Malignant fibrous histiocytoma presenting with complete opacification of the hemithorax: A case report

BACKGROUND

Malignant fibrous histiocytoma, a subtype of primary lung sarcoma is a very rare disease. It usually presents as a lung nodules and the final diagnosis is made by immunohistochemical studies.

METHODS

A 45-year-old patient presented with progressive dyspnea, dry cough and right shoulder pain. Chest X-ray revealed complete opacification of the right hemithorax. Chest computed tomography confirmed the presence of a heterogeneous lesion occupying the whole right hemithorax causing a mass effect on the trachea. Ultrasound guided biopsy was done and final pathology was suggestive of malignant fibrous histiocytoma.

CONCLUSION

Progressive dyspnea in young otherwise healthy patients should be investigated early on. In our case the presence of right shoulder pain indicates advance disease illustrated by the singular imaging findings.     

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

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.     

Poor Perception of Airway Obstruction in Children with Asthma

The aims of this study were to evaluate children's perception of asthma symptoms and to determine a clinically useful method for identifying poor patient perception of airway obstruction. Three methods were used to analyze the relationships among indices of lung function and perception of breathlessness in 35 children. Approximately half the children in our sample did not perceive either airway obstruction or bronchodilation. We propose that <20% improvement in visual analog scale scores post-bronchodilation may provide a simple index for identifying patients with poor perception of airway obstruction, who may be at risk for fatal or near-fatal asthma.     

Comparison of pain and dyspnea perceptual responses in healthy subjects

Dyspnea and pain have a number of similarities. Recent brain imaging experiments showed that similar cortical regions are activated by the perceptions of dyspnea and pain. We tested the hypothesis that an individual’s pain sensitivity might parallel the individual’s dyspnea sensitivity. Studies were carried out in 52 young healthy subjects. Each subject experienced experimentally induced pain and dyspnea. Pain was induced by a cold-pressor test and dyspnea was induced by breathholding while the unpleasant experience of pain and dyspnea was assessed by using a Visual Analogue Scale (VAS). The times from the start of cold stimulation and breathholding to the onset of uncomfortable sensation (pain threshold time and the period of no respiratory sensation, respectively) and to the limit of tolerance (pain endurance time and total breathholding time, respectively) were also measured. In response to cold pain stimulation, a behavioral dichotomy (pain-tolerant and pain-sensitive) was observed. The period of no respiratory sensation was significantly shorter in the PS (pain-sensitive) group than in the PT (pain-tolerant) group (16.9 ± 3.8 vs. 19.6 ± 5.3 s: P < 0.05), whereas no significant difference in the total breathholding time was found between the PT and PS groups. A significant correlation was observed between the pain threshold time and the period of no respiratory sensation in both the PT and PS groups. However, no significant association was observed between pain and dyspnea tolerance in both groups. In conclusion, an individual’s pain threshold is correlated to the individual’s dyspnea threshold, but the individual’s pain tolerance is not consistently correlated to the individual’s dyspnea tolerance.     

Bilateral vocal cord palsy after total thyroidectomy–A new treatment–Case reports

IntroductionDyspnea due to bilateral vocal cord palsy after total thyroidectomy (BVCPATT) is a life-threatening complication; nevertheless, we try to avoid tracheotomy.MethodsUsing normalized glottal area (NGA), we retrospectively studied 14 patients with BVCPATT. Nine patients without dyspnea were treated conservatively, while five with dyspnea received immediate bilevel positive air-way pressure (BiPAP) treatment. Both right and left recurrent nerves were grossly intact during surgery.ResultsThe mean NGA during inspiration of five patients with dyspnea was less than that of nine patients without (6.21 ± 1.57 (mean ± standard deviation) vs. 20.5 ± 9.5; p = 0.001). The mean age of patients with dyspnea was more than that of patients without (61.6 ± 15.6 vs. 38 ± 10.2; p = 0.007). Five patients with dyspnea that occurred at 0–8 days post operation recovered within 3–17 days after BiPAP.ConclusionDyspnea occurred in patients with BVCPATT who were relatively older. The mean NGA during inspiration in patients with dyspnea was less than that in patients without. BiPAP might be a new treatment for dyspnea.     

Symptom evaluation using observational assessment

Symptom management is the cornerstone of hospice and palliative care and begins with a comprehensive assessment. Patient self-report remains the gold standard to determine symptom presence and intensity along with its impact on functional status and quality of life. However, patients often lose the ability to communicate over the course of a progressive illness whether transiently from the development of delirium or an ICU stay with mechanical ventilation or more permanently as a consequence of a cerebrovascular event or progressive neurodegenerative disorder (e.g. dementia).     

37例急性会厌炎的临床诊疗分析

目的：分析急性会厌炎的临床特点，探讨布地奈德吸入法对急性会厌炎的临床治疗效果。方法：选择37例我院急性会厌炎患者，随机分成观察组（19例）和对照组（18例）。所有患者均给予抗生素、激素、补充水电解质等常规综合治疗。观察组在常规治疗基础上给予雾化吸入布地奈德治疗。结果：两组患者在性别、年龄方面差异无统计学意义（P〉0．05）；观察组患者治愈13倒，治愈率为68．4％，对照组患者有4例治疗无效，无效率为22．2％，观察组未见无效病例，两组治愈率比较，差异有统计学意义（P〈0．05）；观察组2例患者治疗后血糖升高，不良反应发生率为10．5％，对照组1例患者中出现血压升高，另有1例患者在治疗后出现恶心、呕吐，不良反应发生率为11．1％，两组不良反应发生率相比差异未见统计学意义（P〉0．05）。结论：雾化吸入布地奈德治疗急性会厌炎，起效快，全身副作用小，安全可靠，值得临床推广应用。     

慢性阻塞性肺疾病患者BODE指数与生活质量的相关性研究

目的 探讨慢性阻塞性肺疾病（COPD）患者BODE指数与生活质量的相关性。方法 选择COPD稳定期患者50例。计算BODE指数及其各项目的评分，包括体重指数（BMI）、气流阻塞程度（FEV1%pred）、呼吸困难（MMRC）、运动能力（6MWD）。采用St.George S呼吸问卷（SGRQ）和一般健康状况调查问卷（SF-36）评价患者的生活质量。结果 50例COPD患者BODE指数评分为4.32±2.62。多元逐步回归分析发现SGRQ中影响BODE指数的因素是活动分（B=0.769，P=0.000），SF-36中影响BODE指数的因素为生理机能（PF）（B=-0.371，P=0.007）、生理职能（RP）（B=-0.340，P=0.011）和一般健康状况（GH）（B=-0.262，P=0.014）。BODE指数中MMRC与SGRQ活动分（B=-0.807，P=0.000）、SF-36的PF（B=-0.882，P=0.000）、RP（B=-0.580，P=0.000）、GH（B=-0.427，P=0.002）独立相关。结论 COPD患者BODE指数和生活质量有密切的关系，BODE指数中呼吸困难对生活质量的影响最大。BODE指数高，患者呼吸困难严重，活动能力差，生活质量下降。