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Query: UMLS:C0392680 (shortness of breath)
 5,217 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Dyspnea, or breathlessness, is a very distressing and prevalent symptom for patients with terminal cancer. Assessment for this symptom is generally poorly conducted, and it is therefore frequently underdiagnosed and inadequately treated. This paper outlines several tools found in the literature that may be beneficial to us in assessing this symptom. There will also be a full report on the application of these scales as used in a hospital audit of all in-patients at the Queensway- Carleton Hospital in Nepean, Ontario, during the month of June 1995. Results of this hospital audit revealed that 33% of all patients in hospital complained of some degree of breathlessness on both the Linear Analogue Scale Assessment and the Borg Scale. However, when the Modified Medical Research Council Dyspnea Scale and the Oxygen Cost Diagram Scale were used 75.6% and 78.5% respectively now complained of significant shortness of breath interfering with their quality of life. We also found that patients experiencing dyspnea were 39% more likely to complain of other symptoms than patients with no shortness of breath and were 55% more likely to report other symptoms as being severe. A short section will also outline the medical and nursing management of dyspnea and will include a discussion of possibly correcting the cause of breathlessness, environmental issues, and pharmacological management of dyspnea. It is advocated that during the terminal stages of a patient's illness, when assessment tools are no longer feasible or possible, that a "breathing comfortably" approach be adopted for patient and family comfort.
Support Care Cancer 1997 Mar
PMID:Dyspnea: assessment and treatment. 906 2

Epithelial-myoepithelial carcinoma is a rare low-grade malignant salivary gland neoplasm that most commonly occurs in the parotid gland but can also arise in minor salivary glands. We report a case of a primary epithelial-myoepithelial carcinoma of the lung. The patient is a 55-year-old black woman who presented with increasing shortness of breath and productive cough of at least 3 months duration. A left lower lobe endobronchial lesion was identified radiographically. Surgical resection of the lesion was performed, obtaining a circumscribed, nonencapsulated 3.9 cm tan mass which was attached to the inner wall of the lateral basal segment bronchus. A biphasic proliferation of epithelial (cytokeratin positive; S-100 protein and muscle-specific actin negative) and myoepithelial (S-100 protein and muscle-specific actin positive with focal weak cytokeratin positive) cells was identified by immunohistochemical and ultrastructural analysis of formalin-fixed tissue. The patient is disease free 7 months after resection. Pulmonary epithelial-myoepithelial carcinoma likely derives from the submucosal bronchial glands and should be added to the growing list of salivary gland-type neoplasms that may occur as primary pulmonary neoplasms. Because its histology is identical to salivary epithelial-myoepithelial carcinoma, pulmonary epithelial-myoepithelial carcinoma should be considered a low-grade malignant neoplasm and should be designated as epithelial-myoepithelial carcinoma is preference to other terms that may not convey its malignant potential. Although follow-up on reported cases is limited, lobectomy with negative bronchial margin should be curative.
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PMID:Epithelial-myoepithelial carcinoma of the lung: immunohistochemical and ultrastructural observations and review of the literature. 915 14

A 77-year-old man with a history significant only for coronary artery disease presented to the ED with left-arm pain, shortness of breath, nausea, and diaphoresis. Six hours after the patient's admission to the hospital for presumed unstable angina, fever and left arm swelling, associated with crepitus and violaceous bullae, developed. The patient was taken to the operating room, where he was found to have extensive myonecrosis requiring forequarter amputation of the left arm. Nontraumatic clostridial myonecrosis is a fulminant, often fatal infection. This rare condition is usually caused by Clostridium septicum and has a high association with underlying malignancy. The patient reported here was found to have a colonic lesion and acute leukemia, both previously undiagnosed. This case illustrates the insidious manner in which spontaneous myonecrosis may present.
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PMID:Nontraumatic gas gangrene. 920 35

Although neuroblastoma is a relatively common malignancy of childhood, it is rarely of cervical origin. We encountered two cases of primary cervical neuroblastoma in infants. The first case was in a newborn who presented with noisy breathing, dyspnea, and choking on feeding soon after birth. Physical examination disclosed a left retropharyngeal mass near the midline causing aerodigestive compromise. Magnetic resonance imaging showed a well-defined hyperintense mass in the corresponding region. The infant underwent complete surgical excision of the mass 1 month after birth. The pathology report confirmed neuroblastoma. Horner's syndrome developed soon after surgery but resolved spontaneously within 6 months. No recurrence was noted during a 3-year follow-up period. The second patient, a 5-month-old female, presented with stridor and shortness of breath of 2-weeks' duration due to a right cervical mass. Magnetic resonance imaging showed a parapharyngeal mass suggestive of neuroblastoma. Complete surgical excision was done at the expense of sacrificing the sympathetic nerve trunk. The pathologic diagnosis was moderately differentiated neuroblastoma. No recurrence was noted when the patient was seen 2 years after surgery, although right-sided Horner's syndrome persisted. Surgical intervention can result in a good prognosis for low stage cervical neuroblastomas; however, long-term follow-up is important.
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PMID:Primary cervical neuroblastoma in infants. 926 64

To assess the efficacy and toxicity of an outpatient combination chemotherapy in small-cell lung cancer (SCLC), we treated 70 consecutive patients with epirubicin 80 mg m(-2) i.v. on day 1 and etoposide 200 mg o.d. p.o. on days 1-4 (EE) at 3-weekly intervals. The median age of patients was 64 years (range 39-84). The male-female ratio was 42:28 and 35 (50%) had metastatic disease. Fifty-seven patients were evaluable for response. The overall response rate was 64.4%, including 14 (23.7%) complete responses and 24 (40.7%) partial responses. Median time to progression was 7 months in responders and 8 months in patients with limited disease. The median survival in patients with limited disease was 10.5 months (range 0.5-70 +) and 7 months (range 0.5-24) in those with extensive disease. Improvement of symptoms occurred in 79% of patients with shortness of breath, 80% with cough, 81% with haemoptysis and 68% with pain. In 19 patients an increase in body weight was noted. Major (WHO grade 3/4) toxicities were neutropenia in 13 (18.5%) patients, alopecia in 33 (47.1%) patients, mucositis in 15 (21.4%) patients, anorexia in eight patients (11.4%), nausea and vomiting in six patients (8.5%) and diarrhoea in 4 (5.7%) patients. In conclusion, EE is an active and well-tolerated outpatient regimen in the treatment of SCLC. The survival data in this unselected group of patients were disappointing and the possible explanations for this are discussed.
Br J Cancer 1997
PMID:Outpatient treatment with epirubicin and oral etoposide in patients with small-cell lung cancer. 930 64

Bronchioloalveolar carcinoma is characterized pathologically by a pulmonary neoplasm showing lepidic growth. More than half of all patients with bronchioloalveolar carcinoma are asymptomatic. The most frequent symptoms and signs are cough, sputum, shortness of breath, weight loss, hemoptysis, and fever. Bronchorrhea is unusual and a late manifestation. Nonmucinous bronchioloalveolar carcinoma tends to be more localized and has a lower frequency of bronchogenic spread than mucinous bronchioloalveolar carcinoma. Bronchioloalveolar carcinoma appears radiographically as a single nodule, segmental or lobar consolidation, or diffuse nodules. At computed tomography (CT), the single nodular form appears as a peripheral nodule or localized ground-glass attenuation with or without consolidation, frequently associated with bubblelike areas of low attenuation and open bronchus signs. The lobar consolidative form may demonstrate the CT angiogram and open bronchus signs. The diffuse nodular form appears as multiple nodules or areas of ground-glass attenuation or consolidation. The single nodular form has a better prognosis than the others but may show false-negative results for malignancy at 2-(fluorine-18) fluoro-2-deoxy-D-glucose positron emission tomography.
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PMID:Bronchioloalveolar carcinoma: clinical, histopathologic, and radiologic findings. 939 50

A 70-year old man with a history of anorexia, weight loss, and progressive shortness of breath was studied by transesophageal echocardiography. In addition to a mass occupying the right ventricular outflow tract, a rare congenital heart anomaly was discovered serendipitously: persistent left superior vena cava, absent right superior vena cava, and no other congenital abnormality. The echocardiographic findings were confirmed by computed tomographic scanning and later during heart surgery performed to resect the malignant tumor.
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PMID:Absent right and persistent left superior vena cava without other congenital anomaly: a rare combination diagnosed by transesophageal echocardiography. 941 26

Carcinoma in situ of the glottic larynx is a rare malignancy, comprising only 1% to 2% of laryngeal biopsy. The management of these lesions remains controversial. In this article, the authors present results and analysis of the management of 20 patients having these lesions treated by radiotherapy. A total of 20 patients who had carcinoma in situ of the glottis were treated with curative intent with radiotherapy at the Veterans Administration Medical Center, Minneapolis, Minnesota, U.S.A. from November 1972 through March 1993. Before radiotherapy, eight patients had only biopsies of the glottic larynx, five had one stripping procedure, and seven patients had two or three stripping procedures. Of the 20 patients, 19 are available for retrospective analysis, with a minimum follow-up of 4 years and a median follow-up of 7.3 years. Treatment was given to all patients by megavoltage units (cobalt 60, 2; 4-mV linear accelerator, 18). Patients were treated using bilateral opposed wedged 6-cm x 6-cm fields, with a dose of 1.75 Gy per fraction to a total median dose of 68.4 Gy in 40 fractions over 56 elapsed treatment days. The Kaplan-Meier method was used for survival analysis. The 4-year disease-free survival was 95% after irradiation. The actuarial disease-free survival for 5 and 10 years was 95%. Surgical salvage failed in one patient who had a laryngectomy for recurrent invasive squamous cell carcinoma at 34 months after radiotherapy. Two patients developed severe shortness of breath because of laryngeal edema, which required tracheostomy. Sixteen patients reported subjective significant improvement of their voice quality, and four reported no change. Radiotherapy is an excellent choice for patients who have recurrent carcinoma in situ after undergoing stripping procedures or for those patients who live too far from a medical facility to allow close follow-up and repetitive surgical procedures. These results are comparable to those of other investigators who used radiotherapy with higher dose per fraction.
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PMID:The role of radiotherapy in the management of carcinoma in situ of the glottic larynx. 962 3

Optimal management of dyspnea in terminal cancer patients requires an understanding of the responsible pathophysiological mechanisms. This prospective study assessed visual analogue scales (VAS) of shortness of breath (SOB) and anxiety, bedside spirometry, maximum inspiratory pressure (MIP), chest radiography, arterial blood gases, hemoglobin, and electrocardiogram, if indicated, in 100 terminally ill cancer patients. Forty-nine percent of the patients had lung cancer. The median VAS scores for SOB and anxiety were 53 mm and 29 mm, respectively. Spirometry was abnormal in 93% of patients, with 5% having obstructive, 41% restrictive, and 47% mixed patterns. The median MIP was 16 cm H2O. Sixty-five percent of the patients had parenchymal or pleural involvement on chest radiograph. Twenty-nine percent had evidence of cardiac ischemia, recent or current myocardial infarction or atrial fibrillation. Patients had a median of five different abnormalities that could have contributed to their shortness of breath. Only anxiety (p = 0.001), a history of smoking (p = 0.02), and pCO2 levels were statistically significantly correlated with SOB VAS scores. The potentially correctable causes of dyspnea included hypoxia (40%), anemia (20%), and bronchospasm (52%). The finding of very low MIPs suggests severe respiratory muscle weakness may contribute significantly to dyspnea in this patient population. Further studies are needed to confirm this finding and characterize the underlying pathophysiology.
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PMID:Dyspnea in the advanced cancer patient. 1058 52

The purpose of this study was to examine the effect of three Therapeutic Touch treatments on the well-being of 20 persons with terminal cancer in palliative care. Participants in the experimental group (n = 10) received three noncontact Therapeutic Touch treatments, the duration of which varied between 15 to 20 minutes. Participants in the control group (n = 10) participated in three rest periods. Well-being was measured at preintervention time and immediately postintervention time using the Well-Being Scale, a visual analogue scale measuring pain, nausea, depression, anxiety, shortness of breath, activity, appetite, relaxation, and inner peace. The results of the study support the hypothesis that three noncontact Therapeutic Touch treatments increase sensation of well-being in persons with terminal cancer.
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PMID:Effect of therapeutic touch on the well-being of persons with terminal cancer. 984 60


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