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Query: UMLS:C0019079 (hemoptysis)
 6,129 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Massive hemoptysis and/or recurrent expectoration of measurable amounts of blood are common complications of chronic bronchopulmonary infections in cystic fibrosis (CF). When conservative treatment fails to control bleeding, surgery or bronchial artery embolization (BAE) is frequently considered. We present our experience and long-term follow up of BAE in 14 CF patients (age range 15-39 years) with massive (6 subjects) and/or recurrent (8 subjects) hemoptysis not responsive to medical treatment. Seven had chronic hypercapnic respiratory failure. After angiographic evaluation, polyvinyl alcohol particles (Ivalon) were injected to embolize obviously enlarged bronchial arteries. Seventeen procedures were performed in 14 patients and 36 bronchial arteries were embolized. All the patients stopped bleeding immediately upon BAE. Most of the patients had postembolization fever, dysphagia, and transient chest pain which were managed symptomatically. After a median follow-up period of 10.5 months (range 0.5-38 months), no recurrence of hemoptysis was observed in 8 patients who are still alive. In 3 patients hemoptysis recurred and they underwent reembolization after 3, 22, and 25 months, respectively. Three subjects died of respiratory failure within 5 months from BAE. Presently, 50% of patients studied had a > or = 1 year interval free of major hemoptysis after the first BAE. Our experience indicates that massive and/or recurrent hemoptysis in CF patients can be safety and effectively managed by BAE if the procedure is performed by a skilled practitioner. The procedure was well tolerated and resulted in prolonged and satisfactory bleeding control in most patients.
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PMID:Bronchial artery embolization in the management of hemoptysis in cystic fibrosis. 756 13

After a patient died of anastomotic necrosis following a tracheal resection for the management of recurrent thyroid cancer invading the trachea, which had been treated 6 years previously by thyroid lobectomy and 4,800 cGy of radiation to control known residual disease, we explored methods to promote the healing of tissues damaged by irradiation. Between 1979 and 1992, 22 patients underwent major airway resection and reconstruction after receiving large doses of radiation. The average dose was 4,979 +/- 1,113 cGy (range, 3,150 to 6,840 cGy); the number of fractions, 20 to 38; and the average dose per fraction, 180 cGy (range, 150 to 200 cGy). The interval between irradiation and surgical treatment was 42 +/- 105 months (range, 1 to 480 months). Seven cervical, eight midtracheal, and five carinal resections were performed, as well as two mainstem sleeve resections. Omentum was used to protect the anastomosis in 15 patients (68%), a pericardial fat pad was used in 2, and pleura was used in 2. In 3 patients, sternohyoid muscle was placed between the anastomosis and a major vascular structure, but without a tissue wrap. Two patients (9.0%) died postoperatively. Anastomotic dehiscence was the cause of death in a patient treated for lymphoma, and adult respiratory distress syndrome was the cause in the other patient; this patient had undergone carinal pneumonectomy. Complications developed in 8 patients (36%). Two cervical dehiscences were treated by T-tube placement, 2 patients suffered wound infection, and 1 patient each suffered a myocardial infarction, dysphagia, hemoptysis, and bronchitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Reconstructive airway operation after irradiation. 781 13

Well-differentiated thyroid carcinoma infrequently invades the upper aerodigestive tract. However, when invasion occurs, it is the source of significant morbidity. The most common structures invaded by thyroid carcinoma are the recurrent laryngeal nerves, larynx, pharynx, and esophagus. Invasion of these structures produces symptoms of airway insufficiency, dysphagia, and hemoptysis. This study was designed to define more clearly the significance of invasion of papillary thyroid carcinoma on survival. At the Mayo Clinic, 262 patients treated for invasive papillary thyroid carcinoma between 1940 and 1990 were retrospectively evaluated. In this group the sites of invasion were muscle 53%, trachea 37%, laryngeal nerve 47%, esophagus 21%, larynx 12%, and other sites 30%. Complete tumor removal was accomplished in 56% of cases. Kaplan-Meier survival curves were calculated for the population. The overall survival was 79% at 5 years, 63% at 10 years, and 54% at 15 years. When the Cox proportional hazard model was applied to the survival data, the factors that had significant influence on survival were invasion of the trachea and the esophagus. Completeness of resection approached statistical significance. Muscle invasion, laryngeal invasion, and recurrent laryngeal nerve invasion had no significant independent influence on survival. These data suggest that when papillary thyroid carcinoma extends beyond the thyroid capsule and invades adjacent structures, the site invaded will influence survival. Survival may be improved in those cases in which complete surgical excision of the tumor is performed.
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PMID:Locally invasive papillary thyroid carcinoma: 1940-1990. 788 55

The EORTC Study Group on Quality of Life has developed a modular system for assessing the quality of life of cancer patients in clinical trials composed of two basic elements: (1) a core quality of life questionnaire, the EORTC QLQ-C30, covering general aspects of health-related quality of life, and (2) additional disease- or treatment-specific questionnaire modules. Two international field studies were carried out to evaluate the practicality, reliability and validity of the core questionnaire, supplemented by a 13-item lung cancer-specific questionnaire module, the EORTC QLQ-LC13. In this paper, the results of an evaluation of the QLQ-LC13 are reported. The lung cancer questionnaire module comprises both multi-item and single-item measures of lung cancer-associated symptoms (i.e. coughing, haemoptysis, dyspnoea and pain) and side-effects from conventional chemo- and radiotherapy (i.e. hair loss, neuropathy, sore mouth and dysphagia). It was administered to patients with non-resectable lung cancer recruited from 17 countries. In total, 883 and 735 patients, respectively, completed the questionnaire prior to and once during treatment. The symptom measures discriminated clearly between patients differing in performance status. All item scores changed significantly in the expected direction (i.e. lung cancer symptoms decreased and treatment toxicities increased) during treatment. With one exception (problems with a sore mouth), the change of toxicity measures over time was related specifically to either chemo- or radiotherapy. However, the single item on neuropathy did not measure adequately the full range of symptoms. The hypothesised scale structure of the questionnaire was partially supported by the data. The multi-item dyspnoea scale met the minimal standards for reliability (Cronbach alpha coefficient > 0.70), while the pain items did not form a scale with reliability estimates acceptable for group comparisons. In conclusion, the results form international field testing lend support to the EORTC QLQ-LC13 as a clinically valid and useful tool for assessing disease- and treatment-specific symptoms in lung cancer patients participating in clinical trials, when combined with the EORTC core quality of life questionnaire. In a few areas, however, the questionnaire module could benefit from further refinements. In addition, its performance over a longer period of time still needs to be investigated.
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PMID:The EORTC QLQ-LC13: a modular supplement to the EORTC Core Quality of Life Questionnaire (QLQ-C30) for use in lung cancer clinical trials. EORTC Study Group on Quality of Life. 808 Jun 79

Between March 1982 and June 1992, 17 patients (age: 21-76 years) were diagnosed with pseudoaneurysm of the thoracic aorta (PTA). Four PTAs developed post-trauma while 13 developed after aortic or cardiac surgery. Unusual presentations included: dyspnea, hoarseness, dysphagia, massive hemoptysis (2 degrees to aortobronchial fistula), massive hematemesis (2 degrees to aorto-esophageal fistula), superior vena cava syndrome, paralyzed right hemidiaphragm, and herald bleeding from the sternotomy. The interval between initial operation and recognition of PTA varied from three months to eight years while the four posttraumatic PTAs presented 5 to 26 years postinjury. The sites of postoperative PTA were: the aortotomy (3), proximal vein graft anastomosis (4), aortic cannulation site (2), and distal anastomosis of ascending aortic graft replacement (4). Aortography was very sensitive, outlining the false aneurysm in 13/13. Five patients had transesophageal echo-cardiography with one false negative. Seven patients died (41%), three from postoperative PTAs from massive hemorrhage intraoperatively and four from sepsis and multiorgan failure following repair. We conclude that patients who have previously had aortic or cardiac surgery or a history of blunt chest trauma presenting with unusual cardiorespiratory symptoms should be aggressively evaluated for PTA. Due to the magnitude of the operative problems encountered, repair of PTA is associated with a significantly high rate of mortality.
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PMID:Pseudoaneurysms of the aorta after cardiac surgery or chest trauma. 825 35

From 1977 to 1992, 23 patients with primary tumors of the trachea were reviewed. Nineteen of these patients had squamous cell carcinomas, 2 had adenoid cystic carcinomas, 1 had a small cell carcinoma, 1 had a poorly differentiated carcinoma, and 1 had a pleomorphic adenoma. The prognosis of squamous cell, small cell and poorly differentiated carcinomas appeared to be grave, especially in association with vocal cord palsy (26%). Short-term survival occurred in 7 to 9 patients with tumors in the upper-middle third of trachea and 4 of them had concurrent acute respiratory distress. Cough (65.2%), dyspnea (91.3%), and hemoptysis (47.8%) were the most common symptoms. For patients with hoarseness, dysphagia, and cervical lymphadenopathy, the prognosis was poor (p < 0.0010). Two patients (8.7%) had multiple malignancies and all died within 1 year. Smoking was not only a risk factor as reported in previous studies, but also a significant prognostic factor (p = 0.0020) in our series. Emergent irradiation ( < 40 Gy in our cases) was useful in alleviating acute respiratory distress, but worthwhile survival was only obtained by the combination of surgery and radiation therapy (p = 0.0200, compared with surgery or irradiation, respectively). There was a significant correlation between prognosis and histologic type, tumor location, clinical presentation, smoking history and management, but not roentography or tumor size. These factors can be used to assess the survival of patients with primary tracheal tumors.
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PMID:Descriptive study of prognostic factors influencing survival of patients with primary tracheal tumors. 852 32

The treatment of choice for advanced inoperable non-small cell lung cancer (NSCLC) is radiation therapy. Palliative radiotherapy schedules vary considerably in different centers, but a 30-Gy dose given in ten fractions over two weeks is a typical standard schedule. Our study was aimed at investigating whether a shorter course of only one 10-Gy fraction allows good palliation in the treatment of inoperable NSCLC patients whose main symptoms are related to an intrathoracic lesion. Patients of both sexes and any age, untreated with radiotherapy, with inoperable and histologically or cytologically proved NSCLC were examined. Seventeen patients, too advanced for radical "curative" radiotherapy and whose main symptoms were related to primary intrathoracic lesions, entered the study even though they had metastases. On admission, 76% (13/17) of patients had cough 76% (13/17) dyspnea, 70.7% (12/17) chest pain and 23.6% (4/17) hemoptysis. They received a single dose of 10 Gy, delivered with an 18-Mv linear accelerator via anteroposteriorly opposing portals without spinal cord shielding. Treatment volume usually included the macroscopically detected lesion identified with a CT simulator. Palliation of symptoms was achieved in high rates of patients: 46% for cough, 69% for dyspnea, 83% for pain and 75% for hemoptysis. These results were obtained within one month of treatment. Unfortunately, palliation of symptoms did not last long, decreasing to 42% within two months of the end of treatment and to 32% at three months. Four patients were retreated, one patient three months and three patients two months after the end of radiotherapy. Ten Gy to the target volume were administered as retreatment with spinal cord shielding. Side-effects were mild: nausea in 3 patients (17%), vomiting in one patient (5%) and grade-II dysphagia in two patients were observed and classified according to WHO criteria. Pain increased 24 hours after radiotherapy in five patients. We can conclude that single dose radiotherapy yields good, but short, palliation of symptoms with acceptable side-effects.
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PMID:[Single-dose palliative radiotherapy in inoperable non-small-cell lung carcinoma]. 868 68

A few patients with traumatic aortic laceration remain undiagnosed and survive long enough to develop a chronic aneurysm. Such aneurysms are frequently asymptomatic; alternatively, they may manifest themselves in the form of chest pain, dysphonia, dysphagia, bronchial irritation, or sudden death. A case of aortobronchial fistula secondary to a chronic post-traumatic aneurysm of the aortic isthmus is presented. Hemoptysis was the main sign. The affected segment of the thoracic aorta was replaced with a Dacron graft and a left superior lobectomy was performed. Nevertheless, the patient died during the postoperative period due to adult respiratory distress syndrome. Pathogenesis, diagnosis, and management of aortobronchial fistulae are discussed.
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PMID:Aortobronchial fistula secondary to chronic post-traumatic thoracic aneurysm. 879 50

Non-small cell lung cancer is the most common cause of cancer death in both males and females. Despite this high incidence and mortality, comparatively little research has addressed the palliative treatment of thoracic symptoms. Until recently, information regarding the indications and effectiveness of radiation in this setting was obtained from retrospective reviews of single institutional experiences. More recently, three major randomized trials from the UK Medical Research Council (1991, 1992, 1994) have addressed the use of external beam radiation in randomized comparisons of different dose and fractionation strategies for patients with non-small cell lung cancer and symptoms due to intra-thoracic tumor. These studies show that shorter fractionation schemes provide equivalent palliation and essentially equivalent survival in the patient groups studied. Moreover, they provide estimates of the probability of successful palliation of common symptoms, and estimates of the toxicity of each regimen. A panel of oncologists with expertise in radiation oncology, medical oncology and epidemiology discussed the above trial results and a literature review. The panel concluded that radiation was indicated in the palliation of hemoptysis, chest pain, dysphagia, and dyspnea, and that the results of the MRC studies provided reasonable estimations of the efficacy and toxicity of radiation in this setting. These studies show that symptoms are more often than not improved with palliative radiotherapy (symptom improvement rates ranged from about 50 to 85%) and that palliation lasted for a substantial portion of the patients' remaining survival. The panel could not reach uniform consensus on the appropriate fractionation for radiation given with palliative intent. The panel agreed that favourable patients with stage IIIB NSCLC should be offered combined modality therapy with the intent of prolonging survival, and that patient preferences regarding the risks and benefits of this therapy should be considered. Further study was recommended, namely, a randomized trial evaluating five fractions of radiation vs a single fraction, using patient-based evaluation of palliation. The panel also recommended phase II development of a combined chemotherapy and low-dose radiation protocol appropriate for future study.
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PMID:The role of palliative thoracic radiotherapy in non-small cell lung cancer. 885 35

The aim of this prospective randomized trial was to compare the symptomatic effects of two different regimens of palliative radiotherapy for lung cancer. Two hundred and sixteen patients needing palliation were randomized to receive either a 17 Gy mid-point dose in two fractions 1 week apart or 22.5 Gy in five daily fractions. Both toxicity and efficacy were evaluated by postal questionnaires. This small study was intended to identify any clinically important differences in toxicity or efficacy between the two regimens. We detected no such difference, although there was a tendency for iatrogenic dysphagia and improvement in chest pain and cough to be more common with the two-fraction regimen. The only symptom that was improved in over 50% of patients for 8 weeks or more was haemoptysis. Haemoptysis and chest pain appeared to be the best indications for treatment. The relief of other symptoms was disappointing in both degree and duration.
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PMID:Palliative radiotherapy for lung cancer: two versus five fractions. 913 93


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