A rare massive presentation of catamenial hemothorax

Catamenial hemothorax is a rare manifestation of thoracic endometriosis syndrome. It is commonly seen associated with pelvic endometriosis in nulliparous reproductive-age women. Most cases are minor and self-limiting. We present a case of a 32-year-old woman who presented with prolonged worsening dyspnea and was found to have a massive hemothorax on evaluation.     

金属支架治疗大气道狭窄

目的　探讨气管支架成形术缓解大气道狭窄的方法、安全性和疗效。资料与方法　气管狭窄患者 32例 ,其中气管切开或插管后局部组织过度增生 7例 ,转移性肿瘤压迫气管 12例 ,多发性软骨炎引起气管塌陷 1例 ,肺癌 12例 ;单纯气管狭窄 2 8例 ,主支气管狭窄 1例 ,气管支气管同时有狭窄者 3例。术前均经CT检查及气管体层片证实气管、支气管狭窄。 13例术前用的卡因喷喉麻醉 ,19例在全身麻醉下置入支架。结果　 32例共放置 37枚气管支架 ,均一次置入成功 ,无操作失败 ,通气全部得到改善 ,手术成功率 10 0 %。 2例气管狭窄经置入支架后复发狭窄再次置入支架。 33枚置于气管 ,4枚置于主支气管。 1例狭窄严重仅容 4F导管通过 ,用球囊导管扩张至 12mm后置入支架 ;其余均直接置入支架。术后通气功能明显改善 ,无需吸氧 ,无明显胸痛、咯血等并发症。 1周后X线复查无支架移位 ,可见支架进一步扩张。 1例甲状腺癌支架置入术后 2周复发呼吸困难 ,CT扫描示支架内有新生物 ,经支架内放射治疗后症状消失。结论　气管内支架成形术方法简单、安全 ,缓解呼吸困难疗效迅速、确实 ,适合良恶性气道狭窄姑息治疗     

吸入性损伤与预防性气管切开术

大面积烧伤合并面颈部烧伤的病例９０％在伤后６～１６ｈ内发生严重呼吸困难,７３％为中重度粘膜损伤,均于气管切开后呼吸困难解除。热力引起的吸入性损伤,上呼吸道的粘膜伤重于下呼吸道,且以喉部受损伤最重。因此,在评估吸入性损伤程度时,应结合粘膜伤全面考虑,因患者早期易发生上呼吸道梗阻,故应采取预防性气管切开术。     

Retrospective analysis of corticosteroid doses administered to patients with terminal cancer for dyspnea alleviation and survival

Dyspnea negatively affects the survival and quality of life of patients with terminal cancer. Although corticosteroids are currently used to treat dyspnea, the association between corticosteroid dosage and survival remains unclear. This retrospective study was conducted to determine the relationship betweencorticosteroid doses, administered to hospitalized patients with terminal cancer for dyspnea alleviation, and survival. Subsequently, we investigated the associations between corticosteroid doses, which were classified into three categories, and the length of survival in days after stratifying 52 patients treated between January 2012 and December 2015 into corticosteroid responders and non-responders. The mean daily corticosteroid doses were 28.68?±?14.4?mg for responders and 29.13?±?18.5?mg for non-responders. The mean corticosteroid doses on the first day were 27.86?±?14.9?mg for responders and 27.73?±?19.5?mg for non-responders. The mean total corticosteroid doses administered during the first 2 days of treatment were 56.84?±?29.2?mg for responders and 57.16?±?38.5?mg for non-responders. The mean survival was 11.33?±?7.5 days and 5.27?±?3.35 days among responders and non-responders, respectively. In conclusion, the administration of corticosteroid for dyspnea alleviation did not correlate with survival. However, reactivity to corticosteroids increased the duration of corticosteroid use, which may have contributed to survival.     

急性呼吸困难患者检测NT-proBNP的护理体会

目的：通过床边即时检测氨基末端脑钠肽前体（NT-proBNP）水平，鉴别心源性和非心源性疾病导致的急性呼吸困难，从而指导临床落实有效的护理措施。方法：采用荧光标记法进行全血NT-proBNP检测，根据测定值鉴别诊断心源性呼吸困难和肺源性呼吸困难，指导护理人员采取正确护理干预。结果：心源性呼吸困难患者NT-proBNP值显著高于肺源性呼吸困难患者，其差异具有统计学意义（P〈0.01）。结论：床边即时NT-proBNP检测提高了医护对心源性呼吸困难的识别能力，患者得到了及时诊断治疗和有效的临床护理，提高了救治水平和患者的满意度。     

New insights into the pathophysiology of mild chronic obstructive pulmonary disease

The classification of mild chronic obstructive pulmonary disease (COPD) requires a postbronchodilator forced expiratory volume in 1 s (FEV₁) to forced vital capacity ratio <0.7 and an FEV₁ ≥80% predicted. Given their relatively well-preserved spirometry, some have argued that respiratory symptoms in patients with mild COPD are unlikely to be related to pulmonary function abnormalities and that early detection of COPD is a ‘waste of resources’. Despite this viewpoint, there is emerging clinical and physiological evidence of peripheral airway dysfunction, diminished quality of life and reduced physical activity levels, and increased mortality, hospitalizations, dyspnea and exercise intolerance in patients with mild COPD compared with healthy controls. The purpose of the present focused review was to summarize recent research regarding the pathophysiology and treatment of mild COPD.     

The Affective Dimension of Dyspnea Improves in a Dyspnea Self-Management Program With Exercise Training

ContextThe perception of dyspnea includes both sensory and affective dimensions that are shaped by emotions and psychological, social, and environmental experiences. Previous investigators have studied either measurement or strategies to decrease the affective dimension with laboratory-induced dyspnea. Few have reported the effect of a therapeutic clinical intervention on the affective dimension of dyspnea.Objectives1) To evaluate the effects of three different versions of a dyspnea self-management program (DM) on the affective dimension of dyspnea, measured by dyspnea-related anxiety (DA) and dyspnea-related distress (DD); and 2) to determine the stability of DA and DD over two baseline incremental treadmill tests (ITTs).MethodsParticipants with chronic obstructive pulmonary disease were randomly assigned to three 12 month DMs with varying doses of supervised exercise (DM, DM-Exposure, and DM-Training). The measurements of the affective dimension, DA and DD, were rated during ITTs on two baseline days and at two, six, and 12 months. Changes over time in DA and DD were analyzed using linear mixed-effects models.ResultsParticipants in the DM-Training group who received 24 nurse-coached exercise sessions had significantly greater reductions in DA and DD compared with those who had four exercise sessions (DM-Exposure) or only received a home-walking program (DM). Reductions in DA and DD in the DM-Training group were only maintained through six months. There were no significant differences in ratings of DA and DD at end between the two baseline ITTs.ConclusionThese findings provide initial support for the positive impact of a self-management program with nurse-coached exercise on the affective dimension of dyspnea. Further investigation of interventions that target the affective dimension in addition to the sensory dimension of dyspnea should be encouraged.