% CI: 1.00-5.97, P = 0.05), syncope (HR: 1.70, 95% CI: 1.18-2.46, P = 0.005), and dyspnea (HR: 1.66, 95% CI: 1.31-2.10, P clinical presentation is observed in about 20% of AMI patients. Cardiac arrest, dyspnea, and syncope represent independent predictors of long-term mortality in STEMI and NSTEMI populations. © 2017 Wiley Periodicals, Inc.

Emergency Physicians Are Able to Detect Right Ventricular Dilation With Good Agreement Compared to Cardiology.

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Rutz, Matt A; Clary, Julie M; Kline, Jeffrey A; Russell, Frances M

2017-07-01

Focused cardiac ultrasound (FOCUS) is a useful tool in evaluating patients presenting to the emergency department (ED) with acute dyspnea. Prior work has shown that right ventricular (RV) dilation is associated with repeat hospitalizations and shorter life expectancy. Traditionally, RV assessment has been evaluated by cardiologist-interpreted comprehensive echocardiography. The primary goal of this study was to determine the inter-rater reliability between emergency physicians (EPs) and a cardiologist for determining RV dilation on FOCUS performed on ED patients with acute dyspnea. This was a prospective, observational study at two urban academic EDs; patients were enrolled if they had acute dyspnea and a computed tomographic pulmonary angiogram without acute disease. All patients had an EP-performed FOCUS to assess for RV dilation. RV dilation was defined as an RV to left ventricular ratio greater than 1. FOCUS interpretations were compared to a blinded cardiologist FOCUS interpretation using agreement and kappa statistics. Of 84 FOCUS examinations performed on 83 patients, 17% had RV dilation. Agreement and kappa, for EP-performed FOCUS for RV dilation were 89% (95% confidence interval [CI] 80-95%) and 0.68 (95% CI 0.48-0.88), respectively. Emergency physician sonographers are able to detect RV dilation with good agreement when compared to cardiology. These results support the wider use of EP-performed FOCUS to evaluate for RV dilation in ED patients with dyspnea. © 2017 by the Society for Academic Emergency Medicine.

Clinical utility of computed tomographic lung volumes in patients with chronic obstructive pulmonary disease.

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Lee, Jae Seung; Lee, Sang-Min; Seo, Joon Beom; Lee, Sei Won; Huh, Jin Won; Oh, Yeon-Mok; Lee, Sang-Do

2014-01-01

Published data concerning the utility of computed tomography (CT)-based lung volumes are limited to correlation with lung function. The aim of this study was to evaluate the clinical utility of the CT expiratory-to-inspiratory lung volume ratio (CT Vratio) by assessing the relationship with clinically relevant outcomes. A total of 75 stable chronic obstructive pulmonary disease (COPD) patients having pulmonary function testing and volumetric CT at full inspiration and expiration were retrospectively evaluated. Inspiratory and expiratory CT lung volumes were measured using in-house software. Correlation of the CT Vratio with patient-centered outcomes, including the modified Medical Research Council (MMRC) dyspnea score, the 6-min walk distance (6MWD), the St. George's Respiratory Questionnaire (SGRQ) score, and multidimensional COPD severity indices, such as the BMI, airflow obstruction, dyspnea, and exercise capacity index (BODE) and age, dyspnea, and airflow obstruction (ADO), were analyzed. The CT Vratio correlated significantly with BMI (r = -0.528, p < 0.001). The CT Vratio was also significantly associated with MMRC dyspnea (r = 0.387, p = 0.001), 6MWD (r = -0.459, p < 0.001), and SGRQ (r = 0.369, p = 0.001) scores. Finally, the CT Vratio had significant correlations with the BODE and ADO multidimensional COPD severity indices (r = 0.605, p < 0.001; r = 0.411, p < 0.001). The CT Vratio had significant correlations with patient-centered outcomes and multidimensional COPD severity indices. © 2013 S. Karger AG, Basel.

Congenital sinus cyst in a foal

International Nuclear Information System (INIS)

Sanders-Shamis, M.; Robertson, J.T.

1987-01-01

Radiography and endoscopy of a 17-day-old Standardbred foal that had right-sided facial swelling and dyspnea since birth revealed a soft tissue mass in the right nasal passage and right maxillary and frontal sinuses. A bone flap was used to expose the mass, and a fluid-filled structure was removed surgically. After surgery, the dyspnea was alleviated. The facial deformity resolved by the time the foal was 6 months old. The upper airway obstruction was absent clinically and endoscopically by the time the foal was 17 months old

Laryngeal plexiform neurofibroma in a child.

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Kasapoglu, Fikret; Ozdemircan, Talip; Erisen, Levent

2013-06-01

Neurofibromatosis (NF) is a genetically inherited, autosomal dominant disease, characterized by multiple cafe au lait spots, cutaneous neurofibromas and "Lisch nodules." Neurofibromatosis can develop from a neural source at any age. However, neurofibroma of the larynx is extremely rare and is usually manifested by obstructive airway symptoms. We encountered a 5-year-old child presenting with stridor and dyspnea, who had a diagnosis of laryngeal plexiform neurofibroma. The purpose of our report is the consideration of laryngeal NF in the differential diagnosis of dyspnea in infants and children.

Therapeutic effects of diaphragmatic plication for acquired unilateral non-malignant diaphragm paralysis in twenty patients

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Reza Bagheri

2013-12-01

Full Text Available Background: Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, (lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery, and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis. Methods: From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score (DS, etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent. Results: Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma (in 11 patients and almost occurred on the left side (in 15 patients. Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4±7 percent and the average FEV1 was 52.4±6 percent and after surgery they were 80.1±8.6 percent and 74.4±1 percent respectively. The average increase in FEV1 and FVC 63.4±4, 61.1±7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study. Conclusion: In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the

Subjective breathing impairment in unilateral vocal fold paralysis.

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Brunner, Elke; Friedrich, Gerhard; Kiesler, Karl; Chibidziura-Priesching, Jutta; Gugatschka, Markus

2011-01-01

Dysphonia is considered a major symptom of unilateral vocal fold paralysis (UVFP). Besides this, many patients complain of further symptoms such as dysphagia and dyspnea, which might not be expected to such an extent. The aim of this survey was to elucidate these symptoms in a cohort of patients with UVFP. Sixty-three patients (22 men, 41 women) suffering from UVFP were interviewed. Therefore we developed a questionnaire dealing with each of the three symptom categories: voice production, swallowing and breathing. All of the surveyed patients reported voice impairment, almost 60% complained of swallowing problems after the onset of paralysis. Seventy-five percent reported a subjectively impaired breathing sensation, not just phonatory dyspnea but during everyday physical activity as well. Our study revealed a certain discrepancy between objectively assessed laryngoscopic findings and subjective symptoms. A majority of patients suffered from an impairment in each of the three laryngeal functions (dysphonia, dysphagia and dyspnea). The latter two differ from the classic approach to this condition but must be considered as well in clinical diagnostics and therapy. Copyright © 2010 S. Karger AG, Basel.

An Unusual Transudative Pleural Effusion Succeeded by Pulmonary and Brain Edema and Death

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Sayyed Gholam Reza Mortazavimoghaddam

2012-01-01

Full Text Available Here we report a 22-year old woman with massive and bilateral transudative effusion succeeded by pulmonary edema and brain edema and death. Investigations for systemic disorders were negative. Exacerbation of dyspnea after intravenous fluid infusion was a main problem. As effusion was refractory to medical treatment, the patient was referred for surgical pleurodesis and bilateral surgical pleurodesis were done separately. Postsurgically, dyspnea exacerbation occurred after each common cold infection. Vertigo and high intracranial pressure were also a problem postsurgically. CSF pressure was 225 mm/H2O. Therapeutic lumbar puncture was done in two sequential weeks, and the patient was on acetazolamide 250 mg/trivise a day. Despite the medical treatment, progressive dyspnea, headache, and high intracranial pressure followed by death nine months after pleurodesis. As there is a gradient of pressure between pleura and CSF, after pleurodesis brain edema must be a consequence of inversing this gradient. In conclusion, when there are any abnormalities about fluid volume or pressure in any of these cavities, we have to study other cavities.

Validation of the dyspnoea-12 scale into Portuguese speaking COPD patients.

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Simsic, Aline Aparecida; Yorke, Janelle; Regueiro, Eloisa Gatti; Di Lorenzo, Valeria Pires; Baddini-Martinez, José

2018-01-08

Dyspnoea-12 assesses dyspnea based on the physical and affective components of the symptom. The aim of this study was to translate the Dyspnoea-12 into Portuguese, and to obtain validation data regarding the use of this tool in patients with chronic obstructive lung disease (COPD). The English version of the scale Dyspnoea-12 underwent a formal translation process into Portuguese as spoken in Brazil with the final version being called Dyspnoea-12-Pt. The latter was applied to 51 Portuguese-speaking patients with COPD (33 men; age: 66.4 ± 8.1 years; FEV 1 : 48.7% ± 17.2% pred). Participants also completed the Medical Research Council dyspnea scale (MRC), the Baseline Dyspnea Index (BDI), the Hospital Anxiety and Depression scale, the Saint George's Respiratory Questionnaire (SGRQ) and performed spirometry and the Six-Minute Walk Test (6 MWT). Forty-five volunteers in stable clinical conditions also completed the Dyspnoea-12-Pt scale approximately 2 weeks after the first evaluation. Dyspnoea-12-Pt showed significant correlations with the scales MRC (r = 0.494), BDI (r = -0.511), SGRQ (r = 0.806), Anxiety (r = 0.471), Depression (0.414) and walked distance in the 6 MWT (r = 0.329). Cronbach's alpha of Dyspnoea-12-Pt total was 0.921 and the intraclass correlation coefficient between sequential measures was 0.829. The scale Dyspnoea-12-Pt exhibits acceptable psychometric properties and may be used as an evaluation tool of dyspnea in Portuguese speaking COPD patients. © 2018 John Wiley & Sons Ltd.

A case of acute respiratory failure in a young man

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Fabio Di Stefano

2007-06-01

Full Text Available A 40 years old man presents with a few hours history of progressive dyspnea. He was suffering from almost a week of low grade fever. The night before the onset of dyspnea he had high fever (39,5°C, polyuria and dysuria. His blood pressure is 115/65 mmHg and his oxygen saturation while breathing ambient air is 81%. Chest auscultation reveals rales bilaterally. A chest radiography shows bilateral pulmonary infiltrates consistent with pulmonary edema. How should this patient be evaluated to establish the cause of the acute pulmonary edema and to determine appropriate therapy?

Laryngeal Chondroma: An Unusual Complication Endotracheal Entubation.

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Gökdoğan, Ozan; Koybasioglu, Ahmet; Ileri, Fikret

2016-06-01

Laryngeal cartilaginous framework tumors are very rare. Chondroma and chondrosarcoma are the most common types of these tumors. A 27-year-old man with a history of intubation presented with exercise-induced dyspnea. A computed tomography scan of larynx showed a rounded and circumscribed mass without infiltration of the adjacent structures which obstructs 75% of airway. Histopathological investigation of the mass revealed the chondroma of the larynx. The patients' history of intubation trauma with the subsequent progressive onset of clinical symptoms demonstrates the relationship between these 2 entities. Clinicians should consider laryngeal chondroma in the differential diagnosis of dyspnea after endotracheal intubation.

Evaluation of Hemodynamic Changes and Respiratory Physical Findings in Patients with Pulmonary Embolism

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Masome Rabieepour

2014-07-01

Full Text Available Introduction: Pulmonary thromboembolism (PTE is a potentially fatal disease with nonspecific symptoms and signs. Patients with Pulmonary embolism often have dyspnea, chest pain, haemoptysis, tachycardia tachypnea and respiratory physical finding including hypoxia and decreased ETCO2. Daily patients with Pulmonary embolism are very few in hospital course and we aimed to determine clinical and paraclinical findings in hospital pulmonary embolism patients. Methods: we assessed in hospital course of 104 patients with pulmonary embolism with symptom (dyspnea, chest pain, and hemoptysis and signs (tachypnea, tachycardia, DVT signs, blood pressure and respiratory physical findings (PO2, ETCO2. Results: majority of patients had risk factor for PTE; the most common was cancer. 21.2% of patients had apparent DVT in Doppler sonography. Isolated dyspnea (38%, chest pain with and without hemoptysis (60% and syncope (2% were observed in patients. Mean duration of dyspnea resolution was 3.4 days. Mean duration of chest pain resolution was 1.76 days. Mean duration of hemoptysis resolution was 2 days. 64.4% of the patients were hypoxic and mean duration of hypoxic resolution was 2.63 days. Mean duration of tachycardia resolution was 2.37 days. No relation was observed between size of PTE and mortality or hypotension and PO2. Mean ETCO2 was 23±2 mmHg and 86.5% of patients had ETCO2 lower than 28. Mean duration of ETCO2 resolution was 3.6 days. Most common physical finding that resolved later than others was ETCO2. In 32.7% of patients, ETCO2 did not resolve.   Key words: Pulmonary thromboembolism; Tachycardia; Tachypnea; Hemoptysis; Hypoxic; ETCO2

Benefits of a 7-week outpatient pulmonary rehabilitation program in COPD patients.

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Croitoru, Alina; Ioniţă, Diana; Stroescu, Carmen; Pele, Irina; Gologanu, Daniela; Dumitrescu, Andreea; Marinescu, Lucia; Anghelescu, Dana; Alexandru, Miron; Bogdan

2013-01-01

Respiratory rehabilitation programs (RR) are essential tools in the management of COPD. We present the results of a 7-week outpatient rehabilitation program in terms of dyspnea, exercise tolerance and quality of life. The following parameters were evaluated before and after RR: dyspnea (mMRC scale), pulmonary function (FEVI, RV- residual volume), exercise tolerance (6MWT- 6 minutes walk test, CPET - cardiopulmonary exercise test), quality of life (SGROQ questionnaire). The RR program was outpatient, hospital based (7 weeks, 3 sessions/ week) and included: exercise training, therapeutic education, and psychological support. 25 patients, COPD stage II-IV GOLD (mean FEVI 44.5 +/-13% predicted), mean age 60.4 +/-12 years, 7 females, average BMI 27.14+/-4 kg/m2, average RV residual volume 221.55+/-86% predicted. Mean 6MWTdistance: 407.48 +/- 84 m and mean maximum power (Pmax) obtained on CPET: 75.67+/-30 Watts. All patients were symptomatic with significant dyspnea (3.06+/-0.7 on mMRC scale) and showed a significant impairment of quality of life: SGRO score 46.23+/- 14. At the end of RR program: dyspnea decreased with 0.67points on mMRC scale (p = 0.000), 6MWT distance increased with 58.5 m (p = 0.0071), Pmax obtained during CPET increased with 11.2 W, without reaching statistical significance (p> 0.05). SGRO score decreased by 5.59 points (p = 0.02). There were no significant improvements in FEV1 and RV values (p> 0.05). In our COPD patients, the 7 week outpatient rehabilitation program was effective, leading to improvement ofsymptoms, exercise tolerance and quality of life.

Trends in funding for research on pain: a report on the National Institutes Of Health grant awards over the years 2003 to 2007.

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Bradshaw, David H; Empy, Court; Davis, Phillip; Lipschitz, David; Dalton, Peter; Nakamura, Yoshio; Chapman, C Richard

2008-12-01

In recent years, the National Institutes of Health (NIH) has experienced unprecedented reductions in its customary annual budget increases. Consequently, researchers, health care policy planners and others have a pressing need for accurate information on NIH funding patterns. We created a unique and objective system for compiling, classifying, and analyzing data on NIH grant awards and funding for research on pain, nausea, and dyspnea using naïve observers, cross-validation by multiple raters, and face validation by experts. We present results of our method and analyses for the period from 2003 to 2007. Following a 12% increase from 2003 to 2004, funding for pain research fell by 9.4% per year on average over the next 3 years. The percent of the total NIH budget going to support pain research increased to 0.78% in 2004 but fell to 0.61% in 2007. A piecewise regression model confirmed the declining trend represented a significant fit to the data (R(2)=0.98, p=0.024). Separate breakdowns by Institutes showed similar patterns. Analyses of nausea and dyspnea research support revealed small but steady increases over the same period. Declining support for pain research disproportionate to decreases in the NIH budget signals a need for measures to promote funding for meritorious applications. Results of 5 year trends in numbers of grants and funding for research in pain, nausea, and dyspnea by the NIH show overall declines for pain but slight increases for nausea and dyspnea. Declining support for pain research that exceeds the reductions in the total NIH budget signals a need for measures to increase pain research funding.

Novel strategy of stents in thyroid mass: a case series report of managing severely dyspneic patients

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Bhandari A

2017-10-01

Full Text Available Adheesh Bhandari,* Ying-hao Wang,* Shi-xu Lv, Er-jie Xia, Ou-Chen Wang Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China *These authors contributed equally to this work Background: Tracheal and bronchial stenosis is a life-threatening condition causing difficulty in breathing and even severe respiratory distress. The silicone tracheobronchial stents were placed using the rigid bronchoscopy into the trachea of severe dyspneic patients and they exhibited symptomatic improvement as well as a rise in the saturation of oxygen. The bronchial stents were applicable to many extensive malignant airway stenosis patients, such as those with esophageal cancer, lung cancer, and laryngeal cancer. But the effectiveness of bronchial stents for thyroid cancer is not certain.Case presentation: Here, we report 3 emergency patients with a thyroid mass referred to our hospital because of grade 4 dyspnea according to the American Thoracic Society shortness of breath guidelines. The main clinical symptoms were severe dyspnea and stridor. The radiographic examination and tomographic examination showed the narrowing and displacement of the trachea. To the best of our knowledge, ideal airway management for the massive thyroid mass was considered to be temporary tracheobronchial stent placement pre-operation.Conclusion: In our study, we applied the tracheobronchial stent to massive thyroid mass patients with dyspnea and aimed to not only improve preoperative airway obstruction but also to protect the potential airway collapse from post-operative tracheomalacia following extubation. We found that application of tracheobronchial stents may provide a new strategy to dyspneic patients with huge thyroid mass. Keywords: tracheobronchial stents, airway management, tracheal stenosis, dyspnea

Respiratory muscle function and exercise limitation in patients with chronic obstructive pulmonary disease: a review.

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Charususin, Noppawan; Dacha, Sauwaluk; Gosselink, Rik; Decramer, Marc; Von Leupoldt, Andreas; Reijnders, Thomas; Louvaris, Zafeiris; Langer, Daniel

2018-01-01

Respiratory muscle dysfunction is common and contributes to dyspnea and exercise limitation in patients with chronic obstructive pulmonary disease (COPD). Improving dynamic function of respiratory muscles during exercise might help to reduce symptoms and improve exercise capacity. Areas covered: The aims of this review are to 1) summarize physiological mechanisms linking respiratory muscle dysfunction to dyspnea and exercise limitation; 2) provide an overview of available therapeutic approaches to better maintain load-capacity balance of respiratory muscles during exercise; and 3) to summarize current knowledge on potential mechanisms explaining effects of interventions aimed at optimizing dynamic respiratory muscle function with a special focus on inspiratory muscle training. Expert commentary: Several mechanisms which are potentially linking improvements in dynamic respiratory muscle function to symptomatic and functional benefits have not been studied so far in COPD patients. Examples of underexplored areas include the study of neural processes related to the relief of acute dyspnea and the competition between respiratory and peripheral muscles for limited energy supplies during exercise. Novel methodologies are available to non-invasively study these mechanisms. Better insights into the consequences of dynamic respiratory muscle dysfunction will hopefully contribute to further refine and individualize therapeutic approaches in patients with COPD.

Successful surgical treatment of a suspected iatrogenic arytenoid cartilage fracture in a dog.

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Doran, Ivan; White, Robert N

2009-01-01

A 3-year-old, intact female golden retriever was presented with a sudden onset of inspiratory obstructive dyspnea following general anesthesia to perform a mastectomy. The cuneiform process of the left arytenoid cartilage was found to be extremely mobile on laryngeal examination. Fracture of the cuneiform process of the left arytenoid cartilage was diagnosed. A combined cricoarytenoid and thyroarytenoid caudolateralization procedure was performed on the left side, and no further dyspnea was observed during a follow-up period of 7 months. Fracture of the cuneiform process of the arytenoid cartilage has not been previously reported in dogs. The condition may respond favorably to cricoarytenoid and thyroarytenoid caudolateralization surgery.

[Pleuro-peritoneal shunt in a patient with intractable pleural effusion after cardiac surgery].

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Tsuji, Maiko; Yamazaki, Takenori

2014-10-01

A 45-year-old man experienced dyspnea on effort and was hospitalized due to severe mitral valve regurgitation and atrial fibrillation. He also had alcoholic cirrhosis. After he was stabilized, mitral valve plasty and Maze procedure were performed. The postoperative clinical course was satisfactory. During the follow-up period, he began to suffer from persistent left pleural effusion, which amounted to about 2,500 to 3,000 ml, and required intercostal tube drainage weekly. Therefore a pleuro-peritoneal shunt was implanted. The pleural effusion decreased, and he obtained significant relief from dyspnea. After one year, we confirmed that pleural effusion had not reoccurred, and removed the pleuro-peritoneal shunt.

DYSPNEA ASSOCIATED WITH ANXIETY: MISTAKES AND DIFFICULTIES IN THE DIAGNOSIS

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L. I. Tyukalova

2013-01-01

Full Text Available Two clinical cases that demonstrate the difficulties diagnosing the causes of shortness of breath, coupled with anxiety, are analyzed. From the standpoint of modern neurophysiology it explains the relationship of these conditions. There were revealed typical diagnostic mistakes: «the effect of precocious focusing", "the negative effect of the narrow specialization

The effect of irradiation on lung function and perfusion in patients with lung cancer

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Abratt, Raymond P.; Willcox, Paul A.

1995-01-01

Purpose: To prospectively study the changes in lung function in patients with lung carcinoma treated with relatively high doses of irradiation. Methods and Materials: Lung function was assessed prior to and at 6 and 12 months following radiation therapy by a clinical dyspnea score, formal pulmonary function tests (lung volume spirometry and diffusion capacity) as well as an ipsilateral hemithorax lung perfusion scan. Changes in dyspnea score were evaluated by the chi-square and the Fishers exact test. Changes in formal lung function tests were compared with the t-test for dependent data and correlations with the t-test for independent data. Fifty-one patients were entered into the study. There were 42 evaluable patients at 6 months after irradiation and 22 evaluable patients at 12 months after irradiation. Results: A worsening of dyspnea score from 1 to 2, which is clinically acceptable, occurred in 50% or more of patients. However, a dyspnea score of 3, which is a serious complication, developed in only 5% of patients. The diffusion capacity (DLCO) decreased by 14% at 6 months and 12% at 12 months) (p < 0.0001). The forced vital capacity and total lung capacity decreased between 6% and 8% at 6 month and 12 months, which was statistically significant. The forced expiratory volume in 1 s decreased between 2 and 3% at 6 month and 12 months, which was not statistically significant. The ipsilateral hemithorax perfusion decreased by 17 and 20% at 6 and 12 months (p < 0.0001). There was no correlation between the initial hemithorax perfusion, or its decrease at follow up and the decrease in DLCO. Conclusion: Lung irradiation results in some loss of lung function in patients with lung cancer with a projected survival of 6 months or more. The pretreatment DLCO assessment should be useful in predicting clinical tolerance to irradiation

Active smoking and COPD phenotype: distribution and impact on prognostic factors

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Riesco JA

2017-07-01

Full Text Available Juan Antonio Riesco,1,2 Bernardino Alcázar,3 Juan Antonio Trigueros,4 Anna Campuzano,5 Joselín Pérez,5 José Luis Lorenzo5 1Pulmonology Department, Hospital San Pedro de Alcántara, 2Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES, Cáceres, 3Pulmonology Department, Hospital La Loja, Granada, 4Centro de Salud de Menasalvas, Toledo, 5Grupo Ferrer Internacional, Barcelona, Spain Purpose: Smoking can affect both the phenotypic expression of COPD and factors such as disease severity, quality of life, and comorbidities. Our objective was to evaluate if the impact of active smoking on these factors varies according to the disease phenotype. Patients and methods: This was a Spanish, observational, cross-sectional, multicenter study of patients with a diagnosis of COPD. Smoking rates were described among four different phenotypes (non-exacerbators, asthma-COPD overlap syndrome [ACOS], exacerbators with emphysema, and exacerbators with chronic bronchitis, and correlated with disease severity (body mass index, obstruction, dyspnea and exacerbations [BODEx] index and dyspnea grade, quality of life according to the COPD assessment test (CAT, and presence of comorbidities, according to phenotypic expression. Results: In total, 1,610 patients were recruited, of whom 46.70% were classified as non-exacerbators, 14.53% as ACOS, 16.37% as exacerbators with emphysema, and 22.40% as exacerbators with chronic bronchitis. Smokers were predominant in the latter 2 groups (58.91% and 57.67%, respectively, P=0.03. Active smoking was significantly associated with better quality of life and a higher dyspnea grade, although differences were observed depending on clinical phenotype. Conclusion: Active smoking is more common among exacerbator phenotypes and appears to affect quality of life and dyspnea grade differently, depending on the clinical expression of the disease. Keywords: COPD, phenotype, smoking, prognostic factors, quality of life 

Revisiting 'Respiratory Function in Emphysema in Relation to Prognosis'

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David V Bates

2000-01-01

Full Text Available BACKGROUND: The 1956 paper by DV Bates, JMS Knott and RV Christie, "Respiratory function in emphysema in relation to prognosis" Quart J Med 1956;97:137-157 is largely reprinted with a commentary by the first author, Dr David Bates. Although the pathology of emphysema was well recognized at the time, the clinical diagnosis and assessment of its severity were known to be imprecise; physiological measurements assessing and following the clinical course had not been established. The study aimed to follow systematically a group of patients, selected by clinical criteria using standardized clinical and physiological techniques, over four years and correlate physiological and clinical changes in relation to prognosis and eventually to postmortem findings. Fifty-nine patients were recruited to an emphysema clinic at St Bartholomew's Hospital, London, England. Inclusion criteria were dyspnea without other causes and no cor pulmonale present. Patients' symptoms were assessed by a standardized questionnaire, and measurements were taken of lung volumes, maximal ventilatory volume, carbon monoxide diffusing capacity at rest, exercise and oxygen saturation by oximetry.  During the four years of the study, 17 patients died (actuarial expected - four and 13 presented with signs of pulmonary heart failure. All postmortem examinations (n=9 showed advanced emphysema. A seasonal variation in dyspnea was established (the period included the infamous 1952 London smog. Four patients improved, and the remainder were unchanged or deteriorated. Close relationships were shown between dyspnea and function results, particularly for the diffusing capacity of lungs for carbon monoxide (DLCO. A comparison among a group of patients with chronic bronchitis without dyspnea showed that the DLCO discriminated between them. A loss of the normal increase in DLCO during exercise was shown in emphysema.

Dietary pattern and health-related quality of life among breast cancer survivors.

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Kim, Na-Hui; Song, Sihan; Jung, So-Youn; Lee, Eunsook; Kim, Zisun; Moon, Hyeong-Gon; Noh, Dong-Young; Lee, Jung Eun

2018-05-10

There is limited evidence for the association between dietary pattern and quality of life among breast cancer survivors. We examined the association between dietary patterns and health-related quality of life (HRQoL) among Korean breast cancer survivors. Our study included a total of 232 women, aged 21 to 79 years, who had been diagnosed with stage I to III breast cancer and who underwent breast cancer surgery at least 6 months prior to our baseline evaluation. We assessed HRQoL using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the Quality of Life Questionnaire Breast Cancer Module 23 (QLQ-BR23). We conducted a factor analysis to identify the major dietary patterns and used a generalized linear model to obtain the least squares mean (LS mean) and 95% confidence interval (CI) for HRQoL according to the dietary pattern scores. We identified 2 major dietary patterns: the Healthy dietary pattern and the Western dietary pattern. We found that breast cancer survivors who had higher Healthy dietary pattern scores tended to have lower dyspnea scores but higher insomnia scores, compared to breast cancer survivors with lower Healthy dietary pattern scores. For dyspnea, the LS mean (95% CI) was 8.86 (5.05-15.52) in the bottom quartile and 2.87 (1.62-5.08) in the top quartile (p for trend = 0.005). This association was limited to survivors with stage I for dyspnea or survivors with stage II or III for insomnia. Healthy dietary patterns were associated with better scores for dyspnea but worse scores for insomnia among breast cancer survivors. Other components of EORTC QLQ did not vary by dietary patterns overall, but they warrant further investigation for subgroups of breast cancer survivors.

Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction.

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Walsted, Emil S; Faisal, Azmy; Jolley, Caroline J; Swanton, Laura L; Pavitt, Matthew J; Luo, Yuan-Ming; Backer, Vibeke; Polkey, Michael I; Hull, James H

2018-02-01

Exercise-induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly understood. The objective of this study was to evaluate exercise-related changes in laryngeal aperture on ventilation, pulmonary mechanics, and respiratory neural drive. We prospectively evaluated 12 subjects (6 with EILO and 6 healthy age- and gender-matched controls). Subjects underwent baseline spirometry and a symptom-limited incremental exercise test with simultaneous and synchronized recording of endoscopic video and gastric, esophageal, and transdiaphragmatic pressures, diaphragm electromyography, and respiratory airflow. The EILO and control groups had similar peak work rates and minute ventilation (V̇e) (work rate: 227 ± 35 vs. 237 ± 35 W; V̇e: 103 ± 20 vs. 98 ± 23 l/min; P > 0.05). At submaximal work rates (140-240 W), subjects with EILO demonstrated increased work of breathing ( P respiratory neural drive ( P respiratory mechanics and diaphragm electromyography with endoscopic video, we demonstrate, for the first time, increased work of breathing and respiratory neural drive in association with the development of EILO. Future detailed investigations are now needed to understand the role of upper airway closure in causing exertional dyspnea and exercise limitation. NEW & NOTEWORTHY Exercise-induced laryngeal obstruction is a prevalent cause of exertional dyspnea in young individuals; yet, how laryngeal closure affects breathing is unknown. In this study we synchronized endoscopic video with respiratory physiological measurements, thus providing the first detailed commensurate assessment of respiratory mechanics and neural drive in relation to laryngeal closure. Laryngeal closure was associated with increased work of breathing and respiratory neural drive preceded by an

[Efficacy of systemic glucocorticoids combined with inhaled steroid on children with acute laryngitis].

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Chen, Q P; Zhou, R F; Zhang, Y M; Yang, L

2018-01-07

Objective: To evaluate the efficacy of systemic glucocorticoid (steroid) combined with high dose inhaled steroid in the treatment of children with acute laryngitis. Methods: A total of 78 children with acute laryngitis were randomly divided into study group( n =40) and control group( n =38) between November 2016 and April 2017. In addition to routine treatment of anti infection and symptomatic treatment, Dexamethasone injection(0.3-0.5 mg/kg, 1-3 d, according to the patient's condition) was provided to each group. In addition to the treatment mentioned above, the study group were assigned to receive 1.0 mg Budesonide suspension for inhalation, oxygen-driven atomizing inhalation, every/30 minutes, 2 times in a row, after that every 12 hours. The improvement of inspiratory dyspnea, hoarseness, barking cough and wheezing of both groups was evaluated at 30 min, 1 h, 2 h, 6 h, 12 h, 24 h and 72 h after treatment.Sigmaplot 11.5 software was used to analyze the data. Results: No significant difference was detected in terms of inspiratory dyspnea, hoarseness, barking cough or stridor score before treatment between the two groups( P >0.05). Compared with those before treatment, symptoms of inspiratory dyspnea, hoarseness, barking cough and stridor score of both groups improved markedly at 12 h and 24 h after treatment( P dyspnea, hoarseness, barking cough or stridor score at each time point after treatment between the two groups( P >0.05). The effective rate was 92.50% and 92.11% in study group and control group, respectively, and no significant difference was noted ( P >0.05). Conclusion: Compared with single systemic glucocorticoid, systemic glucocorticoids combined with inhaled steroid possessed similar efficacy in treating acute laryngitis and relieving laryngeal obstruction of children.

Comparison of intermittent positive pressure breathing and temporary positive expiratory pressure in patients with severe chronic obstructive pulmonary disease.

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Nicolini, Antonello; Mollar, Elena; Grecchi, Bruna; Landucci, Norma

2014-01-01

Results supporting the use and the effectiveness of positive expiratory, pressure devices in chronic obstructive pulmonary disease (COPD) patients are still controversial, We have tested the hypothesis that adding TPEP or IPPB to standard pharmacological therapy may provide additional clinical benefit over, pharmacological therapy only in patients with severe COPD. Fourty-five patients were randomized in three groups: a group was treated; with IPPB,a group was treated with TPEP and a group with pharmacological; therapy alone (control group). Primary outcome measures included the measurement of scale or, questionnaire concerning dyspnea (MRC scale),dyspnea,cough, and, sputum (BCSS) and quality of life (COPD assessment test) (CAT). Secondary, outcome measures were respiratory function testing,arterial blood gas,analysis,and hematological examinations. Both patients in the IPPB group and in the TPEP group showed a significant, improvement in two of three tests (MRC,CAT) compared to the control, group.However,in the group comparison analysis for, the same variables between IPPB group and TPEP group we observed a, significant improvement in the IPPB group (P≤.05 for MRC and P≤.01 for, CAT). The difference of action of the two techniques are evident in the results of, pulmonary function testing: IPPB increases FVC, FEV1, and MIP; this reflects, its capacity to increase lung volume. Also TPEP increases FVC and FEV1 (less, than IPPB), but increases MEP, while decreasing total lung capacity and, residual volume. The two techniques (IPPB and TPEP) improves significantly dyspnea; quality of; life tools and lung function in patients with severe COPD. IPPB demonstrated a greater effectiveness to improve dyspnea and quality of life tools (MRC, CAT) than TPEP. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

Dimensión respiratoria de la escala ALSFRS-R y la función respiratoria en la esclerosis lateral amiotrófica Respiratory domain of revised amyotrophic lateral sclerosis: Functional Rating Scale

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Sandra E. Lima

2009-10-01

Full Text Available Virtualmente todos los pacientes con esclerosis lateral amiotrófica tendrán disnea, que es quizá el síntoma más penoso de esta devastadora enfermedad. El objetivo de este estudio fue correlacionar la dimensión respiratoria de la escala ALSFRS-R, la capacidad vital forzada y las presiones estáticas máximas bucales. Se estudiaron prospectivamente 20 pacientes consecutivos sin disnea durante 24 meses. El puntaje total de la escala ALSFRS-R disminuyó de 34.3 ± 10.3 a 22.1 ± 8.0 (p = 0.0325; la contribución de la dimensión respiratoria fue insignificante. En quienes refirieron disnea (n: 12, la capacidad vital forzada cayó un 41 ± 21 % del valor inicial pero con similar caída (46 ± 23%, 8 pacientes no refirieron disnea. La correlación entre la escala ALSFRS-R con la capacidad vital forzada (litros fue r: 0.73, (p = 0.0016 y con la presión inspiratoria máxima (cm H2O, r: 0.84, p = 0.0038. La correlación entre la capacidad vital forzada (% con la disnea fue r s: 0.23, p = 0.1400. La correlación de la disnea con la presión inspiratoria máxima (% fue r s: 0.58, p = 0.0300 y con la presión espiratoria máxima (%, r s: 0.49, p = 0.0400. La dimensión respiratoria de la escala ALSFRS-R no permitió predecir el grado de deterioro funcional respiratorio. Esto sugiere que dicha dimensión no reemplaza a las mediciones funcionales respiratorias y, debido a que la insuficiencia respiratoria puede no ser evidente, la realización de dichas pruebas provee una base objetiva de seguimiento y permite planear medidas con anticipación.Virtually all patients with amyotrophic lateral sclerosis will complain of dyspnea, which is perhaps the most distressing symptom of this devastating disease. The objective was to correlate respiratory domain of ALSFRS-R with forced vital capacity and maximal static pressures in the mouth. We designed a prospective study in 20 consecutive patients without dyspnea during 24 months. The global decline of ALSFRS

Delayed vocal fold paralysis after continuous interscalene level brachial plexus block with catheter placement: a case report.

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Gollapalli, Lakshman; McKelvey, George; Wang, Hong

2014-08-01

We report an incident of delayed onset of true vocal fold paralysis with continuous interscalene brachial plexus block. A 51 year old woman underwent left shoulder manipulation and lysis of adhesions with fluoroscopy and general anesthesia. An interscalene brachial plexus block was performed and a catheter with a continuous infusion pump was placed for postoperative pain control. Following hospital discharge, approximately 8 hours after the initial catheter bolus the patient developed hoarseness, dysphagia, and dyspnea, secondary to left vocal fold palsy. The patient was admitted for observation and the catheter was discontinued with no intubation required. By the next morning, the patient's dysphagia and dyspnea had resolved and her hoarseness improved. Copyright © 2014. Published by Elsevier Inc.

Respiratory Consequences of Mild-to-Moderate Obesity: Impact on Exercise Performance in Health and in Chronic Obstructive Pulmonary Disease

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Denis E. O'Donnell

2012-01-01

Full Text Available In many parts of the world, the prevalence of obesity is increasing at an alarming rate. The association between obesity, multiple comorbidities, and increased mortality is now firmly established in many epidemiological studies. However, the link between obesity and exercise intolerance is less well studied and is the focus of this paper. Although exercise limitation is likely to be multifactorial in obesity, it is widely believed that the respiratory mechanical constraints and the attendant dyspnea are important contributors. In this paper, we examined the evidence that critical ventilatory constraint is a proximate source of exercise limitation in individuals with mild-to-moderate obesity. We first reviewed existing information on exercise performance, including ventilatory and perceptual response patterns, in obese individuals who are otherwise healthy. We then considered the impact of obesity in patients with preexisting respiratory mechanical abnormalities due to chronic obstructive pulmonary disease (COPD, with particular reference to the effect on dyspnea and exercise performance. Our main conclusion, based on the existing and rather sparse literature on the subject, is that abnormalities of dynamic respiratory mechanics are not likely to be the dominant source of dyspnea and exercise intolerance in otherwise healthy individuals or in patients with COPD with mild-to-moderate obesity.

Acute lung affection in an endurance-trained man under amiodarone medication

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Saurbier, Bernward

2005-06-01

Full Text Available Patients undergoing treatment with amiodarone can develop severe pulmonary side effects. This effect, which is often highly underestimated, can lead to dyspnea, pneumonitis, and further fibrosis. A recent change in the labeling of amdiodarone by the American Food and Drug Administration (FDA supports this suspicion. Tracing the symptoms back to the causing agent can be difficult, as shown in our report. The subject of this case report is an endurance-trained 65 year old male marathon runner who appeared with atrial fibrillation during a routine check up in autumn 2003. After medical cardioversion with flecainide a complaint free interval of 8 months was followed by a relapse, which resulted in a change of medication to amiodarone. Due to misunderstandings the patient kept on taking the amiodarone loading dose for six weeks and returned with severe dyspnea on exertion. Losses in CO diffusing capacity, a lowered macrophages count and a positive lymphocyte transformation test were the only first hand clinical evidence of amiodarone intoxication, despite the sensation of dyspnea. This case shows that special care has to be taken in treatment with amiodarone. Side effects can be hard to trace and do not evidently show a clear connection to amiodarone.

Development of acute pulmonary hypertension after bortezomib treatment in a patient with multiple myeloma: a case report and the review of the literature.

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Akosman, Cengiz; Ordu, Cetin; Eroglu, Elif; Oyan, Basak

2015-01-01

Bortezomib is widely used in treatment of multiple myeloma. In recent years, severe bortezomib-induced lung injury has been reported. The clinical course is generally characterized with fever and dyspnea, followed by respiratory failure with pulmonary infiltrates. Herein, we report a 57-year-old man with newly diagnosed multiple myeloma admitted with dyspnea, fever, and hypotension on the third day of the first dose of bortezomib therapy. He had bilateral jugular venous distention, crackles at the bases of the lungs and hepatomegaly. Transthoracic echocardiography revealed acute pulmonary hypertension (PH) with an estimated pressure of 70 mm Hg. The perfusion scintigraphy ruled out pulmonary embolism, and microbiological examination was negative. On his course, fever, dyspnea, hypoxia, and pulmonary vascular pressure subsided rapidly. The sudden onset of PH and its rapid decrement without any treatment suggests bortezomib as the underlying cause. Subsequently, the patient did not respond to vincristine-doxorubicin-dexamethasone regimen and thalidomide. Bortezomib treatment was repeated, and no pulmonary adverse reactions occurred. Follow-up echocardiographies revealed pulmonary arterial pressures to be maximally of 35 mm Hg. To our knowledge, this is the first case of acute PH after front-line bortezomib therapy. In this report, we review bortezomib-related pulmonary complications in the literature and possible underlying mechanisms.

The efficacy of balneotherapy and physical modalities on the pulmonary system of patients with fibromyalgia.

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Kesiktas, Nur; Karagülle, Zeki; Erdogan, Nergis; Yazıcıoglu, Kamil; Yılmaz, Hurriyet; Paker, Nurdan

2011-01-01

Effects of balneotherapy on Primary Fibromyalgia Syndrome (FMS) have been studied well, except for its effect on the respiratory symptoms of FMS. In this study we allocated 56 patients with FMS into three groups who matched according to age, gender and duration of illness. All three groups received the same three physical therapy modalities (PTM): transcutaneous electrical nerve stimulation (TENS), ultrasound (US) and infrared (IR). The first group received PTM plus balneotherapy (PTM+BT), the second group received PTM alone (PTM), whilst the third group received PTM plus hydrotherapy (PTM+HT). All groups were treated for three weeks and in the same season. All patients were assessed at four time points: (a) at baseline, (b) on the 7th day of therapy, (c) at the end of therapy (after 3 weeks) and (d) at 6 months after the end of therapy. The effectiveness of treatments in all groups were evaluated in three main categories (pain, depressive and respiratory symptoms). Tender point count, total algometric measurements and pain with visual analog scale for pain; Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) for depression; dyspnea scale, and spirometric measurements for respiratory symptoms; plus quality of life with visual analog scale as a general measurement of effectiveness were taken at all four assessment time points.Both at the end of therapy and at the 6 months follow up significant improvements in dyspnea scale, and spirometric measurements, as well as in other measured parameters were observed in group PTM+BT. All groups achieved significant improvements in BDI and HDRS but scores of PTM and PTM+HT groups had overturned at 6 months follow up. Except second group which receieved PTM alone, pain evaluation assessments were improved at 6 month follow up in PTM+HT and PTM+BT groups. But PTM+BT group had more significant improvements at the end of therapy. PTM group had no significant change for dyspnea scale and spirometric

Breathing exercises as adjuvant in the management of COPD : An overview

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Kant S

2006-01-01

Full Text Available COPD is the most common chronic lung disease. It is a major cause of chronic morbidity, mortality and health care used throughout the world and resulting in an economic and social burden that is both substantial and increasing also in our country. Pharmacotherapy alone does not optimize and have limited role in im-proving dyspnea, exercise limitation and quality of life which are characteristic and troublesome features of COPD. Breathing exercises are popular among patients, physician and physiotherapist and has been shown to improve efficiency of ventila-tion and exercise performance. But the efficacy of breathing exercises in relieving dyspnea varies greatly among patients. True values of these techniques have not yet been formally established, though they would seem to have intrinsic merit.

CME 2850.indd

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(MMRC) Dyspnea Scale or the COPD Assessment Test (CAT); and ... and a lower incidence of pneumonia in ... Symptoms. Excercise tolerance. HRQL. ECOPD. Prognosis. Systemic e ects ... increased incidence of community-acquired.

A case of anaphylactoid reaction to acetate in acetate-containing bicarbonate dialysate.

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Misaki, Taro; Suzuki, Yumiko; Naito, Yoshitaka; Shiooka, Tempei; Isozaki, Taisuke

2015-05-01

A 35-year-old man with end-stage kidney disease due to chronic glomerulonephritis was admitted to our hospital to start maintenance hemodialysis (HD). One hour after starting the first session of HD, he experienced general pruritus, urticaria, and dyspnea. Signs and symptoms were resolved by discontinuing HD and administrating an antihistamine drug; HD-associated anaphylactoid reactions were therefore suspected. Over the next few HD sessions, we changed the dialysis membrane, anticoagulant, HD circuit and needle, in that order, but general pruritus and urticaria again appeared within 3 h after starting each session of HD. Finally, when we changed the dialysate from acetate-containing bicarbonate dialysate to acetate-free bicarbonate dialysate, urticaria was clearly less than that seen in previous HD sessions, and subsided after discontinuation of HD. Subsequently, 20 mg of oral prednisolone (PSL) was administered 1 h before starting HD, and the patient did not experience general pruritus, urticaria, or dyspnea after starting the session. When administered acetate-containing bicarbonate dialysate after oral PSL pretreatment, the patient again experienced general pruritus, urticaria and dyspnea. Few reports have been published on the occurrence of anaphylactoid reactions during HD using acetate dialysate. We report a rare case of anaphylactoid reactions with acetate in acetate-containing bicarbonate dialysate that were reduced with the use of acetate-free bicarbonate dialysate and oral PSL pretreatment.

Comparison of Different Disease-Specific Health-Related Quality of Life Measurements in Patients with Long-Term Noninvasive Ventilation

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Toru Oga

2017-01-01

Full Text Available Background. Two disease-specific questionnaires have been developed to assess health-related quality of life (HRQL in patients with chronic respiratory failure: the Severe Respiratory Insufficiency (SRI Questionnaire and the Maugeri Respiratory Failure (MRF Questionnaire. We aimed to compare the characteristics of the SRI, MRF-26, and St. George’s Respiratory Questionnaire (SGRQ for use in patients with home noninvasive ventilation (NIV. Methods. Fifty-six outpatients receiving long-term NIV were recruited and underwent assessments of pulmonary function, arterial blood gas, HRQL, dyspnea, and psychological status. Results. Correlations of the SRI and MRF-26 with the SGRQ were modest. While pulmonary function was weakly related to only some domains of the SRI and MRF-26, the modified Medical Research Council (mMRC dyspnea scale and Hospital Anxiety and Depression Scale (HADS were significantly related to all domains of the SRI and MRF-26. Multiple regression analyses showed that HADS depression and mMRC accounted for 34% and 27% of the variance in the SRI, 24% and 37% in the MRF-26, and 17% and 46% in the SGRQ, respectively. Conclusions. The SRI and MRF-26 were reliable questionnaires for patients receiving long-term NIV. Dyspnea and psychological status were their main common determinants. The SRI covers more psychological health impairments than the MRF. This trial is registered with ClinicalTrials.gov Identifier: NCT00905476.

Novel strategy of stents in thyroid mass: a case series report of managing severely dyspneic patients.

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Bhandari, Adheesh; Wang, Ying-Hao; Lv, Shi-Xu; Xia, Er-Jie; Wang, Ou-Chen

2017-01-01

Tracheal and bronchial stenosis is a life-threatening condition causing difficulty in breathing and even severe respiratory distress. The silicone tracheobronchial stents were placed using the rigid bronchoscopy into the trachea of severe dyspneic patients and they exhibited symptomatic improvement as well as a rise in the saturation of oxygen. The bronchial stents were applicable to many extensive malignant airway stenosis patients, such as those with esophageal cancer, lung cancer, and laryngeal cancer. But the effectiveness of bronchial stents for thyroid cancer is not certain. Here, we report 3 emergency patients with a thyroid mass referred to our hospital because of grade 4 dyspnea according to the American Thoracic Society shortness of breath guidelines. The main clinical symptoms were severe dyspnea and stridor. The radiographic examination and tomographic examination showed the narrowing and displacement of the trachea. To the best of our knowledge, ideal airway management for the massive thyroid mass was considered to be temporary tracheobronchial stent placement pre-operation. In our study, we applied the tracheobronchial stent to massive thyroid mass patients with dyspnea and aimed to not only improve preoperative airway obstruction but also to protect the potential airway collapse from post-operative tracheomalacia following extubation. We found that application of tracheobronchial stents may provide a new strategy to dyspneic patients with huge thyroid mass.

Benefits of pulmonary rehabilitation in patients with COPD and normal exercise capacity.

Science.gov (United States)

Lan, Chou-Chin; Chu, Wen-Hua; Yang, Mei-Chen; Lee, Chih-Hsin; Wu, Yao-Kuang; Wu, Chin-Pyng

2013-09-01

Pulmonary rehabilitation (PR) is beneficial for patients with COPD, with improvement in exercise capacity and health-related quality of life. Despite these overall benefits, the responses to PR vary significantly among different individuals. It is not clear if PR is beneficial for patients with COPD and normal exercise capacity. We aimed to investigate the effects of PR in patients with normal exercise capacity on health-related quality of life and exercise capacity. Twenty-six subjects with COPD and normal exercise capacity were studied. All subjects participated in 12-week, 2 sessions per week, hospital-based, out-patient PR. Baseline and post-PR status were evaluated by spirometry, the St George's Respiratory Questionnaire, cardiopulmonary exercise test, respiratory muscle strength, and dyspnea scores. The mean FEV1 in the subjects was 1.29 ± 0.47 L/min, 64.8 ± 23.0% of predicted. After PR there was significant improvement in maximal oxygen uptake and work rate. Improvements in St George's Respiratory Questionnaire scores of total, symptoms, activity, and impact were accompanied by improvements of exercise capacity, respiratory muscle strength, maximum oxygen pulse, and exertional dyspnea scores (all P exercise after PR. Exercise training can result in significant improvement in health-related quality of life, exercise capacity, respiratory muscle strength, and exertional dyspnea in subjects with COPD and normal exercise capacity. Exercise training is still indicated for patients with normal exercise capacity.

Immediate effect of manual therapy on respiratory functions and inspiratory muscle strength in patients with COPD

Directory of Open Access Journals (Sweden)

Yilmaz Yelvar GD

2016-06-01

Full Text Available Gul Deniz Yilmaz Yelvar,1 Yasemin Çirak,2 Yasemin Parlak Demir,3 Murat Dalkilinç,1 Bülent Bozkurt4 1Department of Musculoskeletal Physiotherapy, 2Department of Cardiopulmonary Physiotherapy, 3Department of Neurological Rehabilitation, School of Physiotherapy and Rehabilitation, 4Department of Respiratory Medicine, Faculty of Medicine, Turgut Özal University, Ankara, Turkey Objective: The objective of this study was to investigate the immediate effect of manual therapy (MT on respiratory functions and inspiratory muscle strength in patients with COPD.Participants and methods: Thirty patients with severe COPD (eight females and 22 males; mean age 62.4±6.8 years referred to pulmonary physiotherapy were included in this study. The patients participated in a single session of MT to measure the short-term effects. The lung function was measured using a portable spirometer. An electronic pressure transducer was used to measure respiratory muscle strength. Heart rate, breathing frequency, and oxygen saturation were measured with a pulse oximeter. For fatigue and dyspnea perception, the modified Borg rating of perceived exertion scale was used. All measurements were taken before and immediately after the first MT session. The ease-of-breathing visual analog scale was used for rating patients’ symptoms subjectively during the MT session.Results: There was a significant improvement in the forced expiratory volume in the first second, forced vital capacity, and vital capacity values (P<0.05. The maximal inspiratory pressure and maximal expiratory pressure values increased significantly after MT, compared to the pre-MT session (P<0.05. There was a significant decrease in heart rate, respiratory rate (P<0.05, and dyspnea and fatigue perception (P<0.05.Conclusion: A single MT session immediately improved pulmonary function, inspiratory muscle strength, and oxygen saturation and reduced dyspnea, fatigue, and heart and respiratory rates in patients with

Mediastinal lymphadenopathy in congestive heart failure: a sequential CT evaluation with clinical and echocardiographic correlations

International Nuclear Information System (INIS)

Chabbert, Valerie; Canevet, Guillaume; Otal, Philippe; Joffre, Francis; Baixas, Cecile; Galinier, Michel; Deken, Valerie; Duhamel, Alain; Remy, Jacques; Remy-Jardin, Martine

2004-01-01

The aim of this study was to evaluate the frequency and evolution after treatment of mediastinal lymphadenopathy associated with congestive left heart failure on CT scans in correlation with clinical and echocardiographic findings. Thirty-one consecutive patients with subacute left heart failure underwent a clinical evaluation using the NYHA classification, a CT examination, and transthoracic echocardiography at the time of initial presentation (T1). After initiation of medical treatment (T2), follow-up CT scans were systematically obtained together with a clinical evaluation. At T1, all patients showed severe (type III: n=12, 39%; type IV: n=12, 39%) to moderate (type I, n=1, 3%; type II, n=6, 19%) dyspnea with a mean ejection fraction of 39% (range 22-74%). On initial CT scans, enlarged mediastinal lymph nodes were seen in 13 patients (42%) with blurred contours in 5 patients (16%) and hazy mediastinal fat in 1 patient (3%). Significant decrease in the size of lymphadenopathy was observed between T1 and T2 (T1, n=13, 42% vs T2, n=10, 32%; p<0.05) with a concurrent decrease in the severity of dyspnea (grade III-IV dyspnea at T1, n=24, 78% vs grade I-II dyspnea at T2, n=26, 83.5%). Patients with enlarged lymph nodes at T1 showed: (a) a significantly lower ejection fraction at echocardiography than those without lymphadenopathy (mean±SD value: 34±12.9 vs 43±13.8%; p=0.04); (b) a significantly larger diameter of the right superior pulmonary vein (mean±SD value: 17±2.75 vs 14±3.9 mm; p=0.04); and (c) a higher frequency of abnormal peribronchovascular thickening (n=5 vs n=1; p=0.06). Mediastinal lymphadenopathy associated with subacute left heart failure was observed in 13 patients (42%), showing regression after initiation of treatment in 8 of 13 patients (62%). (orig.)

The effects of high intensity exercise during pulmonary rehabilitation on ventilatory parameters in people with moderate to severe stable COPD: a systematic review

Directory of Open Access Journals (Sweden)

Osterling K

2014-10-01

Full Text Available Kristin Osterling,1 Kimbly MacFadyen,1 Robert Gilbert,2 Gail Dechman1 1School of Physiotherapy, 2School of Health Sciences, Dalhousie University, Halifax, NS, Canada Objective: The objective of this systematic review was to determine whether people with moderate to severe COPD who are participating in pulmonary rehabilitation and exercising at high intensity demonstrate the changes in ventilatory parameters that are associated with decreased dyspnea. Data sources: The authors searched EMBASE, The Cochrane Library, and CINAHL databases up to December 2013 for relevant randomized control trials, systematic reviews, and observational studies. References of identified studies were also screened. Study selection: Studies conducted in a pulmonary rehabilitation setting that included education and exercise were included. Symptom-limited, graded exercise testing that measured tidal volume, respiratory rate, minute ventilation, and inspiratory capacity was required. The studies that contained these keywords in the title or the abstract were selected for further evaluation of the text. Disagreements between reviewers were resolved by consensus. Four studies met these inclusion criteria. Data extraction: Quality assessment and data extraction were performed independently by two reviewers. Risk of bias and quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Data synthesis: Participants in three studies trained at high intensity (70%–80% maximum workload, demonstrating statistically significant changes in tidal volume and respiratory rate. One study did not demonstrate positive ventilatory benefits; however, participants may not have met the desired training intensity. Two studies reported improvement in dyspnea at submaximal exercise intensities. One study noted an increased maximum workload with no significant change in dyspnea at peak exercise. Conclusion: People with moderate to severe, stable COPD were able

Mediastinal lymphadenopathy in congestive heart failure: a sequential CT evaluation with clinical and echocardiographic correlations

Energy Technology Data Exchange (ETDEWEB)

Chabbert, Valerie; Canevet, Guillaume; Otal, Philippe; Joffre, Francis [Department of Radiology, University of Toulouse, Avenue Jean-Poulhes, 31403, Toulouse (France); Baixas, Cecile; Galinier, Michel [Department of Cardiology, University of Toulouse, Avenue Jean-Poulhes, 31403, Toulouse (France); Deken, Valerie; Duhamel, Alain [Department of Medical Statistics, University of Lille, Place de Verdun, 59037, Lille Cedex (France); Remy, Jacques; Remy-Jardin, Martine [Department of Radiology, Hospital Calmette, University Center of Lille, Boulevard Jules Leclerc, 59037, Lille Cedex (France)

2004-05-01

The aim of this study was to evaluate the frequency and evolution after treatment of mediastinal lymphadenopathy associated with congestive left heart failure on CT scans in correlation with clinical and echocardiographic findings. Thirty-one consecutive patients with subacute left heart failure underwent a clinical evaluation using the NYHA classification, a CT examination, and transthoracic echocardiography at the time of initial presentation (T1). After initiation of medical treatment (T2), follow-up CT scans were systematically obtained together with a clinical evaluation. At T1, all patients showed severe (type III: n=12, 39%; type IV: n=12, 39%) to moderate (type I, n=1, 3%; type II, n=6, 19%) dyspnea with a mean ejection fraction of 39% (range 22-74%). On initial CT scans, enlarged mediastinal lymph nodes were seen in 13 patients (42%) with blurred contours in 5 patients (16%) and hazy mediastinal fat in 1 patient (3%). Significant decrease in the size of lymphadenopathy was observed between T1 and T2 (T1, n=13, 42% vs T2, n=10, 32%; p<0.05) with a concurrent decrease in the severity of dyspnea (grade III-IV dyspnea at T1, n=24, 78% vs grade I-II dyspnea at T2, n=26, 83.5%). Patients with enlarged lymph nodes at T1 showed: (a) a significantly lower ejection fraction at echocardiography than those without lymphadenopathy (mean{+-}SD value: 34{+-}12.9 vs 43{+-}13.8%; p=0.04); (b) a significantly larger diameter of the right superior pulmonary vein (mean{+-}SD value: 17{+-}2.75 vs 14{+-}3.9 mm; p=0.04); and (c) a higher frequency of abnormal peribronchovascular thickening (n=5 vs n=1; p=0.06). Mediastinal lymphadenopathy associated with subacute left heart failure was observed in 13 patients (42%), showing regression after initiation of treatment in 8 of 13 patients (62%). (orig.)

Effects of aerobic training combined with respiratory muscle stretching on the functional exercise capacity and thoracoabdominal kinematics in patients with COPD: a randomized and controlled trial

Directory of Open Access Journals (Sweden)

Wada JT

2016-10-01

Full Text Available Juliano T Wada,1 Erickson Borges-Santos,1 Desiderio Cano Porras,1 Denise M Paisani,1 Alberto Cukier,2 Adriana C Lunardi,1 Celso RF Carvalho1 1Department of Physical Therapy, 2Department of Cardiopneumology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil Background: Patients with COPD present a major recruitment of the inspiratory muscles, predisposing to chest incoordination, increasing the degree of dyspnea and impairing their exercise capacity. Stretching techniques could decrease the respiratory muscle activity and improve their contractile capacity; however, the systemic effects of stretching remain unknown.Objective: The aim of this study was to evaluate the effects of aerobic training combined with respiratory muscle stretching on functional exercise capacity and thoracoabdominal kinematics in patients with COPD.Design: This study was a randomized and controlled trial.Participants: A total of 30 patients were allocated to a treatment group (TG or a control group (CG; n=15, each group.Intervention: The TG was engaged in respiratory muscle stretching and the CG in upper and lower limb muscle stretching. Both groups performed 24 sessions (twice a week, 12 weeks of aerobic training.Evaluations: Functional exercise capacity (6-minute walk test, thoracoabdominal kinematics (optoelectronic plethysmography, and respiratory muscle activity (surface electromyography were evaluated during exercise. Analysis of covariance was used to compare the groups at a significance level of 5%.Results: After the intervention, the TG showed improved abdominal (ABD contribution, compartmental volume, mobility, and functional exercise capacity with decreased dyspnea when compared with the CG (P<0.01. The TG also showed a decreased respiratory muscle effort required to obtain the same pulmonary volume compared to the CG (P<0.001.Conclusion: Our results suggest that aerobic training combined with respiratory muscle stretching increases the functional

[Role of gastroesophageal reflux in acute recurrent laryngeal dyspnea in children].

Science.gov (United States)

Andrieu-Guitrancourt, J; Dehesdin, D; Le Luyer, B; Fouin, M; Peron, J M

1984-01-01

Recurrent laryngeal croup (RLC) in children is rarely discussed unless permanent laryngeal obstruction is involved or there is an allergic basis. An atypical case is described where gastro-esophageal reflux (GER) was not only associated with but was also directly related to the provocation of each period. A series of 15 patients with RLC were investigated for the presence of GER, and this was confirmed in 7 cases. These findings suggest that GER may be responsible for the onset of RLC, as is now admitted for numerous respiratory manifestations in children. Moreover, GER may be implicated in the course of various laryngeal obstructive lesions, particularly subglottic angioma.

Case report: An interesting case of large colloid goiter with dyspnea

Directory of Open Access Journals (Sweden)

Jaya Prakasha Mayya

2017-12-01

Full Text Available Benign nodular goitre is one of the most common endocrine disorder, especially in countries like Nepal where iodine deficiency is endemic. Case History: A 59 years old female presented with large thyroid swelling. Investigations showed it to be colloid goiter compressing the airway. Left hemithyroidectomy was done. Post operative period was uneventful.Discussion: Management of thyroid nodules depends upon assessment of thyroid function, fine needle aspiration cytology and imaging. Surgery is the common method of treatment.   

Management of COPD in general practice in Denmark--participating in an educational program substantially improves adherence to guidelines

DEFF Research Database (Denmark)

Ulrik, Charlotte Suppli; Hansen, Ejvind Frausing; Jensen, Michael Skov

2010-01-01

for registration of smoking status (69% to 85%), BMI (8% to 40%), severity of dyspnea (Medical Research Council) (7% to 38%), and FEV(1)/FVC ratio (28% to 58%) (P counseling, inhalator technique, physical...

Shortness of Breath

Science.gov (United States)

... Resources Evaluation of Chronic Dyspnea by NG Karnani, GM Reisfield, GR Wilson( 04/15/05, http://www. ... Injury Prevention Crisis Situations Pets and Animals myhealthfinder Food and Nutrition Healthy Food Choices Weight Loss and ...

Effects of inspiratory muscle training on dynamic hyperinflation in patients with COPD

Directory of Open Access Journals (Sweden)

Petrovic M

2012-11-01

Full Text Available Milos Petrovic,1 Michael Reiter,2 Harald Zipko,3 Wolfgang Pohl,1 Theodor Wanke11Pulmonary Department and Karl Landsteiner Institute for Clinical and Experimental Pulmology, Hietzing Hospital, Vienna, Austria; 2Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria; 3FH Campus Vienna, University of Applied Sciences – Health Department, Vienna, AustriaAbstract: Dynamic hyperinflation has important clinical consequences in patients with chronic obstructive pulmonary disease (COPD. Given that most of these patients have respiratory and peripheral muscle weakness, dyspnea and functional exercise capacity may improve as a result of inspiratory muscle training (IMT. The aim of the study was to analyze the effects of IMT on exercise capacity, dyspnea, and inspiratory fraction (IF during exercise in patients with COPD. Daily inspiratory muscle strength and endurance training was performed for 8 weeks in 10 patients with COPD GOLD II and III. Ten patients with COPD II and III served as a control group. Maximal inspiratory pressure (Pimax and endurance time during resistive breathing maneuvers (tlim served as parameter for inspiratory muscle capacity. Before and after training, the patients performed an incremental symptom limited exercise test to maximum and a constant load test on a cycle ergometer at 75% of the peak work rate obtained in the pretraining incremental test. ET was defined as the duration of loaded pedaling. Following IMT, there was a statistically significant increase in inspiratory muscle performance of the Pimax from 7.75 ± 0.47 to 9.15 ± 0.73 kPa (P < 0.01 and of tlim from 348 ± 54 to 467 ± 58 seconds (P < 0.01. A significant increase in IF, indicating decreased dynamic hyperinflation, was observed during both exercise tests. Further, the ratio of breathing frequency to minute ventilation (bf/V'E decreased significantly, indicating an improved breathing pattern. A significant decrease in

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: Report of two cases.

Science.gov (United States)

García-Fontán, Eva; Blanco Ramos, Montserrat; García, Jose Soro; Carrasco, Rommel; Cañizares, Miguel Ángel; González Piñeiro, Ana

2018-05-19

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disorder characterized by a proliferation of neuroendocrine cells within the lung. It is classically described as a disease with persistent cough, dyspnea and wheezing in non-smoker middle aged females. CT of the chest reveals diffuse air trapping with mosaic pattern. We present two cases of DIPNECH that were sent to our department to perform a lung biopsy with the diagnostic suspicion of diffuse interstitial disease. Both cases were women with a history of chronic cough and moderate effort dyspnea. The aim of this paper is that physicians take into account this diagnostic entity before treating as an asthmatic a patient with these characteristics, not forgetting that they are prenoplastic lesions. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Two cases of false aneurysm rupture induced by nonvascular tumor

International Nuclear Information System (INIS)

Nakamura, Hiromasa; Komiya, Tatsuhiko; Tamura, Nobushige; Sakaguchi, Genichi; Kobayashi, Taira; Furukawa, Tomokuni; Matsushita, Akihito; Sunagawa, Gengo; Murashita, Takashi

2008-01-01

We presented here 2 cases of rare nonvascular tumor involving the aorta. A 69-year-old woman. She presented leg edema and dyspnea on admission. Computed tomography revealed abdominal aortic aneurysm perforating left common iliac vein. Abdominal aortic aneurysm replacement and fistula closure were done on an emergency basis. Immunohistologic examination revealed that malignant mesothelioma invaded the aortic wall. A 47-year-old woman presented with dyspnea. Enhanced computed tomography revealed rupture of the descending aortic aneurysm (saccular type). Aortic replacement was done on an emergency basis. One year after the operation, computed tomography revealed a giant mass (160 x 70 mm) surrounding the descending thoracic aorta. On biopsy, malignant schwannoma was found to invade the descending aorta. Sometimes nonvascular tumors form aneurysms. So we should be careful in diagnosis before operation. (author)

Acute eosinophilic pneumonia: a case report

Energy Technology Data Exchange (ETDEWEB)

Jung, Gyoo; Sik; Oh, Kyung Seung; Kim, Jong Min; Huh, Jin Do; Joh, Young Duk; Jang, Tae Won; Jung, Man Hong [Kosin Medical College, Busan (Korea, Republic of)

1995-10-15

Acute eosinophilic pneumonia is one of a recently described idiopathic eosinophilic lung disease, which differs from chronic eosinophilic pneumonia. Patients with acute eosinophilic pneumonia develop acute onset of dyspnea, hypoxemia, diffuse pulmonary infiltrates and pleural effusion on chest radiograph, and show an increase in number of eosinophils in bronchoalveolar lavage fluid or lung biopsy specimen. Prompt and complete response to corticosteroid therapy without any recurrence is characteristically seen in patient with this disease. Although the etiology of acute eosinophilic pneumonia is not known, it has been suggested to be related to a hypersensitivity phenomenon to an unidentified inhaled antigen. We report four cases of acute eosinophilic pneumonia presented with acute onset of dyspnea, diffuse pulmonary infiltrates on chest radiograph, and eosinophilia in bronchoalveolar lavage fluid in previously healthy adults.

Acute eosinophilic pneumonia: a case report

International Nuclear Information System (INIS)

Jung, Gyoo; Sik; Oh, Kyung Seung; Kim, Jong Min; Huh, Jin Do; Joh, Young Duk; Jang, Tae Won; Jung, Man Hong

1995-01-01

Acute eosinophilic pneumonia is one of a recently described idiopathic eosinophilic lung disease, which differs from chronic eosinophilic pneumonia. Patients with acute eosinophilic pneumonia develop acute onset of dyspnea, hypoxemia, diffuse pulmonary infiltrates and pleural effusion on chest radiograph, and show an increase in number of eosinophils in bronchoalveolar lavage fluid or lung biopsy specimen. Prompt and complete response to corticosteroid therapy without any recurrence is characteristically seen in patient with this disease. Although the etiology of acute eosinophilic pneumonia is not known, it has been suggested to be related to a hypersensitivity phenomenon to an unidentified inhaled antigen. We report four cases of acute eosinophilic pneumonia presented with acute onset of dyspnea, diffuse pulmonary infiltrates on chest radiograph, and eosinophilia in bronchoalveolar lavage fluid in previously healthy adults

Determinants of health-related quality of life in patients with small cell lung cancer: a systematic PubMed review and meta-analysis

Directory of Open Access Journals (Sweden)

Aristomenis Kossioris

2016-03-01

Conclusions ― Health professionals could pay more attention to the management of cancer-related fatigue and dyspnea as well as to the enhancement of patients’ mobility through low-impact exercise programs or appropriate assistive devices.

Gastric sarcoidosis in children: A case report and review of the ...

African Journals Online (AJOL)

Sherif A. Sadek

2013-03-07

Mar 7, 2013 ... Corticosteroid therapy was started and the symptoms aba- ted almost .... of a dry hacking cough, with or without dyspnea. Bilateral hi- ... Visual symptoms such as eye pain, blurry vision, photophobia, ... Oral prednisolone. 324.

Monitoring changes in quality of life in patients with lung cancer under treatment with chemotherapy and co administration of zoledronic acid by using specialized questionnaires.

Science.gov (United States)

Tremmas, Ioannis; Petsatodis, George; Potoupnis, Michael; Laskou, Stella; Giannakidis, Dimitrios; Mantalovas, Stylianos; Koulouris, Charilaos; Katsaounis, Athanasios; Pavlidis, Efstathios; Amaniti, Aikaterini; Huang, Haidong; Bai, Chong; Shi, Dongchen; Dardas, Athanasios; Zarogoulidis, Paul; Sardeli, Chrisanthi; Konstantinou, Fotis; Katsikogiannis, Nikolaos; Zarogoulidis, Konstantinos; Karapantzos, Ilias; Karapantzou, Chrysanthi; Shen, Xiaping; Kesisoglou, Isaak; Sapalidis, Konstantinos

2018-01-01

Background: Due to the severity of the primary disease in patients with lung cancer, quality of life (QoL) is often overlooked. Factors that form QoL should be taken in consideration when planning the appropriate treatment and determining therapy targets, because of the increasing frequency of bone metastasis leading to high levels of pain. Purpose of this study is to assess quality of life in patients with lung cancer, before and after treatment combined with zoledronic acid. Methods and materials: QoL was assessed in 80 patients (49 males-31 females), of which 45 developed bone metastasis. Prior and post treatment (with co administration of zoledronic acid) seven reliable scales: Pittsburgh Sleep Quality index (PSQI), Epworth Sleeping Scale (ess), Dyspnea Scale (ds), Fatigue Severity Scale (FSS), Brief Pain Inventory (BPI), Fact-G scale for sleep quality and EQ-5D for general health condition. Results: Statistically positive correlations were verified between PSQI-DS, PSQI-FSS, BPI-ESS, DS-FSS, DS-BPI and BPI-FSS (pbetterment in quality of life was marked (p<0,001). Although significant decrease in fatigue levels was observed (p<0,001) there has been an increase in dyspnea symptoms (p<0,001). Conclusions: Significant improvement was apparent when zoledronic acid was co administered in any treatment in patients with lung cancer. Sleep quality, fatigue and pain parameters also improved, with no positive impact on the symptoms of dyspnea.

Fibromyalgia as a cause of uncontrolled asthma: a case-control multicenter study.

Science.gov (United States)

Martinez-Moragon, Eva; Plaza, Vicente; Torres, Isabel; Rosado, Ana; Urrutia, Isabel; Casas, Xavier; Hinojosa, Belen; Blanco-Aparicio, Marina; Delgado, Julio; Quirce, Santiago; Sabadell, Carles; Cebollero, Pilar; Muñoz-Fernández, Ana

2017-12-01

Fibromyalgia can affect the control of asthma when both diseases are present in a single patient. To characterize asthma in patients with concomitant fibromyalgia to assess whether fibromyalgia is an independent factor of asthma severity that influences poor asthma control. We also evaluated how dyspnea is perceived by patients in order to demonstrate that alterations in the perception of airway obstruction may be responsible for poor asthma control. This was a cross-sectional case-control multicenter study, in which 56 patients in the asthma and fibromyalgia group were matched to 36 asthmatics by sex, approximate age, and asthma severity level. All patients were women. Study variables included the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), the Nijmegen hyperventilation syndrome questionnaire, the Hospital Anxiety and Depression Scale, and perception of dyspnea after acute bronchoconstriction. Although patients in both study groups showed similar asthma severity and use of anti-asthmatic drugs, patients in the asthma and fibromyalgia group showed lower scores on the ACT and MiniAQLQ questionnaires, and higher scores of anxiety and depression as well as hyperventilation compared to asthma patients without fibromyalgia. All these differences were statistically significant. Fibromyalgia in patients with asthma influences poor control of the respiratory disease and is associated with altered perception of dyspnea, hyperventilation syndrome, high prevalence of depression and anxiety, and impaired quality of life. Fibromyalgia may be considered a risk factor for uncontrolled asthma in patients suffering from asthma and fibromyalgia concomitantly.

[Argon plasma coagulation combined with cryotherapy via bronchoscopy for the treatment of one child with severe post-intubation tracheal stenosis and literature review].

Science.gov (United States)

Zhou, Kuo; Liang, Jun; Cui, Ai-hua; Fu, Ai-xia; Yang, Qiao-zhi

2013-10-01

To observe the short term effect of argon plasma coagulation (APC) combined with cryotherapy via bronchoscopy for treatment of severe post-intubation tracheal stenosis in a child. A 3-year old boy was admitted for cephalothorax abdominal compound trauma and dyspnea, who had severe post-incubation tracheal stenosis. The agreement about the operation risk was signed by the parents. Endotracheal APC procedure was performed with a bronchoscope under general anesthesia. The APC probe was put into the working channel of the bronchoscope. The stenotic lesion was endoscopically visualized and then coagulated by argon plasma. Such coagulation was carried out several times at the stenotic site until it gradually became dilated. The devitalized tissue was mechanically removed with grasping forceps. Thereafter, bronchoscopic cryosurgery was repeatedly performed at the stenotic site. Clinical symptoms, signs and bronchoscopic manifestations were observed right after operation, after 1 day, 10 days, 1 month and 6 months separately. Tracheal tissue hyperplasia and cyanosis disappeared, laryngeal stridor and dyspnea improved obviously right after the operation. General condition of the patient was well, there was no laryngeal stridor and dyspnea 10 days after operation. The mucosa of the surgical site was smooth and no tracheostenosis was seen under bronchoscope at 1 month and 6 months after the operation. Argon plasma coagulation combined with cryotherapy via bronchoscope is an effective method to treat tracheal stenosis of children, which needs further exploration for the application.

Symptoms in Advanced Cancer Patients in a Greek Hospital: a Descriptive Study

Science.gov (United States)

Lavdaniti, Maria; Fradelos, Evangelos C; Troxoutsou, Konstantina; Zioga, Efrosini; Mitsi, Dimitroula; Alikari, Victoria; Zyga, Sofia

2018-04-27

Background: Advanced cancer patients experience several physical or psychological symptoms which require palliative care for alleviation. Purpose: To assess the prevalence and intensity of symptoms among cancer patients receiving palliative care in a Greek hospital and to examine the association between reported symptoms and social clinical and demographic characteristics. Material-methods: This descriptive research was conducted during a sixmonth period using a convenient sample of 123 advanced cancer patients. All participants were assessed for their symptoms using the Edmonton Symptom Assessment System (ESAS) with a questionnaire covering demographic and clinical characteristics. Results: The mean age was 63.8± 10.8 years, with lung and breast (58.5% and 11.4%, respectively) as the most common primary cancer types. The most severe symptoms were fatigue, sleep disturbance, dyspnea, depression and anxiety. Negative correlations were revealed between age and the following symptoms: pain (r = -0.354, p = 0.001), fatigue (r = -0.280, p = 0.002), nausea (r = -0.178, p = 0.049), anorexia (r = -0.188, p = 0.038), dyspnea (r = -0.251, p = 0.005), and depression (r = -0.223, p = 0.013). Advanced breast cancer patients scored higher in pain, fatigue and dyspnea compared to those with other cancers. Conclusions: Hospitalized cancer patients in Greece experience several symptoms during the last months of their life. These are influenced by demographic characteristics. Appropriate interventions are strongly advised with appropriate recognition and evaluation of symptoms by health professionals. Creative Commons Attribution License

Comparison of Multiple Chronic Obstructive Pulmonary Disease (COPD) Indices in Chinese COPD Patients.

Science.gov (United States)

Zhang, Jinsong; Miller, Anastasia; Li, Yongxia; Lan, Qinqin; Zhang, Ning; Chai, Yanling; Hai, Bing

2018-04-01

Chronic obstructive pulmonary disease (COPD) is a serious chronic condition with a global impact. Symptoms of COPD include progressive dyspnea, breathlessness, cough, and sputum production, which have a considerable impact on the lives of patients. In addition to the human cost of living with COPD and the resulting death, COPD entails a huge economic burden on the Chinese population, with patients spending up to one-third of the average family income on COPD management in some regions is clinically beneficial to adopt preventable measures via prudent COPD care utilization, monetary costs, and hospitalizations. Toward this end, this study compared the relative effectiveness of six indices in predicting patient healthcare utilization, cost of care, and patient health outcome. The six assessment systems evaluated included the three multidimensional Body mass index, Obstruction, Dyspnea, Exercise capacity index, Dyspnea, Obstruction, Smoking, Exacerbation (DOSE) index, and COPD Assessment Test index, or the unidimensional measures that best predict the future of patient healthcare utilization, cost of care, and patient health outcome among Chinese COPD patients. Multiple linear regression models were created for each healthcare utilization, cost, and outcome including a single COPD index and the same group of demographic variables for each of the outcomes. We conclude that the DOSE index facilitates the prediction of patient healthcare utilization, disease expenditure, and negative clinical outcomes. Our study indicates that the DOSE index has a potential role beyond clinical predictions. Copyright©2018. The Korean Academy of Tuberculosis and Respiratory Diseases.

Hermansky-Pudlak syndrome

Directory of Open Access Journals (Sweden)

Preena A

2017-04-01

Full Text Available Hermansky-Pudlak syndrome is a rare autosomal recessive multisystem disease, with oculocutneous albinism, pulmonary fibrosis and bleeding diathesis. Here we report a case of Hermansky-Pudlak syndrome who presented with dyspnea, oculocutaneous albinism and nystagmus.

Computed Tomography of Prosthetic Heart Valves

NARCIS (Netherlands)

Habets, J.

2012-01-01

Prosthetic heart valve (PHV) dysfunction is an infrequent but potentially life-threatening disease with a heterogeneous clinical presentation. Patients with PHV dysfunction clinically can present with symptoms of congestive heart failure (dyspnea, fatigue, edema), fever, angina pectoris, dizziness

Novel Deletion of SLC34A2 in Chinese Patients of PAM Shares ...

Indian Academy of Sciences (India)

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very slowly, with progressive functional respiratory deficiency, asthenia, and tiredness. ... to hospital with progressive dyspnea in the past three years without any other ... including complete exon 5 and part of intron4 and intron5 (Fig 2B).

IDENTIFICATION OF SPONTANEOUS FELINE IDIOPATHIC PULMONARY FIBROSIS: MORPHOLOGY AND ULTRASTRUCTURAL EVIDENCE FOR A TYPE II PNEUMOCYTE DEFECT

Science.gov (United States)

AbstractIdiopathic pulmonary fibrosis currently lacks an animal model that develops the persistent, progressive lung fibrosis characteristic of the disease. Sixteen domestic cats developed dyspnea that was not responsive to therapy and which rapidly progressed until death/eu...

Seronegative neuromyelitis optica presenting with life-threatening respiratory failure.

Science.gov (United States)

Nardone, Raffaele; Zuccoli, Giulio; Brigo, Francesco; Trinka, Eugen; Fitzgerald, Ryan T

2016-11-01

Dyspnea has rarely been reported as a presenting symptom in patients with neuromyelitis optica (NMO). We report an unusual case of NMO relapse presenting with rapidly progressive respiratory failure and briefly discuss the possible pathophysiological mechanisms of this potential life-threatening complication of NMO. The 58-year-old woman with a history of bilateral optic neuritis presented to the emergency department with rapidly worsening dyspnea. Cervical spine magnetic resonance imaging showed extensive abnormal signal with involvement of the medulla oblongata. Since in our patient chest radiography failed to disclose a diaphragmatic palsy that is commonly observed in patients with phrenic nerve involvement, this acute manifestation of the disease may be attributed to brainstem involvement instead of cervical myelitis. Clinicians should be aware of this atypical presentation of NMO, which needs to be promptly recognized and aggressively treated.

Treatment outcome in performance status 2 advanced NSCLC patients administered platinum-based combination chemotherapy

DEFF Research Database (Denmark)

Helbekkmo, Nina; Aasebø, Ulf; Sundstrøm, Stein H

2008-01-01

BACKGROUND: There is no consensus regarding chemotherapy to patients with advanced NSCLC (ANSCLC) and performance status (PS) 2. Using data from a national multicenter study comparing two third-generation carboplatin-based regimens in ANSCLC patients, we evaluated the outcome of PS 2 patients....... PATIENTS AND METHODS: The 123 PS 2 patients were compared to 309 PS 0/1 patients regarding survival, quality of life (QOL) and treatment toxicity. RESULTS: PS 2 patients had lower haemoglobin, lower global QOL and more pain, nausea/vomiting and dyspnea at inclusion. 68% of PS 2 patients received three...... chemotherapy courses vs. 85% in the PS 0/1 group (PPS 2 group, 4.5 vs. 8.9 months and 10% vs. 37% (PPS 2 patients needed blood transfusions (P=0.03) and hospitalization (PPS 2 patients had better relief of pain and dyspnea...

Medical Aspects of Harsh Environments. Volume 2

Science.gov (United States)

2002-01-01

dyspnea, dysphagia , syncope, shock, and unconsciousness. Signs include crepitus under the skin, faint heart sounds, paraly- sis of the recurrent...Complete or fixed second-degree heart block Wolf- Parkinson -White syndrome with paroxys- mal atrial tachycardia or syncope Exercise induced

Left Ventricular Systolic Function Assessed by Global Longitudinal Strain is Impaired in Atrial Fibrillation Compared to Sinus Rhythm

DEFF Research Database (Denmark)

Agner, Bue Fridolin Ross; Katz, Michael G; Williams, Zachary R

2018-01-01

Background: Atrial fibrillation (AF) is the most common aberrant cardiac arrhythmia. Many AF patients present with symptoms of dyspnea and fatigue, but have normal left ventricular ejection fraction (LVEF). Purpose: To determine the reproducibility of measurements of global longitudinal strain (GLS...

Echocardiographic features of an atypical presentation of rapidly progressive cardiac amyloidosis

NARCIS (Netherlands)

Brugts, Jasper J; Houtgraaf, Jaco; Hazenberg, Bouke P C; Kofflard, Marcel Jm

2013-01-01

We present the case of a 66 year old male who presented with dyspnea and reduced exercise tolerance. Echocardiography demonstrated impaired left ventricular (LV) function and restrictive diastolic function with pronounced concentric left ventricular hypertrophy (LVH) without a history of

The Military Deployment Human Exposure Assessment Study (MDHEXAS): Blood and Urine Exposure Biomarkers as Environmental Surveillance Tools for Assessing Military Personnel Exposure to Chemicals During Deployment to Camp McGovern, Bosnia

Science.gov (United States)

2003-01-01

dysp = Dyspnea euph = euphoria excitement = excited fib = fibrosis flush face = flush face ftg = fatigue Head = Headache Gidd = giddiness inco...nausea Neck = neck ache nose = irritated nose Pallor Pulm edema= pulmonar y edema Resp sys = Respiratory System skin = irritated skin som = somnolence

Mise au point

African Journals Online (AJOL)

Case -repart : We report a case of pregnant women who was admitted for compressive goiter with laryngeal dyspnea, which required emergency total thyroidectomy. Conclusion: Urgent thyroidectomy in pregnant women can be performed if we respect the precautions. Keywords: goiter, pregnancy, thyroidectomy.

La prise en charge d'un goitre compressif chez une femme enceinte ...

African Journals Online (AJOL)

Case -report : We report a case of pregnant women who was admitted for compressive goiter with laryngeal dyspnea, which required emergency total thyroidectomy. Conclusion: Urgent thyroidectomy in pregnant women can be performed if we respect the precautions. Keywords: goiter, pregnancy, thyroidectomy.

Chest wall deformity and respiratory distress in a 17-year-old patient with achondroplasia: CT and MRI evaluation

Energy Technology Data Exchange (ETDEWEB)

Herman, T.E.; Siegel, M.J.; McAlister, W.H. (Washington Univ. School of Medicine, St. Louis, MO (United States). Mallinckrodt Inst. of Radiology)

1992-06-01

A marked thoracic deformity associated with intrathoracic tracheal narrowing was seen in a 17-year old with achondroplasia and dyspnea. The role of chest deformity and its evaluation by CT and MRI in achondroplastic patients with respiratory symptoms are considered. (orig.).

Chest wall deformity and respiratory distress in a 17-year-old patient with achondroplasia: CT and MRI evaluation

International Nuclear Information System (INIS)

Herman, T.E.; Siegel, M.J.; McAlister, W.H.

1992-01-01

A marked thoracic deformity associated with intrathoracic tracheal narrowing was seen in a 17-year old with achondroplasia and dyspnea. The role of chest deformity and its evaluation by CT and MRI in achondroplastic patients with respiratory symptoms are considered. (orig.)

[Discordance between mitral valve area (MVA) and pressure gradient in patients with mitral valve stenosis: mean transmitral valve gradient is a severity index or a tolerance index of severity of mitralss valve stenosis?

Science.gov (United States)

Najih, Hayat; Arous, Salim; Laarje, Aziza; Baghdadi, Dalila; Benouna, Mohamed Ghali; Azzouzi, Leila; Habbal, Rachida

2016-01-01

Rheumatic mitral valve stenosis (MVS) is a frequent valvulopathy in developing countries. However, industrialized countries have seen the emergence of new etiologies of MVS in recent years, in particular drug-induced and/or toxic valvular regurgitation and stenosis. For this reason, the echocardiographic assessment of MVS and especially the definition of objective diagnostic criteria for severe MVS remains relevant. The objectives are: to determine whether there is a direct causal link between mean transmitral gradient (MTG) and severity of MVS in patients with severe MVS or true severe MVS (primary criterion); to analyze different parameters determining mean transmitral gradient (MTG) (secondary criterion). We conducted a single-center cross-sectional study including all patients with severe or true severe MVS admitted to the Department of Cardiology, University Hospital Ibn Rushd, Casablanca over a period of one year (January 2014-December 2014). We analyzed data from two groups of patients separately: those with a mean transmitral gradientgradient>10mmHg (group 2). 50 patients with severe or true severe MVS have been included in the study. The average age of our patients was 41.7 years with a female predominance (sex ratio 0,25). 64% of patients had severe MVS and 36% of patients had true severe MVS. 52% (26 patients) had MTG gradient> 10mmHg, suggesting no direct correlation between the severity of MVS and MTG (Pearson's correlation coefficient R: -0,137). With regards to dyspnea, 80% of patients of group 1 had stage II NYHA dyspnea (classification system) and 70% of patients of group 2 had stage III NYHA dyspnea (41%) or IV NYHA dyspnea (29%), which means that there was a significant correlation between MTG and the severity of dyspnea (R: 0,586 and p: 0,001). The analytical study of heart rate and the presence of cardiac decompensation compared with mean gradient transmitral showed a significant correlation. Indeed, among patients in group 1, 96% had HR

Clinical management practices adopted by physiotherapists in India for chronic obstructive pulmonary disease: A national survey

Directory of Open Access Journals (Sweden)

Aripta Jingar

2013-01-01

Full Text Available Background and Objective: Evidence supports the use of pulmonary rehabilitation in the treatment of chronic obstructive pulmonary disease (COPD patients both during acute exacerbation and at later stages. It is used in India; but, to date, there has been no study that has investigated the structure of pulmonary rehabilitation programs for COPD patients in India. The recent study aims to determine the current practice patterns of Indian Physiotherapists for COPD patients admitted in Intensive Care Units (ICUs and wards in terms of assessment and treatment. Materials and Methods: A questionnaire-based survey was conducted across India. Questionnaires were distributed to around 800 physiotherapists via E-mail. Physiotherapists with a Master Degree and a specialization in cardiopulmonary science or a minimum of 1 year of experience in treating cardiopulmonary patients were included. The questionnaires addressed assessment measures and treatment techniques given to COPD patients. Results: A total of 342 completed questionnaires were received, yielding a response rate of 43.8%, with a majority of responses from Karnataka, Maharashtra and Gujarat. The assessment and treatment techniques used were almost similar between ICUs and wards. More than 80% of the responders carried out the assessment of certain respiratory impairments in both ICUs and wards. An objective measure of dyspnea was taken by less than 40% of the responders, with little attention given to functional exercise capacity and health-related quality of life. Eighty-five percent of the responders used Dyspnea-relieving strategies and traditional airway clearance techniques in both ICUs and wards. Eighty-three percent of the responders were giving patients in the wards training for upper and lower extremity. Fifty percent were giving strength training in the wards. Conclusion: Whether patients are admitted in ICUs or Wards, the practice pattern adopted by Physiotherapists to treat them vary

Contribution of Respiratory Muscle Oxygen Consumption to Breathing Limitation and Cyspnea

Directory of Open Access Journals (Sweden)

Pere Casan

1997-01-01

Full Text Available During exercise, the sustainable activity of large muscle groups is limited by oxygen delivery. The purpose of this study was to see whether the oxygen consumption of the respiratory muscles reaches a similar critical value under maximal resistive loading and hyperventilation. A secondary objective was to see whether dyspnea (estimated discomfort experienced with breathing using the Borg 0-10 scale and the oxygen consumption of the respiratory muscles are closely related across conditions. This would be expected if intramuscular sensory nerve fibres stimulated as a consequence of metabolic events contributed to this sensation. In six normal subjects the respiratory muscles were progressively activated by the addition of incremental inspiratory resistive loads to a maximum of 300 cm H20×s/L (SD=66.4, and incremental dead space to a maximum of 2638 mL (SD=452, associated with an increase in ventilation to 75.1 L/min (SD=29.79. Each increment was maintained for 5 mins to allow the measurement of oxygen uptake in a steady state. During resistive loading total oxygen consumption increased from 239 mL/min (SD=38.2 to 299 mL/min (SD=52.3 and dyspnea increased to "very severe" (Borg scale 7.5, SD=1.55. During dead space loading total oxygen consumption increased from 270 mL/min (SD=20.2 to 426 mL/min (SD=81.9 and dyspnea increased to "very severe" (7.1, SD=0.66. Oxygen cost of inspiratory muscle power was 25 mL/watt (95% confidence limits 16.7 to 34.3 with dead space loading and 91 mL/watt (95% confidence limits 54 to 128 with resistive loading. Oxygen consumption did not reach a critical common value in the two types of loading, 60 mL/min (SD 22.3 during maximal resistive loading and 156 mL/min (SD 82.4 during maximal dead space loading (P<0.05. Physiological factors limiting the respiratory muscles are not uniquely related to oxygen consumption and appear to be expressed through the activation of sensory structures, perceptually manifested as

WE-AB-207B-12: Prospective Study of the Relationship Between Dose-Volume Clinical Toxicity and Patient Reported Outcomes in Lung Cancer Patients Treated with SBRT

Energy Technology Data Exchange (ETDEWEB)

Mayyas, E; Vance, S; Brown, S; Liu, J; Kim, J; Zhen, S; Devpura, S; Ajlouni, M; Salim, S; Chetty, I; Movsas, B [Henry Ford Health System, Detroit, MI (United States)

2016-06-15

Purpose: To determine in a prospective study, the correlation between radiation dose/volume, clinical toxicities and patient-reported, quality of life (QOL) resulting from lung SBRT. Methods: For 106 non-small cell lung cancer (NSCLC) patients receiving SBRT (12 Gy × 4), symptoms including cough, dyspnea, fatigue and pneumonitis were measured at baseline (before treatment), after treatment and 3, 6, and 12 months post-treatment. Toxicity was graded from zero to five. Dosimetric parameters such as the MLD, D10%, D20%, and lung subvolumes (V10 and V20) were obtained from the treatment plan. Dosimetric parameters and number of patients demonstrating toxicity ≥ grade 2 were tabulated. Linear regression analysis was used to calculate correlations between MLD and D10, D20, V10 and V20. Results: The percentages of patients with > grade 2 pneumonitis, fatigue, cough, and dyspnea over 3 to 12 months increased from 0.0% to 3.5%, 3.2% to 10.5%, 4.3% to 8.3%, and 10.8% to 18.8%, respectively. Computed dose indices D10%, D20% were 7.9±4.8 Gy and 3.0±2.3 Gy, respectively. MLD ranged from 0.34 Gy up to 9.9 Gy with overall average 3.0±1.7 Gy. The averages of the subvolumes V10 and V20 were respectively 8.9±5.3% and 3.0±2.4%. The linear regression analysis showed that V10 and D10 demonstrated the strongest correlation to MLD; R2= 0.92 and 0.87, respectively. V20, and D20 were also strongly correlated with MLD; R2 = 0.81 and 0.84 respectively. A correlation was also found to exist between MLD > 2 Gy and ≥ grade 2 cough and dyspnea. Subvolume values for 2Gy MLD were 5.3% for V10 and 2% for V20. Conclusion: Dosimetric indices: MLD ≥ 2Gy, D10 ≥ 5Gy and V10 ≥ 5% of the total lung volume were predictive of > grade 2 cough and dyspnea QOL data. The QOL results are a novel component of this work. acknowledgement of the Varian grant support.

Reexpansion pulmonary edema after drainage of tension ...

African Journals Online (AJOL)

A new chest Xray revealed a left reexpansion pulmonary edema. Glucocorticoids, diuretic stimulants, analgesic and bronchodilatators were administered in the intensive care unit. Gradually, the edema and dyspnea diminished and the patient could be discharged in good clinical condition. Reexpansion pulmonary edema ...

Mitral valve perforation appearing years after radiofrequency ablation

DEFF Research Database (Denmark)

Fisch-Thomsen, Marie; Jensen, Jesper K; Egeblad, Henrik

2011-01-01

The case is reported of a young adult with Wolff-Parkinson-White (WPW) syndrome who, three years after a complicated radiofrequency (RF) catheter ablation procedure, developed dyspnea on exertion. Echocardiography revealed severe mitral valve regurgitation caused by a perforation of the posterior...

Large Hiatal Hernia Compressing the Heart.

Science.gov (United States)

Matar, Andrew; Mroue, Jad; Camporesi, Enrico; Mangar, Devanand; Albrink, Michael

2016-02-01

We describe a 41-year-old man with De Mosier's syndrome who presented with exercise intolerance and dyspnea on exertion caused by a giant hiatal hernia compressing the heart with relief by surgical treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Side effects of vagus nerve stimulation during physical exercise

NARCIS (Netherlands)

Mulders, D.M.; de Vos, Cecilia Cecilia Clementine; Vosman, I.; Driesse, M.J.; van Putten, Michel Johannes Antonius Maria

2012-01-01

RATIONALE: Vagus nerve stimulation (VNS) is a treatment option in the case of refractory epilepsy. However, several side effects have been reported, including dyspnea, coughing and bradycardias [JCA 2010: 22;213-222]. Although some patients experience hardly any side effects from the stimulation

The Groningen Laryngomalacia Classification System-Based on Systematic Review and Dynamic Airway Changes

NARCIS (Netherlands)

van der Heijden, Martijn; Dikkers, Frederik G.; Halmos, Gyorgy B.

2015-01-01

Objective: Laryngomalacia is the most common cause of dyspnea and stridor in newborn infants. Laryngomalacia is a dynamic change of the upper airway based on abnormally pliable supraglottic structures, which causes upper airway obstruction. In the past, different classification systems have been

Temazepam 10mg does not affect breathing and gas exchange in patients with severe normocapnic COPD.

NARCIS (Netherlands)

Stege, G.; Heijdra, Y.F.; Elshout, F.J.J. van den; Ven, M.J.T. van de; Bruijn, P.J. de; Sorge, A.A. van; Dekhuijzen, P.N.R.; Vos, P.J.E.

2010-01-01

BACKGROUND: Benzodiazepines can improve sleep quality, but are also thought to cause respiratory depression in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to assess the effects of temazepam on indices of circadian respiratory function, dyspnea, sleep

Effect of Nesiritide in Patients with Acute Decompensated Heart Failure

NARCIS (Netherlands)

O'Connor, C. M.; Starling, R. C.; Hernandez, A. F.; Armstrong, P. W.; Dickstein, K.; Hasselblad, V.; Heizer, G. M.; Komajda, M.; Massie, B. M.; McMurray, J. J. V.; Nieminen, M. S.; Reist, C. J.; Rouleau, J. L.; Swedberg, K.; Adams, K. F.; Anker, S. D.; Atar, D.; Battler, A.; Botero, R.; Bohidar, N. R.; Butler, J.; Clausell, N.; Corbalan, R.; Costanzo, M. R.; Dahlstrom, U.; Deckelbaum, L. I.; Diaz, R.; Dunlap, M. E.; Ezekowitz, J. A.; Feldman, D.; Felker, G. M.; Fonarow, G. C.; Gennevois, D.; Gottlieb, S. S.; Hollander, J. E.; Howlett, J. G.; Hudson, M. P.; Kociol, R. D.; Krum, H.; Laucevicius, A.; Levy, W. C.; Mendez, G. F.; Metra, M.; Mittal, S.; Oh, B. -H.; Pereira, N. L.; Ponikowski, P.; Wilson, W. H.; Tanomsup, S.; Teerlink, J. R.; Triposkiadis, F.; Troughton, R. W.; Voors, A. A.; Whellan, D. J.; Zannad, F.; Califf, R. M.; Hill, Joseph A.

2011-01-01

Background Nesiritide is approved in the United States for early relief of dyspnea in patients with acute heart failure. Previous meta-analyses have raised questions regarding renal toxicity and the mortality associated with this agent. Methods We randomly assigned 7141 patients who were

The Role of Echocardiography in Coronary Artery Disease and Acute Myocardial Infarction

Science.gov (United States)

Esmaeilzadeh, Maryam; Parsaee, Mozhgan; Maleki, Majid

2013-01-01

Echocardiography is a non-invasive diagnostic technique which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, in a patient with acute chest pain, Transthoracic Echocardiography is essential both for diagnosing acute coronary syndrome, zeroing on the evaluation of ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnea, including aortic dissection and pericardial effusion. Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary perfusion and is, therefore, useful in the diagnosis and triage of patients with acute chest pain or dyspnea. This review has focused on the current applications of echocardiography in patients with coronary artery disease and myocardial infarction. PMID:23646042

A rare cause of hemoptysis

Directory of Open Access Journals (Sweden)

Meghan Aversa

2014-01-01

Full Text Available Angiosarcomas are rare, malignant, endothelial-cell tumors of vascular origin that can arise at any body site. They frequently metastasize to the lung, heralded by dyspnea, hemoptysis, chest pain, pneumothoraces, and diffuse pulmonary hemorrhage. However, in most cases lung metastases are discovered after the diagnosis of a primary angiosarcoma has already been established. Very rarely will an undiagnosed metastatic angiosarcoma present as diffuse pulmonary hemorrhage. We describe the case of a 59-year-old male who presented to hospital with dyspnea and hemoptysis. CT chest revealed rapidly progressing nodular changes and broncho-alveolar lavage returns were progressively bloody. Open lung wedge biopsy ultimately revealed metastatic angiosarcoma and extensive pulmonary hemorrhage. Our case highlights the key clinical, radiological, and pathological features of this rare malignancy that frequently metastasizes to the lung and reminds clinicians to consider it as a cause of hemoptysis and pulmonary hemorrhage.

[Experience in treating patients with chronic obstructive bronchitis with fenspirid].

Science.gov (United States)

Kirichenko, A A; Shabanova, T M

2002-01-01

To study a clinical effect of fenspirid and its impact on external respiration function in patients with chronic obstructive bronchitis (COB) in the exacerbation phase. 30 COB patients participated in the trial (20 males, 10 females, age 39-80 years). The severity of clinical symptoms (cough, sputum, dyspnea) was studied using special scales. External respiration function was examined by a spirometric system "Tamrac system spiro sense Y2 14". Fenspirid treatment was conducted in a dose 80 mg twice a day for 3 months. Control examinations were made 2 weeks, 1 and 3 months after the treatment start. A 3-month treatment with fenspirid resulted in regression of COB symptoms: cough and sputum ceased, dyspnea decreased. This led to improvement in external respiration function, especially in patients with mixed ventilatory disorders with prevailing restriction. Fenspirid is an effective and well tolerated treatment of chronic obstructive bronchitis.

Saccular lung cannulation in a ball python (Python regius) to treat a tracheal obstruction.

Science.gov (United States)

Myers, Debbie A; Wellehan, James F X; Isaza, Ramiro

2009-03-01

An adult male ball python (Python regius) presented in a state of severe dyspnea characterized by open-mouth breathing and vertical positioning of the head and neck. The animal had copious discharge in the tracheal lumen acting as an obstruction. A tube was placed through the body wall into the caudal saccular aspect of the lung to allow the animal to breathe while treatment was initiated. The ball python's dyspnea immediately improved. Diagnostics confirmed a bacterial respiratory infection with predominantly Providencia rettgeri. The saccular lung (air sac) tube was removed after 13 days. Pulmonary endoscopy before closure showed minimal damage with a small amount of hemorrhage in the surrounding muscle tissue. Respiratory disease is a common occurrence in captive snakes and can be associated with significant morbidity and mortality. Saccular lung cannulation is a relatively simple procedure that can alleviate tracheal narrowing or obstruction, similar to air sac cannulation in birds.

Thoracic surgery in solving enormous elevation of the left hemidiaphragm

Directory of Open Access Journals (Sweden)

Cvijanović Vlado

2007-01-01

Full Text Available Background. Acquired elevation of the diaphragm is mostly the result of phrenic nerve paralysis, some of thoracic and abdominal patological states, and also some of neuromuscular diseases. Surgical treatment is rarely performed and is indicated when lung compression produces disabilitating dyspnea, and includes plication of diaphragm. The goal of this case report has been to show completely documented diagnostic procedures and surgical treatment one of rare pathological condition. Case report. A 62-year-old patient was admitted to our clinic because of surgical treatment of the enormous elevation of the left hemidiaphragm. After thoracotomy and plication of the bulging diaphragm, lung compression did not exist any more and mediastinum went back in the normal position. Conclusion. Elevation of the diaphragm rarely demands surgical correction. When it is complicated with lung compression and disabilitating dyspnea, surgical treatment has extremely useful functional effect.

Severe Pleuropulmonary Paragonimiasis Caused by Paragonimus mexicanus Treated as Tuberculosis in Ecuador.

Science.gov (United States)

Calvopina, Manuel; Romero-Alvarez, Daniel; Macias, Rubén; Sugiyama, Hiromu

2017-01-11

A 30-year-old male, from a subtropical region of Ecuador, was hospitalized with a 5-year history of persistent cough with rusty brown sputum, chest pain, and progressive dyspnea. The patient underwent thoracic surgery 3 years ago for pleural effusion and subsequently received a 9-month regimen treatment of tuberculosis. However, there was no clinical resolution and symptoms became progressively worse. A chest radiograph and computerized tomography scan showed several small nodules in both lungs. Eggs of Paragonimus spp. were observed in sputum smears, but the smears were negative for acid-fast bacilli. Molecular characterization of eggs by the internal transcribed spacer-2 regions identified them as Paragonimus mexicanus The patient was treated with praziquantel and tested negative parasitologically for 12 months. There was clinical resolution of the cough and expectoration, but dyspnea and chest pain persisted. © The American Society of Tropical Medicine and Hygiene.

[An uncommon cause of dyspnea in children. Plexiform neurofibroma of the larynx].

Science.gov (United States)

Moussali, N; Belmoukari, S; Elmahfoudi, H; Elbenna, N; Abdelouafi, A; Gharbi, A

2013-06-01

Plexiform neurofibroma is a rare benign tumor developed from cells of the sheath of Schwann peripheral nervous system often associated with neurofibromatosis type 1 or Von Recklinghausen disease. Laryngeal involvement in neurofibromatosis is rare and usually presents with obstructive respiratory symptoms. Imaging including CT and MRI provides the diagnosis as well as the staging of this lesion, whose treatment is primarily surgical. We report the case of a plexiform neurofibroma of the larynx found in a 4-year-old child revealing a mass completely obstructing the laryngeal vestibule. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

An unusual cause of severe dyspnea: A laryngeal live leech: Case report

Directory of Open Access Journals (Sweden)

Said Anajar

2017-01-01

Conclusion: Leeches should be suspected as an airway foreign body in patients with a recent history of drinking from stream water. Prevention remains the best treatment for such cases based simply on hygiene measures like not drinking stream water directly and filtering drinking water before it is used.

Quality of Life on Arterial Hypertension: Validity of Known Groups of MINICHAL

International Nuclear Information System (INIS)

Soutello, Ana Lúcia Soares; Rodrigues, Roberta Cunha Matheus; Jannuzzi, Fernanda Freire; São-João, Thaís Moreira; Martini, Gabriela Giordano; Nadruz Jr, Wilson; Gallani, Maria-Cecília Bueno Jayme

2015-01-01

In the care of hypertension, it is important that health professionals possess available tools that allow evaluating the impairment of the health-related quality of life, according to the severity of hypertension and the risk for cardiovascular events. Among the instruments developed for the assessment of health-related quality of life, there is the Mini-Cuestionario of Calidad de Vida en la Hipertensión Arterial (MINICHAL) recently adapted to the Brazilian culture. To estimate the validity of known groups of the Brazilian version of the MINICHAL regarding the classification of risk for cardiovascular events, symptoms, severity of dyspnea and target-organ damage. Data of 200 hypertensive outpatients concerning sociodemographic and clinical information and health-related quality of life were gathered by consulting the medical charts and the application of the Brazilian version of MINICHAL. The Mann-Whitney test was used to compare health-related quality of life in relation to symptoms and target-organ damage. The Kruskal-Wallis test and ANOVA with ranks transformation were used to compare health-related quality of life in relation to the classification of risk for cardiovascular events and intensity of dyspnea, respectively. The MINICHAL was able to discriminate health-related quality of life in relation to symptoms and kidney damage, but did not discriminate health-related quality of life in relation to the classification of risk for cardiovascular events. The Brazilian version of the MINICHAL is a questionnaire capable of discriminating differences on the health‑related quality of life regarding dyspnea, chest pain, palpitation, lipothymy, cephalea and renal damage

Quality of Life on Arterial Hypertension: Validity of Known Groups of MINICHAL

Science.gov (United States)

Soutello, Ana Lúcia Soares; Rodrigues, Roberta Cunha Matheus; Jannuzzi, Fernanda Freire; São-João, Thaís Moreira; Martini, Gabriela Giordano; Nadruz Jr., Wilson; Gallani, Maria-Cecília Bueno Jayme

2015-01-01

Introductions In the care of hypertension, it is important that health professionals possess available tools that allow evaluating the impairment of the health-related quality of life, according to the severity of hypertension and the risk for cardiovascular events. Among the instruments developed for the assessment of health-related quality of life, there is the Mini-Cuestionario of Calidad de Vida en la Hipertensión Arterial (MINICHAL) recently adapted to the Brazilian culture. Objective To estimate the validity of known groups of the Brazilian version of the MINICHAL regarding the classification of risk for cardiovascular events, symptoms, severity of dyspnea and target-organ damage. Methods Data of 200 hypertensive outpatients concerning sociodemographic and clinical information and health-related quality of life were gathered by consulting the medical charts and the application of the Brazilian version of MINICHAL. The Mann-Whitney test was used to compare health-related quality of life in relation to symptoms and target-organ damage. The Kruskal-Wallis test and ANOVA with ranks transformation were used to compare health-related quality of life in relation to the classification of risk for cardiovascular events and intensity of dyspnea, respectively. Results The MINICHAL was able to discriminate health-related quality of life in relation to symptoms and kidney damage, but did not discriminate health-related quality of life in relation to the classification of risk for cardiovascular events. Conclusion The Brazilian version of the MINICHAL is a questionnaire capable of discriminating differences on the health‑related quality of life regarding dyspnea, chest pain, palpitation, lipothymy, cephalea and renal damage. PMID:25993593

Quality of Life on Arterial Hypertension: Validity of Known Groups of MINICHAL

Energy Technology Data Exchange (ETDEWEB)

Soutello, Ana Lúcia Soares; Rodrigues, Roberta Cunha Matheus; Jannuzzi, Fernanda Freire; São-João, Thaís Moreira, E-mail: thaisms@gmail.com; Martini, Gabriela Giordano; Nadruz Jr, Wilson [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil); Gallani, Maria-Cecília Bueno Jayme [Université Laval (Canada)

2015-04-15

In the care of hypertension, it is important that health professionals possess available tools that allow evaluating the impairment of the health-related quality of life, according to the severity of hypertension and the risk for cardiovascular events. Among the instruments developed for the assessment of health-related quality of life, there is the Mini-Cuestionario of Calidad de Vida en la Hipertensión Arterial (MINICHAL) recently adapted to the Brazilian culture. To estimate the validity of known groups of the Brazilian version of the MINICHAL regarding the classification of risk for cardiovascular events, symptoms, severity of dyspnea and target-organ damage. Data of 200 hypertensive outpatients concerning sociodemographic and clinical information and health-related quality of life were gathered by consulting the medical charts and the application of the Brazilian version of MINICHAL. The Mann-Whitney test was used to compare health-related quality of life in relation to symptoms and target-organ damage. The Kruskal-Wallis test and ANOVA with ranks transformation were used to compare health-related quality of life in relation to the classification of risk for cardiovascular events and intensity of dyspnea, respectively. The MINICHAL was able to discriminate health-related quality of life in relation to symptoms and kidney damage, but did not discriminate health-related quality of life in relation to the classification of risk for cardiovascular events. The Brazilian version of the MINICHAL is a questionnaire capable of discriminating differences on the health‑related quality of life regarding dyspnea, chest pain, palpitation, lipothymy, cephalea and renal damage.

Hemodynamic and tissue oxygenation responses to exercise and beta-adrenergic blockade in patients with hyperthyroidism.

Science.gov (United States)

Monachini, Maristela C; Lage, Silvia G; Ran, Miguel A N; Cardoso, Rita H A; Medeiros, Caio; Caramelli, Bruno; Sposito, Andrei C; Ramires, José A F

2004-07-01

Exercise-induced dyspnea is a frequent feature in patients with hyperthyroidism. Data from clinical studies to elucidate the origin of this symptom are lacking. In the current study, we examined the hemodynamic and oxygenation responses to exercise and beta-adrenergic blockade in patients with hyperthyroidism and their relationship with dyspnea. Hemodynamic studies were performed under resting conditions and after isotonic exercise in 15 patients with hyperthyroidism and 11 control subjects. Exercise was applied using a bicycle ergometer, with progressive loads. In the hyperthyroid group, measurements were repeated at rest and during supine exercise after administering 15 mg of intravenous metoprolol. End-diastolic pulmonary artery pressure and cardiac index were higher in the hyperthyroid group than in controls (18.6 +/- 5.3 vs. 11.2 +/- 4.9 mmHg; p = 0.02, and 6.0 +/- 1.7 vs. 2.8 +/- 0.5 l/min/m2; p = 0.0001, respectively). After exercise, there was an increase in end-diastolic pulmonary artery pressure in the hyperthyroid group (18.6 +/- 5.3 to 25.5 +/- 9.9 mmHg; p = 0.02), revealing impaired cardiocirculatory reserve. Pulmonary arteriolar resistance increased significantly in parallel with end-diastolic pulmonary artery pressure after drug administration, suggesting an inadequate cardiovascular response after beta blockade in patients with hyperthyroidism. We observed that functional left ventricular reserve is impaired in patients with hyperthyroidism, suggesting an explanation for the frequent symptom of dyspnea and impaired exercise tolerance. Moreover, we also suggest that beta-adrenergic blockade may adversely affect cardiovascular function in patients with hyperthyroidism.

Expandable metallic stents in the palliative treatment of malignant tracheobronchial stenosis

Energy Technology Data Exchange (ETDEWEB)

Park, Jong Woong; Jung, Gyoo Sik; Kim, Seong Min; Lee, Seung Ryong; Kim, Hyun Sook; Huh, Jin Do; Joh, Young Duk [Kosin Medical College, Pusan (Korea, Republic of)

1998-05-01

The purpose of this study is to report the outcome of using expandable metallic stent in the management of malignant tracheobronchial stenosis with dyspnea. Under fluoroscopic and bronchoscopic guidance, seven patients with malignant airway stenosis were treated with ten expandable metallic stents. The cause of stenosis was metastasis from esophageal cancer in five patients, recurrent adenoid cystic carcinoma of the trachea in one, and primary lung cancer in one. The major sites of obstruction were the trachea in four patients, the left main bronchus in one, the trachea and left main bronchus in one, and the trachea and both bronchi in one. Chest radiography (n=7), bronchoscopy (n=5), pulmonary function test (PFT)(n=3), and spirometry(n=1) were performed before and after stent placement. In all seven patients, the stent was successfully placed at the lesion sites and dyspnea began to improve immediately. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After stent placement, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) improved 53% and 56%, respectively. Peak flow velocity also changed from 46 L/min to 200 L/min. During median follow-up of 67 (41-1565) days, one stent migration occurred. In one patient, proximal tumor overgrowth occurred, and in one, tumor ingrowth was treated with balloon dilatation. For in the palliative treatment of malignant tracheobronchial stenosis with dyspnea, placement of expandable metal stents is safe and effective. (author). 21 refs., 1 tabs., 3 figs.

Expandable metallic stents in the palliative treatment of malignant tracheobronchial stenosis

International Nuclear Information System (INIS)

Park, Jong Woong; Jung, Gyoo Sik; Kim, Seong Min; Lee, Seung Ryong; Kim, Hyun Sook; Huh, Jin Do; Joh, Young Duk

1998-01-01

The purpose of this study is to report the outcome of using expandable metallic stent in the management of malignant tracheobronchial stenosis with dyspnea. Under fluoroscopic and bronchoscopic guidance, seven patients with malignant airway stenosis were treated with ten expandable metallic stents. The cause of stenosis was metastasis from esophageal cancer in five patients, recurrent adenoid cystic carcinoma of the trachea in one, and primary lung cancer in one. The major sites of obstruction were the trachea in four patients, the left main bronchus in one, the trachea and left main bronchus in one, and the trachea and both bronchi in one. Chest radiography (n=7), bronchoscopy (n=5), pulmonary function test (PFT)(n=3), and spirometry(n=1) were performed before and after stent placement. In all seven patients, the stent was successfully placed at the lesion sites and dyspnea began to improve immediately. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After stent placement, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) improved 53% and 56%, respectively. Peak flow velocity also changed from 46 L/min to 200 L/min. During median follow-up of 67 (41-1565) days, one stent migration occurred. In one patient, proximal tumor overgrowth occurred, and in one, tumor ingrowth was treated with balloon dilatation. For in the palliative treatment of malignant tracheobronchial stenosis with dyspnea, placement of expandable metal stents is safe and effective. (author). 21 refs., 1 tabs., 3 figs

Subjective sleep quality in sarcoidosis.

Science.gov (United States)

Bosse-Henck, Andrea; Wirtz, Hubert; Hinz, Andreas

2015-05-01

Poor sleep is common among patients with medical disorders. Sleep disturbances can be a cause of fatigue and poor quality of life for patients suffering from sarcoidosis. Studies on subjective sleep quality or prevalence of insomnia have not been reported so far. The aim of this study was to investigate the subjectively reported sleep quality and its relation to psychological and physical factors in sarcoidosis patients. 1197 patients from Germany diagnosed with sarcoidosis were examined using the Pittsburgh Sleep Quality Index (PSQI), the Medical Research Council (MRC) dyspnea scale, the Hospital Anxiety and Depression Scale (HADS) and the Multidimensional Fatigue Inventory (MFI). 802 patients (67%) had PSQI global scores >5, indicating subjectively poor quality of sleep. The mean PSQI score was 7.79 ± 4.00. Women reported a significantly inferior individual quality of sleep than men. The subjective quality of sleep was lowered significantly with increasing dyspnea for men and women. 294 patients (25%) had PSQI global scores >10 usually found in patients with clinically relevant insomnia. In this group 86% had high values for fatigue, 69% for anxiety, and 59% for depression. The prevalence of known sleep apnea was 8.7% and 15.7% for restless legs. Poor subjective sleep quality in sarcoidosis patients is about twice as common as in the general population and is associated with fatigue, anxiety, depression and dyspnea. Questions about sleep complaints should therefore be included in the management of sarcoidosis. Copyright © 2014 Elsevier B.V. All rights reserved.

Phrenic nerve palsy associated with birth trauma--case reports and a literature review.

Science.gov (United States)

Shiohama, Tadashi; Fujii, Katsunori; Hayashi, Masaharu; Hishiki, Tomoro; Suyama, Maiko; Mizuochi, Hiromi; Uchikawa, Hideki; Yoshida, Shigetoshi; Yoshida, Hideo; Kohno, Yoichi

2013-04-01

Phrenic nerve palsy is a peripheral nerve disorder caused by excessive cervical extension due to birth trauma or cardiac surgery. We describe two new patients with phrenic nerve palsy associated with birth trauma. Both patients exhibited profound dyspnea and general hypotonia immediately after birth. A chest roentgenogram and fluoroscopy revealed elevation of the diaphragm, leading to a diagnosis of phrenic nerve palsy associated with birth trauma. Since they had intermittently exhibited dyspnea and recurrent infection, we performed video-assisted thoracoscopic surgery (VATS) plication in both cases, at an early and a late stage, respectively. Both patients subsequently exhibited a dramatic improvement in dyspnea and recurrent respiratory infection. Interestingly, the late stage operated infant exhibited spontaneous recovery at 7 months with cessation of mechanical ventilation once. However, this recovery was transient and subsequently led to an increased ventilation volume demand, finally resulting in surgical treatment at 15 months. Histological examination of the diaphragm at this time showed grouped muscle atrophy caused by phrenic nerve degeneration. To our knowledge, this is the first pathologically proven report of grouped muscle atrophy of the diaphragm due to phrenic nerve degeneration, suggesting that partial impairment of phrenic nerves resulted in respiratory dysfunction with incomplete recovery. We conclude that recently developed VATS plication is a safe and effective treatment for infants with phrenic nerve palsy, and should be considered as a surgical treatment at an early period. Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Improved lung function and quality of life following guaifenesin treatment in a patient with chronic obstructive pulmonary disease (COPD: A case report

Directory of Open Access Journals (Sweden)

William W. Storms

Full Text Available We report improved lung function and quality of life following daily use of guaifenesin/dextromethorphan (Mucinex DM®, Reckitt Benckiser for the treatment of mucus-related symptoms in a patient with COPD, who presented with increasing dyspnea, progressive cough and chest congestion.

Pneumomediastinum from a severe asthma attack.

Science.gov (United States)

Hashim, Taimoor; Chaudry, Ayesha H; Ahmad, Khurram; Imhoff, Jennifer; Khouzam, Rami

2013-07-01

Spontaneous pneumomediastinum is a rare complication of an asthma exacerbation characterized by chest pain, dyspnea, neck swelling, and subcutaneous emphysema. Although the condition is usually benign and treatment is primarily supportive, surgical intervention may be needed if the patient develops hemodynamic or respiratory failure.

Clinicopathological observations in experimental Peste Des Petit ...

African Journals Online (AJOL)

The clinical signs were severe and the order of manifestation was anorexia, pyrexia, dyspnea, oculo-nasal discharge, recumbency and death. The lesions observed were severe fibrinous bronchointerstitial pneumonia and pleurisy with thickened alveolar septa, edema and neutrophilic infiltrations of the interstitium with giant ...

Libman–Sacks endocarditis, and other echocardiographic findings in systemic lupus erythematosus: Case report

OpenAIRE

Hamza, Mohamed Atef; Allam, Lamyaa

2012-01-01

Case report of a 19 year-old female patient with systemic lupus erythematosus (SLE) who was presented to Ain Shams University Hospital complaining of dyspnea on moderate exertion. Echocardiography showed the presence of sterile vegetation on the mitral valve, Libman–Sacks endocarditis (LSE).

An Echodensity in the Sinus of Valsalva

NARCIS (Netherlands)

Amir, Rabia; Yeh, Lu; Matyal, Robina; Mahmood, Feroze

2016-01-01

A 60-YEAR-OLD woman was referred to the authors’ institution for surgical treatment of severe aortic valve stenosis with progressive exertional dyspnea. A few months before the current admission, she had been treated in an outside hospital for congestive heart failure. Cardiac catheterization

Heat-Related Illnesses

Science.gov (United States)

1988-04-01

dyspnea, dysphagia , and urinary incontinence. 2 6 Although the muscular rigidity and hyperthermia are reminiscent of malignant hyperthermia, the putative...401, 1986. 106. Litman, R.E.: Heatstroke in parkinsonism . Arch Int Med, 89:562- 567, 1952. 107. Logue, R.B., Hanson, J.F.: Electrocardiographic

Right atrial myxoma as a possible cause of hemorrhagic stroke and ...

African Journals Online (AJOL)

Right atrial myxomas are rare primary tumors of the heart. They may remain asymptomatic or eventually cause constitutional signs and symptoms. Less frequently, obstruction of the tricuspid valve occurs, resulting in exertional dyspnea, syncope, or sudden death. Neurological manifestation as initial presentation of atrial ...

Laryngeal sarcoidosis: a case report presenting transglottic involvement

NARCIS (Netherlands)

Broek, E.M.J.M. van den; Heijnen, B.J.; Verbist, B.M.; Sjögren, E.V.

2013-01-01

Isolated laryngeal sarcoidosis is a very rare disease. In most cases, it will present as a supraglottic pale edematous swelling. In our case, the patient presented with hoarseness and dyspnea during exertion. Laryngeal examination did show not only supraglottic edema but also prominent subglottic

Ventilatory disorders in heart failure

NARCIS (Netherlands)

Güder, G.

2017-01-01

Introduction: Chronic obstructive pulmonary disease (COPD), heart failure (HF) or both syndromes are the most common reasons for dyspnea in the elderly. Currently there is no standard to diagnose COPD and multiple definitions (fixed ratio [GOLD], lower limit of normal [LLN]) are discussed. Further,

[Choriocarcinoma causing a pulmonary embolus.

DEFF Research Database (Denmark)

Theliade, J.E.; Skovby, A.M.; Kirk, V.

2008-01-01

A 32 year-old women experienced dyspnea and thoracic pain that persisted with variable intensity over a course of eight months until acute worsening necessitated admission. A CT scan demonstrated a central pulmonary embolus. Subsequent surgical embolectomy produced a grained substance that was hi...

Endovascular treatment of superior vena cava syndrome

DEFF Research Database (Denmark)

Duvnjak, Stevo; Andersen, Poul Erik

2011-01-01

there was an immediate clinical improvement with considerable reduction in the edema of upper extremities and head. There was, however, continous dyspnea in five patients (17%) and two patients (7%) had persistent visible collateral venous circulations on the upper chest. There were no stent associated complications...

Libman–Sacks endocarditis, and other echocardiographic findings in systemic lupus erythematosus: Case report

Directory of Open Access Journals (Sweden)

Mohamed Atef Hamza

2012-09-01

Full Text Available Case report of a 19 year-old female patient with systemic lupus erythematosus (SLE who was presented to Ain Shams University Hospital complaining of dyspnea on moderate exertion. Echocardiography showed the presence of sterile vegetation on the mitral valve, Libman–Sacks endocarditis (LSE.

Recurrence of floor of the mouth dysontogenic cyst in childhood

African Journals Online (AJOL)

symptoms. The DC can raise the tongue and produce difficulty in mastication, swallowing, speaking, and breath- ing; therefore, the patients usually present with dysphagia, dysphonia, and dyspnea. Rarely the DC presents intraoral or cutaneous fistulas, a consequence of secondary infec- tions, with only four cases reported, ...

Cardiac calcified amorphous tumor: A systematic review of the literature

Directory of Open Access Journals (Sweden)

Quentin de Hemptinne

2015-06-01

Conclusion: In this review, the most frequent presenting symptoms were dyspnea and embolic events. Mitral valve and annulus were the most frequent location of CAT. Surgery was most of the time required to confirm diagnosis, and was relatively safe. Overall outcome after surgical resection was good.

Diuretic response and renal function in heart failure

NARCIS (Netherlands)

ter Maaten, Jozine Magdalena

2016-01-01

In patients with heart failure fluid overload is a frequently occurring problem, which is among others caused by an impaired function of the heart. This fluid overload may lead to severe dyspnea warranting an acute hospitalization. The first choice treatment of this fluid overload is administration

Characteristics of revisits of children at risk for serious infections in pediatric emergency care

NARCIS (Netherlands)

E. De Vos-Kerkhof (Evelien); D.H.F. Geurts (Dorien); E.W. Steyerberg (Ewout); M. Lakhanpaul (Monica); H.A. Moll (Henriëtte); R. Oostenbrink (Rianne)

2018-01-01

textabstractIn this study, we aimed to identify characteristics of (unscheduled) revisits and its optimal time frame after Emergency Department (ED) discharge. Children with fever, dyspnea, or vomiting/diarrhea (1 month–16 years) who attended the ED of Erasmus MC-Sophia, Rotterdam (2010–2013), the

Genome-Wide Association Identifies Multiple Genomic Regions Associated with Susceptibility to and Control of Ovine Lentivirus

Science.gov (United States)

2012-10-17

to varying degrees of dyspnea (respiratory distress), cachexia (body condition wasting), mastitis , arthritis, and/or encephalitis [5,6]. One of the...General Transcription Factor IIH, polypeptide 5), the gene order does not agree with other mammal genomes including cow , human, dog, and mouse, and it may

The Seminal Literature of Anthrax Research

Science.gov (United States)

2007-05-01

few days takes a fulminant course, manifested by dyspnea, cough, chills, and a high-grade bac- teremia. Massive hilar adenopathy and mediastinal...causes death of the infected host (Pezard et al. 1991). The genes responsible for capsular biosynthesis (Green, 1985) and the synthesis of LT and ET

Chemotherapy and quality of life in NSCLC PS 2 patients

DEFF Research Database (Denmark)

Helbekkmo, Nina; Strøm, Hans H; Sundstrøm, Stein H

2009-01-01

, fatigue, dyspnea, sleeping problems and appetite loss in comparison to the PS 0/1 group. CONCLUSIONS: PS 2 NSCLC patients seem to achieve valuable HRQOL benefits from platinum-based combination therapy. Prospective clinical studies with predefined HRQOL outcomes in PS 2 patients are needed to confirm...

Multiple applications of the Boussignac continuous positive airway pressure system

NARCIS (Netherlands)

Dieperink, Willem

2008-01-01

Continuous positive airway pressure, (CPAP) is a form of treatment to support patients with dyspnea. For the application of CPAP a mechanical ventilator or complex CPAP apparatus is mostly used. The Boussignac CPAP (BCPAP) system developed by George Boussignac does not need such apparatus. The BCPAP

Surgical exclusion of a saccular aneurysm within a patent ductus arteriosus in an adult patient with Ortner's syndrome.

NARCIS (Netherlands)

Murana, G.; Cefarelli, M.; Kloppenburg, G.; Morshuis, W.J.; Heijmen, R.H.

2016-01-01

In adult the patent ductus arteriosus is a rare condition associated sometimes with lethal complications. We describe the case of a 44-year-old woman with a history of systemic lupus erythematosus admitted to our hospital with hoarseness and severe dyspnea. Clinical imaging examinations indicated a

October 2015 Phoenix pulmonary journal club: lung volume reduction

Directory of Open Access Journals (Sweden)

Mathew M

2015-11-01

Full Text Available No abstract available. Article truncated at 150 words. The October 2015 pulmonary journal club focused on the review of older studies evaluating lung volume reduction surgery and how this has transitioned toward the development of non-surgical modes of lung volume reduction. The physiology behind dyspnea in chronic obstructive pulmonary disease (COPD is a complex process. One of the proposed mechanisms has been hyperinflation associated with air trapping. In the mid 1990s studies by Cooper and Peterson (1 offered a promising approach in which lung volume reduction (LVR could improve ventilatory mechanics and improve dyspnea. As the procedure gained more popularity, additional larger scale trials were performed to support its validity. We reviewed 2 studies looking at lung volume reduction. The first was "The Effect of Lung Volume Reduction Surgery In Patients With Severe Emphysema” (2 . This was a smaller, randomized controlled trial (RCT that looked at 2 groups of 24 patients. Once group received LVR while the ...

[About a case of laryngeal location of SAPHO].

Science.gov (United States)

Vatin, L; Jean, E; Rivière, D; Montava, M; Giovanni, A; Dessi, P; Lagier, A

2017-10-01

Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) is a syndrome that combines dermatological, articular and osseous inflammatory manifestations. Bilateral laryngeal immobility relative to cricoarytenoid joint origin is very uncommon. This article presents a case of bilateral cricoarytenoid joint ankylosis in a SAPHO syndrome context. A 53-year-old patient presenting with a two year history of intermittent bouts of dyspnea. A SAPHO syndrome was discussed on repeated thoracic CT-scan. The link between dyspnea and SAPHO syndrome had not been made immediately given the absence of any known anteriority. However, having ruled out other etiologies and after having had to perform a tracheotomy due a worsening of the respiratory condition, this diagnosis was considered. Treatment by corticosteroids and infliximab permitted a clinical improvement of the patient. This clinical case report should increase awareness of possible cricoarytenoid joint involvement in SAPHO. Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

February 2016 pulmonary case of the month

Directory of Open Access Journals (Sweden)

Garrett A

2016-02-01

Full Text Available No abstract available. Article after first page. History of Present Illness: A 77-year-old woman presented with dyspnea on exertion which was progressive for several years. She remains active but is "winded" with vigorous exercise or altitude. She denied cough, orthopnea , paroxysmal nocturnal dyspnea, chest pain or a prior history of pulmonary infections. Past Medical, Social and Family History: She has a history of a seizure disorder and fibromyalgia. She has never smoked or drank and has no history of occupational exposures. There was no family history of respiratory disease. Physical Examination: Her physical exam was unremarkable. Current Medications: Topamax and alprazolam. Radiography: A chest radiograph was performed (Figure 1. Which of the following describe the initial chest x-ray? 1. The chest x-ray is normal. 2. There is a left lower mass: 3. There is bronchial dilatation and edema. 4. There is hyperinflation. 5. Three is a retrocardiac left lower pneumonia. ...

Cardiac tamponade 7 years after radiotherapy in a child with Hodgkin's disease

Energy Technology Data Exchange (ETDEWEB)

Fukuda, Minoru; Horibe, Keizo; Miyajima, Yuji; Matsumoto, Kimikazu; Goto, Masahiko; Nishibata, Kenji; Nagashima, Masami (Nagoya Univ. (Japan). Faculty of Medicine); Tauchi, Akira

1994-11-01

A 12-year-old boy with massive pericardial effusion which developed 7 years after radiotherapy was reported. In May 1986, he had stage I Hodgkin's disease of the right axillary lymph nodes. He received 40 Gy mantle field radiotherapy without chemotherapy following complete resection of the tumor. Seven years later, he was admitted with symptoms of dyspnea and facial edema. Chest X-ray films showed pleural effusion and echocardiography showed cardiac tamponade. Cytologic examinations of the pleural and pericardial effusion, computed tomography of chest, and gallium scintigraphy showed no signs of malignancy. He was diagnosed as suffering from acute pericarditis and cardiac tamponade, most likely due to radiotherapy. Following initial improvement by pericardiocentesis, dyspnea reappeared with an increase in pericardial effusion. The effusion subsided in response to prednisolone following the second pericadiocentesis. Although pericarditis following radiotherapy is rarely reported in Japan, partly because of the low incidence of Hodgkin's disease, it should be emphasized as a major sequela of radiotherapy. (author).

The optimization of iloprost inhalation under moderate flow of oxygen therapy in severe pulmonary arterial hypertension.

Science.gov (United States)

Nakayama, Kazuhiko; Emoto, Noriaki; Tamada, Naoki; Okano, Mitsumasa; Shinkura, Yuto; Yanaka, Kenichi; Onishi, Hiroyuki; Hiraishi, Mana; Yamada, Shinichiro; Tanaka, Hidekazu; Shinke, Toshiro; Hirata, Ken-Ichi

2018-01-01

Inhaled iloprost efficiently improves pulmonary hemodynamics, exercise capacity, and quality of life in patients with pulmonary arterial hypertension (PAH). However, the process of inhalation is laborious for patients suffering from resting dyspnea. We describe a 75-year-old man with idiopathic PAH and a low gas transfer. Investigations excluded significant parenchymal lung disease and airflow obstruction (presuming FEV1/FVC ration > 70%). The patient struggled to complete iloprost inhalation due to severe dyspnea and hypoxemia. As such, we optimized the methods of oxygen supply from the nasal cannula to the trans-inhalator during the inhalation. We successfully shortened the inhalation duration that effectively reduced the laborious efforts required of patients. We also recorded pulmonary hemodynamics during inhalation of nebulized iloprost. This revealed significant hemodynamic improvement immediately following inhalation but hemodynamics returned to baseline within 2 hours. We hope that this optimization will enable patients with severe PAH to undergo iloprost inhalation.

[Persistent dysphonia showing a laryngeal foreign body in a child].

Science.gov (United States)

Hammoudi, K; Bakhos, D; Bakhos-Merieau, E; Pondaven, S; Lescanne, E

2011-07-01

Inhalation of a laryngotracheobronchial foreign body is a common pediatric emergency situation. It is a source of morbidity and even mortality, especially among children under 3 years of age. A 14-month-old child presented suddenly combining bitonal dysphonia and dyspnea. Given the persistence of symptoms after 1.5 months and the normality of examinations requested by his doctor (pH, cervical ultrasonography, cervical and thoracic radiography), an ENT opinion was sought. An aerodigestive tract endoscopy was carried out in the emergency setting, finding a glottic foreign body associated with subglottic granulomas. The foreign body extraction led to the immediate disappearance of dyspnea. Dysphonia gradually improved under Budesonide aerosols. The lack of penetration syndrome in the interrogation and non specific symptoms may lead to an important diagnosis and treatment delay with dramatic consequences in case of airway foreign body. Endoscopy under general anesthesia must be practiced if there is any doubt for a thorough examination of the airways. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Pediatric mumps with laryngeal edema.

Science.gov (United States)

Hattori, Yujiro; Oi, Yasufumi; Matsuoka, Ryo; Daimon, Yumi; Ito, Asami; Kubota, Wataru; Konishi, Kyoko; Onguchi, Toshimi; Sato, Akihiro; Yamashita, Yukio; Ishihara, Jun

2013-10-01

Mumps virus infection primarily affects the salivary glands and may incur various complications. Laryngeal edema is such a rare complication that few adult cases have been reported. We report the first known pediatric patient with mumps with laryngeal edema. An 8-year-old boy developed dyspnea after a rapidly progressive swelling of his face and neck. Laryngoscopy revealed edematous changes in the supraglottic and subglottic regions, and computed tomography confirmed significant laryngeal edema in addition to swelling of the cervical soft tissue and the salivary glands. Laboratory findings revealed a high serum amylase level and confirmed the diagnosis of mumps. Intravenous steroid administration alleviated the dyspnea, although the patient required temporary tracheal intubation to maintain airway patency. He did not need tracheotomy and did not experience any other complications. Laryngeal edema must be regarded as a rare, potentially life-threatening complication of mumps. When mumps is diagnosed with significant swelling of the neck, an emergency airway should be established to prevent airway obstruction.

October 2013 pulmonary case of the month: a hidden connection

Directory of Open Access Journals (Sweden)

Cawcutt K

2013-10-01

Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness A 58 year old woman, former smoker, presented to the pulmonary outpatient clinic at Mayo Clinic Rochester with dyspnea on exertion. In clinic, she was found to be tachycardic and febrile, and therefore, she was directly admitted to a medicine ward for possible sepsis. She had progressive dyspnea on exertion, accompanied by symptoms of dry cough, muscle weakness, dry mouth, easy bruising and constipation without weight loss for approximately 9 months. During this time, she was also diagnosed with an idiopathic pulmonary embolus with initiation of warfarin. PMH, SH, FH During an extensive work-up for these symptoms she was found to have a Ca2+ channel antibody, with concern raised for possible paraneoplastic etiology, as positron emission tomography (PET imaging also revealed abnormal uptake in lungs along with multiple lymph nodes, pancreatic tail, decreased cerebral metabolism suggestive of a diffuse encephalopathy and bilateral pulmonary infiltrates with cavitation …

January 2014 pulmonary case of the month: too much, too late

Directory of Open Access Journals (Sweden)

Chima-Okereke C

2014-01-01

Full Text Available No abstract available. Article truncated at 150 words. Chief Complaint: Difficulty breathing History of Present Illness A 49-year-old gentleman with history of hepatitis C cirrhosis complicated by ascites presented to the emergency room of Olive View Medical Center in San Fernando Valley, California complaining of worsening shortness of breath. The patient reports that he occasionally has shortness of breath, usually about 2-3 times a year. However for the past 2 months, he has had worsening dyspnea on exertion and cannot walk further than 5 minutes. He also reports orthopnea and paroxysmal nocturnal dyspnea. He has been having a dry cough for the past 3-4 weeks. He has a history of chronic ascites that has required multiple taps. He has been taking his prescribed diuretics however instead of taking these medications daily he takes them about every other day due to financial constraints. However, his abdominal distention and his lower extremity swelling are stable. He reports some nausea with …

Lymphome t/nk primitif du larynx : localisation inhabituelle de ...

African Journals Online (AJOL)

The patient was 22-year old male who presented with dysphonia, dyspnea. Chemotherapy protocol SMiLE and radiotherapy were instituted with complete remission of the tumor. Eight months afterward, he presented with tumor recurrence, palpebral edema, obstruction of the lacrymonasal duct. He died within few days with ...

Massive pulmonary cryptococcosis in an immunocompetent patient.

Science.gov (United States)

Silachamroon, U; Shuangshoti, S

1998-03-01

A 64-year-old man presented with progressive dyspnea. The symptom of severe hypoxia requiring mechanical ventilator, and bilateral pulmonary infiltrates on the chest film led to the clinical diagnosis of adult respiratory distress syndrome. Autopsy demonstrated widespread cryptococci and mucinous material in alveoli with mild inflammatory response.

Evaluation of a point-of-care ultrasound scan list in a resource-limited emergency centre in Addis Ababa Ethiopia

Directory of Open Access Journals (Sweden)

Maja Stachura

2017-09-01

Discussion: In this urban, low-resource, academic EC in Ethiopia, POCUS provided clinically relevant information for patient management, particularly for polytrauma, undifferentiated shock and undifferentiated dyspnea. Results have subsequently been used to develop a locally relevant emergency department ultrasound curriculum for Ethiopia’s first emergency medicine residency program.

Hypoxemia after pneumothorax exsufflation: a case report ...

African Journals Online (AJOL)

We describe a 36-year-old patient who was admitted to the emergency ward for acute dyspnea due to a spontaneous pneumothorax. He was successfully drained but shortly after presented a severe hypoxemia due to pulmonary oedema secondary to pulmonary re-expansion. The physiopathology behind this complication ...

Interventional and surgical treatment of a hemothorax caused by a ruptured vertebral artery in a patient with neurofibromatosis type I

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Lee, Ji Hoon; Kim, Dong Hun; Kim, Dong Hyun; Seo, Hong Joo [Chosun University College of Medicine, Gwangju (Korea, Republic of)

2014-04-15

We report a case of a massive hemothorax arising from a ruptured vertebral artery aneurysm in a patient with neurofibromatosis type 1 suffering from sudden onset of dyspnea. The vertebral artery aneurysm was treated with endovascular coil embolization. Then, an open thoracotomy was performed to evacuate the hematoma.

Congenital pulmonary arteriovenous malformation: a rare cause of ...

African Journals Online (AJOL)

Pulmonary arteriovenous malformation (PAVM) is a rare condition in which there is abnormal connection between pulmonary arteries and veins. The disorder usually appears in late childhood or early adult life, with dyspnea on exertion, clubbing or cyanosis. We present two patients with severe cyanosis and their work-up ...

Chylous vaginal discharge in a patient with lymphangioleiomyomatosis.

Science.gov (United States)

Iwamoto, Ichiro; Fujino, Toshinori; Douchi, Tsutomu

2008-09-01

We present the case of a patient having chylous vaginal discharge, which may be a symptom of the secondary to an established diagnosis of the systemic disorder, lymphangioleiomyomatosis, a disease predominantly affecting women during their reproductive years. Lymphangioleiomyomatosis causes dyspnea, pneumothorax, chylous pleural effusions, and eventually respiratory failure.

Quality of Life on Arterial Hypertension: Validity of Known Groups of MINICHAL

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Ana Lúcia Soares Soutello

2015-04-01

Full Text Available Introductions: In the care of hypertension, it is important that health professionals possess available tools that allow evaluating the impairment of the health-related quality of life, according to the severity of hypertension and the risk for cardiovascular events. Among the instruments developed for the assessment of health-related quality of life, there is the Mini-Cuestionario of Calidad de Vida en la Hipertensión Arterial (MINICHAL recently adapted to the Brazilian culture. Objective: To estimate the validity of known groups of the Brazilian version of the MINICHAL regarding the classification of risk for cardiovascular events, symptoms, severity of dyspnea and target-organ damage. Methods: Data of 200 hypertensive outpatients concerning sociodemographic and clinical information and health-related quality of life were gathered by consulting the medical charts and the application of the Brazilian version of MINICHAL. The Mann-Whitney test was used to compare health-related quality of life in relation to symptoms and target-organ damage. The Kruskal-Wallis test and ANOVA with ranks transformation were used to compare health-related quality of life in relation to the classification of risk for cardiovascular events and intensity of dyspnea, respectively. Results: The MINICHAL was able to discriminate health-related quality of life in relation to symptoms and kidney damage, but did not discriminate health-related quality of life in relation to the classification of risk for cardiovascular events. Conclusion: The Brazilian version of the MINICHAL is a questionnaire capable of discriminating differences on the health‑related quality of life regarding dyspnea, chest pain, palpitation, lipothymy, cephalea and renal damage.

Extrapulmonary features of bronchiectasis: muscle function, exercise capacity, fatigue, and health status

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Ozalp Ozge

2012-06-01

Full Text Available Abstract Background There are limited number of studies investigating extrapulmonary manifestations of bronchiectasis. The purpose of this study was to compare peripheral muscle function, exercise capacity, fatigue, and health status between patients with bronchiectasis and healthy subjects in order to provide documented differences in these characteristics for individuals with and without bronchiectasis. Methods Twenty patients with bronchiectasis (43.5 ± 14.1 years and 20 healthy subjects (43.0 ± 10.9 years participated in the study. Pulmonary function, respiratory muscle strength (maximal expiratory pressure – MIP - and maximal expiratory pressure - MEP, and dyspnea perception using the Modified Medical Research Council Dyspnea Scale (MMRC were determined. A six-minute walk test (6MWT was performed. Quadriceps muscle, shoulder abductor, and hand grip strength (QMS, SAS, and HGS, respectively using a hand held dynamometer and peripheral muscle endurance by a squat test were measured. Fatigue perception and health status were determined using the Fatigue Severity Scale (FSS and the Leicester Cough Questionnaire (LCQ, respectively. Results Number of squats, 6MWT distance, and LCQ scores as well as lung function testing values and respiratory muscle strength were significantly lower and MMRC and FSS scores were significantly higher in patients with bronchiectasis than those of healthy subjects (p p p p p  Conclusions Peripheral muscle endurance, exercise capacity, fatigue and health status were adversely affected by the presence of bronchiectasis. Fatigue was associated with dyspnea and health status. Respiratory muscle strength was related to peripheral muscle strength and health status, but not to fatigue, peripheral muscle endurance or exercise capacity. These findings may provide insight for outcome measures for pulmonary rehabilitation programs for patients with bronchiectasis.

Spontaneous pneumothorax and pneumomediastinum in IPF

International Nuclear Information System (INIS)

Franquet, T.; Gimenez, A.; Torrubia, S.; Sabate, J.M.; Rodriguez-Arias, J.M.

2000-01-01

Patients with idiopathic pulmonary fibrosis (IPF) are at risk for a variety of acute pulmonary complications, including pneumothorax and pneumomediastinum. Our aim was to describe the radiographic and CT findings and to determine the frequency of complicating spontaneous pneumothorax and pneumomediastinum in patients with IPF. A retrospective study was performed including 78 consecutive patients who underwent CT scanning of the chest and who had confirmed IPF. The chest radiographs and CT scans were reviewed by two chest radiologists and classified as showing features of extra-alveolar air collections. The CT scans showed extra-alveolar air in 9 (11.2 %) of 78 patients (six females and three males; age range 26-90 years, mean age 65 years). Pneumothorax was demonstrated in 5 patients and mediastinal air collections in 4 patients. All patients had dyspnea for 1-48 months (mean 14 months). Of the five cases with pneumothorax, four developed acute onset of dyspnea and pleuritic chest pain, whereas 1 patient had a relatively stable functional status. Of the 4 patients with pneumomediastinum, three presented with nonpleuritic chest pain and acute dyspnea. Chest radiographs showed extra-alveolar air in 6 patients. Three cases were predicted to be negative by chest radiographs. Follow-up CT showed that air collections had resolved completely in 5 patients. Two patients died of respiratory failure within 4 months after CT. Extra-alveolar air should be recognized as a relatively common IPF-related complication. Chest CT is a useful imaging method in determining air collections in patients with IPF that become acutely breathless and their chest radiograph fails to reveal the presence of extra-alveolar air. (orig.)

Differences in adjustment between individuals with alpha-1 antitrypsin deficiency (AATD)-associated COPD and non-AATD COPD.

Science.gov (United States)

Holm, Kristen E; Borson, Soo; Sandhaus, Robert A; Ford, Dee W; Strange, Charlie; Bowler, Russell P; Make, Barry J; Wamboldt, Frederick S

2013-04-01

Smokers who have severe alpha-1 antitrypsin deficiency (AATD) are at risk for developing COPD earlier in life than smokers without AATD, and are likely to experience challenges adjusting to their illness because they are in a highly productive life stage when they are diagnosed with COPD. This study examined whether individuals with AATD-associated COPD differ from individuals with non-AATD COPD with regard to depression, anxiety, dyspnea, and health-related quality of life (HRQL). Cross-sectional data were collected via self-report questionnaires completed by 480 individuals with non-AATD COPD and 578 individuals with AATD-associated COPD under protocols with IRB approval. Multiple linear regression models were used to test whether individuals with non-AATD COPD differed from individuals with AATD-associated COPD with regard to depression, anxiety, dyspnea, and HRQL. All models adjusted for demographic and health characteristics. Individuals with AATD-associated COPD did not report more symptoms of depression or anxiety; however, they did report more dyspnea (B = 0.31, 95% CI = 0.16 to 0.47, p < 0.001) and impairment in HRQL (B = 4.75, 95% CI = 2.10 to 7.41, p < 0.001) than other individuals with COPD. Individuals with AATD-associated COPD were more likely to be a member of a couple (rather than single) and had a higher level of education when compared to individuals with non-AATD COPD. Resources available to persons with AATD-associated COPD, such as being in a serious relationship and having higher education, may offset the effect of age when considering symptoms of depression and anxiety in patients with COPD.

Differences in Adjustment between Individuals with Alpha-1 Antitrypsin Deficiency (AATD) Associated COPD and Non-AATD COPD

Science.gov (United States)

Holm, Kristen E.; Borson, Soo; Sandhaus, Robert A.; Ford, Dee W.; Strange, Charlie; Bowler, Russell P.; Make, Barry J.; Wamboldt, Frederick S.

2013-01-01

Smokers who have severe alpha-1 antitrypsin deficiency (AATD) are at risk for developing COPD earlier in life than smokers without AATD, and are likely to experience challenges adjusting to their illness because they are in a highly productive life stage when they are diagnosed with COPD. This study examined whether individuals with AATD-associated COPD differ from individuals with non-AATD COPD with regard to depression, anxiety, dyspnea, and health-related quality of life (HRQL). Cross-sectional data were collected via self-report questionnaires completed by 480 individuals with non-AATD COPD and 578 individuals with AATD-associated COPD under protocols with IRB approval. Multiple linear regression models were used to test whether individuals with non-AATD COPD differed from individuals with AATD-associated COPD with regard to depression, anxiety, dyspnea, and HRQL. All models adjusted for demographic and health characteristics. Individuals with AATD-associated COPD did not report more symptoms of depression or anxiety; however, they did report more dyspnea (B = 0.31, 95% CI = 0.16 to 0.47, p < 0.001) and impairment in HRQL (B = 4.75, 95% CI = 2.10 to 7.41, p < 0.001) than other individuals with COPD. Individuals with AATD-associated COPD were more likely to be a member of a couple (rather than single) and had a higher level of education when compared to individuals with non-AATD COPD. Resources available to persons with AATD-associated COPD, such as being in a serious relationship and having higher education, may offset the effect of age when considering symptoms of depression and anxiety in patients with COPD. PMID:23547634

The continuum of physiological impairment during treadmill walking in patients with mild-to-moderate COPD: patient characterization phase of a randomized clinical trial.

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Denis E O'Donnell

Full Text Available To have a better understanding of the mechanisms of exercise limitation in mild-to-moderate chronic obstructive pulmonary disease (COPD, we compared detailed respiratory physiology in patients with COPD and healthy age- and sex-matched controls.Data were collected during the pre-treatment, patient characterization phase of a multicenter, randomized, double-blind, crossover study. Patients with COPD met Global Initiative for Chronic Obstructive Lung Disease (GOLD 1 or 2 spirometric criteria, were symptomatic, and had evidence of gas trapping during exercise. All participants completed pulmonary function and symptom-limited incremental treadmill exercise tests.Chronic activity-related dyspnea measured by Baseline Dyspnea Index was similarly increased in patients with GOLD 1 (n = 41 and 2 (n = 63 COPD compared with controls (n = 104. Plethysmographic lung volumes were increased and lung diffusing capacity was decreased in both GOLD groups. Peak oxygen uptake and work rate were reduced in both GOLD groups compared with controls (p<0.001. Submaximal ventilation, dyspnea, and leg discomfort ratings were higher for a given work rate in both GOLD groups compared with controls. Resting inspiratory capacity, peak ventilation, and tidal volume were reduced in patients with GOLD 2 COPD compared with patients with GOLD 1 COPD and controls (p<0.001.Lower exercise tolerance in patients with GOLD 1 and 2 COPD compared with controls was explained by greater mechanical abnormalities, greater ventilatory requirements, and increased subjective discomfort. Lower resting inspiratory capacity in patients with GOLD 2 COPD was associated with greater mechanical constraints and lower peak ventilation compared with patients with GOLD 1 COPD and controls.ClinicalTrials.gov: NCT01072396.

Late thrombosis of a mitral bioprosthetic valve with associated massive left atrial thrombus

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Preetham R Muskula

2017-04-01

Full Text Available An 84-year-old man presented 5 years after bioprosthetic mitral valve replacement with three months of worsening dyspnea on exertion. A new mitral stenosis murmur was noted on physical examination, and an electrocardiogram revealed newly recognized atrial fibrillation. Severe mitral stenosis (mean gradient = 13 mmHg was confirmed by transthoracic echocardiography. Transesophageal echocardiography revealed markedly thickened mitral bioprosthetic leaflets with limited mobility, and a massive left atrial thrombus (>4 cm in diameter (Fig. 1A, B, C, D and Videos 1, 2, 3 and 4. Intravenous heparin was initiated, and 5 days later, he was taken to the operating room for planned redo mitral valve replacement and left atrial thrombus extraction. Intraoperative transesophageal echocardiography revealed near-complete resolution of the bioprosthetic leaflet thickening, and a mean mitral gradient of only 3 mmHg (Fig. 2A, B, C and Videos 5, 6 and 7. The patient underwent resection of the massive left atrial thrombus (Fig. 2D but did not require redo mitral valve replacement. He was initiated on heparin (and transitioned to warfarin early in the post-operative period, with complete resolution of dyspnea on exertion at 3-month follow-up. Bioprosthetic valve thrombosis is increasingly recognized as a cause of early prosthetic valve dysfunction (1, 2. This case illustrates that bioprosthetic valve thrombosis may occur years after valve replacement; therefore, any deterioration in a patient’s clinical status (new-onset dyspnea, heart failure or atrial fibrillation warrants a thorough evaluation of the bioprosthetic valve with transesophageal echocardiography. In this case, initiation of anticoagulation obviated the need for redo mitral valve replacement.

Case report

African Journals Online (AJOL)

ebutamanya

2015-05-22

May 22, 2015 ... was hospitalized for dyspnea stage IV, low consciousness level without fever and focal neurological signs and sudden onset oliguria. , five days after a normal vaginal delivery. The review of systems highlighted a diffuse arthralgia, a Raynaud's phenomenon and a thickening of fingers skin since one a year ...

Ectopic pancreas in a giant mediastinal cyst

NARCIS (Netherlands)

Li, Wilson W.; van Boven, Wim Jan; Jurhill, Roy R.; Bonta, Peter I.; Annema, Jouke T.; de Mol, Bas A.

2016-01-01

Ectopic pancreas located in the mediastium is an extremely rare anomaly. We present a case of an ectopic pancreas located in a giant mediastinal cyst in an 18-year-old man. He presented with symptoms of dyspnea due to external compression of the cyst on the left main bronchus. Complete surgical

Communication between the right and circumflex coronary arteries discovered incidentally by multidetector computed tomography

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Kwon, Se Hwan; Kim, Eui Jong; Woo, Jong Shin; Kim, Soo Joong; Youn, Hyo Chul; Oh, Joo Hyeong [College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

2016-09-15

Intercoronary communication is a rare congenital coronary anomaly. We present a case of a 48-year-old man with an incidentally discovered communication between the right and circumflex coronary arteries, who was admitted with chest tightness and exertional dyspnea. The initial diagnosis was made using electrocardiogram-gated multidetector computed tomography.

Insuffisance cardiaque de l'adulte dans les centres hospitaliers ...

African Journals Online (AJOL)

There was a male predominance with malefemale ratio of 1.48. Exertional dyspnea (75%), pulmonary rales (62.5%), edema (60.6%) were the main symptoms found. The rate of laboratory explorations achievement is very low due to the financial straits. Cardiomyopathies (85.7%), valvular heart disease (68%) and arterial ...

Predictive Factors associated with Death of Elderly in Nursing Homes

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Kiwol Sung, PhD, RN

2014-06-01

Conclusion: Dyspnea, problematic behaviors, and ADL data were identified as the key factors associated with death among nursing home residents. Future plans for the prediction of death among nursing home residents can be made by nursing staff, factoring in these identified variables, to ensure more comfortable conditions and more responsive care.

Carcinome adenoide kystique sous-glottique | Gassab | Journal ...

African Journals Online (AJOL)

Case report: A 75-year-old man, presented with a laryngeal dyspnea. The computed tomography of the larynx showed a posterior subglottic tumor. The panendoscopy revealed a large nonulcerated submucosal tumor in the posterior wall of the subglottic area. Biopsies made the diagnosis of laryngeal ACC. The patient had ...

Case report

African Journals Online (AJOL)

abp

16 janv. 2017 ... We report the case of a 70-year-old man with no past medical history presenting with laryngeal dyspnea associated with low abundant paroxysmal hemoptysis. The patient underwent nasofibroscopy showing the presence of a living and mobile organism at the subglottic level evoking a leech. Extraction ...

Endurance and strength training in pulmonary rehabilitation for COPD patients

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Rasha Daabis

2017-04-01

Conclusion: PR is an effective intervention for the post-exacerbation management of COPD patients. It leads to significant improvements of dyspnea, HRQL and functional exercise capacity. When added to a program of ET, strength training confers additional benefits in muscle force, but not in overall exercise capacity or health status.

Laryngeal obstruction caused by lymphoma in an adult dairy cow

OpenAIRE

Lardé, Hélène; Nichols, Sylvain; Babkine, Marie; Chénier, Sonia

2014-01-01

A Holstein cow was presented for inspiratory dyspnea. Endoscopic evaluation revealed swollen arytenoids and a presumptive diagnosis of bilateral arytenoidal chondritis was made. A partial arytenoidectomy was performed, the right arytenoid was submitted for histopathology, and a diagnosis of laryngeal lymphoma was made. Due to the poor prognosis, the cow was euthanized.

Traumatismes externes du larynx | Ghorbal | Journal Tunisien d'ORL ...

African Journals Online (AJOL)

Le but de ce travail est de rappeler la présentation clinique des traumatismes externes du larynx et d'étayer notre attitude dans la prise en charge de ces ... Introduction: External laryngeal trauma is rare but acutely life-threatening. ... The main presenting symptoms were hoarseness, cervical pain, dyspnea and bleeding.

Prolonged Dyspnea after Interscalene Block: Attributed to Undiagnosed Addison's Disease and Myasthenia Gravis.

Science.gov (United States)

Skedros, John G; Kiser, Casey J; Mendenhall, Shaun D

2011-01-01

This report describes a patient who had a series of daily interscalene nerve blocks to treat pain following a shoulder manipulation for postsurgical stiffness. She experienced acute respiratory compromise that persisted for many weeks. All typical and unusual causes of these symptoms were ruled out. Her treating pulmonologist theorized that the ipsilateral carotid body had been injured. However, it was subsequently determined that the constellation of symptoms and their prolonged duration were best explained by a poor stress response from Addison's disease coupled with exacerbation of early onset myasthenia gravis. This patient's case is not a typical reaction to interscalene nerve blocks, and thus preoperative testing would not be recommended for myasthenia gravis or Addison's disease without underlying suspicion. We describe this report to inform physicians to consider a workup for these diagnoses if a typical workup rules out all usual causes of complications from an interscalene block.

Prolonged Dyspnea after Interscalene Block: Attributed to Undiagnosed Addison's Disease and Myasthenia Gravis

OpenAIRE

Skedros, John G.; Kiser, Casey J.; Mendenhall, Shaun D.

2011-01-01

This report describes a patient who had a series of daily interscalene nerve blocks to treat pain following a shoulder manipulation for postsurgical stiffness. She experienced acute respiratory compromise that persisted for many weeks. All typical and unusual causes of these symptoms were ruled out. Her treating pulmonologist theorized that the ipsilateral carotid body had been injured. However, it was subsequently determined that the constellation of symptoms and their prolonged duration wer...

Prolonged Dyspnea after Interscalene Block: Attributed to Undiagnosed Addison's Disease and Myasthenia Gravis

Directory of Open Access Journals (Sweden)

John G. Skedros

2011-01-01

Full Text Available This report describes a patient who had a series of daily interscalene nerve blocks to treat pain following a shoulder manipulation for postsurgical stiffness. She experienced acute respiratory compromise that persisted for many weeks. All typical and unusual causes of these symptoms were ruled out. Her treating pulmonologist theorized that the ipsilateral carotid body had been injured. However, it was subsequently determined that the constellation of symptoms and their prolonged duration were best explained by a poor stress response from Addison's disease coupled with exacerbation of early onset myasthenia gravis. This patient's case is not a typical reaction to interscalene nerve blocks, and thus preoperative testing would not be recommended for myasthenia gravis or Addison's disease without underlying suspicion. We describe this report to inform physicians to consider a workup for these diagnoses if a typical workup rules out all usual causes of complications from an interscalene block.

Exercise induced dyspnea in the young. Larynx as the bottleneck of the airways.

Science.gov (United States)

Røksund, Ola Drange; Maat, Robert Christiaan; Heimdal, John Helge; Olofsson, Jan; Skadberg, Britt Torunn; Halvorsen, Thomas

2009-12-01

Exercise induced asthma may symptomatically be difficult to differentiate from exercise related obstruction in the upper airways, sometimes leading to diagnostic confusion and inappropriate treatment. Larynx accounts for a significant fraction of total airway resistance, but its role as a limiting factor for airflow during exercise has been hampered by lack of diagnostic tools. We aimed to study laryngeal function in exercising humans by transnasal laryngoscopy. Continuous video recording of the larynx was performed in parallel with continuous film recording of the upper part of the body and recording of breath sounds in subjects running to respiratory distress or exhaustion on a treadmill. A successful examination was obtained in 20 asymptomatic volunteers and 151 (91%) of 166 young patients with a history of inspiratory distress or stridor during exercise. At rest, six patients had abnormal laryngeal findings. During exercise, a moderate or severe adduction of laryngeal structures was observed in parallel with increasing inspiratory distress in 113 (75%) patients. In 109 of these, adduction started within supraglottic structures, followed by adduction of the vocal cords in 88. In four patients, laryngeal adduction started in the vocal cords, involving supraglottic structures secondarily in three. Larynx can safely be studied throughout a maximum intensity exercise treadmill test. A characteristic laryngeal response pattern to exercise was visualised in a large proportion of patients with suspected upper airway obstruction. Laryngoscopy during ongoing symptoms is recommended for proper assessment of these patients.

[Correlation factors of 127 times pre-crisis state in patients with myasthenia gravis].

Science.gov (United States)

Ou, C Y; Ran, H; Qiu, L; Huang, Z D; Lin, Z Z; Deng, J; Liu, W B

2017-10-10

Objective: To investigate the clinical features of the Pre-Crisis State and analyze the correlated risk factors of Pre-Crisis State of myasthenia crisis. Methods: We included 93 patients with myasthenia gravis (MG) who experienced 127 times Pre-Crisis State between October 2007 and July 2016. Those patients were hospitalized in the MG specialize center, Department of Neurological Science, first Affiliated Hospital of Sun Yat-sen University. The information of the general situation, the clinical manifestations and the blood gas analysis in those patients were collected using our innovated clinical research form. Statistic methods were applied including descriptive analysis, univariate logistic analysis, multivariate correlation logistic analysis, etc. Results: (1)The typical features of MG Pre-Crisis State included: dyspnea (127 times, 100% not requiring intubation or non-invasive ventilation), bulbar-muscle weakness (121 times, 95.28%), the increased blood partial pressure of carbon dioxide (PCO(2)) (94 times, 85.45%), expectoration weakness (99 times, 77.95%), sleep disorders (107 times, 84.25%) and the infection (99 times, 77.95%). The occurrence of dyspnea in combination with bulbar-muscle weakness ( P =0.002) or the increased blood PCO(2) ( P =0.042) often indicated the tendency of crisis. (2) The MG symptoms which were proportion to the occurrence of crisis includes: bulbar-muscle weakness ( P =0.028), fever ( P =0.028), malnutrition ( P =0.066), complications ( P =0.071), excess oropharyngeal secretions ( P =0.005) and the increased blood PCO(2) ( P =0.007). The perioperative period of thymectomy would not increase the risk of crisis. Conclusions: Dyspnea indicates the occurrence of the Pre-Crisis State of MG. In order to significantly reduce the morbidity of myasthenia crisis, the bulbar-muscle weakness, the increased blood PCO(2), expectoration weakness, sleep disorders, infection & fever and excess oropharyngeal secretions should be treated timely.

Evaluation of a classical unani pharmacopeial formulation safoof-e-muhazzil in hyperlipidemia: A randomized, standard controlled clinical study

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Umar Jahangir

2014-01-01

Full Text Available Aim of the Study: The aim of the following study is to evaluate the efficacy and tolerability of a compound Unani formulation in hyperlipidemia on clinical and biochemical parameters. Materials and Methods: A total of 90 patients with total cholesterol level of 220 mg/dl and above were included. In Group ′A′ thirty patients with total cholesterol 243.5 ± 5.294 mg/dl received Unani formulation safoof-e-muhazzil (SM in its classical powder form 5 g twice daily orally, in Group ′B′ thirty patients with total cholesterol 234 ± 3.822 mg/dl received the SM but in compressed tablet form in the same dosage and in Group ′C′ 30 patients with total cholesterol 242.7 ± 5.563 mg/dl received atorvastatin 10 mg as a standard control. Follow-up was carried out on second, fourth and 6th week and patients were evaluated on clinical as well as biochemical parameters. Results: Group A before treatment had mean total cholesterol of 243.5 ± 5.294 mg/dl which decreased significantly after treatment to 225.6 ± 5.953 mg/dl (P 0.5 relief in palpitation and 26.17% (P < 0.001 relief in dyspnea post-treatment. Group B fatigue decreased significantly by 18.14% (P < 0.01, palpitation by 22.91% (P < 0.01 and dyspnea by 20.46% (P < 0.01. In Group C a non-significant increase of 2.2% was observed in fatigue post-treatment, palpitation decreased by 10.22% non-significantly and dyspnea decreased significantly by 17.64% (P < 0.001. Results indicate that the test drug safely and effectively ameliorates the clinical condition of patients with hyperlipidemia while decreasing cholesterol level as well.

Directly measured secondhand smoke exposure and COPD health outcomes

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Balmes John

2006-06-01

Full Text Available Abstract Background Although personal cigarette smoking is the most important cause and modulator of chronic obstructive pulmonary disease (COPD, secondhand smoke (SHS exposure could influence the course of the disease. Despite the importance of this question, the impact of SHS exposure on COPD health outcomes remains unknown. Methods We used data from two waves of a population-based multiwave U.S. cohort study of adults with COPD. 77 non-smoking respondents with a diagnosis of COPD completed direct SHS monitoring based on urine cotinine and a personal badge that measures nicotine. We evaluated the longitudinal impact of SHS exposure on validated measures of COPD severity, physical health status, quality of life (QOL, and dyspnea measured at one year follow-up. Results The highest level of SHS exposure, as measured by urine cotinine, was cross-sectionally associated with poorer COPD severity (mean score increment 4.7 pts; 95% CI 0.6 to 8.9 and dyspnea (1.0 pts; 95% CI 0.4 to 1.7 after controlling for covariates. In longitudinal analysis, the highest level of baseline cotinine was associated with worse COPD severity (4.7 points; 95% CI -0.1 to 9.4; p = 0.054, disease-specific QOL (2.9 pts; -0.16 to 5.9; p = 0.063, and dyspnea (0.9 pts; 95% CI 0.2 to 1.6 pts; p Conclusion Directly measured SHS exposure appears to adversely influence health outcomes in COPD, independent of personal smoking. Because SHS is a modifiable risk factor, clinicians should assess SHS exposure in their patients and counsel its avoidance. In public health terms, the effects of SHS exposure on this vulnerable subpopulation provide a further rationale for laws prohibiting public smoking.

Management of Benign Tracheal Stenosis by Small-diameter Tube-assisted Bronchoscopic Balloon Dilatation

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Yi-Lin Liang

2015-01-01

Full Text Available Background: A limitation of bronchoscopic balloon dilatation (BBD is that airflow must be completely blocked for as long as possible during the operation. However, the patient often cannot hold his or her breath for a long period affecting the efficacy of the procedure. In this study, we used an extra-small-diameter tube to provide assisted ventilation to patients undergoing BBD and assessed the efficacy and safety of this technique. Methods: Bronchoscopic balloon dilatation was performed in 26 patients with benign tracheal stenosis using an extra-small-diameter tube. The tracheal diameter, dyspnea index, blood gas analysis results, and complications were evaluated before and after BBD. Statistical analyses were performed by SPSS version 16.0 for Windows (SPSS, Inc., Chicago, IL, USA. Results: Sixty-three BBD procedures were performed in 26 patients. Dyspnea immediately improved in all patients after BBD. The tracheal diameter significantly increased from 5.5 ± 1.5 mm to 13.0 ± 1.3 mm (P < 0.001, and the dyspnea index significantly decreased from 3.4 ± 0.8 to 0.5 ± 0.6 (P < 0.001. There was no significant change in the partial pressure of oxygen during the operation (before, 102.5 ± 27.5 mmHg; during, 96.9 ± 30.4 mmHg; and after, 97.2 ± 21.5 mmHg; P = 0.364, but there was slight temporary retention of carbon dioxide during the operation (before, 43.5 ± 4.2 mmHg; during, 49.4 ± 6.8 mmHg; and after, 40.1 ± 3.9 mmHg; P < 0.001. Conclusion: Small-diameter tube-assisted BBD is an effective and safe method for the management of benign tracheal stenosis.

Study of efficacy and toxicity of hypofractionated thoracic radiotherapy 17 gray in 2 fractions for palliation in advanced non-small-cell lung cancer

International Nuclear Information System (INIS)

Arif, S.; Rasul, S.; Haider, N.; Mahmood, A.; Syed, A.S.; Nadeem, M.

2012-01-01

Objective: To determine the efficacy and toxicity of hypofractionated thoracic radiotherapy 17 Gray (Gy) in 2 fractions for palliation in advanced non-small-cell lung carcinoma. Study design: A quasi-experimental study. Place and duration of study: Oncology department, Combined Military Hospital, Rawalpindi, from 4th July 2008 to 4th Nov 2009. Material and Methods: Fifty four patients with histologically and/or cytologically confirmed unresectable stages III and IV non small cell lung cancer, with performance status 2 or 3 and expected survival > 2 months were treated with megavoltage radiation therapy 17 Gy in 2 fractions one week apart, with symptoms due to intrathoracic disease (cough, dyspnea and hemoptysis) and toxicity due to radiation therapy (dysphagia secondary to esophagitis) assessed as per common toxicity criteria adverse event version 3.0 on day 0 before treatment and day 30 after start of treatment. Results: Grades of cough, hemoptysis and dyspnea showed significant improvement after treatment (p<0.001). A total of 42.68% patients showed an improvement in grade of cough (23 out of 54 patients), 85.7% of patients showed improvement in grade of hemoptysis (36 out of 42 patients) and 55.65% patients showed improvement in grade of dyspnea (30 out of 54 patients). Twenty two point two percent patients (12 out of 54) showed increase in grade of dysphagia. Although, there was a statistically significant increase in grade of dysphagia after treatment but it was limited to grade 1 and 2 only. Considering that no patient had grade 3 or 4 dysphagia, this toxicity was acceptable. Conclusion: Based on our results hypofractionated thoracic radiotherapy, 17 Gy in 2 fractions, is effective with acceptable toxicity in palliation in advanced non small cell lung cancer and is recommended as it will result in shorter duration of hospital stay and low hospital stay charges. (author)

Use of the covered Y-shaped metallic stent in the treatment of airway stenoses involving the lower trachea and the tracheal carina: preliminary clinical study

International Nuclear Information System (INIS)

Yang Ruimin; Li Fenbao; Zhang Mingqiu; Wu Gang; Han Xinwei

2007-01-01

Objective: To describe a new kind of Y-shaped metallic stent delivery system and evaluate its feasibility and preliminary effect for managing multiple airway stenoses involving the lower trachea and the tracheal carina. Methods: The Y-shaped metallic stent delivery system consisted of three-tier structure. The inner-tier was composed of four parallel guiding tubes, which was used for two guidewires and two threads passing through, the middle-tier was delivery catheter, which contained the four guiding tubes, and the outer-tier was introducer sheath. Under the fluoroscopic guidance, 15 patients with multiple stenoses involving the lower trachea and the tracheal carina were treated with the new covered self-expandable Y-shaped metallic stents. Results: Stent placement in the tracheo-bronchial tree was technically successful in all patients with obliteration of the dyspnea immediately after stent placement, and SaO2 was increased form preoperative 75%-89% to postoperative 96%-99%. During follow-up a period of 3-58 weeks (M 22 weeks), all stenosis were resolved without stent-related complications, and the general physical of all 15 patents was improved with no occurrence of obviously dyspnea and bleeding. Karnofsky performance status (KPS) was improved from preoperative 26%-45% to postoperative 72%-95%. Five patients died of the following causes unrelated to stent insertion: multiple organ failure (n=3), cachexia (n=1) and pulmonary infection caused by gastrobronehial fistula (n=1), and the remaining 10 patients were alive with no evidence of dyspnea at the time of this report. Conclusion: Deployment of the covered Y-shaped metallic stent with the use of Y metallic stent delivery system in the management of airway stenoses involving the lower trachea and the tracheal carina was a simple and safe procedure and with a good short-term clinical efficacy. (authors)

Use of the covered Y-shaped metallic stent in the treatment of airway stenoses involving the lower trachea and the tracheal carina: preliminary clinical study

Energy Technology Data Exchange (ETDEWEB)

Ruimin, Yang; Fenbao, Li; Mingqiu, Zhang [Department of Intervention, First Affiliated Hospital, Xinxiang Medical Univ., Xinxiang (China); Gang, Wu; Xinwei, Han

2007-09-15

Objective: To describe a new kind of Y-shaped metallic stent delivery system and evaluate its feasibility and preliminary effect for managing multiple airway stenoses involving the lower trachea and the tracheal carina. Methods: The Y-shaped metallic stent delivery system consisted of three-tier structure. The inner-tier was composed of four parallel guiding tubes, which was used for two guidewires and two threads passing through, the middle-tier was delivery catheter, which contained the four guiding tubes, and the outer-tier was introducer sheath. Under the fluoroscopic guidance, 15 patients with multiple stenoses involving the lower trachea and the tracheal carina were treated with the new covered self-expandable Y-shaped metallic stents. Results: Stent placement in the tracheo-bronchial tree was technically successful in all patients with obliteration of the dyspnea immediately after stent placement, and SaO2 was increased form preoperative 75%-89% to postoperative 96%-99%. During follow-up a period of 3-58 weeks (M 22 weeks), all stenosis were resolved without stent-related complications, and the general physical of all 15 patents was improved with no occurrence of obviously dyspnea and bleeding. Karnofsky performance status (KPS) was improved from preoperative 26%-45% to postoperative 72%-95%. Five patients died of the following causes unrelated to stent insertion: multiple organ failure (n=3), cachexia (n=1) and pulmonary infection caused by gastrobronehial fistula (n=1), and the remaining 10 patients were alive with no evidence of dyspnea at the time of this report. Conclusion: Deployment of the covered Y-shaped metallic stent with the use of Y metallic stent delivery system in the management of airway stenoses involving the lower trachea and the tracheal carina was a simple and safe procedure and with a good short-term clinical efficacy. (authors)

Intensity cut-points for the Respiratory Distress Observation Scale

Science.gov (United States)

Campbell, Margaret L; Templin, Thomas N

2015-01-01

Background The Respiratory Distress Observation Scale© is an innovative solution to assessment when a dyspnea report cannot be elicited. The Respiratory Distress Observation Scale has acceptable reliability and validity psychometrics. Aim To identify distress-intensity cut-points of the Respiratory Distress Observation Scale. Design Receiver operating characteristic curve analysis was conducted with inpatients stratified by four levels of respiratory distress—none, mild, moderate, or severe. Patients provided three self-report measures of dyspnea: dichotomous (yes/no); a ranking of none, mild, moderate, or severe; and a numerical rating scale. Respiratory distress was assessed using the Respiratory Distress Observation Scale instrument. Setting/participants Participants were 136 adult inpatients, mean age 61.8 years (standard deviation = 13.18 years), 89.7% African American, and 56.6% female, who were recruited from an urban, tertiary care hospital in the Midwest of the United States. Results In all, 47% (n = 64) self-reported dyspnea (yes/no). Ranking was distributed as follows: none = 36, mild = 35, moderate = 40, and severe = 25. Numerical rating scale scores ranged from 0 to 10, mean = 4.99 (standard deviation = 2.9). Respiratory Distress Observation Scale scores ranged from 0 to 7, median (interquartile range) = 2 (1–3). Receiver operating characteristic curve analysis–determined Respiratory Distress Observation Scale score of 0–2 suggests little or no respiratory distress; score ≥3 signified moderate to severe distress. Conclusion A Respiratory Distress Observation Scale score ≥3 signifies a patient’s need for palliation of respiratory distress. An end-point for identifying responsiveness to treatment, in other words, respiratory comfort, is Respiratory Distress Observation Scale <3. Because patients with imminent respiratory failure, as typified by dying patients, were not represented yielding lower than expected Respiratory Distress

Panic Anxiety in Humans with Bilateral Amygdala Lesions: Pharmacological Induction via Cardiorespiratory Interoceptive Pathways.

Science.gov (United States)

Khalsa, Sahib S; Feinstein, Justin S; Li, Wei; Feusner, Jamie D; Adolphs, Ralph; Hurlemann, Rene

2016-03-23

We previously demonstrated that carbon dioxide inhalation could induce panic anxiety in a group of rare lesion patients with focal bilateral amygdala damage. To further elucidate the amygdala-independent mechanisms leading to aversive emotional experiences, we retested two of these patients (B.G. and A.M.) to examine whether triggering palpitations and dyspnea via stimulation of non-chemosensory interoceptive channels would be sufficient to elicit panic anxiety. Participants rated their affective and sensory experiences following bolus infusions of either isoproterenol, a rapidly acting peripheral β-adrenergic agonist akin to adrenaline, or saline. Infusions were administered during two separate conditions: a panic induction and an assessment of cardiorespiratory interoception. Isoproterenol infusions induced anxiety in both patients, and full-blown panic in one (patient B.G.). Although both patients demonstrated signs of diminished awareness for cardiac sensation, patient A.M., who did not panic, reported a complete lack of awareness for dyspnea, suggestive of impaired respiratory interoception. These findings indicate that the amygdala may play a role in dynamically detecting changes in cardiorespiratory sensation. The induction of panic anxiety provides further evidence that the amygdala is not required for the conscious experience of fear induced via interoceptive sensory channels. We found that monozygotic twins with focal bilateral amygdala lesions report panic anxiety in response to intravenous infusions of isoproterenol, a β-adrenergic agonist similar to adrenaline. Heightened anxiety was evident in both twins, with one twin experiencing a panic attack. The twin who did not panic displayed signs of impaired cardiorespiratory interoception, including a complete absence of dyspnea sensation. These findings highlight that the amygdala is not strictly required for the experience of panic anxiety, and suggest that neural systems beyond the amygdala are also

High frequency chest wall oscillation for asthma and chronic obstructive pulmonary disease exacerbations: a randomized sham-controlled clinical trial

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Lewis Stephanie

2011-09-01

Full Text Available Abstract Background High frequency chest wall oscillation (HFCWO is used for airway mucus clearance. The objective of this study was to evaluate the use of HFCWO early in the treatment of adults hospitalized for acute asthma or chronic obstructive pulmonary disease (COPD. Methods Randomized, multi-center, double-masked phase II clinical trial of active or sham treatment initiated within 24 hours of hospital admission for acute asthma or COPD at four academic medical centers. Patients received active or sham treatment for 15 minutes three times a day for four treatments. Medical management was standardized across groups. The primary outcomes were patient adherence to therapy after four treatments (minutes used/60 minutes prescribed and satisfaction. Secondary outcomes included change in Borg dyspnea score (≥ 1 unit indicates a clinically significant change, spontaneously expectorated sputum volume, and forced expired volume in 1 second. Results Fifty-two participants were randomized to active (n = 25 or sham (n = 27 treatment. Patient adherence was similarly high in both groups (91% vs. 93%; p = 0.70. Patient satisfaction was also similarly high in both groups. After four treatments, a higher proportion of patients in the active treatment group had a clinically significant improvement in dyspnea (70.8% vs. 42.3%, p = 0.04. There were no significant differences in other secondary outcomes. Conclusions HFCWO is well tolerated in adults hospitalized for acute asthma or COPD and significantly improves dyspnea. The high levels of patient satisfaction in both treatment groups justify the need for sham controls when evaluating the use of HFCWO on patient-reported outcomes. Additional studies are needed to more fully evaluate the role of HFCWO in improving in-hospital and post-discharge outcomes in this population. Trial Registration ClinicalTrials.gov: NCT00181285

Effect of Bronchodilation and Exercise Training with Behavior Modification on Exercise Tolerance and Downstream Effects on Symptoms and Physical Activity in COPD.

Science.gov (United States)

Troosters, Thierry; Maltais, François; Leidy, Nancy; Lavoie, Kim L; Sedeno, Maria; Janssens, Wim; Garcia-Aymerich, Judith; Erzen, Damijan; De Sousa, Dorothy; Korducki, Lawrence; Hamilton, Alan; Bourbeau, Jean

2018-04-17

Bronchodilation and exercise training (ExT) improve exercise tolerance in patients with chronic obstructive pulmonary disease (COPD); however, behavior modification is required to impact on daily physical activity (PA). To assess whether tiotropium/olodaterol, ±ExT, would improve exercise endurance time (EET) and PA compared with placebo in patients participating in a self-management behavior-modification (SMBM) program. A 12-week, randomized, partially double-blind, placebo-controlled, parallel-group trial in patients with COPD (PHYSACTO®; NCT02085161). All patients were enrolled into SMBM and randomized 1:1:1:1 to once-daily placebo, tiotropium 5 µg, tiotropium/olodaterol 5/5 µg, or tiotropium/olodaterol 5/5 µg plus 8 weeks ExT. EET, measured by endurance shuttle walk test after 8 weeks, was the primary endpoint. Additional endpoints assessed downstream effects on PA (measured via accelerometry), and activity-related dyspnea and difficulty (using validated patient-reported questionnaires). SMBM + tiotropium/olodaterol, ±ExT, significantly improved EET at Week 8 versus SMBM + placebo (treatment ratio versus placebo: with ExT 1.46 [95% CI: 1.20, 1.78]; P=0.0002; without ExT 1.29 [1.06, 1.57]; P=0.0109). No significant increases in steps per day from baseline were observed over SMBM + placebo at Week 12 (increase of 1,098) when other therapies were added. Adding tiotropium/olodaterol, ±ExT, to SMBM reduced activity-related dyspnea versus placebo, while adding tiotropium/olodaterol + ExT reduced activity-related difficulty. Tiotropium/olodaterol, ±ExT, improved EET in patients with COPD taking part in an SMBM program. Combination bronchodilation, ±ExT, did not provide additional increases in objective PA compared with SMBM alone, but did reduce physical activity-related dyspnea and difficulty. Clinical trial registration available at www.clinicaltrials.gov, ID NCT02085161.

sommaire N°13

African Journals Online (AJOL)

7 déc. 2011 ... Dysphonia is considered as its main symptom and it can be associated with dyspnea according to tumor location. It is essentially an epidermoid carcinoma. Alcohol- smoking plays an important role in the genesis of this type of cancer. Materials and methods : Our study is retrospective concerning 90 cases ...

Danish national sedation strategy. Targeted therapy of discomfort associated with critical illness. Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM)

DEFF Research Database (Denmark)

Fonsmark, Lise; Hein, Lars; Nibroe, Helle

2015-01-01

should be to focus on the reversible causes of agitation, such as: pain, anxiety, delirium, dyspnea, withdrawal symptoms, sleep or gastrointestinal symptoms. If sedation is used a validated sedation scale is recommended. On a daily basis sedation should be interrupted and only restarted after a thorough...... search for reversible causes of discomfort and stress....

Predictive factors associated with death of elderly in nursing homes.

Science.gov (United States)

Sung, Kiwol

2014-06-01

An increasing elderly population reflects a great need for readily accessible, clinically useful methods to identify mortality-related factors in nursing home residents. The purpose of this study was to identify factors associated with the deaths of nursing home residents. Data was collected from a Minimal Data Set of 195 elderly nursing home residents, followed by analysis of demographic factors, disease and nursing condition factors, Activities of Daily Living (ADL), cognitive function, behavioral patterns, and dysfunctional status. Major factors associated with death among nursing home residents were identified as dyspnea (odds ratio [OR] = 4.88), problematic behaviors (OR = 3.95), and ADL (OR = 3.61). These variables accounted for 31.1% of the variance in death. Dyspnea, problematic behaviors, and ADL data were identified as the key factors associated with death among nursing home residents. Future plans for the prediction of death among nursing home residents can be made by nursing staff, factoring in these identified variables, to ensure more comfortable conditions and more responsive care. Copyright © 2014. Published by Elsevier B.V.

Rituximab-Induced Bronchiolitis Obliterans Organizing Pneumonia

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Ahmet B. Ergin

2012-01-01

Full Text Available Rituximab-induced lung disease (R-ILD is a rare entity that should be considered in patients treated with rituximab who present with dyspnea, fever, and cough, but no clear evidence of infection. A variety of pathologic findings have been described in this setting. Bronchiolitis obliterans organizing pneumonia (BOOP is the most common clinicopathologic diagnosis, followed by interstitial pneumonitis, acute respiratory distress syndrome (ARDS, and hypersensitivity pneumonitis. Prompt diagnosis and treatment with corticosteroids are essential as discussed by Wagner et al. (2007. Here we present a case of an 82-year-old man who was treated with rituximab for recurrent marginal zone lymphoma. After the first infusion of rituximab, he reported fever, chills, and dyspnea. On computed tomography imaging, he was found to have bilateral patchy infiltrates, consistent with BOOP on biopsy. In our patient, BOOP was caused by single-agent rituximab, in the first week after the first infusion of rituximab. We reviewed the relevant literature to clarify the different presentations and characteristics of R-ILD and raise awareness of this relatively overlooked entity.

Associations of symptoms related to isocyanate, ureaformol, and formophenolic exposures with respiratory symptoms and lung function in coal miners

Energy Technology Data Exchange (ETDEWEB)

Bertrand, J.P.; Simon, V.; Chau, N. [Houilleres Bassin Lorraine, Freyming Merlebach (France)

2007-04-15

The respiratory effects of diphenylmethane diisocyanate (MDI)-based resins and ureaformol- and formophenolic-based resins, used in coal mining, are unknown. This cross-sectional study of 354 miners evaluated respiratory health in miners with MDI-related symptoms (IS) and ureaformol/formophenolic-related symptoms (UFS). The protocol included clinical examination, chest radiograph, questionnaire on respiratory symptoms, smoking habit, job history, resin handling, and spirometry. Resin handling concerned 27.7% of the miners. IS affected 5.6%, and 1.4% also after work. UFS affected 22.6%, and 2.3% also after work. Wheezing affected 35.6%; chronic cough, expectoration, or bronchitis about 10%; dyspnea 5.4%; and asthma 2.8%. The miners with UFS had significantly more frequent chronic cough, expectoration, chronic bronchitis, dyspnea, and wheezing, whereas those with IS at and after work had markedly lower FVC, FEV1, MMEF, FEF50% and FEF25%. These findings raise the possibility of deleterious effects of exposures to MDI and ureaformol/ ormophenolic resins on respiratory health and lung function in coal miners during their working life.

Omalizumab (anti-IgE) therapy in the asthma-COPD overlap syndrome (ACOS) and its effects on circulating cytokine levels.

Science.gov (United States)

Yalcin, Arzu Didem; Celik, Betul; Yalcin, Ata Nevzat

2016-06-01

The term "asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome" (ACOS) has been applied to the condition, in which a person has clinical features of both asthma and COPD. The patients (N = 10) were presented to our clinic with low lung function, limited reversibility of airway obstruction, hyperinflation, abnormal body composition, dyspnea and episodic wheezing. Based on the clinical and laboratory findings, the patients were diagnosed with ACOS. Patients' serum IL-2 (sIL-2), sIL-4 sIL-6, sIL-10, sIL-17, sTNF-α and sIFN-γ levels were investigated as an apoptotic marker and a marker for inflammation. Having undergone omalizumab treatment and a long-term (12 months) later, patients had a decreased IgE, fractional exhaled nitric oxide concentrations (FENO), eosinophil, neutrophils, macrophages, eosinophil cationic peptide (ECP) and sIL-4 levels. To our knowledge, this is the first documentation of omalizumab use in ACOS. We demonstrated decreased IL-4, allergic pulmonary symptoms (dyspnea, wheezing, bronchial hyper responsiveness) and migraine attacks in the patients.

[Diseases to differentiate from COPD, with emphasis on bronchial asthma].

Science.gov (United States)

Kanazawa, Minoru

2007-04-01

Differential diagnosis of chronic obstructive pulmonary disease (COPD) from asthma is not a difficult task for many clinicians. Patients with COPD have a history of heavy smoking and show a slowly progressive dyspnea on exertion and there is little variability in symptoms, and they show a poor response to bronchodilators and corticosteroids. Asthma usually begins in early childhood with atopy, shows episodic dyspnea with wheezing, especially during night and early morning. Some patients, however, show adult onset, irreversible airflow limitation, and neutrophilic airway inflammation. The airway remodeling in asthma may be the cause of confusing pathophysiology. Other diseases showing airway hyperresponsiveness, such as allergic bronchopulmonary aspergillosis, Churg-Strauss syndrome, and left heart failure presenting cardiac asthma, may sometimes show similar clinical pictures to COPD. Chronic airway diseases are also possible candidates for differential diagnosis of COPD. Bronchiectasis, sinobronchial syndrome, diffuse panbronchiolitis, obliterative bronchiolitis, and other chronic airway diseases should be considered. Some interstitial lung diseases, such as smoking-related interstitial lung diseases and lymphangioleiomyomatosis, often show obstructive ventilatory impairment, and therefore should be considered in differential diagnosis of COPD.

Respiratory muscle involvement in sarcoidosis.

Science.gov (United States)

Schreiber, Tina; Windisch, Wolfram

2018-07-01

In sarcoidosis, muscle involvement is common, but mostly asymptomatic. Currently, little is known about respiratory muscle and diaphragm involvement and function in patients with sarcoidosis. Reduced inspiratory muscle strength and/or a reduced diaphragm function may contribute to exertional dyspnea, fatigue and reduced health-related quality of life. Previous studies using volitional and non-volitional tests demonstrated a reduced inspiratory muscle strength in sarcoidosis compared to control subjects, and also showed that respiratory muscle function may even be significantly impaired in a subset of patients. Areas covered: This review examines the evidence on respiratory muscle involvement and its implications in sarcoidosis with emphasis on pathogenesis, diagnosis and treatment of respiratory muscle dysfunction. The presented evidence was identified by a literature search performed in PubMed and Medline for articles about respiratory and skeletal muscle function in sarcoidosis through to January 2018. Expert commentary: Respiratory muscle involvement in sarcoidosis is an underdiagnosed condition, which may have an important impact on dyspnea and health-related quality of life. Further studies are needed to understand the etiology, pathogenesis and extent of respiratory muscle involvement in sarcoidosis.

Food-dependent exercise-induced anaphylaxis to flaxseed

Directory of Open Access Journals (Sweden)

Helmut Gall

2000-01-01

Full Text Available The present paper reports on a 26-year-old atopic patient suffering from seasonal rhinoconjunctivitis and flexural eczemas. On two occasions, he experienced nausea, generalized urticaria and dyspnea within 2 h after consumption of a wholemeal roll and subsequent exercise (football training or walking. In each case, the episode necessitated intravenous emergency therapy with an antihistamine and a corticosteroid. In order to elucidate the two exercise-induced anaphylactic events we performed prick tests and the radioallergosorbent test (RAST with the ingredients of the wholemeal roll. Only flaxseed gave positive results. In addition, we performed an exercise test on a bicycle ergometer (15 min at 150 W and an oral challenge test with foods, using a double-blind and placebo-controlled study. Only oral challenge with a teaspoon of flaxseed with additional exercise on the bicycle ergometer elicited itching, urticaria, nausea, coughing and dyspnea. The oral challenge with flaxseed followed by exercise induced immediate-type reactions and, thus, led to the diagnosis of food-dependent exercise- induced anaphylaxis to flaxseed.

Current Treatment Options for Bilateral Vocal Fold Paralysis: A State-of-the-Art Review

Science.gov (United States)

Li, Yike; Garrett, Gaelyn; Zealear, David

2017-01-01

Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds. Bilateral VFP (BVFP) is characterized by inspiratory dyspnea due to narrowing of the airway at the glottic level with both vocal folds assuming a paramedian position. The primary objective of intervention for BVFP is to relieve patients’ dyspnea. Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy. Other options that have been used with varying success include reinnervation techniques and botulinum toxin (Botox) injections into the vocal fold adductors. More recently, research has focused on neuromodulation, laryngeal pacing, gene therapy, and stem cell therapy. These newer approaches have the potential advantage of avoiding damage to the voicing mechanism of the larynx with an added goal of restoring some physiologic movement of the affected vocal folds. However, clinical data are scarce for these new treatment options (i.e., reinnervation and pacing), so more investigative work is needed. These areas of research are expected to provide dramatic improvements in the treatment of BVFP. PMID:28669149

Larynx Trauma and Hyoid Bone Fracture after Bite Injury in Dog: Case Report

Science.gov (United States)

Manchi, George; Brunnberg, Mathias M.; Shahid, Muhammad; Al Aiyan, Ahmad; Brunnberg, Leo; Stein, Silke

2016-01-01

An 8-year-old male Jack Russell crossbreed dog was admitted to our hospital with dyspnea and shock following a dog-bite injury on the ventral neck. Radiographs revealed subcutaneous emphysema and bilateral thyrohyoid bone fractures. Intraoperatively, rupture of both sternohyoid muscles, both hyoepiglotticus muscles, both thyrohyoid muscles, and a partial cranial rupture of the superficial sphincter colli muscle were detected. Part of the epiglottis was detached from the thyroid cartilage. The patient’s severed muscles and torn epiglottis were reattached using a simple interrupted suture pattern. Hyoepiglotticus muscles could not be identified. The bilateral thyrohyoid bone fractures were repaired with intraosseous wire suture. A temporary tracheostomy tube and an esophageal feeding tube were placed postoperatively. The dog was discharged after 8 days, re-examined at 2 and 6 months and laryngeal and pharyngeal function were evaluated as normal. To the authors’ knowledge, this is the first report of a dog that presented with laryngeal trauma with hyoid bone fracture and acute dyspnea that underwent surgical treatment resulting in an acceptable outcome. PMID:27579303

An 11-Year-Old Male Patient with Refractory Asthma and Heartburn

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Tareq Al-Abdoulsalam

2011-01-01

Full Text Available Achalasia is characterized by obstruction of the distal esophagus and subsequent dilation of the proximal esophagus, and is considered to be a rare disorder in children. Patients commonly present with gastrointestinal (GI symptoms such as dysphagia; however, pulmonary symptoms may also occur. Rare pulmonary symptoms due to achalasia are dyspnea and wheeze due to tracheal compression. The authors describe an 11-year-old boy who was referred to a pediatric respiratory clinic for asthma that was not responsive to inhaled medications. The child presented with a one-year history of dyspnea on exertion, cough and wheeze. He also complained of chronic dyspepsia. The presence of GI symptoms, in addition to abnormalities on chest radiograph and spirometry, suggested the presence of achalasia. The diagnosis was confirmed and the patient subsequently underwent surgical myotomy that relieved his GI and pulmonary symptoms, and normalized spirometry. The present article is an illustrative case report to remind pediatricians to consider other diagnoses when a patient does not respond to asthma medications.

Gianturco-Rösch Z stents in tracheobronchial stenoses.

Science.gov (United States)

Petersen, B D; Uchida, B T; Barton, R E; Keller, F S; Rösch, J

1995-01-01

To evaluate expandable metallic Gianturco-Rösch Z (GRZ) stents for treatment of benign and malignant tracheobronchial stenoses. Six patients, ages 45-73 years, were treated for severe dyspnea with placement of GRZ stents. Three patients had benign tracheal lesions (one tracheomalacia, two postoperative) and received uncovered GRZ stents. Three patients had malignant stenoses at the level of the carina; one received an uncovered stent and the other two received silicone-covered GRZ stents. Two patients with benign lesions responded well to stent placement. One was asymptomatic for a year and then was lost to follow-up; the other improved substantially but died of end-stage lung disease 5 months after stent placement. A third patient with a benign high tracheal lesion did poorly; symptoms recurred secondary to inferior migration of a stent, which was removed surgically at 4 months. All patients with malignant lesions improved symptomatically after stent placement and remained without significant dyspnea until death (from 1 to 6 months). Expandable GRZ stents are promising devices for treatment of benign lesions and offer effective palliation of malignant tracheobronchial stenoses.

EPIDEMIOLOGY OF OBSTRUCTIVE PULMONARY DISEASE IN SHAHRE-KORD

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B AMRA

2000-03-01

Full Text Available Introduction. There is no published data regarding prevalence of obstructive airway diseases in Iran. We have investigated the prevalence of respiratory symptoms in Shahre-kord to be compared with those in Europe and USA. Methods. Two thousands subjects (977 male and 1016 female were selected by proportional random cluster sampling from Shahre-kord residents aged 1 to 87 years. They were interviewed to complete a respiratory questionnaire and those who were suspected to have airways disorders were invited for physical examinations and spirometry. Findings. The most frequently reported symptoms were: chronic cough (7/4 percent, wheeze ever in life time (5/5 percent, morning cough (6 percent, history of chronic bronchitis (1/8 percent, dyspnea associated with wheeze (3/2 percent, exertional dyspnea (2/9 percent. Cigarette smoking was less popular in our group than the Europ-American populations. Conclusion. Obstructive pulmonary disease are less prevalent in Shahre-kord than those reported in Europe and USA. This finding may be due to smoking habits and less polluted air in Shahre-kord.

Active Video Game Playing in Children and Adolescents With Cystic Fibrosis: Exercise or Just Fun?

Science.gov (United States)

Salonini, Elena; Gambazza, Simone; Meneghelli, Ilaria; Tridello, Gloria; Sanguanini, Milva; Cazzarolli, Clizia; Zanini, Alessandra; Assael, Baroukh M

2015-08-01

Xbox Kinect has been proposed as an exercise intervention in cystic fibrosis (CF), but its potential has not been compared with standard training modalities. Using a crossover design, subjects were randomized to 2 intervention groups: Xbox Kinect and a traditional stationary cycle. Heart rate, SpO2, dyspnea, and fatigue were measured. Subject satisfaction was tested. Thirty subjects with CF (11 males, mean ± SD age of 12 ± 2.5 y, mean ± SD FEV1 of 73 ± 16% of predicted) were enrolled. Xbox Kinect provided a cardiovascular demand similar to a stationary cycle, although the modality was different (interval vs. continuous). Maximum heart rates were similar (P = .2). Heart rate target was achieved more frequently with a stationary cycle (P = .02). Xbox Kinect caused less dyspnea (P = .001) and fatigue (P < .001) and was more enjoyable than a stationary cycle (P < .001). Subjects preferred Xbox Kinect for its interactivity. Xbox Kinect has the potential to be employed as an exercise intervention in young subjects with CF, but investigation over longer periods is needed. Copyright © 2015 by Daedalus Enterprises.

Achalasia with megaesophagus and tracheal compression in a young patient: A case report

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J. Moritz Kaths

2015-01-01

Conclusion: This report emphasizes that physicians should be alert and consider airway obstruction and signs of dyspnea as severe and threatening symptoms in extensive cases of achalasia with megaesophagus. Early surgical treatment provides a therapeutic option to obviate the occurrence of acute respiratory distress and consecutive complications. In particular, difficulties in intubation prior to surgery must be considered.

Takotsubo Myocardiopathy and Hyperthyroidism: A Case Report and Literature Review

OpenAIRE

Rueda, Dar?o; Aguirre, Rafael; Contardo, Dami?n; Finocchietto, Paola; Hern?ndez, Silvia; di Fonzo, Horacio

2017-01-01

Patient: Male, 34 Final Diagnosis: Takotsubo myocardiopathy and hyperthyroidism Symptoms: Chest pain ? dyspnea Medication: ? Clinical Procedure: ? Specialty: Cardiology Objective: Rare co-existance of disease or pathology Background: Takotsubo cardiomyopathy (TM), also called stress myocardiopathy or transient left ventricular apical ballooning syndrome, is characterized by acute left ventricular dysfunction with reversible wall motion abnormalities. TM resembles acute coronary syndrome (ACS)...

A phase II trial of pemetrexed plus gemcitabine in locally advanced and/or metastatic transitional cell carcinoma of the urothelium

DEFF Research Database (Denmark)

Maase, Hans von der; Lehmann, J.; Gravis, G.

2006-01-01

.1-14.6 months). CTC grade 3/4 hematologic       toxicities included anemia (19%), thrombocytopenia (9%), neutropenia       (38%), febrile neutropenia (17%) and neutropenic sepsis (3%). Grade 3/4       non-hematologic toxicities included elevated transaminases (12%), dyspnea       (8%), fatigue (8...

Spontaneous rupture of the esophagus associated with intramural rupture caused by ingestion of weeding medicine (Lasso)

Energy Technology Data Exchange (ETDEWEB)

Kim, Jong Keon; Park, Heung Il; Kwun, Chung Sik [Chun Nam University College of Medicine, Kwangju (Korea, Republic of)

1975-06-15

This is a report of a case of spontaneous rupture of the esophagus associated with intramural rupture caused by ingestion of weeding medicine for the purpose of suicide in a 27 year old Korean male whose chief complaints were dyspnea, epigastric pain, swallowing disturbance, and hoarseness for 3 days prior to admission. A review of literature is submitted.

The United States Army Medical Department Journal, April - June 2011. Prehospital combat casualty care; The starting point of battlefield survival

Science.gov (United States)

2011-04-01

from a porcine model of acute respiratory diseases secondary to pulmonary contusion. TRANSCUTANEOUS CO2 Are more accurate methods of estimating...combat medic diagnoses a tension pneumothorax from observing the patient and, if feasible, by auscultation with a stethoscope . Dyspnea, distended...Jugular veins, hypotension, and decreased unilateral breath sounds are the major findings for the diagnosis. The stethoscope was invented in 1816 by

Laryngeal dysfunction after thyroid surgery: diagnostic and treatments

OpenAIRE

FINCK, Camille

2006-01-01

Vocal fold hypomobility after thyroidectomy is a frequent complication of thyroidectomy. Laryngeal nerve paresis or paralysis may present with various symptoms like dysphagia, aspiration, voice alteration or dyspnea. Are described: the normal anatomophysiology of the larynx, the symptoms of nerve trauma following thyroidectomy, techniques of thoroughfull laryngeal and voice examination, some clinical entities( unilateral recurrent nerve paralysis, bilateral recurrent nerve paralysis, superior...

IDIOPATHIC LARYN GEAL STENOSIS - A VERY RARE CASE

OpenAIRE

Sudip Kumar; Ruma; Rajesh; Arvind Kumar; Subhendu

2014-01-01

A 35 year old lady presented in the Out Patient Department with cough , dyspnea and gradual hoarseness for last 5 years. After proper history taking and thorough clinical examination , diagnosis of Laryngeal Stenosis was made. Subsequently by excluding important causes of Laryngeal Stenosis like trauma , chronic infection , tuberculosis and other granulomatous diseases , the diagnosis of Idiopathic Laryngeal Stenosis was established KEYWORDS ...

Dyspnea in Children as a Symptom of Acute Respiratory Tract Infections and Antibiotic Prescribing

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Valentina Risteska-Nejashmikj

2018-03-01

CONCLUSION: Perceptions and the parent's attitudes do not correlate with the severity of clinical picture of the disease in children and lack of use Evidence-based medicine (EBM, insecurity, fear, loss of patients effect on antibiotic prescribing of the doctors.

Pediatric Interstitial Lung Disease Masquerading as Difficult Asthma: Management Dilemmas for Rare Lung Disease in Children

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EY Chan

2005-01-01

Full Text Available Idiopathic nontransplant-related childhood bronchiolitis obliterans is an uncommon disease. Most patients present with chronic recurrent dyspnea, cough and wheezing, which are also features of asthma, by far a much more common condition. The present case study reports on a six-year-old girl who presented to a tertiary care centre with recurrent episodes of respiratory distress on a background of baseline tachypnea, chronic hypoxemia and exertional dyspnea. Her past medical history revealed significant lung disease in infancy, including respiratory syncytial virus bronchiolitis and repaired gastroesophageal reflux. She was treated for 'asthma exacerbations' throughout her early childhood years. Bronchiolitis obliterans was subsequently diagnosed with an open lung biopsy. She did not have sustained improvement with systemic corticosteroids, hydroxychloroquine or clarithromycin. Cardiac catheterization confirmed the presence of secondary pulmonary hypertension. Treatment options remain a dilemma for this patient because there is no known effective treatment for this condition, and the natural history is not well understood. The present case demonstrates the need for careful workup in 'atypical asthma', and the urgent need for further research into the rare lung diseases of childhood.

Common Arterial Trunk in a 3-Day-Old Alpaca Cria

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Tsumugi Anne Kurosawa

2016-01-01

Full Text Available A 3-day-old alpaca cria presented for progressive weakness and dyspnea since birth. Complete bloodwork, thoracic radiographs, and endoscopic examination of the nasal passages and distal trachea revealed no significant findings. Echocardiogram and contrast study revealed a single artery overriding a large ventricular septal defect (VSD. A small atrial septal defect or patent foramen ovale was also noted. Color flow Doppler and an agitated saline contrast study revealed bidirectional but primarily right to left flow through the VSD and bidirectional shunting through the atrial defect. Differential diagnosis based on echocardiographic findings included common arterial trunk, Tetralogy of Fallot, and pulmonary atresia with a VSD. Postmortem examination revealed a large common arterial trunk with a quadricuspid valve overriding a VSD. Additionally, defect in the atrial septum was determined to be a patent foramen ovale. A single pulmonary trunk arose from the common arterial trunk and bifurcated to the left and right pulmonary artery, consistent with a Collet and Edwards’ type I common arterial trunk with aortic predominance. Although uncommon, congenital cardiac defects should be considered in animals presenting with clinical signs of hypoxemia, dyspnea, or failure to thrive.

Laryngeal neuropathy of Charcot-Marie-Tooth disease: further observations and novel mutations associated with vocal fold paresis.

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Benson, Brian; Sulica, Lucian; Guss, Joel; Blitzer, Andrew

2010-02-01

To describe and define laryngeal neuropathy in Charcot-Marie-Tooth (CMT) disease. Retrospective record review from a university laryngology practice. Four adult CMT patients presented with laryngeal symptoms. Three patients exhibited bilateral vocal fold palsy, in each case with more severe hypomobility on the left. One case exhibited an isolated left vocal fold palsy. All patients complained of hoarseness and stridor, three had dyspnea, two patients had dysphagia, and one had obstructive sleep apnea (OSA). One patient has required airway surgery to date. Genetic testing revealed known sequence alterations in one case and sequence alterations previously not associated with laryngeal dysfunction in two cases. One case was familial and two were sporadic; information is not available in a fourth. The clinical course of the cases suggests slowly progressive neuropathy that appears to be nerve length dependent. The lack of severe respiratory distress despite dense bilateral paresis is consistent with existing reports and with the reported low rate of tracheostomy in adults with laryngeal manifestations of CMT. Genetic testing does not currently inform expectations or management of laryngeal disease. Dyspnea, dysphagia, and OSA symptoms in patients with CMT require careful laryngologic evaluation.

Clinical Utility of Exercise Training in Heart Failure with Reduced and Preserved Ejection Fraction

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Asrar Ul Haq, Muhammad; Goh, Cheng Yee; Levinger, Itamar; Wong, Chiew; Hare, David L

2015-01-01

Reduced exercise tolerance is an independent predictor of hospital readmission and mortality in patients with heart failure (HF). Exercise training for HF patients is well established as an adjunct therapy, and there is sufficient evidence to support the favorable role of exercise training programs for HF patients over and above the optimal medical therapy. Some of the documented benefits include improved functional capacity, quality of life (QoL), fatigue, and dyspnea. Major trials to assess exercise training in HF have, however, focused on heart failure with reduced ejection fraction (HFREF). At least half of the patients presenting with HF have heart failure with preserved ejection fraction (HFPEF) and experience similar symptoms of exercise intolerance, dyspnea, and early fatigue, and similar mortality risk and rehospitalization rates. The role of exercise training in the management of HFPEF remains less clear. This article provides a brief overview of pathophysiology of reduced exercise tolerance in HFREF and heart failure with preserved ejection fraction (HFPEF), and summarizes the evidence and mechanisms by which exercise training can improve symptoms and HF. Clinical and practical aspects of exercise training prescription are also discussed. PMID:25698883

Preoperative Emboli in a Pregnant Woman with Myxoma

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Freidoun Sabzi

2016-07-01

Full Text Available The left atrium is the most common location of myxomas, which are benign tumors. Only a few cases of myxomas in pregnancies have been reported. Our thorough medical literature search showed only 17 reported cases in the course of pregnancy. Myxomas during pregnancy and in the preterm period constitute a serious phenomenon that can mimic an early sign of a life-threatening pathology like severe mitral stenosis. We describe a 33-year-old woman, who presented with acute dyspnea to a gynecology center and was referred to our hospital for further evaluation of pulmonary embolism. Transthoracic echocardiography showed a huge left atrial myxoma, and computed tomography scan illustrated paradoxical pulmonary embolism in the left upper lung lobe via a large patent foramen ovale. The tumor required urgent cardiac surgery. In this article, we review causes of dyspnea in pregnancy and the cardiovascular effects of myxomas in pregnancy. We also describe the pathophysiological effects of cardiopulmonary bypass on the mother, fetus, and the feto-placental system during open-heart surgery. We performed a successful surgical resection of a myxoma in a pregnant woman. Given the rarity of such cases, individual multidisciplinary assessment and management strategies are essential.

Radioactive iodine treatment of a functional thyroid carcinoma producing hyperthyroidism in a dog

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Peterson, M.E.; Kintzer, P.P.; Hurley, J.R.; Becker, D.V.

1989-01-01

Radioactive iodine ( 131 I) was used in the treatment of a 12-year-old female dog with hyperthyroidism resulting from a large, unresectable (and metastatic) thyroid carcinoma associated with signs of severe inspiratory stridor and dyspnea. Hyperthyroidism was diagnosed on the basis of clinical signs (polyuria, polydipsia, polyphagia, weight loss, nervousness) and high basal serum thyroxine (T4) concentrations, as well as thyroid radioiodine kinetic studies that showed a high radioiodine uptake into the thyroid (% thyroid uptake) and markedly increased serum concentrations of protein-bound iodine-131 (PB 131 I) after 131 I tracer injection. Thyroid imaging revealed diffuse radionuclide accumulation by the tumor, which involved both thyroid lobes. The dog was treated with three large doses of radioiodine ( 131 I), ranging from 60 to 75 mCi, given at intervals of 5 to 7 months. The dog became euthyroid, and the size of the tumor decreased by approximately 25% after each 131 I treatment, improving the severe inspiratory stridor and dyspnea, but both the hyperthyroid state and breathing difficulty recurred within a few months of each treatment. The dog was euthanatized 5 months after the last treatment because of progressive tracheal compression and pulmonary metastasis

COMBINED REDUCED FORCED EXPIRATORY VOLUME IN 1-SECOND (FEV1) AND PERIPHERAL ARTERY DISEASE IN SEDENTARY ELDERS WITH FUNCTIONAL LIMITATIONS

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Vaz Fragoso, Carlos A.; Hsu, Fang-Chi; Brinkley, Tina; Church, Timothy; Liu, Christine K.; Manini, Todd; Newman, Anne B.; Stafford, Randall S.; McDermott, Mary M.; Gill, Thomas M.

2014-01-01

Objectives Because they are potentially modifiable and may coexist, we evaluated the combined occurrence of a reduced forced expiratory volume in 1-second (FEV1) and peripheral artery disease (PAD), including its association with exertional symptoms, physical inactivity, and impaired mobility, in sedentary elders with functional limitations. Design Cross-sectional. Setting Lifestyle Interventions and Independence in Elder (LIFE) Study. Participants 1307 sedentary community-dwelling persons, mean age 78.9, with functional limitations (Short Physical Performance Battery [SPPB] the San Diego Claudication Questionnaire. Physical inactivity was evaluated by percent of accelerometry wear-time with activity the 400MWT (gait-speed The two combined conditions were associated with exertional dyspnea (adjusted odds ratio [adjOR] 2.59 [1.20, 5.60]) and slow gait-speed (adjOR 3.15 [1.72, 5.75]) but not with exertional leg symptoms, high sedentary-time, and moderate-to-severe mobility impairment. Conclusions In sedentary community-dwelling elders with functional limitations, a reduced FEV1 and PAD frequently coexisted and, in combination, were strongly associated with exertional dyspnea and slow gait-speed (a frailty indicator that increases the risk of deleterious outcomes). PMID:24973990

Respiratory muscle endurance is limited by lower ventilatory efficiency in post-myocardial infarction patients

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Neves,Laura M. T.; Karsten,Marlus; Neves,Victor R.; Beltrame,Thomas; Borghi-Silva,Audrey; Catai,Aparecida M.

2014-01-01

Background: Reduced respiratory muscle endurance (RME) contributes to increased dyspnea upon exertion in patients with cardiovascular disease. Objective: The objective was to characterize ventilatory and metabolic responses during RME tests in post-myocardial infarction patients without respiratory muscle weakness. Method: Twenty-nine subjects were allocated into three groups: recent myocardial infarction group (RG, n=9), less-recent myocardial infarction group (LRG, n=10), and contr...

A Review of Palliative Sedation.

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Bobb, Barton

2016-09-01

Palliative sedation has become a standard practice to treat refractory symptoms at end-of-life. Dyspnea and delirium are the two most commonly treated symptoms. The medications used in palliative sedation are usually benzodiazepines, barbiturates, antipsychotics, and/or anesthetics. Some ethical considerations remain, especially surrounding the use of palliative sedation in psychological distress and existential suffering. Copyright © 2016 Elsevier Inc. All rights reserved.

Tension Hydrothorax Related to Disseminated Endometriosis

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AnnaKate Deal, MD

2016-01-01

Full Text Available We present the case of a 34-year-old woman presenting to the emergency department (ED with dyspnea, cough, and fever. She was found to have a tension hydrothorax and was treated with ultrasound-guided thoracentesis in the ED. Subsequent inpatient evaluation showed the patient had disseminated endometriosis. Tension hydrothorax has not been previously described in the literature as a complication of this disease.

Pleural Effusion or Main Left Bronchus Mucus Obstruction: To Drain or Not to Drain? Decision-Making for Young Surgeon on Call

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Danilo Coco

2018-01-01

Full Text Available Mucous plugs occur in a number of pulmonary conditions. Central right or left bronchus mucus plug causes complete pulmonary collapse making it an emergency life-threatening case. We describe the case of an 80-year-old man that, in postoperative period after a urological intervention, has had a progressive tachypnea and dyspnea during hospitalization for urological problems. Young surgeon on call was called.

Mycobacterium intracellulare Pleurisy Identified on Liquid Cultures of the Pleural Fluid and Pleural Biopsy

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Lim, Jong Gu; O, Sei Won; Lee, Ki Dong; Suk, Dong Keun; Jung, Tae Young; Shim, Tae Sun; Chon, Gyu Rak

2013-01-01

Pleural effusion is a rare complication in non-tuberculous mycobacterial infection. We report a case of Mycobacterium intracellulare pleuritis with idiopathic pulmonary fibrosis in a 69-year-old man presenting with dyspnea. Pleural effusion revealed lymphocyte dominant exudate. M. intracellulare was identified using a polymerase chain reaction-restriction fragment length polymorphism method and liquid cultures of pleural effusion and pleural biopsy. After combination therapy for M. intracellu...

Giant intrapericardial lipoma: An unusual cause of dyspnoea

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Sudarshan Kumar Vijay

2013-01-01

Full Text Available The pericardial lipomas are rare benign cardiac tumors. The clinical presentation of these cardiac neoplasms varies according to the site of growth. We describe here a case of massive intrapericardial lipoma leading to severe dyspnea, its diagnostic work up and briefly review the existing literature of this uncommon disorder. The patient underwent successful surgical resection of the tumor with complete alleviation of the symptoms.

Unexpected causes of pulmonary hypertension in a previously healthy Thai rural man with right-sided heart failure

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Angkananard, Teeranan; Chonmaitree, Piyanant; Petborom, Pichaya

2014-01-01

Patient Male, 52 Final Diagnosis: Pulmonary hypertension Symptoms: Diarrhea • dyspnea • jaundice Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Hyperthyroidism is one of the important causes of high-output failure and reversible pulmonary artery hypertension. Severe pulmonary artery hypertension is rarely found in associated with hyperthyroidism due to the small number of cases reported. We present an interesting case ...

Extended Storage of Pathogen-Reduced Platelet Concentrates (PRECON)

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2016-10-01

certified in the Protection of Human Research Subjects. XI. STUDY PROCEDURES Screening An abbreviated version of blood donor screening will be...complete blood count (CBC) to obtain the hematocrit and platelet count. Only criteria aimed at assuring donor safety will apply. Recipient safety...platelet infusion, the subject will be carefully monitored for adverse reactions ; i.e., fever, chills, dyspnea, urticaria or pain (infusion site, chest

Noninvasive ventilation reduces energy expenditure in amyotrophic lateral sclerosis

OpenAIRE

Georges , Marjolaine; Morélot-Panzini , Capucine; Similowski , Thomas; Gonzalez-Bermejo , Jesus

2014-01-01

International audience; BackgroundAmyotrophic lateral sclerosis (ALS) leads to chronic respiratory failure. Diaphragmatic dysfunction, a major driver of dyspnea and mortality, is associated with a shift of the burden of ventilation to extradiaphragmatic inspiratory muscles, including neck muscles. Besides, energy expenditure is often abnormally high in ALS, and this is associated with a negative prognostic value. We hypothesized that noninvasive ventilation (NIV) would relieve inspiratory nec...

EFFICACY OF PELVIC FLOOR THERAPY IN TREATING URINARY INCONTINENCE AMONG FEMALE COPD PATIENTS

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Mohankumar Thekkinkattil; T. S. Muthukumar; R. Monisha

2016-01-01

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The major manifestation of COPD includes dyspnea, decreased oxygenation and reduced exercise tolerance. The other manifestations such as urinary incontinence are less noted and treated inadequately. The prevalence of urinary incontinence in Indian COPD population has not been well documented. The treatment of urinary incontinence includes pelvic floor exercises (Kegel’s exercises)...

Chemical Terrorism for the Intensivist

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2012-05-01

used in the ICU, and the clinician needs to be mindful of this interaction (nerve agents and neuromuscular blockers ).6 Chemical and biological attacks...Frothy Sputum Headache, Fatigue, Anxiety , Irritability, Cardiac Arrest, Dyspnea Coma, Seizures Conjunctivitis, Sore Throat, Epistaxis, Erythema, Skin...Steroids and beta -agonists are com- monly used, and although there is no strong human clinical data to support this practice, there is some animal evidence

Chemical Agent Data Sheets. Volume 1

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1974-12-01

petechial hemorrhage with discoloration; I edema with extension of the swelling, necrosis and ultimately dry gangrene; ulceration and eventually...vomiting, depression, and fever , and are far more prone to occur iii hot than in temperate climates. halaise and nausea generally are the first...productive. Fever , dyspnea, and moist rales may develop. The incidence of bronchopneurnonia is high. Convalescence is slow and cough may persist a

Effect of Aerobic Exercise Training on Ventilatory Efficiency and Respiratory Drive in Obese Subjects.

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Chlif, Mehdi; Chaouachi, Anis; Ahmaidi, Said

2017-07-01

Obese patients show a decline in exercise capacity and diverse degrees of dyspnea in association with mechanical abnormalities, increased ventilatory requirements secondary to the increased metabolic load, and a greater work of breathing. Consequently, obese patients may be particularly predisposed to the development of respiratory muscle fatigue during exercise. The aim of this study was to assess inspiratory muscle performance during incremental exercise in 19 obese male subjects (body mass index 41 ± 6 kg/m 2 ) after aerobic exercise training using the noninvasive, inspiratory muscle tension-time index (T T0.1 ). Measurements performed included anthropometric parameters, lung function assessed by spirometry, rate of perceived breathlessness with the modified Borg dyspnea scale (0-10), breathing pattern, maximal exercise capacity, and inspiratory muscle performance with a breath-by-breath automated exercise metabolic system during an incremental exercise test. T T0.1 was calculated using the equation, T T0.1 = P 0.1 /P Imax × T I /T tot (where P 0.1 represents mouth occlusion pressure, P Imax is maximal inspiratory pressure, and T I /T tot is the duty cycle). At rest, there was no statistically significant difference for spirometric parameters and cardiorespiratory parameters between pre- and post-training. At maximal exercise, the minute ventilation, the rate of exchange ratio, the rate of perceived breathlessness, and the respiratory muscle performance parameters were not significantly different pre- and post-training; in contrast, tidal volume ( P = .037, effect size = 1.51), breathing frequency ( P = .049, effect size = 0.97), power output ( P = .048, effect size = 0.79), peak oxygen uptake ( P = .02, effect size = 0.92) were significantly higher after training. At comparable work load, training induces lower minute ventilation, mouth occlusion pressure, ratio of occlusion pressure to maximal inspiratory pressure, T T0.1 , and rate of perceived

[A clinical case of development of lactic acid acidosis in a diabetic patient taking metformin].

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Cesur, Mustafa; Cekmen, Nedum; Cetinbas, Riza R; Badalov, Pavel; Erdemli, Ozcan

2006-01-01

Metformin is a biguanide. Due to its effects in suppressing the hepatic production of endogenous glucose and in increasing insulin sensitivity in adipose tissue and skeletal muscle, the agent is used particularly in type 2 diabetes mellitus and metabolic syndrome, in which insulin resistance is especially pronounced. Lactic acidosis is one of the most important side effects of metformin. A male patient, born in 1923, was admitted to the emergency unit of our hospital for sudden vertigo, weakness, dyspnea, cyanosis, and lethargy. His history data showed that the patient had been suffering from type 2 diabetes mellitus for 10 years and taking Glargin (insulin), 12 U/kg, once daily and Glucophage (metformin), 850 mg thrice daily. The patient's general condition was fair; stupor, time and spatial orientation were absent. Analysis of arterial blood gases showed the presence of metabolic acidosis, hypokalemia, hypoxemia, and hypercapnia. Thereafter the patient was transferred to the intensive care unit of the hospital; intubated and connected to a T-bird ventilation apparatus. On the following day, an analysis of arterial blood gases indicated the proximity of the results to their physiological parameters. Ventilation was stopped; and monitoring of the patient continued by following the T-shape type of ventilation discontinuation. There were no X-ray signs of pneumonia or pulmonary edema. On the same day, the patient was extubated and oxygen inhalation in a dose of L/min was continued through a mask. On day 4 since therapy was initiated, the patient's vital signs, serum sugar and lactate levels became normal. By determining a new treatment regimen, the patient was discharged from the intensive care unit. Dyspnea, acidosis, and hypoxia developed in the patient resulted from lactic acidosis caused by the use of metformin. It should be remembered that dyspnea, acidosis, and hypoxia, which suddenly developed in metformin-treated patients with type 2 diabetes mellitus, may be

Effect of a Motivational Interviewing-Based Health Coaching on Quality of Life in Subjects With COPD.

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Rehman, Hamid; Karpman, Craig; Vickers Douglas, Kristin; Benzo, Roberto P

2017-08-01

Improving quality of life (QOL) is a key goal in the care of patients with COPD. Pulmonary rehabilitation (PR) has clearly been shown to improve QOL, but is not accessible to many eligible patients. There is a need for alternative programs designed to improve patient well-being that are accessible to all patients with COPD. Our goal was to pilot test a simple, telephone-based health-coaching intervention that was recently shown to decrease readmission among hospitalized COPD patients and stable COPD patients eligible for PR. Subjects received a 3-month intervention consisting of 10 health-coaching telephone calls based on motivational interviewing principles. Outcome measures included dyspnea level, measured by the modified Medical Research Council scale, and QOL, measured by the Chronic Respiratory Questionnaire and a single-item general self-rated health status. Fifty subjects with moderate to severe COPD were enrolled in the study. Forty-four subjects (86%) completed the study intervention. Dyspnea measured by the modified Medical Research Council score improved significantly after the intervention ( P = .002). The domains of fatigue, emotional function, and mastery on the Chronic Respiratory Disease Questionnaire and the single-item QOL question also improved significantly after the 3 months of health coaching ( P = .001, P = .001, P = .007, and P = .03, respectively). Thirty-six (71%) subjects had a clinically meaningful improvement in at least 1 study end point (either in the severity of dyspnea or a domain of QOL). Thirty subjects (58%) had an improvement of ≥0.5 points, the minimum clinically important difference in at least 1 component of the Chronic Respiratory Disease Questionnaire. A telephone-delivered motivational interviewing-based coaching program for COPD patients is a feasible, well-accepted (by both participants and providers), simple, and novel intervention to improve the well-being of patients with COPD. This pilot study provides insight into

Enhancing the quality of life for palliative care cancer patients in Indonesia through family caregivers: a pilot study of basic skills training.

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Kristanti, Martina Sinta; Setiyarini, Sri; Effendy, Christantie

2017-01-17

Palliative care in Indonesia is problematic because of cultural and socio-economic factors. Family in Indonesia is an integral part of caregiving process in inpatient and outpatient settings. However, most families are not adequately prepared to deliver basic care for their sick family member. This research is a pilot project aiming to evaluate how basic skills training (BST) given to family caregivers could enhance the quality of life (QoL) of palliative care cancer patients in Indonesia. The study is a prospective quantitative with pre and post-test design. Thirty family caregivers of cancer patients were trained in basic skills including showering, washing hair, assisting for fecal and urinary elimination and oral care, as well as feeding at bedside. Patients' QoL were measured at baseline and 4 weeks after training using EORTC QLQ C30. Hypothesis testing was done using related samples Wilcoxon Signed Rank. A paired t-test and one-way ANOVA were used to check in which subgroups was the intervention more significant. The intervention showed a significant change in patients' global health status/QoL, emotional and social functioning, pain, fatigue, dyspnea, insomnia, appetite loss, constipation and financial hardship of the patients. Male patient's had a significant effect on global health status (qol) (p = 0.030); female patients had a significant effect on dyspnea (p = 0.050) and constipation (p = 0.038). Younger patients had a significant effect in global health status/QoL (p = 0.002). Patients between 45 and 54 years old had significant effect on financial issue (p = 0.039). Caregivers between 45 and 54 years old had significant effect on patients' dyspnea (p = 0.031). Basic skills training for family caregivers provided some changes in some aspects of QoL of palliative cancer patients. The intervention showed promises in maintaining the QoL of cancer patients considering socio-economic and cultural challenges in the provision of

Forecasting COPD hospitalization in the clinic: optimizing the chronic respiratory questionnaire.

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Abascal-Bolado, Beatriz; Novotny, Paul J; Sloan, Jeff A; Karpman, Craig; Dulohery, Megan M; Benzo, Roberto P

2015-01-01

Forecasting hospitalization in patients with COPD has gained significant interest in the field of COPD care. There is a need to find simple tools that can help clinicians to stratify the risk of hospitalization in these patients at the time of care. The perception of quality of life has been reported to be independently associated with hospitalizations, but questionnaires are impractical for daily clinical use. Individual questions from valid questionnaires can have robust predictive abilities, as has been suggested in previous reports, as a way to use patient-reported outcomes to forecast important events like hospitalizations in COPD. Our primary aim was to assess the predictive value of individual questions from the Chronic Respiratory Questionnaire Self-Assessment Survey (CRQ-SAS) on the risk of hospitalization and to develop a clinically relevant and simple algorithm that clinicians can use in routine practice to identify patients with an increased risk of hospitalization. A total of 493 patients with COPD prospectively recruited from an outpatient pulmonary clinic completed the CRQ-SAS, demographic information, pulmonary function testing, and clinical outcomes. The cohort had a mean age of 70 years, was 54% male, with forced expiratory volume in 1 second percentage predicted 42.8±16.7, and modified Medical Research Council dyspnea scale score of 2±1.13. Our analysis validated the original CRQ-SAS domains. Importantly, recursive partitioning analysis identified three CRQ-SAS items regarding fear or panic of breathlessness, dyspnea with basic activities of daily living, and depressive symptoms that were highly predictive of hospitalization. We propose a robust (area under the curve =0.70) but short and easy algorithm for daily clinical care to forecast hospitalizations in patients with COPD. We identified three themes - fear of breathlessness, dyspnea with basic activities of daily living, and depressive symptoms - as important patient-reported outcomes to

Elevated 18F-NaF uptake in cricoid cartilage in a patient with laryngeal carcinoma: A case report and literature review.

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Xia, Yuxiao; Qi, Chi; Zhang, Shumao; Huang, Zhanwen; Chen, Yue

2017-12-01

Laryngeal cancer is aggressive tumor that arises from the tissues of the larynx. Although any bone can be affected, involvement of cricoid cartilage was reported very rarely, and there has been no report of 18F-sodium fluoride positron emission tomography-computed tomography (F-NaF PET-CT) and 3D PET-CT for the evaluation of cricoid cartilage invasion. A 54-year-old male discovered a protruding mass in the right anterior neck, which had rapidly increased in size over a period of 2 months. Subsequently, hoarseness, dysphagia, and dyspnea were gradually developed. F-FDG PET-CT demonstrated that the abnormal activity was located in a soft tissue mass, which was about 4.2 cm × 3.8 cm × 3.6 cm in largest dimension in the laryngeal cavity of supraglottic portion (SUVmax: 23.6). A swollen lymph node was revealed in the right submandibular region, which had intense FDG activity with a SUVmax of 18.4. However, there is a high uptake of F-FDG in the region near the bone, which is uncertain whether there is any skeletal invasion. NaF PET-CT and 3D PET-CT demonstrated increased uptake in the right side of cricoid cartilage (SUVmax: 13.2). The histopathologic examination confirmed squamous cell carcinoma of larynx. The patient underwent tracheotomy and received anti-infective treatment to relieve symptoms of dyspnea and prevent asphyxia. Clinical follow up of the patient revealed that dyspnea was significantly relieved. The case report shows the imaging features of cricoid cartilage invasion, including F-FDG PET/CT, 18F-sodium fluoride positron emission tomography-computed tomography (F-NaF PET-CT), and 3D PET-CT. Precise understanding of the invasion scope, accurately staging of laryngeal carcinoma, and choosing of the most suitable surgical scheme are the factors that lead to the optimal treatment of laryngeal neoplasms.

Elevated 18F-NaF uptake in cricoid cartilage in a patient with laryngeal carcinoma

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Xia, Yuxiao; Qi, Chi; Zhang, Shumao; Huang, Zhanwen; Chen, Yue

2017-01-01

Abstract Rationale: Laryngeal cancer is aggressive tumor that arises from the tissues of the larynx. Although any bone can be affected, involvement of cricoid cartilage was reported very rarely, and there has been no report of 18F-sodium fluoride positron emission tomography-computed tomography (18F-NaF PET-CT) and 3D PET-CT for the evaluation of cricoid cartilage invasion. Patient concerns: A 54-year-old male discovered a protruding mass in the right anterior neck, which had rapidly increased in size over a period of 2 months. Subsequently, hoarseness, dysphagia, and dyspnea were gradually developed. Diagnoses: 18F-FDG PET-CT demonstrated that the abnormal activity was located in a soft tissue mass, which was about 4.2 cm × 3.8 cm × 3.6 cm in largest dimension in the laryngeal cavity of supraglottic portion (SUVmax: 23.6). A swollen lymph node was revealed in the right submandibular region, which had intense FDG activity with a SUVmax of 18.4. However, there is a high uptake of 18F-FDG in the region near the bone, which is uncertain whether there is any skeletal invasion. NaF PET-CT and 3D PET-CT demonstrated increased uptake in the right side of cricoid cartilage (SUVmax: 13.2). The histopathologic examination confirmed squamous cell carcinoma of larynx. Interventions: The patient underwent tracheotomy and received anti-infective treatment to relieve symptoms of dyspnea and prevent asphyxia. Outcomes: Clinical follow up of the patient revealed that dyspnea was significantly relieved. Lessons: The case report shows the imaging features of cricoid cartilage invasion, including 18F-FDG PET/CT, 18F-sodium fluoride positron emission tomography-computed tomography (18F-NaF PET-CT), and 3D PET-CT. Precise understanding of the invasion scope, accurately staging of laryngeal carcinoma, and choosing of the most suitable surgical scheme are the factors that lead to the optimal treatment of laryngeal neoplasms. PMID:29245332

Cross sectional analysis of respiratory symptoms in an injection drug user cohort: the impact of obstructive lung disease and HIV

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Mehta Shruti H

2010-05-01

Full Text Available Abstract Background Injection drug use is associated with an increased risk of human immunodeficiency virus (HIV infection and with obstructive lung diseases (OLD. Understanding how HIV and OLD may impact respiratory symptoms among injection drug users (IDUs is important to adequately care for this high-risk population. We characterized the independent and joint effects of HIV and OLD on respiratory symptoms of a cohort of inner-city IDUs. Methods Demographics, risk behavior and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome Link to the IntraVenous Experience study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Participants completed a modified American Thoracic Society respiratory questionnaire and the Medical Research Council (MRC dyspnea score to assess respiratory symptoms of cough, phlegm, wheezing and dyspnea. Results Of 974 participants, 835 (86% were current smokers and 288 (29.6% were HIV-infected. The prevalence of OLD (FEV1/FVC ≤ 0.70 was 15.5%, and did not differ by HIV status. OLD, but not HIV, was associated with increased frequency of reported respiratory symptoms. There was a combined effect of OLD and HIV on worsening of MRC scores. OLD and HIV were independently associated with an increased odds of reporting an MRC ≥ 2 (OR 1.83 [95%CI 1.23-2.73] and 1.50 [95%CI 1.08-2.09], respectively. COPD, but not HIV, was independently associated with reporting an MRC ≥ 3 (OR 2.25 [95%CI 1.43-3.54] and 1.29 [95%CI 0.87-1.91], respectively. Conclusions While HIV does not worsen cough, phlegm or wheezing, HIV significantly increases moderate but not severe dyspnea in individuals of similar OLD status. Incorporating the MRC score into routine evaluation of IDUs at risk for OLD and HIV provides better assessment than cough, phlegm and wheezing alone.

Clinical characteristics of the asthma-COPD overlap syndrome--a systematic review.

Science.gov (United States)

Nielsen, Mia; Bårnes, Camilla Boslev; Ulrik, Charlotte Suppli

2015-01-01

In recent years, the so-called asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) has received much attention, not least because elderly individuals may present characteristics suggesting a diagnosis of both asthma and COPD. At present, ACOS is described clinically as persistent airflow limitation combined with features of both asthma and COPD. The aim of this paper is, therefore, to review the currently available literature focusing on symptoms and clinical characteristics of patients regarded as having ACOS. Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic literature review was performed. A total of 11 studies met the inclusion criteria for the present review. All studies dealing with dyspnea (self-reported or assessed by the Medical Research Council dyspnea scale) reported more dyspnea among patients classified as having ACOS compared to the COPD and asthma groups. In line with this, ACOS patients have more concomitant wheezing and seem to have more cough and sputum production. Compared to COPD-only patients, the ACOS patients were found to have lower FEV1% predicted and FEV1/FVC ratio in spite of lower mean life-time tobacco exposure. Furthermore, studies have revealed that ACOS patients seem to have not only more frequent but also more severe exacerbations. Comorbidity, not least diabetes, has also been reported in a few studies, with a higher prevalence among ACOS patients. However, it should be acknowledged that only a limited number of studies have addressed the various comorbidities in patients with ACOS. The available studies indicate that ACOS patients may have more symptoms and a higher exacerbation rate than patients with asthma and COPD only, and by that, probably a higher overall respiratory-related morbidity. Similar to patients with COPD, ACOS patients seem to have a high occurrence of comorbidity, including diabetes. Further research into the ACOS, not least

Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients: A randomized controlled trial

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Zijlstra Jan G

2011-08-01

Full Text Available Abstract Background The use of noninvasive intermittent positive pressure ventilation (NIPPV in chronic obstructive pulmonary disease (COPD patients with chronic hypercapnic respiratory failure remains controversial as long-term data are almost lacking. The aim was to compare the outcome of 2-year home-based nocturnal NIPPV in addition to rehabilitation (NIPPV + PR with rehabilitation alone (PR in COPD patients with chronic hypercapnic respiratory failure. Methods Sixty-six patients could be analyzed for the two-year home-based follow-up period. Differences in change between the NIPPV + PR and PR group were assessed by a linear mixed effects model with a random effect on the intercept, and adjustment for baseline values. The primary outcome was health-related quality of life (HRQoL; secondary outcomes were mood state, dyspnea, gas exchange, functional status, pulmonary function, and exacerbation frequency. Results Although the addition of NIPPV did not significantly improve the Chronic Respiratory Questionnaire compared to rehabilitation alone (mean difference in change between groups -1.3 points (95% CI: -9.7 to 7.4, the addition of NIPPV did improve HRQoL assessed with the Maugeri Respiratory Failure questionnaire (-13.4% (-22.7 to -4.2; p = 0.005, mood state (Hospital Anxiety and Depression scale -4.0 points (-7.8 to 0.0; p = 0.05, dyspnea (Medical Research Council -0.4 points (-0.8 to -0.0; p = 0.05, daytime arterial blood gases (PaCO2 -0.4 kPa (-0.8 to -0.2; p = 0.01; PaO2 0.8 kPa (0.0 to 1.5; p = 0.03, 6-minute walking distance (77.3 m (46.4 to 108.0; p Conclusions The addition of NIPPV to pulmonary rehabilitation for 2 years in severe COPD patients with chronic hypercapnic respiratory failure improves HRQoL, mood, dyspnea, gas exchange, exercise tolerance and lung function decline. The benefits increase further with time. Trial registration ClinicalTrials.Gov (ID NCT00135538.

Incidence and Symptoms of High Altitude Illness in South Pole Workers: Antarctic Study of Altitude Physiology (ASAP

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Paul J. Anderson

2011-01-01

Full Text Available Introduction Each year, the US Antarctic Program rapidly transports scientists and support personnel from sea level (SL to the South Pole (SP, 2835 m providing a unique natural laboratory to quantify the incidence of acute mountain sickness (AMS, patterns of altitude related symptoms and the field effectiveness of acetazolamide in a highly controlled setting. We hypothesized that the combination of rapid ascent (3 hr, accentuated hypobarism (relative to altitude, cold, and immediate exertion would increase altitude illness risk. Methods Medically screened adults (N = 246, age = 37 ± 11 yr, 30% female, BMI = 26 ± 4 kg/m 2 were recruited. All underwent SL and SP physiological evaluation, completed Lake Louise symptom questionnaires (LLSQ, to define AMS, and answered additional symptom related questions (eg, exertional dyspnea, mental status, cough, edema and general health, during the 1st week at altitude. Acetazolamide, while not mandatory, was used by 40% of participants. Results At SP, the barometric pressure resulted in physiological altitudes that approached 3400 m, while T ° C averaged -42, humidity 0.03%. Arterial oxygen saturation averaged 89% ± 3%. Overall, 52% developed LLSQ defined AMS. The most common symptoms reported were exertional dyspnea-(87%, sleeping difficulty-(74%, headache-(66%, fatigue-(65%, and dizziness/lightheadedness-(46%. Symptom severity peaked on days 1-2, yet in >20% exertional dyspnea, fatigue and sleep problems persisted through day 7. AMS incidence was similar between those using acetazolamide and those abstaining (51 vs. 52%, P = 0.87. Those who used acetazolamide tended to be older, have less altitude experience, worse symptoms on previous exposures, and less SP experience. Conclusion The incidence of AMS at SP tended to be higher than previously reports in other geographic locations at similar altitudes. Thus, the SP constitutes a more intense altitude exposure than might be expected considering physical

Cooking smoke and respiratory symptoms of restaurant workers in Thailand.

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Juntarawijit, Chudchawal; Juntarawijit, Yuwayong

2017-02-17

Restaurant workers are at risk from exposure to toxic compounds from burning of fuel and fumes from cooking. However, the literature is almost silent on the issue. What discussion that can be found in the literature focuses on the potential effects from biomass smoke exposure in the home kitchen, and does not address the problem as occurring in the workplace, particularly in restaurants. This was a cross-sectional survey of 224 worker from 142 food restaurants in the Tha Pho sub-district of Phitsanulok, a province in Thailand. The standard questionnaire from the British Medical Research Council was used to collect data on chronic respiratory symptoms, including cough, phlegm, dyspnea, severe dyspnea, stuffy nose in the participating workers. Data on their health symptoms experienced in the past 30 days was also asked. A constructed questionnaire was used to collect exposure data, including type of job, time in the kitchen, the frequency of frying food, tears while cooking (TWC), the type of restaurant, fuel used for cooking, the size and location of the kitchen, and the exhaust system and ventilation. The prevalence of the symptoms was compared with those obtained from 395 controls, who were neighbors of the participants who do not work in a restaurant. In comparison to the control group, the restaurant workers had twice or more the prevalence on most of the chronic health symptoms. Men had a higher risk for "dyspnea", "stuffy nose" and "wheeze" while women had higher risk of "cough". A Rate Ratio (RR) of susceptibility was established, which ranged from 1.4 up to 9.9. The minimum RR was for women with "severe dyspnea" (RR of 1.4, 95%CI 0.8, 2.5) while the men showed the maximum RR of 9.9 (95%CI 4.5-22.0) for "wheeze". Possible risk factors identified were job description, job period, size of restaurant, kitchen location, type of cooking oil, hours of stay in the kitchen area, number of fry dishes prepared, frequency of occurrence of TWC, and additional cooking at

Efeito de curto prazo do tiotrópio nos portadores de DPOC em tratamento com β2-agonista Short-term effect of tiotropium in COPD patients being treated with a β2 agonist

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Frederico Leon Arrabal Fernandes

2010-04-01

Full Text Available OBJETIVO: Avaliar o impacto de curto prazo do uso de tiotrópio em pacientes com DPOC grave e muito grave com queixas de dispneia apesar do tratamento com outros broncodilatadores. MÉTODOS: Estudo prospectivo incluindo pacientes com DPOC grave ou muito grave, com queixa de dispneia de pequenos esforços ou ao repouso. A cada 15 dias, o tratamento broncodilatador foi modificado: salmeterol, tiotrópio e associação salmeterol+tiotrópio. Ao final de cada regime, foram realizados testes de função pulmonar e teste de caminhada de seis minutos (TC6. Também foram avaliados o grau de dispneia e a capacidade de realização de atividades de vida diária. Para a avaliação das atividades de vida diária, foi utilizada a escala London Chest Activity of Daily Living (LCADL validado para uso no Brasil. RESULTADOS: Foram avaliados 52 pacientes. Desses, 30 completaram o estudo. A introdução de tiotrópio como monoterapia resultou em uma melhora significativa (p OBJECTIVE: To evaluate the short-term impact of tiotropium in patients with severe or very severe COPD who complain of dyspnea despite being currently treated with other bronchodilators. METHODS: A prospective study including patients with severe or very severe COPD and complaining of dyspnea at rest or on minimal exertion. Every 15 days, the bronchodilator treatment regimen was altered, from salmeterol to tiotropium to salmeterol+tiotropium. At the end of each regimen, pulmonary function tests and the six-minute walk test (6MWT were performed. The degree of dyspnea and the ability to perform activities of daily living were also assessed. To evaluate patient ability to perform activities of daily living, we employed the London Chest Activity of Daily Living (LCADL, validated for use in Brazil. RESULTS: We evaluated 52 patients, 30 of whom completed the study. The use of tiotropium in isolation resulted in significant improvement in dyspnea at baseline (mean Medical Research Council scale score

O uso da ventilação mecânica não-invasiva nos cuidados paliativos de paciente com sarcoma torácico metastático: relato de caso The use of noninvasive mechanical ventilation in the palliative care of a patient with metastatic thoracic sarcoma: case report

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Mariana Almada Bassani

2008-06-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Os cuidados paliativos se baseiam na prevenção e alívio do sofrimento, identificando, avaliando e tratando a dor e outros problemas físicos, psicossociais e espirituais. Quadros súbitos de dispnéia são freqüentes em pacientes oncológicos em fase terminal. Nestes casos, a ventilação mecânica não-invasiva pode ser uma boa opção no manuseio da dispnéia, promovendo conforto e permitindo o contato do paciente com seus familiares. O objetivo deste estudo foi apresentar os benefícios obtidos com a ventilação mecânica não-invasiva no paciente sob cuidados paliativos. RELATO DO CASO: Paciente com 29 anos, em pós-operatório imediato de cesariana, admitida na unidade de terapia intensiva (UTI para tratamento de insuficiência respiratória aguda. À radiografia de tórax visualizava-se massa pulmonar a direita. Após investigação clínica e de imagem foi diagnosticado sarcoma torácico metastático em fase avançada, sendo indicadas pela equipe de Oncologia medidas e cuidados paliativos. Para alivio da dispnéia, a equipe multidisciplinar da UTI optou pelo uso de ventilação mecânica não-invasiva (modalidade CPAP + PSV, permitindo a interação da mãe com o bebê e familiares. CONCLUSÕES: No contexto de cuidados paliativos, a VMNI mostrou-se ser um método capaz de contribuir para o controle da dispnéia provendo conforto e alívio ao paciente.BACKGROUND AND OBJECTIVES: Palliative care is based on prevention and relief of suffering, identifying, assessing and treating pain and other physical, psychological, social and spiritual problems. Sudden dyspnea is frequently observed in terminal oncologic patients. In these cases, noninvasive ventilation can be an adequate option to control dyspnea promoting comfort and allowing patient interaction with their relatives. The aim of this article was to present the benefits of noninvasive ventilation in the palliative care setting. CASE REPORT: The case of a 29

Nephrotic Syndrome in a Child Suffering from Tetralogy of Fallot: A Rare Association

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Pépé Mfutu Ekulu

2015-01-01

Full Text Available Nephrotic syndrome is an uncommon complication of tetralogy of Fallot and has been rarely reported in pediatric population. We describe a 4-year-old female Congolese child who was referred for investigation for persistent dyspnea, edema, and cyanosis and nephrotic range proteinuria. Our patient presented with a tetralogy of Fallot and nephrotic syndrome. Conclusion. This case reminds us that children with tetralogy of Fallot may develop nephrotic proteinuria.

Influence of Very High Breathing Resistance on Exercise Tolerance, Part 1 - Dry Exercise

Science.gov (United States)

2016-01-01

endurance times. 15. SUBJECT TERMS control of breathing, ventilation, CO2, carbon dioxide, hypercapnia, CO2 retention , dyspnea, exercise, performance...to be near his exercise capacity , until the subject could no longer continue. Subjects were asked to give scores of Relative Perceived Exertion (RPE...span gas (5% CO2 and 16% O2 in nitrogen). The pressure transducer outputs were compared to a water manometer. Data analysis Breath by breath

Parapharyngeal branchial cleft cyst: a case report

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Marcele Oliveira dos Santos

2015-03-01

Full Text Available A 30-year-old woman presented with a 2-year history of right-sided pharyngeal foreign body sensation. There were no signs of dysarthria, dysphagia, odynophagia, or dyspnea. On physical examination, we observed a fluctuant, painless mass in the oropharynx, pressing against the right lateral pharyngeal wall, covered with normal mucosa. Full examination of the head and neck, including cranial nerve evaluation, detected no further abnormalities.

Amyotrophic Lateral Sclerosis Presenting Respiratory Failure as the Sole Initial Manifestation

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Fuyuki Tateno

2014-08-01

Full Text Available It is rare that amyotrophic lateral sclerosis (ALS presents with respiratory failure as the sole initial manifestation. A 72-year-old man with mild chronic obstructive pulmonary disease developed exertional dyspnea for 13 months. He then progressed to limb weakness that led to the diagnosis of ALS. Although rare, ALS can present with respiratory failure as the sole initial manifestation more than 1 year prior to limb weakness.

Influence of N-acetylcysteine on oxidative stress in slow-twitch soleus muscle of heart failure rats

OpenAIRE

Martinez, Paula Felippe [UNESP; Bonomo, Camila [UNESP; Guizoni, Daniele Mendes [UNESP; Oliveira Junior, Silvio Assis [UNESP; Damatto, Ricardo Luiz [UNESP; Cezar, Marcelo Diarcadia Mariano [UNESP; Lima, Aline Regina Ruiz [UNESP; Pagan, Luana Urbano [UNESP; Seiva, Fabio Rodrigues; Fernandes, Denise Castro; Laurindo, Francisco Rafael Martins; Novelli, Ethel Lourenzi Barbosa [UNESP; Matsubara, Luiz Shiguero [UNESP; Zornoff, Leonardo Antonio Mamede [UNESP; Okoshi, Katashi [UNESP

2015-01-01

Background: Chronic heart failure is characterized by decreased exercise capacity with early exacerbation of fatigue and dyspnea. Intrinsic skeletal muscle abnormalities can play a role in exercise intolerance. Causal or contributing factors responsible for muscle alterations have not been completely defined. This study evaluated skeletal muscle oxidative stress and NADPH oxidase activity in rats with myocardial infarction (MI) induced heart failure. Methods and Results: Four months after MI,...

Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

OpenAIRE

Lee, Jea-Geun; Choi, Joon Hyouk; Kim, Song-Yi; Kim, Ki-Seok; Joo, Seung-Jae

2016-01-01

Background and Objectives A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. Subjects and Methods Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were ex...

Nocardia nova identification in a transtracheal wash of a horse with recurrent airway obstruction

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Condas, LAZ; Ribeiro, MG; Olivo, G; Franco, MMJ; Gonoi, T; Matsuzawa, T; Yazawa, K; Gonçalves, RC; Borges, AS

2015-01-01

A horse with recurrent airway disease was presented with dyspnea, mucopurulent bilateral nasal discharge and abnormal lung sounds. Microbiological culture, cytological examination and molecular identification (16S rRNA gene sequence) were performed with the transtracheal wash material and allowed the identification of Nocardia nova, an uncommon agent associated with equine respiratory abnormalities. Un equino con enfermedad pulmonar recurrente presentó disnea, secreción nasal purulenta bil...

Laryngeal granuloma: a complication of prolonged endotracheal intubation.

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Keiser, G. J.; Bozentka, N. E.; Gold, B. D.

1991-01-01

Laryngeal granuloma is an uncommon complication arising from irritation of the laryngeal structures. We present a case where bilateral laryngeal granulomas became clinically evident 3 mo after orthognathic surgery. The patient, a 19-yr-old female, developed acute dyspnea after experiencing gradual voice loss. Excision of the lesions under endotracheal general anesthesia led to an uneventful outcome. The causes, predisposing factors, diagnostic features, and treatment of laryngeal granuloma ar...

Laryngeal lipoma associated with Madelung's disease: a case report.

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Landínez-Cepeda, Guillermo Arturo; Alarcos-Tamayo, Emilio V; Millás-Gómez, Teresa; Morais-Pérez, Darío

2012-01-01

Multiple symmetric lipomatosis is an alteration in the neck, upper trunk and upper extremities fat deposits. It produces an aesthetic problem and sometimes upper airway obstruction when the larynx is infiltrated by the mass. We report the case of a male with Madelung's disease, which began with acute dyspnea caused by laryngeal fat deposits and obstructive lipoma. Copyright © 2010 Elsevier España, S.L. All rights reserved.

ANTIANAPHYLACTIC ACTIVITY OF HELIOTROPIUM INDICUM LEAVES

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M Shenoy Ashoka; C. Shastry Shashidhar

2011-01-01

The alcoholic extract of Heliotropium indicum leaves was evaluated using Wistar rats and Duncan Hartley guinea pigs. The antianaphylactic activity was investigated in rats using the active anaphylaxis model. The effect on mast cell stabilization was performed by ex vivo challenge of antigen in sensitized rat intestinal mesenteries. Antihistaminic activity was studied in guinea pigs using histamine-induced bronchospasm where preconvulsive dyspnea was used as an end point following exposure to ...

Annual Trauma Anesthesia and Critical Care Symposium (6th) Held in Baltimore, MD on 20-23 May 1993

Science.gov (United States)

1993-10-01

increasing intracranial pressure, and increased metabolic demand (e.g. seizures or fever ), however, may be attenuated with appropriate care. In...Dyspnea C. Cyanosis D. Headache E. Irritability F. Confusion G. Tachycardia S H. Pyrexia I. Petechial Rash VII. Clinical Findings (Severe F.E.S.) A...Frank Pulmonary Edema B. Convulsions/Coma C. ECG Showing Right Heart Strain D. Pyrexia E. Petechial Hemorrhage F. Jaundice G. Renal Impairment S O

Pulmonary hemorrhage following anabolic agent abuse: Two cases

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Hvid-Jensen, Helene S.; Rasmussen, Finn; Bendstrup, Elisabeth

2016-01-01

Numerous adverse effects follow anabolic agent abuse. Pulmonary hemorrhage is not considered one of them. We present two cases of young male bodybuilders who developed diffuse alveolar bleeding as a result of anabolic steroid abuse. Diffuse alveolar hemorrhage associated with anabolic agent abuse has not been described previously in the literature. Both patients developed acute dyspnea and hemoptysis with consistent radiological findings. In both cases symptoms promptly resolved with cessatio...

An inflammatory pseudotumour of the larynx: a case report and literature review of an unusual tumour

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Dava, Chaido J; Hajiioannou, Jiannis K; Terzis, Anastasios; Bizakis, John

2012-01-01

Background: Inflammatory pseudotumour (IPT) is a rare benign pseudoneoplastic proliferation of unknown etiology, often showing locally aggressive behaviour. Conflicting theories about exaggerated response to injury versus true neoplastic origin have been suggested. Methods: We report a case of laryngeal pseudotumour in a 73-year-old man presenting with hoarseness and slowly progressive dyspnea and a short review of the English language literature on the subject. Results: Management consisted ...

Pulmonary Cement Embolism following Percutaneous Vertebroplasty

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Ümran Toru

2014-01-01

Full Text Available Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.

Primary leiomyosarcoma of the lung in a girl

International Nuclear Information System (INIS)

Beluffi, G.; Pavia Univ.; Bertolotti, P.; Mietta, A.; Manara, G.; Luisetti, M.

1986-01-01

Leiomyosarcoma of the lung is a type of tumour rarely found in childhood. It arises from smooth muscle either of bronchial or arterial walls, has a variable pattern of local growth, blood-borne metastatic spread with lymph nodes sparing and a clinical course characterized by fever, cough and worsening dyspnea. We report a case which occurred in a 14-year-old girl, reviewing all the other cases found in literature. (orig.)

Cartap poisoning: A rare case report.

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Kumar, A S Praveen; Amalnath, Deepak; Dutta, T K

2011-10-01

Cartap is a pesticide commonly used to control weevil and caterpillars. It is an analogue of nereistoxin, a neurotoxic substance isolated from the marine annelid Lumbriconereis heteropoda. It causes neuromuscular blockade. Poisoning with cartap is very rare and not yet reported from India. We report a 35-year-old lady with cartap poisoning who presented with nausea, vomiting, and dyspnea. She improved with N-acetyl cysteine and symptomatic management.

Cartap poisoning: A rare case report

OpenAIRE

Kumar, A. S. Praveen; Amalnath, Deepak; Dutta, T. K.

2011-01-01

Cartap is a pesticide commonly used to control weevil and caterpillars. It is an analogue of nereistoxin, a neurotoxic substance isolated from the marine annelid Lumbriconereis heteropoda. It causes neuromuscular blockade. Poisoning with cartap is very rare and not yet reported from India. We report a 35-year-old lady with cartap poisoning who presented with nausea, vomiting, and dyspnea. She improved with N-acetyl cysteine and symptomatic management.

Safety of adenosine stress myocardial perfusion imaging by a one-route infusion protocol

International Nuclear Information System (INIS)

Kawai, Yuko; Kishino, Koh

2006-01-01

When adenosine stress testing is performed, a vein is generally accessed in each arm. To determine whether the one-route infusion protocol, that is, infusion via one upper arm vein, is safe, myocardial perfusion imaging was performed during adenosine stress testing in patients with angina pectoris. Sixty-six consecutive patients (43 men, 68±11 years of age) with suspected coronary artery disease were enrolled in this study. For the stress test, adenosine was injected at 120 μg/kg/min for 6 minutes. Systolic blood pressure, diastolic blood pressure, and heart rate did not show any significant changes after injection of the adenosine and radioisotope (RI) tracer. Adverse events during infusion of the adenosine were seen in 42 (64%) patients and included chest discomfort/oppression in 17 (26%) and dyspnea/throat discomfort in 15 (23%). On the other hand, adverse events just after infusion of the RI tracer occurred in 5 (8%) patients and included chest oppression in 2 (3%) and dyspnea in 1 (2%). Almost all adverse events disappeared quickly without treatment. Therefore, we concluded that adenosine stress myocardial perfusion imaging using a one-route infusion protocol is safe and useful to do for patients unable to secure veins in both arms. (author)

Lung adenocarcinoma mimicking pulmonary fibrosis-a case report

International Nuclear Information System (INIS)

Mehić, Bakir; Duranović Rayan, Lina; Bilalović, Nurija; Dohranović Tafro, Danina; Pilav, Ilijaz

2016-01-01

Lung cancer is usually presented with cough, dyspnea, pain and weight loss, which is overlapping with symptoms of other lung diseases such as pulmonary fibrosis. Pulmonary fibrosis shows characteristic reticular and nodular pattern, while lung cancers are mostly presented with infiltrative mass, thick-walled cavitations or a solitary nodule with spiculated borders. If the diagnosis is established based on clinical symptoms and CT findings, it would be a misapprehension. We report a case of lung adenocarcinoma whose symptoms as well as clinical images overlapped strongly with pulmonary fibrosis. The patient’s non-productive cough, progressive dyspnea, restrictive pattern of pulmonary function test and CT scans (showing reticular interstitial opacities) were all indicative of pulmonary fibrosis. The patient underwent a treatment consisting of corticosteroids and antibiotics, to no avail. Histopathology of the lung showed that the patient suffered from mucinous adenocarcinoma. Albeit the immunohistochemical staining was not consistent with lung adenocarcinoma, tumor’s morphological characteristics were consistent, and were used to make the definitive diagnosis. Given the fact that radiography cannot always make a clear-cut difference between pulmonary fibrosis and lung adenocarcinomas, and that clinical symptoms often overlap, histological examination should be considered as gold standard for diagnosis of lung adenocarcinoma

Two Sisters with Idiopathic Pulmonary Hemosiderosis

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Mehmet Gencer

2007-01-01

Full Text Available Idiopathic pulmonary hemosiderosis (IPH is a rare cause of diffuse alveolar hemorrhage with unknown etiology. In the present report, the presentations of two sisters are described: one sister had IPH, eosinophilia and a high serum immunoglobulin E (IgE level; and the other had IPH, pneumothorax, eosinophilia and a high serum IgE level. Both cases had quite unusual presentations. The first patient was 23 years of age, and had suffered from dry cough and progressive dyspnea for four years. Her hemoglobin level was 60 g/L, total serum IgE level was 900 U/mL and eosinophilia was 9%. Her chest radiography revealed diffuse infiltration. She died due to respiratory failure. The second patient was 18 years of age. She had also suffered from dry cough and gradually increasing dyspnea for two years. She had partial pneumothorax in the right lung and diffuse infiltration in other pulmonary fields on chest radiography. Her hemoglobin level was 99 g/L, total serum IgE level was 1200 U/mL and eosinophilia was 8%. IPH was diagnosed by open lung biopsy. All these findings suggested that familial or allergic factors, as well as immunological factors, might have contributed to the etiology of IPH.

Postpneumonectomy Compression of the Mitral Annulus: Rare Vascular Complication in Sportive Patient.

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Debeaumont, David; Bota, Susana; Baste, Jean-Marc; Bellefleur, Marie; Stepowski, Dimitri; Vincent, Florence; Bonnevie, Tristan; Gravier, Francis-Edouard; Netchitailo, Marie; Tardif, Catherine; Boutry, Alain; Muir, Jean-François; Coquart, Jérémy

2016-01-01

Numerous postpneumonectomy complications exist. We present a rare clinical case of postpneumonectomy exertional dyspnea revealing compression of the mitral annulus by the descending aorta. The patient was 42-year-old former smoker with pulmonary emphysema. He has been operated on, in 2012 (i.e., right pneumonectomy). Before the surgery, the patient was a recreational runner. However, after some months, it was difficult for the patient to resume running. Cardiopulmonary exercise testing indicated moderate exercise intolerance with important oxygen desaturation. More interestingly, a decrease of low oxygen pulse was noticed from the first ventilatory threshold with no electrical modification on the electrocardiogram. This decrease was indicative of a decline in stroke volume. The thoracic scan revealed a right pneumonectomy pocket with a liquid abnormal content. Moreover, the mediastinum had shifted toward the pneumonectomy space and the left lung was distended and emphysematous. Echocardiography revealed a major change in the mediastinal anatomy. The mitral annulus was observed to be compressed by the rear wall of the descending aorta. The diagnosis of postpneumonectomy syndrome or platypnea-orthodeoxia syndrome was ruled out in this patient. Mitral annular compression by the descending aorta is rare complication, which must be researched in patients with postpneumonectomy exertional dyspnea.

Postpneumonectomy Compression of the Mitral Annulus: Rare Vascular Complication in Sportive Patient

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David Debeaumont

2016-01-01

Full Text Available Numerous postpneumonectomy complications exist. We present a rare clinical case of postpneumonectomy exertional dyspnea revealing compression of the mitral annulus by the descending aorta. The patient was 42-year-old former smoker with pulmonary emphysema. He has been operated on, in 2012 (i.e., right pneumonectomy. Before the surgery, the patient was a recreational runner. However, after some months, it was difficult for the patient to resume running. Cardiopulmonary exercise testing indicated moderate exercise intolerance with important oxygen desaturation. More interestingly, a decrease of low oxygen pulse was noticed from the first ventilatory threshold with no electrical modification on the electrocardiogram. This decrease was indicative of a decline in stroke volume. The thoracic scan revealed a right pneumonectomy pocket with a liquid abnormal content. Moreover, the mediastinum had shifted toward the pneumonectomy space and the left lung was distended and emphysematous. Echocardiography revealed a major change in the mediastinal anatomy. The mitral annulus was observed to be compressed by the rear wall of the descending aorta. The diagnosis of postpneumonectomy syndrome or platypnea-orthodeoxia syndrome was ruled out in this patient. Mitral annular compression by the descending aorta is rare complication, which must be researched in patients with postpneumonectomy exertional dyspnea.

Spontaneous Pneumomediastinum with a Rare Presentation

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Ehsan Bolvardi

2014-01-01

Full Text Available Spontaneous pneumomediastinum is an unusual and benign condition in which air is present in mediastinum. A 20-year-old male patient presented to ED with complaint of hoarseness and odynophagia from the day before, after weightlifting. The patient was nonsmoker and denied history of other diseases. On physical examination he had no dyspnea with normal vital signs. Throat examination and pulmonary auscultation were normal and no crepitation was palpable. We could not find subcutaneous emphysema in neck and chest examination. In neck and chest X-ray we found that air is present around the trachea. There was no apparent pneumothorax in CXR. In cervical and chest CT free air was present around trachea and in mediastinum. Subcutaneous emphysema was also evident. But there was no pneumothorax. The patient was admitted and went under close observation, oxygen therapy, and analgesic. The pneumomediastinum and subcutaneous emphysema gradually resolved within a week by conservative therapy and he was discharged without any complication. Many different conditions could be trigged because of pneumomediastinum but it is rarely seen in intense physical exertion such as weightlifting and bodybuilding. Two most common symptoms are retrosternal chest pain and dyspnea. But the patient here complained of hoarseness and odynophagia.

Transmission studies involving a wet fowl pox isolate.

Science.gov (United States)

Eleazer, T H; Harrell, J S; Blalock, H G

1983-01-01

An isolate of fowl pox (FP) virus from a case of "wet" pox in commercial white leghorn (WL) pullets was used to expose WL cockerels via the comb-scratch (CS), eye-drop (ED), or laryngeal-swab (LS) route. Seven days postinoculation (PI), the groups challenged via CS had scabby proliferative pox lesions at the challenge site, the groups challenged via LS had slight dyspnea and rales, and 20% of the cockerels challenged via ED had mild conjunctivitis and lacrimation. By termination of the trial on day 21 PI, the CS-challenged groups had developed pronounced pox lesions. The LS-challenged groups showed severe dyspnea and rales with pronounced raised plaque-like lesions at the opening to the trachea and extending into the upper quarter of the trachea with heavy yellowish caseous exudate partly occluding the glottis. The ED-challenged groups had severe lacrimation and conjunctivitis and small pox lesions on the face, comb, and wattles; 12 of 18 had proliferative lesions on the oral mucosa in the area of the larynx. Forty-five percent of the LS-challenged groups died of suffocation. Pox virus was re-isolated from tissues in all treatment groups. Wet pox transmission appears to be possible via the LS and ED routes.

Systemic reaction after performing a food prick-to-prick test. A case report

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Karen Estefanía Hernández-Moreno

2017-02-01

Full Text Available Background: Skin prick test is the most widely used test for the diagnosis of IgE-mediated conditions. Commercial extracts are used for its performance, but in the case of fruits and vegetables it is preferable using fresh food. Although both tests possess a good safety profile, hypersensitivity reactions have been recorded. Clinical case: Forty-seven-year old woman with a history of persistent allergic rhinitis, sensitized to the pollen of grasses, olive and salsola; she was referred to an allergology department due to anaphylaxis triggered by the consumption of avocado, cantaloupe, carrots and watermelon. Minutes after skin prick test with standardized extract and skin prick with fresh foods, she developed dyspnea, pruritus, erythema, dizziness and sibilance; she was administered 0.5 mg of intramuscular adrenalin and 4 salbutamol inhalations and placed in the Trendelemburg position. Dyspnea persisted, and vital signs monitoring showed heart and respiratory rates increase and, hence, salbutamol was applied again, together with 2 L/min of oxygen delivered by nasal cannula, intravenous fluids and 100 mg intravenous hydrocortisone; improvement was observed at 40 minutes. The patient was hospitalized for 48 hours. Conclusions: Although skin tests are safe, the risk of hypersensitivity and anaphylactic reactions should not be ruled out, especially in susceptible patients.

A Case Report of Rare Tracheal Mucormycosis in a Diabetic Patient

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M Parham

2012-05-01

Full Text Available

Background and Objectives: Mucormycosis is a systemic killer fungal disease in diabetes resulting in immune deficiency and malignancies that can lead to death if left untreated. Its treatment includes eliminating background diseases, performing surgery, and using anti- fungal drugs such as Amphotripcin B. The aim of this study was to report a Tracheal Mucormycosis which was treated with surgery and anti- fungal drug.

Case Report

The patient was a diabetic woman that had referred to the hospital complaining of dyspnea, nausea and vomiting. She had been suffering from fever, dyspnea, and vomiting for two weeks. She went to a public care center and was treated with Ceftriacxon, Dexamethasone and Diphenhydramin. Despite this treatment, her problem worsened, so she referred to the hospital again. On admission, she was suffering from fever, respiratory distress, tachycardia and tachypenea. Epiglottis was edematous and Erythematous. Diabetic ketoacidosis was diagnosed based on her laboratory tests. Because of worsening of the respiratory distress, tracheostomy was performed. Diagnostic Bronchoscopy and biopsy were on done on the patient on the second day of her admission and Mucormycosis was reported by the pathologist.

Pneumocystis carinii pneumonia in systemic lupus erythematosus: a report of two cases.

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Tsai, H C; Lee, S S; Lin, H H; Lu, L Y; Liu, Y C

2001-10-01

Patients with systemic lupus erythematosus (SLE) have increased susceptibility to infection by Pneumocystis carinii, but this condition has rarely been reported in Taiwan. Here, we describe two cases of patients with SLE who developed Pneumocystis carinii pneumonia (PCP). The first patient was a 39-year-old woman presenting with fever and dyspnea that had lasted 2 weeks. Chest roentgenography disclosed bilateral interstitial and alveolar infiltrates. The second patient was a 22-year-old woman presenting with a 4-day history of malaise, cough, dyspnea, and fever. She had concomitant Mycobacterium tuberculosis infection. Both patients had been treated with varying doses of corticosteroids and/or cytotoxic drugs within 4 months before presentation. Diagnosis was established based on the findings of bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB). Both patients received trimethoprim-sulfamethoxazole (20 mg.kg-1.d-1 trimethoprim), but finally died of nosocomial septicemia (Acinetobacter baumanni and Pseudomonas aeruginosa bacteremia in one, P. aeruginosa bacteremia in the other). These two cases demonstrate that PCP should be included in the differential diagnosis of patients with SLE presenting with pneumonic processes. In addition, a second opportunistic pathogen should be suspected. Bronchoscopic examination should be performed if the diagnosis is not clear and should include TBLB and BAL.

Radioactive iodine treatment of a functional thyroid carcinoma producing hyperthyroidism in a dog

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Peterson, M.E.; Kintzer, P.P.; Hurley, J.R.; Becker, D.V.

1989-01-01

Radioactive iodine (/sup 131/I) was used in the treatment of a 12-year-old female dog with hyperthyroidism resulting from a large, unresectable (and metastatic) thyroid carcinoma associated with signs of severe inspiratory stridor and dyspnea. Hyperthyroidism was diagnosed on the basis of clinical signs (polyuria, polydipsia, polyphagia, weight loss, nervousness) and high basal serum thyroxine (T4) concentrations, as well as thyroid radioiodine kinetic studies that showed a high radioiodine uptake into the thyroid (% thyroid uptake) and markedly increased serum concentrations of protein-bound iodine-131 (PB/sup 131/I) after /sup 131/I tracer injection. Thyroid imaging revealed diffuse radionuclide accumulation by the tumor, which involved both thyroid lobes. The dog was treated with three large doses of radioiodine (/sup 131/I), ranging from 60 to 75 mCi, given at intervals of 5 to 7 months. The dog became euthyroid, and the size of the tumor decreased by approximately 25% after each /sup 131/I treatment, improving the severe inspiratory stridor and dyspnea, but both the hyperthyroid state and breathing difficulty recurred within a few months of each treatment. The dog was euthanatized 5 months after the last treatment because of progressive tracheal compression and pulmonary metastasis.

Inspiratory Capacity during Exercise: Measurement, Analysis, and Interpretation

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Jordan A. Guenette

2013-01-01

Full Text Available Cardiopulmonary exercise testing (CPET is an established method for evaluating dyspnea and ventilatory abnormalities. Ventilatory reserve is typically assessed as the ratio of peak exercise ventilation to maximal voluntary ventilation. Unfortunately, this crude assessment provides limited data on the factors that limit the normal ventilatory response to exercise. Additional measurements can provide a more comprehensive evaluation of respiratory mechanical constraints during CPET (e.g., expiratory flow limitation and operating lung volumes. These measurements are directly dependent on an accurate assessment of inspiratory capacity (IC throughout rest and exercise. Despite the valuable insight that the IC provides, there are no established recommendations on how to perform the maneuver during exercise and how to analyze and interpret the data. Accordingly, the purpose of this manuscript is to comprehensively examine a number of methodological issues related to the measurement, analysis, and interpretation of the IC. We will also briefly discuss IC responses to exercise in health and disease and will consider how various therapeutic interventions influence the IC, particularly in patients with chronic obstructive pulmonary disease. Our main conclusion is that IC measurements are both reproducible and responsive to therapy and provide important information on the mechanisms of dyspnea and exercise limitation during CPET.

Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years

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Patrícia Dionísio

Full Text Available ABSTRACT Objective: To characterize clinically all of the patients with spontaneous pneumomediastinum (SPM admitted to an adult pulmonology ward in Lisbon, Portugal. Methods: This was a retrospective descriptive study of all adult patients (≥ 18 years of age diagnosed with SPM between January of 2004 and September of 2015. Results: At least one predisposing factor was identified in most (88.9% of the 18 patients who presented with SPM during the study period. With regard to precipitating factors, bouts of cough were present in 50.0% of the patients. Other precipitating factors included a sudden increase in tobacco consumption, inhaled drug use, occupational inhalation of varnish fumes, intense exercise, and vomiting. The most common complaints were dyspnea (in 83.3% and chest pain (in 77.8%. Other complaints included cough, neck pain, dysphagia, and odynophagia. Subcutaneous emphysema was found in most of the patients. The diagnosis of SPM was based on chest X-ray findings in 61.1% of the patients. Conclusions: Although SPM is a rare condition, it should be considered in the differential diagnosis of chest pain and dyspnea. It can develop without a triggering event or conclusive findings on a chest X-ray, which is usually sufficient for diagnosis.

Severe non-anion gap metabolic acidosis induced by topiramate: a case report.

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Shiber, Joseph R

2010-05-01

A non-anion gap acidosis can be induced by topiramate, causing symptomatic dyspnea and confusion. Discuss the pathophysiology of the hyperchloremic metabolic acidosis caused by topiramate, the typical clinical presentation, and the recommended treatment. This case presents a young woman with a clinically significant non-anion gap metabolic acidosis believed to be caused by topiramate. She had been taking the medication for several months without prior adverse effects. Once she began having dyspnea as a respiratory response to the renal tubule acidosis, she had decreased oral intake of food and fluids, which induced a pre-renal acute renal failure that worsened her acidemia. In the Emergency Department, she received intravenous fluids and sodium bicarbonate, and later was intubated for mechanical ventilation due to respiratory fatigue. With the topiramate withdrawn, the patient had a full recovery of her renal function and metabolic acid-base status over the next 72 h. This case serves to increase awareness of this possible adverse effect and the recommended treatment as topiramate becomes more widely used. Topiramate can induce a renal tubule acidosis resulting in a hyperchloremic metabolic acidosis. Recognition of the underlying cause is crucial so that the drug can be withdrawn while supportive care is provided. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Treatment of tracheobronchial stenosis with a self-expandable metallic stents

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Kim, Yong Soo; Jeon, Seok Chol; Choi, Chul Seung; Choi, Yo Won; Hahm, Chang Kok [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

1994-07-15

We analysed the role of modified Gianturco self-expandable stents in the treatment of tracheobronchial stenosis in 13 patients. We inserted modified Gianturco self-expandable stents under the fluoroscopic and bronchoscopic guidance. There were stenosis in the trachea(n=2), the right main bronchus(n=2), and the left main bronchus(n=9). The causes of the stenosis were endobronchial tuberculosis(n=10), intubation granuloma(n=1), restenosis after surgical reconstruction(n=2). Dyspnea or wheezing was improved within 1 or 2 days following the procedure. There were 32% and 22% respective increase in average FEV1 and FVC. Lung perfusion scan showed 9.6% increase of perfusion in the involved lung. No complications related to the procedure were encountered. During follow-up period of up to 31 months, 2 patients showed tracheal or bronchial restenosis, at 3 and 6 months, retrospectively. There was a distal migration of the stents in one case. During the follow up period after stent insertion, improvement of the obstructive changes and dyspnea persisted in 10 out of 13 patients. The modified Gianturco self-expandable metallic stents may be a good choice for the treatment of tracheobronchial stenosis, either as a primary treatment, or when the reconstruction failed.

Health-related quality-of-life outcomes: a reflexology trial with patients with advanced-stage breast cancer.

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Wyatt, Gwen; Sikorskii, Alla; Rahbar, Mohammad Hossein; Victorson, David; You, Mei

2012-11-01

To evaluate the safety and efficacy of reflexology, a complementary therapy that applies pressure to specific areas of the feet. Longitudinal, randomized clinical trial. Thirteen community-based medical oncology clinics across the midwestern United States. A convenience sample of 385 predominantly Caucasian women with advanced-stage breast cancer receiving chemotherapy and/or hormonal therapy. Following the baseline interview, women were randomized into three primary groups: reflexology (n = 95), lay foot manipulation (LFM) (n = 95), or conventional care (n = 96). Two preliminary reflexology (n = 51) and LFM (n = 48) test groups were used to establish the protocols. Participants were interviewed again postintervention at study weeks 5 and 11. Breast cancer-specific health-related quality of life (HRQOL), physical functioning, and symptoms. No adverse events were reported. A longitudinal comparison revealed significant improvements in physical functioning for the reflexology group compared to the control group (p = 0.04). Severity of dyspnea was reduced in the reflexology group compared to the control group (p Reflexology may be added to existing evidence-based supportive care to improve HRQOL for patients with advanced-stage breast cancer during chemotherapy and/or hormonal therapy. Reflexology can be recommended for safety and usefulness in relieving dyspnea and enhancing functional status among women with advanced-stage breast cancer.

STUDY ON ADHERENCE TO CAPECITABINE AMONG PATIENTS WITH COLORECTAL CANCER AND METASTATIC BREAST CANCER

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Adiel Goes de FIGUEIREDO JUNIOR

2014-09-01

Full Text Available Context Capecitabine, an oral drug, is as effective as traditional chemotherapy drugs. Objectives To investigate the adhesion to treatment with oral capecitabine in breast and colorectal cancer, and to determine any correlation with changes in patient’s quality of life. Methods Patients with colorectal cancer or breast cancer using capecitabine were included. The patients were asked to bring any medication left at the time of scheduled visits. The QLQ-C30 questionnaire was applied at the first visit and 8-12 weeks after treatment. Results Thirty patients were evaluated. Adherence was 88.3% for metastatic colon cancer, 90.4% for non-metastatic colon cancer, 94.3% for rectal cancer and 96.2% for metastatic breast cancer. No strong correlation between adherence and European Organisation for Research and Treatment of Cancer QLQ-C30 functional or symptom scale rates had been found. There was no statistically significant correlation between compliance and the functional and symptom scales of the questionnaire before and after chemotherapy, with the exception of dyspnea. Conclusions Although no absolute adherence to oral capecitabine treatment had been observed, the level of adherence was good. Health professionals therefore need a greater focus in the monitoring the involvement of patients with oral treatment regimens. Patients with lesser degrees of dyspnea had greater compliance.

[Electrocautery and bronchoscopy as a first step for the management of central airway obstruction and associated hemoptysis].

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Jalilie, Alfredo; Carvajal, Juan Carlos; Aparicio, Rodrigo; Meneses, Manuel

2016-11-01

Central airway obstruction caused by malignant or benign lesions, associated in some cases with hemoptysis, is a condition with high morbidity and mortality. The use of electrocautery by flexible bronchoscopy is an initial treatment option with immediate improvement of obstruction symptoms. It is as effective as Nd: YAG laser. To describe the usefulness of electrocautery in the management of central obstruction of the airway and hemoptysis. A retrospective, descriptive study of patients referred for management of central airway obstruction or associated hemoptysis. Diagnoses, symptoms (dyspnea, cough, and hemoptysis) and radiology before and after the procedures were analyzed. Eighteen patients aged 59 ± 12 years (66% males) were evaluated, registering 25 endoscopic procedures. Three conditions were found: partial or complete airway obstruction, hemoptysis and post lung transplant bronchial stenosis. Seventy two percent presented with dyspnea, 61% with cough and 33% with hemoptysis. Sixty six percent of patients had airway obstruction caused by malignant metastatic lesions. After electrocautery, 17 patients (94.4%) improved their symptoms and achieved complete airway clearing. Three patients had significant bronchial stenosis after lung transplant achieving subsequent clearing after electrocautery. Electrocautery during flexible bronchoscopy is an effective and safe procedure for the management of central airway obstruction and associated hemoptysis.

Effect of Electroacupuncture Rehabilitation in Transverse Myelitis: A Case Report

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Sriloy Mohanty

2017-08-01

Full Text Available A 32-year-old male diagnosed with transverse myelitis in 2013 came to our clinic in 2015 with complaints of paraplegia, sensory disturbances, pain, exertional dyspnea, poor quality of sleep, emotional instability, and depression. This was a recurrent attack that had been exacerbated by post-traumatic stress. Owing to pain and functional disabilities, he was struggling to actively participate in the treatment modalities offered at our center. A modified protocol of electroacupuncture was planned for a period of 21 days, every day, with each session lasting for 30 minutes. Assessments based on the brief version of World Health Organization Brief Quality of Life (WHO Brief QOL questionnaire, Pittsburgh sleep quality index, visual analog scale, and a disease-specific physical examination showed momentous improvement in functional health status as well as mental well-being. The quality of life showed significant improvement particularly in the physical and psychological dimensions of WHO Brief QOL. The patient reported a reduction in pain, dyspnea, and fatigue accompanied by an improvement in the quality of sleep and mood. This case report suggests that acupuncture can play a vital role in amelioration of symptoms, thereby improving the health status in patients with transverse myelitis.

Accuracy of chest radiographs in the emergency diagnosis of heart failure

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Studler, Ueli; Kretzschmar, Martin; Steinbrich, Wolfgang [University Hospital Basel, Department of Radiology, Basel (Switzerland); Christ, Michael; Breidthardt, Tobias; Noveanu, Markus; Perruchoud, Andre P.; Mueller, Christian [University Hospital Basel, Department of Internal Medicine, Basel (Switzerland); Schoetzau, Andreas [Institute of Biostatistics, Basel (Switzerland)

2008-08-15

The purpose of this study was to determine the diagnostic accuracy of chest radiographic findings of heart failure (HF) in current patients presenting with dyspnea in the emergency department. In a secondary analysis of the BASEL study, initial chest radiographs of 277 patients with acute dyspnea were evaluated by two radiologists blinded to the adjudicated diagnosis (56% had the final diagnosis of HF). Predefined radiographic criteria of HF were used. Statistical analysis included receiver-operating characteristic (ROC) analysis and calculation of a logistic regression model including B-type natriuretic peptide (BNP) levels. The reader's overall impression showed the highest area under the ROC curve for the diagnosis of HF in both supine and erect patient positions (0.855 and 0.857). Among individual radiographic findings, peribronchial cuffing in the supine position (0.829) showed the highest accuracies. The lowest accuracy was found for the vascular pedicle width in the supine position (0.461). Logistic regression analysis showed no significant differences between the reader's overall impression, the radiographic model, and BNP testing. In our study, the combination of radiographic features provided valuable information and was of comparable accuracy as BNP-testing for the diagnosis of HF. (orig.)

Cyclooxygenase Inhibitor Associated with Carboplatin in Treatment of Metastatic Nasal Carcinoma in Dog

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Carlos Eduardo Fonseca-Alves

2014-01-01

Full Text Available A 10-year-old, intact male, pinscher was presented with unilateral bloodstained nasal discharge, sneezing, dyspnea, zygomatic arch deformity, submandibular lymph node increase, blindness in right eye, and exophthalmia. After clinical examination, it was found that the animal presented with upper respiratory tract dyspnea origin, possibly caused by an obstructive process. Complete blood count (CBC, ocular ultrasonography, thoracic radiographs, mandibular lymph node, and nasal sinus fine needle aspiration were performed. The right mandibular lymph node excisional biopsy was conducted and a tumor sample was obtained through the nasal fistula at hard palate. The material was processed, paraffin embedded, sectioned, and stained with hematoxylin and eosin. Immunohistochemical staining for cytokeratin (AE1/AE3, vimentin, and COX-2 was performed. After histopathological evaluation nasal carcinoma diagnosis was obtained. Chemotherapy was established with carboplatin 300 mg/m2 intravenously—four cycles with intervals of 21 days—and firocoxib 5 mg/kg orally every 24 hours for 7 months. After 7 months the treatment started, the animal presented with ataxia, vocalization, hyperesthesia, and anorexia. Due the clinical condition presented, the animal owner opted for performing euthanasia. The chemotherapy protocol was effective causing the disease stagnation, minimizing the clinical signs, and extending patient survival and quality of life.

Prospective Observations of Discomfort, Pain, and Dyspnea in Nursing Home Residents With Dementia and Pneumonia

NARCIS (Netherlands)

Maaden, T. van der; Steen, J.T. van der; Vet, H.C. de; Hertogh, C.M.; Koopmans, R.T.

2016-01-01

OBJECTIVES: To describe observations of suffering in patients with dementia from the diagnosis of pneumonia until cure or death. DESIGN: Prospective observational study between January 2012 and May 2014. SETTING: Dutch nursing homes (32). PARTICIPANTS: Nursing home patients with dementia and

Simultaneous staphylectomy and unilateral arytenoid lateralization in dogs presenting for dyspnea: 23 cases (2010-2013).

Science.gov (United States)

Heffernan, Ann E; Biskup, Jeffery J; Kramek, Betty A; Anderson, Greg M

2016-10-01

This retrospective study assesses postoperative complications with simultaneous staphylectomy and unilateral arytenoid lateralization (SP + UAL) in dogs with laryngeal paralysis and concurrent elongation of the soft palate compared to dogs having a UAL alone. Medical records of dogs having a UAL performed from 2010 to 2013 were reviewed. Twenty-three dogs were diagnosed with a concurrent elongated soft palate and had a SP + UAL performed and 89 dogs were diagnosed with an appropriate soft palate and had only a UAL performed. A telephone questionnaire for long-term postoperative outcomes was completed. Survival probability was not statistically different between the 2 groups. Dogs in the SP + UAL group were more likely to be seen for respiratory distress after surgery ( P = 0.05). There was no significant difference between the 2 groups in the number of dogs which developed postoperative aspiration pneumonia. The overall complication rate for both groups was high, with postoperative pneumonia being the most common complication.

Clinical Predictors of Intensive Care Unit Admission for Asthmatic Children

OpenAIRE

Mohammad Hasan Kargar Maher; Parinaz Habibi; Nemat Bilan

2015-01-01

IntroductionChildren with severe asthma attack are a challenging group of patients who could be difficult to treat and leading to significant morbidity and mortality. Asthma attack severity is qualitatively estimated as mild, moderate and severe attacks and respiratory failure based on conditions such as respiration status, feeling of dyspnea, and the degree of unconsciousness. part of which are subjective rather than objective. We investigated clinical findings as predictors of severe attack...

Upper airway obstruction in a llama caused by aberrant nasopharyngeal bots (Cephenemyia sp.)

International Nuclear Information System (INIS)

Mattoon, J.S.; Gerros, T.C.; Parker, J.E.; Carter, C.A.; LaMarche, R.M.

1997-01-01

A 9 month old female llama was presented with inspiratory dyspnea. Radiographically, there was a large soft tissue mass nearly occluding the nasopharynx. During endoscopic examination three nasopharyngeal bots were identified embedded in the mass. The larvae were removed and the patient treated with ivermectin. The patient was discharged one week later free of clinical respiratory disease. In follow-up radiographs made 6 weeks later, only residual radiopacity in the area of the mass remained

A case of vildagliptin-induced interstitial pneumonia

OpenAIRE

Kuse, Naoyuki; Abe, Shinji; Kuribayashi, Hidehiko; Inomata, Minoru; Saito, Hitoshi; Fukuda, Yuh; Gemma, Akihiko

2016-01-01

A 65-year-old Japanese male with type 2 diabetes mellitus was admitted to our hospital with a productive cough and worsening dyspnea. He had started receiving vildagliptin, which is one of the dipeptideylpeptidase-4 (DPP-4) inhibitors, several days before the appearance of his symptoms. Laboratory findings revealed markedly elevated levels of immunoglobulin E and Krebs von den Lungen-6. Chest computed tomography revealed ground-glass opacity with irregular reticulation throughout both lungs. ...

Bilateral vocal fold immobility: a 13 year review of etiologies, management and the utility of the empey index

OpenAIRE

Brake, Maria K.; Anderson, Jennifer

2015-01-01

Background Bilateral vocal fold immobility (BVFI) is a rare diagnosis causing dyspnea, dysphonia and dysphagia. Management depends on respiratory performance, airway patency, vocal ability, and quality-of-life priorities. The authors review the presentation, management and outcome in patients diagnosed with BVFI. The utility and efficacy of the Empey index (EI) and the Expiratory Disproportion Index (EDI) are evaluated as an objective monitoring tools for BVFI patients. Methods A 13-year retr...

Primary laryngeal localization of multiple myeloma: A case report

OpenAIRE

Allegra, Eugenia; Marino, Nicol?; Modica, Domenico; Emmanuele, Carmela; Saita, Vincenzo

2017-01-01

Multiple myeloma is a lymphoproliferative disease that may involve the bone marrow as well as extramedullary soft tissues. However, laryngeal localization of multiple myeloma is extremely rare. We herein present the case of a 68-year-old male patient with a history of dyspnea, dysphonia and dysphagia. Laryngoscopic examination revealed a lesion involving the right glottis and right vestibular (false) vocal fold, with absence of ipsilateral laryngeal motility and constriction of the airway. Co...

Nonoperative Management of Multiple Penetrating Cardiac and Colon Wounds from a Shotgun: A Case Report and Literature Review

OpenAIRE

Jaramillo, Paula M.; Montoya, Jaime A.; Mejia, David A.; Pereira Warr, Salin

2018-01-01

Introduction. Surgery for cardiac trauma is considered fatal and for wounds of the colon by associated sepsis is normally considered; however, conservative management of many traumatic lesions of different injured organs has progressed over the years. Presentation of the Case. A 65-year-old male patient presented with multiple shotgun wounds on the left upper limb, thorax, and abdomen. On evaluation, he was hemodynamically stable with normal sinus rhythm and normal blood pressure, no dyspnea,...

A case of polyserositis in a 56-year-old female patient

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Aratrika T Das

2016-01-01

Full Text Available Polyserositis is defined as general inflammation of serous membranes associated with serous effusion due to many causes. In this case, we report polyserositis as a complication of connective tissue disorder. A 56-year-old female with a history of hypertension, hypothyroidism, and bipolar disorder having dyspnea along with pleural effusion which was repeatedly tapped and treated on suspicion of tuberculosis. She became better on steroid treatment and her respiratory distress resolved.

A case of taurine-containing drink induced anaphylaxis

OpenAIRE

Lee, Seung-Eun; Lee, Suh-Young; Jo, Eun-Jung; Kim, Mi-Young; Yang, Min-Suk; Chang, Yoon-Seok; Kim, Sae-Hoon

2013-01-01

Taurine is one of most abundant free amino acids in mammalian tissue. It has been used for various health functional foods as a main ingredient in food industry. A 33-year-old female patient repeatedly experienced generalized itching, urticaria, dyspnea and dizziness after drinking taurine-containing drinks. The patient showed positive response to oral challenge tests with taurine-containing drinks. The patient also showed positive response with synthetic taurine but not with natural taurine....

Interstitial lung disease: Diagnostic approach

OpenAIRE

Kaushik Saha

2014-01-01

Interstitial lung disease (ILD) is a final common pathway of a broad heterogeneous group of parenchymal lung disorders. It is characterized by progressive fibrosis of the lung leading to restriction and diminished oxygen transfer. Clinically, the presenting symptoms of ILD are non-specific (cough and progressive dyspnea on exertion) and are often attributed to other diseases, thus delaying diagnosis and timely therapy. Clues from the medical history along with the clinical context and radiolo...

Clinical and Physiological Effects of Exercise Training in Dyspneic Mild COPD Patients: Design of the Study

OpenAIRE

Gonzalo Labarca; Andrea Bustamante; Francisco Rodríguez; Igor Nuñez; Gonzalo Valdivia; Paul Mac Nab; Álvaro Huete; Jaime Leppe; Fernando Saldías; Orlando Díaz

2017-01-01

Introduction: Mild chronic obstructive pulmonary disease (COPD) may be associated with physical inactivity, exercise limitation, and impaired health related quality of life, because of a combination of deconditioning, dyspnea, and reduced peripheral muscle mass. Although the benefits of exercise training (ET) in counteracting these consequences are well established in moderate-to-very-severe COPD, it is unclear if they are also effective in mild disease. The aim of this paper is to describe t...

Juvenile hyperthyroidism in a cat.

Science.gov (United States)

Gordon, Jana M; Ehrhart, E J; Sisson, D D; Jones, M A

2003-01-01

An 8-month-old, male domestic shorthaired cat presented for chronic weight loss, intermittent dyspnea, chronic diarrhea, hyperactivity, and weakness. The cat had a palpable thyroid nodule and increased serum total thyroxine and 3,5,3' triiodothyronine levels. The cat was diagnosed with hyperthyroidism, and a unilateral thyroidectomy was performed followed by radioactive iodine at a later date. The clinical signs resolved following radioactive iodine, and the cat subsequently developed clinical hypothyroidism.

Biodegradable SX-ELLA tracheal stent as a new minimally invasive solution for severe tracheomalacia in newborns

OpenAIRE

Sztanó, B; Rácz, G; Szegesdi, I; Rovó, L

2015-01-01

Introduction: The solution of severe tracheomalacia in early childhood means a great challenge even nowadays. The dyspnea often requires an immediate surgical investigation. Unfortunately, tracheal segmentresection and replacement of the tracheal wall, which methods are widely used in adults, are really hard to be performed at this age because of the patients' small size. The babies' tissues are so thin and mild, so the application of classical airway stents has a high risk of intrathoracal ...

Diagnosis and management of an elderly patient with severe tracheomalacia: A case report and review of the literature

OpenAIRE

JIANG, AI-GUI; GAO, XIAO-YAN; LU, HUI-YU

2013-01-01

Severe adult tracheomalacia is a dangerous disease that is difficult to manage, particularly at the time of airway infection, and has a high mortality rate. The present study reports the diagnosis and treatment of an elderly patient with severe adult tracheomalacia. In March 2012, the 59-year-old patient presented with progressive dyspnea to the Department of Respiratory Medicine, Taizhou People?s Hospital (Jiangsu, China). Following admission, chest radiography revealed symptoms consistent w...

Inhibitory effect of cervical trachea and chest wall vibrations on cough reflex sensitivity and perception of urge-to-cough in healthy male never-smokers

OpenAIRE

Kashiwazaki, Naohiro; Ebihara, Satoru; Gui, Peijun; Katayama, Norihiro; Ito, Kumiko; Sato, Ryuhei; Oyama, Chika; Ebihara, Takae; Kohzuki, Masahiro

2013-01-01

Background Non-pharmacological options for symptomatic management of cough are desired. Although chest wall mechanical vibration is known to ameliorate cough reflex sensitivity, the effect of mechanical vibrations on perceptions of urge-to-cough has not been studied. Therefore, we investigated the effect of mechanical vibration of cervical trachea, chest wall and femoral muscle on cough reflex sensitivity, perceptions of urge-to-cough as well as dyspnea. Methods Twenty-four healthy male never...

Colobomata associated with Noonan's syndrome.

OpenAIRE

Kleanthous, L.; Cruz, D.; D'Graham, E.; Efthimiou, J.

1987-01-01

A patient with Noonan's syndrome and fundal colobomata in both eyes is described. To our knowledge, this is the first report of the association of colobomata with Noonan's syndrome. Although the patient had poor sight since early childhood and dyspnea on exertion as a teenager, the diagnosis of Noonan's syndrome was not made until early adulthood. We hope this report will encourage recognition of this syndrome and its implications at an earlier stage.

The relationship between host factors of allergic nature and respiratory symptoms.

Science.gov (United States)

Gepts, L; Minette, A

1977-01-01

Respiratory symptoms and personal history of allergy were examined in 1659 children, including the entire elementary school population of four villages of the Belgian Ardennes. Levels of atmospheric pollution were monitored during the survey and proved to be very low. It is suggested that socio-economic factors produce a small increase in respiratory symptoms, particularly in cough symptoms. A personal history of eczema and of hay fever was highly associated with dyspnea and wheezing.

Efficacy of Interventions to Improve Respiratory Function After Stroke.

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Menezes, Kênia Kp; Nascimento, Lucas R; Avelino, Patrick R; Alvarenga, Maria Tereza Mota; Teixeira-Salmela, Luci F

2018-07-01

The aim of this study was to systematically review all current interventions that have been utilized to improve respiratory function and activity after stroke. Specific searches were conducted. The experimental intervention had to be planned, structured, repetitive, purposive, and delivered with the aim of improving respiratory function. Outcomes included respiratory strength (maximum inspiratory pressure [P Imax ], maximum expiratory pressure [P Emax ]) and endurance, lung function (FVC, FEV 1 , and peak expiratory flow [PEF]), dyspnea, and activity. The quality of the randomized trials was assessed by the PEDro scale using scores from the Physiotherapy Evidence Database (www.pedro.org.au), and risk of bias was assessed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The 17 included trials had a mean PEDro score of 5.7 (range 4-8) and involved 616 participants. Meta-analyses showed that respiratory muscle training significantly improved all outcomes of interest: P Imax (weighted mean difference 11 cm H 2 O, 95% CI 7-15, I 2 = 0%), P Emax (8 cm H 2 O, 95% CI 2-15, I 2 = 65%), FVC (0.25 L, 95% CI 0.12-0.37, I 2 = 29%), FEV 1 (0.24 L, 95% CI 0.17-0.30, I 2 = 0%), PEF (0.51 L/s, 95% CI 0.10-0.92, I 2 = 0%), dyspnea (standardized mean difference -1.6 points, 95% CI -2.2 to -0.9; I 2 = 0%), and activity (standardized mean difference 0.78, 95% CI 0.22-1.35, I 2 = 0%). Meta-analyses found no significant results for the effects of breathing exercises on lung function. For the remaining interventions (ie, aerobic and postural exercises) and the addition of electrical stimulation, meta-analyses could not be performed. This systematic review reports 5 possible interventions used to improve respiratory function after stroke. Respiratory muscle training proved to be effective for improving inspiratory and expiratory strength, lung function, and dyspnea, and benefits were carried over to activity. However, there is still no evidence to accept or

Quantitative Assessment of Erector Spinae Muscles in Patients with Chronic Obstructive Pulmonary Disease. Novel Chest Computed Tomography-derived Index for Prognosis.

Science.gov (United States)

Tanimura, Kazuya; Sato, Susumu; Fuseya, Yoshinori; Hasegawa, Koichi; Uemasu, Kiyoshi; Sato, Atsuyasu; Oguma, Tsuyoshi; Hirai, Toyohiro; Mishima, Michiaki; Muro, Shigeo

2016-03-01

Loss of skeletal muscle mass and physical inactivity are important manifestations of chronic obstructive pulmonary disease (COPD), and both are closely related to poor prognoses in patients with COPD. Antigravity muscles are involved in maintaining normal posture and are prone to atrophy with inactivity. The erector spinae muscles (ESM) are one of the antigravity muscle groups, and they can be assessed by chest computed tomography (CT). We hypothesized that the cross-sectional area of ESM (ESMCSA) visualized on chest CT images may serve as a predictor of mortality in patients with COPD. This study was part of the prospective observational study undertaken at Kyoto University Hospital. ESMCSA was measured on a single-slice axial CT image at the level of the 12th thoracic vertebra in patients with COPD. The cross-sectional area of the pectoralis muscles (PMCSA) was also measured. We evaluated the relationship between ESMCSA and clinical parameters, including mortality, in patients with COPD. Age- and height-matched smoking control subjects were also evaluated. In total, 130 male patients and 20 smoking control males were enrolled in this study. ESMCSA was significantly lower in patients with COPD than in the smoking control subjects and was significantly correlated with disease severity. There was a significant but only moderate correlation between ESMCSA and PMCSA. ESMCSA was significantly correlated with previously reported prognostic factors, such as body mass index, dyspnea (modified Medical Research Council dyspnea scale score), FEV1 percent predicted value, inspiratory capacity to total lung capacity ratio, and emphysema severity (percentage of the lung field occupied by low attenuation area). Compared with PMCSA, ESMCSA was more strongly associated with mortality in patients with COPD. Stepwise multivariate Cox proportional hazards analysis revealed that, among these known prognostic factors, ESMCSA was the strongest risk factor for mortality (hazard ratio, 0

Strategies for the management and prevention of conformation-related respiratory disorders in brachycephalic dogs

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Packer RMA

2015-06-01

Full Text Available Rowena MA Packer,1 Michael S Tivers2 1Department of Clinical Science and Services, Royal Veterinary College, University of London, London, 2School of Veterinary Sciences, University of Bristol, Bristol, UK Abstract: Brachycephalic (short-muzzled dogs are increasingly popular pets worldwide, with marked increases in registrations of breeds such as the Pug and French Bulldog over the past decade in the UK. Despite their popularity, many brachycephalic breeds are affected by an early-onset, lifelong respiratory disorder, brachycephalic obstructive airway syndrome (BOAS. This disorder arises due to a mismatch in the proportions of the skull and the soft tissues held within the nose and pharynx, resulting in obstruction of the airway during respiration. Increased airway resistance encourages secondary changes such as eversion of the laryngeal saccules and collapse of the larynx. Clinical signs of BOAS are often early onset and chronic, including dyspnea, exercise intolerance, heat intolerance, and abnormal and increased respiratory noise. Episodes of severe dyspnea can also occur, leading to cyanosis, syncope, and death. BOAS may have a severe impact upon the welfare of affected dogs, compromising their ability to exercise, play, eat, and sleep. Although a well-described condition, with surgical treatments for the palliation of this disorder published since the 1920s, many dogs still experience airway restrictions postsurgically and a compromised quality of life. In addition, the prevalence of this disorder does not appear to have substantially reduced in this time, and may have increased. Ultimately, strategies to improve the breeding of these dogs to prevent BOAS are required to improve brachycephalic health and welfare. Recent studies have revealed conformational risk factors associated with BOAS, such as short muzzles and thick necks, which should be discouraged to avoid perpetuating this serious disorder. Positive changes to brachycephalic

Clinical characteristics of the asthma–COPD overlap syndrome – a systematic review

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Nielsen M

2015-07-01

Full Text Available Mia Nielsen,1 Camilla Boslev Bårnes,1 Charlotte Suppli Ulrik1,2 1Department of Pulmonary Medicine, Hvidovre Hospital, 2University of Copenhagen, Copenhagen, Denmark Background and objective: In recent years, the so-called asthma–chronic obstructive pulmonary disease (COPD overlap syndrome (ACOS has received much attention, not least because elderly individuals may present characteristics suggesting a diagnosis of both asthma and COPD. At present, ACOS is described clinically as persistent airflow limitation combined with features of both asthma and COPD. The aim of this paper is, therefore, to review the currently available literature focusing on symptoms and clinical characteristics of patients regarded as having ACOS.Methods: Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA guidelines, a systematic literature review was performed.Results: A total of 11 studies met the inclusion criteria for the present review. All studies dealing with dyspnea (self-reported or assessed by the Medical Research Council dyspnea scale reported more dyspnea among patients classified as having ACOS compared to the COPD and asthma groups. In line with this, ACOS patients have more concomitant wheezing and seem to have more cough and sputum production. Compared to COPD-only patients, the ACOS patients were found to have lower FEV1% predicted and FEV1/FVC ratio in spite of lower mean life-time tobacco exposure. Furthermore, studies have revealed that ACOS patients seem to have not only more frequent but also more severe exacerbations. Comorbidity, not least diabetes, has also been reported in a few studies, with a higher prevalence among ACOS patients. However, it should be acknowledged that only a limited number of studies have addressed the various comorbidities in patients with ACOS.Conclusion: The available studies indicate that ACOS patients may have more symptoms and a higher exacerbation rate than patients with asthma

Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction

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Hiroshi Ito

2010-05-01

Full Text Available Hiroshi Ito1, Hiroyoshi Kawaai1, Shinya Yamazaki1, Yosuke Suzuki21Division of Systemic Management, Department of Oral Function, 2Division of Radiology and Diagnosis, Department of Medical Sciences, Ohu University, Post Graduate School of Dentistry, Koriyama City, Fukushima Prefecture, JapanAbstract: From a retrospective evaluation of data on accidents and deaths during dental procedures, it has been shown that several patients who refused dental treatment died of asphyxia during dental procedures. We speculated that forcible maximum opening of the mouth by using a mouth prop triggers this asphyxia by affecting the upper airway. Therefore, we assessed the morphological changes of the upper airway following maximal opening of the mouth. In 13 healthy adult volunteers, the sagittal diameter of the upper airway on lateral cephalogram was measured between the two conditions; closed mouth and maximally open mouth. The dyspnea in each state was evaluated by a visual analog scale. In one subject, a computed tomograph (CT was taken to assess the three-dimensional changes in the upper airway. A significant difference was detected in the mean sagittal diameter of the upper airway following use of the prop (closed mouth: 18.5 ± 3.8 mm, maximally open mouth: 10.4 ± 3.0 mm. All subjects indicated upper airway constriction and significant dyspnea when their mouth was maximally open. Although a CT scan indicated upper airway constriction when the mouth was maximally open, muscular compensation was admitted. Our results further indicate that the maximal opening of the mouth narrows the upper airway diameter and leads to dyspnea. The use of a prop for the patient who has communication problems or poor neuromuscular function can lead to asphyxia. When the prop is used for patient refusal in dentistry, the respiratory condition should be monitored strictly, and it should be kept in mind that the “sniffing position” is effective for avoiding upper airway

Extraskeletal multiple myeloma presenting with an atrial mass: a case report and a review of the literature

OpenAIRE

Vigo, Federica; Ciammella, Patrizia; Valli, Riccardo; Cagni, Elisabetta; Iotti, Cinzia

2012-01-01

Abstract Introduction Extraskeletal presentation at diagnosis or during the course of multiple myeloma is a rare event. The prognosis is usually very poor. At the moment there is no agreed gold standard for the treatment of this presentation. Case presentation A 79-year-old Caucasian woman was treated at our hospital for right atrial myeloma localization. Our patient showed the following signs and symptoms of congestive heart failure: dyspnea, hypotension, cyanosis and facial edema. Surgery w...

Conservative cricoid surgery for chondrosarcoma: a case report.

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Gaio, Elena; Maggiore, Giandomenico; Canesso, Alessandra; Artico, Riccardo

2014-02-01

We present the case of a 39-year-old man who presented with hoarseness and progressively worsening dyspnea. Findings on laryngoscopy and computed tomography strongly suggested the presence of a chondrosarcoma. The patient underwent open surgery for removal of the lesion with wide margins. Reconstruction was carried out with two segments of costal cartilage. Laryngeal chondrosarcomas are rare, malignant, usually well-differentiated neoplasms that should be treated with conservative surgery. Recurrences should be treated more aggressively.

Transarterial embolization treatment for aberrant systemic arterial supply to the normal lung: A case report and literature review

Energy Technology Data Exchange (ETDEWEB)

Kim, Bo Ra; Jo, Jeong Hyun; Park, Byeong Ho [Dept. of Radiology, Dong A University Hospital, Dong A University College of Medicine, Busan (Korea, Republic of)

2017-06-15

A 24-year-old man presented with dyspnea on exertion and intermittent blood-tinged sputum. He was diagnosed with aberrant systemic arterial supply to the normal lung (ASANL) based on the results of imaging studies. The patient was successfully treated with transarterial embolization using coils and a vascular plug and his symptoms disappeared during the follow-up. Herein, we reported the imaging findings of ASANL, differential diagnoses, and its treatment options. In addition, we reviewed the relevant literature.

Cardiovocal syndrome – A rare presentation of primary pulmonary hypertension

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Om Shankar

2014-05-01

Full Text Available Primary pulmonary hypertension is a well known entity with characteristic features more common in females presenting commonly with dyspnea. However primary pulmonary hypertension presenting as hoarseness of voice is rare occurring most likely due to compression of left recurrent laryngeal nerve between normal aorta and dilated tense pulmonary artery. Here we are presenting a case of 19 year old boy with primary pulmonary hypertension who presented with hoarseness of voice as predominant symptom.

Massive Emphysema and Pneumothorax Following Shoulder Arthroscopy under General Anaesthesia: A Case Report.

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Shariyate, Mohammad J; Kachooei, Amir R; Ebrahimzadeh, Mohammad H

2017-11-01

The patient was a 61-year-old female with massive rotator cuff tear who had no history of smoking, COPD, asthma, or other pulmonary diseases. Four hours following shoulder arthroscopy, the patient developed progressive dyspnea, which was diagnosed as pneumothorax with subcutaneous emphysema extending to the neck and face. Chest tube was inserted promptly. The patient was discharged with a good condition after 7 days. Follow up of the patient for the next 3 months was uneventful.

Hematoma subcapsular esplénico en paciente portador de rasgo falciforme

OpenAIRE

Ugalde,Diego; Conte,Guillermo; Ugalde,Héctor; Figueroa,Gastón; Cuneo,Marianela; Muñoz,Macarena; Mayor,Javiera

2011-01-01

Drepanocytic anemia is an uncommon hereditary disease in Chile. The heterozygous state of drepanocytic anemia or "sickle trait" has a frequency of 8% among Afro-Americans. A small number of patients carrying hemoglobin S are homozygous, with clinical manifestations of hemolytic anemia and thrombotic disease. Sickle trait is usually asymptomatic. We report a 59-year-old male who presented an acute abdominal pain and dyspnea while staying at high altitude. Six days later, an angio CAT scan show...

[Immersion pulmonary edema].

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Desgraz, Benoît; Sartori, Claudio; Saubade, Mathieu; Héritier, Francis; Gabus, Vincent

2017-07-12

Immersion pulmonary edema may occur during scuba diving, snorke-ling or swimming. It is a rare and often recurrent disease, mainly affecting individuals aged over 50 with high blood pressure. However it also occurs in young individuals with a healthy heart. The main symptoms are dyspnea, cough and hemoptysis. The outcome is often favorable under oxygen treatment but deaths are reported. A cardiac and pulmonary assessment is necessary to evaluate the risk of recurrence and possible contraindications to immersion.

Primary oral and nasal transmissible venereal tumor in a mix-breed dog

OpenAIRE

Rezaei, Mahdieh; Azizi, Shahrzad; Shahheidaripour, Shima; Rostami, Sara

2016-01-01

Transmissible venereal tumor (TVT) is a coitally transmitted tumor of dogs with widespread distribution. The present study describes the occurrence of the primary oral and nasal TVT in a 10-year-old, female, mix-breed dog. The case was presented with a history of anorexia, inability to swallow and dyspnea. Clinical examinations revealed the emaciation, muzzle deformity due to the presence of a friable, fleshy, cauliflower-like mass in the oral cavity and submandibular lymphadenopathy. TVT was...

A case of laryngeal angioleiomyoma and review of literature

OpenAIRE

Zhao, Xue; Yu, Dan; Zhao, Yin; Liu, Yan; Qi, Xinmeng; Jin, Chunshun

2015-01-01

Angioleiomyoma is a rare benign vascular smooth muscle tumor that arise from the tunica media of veins and arteries. Here a case of laryngeal angioleiomyoma in a 57-year-old Chinese man is reported. The patient presented with dysphagia for one and half-month and dyspnea during the previous one week, was hospitalized for treatment with a tracheotomy and laryngofissure with the unblock mass excision. Final pathological evaluation of the neoplasm confirmed a diagnosis of laryngeal angioleiomyoma...

An Unusual Laryngeal Foreign Body in Adult.

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Ndiaye, Cire; Regonne, Eric Joel; Ahmed, Houra; Diom, Evelyne Siga; Deguenonvo, Richard Edouard Alain; Mbaye, Aminata; Zemene, Yilkal; Ndiaye, Issa Cheikh

2016-01-01

The accidental aspiration of a foreign body is a frequent domestic accident among children but a rare occurrence in adults. The laryngeal impaction of a coin is an unusual accident; only a few cases have been reported in the literature. Diagnosis is mostly achieved by clinicoradiological examinations. The authors report an uncommon case of laryngeal impaction of a coin in a 21-year-old patient, presenting with dysphonia without dyspnea or stridor. The extraction was performed by endoscopy.

Importance of back blow maneuvers in a 6 month old patient with sudden upper airway obstruction

OpenAIRE

Gencpinar, Pinar; Duman, Murat

2016-01-01

Foreign body aspiration in children under four years old is one of the most frequently observed reasons for accident related deaths. It is more common in this age group due to inadequate swallowing functions and exploration of objects with the mouth. The most frequently encountered foreign bodies are food and toy parts. Life threatening complete laryngeal obstruction is rarely observed. Dyspnea, hypersalivation, cough and cyanosis can be seen. The basic and life-saving treatment approach is c...

An Unusual Laryngeal Foreign Body in Adult

OpenAIRE

Ndiaye, Cire; Regonne, Eric Joel; Ahmed, Houra; Diom, Evelyne Siga; Deguenonvo, Richard Edouard Alain; Mbaye, Aminata; Zemene, Yilkal; Ndiaye, Issa Cheikh

2016-01-01

The accidental aspiration of a foreign body is a frequent domestic accident among children but a rare occurrence in adults. The laryngeal impaction of a coin is an unusual accident; only a few cases have been reported in the literature. Diagnosis is mostly achieved by clinicoradiological examinations. The authors report an uncommon case of laryngeal impaction of a coin in a 21-year-old patient, presenting with dysphonia without dyspnea or stridor. The extraction was performed by endoscopy.

A rare case of watermelon stomach in woman with continuous ambulatory peritoneal dialysis and systemic lupus erythematosus.

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Jinga, Mariana; Checheriţă, I A; Becheanu, G; Jinga, V; Peride, Ileana; Niculae, A

2013-01-01

We report a case of a 42-year-old woman with systemic lupus erythematosus and chronic kidney disease stage 5 undergoing continuous ambulatory peritoneal dialysis, presenting asthenia, dizziness, abdominal pain and small efforts dyspnea. After a complete physical and clinical examination, including laboratory tests, esophagogastroduodenal endoscopy and gastric lesions biopsy, she was diagnosed with gastric antral vascular ectasia. We are facing a rare case of antral vascular ectasia in a patient associating both chronic kidney disease and autoimmune disease.

Endoarterial pulmonary metastasis of malignant trophoblast associated with a term intrauterine pregnancy.

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Carlson, J A; Day, T G; Kuhns, J G; Howell, R S; Masterson, B J

1984-02-01

A previously healthy gravida 4, para 3, developed preclampsia and progressive dyspnea at the 37th gestational week and had bilateral pulmonary infiltrates on chest roentgenogram. She delivered a healthy, term, male infant with a normal appearing placenta. Postpartum, her respiratory status gradually worsened. A lung biopsy on the 20th postpartum day revealed intravascular trophoblasts, diffuse arteriolar thrombosis with pulmonary infarction, and subacute interstitial pneumonitis. Combination chemotherapy was instituted, but the patient died from respiratory insufficiency.

Clinical trial experience using erythropoietin during radiation therapy

International Nuclear Information System (INIS)

Lavey, R.S.

1998-01-01

Oncologists have several reasons for trying to maintain or increase hemoglobin levels in their patients during therapy. Relief of the symptoms of anemia, including fatigue and dyspnea, are traditional, well-accepted indications. A newer rationale is to enhance the efficacy of radiation therapy and/or chemotherapy in controlling tumors. A laboratory animal study found that administration of recombinant human erythropoietin (rHuEPO) increased intratumoral median oxygen levels and diminished the proportion of measurements in the very low ( [de

Long Term Effects of Tear Gases on Respiratory System: Analysis of 93 Cases

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Peri Arbak

2014-01-01

Full Text Available Aim. This study aimed to assess the long-term respiratory effects of tear gases among the subjects with history of frequent exposure. Materials and Methods. A questionnaire by NIOSH and pulmonary function tests was performed in 93 males exposed to the tear gases frequently and 55 nonexposed subjects. Results. The mean numbers of total exposure and last 2 years exposure were 8.4±6.4 times, 5.6±5.8 times, respectively. Tear gas exposed subjects were presented with a higher rate for cough and phlegm more than 3 months (24.7% versus 11.3%, P>0.05. Mean FEV1/FVC and % predicted MMFR in smoker exposed subjects are significantly lower than those in smoker controls (81.7% versus 84.1%, P=0.046 and 89.9% versus 109.6%, P=0.0004, resp.. % predicted MMFR in nonsmoker exposed subjects is significantly lower than that in nonsmoker controls (99.4% versus 113.1%, P=0.05. Odds ratios for chest tightness, exercise dyspnea, dyspnea on level ground, winter morning cough, phlegm, and daily phlegm were increased almost 2 to 2.5 folds among tear gas exposed subjects. Conclusion. The rates for respiratory complaints were high in the case of the exposure to the tear gases previously. Tears gas exposed subjects were found to be under the risk for chronic bronchitis.

Continuous Positive Airway Pressure During Exercise Improves Walking Time in Patients Undergoing Inpatient Cardiac Rehabilitation After Coronary Artery Bypass Graft Surgery: A RANDOMIZED CONTROLLED TRIAL.

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Pantoni, Camila Bianca Falasco; Di Thommazo-Luporini, Luciana; Mendes, Renata Gonçalves; Caruso, Flávia Cristina Rossi; Mezzalira, Daniel; Arena, Ross; Amaral-Neto, Othon; Catai, Aparecida Maria; Borghi-Silva, Audrey

2016-01-01

Continuous positive airway pressure (CPAP) has been used as an effective support to decrease the negative pulmonary effects of coronary artery bypass graft (CABG) surgery. However, it is unknown whether CPAP can positively influence patients undergoing CABG during exercise. This study evaluated the effectiveness of CPAP on the first day of ambulation after CABG in patients undergoing inpatient cardiac rehabilitation (CR). Fifty-four patients after CABG surgery were randomly assigned to receive either inpatient CR and CPAP (CPG) or standard CR without CPAP (CG). Cardiac rehabilitation included walking and CPAP pressures were set between 10 to 12 cmH2O. Participants were assessed on the first day of walking at rest and during walking. Outcome measures included breathing pattern variables, exercise time in seconds (ETs), dyspnea/leg effort ratings, and peripheral oxygen saturation (SpO2). Twenty-seven patients (13 CPG vs 14 CG) completed the study. Compared with walking without noninvasive ventilation assistance, CPAP increased ETs by 43.4 seconds (P = .040) during walking, promoted better thoracoabdominal coordination, increased ventilation during walking by 12.5 L/min (P = .001), increased SpO2 values at the end of walking by 2.6% (P = .016), and reduced dyspnea ratings by 1 point (P = .008). Continuous positive airway pressure can positively influence exercise tolerance, ventilatory function, and breathing pattern in response to a single bout of exercise after CABG.

Designing and testing a web-based interface for self-monitoring of exercise and symptoms for older adults with chronic obstructive pulmonary disease.

Science.gov (United States)

Johnston, Sandra K; Nguyen, Huong Q; Wolpin, Seth

2009-01-01

The use of information and communication technologies to support collaborative management of chronic obstructive pulmonary disease and associated symptoms is particularly appealing since most people with chronic obstructive pulmonary disease continue to experience dyspnea despite optimal medical therapy and therefore must engage in the long-term tasks of self-management. Exercise is an effective therapy to reduce dyspnea in patients with chronic obstructive pulmonary disease. The purpose of this article was to describe our process of developing a set of integrated tools to support collaborative symptom and exercise monitoring for patients with chronic obstructive pulmonary disease. This process could be followed by other researchers and clinicians interested in developing collaborative management tools for other chronic conditions. User-centered design principles guided the 4-phase development process of a set of integrated tools for self-symptom management. The usability challenges uncovered during the field testing were mostly minor and were easily corrected. Patients had a strong preference for a calendar-like display of completed exercise coupled with simultaneous goal viewing. Field usability testing showed that the integrated set of tools was relatively easy to learn, efficient to use, and with minimal errors and has a high level of user satisfaction. An iterative, multimodal process is essential to successful development of acceptable Web-based tools for self-management in chronic obstructive pulmonary disease.

Variability in the evaluation of the Federal black lung benefits claimant.

Science.gov (United States)

Roy, T M; Snider, H L; Anderson, W H

1987-12-01

A critical review of the medical data accumulated on 100 consecutive miners referred for evaluation for disability under the Federal Coal Mine Health and Safety Act documented the generation of an excess of unreliable data at an unacceptable cost, even though the evaluations had been performed by physicians who regularly perform this service. Physician training appears to have an impact on the accuracy and reproducibility of historical inquiry regarding items that would identify other causes of activity-limiting dyspnea. Physicians with pulmonary training are statistically more likely to include the cigarette smoking history, as well as history for the presence or absence of exertional chest pain and paroxysmal nocturnal dyspnea. Spirometric pulmonary functions that are supervised and interpreted by physicians with pulmonary training are less likely to show wide variation between the forced expiratory volume in 1 sec, and the direct maximum voluntary ventilation. Regardless of the source, the direct MVV measurement does not contribute additional useful information about a claimant's pulmonary impairment. Arterial blood gas analysis does not add to the discriminatory value of spirometry and should be dropped from the routine claimant's evaluation. Electrocardiography identifies cardiovascular disease in a sufficient number of applicants to make this test worthwhile. The presence or absence of pneumonconiosis on chest radiograph does not vary significantly when interpreted by the examining physician regardless of pulmonary training.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of habitual waterpipe tobacco smoking on pulmonary function and exercise capacity in young healthy males: A pilot study.

Science.gov (United States)

Hawari, F I; Obeidat, N A; Ghonimat, I M; Ayub, H S; Dawahreh, S S

2017-01-01

Evidence regarding the health effects of habitual waterpipe smoking is limited, particularly in young smokers. Respiratory health and cardiopulmonary exercise tests were compared in young male habitual waterpipe smokers (WPS) versus non-smokers. 69 WPS (≥3 times/week for three years) and 69 non-smokers were studied. Respiratory health was assessed through the American Thoracic Society and the Division of Lung Diseases (ATS-DLD-78) adult questionnaire. Pulmonary function and cardiopulmonary exercise tests were performed. Self-reported respiratory symptoms, forced expiratory volume in first second (FEV 1 ), forced vital capacity (FVC), FEV 1 /FVC ratio, forced expiratory flow between 25 and 75% of FVC (FEF 25-75% ), peak expiratory flow (PEF), exercise time, peak end-tidal CO 2 tension (PetCO 2 ), subject-reported leg fatigue and dyspnea; peak O 2 uptake (VO 2 max), and end-expiratory lung volume (EELV) change from baseline (at peak exercise) were measured. WPS were more likely than non-smokers to report respiratory symptoms. WPS also demonstrated: shorter exercise time; lower peak VO 2 ; higher perceived dyspnea at mid-exercise; lower values of the following: FEV 1 , FVC, PEF, and EELV change. Habitual waterpipe tobacco smoking in young seemingly healthy individuals is associated with a greater burden of respiratory symptoms and impaired exercise capacity. Copyright © 2016 Elsevier Ltd. All rights reserved.

Acupuncture as an adjunct to pulmonary rehabilitation.

LENUS (Irish Health Repository)

Deering, Brenda M

2012-02-01

PURPOSE: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and by both systemic and airway inflammation. In COPD, acupuncture has been shown to improve quality-of-life scores and decrease breathlessness; similar findings have also been reported after pulmonary rehabilitation (PR). The hypothesis of this study was that acupuncture in conjunction with pulmonary rehabilitation would improve COPD outcome measures compared to pulmonary rehabilitation alone. METHODS: The design was a randomized prospective study; all subjects had COPD. There were 19 controls, 25 who underwent PR, and 16 who had both acupuncture and PR. The primary outcome measure was a change in measures of systemic inflammation at the end of PR and at 3 month followup. Lung function, including maximum inspiratory pressure (PiMax), quality-of-life scores, functional capacity including steps taken, dyspnea scores, and exercise capacity, were secondary endpoints. RESULTS: After PR, both groups had significantly improved quality-of-life scores, reduced dyspnea scores, improved exercise capacity, and PiMax, but no change in measures of systemic inflammation compared with the controls. There were no differences in most of the outcome measures between the 2 treatment groups except that subjects who had both acupuncture and PR remained less breathless for a longer period. CONCLUSION: The addition of acupuncture to PR did not add significant benefit in most of the outcomes measured.

Appearances Can Be Deceiving: What Is the Diagnosis for this Community-Acquired Pneumonia?

Directory of Open Access Journals (Sweden)

Frank YH Lin

2001-01-01

Full Text Available A and asbestos exposure (in the 1970s presented to the emergency department with a one-month history of progressive dyspnea, right-sided pleuritic chest pain, cough productive of white-coloured sputum and malaise. His health problems had commenced four months before presentation while he was vacationing at a northern Ontario resort. At that time, he had felt unwell and had developed a fever with rightsided pleuritic chest pain that radiated to his right shoulder. The diagnosis was an upper respiratory tract infection, made by the local physician; the patient was treated with a 10-day course of cephalexin. Although his condition had initially improved after the antibiotic therapy, during the month before presentation he had experienced increasing fatigue, cough with clear sputum production and a loss of appetite. He also developed worsening right-sided pleuritic chest pain that radiated to the right shoulder, dyspnea and orthopnea. He had no nausea, vomiting, diarrhea or hemoptysis. However, he had lost 4 kg and had drenching night sweats over the previous three and a half months. Further history revealed that he had drunk well water during his vacation in northern Ontario and that several families who were with him at that time also became ill, although he was not aware of the nature of their symptoms.

Barriers associated with reduced physical activity in COPD patients.

Science.gov (United States)

Amorim, Priscila Batista; Stelmach, Rafael; Carvalho, Celso Ricardo Fernandes; Fernandes, Frederico Leon Arrabal; Carvalho-Pinto, Regina Maria; Cukier, Alberto

2014-10-01

To evaluate the ability of COPD patients to perform activities of daily living (ADL); to identify barriers that prevent these individuals from performing ADL; and to correlate those barriers with dyspnea severity, six-minute walk test (6MWT), and an ADL limitation score. In COPD patients and healthy, age-matched controls, the number of steps, the distance walked, and walking time were recorded with a triaxial accelerometer, for seven consecutive days. A questionnaire regarding perceived barriers and the London Chest Activity of Daily Living (LCADL) scale were used in order to identify the factors that prevent the performance of ADL. The severity of dyspnea was assessed with two scales, whereas submaximal exercise capacity was determined on the basis of the 6MWT. We evaluated 40 COPD patients and 40 controls. In comparison with the control values, the mean walk time was significantly shorter for COPD patients (68.5 ± 25.8 min/day vs. 105.2 ± 49.4 min/day; p barriers to performing ADL were lack of infrastructure, social influences, and lack of willpower. The 6MWT distance correlated with the results obtained with the accelerometer but not with the LCADL scale results. Patients with COPD are less active than are healthy adults of a comparable age. Physical inactivity and the barriers to performing ADL have immediate implications for clinical practice, calling for early intervention measures.

Effectiveness of percutaneous closure of patent foramen ovale for hypoxemia.

Science.gov (United States)

Fenster, Brett E; Nguyen, Bryant H; Buckner, J Kern; Freeman, Andrew M; Carroll, John D

2013-10-15

The aim of this study was to evaluate the ability of percutaneous patent foramen ovale (PFO) closure to improve systemic hypoxemia. Although PFO-mediated right-to-left shunt (RTLS) is associated with hypoxemia, the ability of percutaneous closure to ameliorate hypoxemia is unknown. Between 2004 and 2009, 97 patients who underwent PFO closure for systemic hypoxemia and dyspnea that was disproportionate to underlying lung disease were included for evaluation. All patients exhibited PFO-mediated RTLS as determined by agitated saline echocardiography. Procedural success was defined as implantation of a device without major complications and mild or no residual shunt at 6 months. Clinical success was defined as a composite of an improvement in New York Heart Association (NYHA) functional class, reduction of dyspnea symptoms, or decreased oxygen requirement. Procedural success was achieved in 96 of 97 (99%), and clinical success was achieved in 68 of 97 (70%). The presence of any moderate or severe interatrial shunt by agitated saline study (odds ratio [OR] = 4.7; p gender (OR = 0.30; p <0.017) decreased the likelihood of success. In conclusion, based on the largest single-center experience of patients referred for PFO closure for systemic hypoxemia, PFO closure was a mechanically effective procedure with an associated improvement in echocardiographic evidence of RTLS, NYHA functional class, and oxygen requirement. Copyright © 2013 Elsevier Inc. All rights reserved.

Comparison of Pulmonary Functions, Physical Activity Level and Quality of Life in Obese and Pre-Obese Individuals

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Rıdvan Aktan

2017-12-01

Full Text Available Objective: There are studies regarding pulmonary functions of obese individuals in literature; however, there is insufficient data regarding pre-obese individuals. This study aimed to compare the pulmonary functions, physical activity levels, and health-related quality of life (HRQOL of obese and pre-obese individuals. Methods: The characteristics of 62 subjects participating in the study were recorded All subjects were evaluated using pulmonary function tests (PFT, short form-36 health survey (SF-36, obesity and weight loss quality of life measure (OWLQOL, international physical activity questionnaires (IPAQ, and modified medical research council (mMRC scale. Results: The severity of perceived dyspnea in obese subjects was significantly higher than that in pre-obese subjects. The PFT parameters (FVC, FEV1, PEF, FEF25–75, FEF25–75%, MVV, and MVV% were significantly lower in obese subjects. Although individuals in both groups were inactive, the inactivity levels in obese subjects were significantly higher. HRQOL scores were significantly lower in obese individuals. The body mass index (BMI was significantly correlated with dyspnea severity, SF-36 subscores, OWLQOL scores, and PFT parameters. Conclusion: While an increasing BMI has an adverse effect on the pulmonary functions of pre-obese individuals, increased BMI coupled with reduced pulmonary functions causes a decrease in the physical activity levels and reduces HRQOL of obese individuals.

Is there an association between depression and cardiovascular mortality or sudden death?

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Alboni, Paolo; Favaron, Elisa; Paparella, Nelly; Sciammarella, Massimo; Pedaci, Mario

2008-04-01

The results of many studies and recent meta-analyses strongly suggest that depression is a risk factor for total and cardiovascular mortality, both in the general population and in patients with known heart disease. By contrast, the association between depression and sudden death or cardiac arrest has received little attention. This issue has been investigated in three recent studies; two were carried out in the general population and showed depression to be a independent risk factor for sudden death. The other study was carried out in patients with acute myocardial infarction (AMI); the adjusted relative risk (RR) of sudden death was significantly increased in depressed patients but, after adjustment for dyspnea/fatigue (a common symptom for heart disease and depression), the RR was no longer statistically significant. However, when the cognitive-affective depressive symptoms were examined separately from the somatic ones (dyspnea/fatigue, etc.), there was a clear trend for an association between cognitive-affective symptoms and sudden death. Because a risk factor can be defined as 'independent' only in a multivariate analysis in which variables are dichotomized, the presence of common symptoms between heart disease and depression represents a very difficult problem. However, taken together, the results of studies carried out in the general population and in patients with AMI strongly suggest that depression is a significant risk factor for sudden death.

[Pyothorax in 26 cats: clinical signs, laboratory results and therapy (2000-2007)].

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Ottenjann, Mareike; Lübke-Becker, Antina; Linzmann, Helge; Brunnberg, Leo; Kohn, Barbara

2008-01-01

Common historical findings in 26 cats with pyothorax were dyspnea (85%), lethargy (65%), and anorexia (62%), common clinical findings were dyspnea (89%), tachypnea (73%), fever (39%), and hypothermia (27%). Frequent laboratory abnormalities were leukocytosis (68%) with a left shift (100%), anemia (65%), hypoalbuminemia (91%), hyperglobulinemia (86%), hyperbilirubinemia (60%) as well as azotemia (52%). The thoracic effusion was purulent in all cats, the thoracic fluid evaluation (n = 19) met the criteria for an inflammatory exudate (protein 32-63 g/l, median 44; cell count 54.4-390 x 10(9)/l, median 100). Cytological analysis revealed bacteria in 21 of 24 cats. From 16 cats 13 different genera were isolated, 5 cultures were without bacterial growth. In 12.5% of the cats a single population of bacteria was identified, and in 87.5% a mixture of 2-4 different bacterial species were cultured. Obligate anaerobic bacteria were the most common isolates (70%) followed by facultative anaerob (22.5%) and aerob growing (7.5%) bacteria. Bacterial culture most often yielded Fusobacteria spp., Prevotella spp., Pasteurella spp., Porphyromonas spp. and Bacteroides spp. Three cats were euthanized at the day of presentation. A thoracic lavage was performed in 22 cats; mechanical complications with the chest tubes occured in 4 cats. Thoracotomy was performed in 2 cats. Of the 23 treated cats 17 survived (74%).

[Results of a physical therapy program in nursing home residents: A randomized clinical trial].

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Casilda-López, Jesús; Torres-Sánchez, Irene; Garzón-Moreno, Victor Manuel; Cabrera-Martos, Irene; Valenza, Marie Carmen

2015-01-01

The maintenance of the physical functionality is a key factor in the care of the elderly. Inactive people have a higher risk of death due to diseases associated with inactivity. In addition, the maintenance of optimal levels of physical and mental activity has been suggested as a protective factor against the development and progression of chronic illnesses and disability. The objective of this study is to assess the effectiveness of an 8-week exercise program with elastic bands, on exercise capacity, walking and balance in nursing home residents. A nursing home sample was divided into two groups, intervention group (n=26) and control group (n=25). The intervention group was included in an 8-week physical activity program using elastic bands, twice a week, while the control group was took part in a walking programme. Outcome measurements were descriptive variables (anthropometric characteristics, quality of life, fatigue, fear of movement) and fundamental variables (exercise capacity, walking and balance). A significant improvement in balance and walking speed was observed after the programme. Additionally, exercise capacity improved significantly (P≤.001), and the patients showed an improvement in perceived dyspnea after the physical activity programme in the intervention group. The exercise program was safe and effective in improving dyspnea, exercise capacity, walking, and balance in elderly. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

The diagnosis and treatment of two kinds of pulmonary embolism complications after interventional therapy

International Nuclear Information System (INIS)

Su Hongying; Xiao Liang; Zhong Hongshan; Xu Ke; Zheng Yanbo; Lu Zaiming

2008-01-01

Objective: To summarize the different types, clinical manifestation, treatment and prognosis of pulmonary embolism after interventional therapy in order to promote the diagnosis and treatment for the severe complication. Methods: The cases of pulmonary embolism complications after interventional therapy were collected from three hospitals between 1998 and 2005. The patients were divided into two types of iodized oil and thrombus pulmonary embolism according to the different types of the embolus. The experience of the clinical manifestation, diagnosis and treatment were summarized. Results: Ten patients with pulmonary embolism complication after interventional therapy were collected, including five with thrombus pulmonary embolism and four with iodized oil pulmonary embolism. All 5 cases of the thrombus pulmonary embolism suffered burst dyspnea and apsychia, two died and the others recovered or turned better. Aggravating dyspnea without shock occurred in the five iodized oil pulmonary embolism cases, 1 to 3 days after interventional therapy. The symptoms disappeared 15 to 50 days after combined therapy including majorly oxygen supply therapy. Conclusion: Pulmonary embolism is an emergent and severe complication after interventional therapy including acute thrombus pulmonary embolism without deep vein thrombosis which can be effectively treated be effectively treated with maintaining effective circulation and thrombolysis; and iodized oil pulmonary embolism with slow onsets could disappear within 1 month after combined therapy with mainly oxygen supplying therapy. The diagnosis and antidiastole mainly rely on enhancement of CT scan. (authors)

Ultrasound-Guided Interscalene Catheter Complicated by Persistent Phrenic Nerve Palsy

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Andrew T. Koogler

2018-01-01

Full Text Available A 76-year-old male presented for reverse total shoulder arthroplasty (TSA in the beach chair position. A preoperative interscalene nerve catheter was placed under direct ultrasound-guidance utilizing a posterior in-plane approach. On POD 2, the catheter was removed. Three weeks postoperatively, the patient reported worsening dyspnea with a subsequent chest X-ray demonstrating an elevated right hemidiaphragm. Pulmonary function testing revealed worsening deficit from presurgical values consistent with phrenic nerve palsy. The patient decided to continue conservative management and declined further invasive testing or treatment. He was followed for one year postoperatively with moderate improvement of his exertional dyspnea over that period of time. The close proximity of the phrenic nerve to the brachial plexus in combination with its frequent anatomical variation can lead to unintentional mechanical trauma, intraneural injection, or chemical injury during performance of ISB. The only previously identified risk factor for PPNP is cervical degenerative disc disease. Although PPNP has been reported following TSA in the beach chair position without the presence of a nerve block, it is typically presumed as a complication of the interscalene block. Previously published case reports and case series of PPNP complicating ISBs all describe nerve blocks performed with either paresthesia technique or localization with nerve stimulation. We report a case of a patient experiencing PPNP following an ultrasound-guided placement of an interscalene nerve catheter.

Intracavitary drainage procedure for giant bullae in compromised patients.

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Verma, R K; Nishiki, M; Mukai, M; Fujii, T; Kuranishi, F; Yoshioka, S; Ohtani, M; Dohi, K

1991-09-01

Two cases of giant bullae were treated by intracavitary suction and drainage procedure under local anesthesia because of the poor pulmonary function. After staged bullectomy, the patients returned to normal life. The first case was admitted to our intensive care unit (ICU). Tube drainage was performed in the giant bulla of the left lung immediately after admission. One month after recovery from right heart failure and mediastinal shift to the right side, bullectomy was performed using linear stapler. The patient was discharged 20 days later. The second case was admitted with severe dyspnea and bilateral giant bullae were noticed. We performed tube drainage for larger bulla of the left lung under local anesthesia. Two months later, bullectomy was performed on the right side, because the bulla on the left side became smaller and the general condition of the patient improved. The patient was discharged three months later on foot and has since been asymptomatic. Giant bulla is a well-established clinical entity which includes abnormal dilatation of various parts of the tracheo-bronchial tree and other discrete sacs originating from the interstitial portion of the lung. Giant bullae are frequently associated with marked dyspnea and emphysematous symptoms. However, these symptoms depend upon various factors: size, location, valvular mechanism, condition of the contiguous lung parenchyma and the changes that may take place in the intrathoracic pressure.

Cardiac comorbidity is an independent risk factor for radiation-induced lung toxicity in lung cancer patients

International Nuclear Information System (INIS)

Nalbantov, Georgi; Kietselaer, Bas; Vandecasteele, Katrien; Oberije, Cary; Berbee, Maaike; Troost, Esther; Dingemans, Anne-Marie; Baardwijk, Angela van; Smits, Kim; Dekker, André; Bussink, Johan; Ruysscher, Dirk De; Lievens, Yolande; Lambin, Philippe

2013-01-01

Purpose: To test the hypothesis that cardiac comorbidity before the start of radiotherapy (RT) is associated with an increased risk of radiation-induced lung toxicity (RILT) in lung cancer patients. Material and methods: A retrospective analysis was performed of a prospective cohort of 259 patients with locoregional lung cancer treated with definitive radio(chemo)therapy between 2007 and 2011 (ClinicalTrials.gov Identifiers: NCT00572325 and NCT00573040). We defined RILT as dyspnea CTCv.3.0 grade ⩾2 within 6 months after RT, and cardiac comorbidity as a recorded treatment of a cardiac pathology at a cardiology department. Univariate and multivariate analyses, as well as external validation, were performed. The model-performance measure was the area under the receiver operating characteristic curve (AUC). Results: Prior to RT, 75/259 (28.9%) patients had cardiac comorbidity, 44% of whom (33/75) developed RILT. The odds ratio of developing RILT for patients with cardiac comorbidity was 2.58 (p < 0.01). The cross-validated AUC of a model with cardiac comorbidity, tumor location, forced expiratory volume in 1 s, sequential chemotherapy and pretreatment dyspnea score was 0.72 (p < 0.001) on the training set, and 0.67 (p < 0.001) on the validation set. Conclusion: Cardiac comorbidity is an important risk factor for developing RILT after definite radio(chemo)therapy of lung cancer patients

Subglottic Chondrosarcoma Presenting Only Mild Acute-Onset Dyspnea: A Case Report and Review of the Literature

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Su-wei Tsai

2014-01-01

Full Text Available Chondrosarcoma is categorized as a malignant cartilaginous tumor, which occurs rarely in the craniofacial region. We report the case of a 68-year-old man with chondrosarcoma in the subglottic area. His chief symptoms were hoarseness and mild dysphagia. A computed tomography scan revealed a lesion with expansion of the cricoid cartilage and marked reduction of the airway. After biopsy, histological inspection showed that chondrocytes are multi-nucleus, their size does not differ much and mitosis is not obvious. These are all characteristics of a low-grade chondrosarcoma. We performed an organ-preserving operation by debulking the low-grade malignant tumor in order to keep a patent airway. No further metastasis or airway compromise was evident during the 1-year follow-up visit.

Simultaneous staphylectomy and unilateral arytenoid lateralization in dogs presenting for dyspnea: 23 cases (2010–2013)

Science.gov (United States)

Heffernan, Ann E.; Biskup, Jeffery J.; Kramek, Betty A.; Anderson, Greg M.

2016-01-01

This retrospective study assesses postoperative complications with simultaneous staphylectomy and unilateral arytenoid lateralization (SP + UAL) in dogs with laryngeal paralysis and concurrent elongation of the soft palate compared to dogs having a UAL alone. Medical records of dogs having a UAL performed from 2010 to 2013 were reviewed. Twenty-three dogs were diagnosed with a concurrent elongated soft palate and had a SP + UAL performed and 89 dogs were diagnosed with an appropriate soft palate and had only a UAL performed. A telephone questionnaire for long-term postoperative outcomes was completed. Survival probability was not statistically different between the 2 groups. Dogs in the SP + UAL group were more likely to be seen for respiratory distress after surgery (P = 0.05). There was no significant difference between the 2 groups in the number of dogs which developed postoperative aspiration pneumonia. The overall complication rate for both groups was high, with postoperative pneumonia being the most common complication. PMID:27708449

Esophageal Gastrointestinal Stromal Tumors Presenting as Mediastinal Mass

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M. Kafeel

2013-11-01

Full Text Available Gastrointestinal stromal tumors (GISTs are the most common mesenchymal tumors of the gastrointestinal tract and are predominant in the stomach and intestine but rare in the esophagus. Here, we report a case of esophageal GIST which presented as a mediastinal mass on chest X-ray and dyspnea. The case was initially diagnosed as leiomyosarcoma, which could create a diagnostic dilemma. Therefore, recognizing this uncommon presentation as a mediastinal mass with esophageal GIST is important in the differential diagnosis.

Branchial cysts: an unusual cause of a mediastinal mass: a case report

OpenAIRE

Kotecha, Vihar; Muturi, Alex; Ruturi, Josiah

2015-01-01

Introduction Complex embryological processes form the head and neck of humans. It is not flawless; remnants lead to sinuses or cysts, commonly in the head and neck region. Case presentation We present the a case of an 8-year-old boy, a primary school pupil, from rural Kenya with chronic cough, wheezing, difficulty in breathing and dyspnea on exertion. He was treated with antibiotics and antitubercular drugs without improvement prior to referral to our hospital. A computed tomography scan of h...

Pulmonary complications of crack cocaine use: high-resolution computed tomography of the chest

International Nuclear Information System (INIS)

Mancano, Alexandre

2008-01-01

Here, we report high-resolution computed tomography (HRCT) findings in a patient who developed sudden hemoptysis, dyspnea and chest pain after smoking crack cocaine. Chest X-rays showed consolidations, primarily in the upper lobes, and HRCT scans showed ground glass attenuation opacities, consolidations and air-space nodules. A follow-up CT, after drug use discontinuation and administration of corticosteroids, showed partial resolution of pulmonary lesions and the appearance of cavitations. Clinical, imaging and laboratory findings led to a diagnosis of 'crack lung'. (author)

Direct type gerbode defect with cleft in anterior mitral leaflet: A rarest of rare combination

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Rakesh Jain

2016-01-01

Full Text Available A 15-year-old boy was evaluated for the new onset of dyspnea. He had no significant medical or surgical history. On echocardiography, he was found to have a direct communication between the left ventricle and the right atrium through the atrioventricular (AV septum (a rare type of Gerbode defect with an associated cleft in the anterior mitral leaflet. The combination of direct type Gerbode defect with the cleft of the anterior mitral leaflet is extremely rare.

Intimal sarcoma of the pulmonary artery presenting as pulmonary embolism

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Plata, María Camila; Rey, Diana Lucía; Villaquirán, Claudio; Rosselli, Diego

2017-01-01

SUMMARY Pulmonary artery sarcomas are extremely rare; due to their insidious growth, diagnosis occurs late and prognosis is poor. We present the case of a 33-year-old woman with a history of dyspnea, chest pain and syncope. An obstructing mass on the right ventricle, main pulmonary artery and right branch were interpreted as a possible pulmonary embolism. RESUMEN Los sarcomas de la arteria pulmonar son extremadamente raros; debido a su crecimiento lento y silencioso, el diagnóstico suele s...

Mycobacterium intracellulare Pleurisy Identified on Liquid Cultures of the Pleural Fluid and Pleural Biopsy.

Science.gov (United States)

Lim, Jong Gu; O, Sei Won; Lee, Ki Dong; Suk, Dong Keun; Jung, Tae Young; Shim, Tae Sun; Chon, Gyu Rak

2013-03-01

Pleural effusion is a rare complication in non-tuberculous mycobacterial infection. We report a case of Mycobacterium intracellulare pleuritis with idiopathic pulmonary fibrosis in a 69-year-old man presenting with dyspnea. Pleural effusion revealed lymphocyte dominant exudate. M. intracellulare was identified using a polymerase chain reaction-restriction fragment length polymorphism method and liquid cultures of pleural effusion and pleural biopsy. After combination therapy for M. intracellulare pulmonary disease, the patient was clinically well at a 1-month follow-up.

Massive Emphysema and Pneumothorax Following Shoulder Arthroscopy under General Anaesthesia: A Case Report

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Mohammad J. Shariati

2017-11-01

Full Text Available The patient was a 61-year-old female with massive rotator cuff tear who had no history of smoking, COPD, asthma, or other pulmonary diseases. Four hours following shoulder arthroscopy, the patient developed progressive dyspnea, which was diagnosed as pneumothorax with subcutaneous emphysema extending to the neck and face. Chest tube was inserted promptly. The patient was discharged with a good condition after 7 days. Follow up of the patient for the next 3 months was uneventful.

Impact of hospice care on end-of-life hospitalization of elderly patients with lung cancer in Taiwan

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Shih-Chao Kang

2012-05-01

Conclusion: Hospice care has provided a humane and cost-efficient pathway for end-of-life elderly patients with lung cancer. Parenteral nutrition/hydration should be limited for terminal care patients. Opioids should be promoted for the relief of pain and dyspnea in acute ward care. Family physicians and radiation oncologists play important roles in hospice care. Compared with the prevalence of hospice care in the United Kingdom and other developed countries, hospice care in Taiwan is in the position to be expanded.

An Unusual Laryngeal Foreign Body in Adult

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Cire Ndiaye

2016-01-01

Full Text Available The accidental aspiration of a foreign body is a frequent domestic accident among children but a rare occurrence in adults. The laryngeal impaction of a coin is an unusual accident; only a few cases have been reported in the literature. Diagnosis is mostly achieved by clinicoradiological examinations. The authors report an uncommon case of laryngeal impaction of a coin in a 21-year-old patient, presenting with dysphonia without dyspnea or stridor. The extraction was performed by endoscopy.

Bronchial provocation testing does not detect exercise-induced laryngeal obstruction

DEFF Research Database (Denmark)

Walsted, Emil Schwarz; Hull, James H; Sverrild, Asger

2017-01-01

INTRODUCTION: Exercise-induced laryngeal obstruction (EILO) is a key differential diagnosis for asthma in the presence of exertional respiratory symptoms. Continuous laryngoscopy during exercise (CLE), the current gold standard diagnostic test for EILO, has practical limitations. We aimed...... to establish if inspiratory flow data obtained during standard bronchoprovocation testing, to establish the presence of extra-thoracic hyper-responsiveness, may prove diagnostic for EILO and thus preclude requirement for CLE testing. METHODS: We consecutively evaluated 37 adult subjects with exertional dyspnea...

A Rare Cause of Upper Airway Obstruction in a Child

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Ahmed, H.; Ndiaye, C.; Barry, M. W.; Thiongane, Aliou; Mbaye, A.; Zemene, Y.; Ndiaye, I. C.

2017-01-01

Ventricular band cyst is a rare condition in children but can result in severe upper airway obstruction with laryngeal dyspnea or death. The diagnosis should be considered in any stridor in children with previous history of intubation or respiratory infections. We report a case of a 4-year-old girl, received in an array of severe respiratory distress, emergency endoscopy was done, and a large ventricular tape band cyst obstructing the air way was found. Complete excision was made, and postope...