Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0019079 (hemoptysis)
 6,129 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The prognostic staging of cancer in general, and lung cancer in particular, has customarily depended mainly on morphologic distinctions. The gross anatomic extensiveness of cancers is cited with TNM stages that describe the primary tumor (T), spread to regional lymph nodes (N), and metastatic dissemination (M) to distant sites. Microscopic characteristics are cited according to the cancer's cell type (e.g., adenocarcinoma, epidermoid carcinoma) and/or grade of differentiation (e.g., well differentiated, poorly differentiated, anaplastic). Although the clinical manifestations, functional effects, and associated co-morbidity of a cancer are universally recognized as having major prognostic importance, they have not been classified with a standard system of taxonomy. When considered at all, clinical phenomena have been cited with a surrogate index of "performance status" that ignores the underlying clinical dysfunctions while being greatly affected by non-clinical phenomena, such as the patient's psychic status, economic motivations, and system of social support. The current research was done to develop a standard system of taxonomy (or "staging") for the prognostic impact of clinical distinctions in patients with primary lung cancer. Appropriate data were obtained, computer-coded, and analyzed from medical records for the complete clinical course of an inception cohort of 1266 patients who were first treated at either the Yale-New Haven Hospital or the West Haven Veterans Administration Hospital during the interval January 1, 1953-December 31, 1964. The information under analysis included clinical phenomena as well as anatomic extensiveness (TNM stage), microscopic histology, the chronometric duration of the interval from the first symptom of lung cancer to zero time, the iatrotropic reason why the patient sought medical attention, the presence of anemia, the amount of customary cigarette use, and the conventional demographic data for age and gender. The main clinical phenomena were expressed in variables for symptom pattern severity, and co-morbidity. Symptom pattern referred to the existence of specific pulmonic symptoms (e.g., hemoptysis), systemic symptoms (e.g., complaint of weight loss), and metastatic symptoms that might be mediastinal (e.g., superior vena cava syndrome), regional (e.g., the Horner syndrome), or distantly metastatic (e.g., central nervous system). The symptom severity variable included the amount of weight loss, and the existence of severe dyspnea or particularly severe tumor effects (such as mental obtundation, rather than hemiparesis in patients with CNS metastasis). Prognostic co-morbidity was cited for coexisting diseases, such as recurrent myocardial infarctions, that might be more lethal than the lung cancer itself.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:A clinical-severity staging system for patients with lung cancer. 229 74

Patients with arteriovenous pulmonary malformations are at risk of developing secondary brain disease such as transient ischemic attacks, strokes or abscesses. Lethal haemothorax and haemoptysis also occur. 12 of 14 malformations in five patients were treated using a total of eight procedures. One patient experienced a transient unilateral hemiparesis, otherwise no complications occurred. None of the 43 deployed occlusion coils was lost through the fistulas. Complete occlusion was achieved in all lesions where coils could be placed in a stable position. One patient suffered a minor recurrence. The use of interlocking detachable coils (IDC) which can be retracted or repositioned prior to full deployment is recommended.
 ...
PMID:[Embolization of congenital pulmonary arteriovenous malformations]. 871 1

Lung cancer during pregnancy is rare, although the number of case reports has been increasing in recent years. Herein, we describe two cases of lung carcinoma complicating pregnancy with different presentations and outcomes, and review the relevant literature. The first case involved a 31-year-old patient with squamous cell carcinoma with multiple bone metastases. The initial symptoms were productive cough and dyspnea on exertion during the second trimester of pregnancy, to which the patient paid little attention. Chemoradiation was started 1 month postpartum, soon after the diagnosis was made, but with little response. She died at home several days after palliative radiotherapy. The second case involved a 34-year-old patient with poorly differentiated lung carcinoma with brain metastasis. Left hemiparesis had developed initially during the third trimester. She underwent excision of the metastatic brain tumor and received radiotherapy to the left lung tumor and brain. The patient is still alive after a follow-up period of more than 1 year. Delayed diagnosis may be the main problem in the management of lung cancer during pregnancy, because of misinterpretation of common respiratory symptoms and physicians' reluctance to use radiologic imaging studies owing to concerns over the safety of the fetus. Thus, we suggest chest radiographs with abdominal lead shielding for pregnant patients with protracted cough and hemoptysis. Treatment of unresectable lung cancer during pregnancy generally consisted of radiation therapy with or without chemotherapy in previous reports, but the optimal therapy is still unknown, owing to inadequate case numbers and insufficient follow-up data.
 ...
PMID:Lung cancer in pregnancy: report of two cases. 974 70

The coughing paroxysms of patients with cystic fibrosis may occasion neurological symptoms. Although cough syncope is well-known, and is associated with headache and paralysis, a migrainous mechanism has not been reported. We reviewed the medical records, autonomic testing results, and responses to treatment in two cystic fibrosis patients with similar presentations of cough-induced impairment of consciousness followed by headache and paralysis. A 24-year-old woman and an unrelated 38-year-old man, both with cystic fibrosis, developed post-tussive neurologic deficits. Both patients reported infrequent dramatic spells, always preceded by major hemoptysis, and associated with left-sided paralysis, transient blindness, nausea, and severe pulsating headaches. Autonomic testing demonstrated only postural tachycardia and a near-vasodepressor episode in the woman, and mild, generalized sympathetic dysfunction in the man. Treatment for presumptive migraine with aura with verapamil nearly eradicated symptoms in both patients. Discontinuation of verapamil in the woman was associated with symptom recurrence and a stroke, with significant persistent residual left hemiparesis. In conclusion, cough-induced neurologic deficits were previously reported with cystic fibrosis, without clear understanding of the mechanism of impairment of consciousness. Based on the hemiparesis, nausea, and throbbing headache, which repeatedly followed the events in both patients, and based on the response to verapamil, we hypothesize a migrainous mechanism in both of our patients. The pathophysiology that links the hemoptysis to the spells deserves further investigation.
 ...
PMID:Cough-induced hemiplegic migraine with impaired consciousness in cystic fibrosis. 1637 53

Twenty patients with primary hepatic alveolar echinococcosis were treated with continuous long-term albendazole at a dose of 20 mg/kg/d for an average of 5.7 years (1.5-13.5 years) and were followed up for an average of 12.7 years (4.1-13.5 years). The therapeutic effects were evaluated by clinical, laboratory (haemogram, liver function tests), ultrasonography and computed tomography (CT) examinations. The CT pattern of hepatic lesions was classified into three types: solid form (5 cases), pseudocystic form (6 cases) and 'geographic map' (mixed) form (9 cases). Short-term results were encouraging. Jaundice and haemoptysis disappeared within 1 month of starting treatment, and hemiparesis in a patient with cerebral metastases also gradually improved. Treatment was less effective in two patients with advanced disease. On long-term follow-up, three patients were apparently cured, and the remaining 17 patients showed a good initial response, but recurrence occurred in 13 patients (65%). Therapeutic outcome was favourable with the solid form, but poor with the pseudocystic form. The mixed form was a transitional phase and slowly progressive. Involvement of the porta hepatis was the cause of various complications with high morbidity and mortality. Five patients (25%) died during the period of observation, the 10-year survival rate being, therefore, 75%.
 ...
PMID:Continuous albendazole therapy in alveolar echinococcosis: long-term follow-up observation of 20 cases. 1945 28

A 26-year-old female patient under albendazole treatment because of multiple liver and lung hydatid cysts was admitted with headache and convulsions. Bilateral papilloedema and slight right hemiparesis were observed in neurological examination. Neuroradiological evaluation revealed a cystic lesion causing midline shift and oedema in the left frontal lobe. The cyst was removed unruptured using Dowling's technique and postoperative outcome was uneventful. Albendazole therapy was continued due to systemic infection. In her second month of follow-up, she suffered from severe headache and abundant haemoptysis. Control cranial magnetic resonance imaging (MRI) revealed a ring-shaped slightly contrast-enhancing lesion including heterogeneous fibrillary ingredient with surrounding oedema in the left frontal lobe. The further follow-up cranial MRI suggested brain abscess.We present a complicated case of brain hydatid cyst and its management with a successful outcome.
 ...
PMID:The management of a complicated brain hydatid cyst: case report. 2012 63

BACKGROUND Patent foramen ovale (PFO) are common, normally resulting in a left-to-right shunt or no net shunting. Pulmonary embolism (PE) can cause sustained increased pulmonary vascular resistance (PVR) and right atrial pressure. Increasing positive end-expiratory pressure (PEEP) improves oxygenation at the expense of increasing intrathoracic pressures (ITP). Airway pressure release ventilation (APRV) decreases shunt fraction, improves ventilation/perfusion (V/Q) matching, increases cardiac output, and decreases right atrial pressure by facilitating low airway pressure. CASE REPORT A 40-year-old man presented with dyspnea and hemoptysis. Oxygen saturation (SaO2) 80% on room air with A-a gradient of 633 mmHg. Post-intubation SaO2 dropped to 71% on assist control, FiO2 100%, and PEEP of 5 cmH20. Successive PEEP dropped SaO2 to 60-70% and blood pressure plummeted. APRV was initaiated with improvement in SaO2 to 95% and improvement in blood pressure. Hemiparesis developed and CT head showed infarction. CT pulmonary angiogram found a large pulmonary embolism. Transthoracic echocardiogram detected right-to left intracardiac shunt, with large PFO. CONCLUSIONS There should be suspicion for a PFO when severe hypoxemia paradoxically worsens in response to increasing airway pressures. Concomitant venous and arterial thromboemboli should prompt evaluation for intra-cardiac shunt. Patients with PFO and hypoxemia should be evaluated for causes of sustained right-to-left pressure gradient, such as PE. Management should aim to decrease PVR and optimize V/Q matching by treating the inciting incident (e.g., thrombolytics in PE) and by minimizing ITP. APRV can minimize PVR and maximize V/Q ratios and should be considered in treating patients similar to the one whose case is presented here.
...
PMID:Worsening Hypoxemia in the Face of Increasing PEEP: A Case of Large Pulmonary Embolism in the Setting of Intracardiac Shunt. 2737 10

Genetic mutations of sporadic hemiplegic migraine (SHM) are mostly unknown. SHM pathophysiology relies on cortical spreading depression (CSD), which might be responsible for ischemic brain infarction. Cystic fibrosis (CF) is caused by a monogenic mutation of the chlorine transmembrane conductance regulator (CFTR), possibly altering brain excitability. We describe the case of a patient with CF, who had a migrainous stroke during an SHM attack. A 32-year-old Caucasian male was diagnosed with CF, with heterozygotic delta F508/unknown CFTR mutation. The patient experiences bouts of coughing sometimes triggering SHM attacks with visual phosphenes, aphasia, right-sided paresthesia, and hemiparesis. He had a 48-hour hemiparesis triggered by a bout of coughing with hemoptysis, loss of consciousness, and severe hypoxia-hypercapnia. MRI demonstrated transient diffusion hyperintensity in the left frontal-parietal-occipital regions resulting in a permanent infarction in the primary motor area. Later, a brain perfusion SPECT showed persistent diffuse hypoperfusion in the territories involved in diffusion-weighted imaging alteration. Migrainous infarction, depending on the co-occurrence of 2 strictly related phenomena, CSD and hypoxia, appears to be the most plausible explanation. Brain SPECT hypoperfusion suggests a more extensive permanent neuronal loss in territories affected by aura. CF may be then a risk factor for hemiplegic migraine and stroke since bouts of coughing can facilitate brain hypoxia, triggering auras.
 ...
PMID:Migrainous Infarction in a Patient With Sporadic Hemiplegic Migraine and Cystic Fibrosis: A 99mTc-HMPAO Brain SPECT Study. 3062 50

Pulmonary Arteriovenous Fistula (PAVF) is an abnormal communication between the pulmonary veins and pulmonary arteries. Most individuals may have the condition since birth (congenital occurrence), but it can also be an acquired condition. Most individuals with Pulmonary Arteriovenous Fistula also have a hereditary haemorrhagic telangiectasia. The common signs and symptoms of Pulmonary Arteriovenous Fistula are shortness of breath, haemoptysis, chest pain, dizziness, and syncope. Pulmonary Arteriovenous Fistula is treated with embolization and surgery. PAVF are more common in females than males. Complete evaluation of medical history along with a thorough physical examination required to diagnose PAVF. The CT scan is more sensitive than a chest x-ray in establishing a diagnosis. However pulmonary angiography is the gold standard. Many clinical conditions may have similar signs and symptoms. PAVF is associated with variety of complications, some of which may be life-threatening. These may include: Stroke, bleeding in the lung and brain abscess. Typically, individuals with mild conditions presenting no symptoms may not require any treatment. The treatment of Pulmonary Arteriovenous Fistula may include: Embolization and surgery (the later may be required in a cases not responding to embolization). During surgery, the abnormal vessels are removed along with surrounding lung tissue. We report a rare case of large right pulmonary arterio-venous fistula (PAVF) which was misdiagnosed as mass lung in a 30-year-old lady who presented with generalized seizures due to secondary polycythemia, right sided hemiparesis, central cyanosis and clubbing. She had hypoxemia while breathing ambient air and little improvement with 100% oxygen. Diagnosis was clinched by pulmonary CT angiography which revealed a large PAVF.
 ...
PMID:An unusual case of pulmonary arterio-venous fistula (PAVF). 3174 78

Ischemic stroke involving multiple artery territory with normal vessels gives a clue for an embolic stroke. Paradoxical embolization is a recognized cause of ischemic stroke. We describe a 48-year-old male who presented with acute onset giddiness, mild dysarthria, right hemiparesis, and ataxia. Clinical examinations indicated left cerebellar signs with right hemiparesis. Additionally, the patient had significant clubbing and mild cyanosis. A strong family history of epistaxis and hemoptysis was noted. His Magnetic resonance imaging of the brain showed acute left cerebellar and left frontal cortical infarct with normal vessels. The routine stroke and cardiac workup were normal. Chest X-ray showed bilateral lower zone opacities. Contrast-enhanced computerized tomogram (CT) of the chest showed bilateral pulmonary arteriovenous malformation. Paradoxical embolism due to pulmonary arteriovenous malformation resulted in ischemic stroke in our patient. He fulfilled all of the four criteria for diagnosing definite hereditary hemorrhagic telangiectasia. Our case highlights the importance of a systematic search for paradoxical embolism in a cryptogenic stroke.
 ...
PMID:Paradoxical Embolism in a Case of Hereditary Hemorrhagic Telangiectasia: Case Report with Literature Review. 3264 84


1