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Dyspnea approach

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https://www.readbyqxmd.com/read/28982259/the-comfort-measures-order-set-at-a-tertiary-care-academic-hospital-is-there-a-comparable-difference-in-end-of-life-care-between-patients-dying-in-acute-care-when-cmos-is-utilized
#1
Christine Lau, Kalli Stilos, Allyson Nowell, Fanchea Lau, Jennifer Moore, Lesia Wynnychuk
BACKGROUND: Standardized protocols have been previously shown to be helpful in managing end-of-life (EOL) care in hospital. The comfort measures order set (CMOS), a standardized framework for assessing imminently dying patients' symptoms and needs, was implemented at a tertiary academic hospital. OBJECTIVE: We assessed whether there were comparable differences in the care of a dying patient when the CMOS was utilized and when it was not. METHODS: A retrospective chart review was completed on patients admitted under oncology and general internal medicine, who were referred to the inpatient palliative care team for "EOL care" between February 2015 and March 2016...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28980071/prevalence-of-delirium-in-advanced-cancer-patients-in-home-care-and-hospice-and-outcomes-after-1%C3%A2-week-of-palliative-care
#2
Sebastiano Mercadante, Francesco Masedu, Isabella Balzani, Daniela De Giovanni, Luigi Montanari, Cristina Pittureri, Raffaella Bertè, Domenico Russo, Laura Ursini, Franco Marinangeli, Federica Aielli
AIM: The aim of this study was to assess the prevalence of delirium in advanced cancer patients admitted to different palliative care services in Italy and possible related factors. The secondary outcome was to assess the changes of delirium after 1 week of palliative care. METHODS: A consecutive sample of patients was screened for delirium in period of 1 year in seven palliative care services. General data, including primary tumor, age, gender, concomitant disease, palliative prognostic score (PaP), and Karnofsky status, were collected...
October 5, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28978214/strategies-to-manage-costs-in-idiopathic-pulmonary-fibrosis
#3
Gary M Owens
Idiopathic pulmonary fibrosis (IPF) is a diagnostically challenging disease. Clinicians are faced with the need to exclude alternative diagnoses, limited treatment and management guidelines, and few treatment options. Patients with IPF have significantly increased healthcare usage compared with similar patients without the disease. Medicare estimates for this disease are as high as $3 billion, not including cost of treatment. The disease, characterized by worsening dyspnea, declining lung function, nonspecific respiratory symptoms, and a varied clinical course randomly punctuated by episodes of acute exacerbations, is also accompanied by a host of comorbid conditions that contribute significantly to increased healthcare usage and cost...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28944173/hypertrophic-obstructive-cardiomyopathy-the-mayo-clinic-experience
#4
Kunal D Kotkar, Sameh M Said, Joseph A Dearani, Hartzell V Schaff
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease characterized by left ventricular hypertrophy in the absence of other etiologies. Clinical presentation may vary from asymptomatic to sudden cardiac death. Medical treatment is the first-line therapy for symptomatic patients. Extended left ventricular septal myectomy is the procedure of choice if medical treatment is unsuccessful or intolerable. MAYO CLINIC EXPERIENCE: More than 3,000 patients have had septal myectomy for HCM at the Mayo Clinic (MN, USA) from 1993 to 2016...
July 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28938687/mediastinal-lesions-across-the-age-spectrum-a-clinicopathological-comparison-between-pediatric-and-adult-patients
#5
Tingting Liu, Lika'a Fasih Y Al-Kzayer, Xiao Xie, Hua Fan, Shamil Naji Sarsam, Yozo Nakazawa, Lei Chen
The objective of this study was to identify the differences in histopathological distribution and clinical features of mediastinal lesions (MLs) across the age spectrum in Chinese series of patients and to compare with the available literature. A total of 409 cases of MLs, including 137 pediatric and 272 adult patients from a single institution, was reviewed and categorized into groups according to age. Among the 409 cases, the age showed a bimodal distribution with an increased incidence of MLs among (< 10 year) and (60-< 70 year) age groups...
August 29, 2017: Oncotarget
https://www.readbyqxmd.com/read/28932570/the-technique-of-endoscopic-airway-tumor-treatment
#6
REVIEW
Simone Scarlata, Lello Fuso, Gabriele Lucantoni, Francesco Varone, Daniele Magnini, Raffaele Antonelli Incalzi, Gianni Galluccio
More than half of primary lung cancers are not resectable at diagnosis and 40% of deaths may be secondary to loco-regional disease. Many of these patients suffer from symptoms related to airways obstruction. Indications for therapeutic endoscopic treatment are palliation of dyspnea and other obstructive symptoms in advanced cancerous lesions and cure of early lung cancer. Bronchoscopic management is also indicated for all those patients suffering from benign or minimally invasive neoplasm who are not suitable for surgery due to their clinical conditions...
August 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28919733/cycle-ergometer-and-inspiratory-muscle-training-offer-modest-benefit-compared-with-cycle-ergometer-alone-a-comprehensive-assessment-in-stable-copd-patients
#7
Kai Wang, Guang-Qiao Zeng, Rui Li, Yu-Wen Luo, Mei Wang, Yu-He Hu, Wen-Hui Xu, Lu-Qian Zhou, Rong-Chang Chen, Xin Chen
BACKGROUND: Cycle ergometer training (CET) has been shown to improve exercise performance of the quadriceps muscles in patients with COPD, and inspiratory muscle training (IMT) may improve the pressure-generating capacity of the inspiratory muscles. However, the effects of combined CET and IMT remain unclear and there is a lack of comprehensive assessment. MATERIALS AND METHODS: Eighty-one patients with COPD were randomly allocated to three groups: 28 received 8 weeks of CET + IMT (combined training group), 27 received 8 weeks of CET alone (CET group), and 26 only received 8 weeks of free walking (control group)...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28918335/modern-diagnosis-of-chronic-thromboembolic-pulmonary-hypertension
#8
Aileen Kharat, Anne-Lise Hachulla, Stéphane Noble, Frédéric Lador
Chronic thromboembolic pulmonary hypertension (CTEPH) should be suspected in patients presenting persistent dyspnea three months after a pulmonary embolism or in patients presenting with acute pulmonary embolism and suggestive images on the CT-scan. For these patients, a specific diagnostic work-up should be performed. First step consists of the ventilation/perfusion (V/Q) scan which is a good screening test due to its high sensitivity and high negative predictive value. Pulmonary angiography remains the gold standard approach for the confirmation of the diagnosis and pre-surgical evaluation of CTEPH...
September 9, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28912182/hypertrophic-obstructive-cardiomyopathy-surgical-myectomy-and-septal-ablation
#9
REVIEW
Rick A Nishimura, Hubert Seggewiss, Hartzell V Schaff
Hypertrophic cardiomyopathy is a genetic disorder characterized by marked hypertrophy of the myocardium. It is frequently accompanied by dynamic left ventricular outflow tract obstruction and symptoms of dyspnea, angina, and syncope. The initial therapy for symptomatic patients with obstruction is medical therapy with β-blockers and calcium antagonists. However, there remain a subset of patients who have continued severe symptoms, which are unresponsive to medical therapy. These patients can be treated with septal reduction therapy, either surgical septal myectomy or alcohol septal ablation...
September 15, 2017: Circulation Research
https://www.readbyqxmd.com/read/28904792/desmoplastic-small-round-cell-tumors-of-the-pleura-a-review-of-the-clinical-literature
#10
REVIEW
Alessandro Giuseppe Fois, Pietro Pirina, Antonella Arcadu, Francesca Becciu, Sandra Manca, Viviana Marras, Sara Canu, Gaetano Castagna, Giorgio Carlo Ginesu, Angelo Zinellu, Panagiotis Paliogiannis
Desmoplastic small round cell tumor of the pleura is a rare malignancy, with only a few cases reported in the scientific literature. The aim of the present review is to discuss the demographic, pathological, clinical, and therapeutic features of this rare tumor. English-language articles published since 1989, when the first case of desmoplastic small round cell tumor of the pleura was described, were retrieved, and fifteen cases included in fourteen articles were revised. The mean age of the patients was 25...
2017: Multidisciplinary Respiratory Medicine
https://www.readbyqxmd.com/read/28894061/-successful-repair-of-chronic-expanding-hematoma-after-coronary-artery-bypass-grafting-by-lower-partial-sternotomy-approach-report-of-a-case
#11
Takateru Yamamoto, Kouhei Takahashi, Katsuaki Tsukioka, Tetsuya Kono
Chronic expanding hematoma (CEH) after coronary artery bypass grafting (CABG) is extremely rare. We reported a case of successful surgical repair of CEH through lower partial sternotomy approach. The patient was a 73-year-old man who underwent CABG. Fifteen years after the operation, he was admitted to referral hospital because of dyspnea on exertion. Echocardiography and computed tomography revealed a giant intrapericardial mass, which was pressing on the inferior wall of the ventricle. To avoid injury of the aorta and the patent bypass graft in the reentry of the chest, we selected lower partial sternotomy approach...
September 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28885054/a-multicenter-rct-of-zephyr%C3%A2-endobronchial-valve-treatment-in-heterogeneous-emphysema-transform
#12
Samuel V Kemp, Dirk-Jan Slebos, Alan Kirk, Malgorzata Kornaszewska, Kris Carron, Lars Ek, Gustav Broman, Gunnar Hillerdal, Herve Mal, Christophe Pison, Amandine Briault, Nicola Downer, Kaid Darwiche, Jagan Rao, Ralf-Harto Hübner, Christof Ruwwe-Glosenkamp, Valéry Trosini-Desert, Ralf Eberhardt, Felix J Herth, Eric Derom, Thomas Malfait, Pallav L Shah, Justin L Garner, Nick H Ten Hacken, Hazem Fallouh, Sylvie Leroy, Charles H Marquette
RATIONALE: Single-center RCTs of Zephyr Endobronchial Valve (EBV) treatment have demonstrated benefit in severe heterogeneous emphysema. This is the first multicenter study evaluating this treatment approach. OBJECTIVES: To evaluate the efficacy and safety of Zephyr EBVs in patients with heterogeneous emphysema and absence of collateral ventilation. METHODS: Prospective, multicenter 2:1 RCT of EBVs plus standard of care or standard of care (SoC) alone...
September 8, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28872517/favorable-outcome-in-coccidioides-endophthalmitis-a-combined-medical-and-surgical-treatment-approach
#13
Jennifer J Ling, Derek J Bays, George R Thompson, Ala Moshiri, Mark J Mannis
PURPOSE: To describe a case of Coccidioides endophthalmitis that resulted in a favorable visual outcome after a combined medical and surgical approach. METHODS: A 33-year-old previously healthy woman was referred for evaluation of dyspnea and left-sided vision loss, which began 3 months before, after a trip to Nevada. She was found to have a pulmonary cavitary lesion and fluffy white material in the anterior chamber. An aqueous and vitreous paracentesis grew Coccidioides species...
August 31, 2017: Cornea
https://www.readbyqxmd.com/read/28854949/pulmonary-tumor-embolism-secondary-to-soft-tissue-and-bone-sarcomas-a-case-report-and-literature-review
#14
Nicholas Latchana, Vincent C Daniel, Robert W Gould, Raphael E Pollock
BACKGROUND: Tumor embolisms (TE) are an underappreciated source of pulmonary embolisms in sarcoma. Most evidence in the literature is limited to case reports and none have described the presence of TE secondary to myxofibrosarcoma. We report the first case of myxofibrosarcoma TE and perform a review of the literature for TE secondary to bone and soft tissue sarcomas (STS). CASE PRESENTATION: A 36-year-old female presented with debilitating pain of the right upper extremity secondary to a recurrent soft tissue sarcoma...
August 30, 2017: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28845879/-a-case-of-severe-left-main-isolated-stenosis-in-a-young-woman-with-previous-history-of-non-hodgkin-lymphoma
#15
Sebastian Cinconze, Lucia Coppini, Daniela Lina, Iacopo Tadonio, Maria Alberta Cattabiani, Emilia Solinas, Luigi Vignali, Alberto Menozzi
We report the case of a 34-year-old female treated with radiotherapy and chemotherapy for non-Hodgkin lymphoma at the age of 16. The patient came to our attention because of progressive dyspnea on effort and a positive result on a pharmacologic stress echo test. Coronary angiography revealed focal critical ostial stenosis of the left main coronary artery. Considering the high surgical risk due to possible post-radiation thoracic adherence and the young patient age, she underwent successful stenting of the left main stenosis with drug-eluting stent, followed by an intravascular ultrasound-guided post-dilation and final kissing balloon inflation...
September 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28839496/use-of-nasal-non-invasive-ventilation-with-a-ram-cannula-in-the-outpatient-home-setting
#16
Wilfredo De Jesus Rojas, Cheryl L Samuels, Traci R Gonzales, Katrina E McBeth, Aravind Yadav, James M Stark, Cindy Jon, Ricardo A Mosquera
BACKGROUND: Nasal non-invasive-ventilation (Nasal NIV) is a mode of ventilatory support providing positive pressure to patients via a nasal interface. The RAM Cannula is an oxygen delivery device that can be used as an alternative approach to deliver positive pressure. Together they have been successfully used to provide respiratory support in neonatal in-patient settings. OBJECTIVE: To describe the outpatient use of Nasal NIV/RAM Cannula as a feasible alternative for home respiratory support in children with chronic respiratory failure...
2017: Open Respiratory Medicine Journal
https://www.readbyqxmd.com/read/28821988/presentation-and-management-of-symptomatic-central-bone-cement-embolization
#17
Ahmed Samir Barakat, Tamer Owais, Mohamed Alhashash, Mootaz Shousha, Hesham El Saghir, Bernward Lauer, Heinrich Boehm
BACKGROUND CONTEXT: With more cement augmentation procedures done, the occurrence of serious complications is also expected to rise. Symptomatic central cement embolization is a rare but very serious complication. Moreover, the pathophysiology and treatment of intrathoracic cement embolism remain controversial. PURPOSE: In this case series, we are trying to identify various presentations and suggest our emergent management scheme for symptomatic central cement embolization...
August 18, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28819869/new-echocardiographic-parameters-in-the-diagnosis-of-heart-failure-with-preserved-ejection-fraction
#18
Monika Špinarová, Jaroslav Meluzín, Helena Podroužková, Radka Štěpánová, Lenka Špinarová
Heart failure with preserved ejection fraction (HFpEF) is a serious clinical disease. The pathophysiology of HFpEF is complex, and specific diagnostic criteria have evolved over time. Limited data are available on the quantification of diastolic function using two-dimensional real-time echocardiography, and a simple parameter has not yet been established. The aim of this work is to evaluate new echocardiographic parameters-the diastolic wall strain of the posterior wall (DWS PW) and the vortex formation time (VFT)...
August 17, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28819824/-update-pulmonary-arterial-hypertension-definitions-diagnosis-therapy
#19
N Sommer, M J Richter, K Tello, F Grimminger, W Seeger, H A Ghofrani, H Gall
The term pulmonary arterial hypertension comprises a group of pulmonary vascular diseases of different etiologies that are characterized by similar precapillary vascular remodeling processes and result in exertional dyspnea and right heart insufficiency. The specific pharmacological treatment approach considers the risk of mortality and phenotypical properties and includes treatment with phosphodiesterase type 5 inhibitors, endothelin receptor antagonists and prostanoids, as well as with more novel substances, such as a soluble guanylyl cyclase stimulator and an oral prostacyclin receptor agonist...
August 17, 2017: Der Internist
https://www.readbyqxmd.com/read/28819622/mixed-pyolaryngocele-a-rare-case-of-deep-neck-infection
#20
Rachid Mahdoufi, Ismail Barhmi, Nabil Tazi, Redallah Abada, Mohamed Roubal, Mohamed Mahtar
INTRODUCTION: Pyolaryngocele is a very rare and serious complication of laryngocele. It can present as deep neck space infection and mislead the diagnosis. Our aim is to bring this unusual entity to the attention of surgeons and describe its clinical features. CASE REPORT: We report a case of a 45-year-old male patient with a five-week history of neck swelling, dysphonia, dyspnea and odynophagia. An urgent CT scan showed a mixed pyolaryngocele. The management consisted of a high dose antibiotic and an excision of the residual laryngocele via an external approach...
July 2017: Iranian Journal of Otorhinolaryngology
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