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Pulmonary complications including chest infections, atelectasis, pulmonary hypoplasia and ventilatory failure are the leading cause of death in the muscular dystrophies and atrophies. Ventilatory insufficiency is virtually inevita...
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Pulmonary complications including chest infections, atelectasis, pulmonary hypoplasia and ventilatory failure are the leading cause of death in the muscular dystrophies and atrophies. Ventilatory insufficiency is virtually inevitable in Duchenne muscular dystrophy and type 1 spinal muscular atrophy (SMA), but more variable in limb-girdle, congenital, and facioscapulohumeral muscular dystrophy. A cardiomyopathy may complicate Duchenne, Becker, and Emery-Dreifuss muscular dystrophies. Most patients respond well to ventilatory support with reduced pulmonary morbidity and extended survival. Careful monitoring and anticipation of complications are important so that ventilatory assistance can be started in a timely fashion.
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Stroke is the third leading cause of death in the United States. Stroke survivors often experience medical complications and long-term disability. Disturbances in respiratory system function and complications affecting the respira...
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Stroke is the third leading cause of death in the United States. Stroke survivors often experience medical complications and long-term disability. Disturbances in respiratory system function and complications affecting the respiratory system are common after stroke. The nature of these disorders depends on the severity and site of neurological injury. Alterations in breathing control, respiratory mechanics, and breathing pattern are common and may lead to gas exchange abnormalities or the need for mechanical ventilation. Stroke can lead to sleep disordered breathing such as central or obstructive sleep apnea. Sleep disordered breathing may also play a role in the pathogenesis of cerebral infarction. Venous thromboembolism, swallowing abnormalities, aspiration, and pneumonia are among the most common respiratory complications of stroke. Neurogenic pulmonary edema occurs less often. Close observation of the stroke patient for these potential disturbances, and implementation of prophylactic measures can prevent significant morbidity and mortality.
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Neuromuscular respiratory failure is a common complication of both the Guillain-Barre syndrome and myasthenia gravis. Several key pathophysiological mechanisms contribute to the spiral of respiratory insufficiency in these disease...
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Neuromuscular respiratory failure is a common complication of both the Guillain-Barre syndrome and myasthenia gravis. Several key pathophysiological mechanisms contribute to the spiral of respiratory insufficiency in these diseases, including inspiratory, expiratory, and bulbar muscle weakness. It is important to identify patients with impending respiratory failure early to avoid emergency intubations. Several clinical features and bedside pulmonary function tests (PFTs) are useful in guiding decisions about intubation. Weaning is initiated when respiratory muscles have recovered sufficiently, and again, PFT criteria are helpful. Intravenous immunoglobulin and plasmapheresis are the cornerstones of specific therapy for both illnesses when complicated by respiratory failure. Mortality and morbidity are dramatically increased by respiratory failure and are mainly due to associated medical complications. Optimal outcomes depend on avoidance of these and prompt implementation of immunomodulatory therapy.
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Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with no known cure. Involvement of muscles of the respiratory system, the inspiratory, expiratory, and upper airway muscles, is the major cause of morb...
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Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with no known cure. Involvement of muscles of the respiratory system, the inspiratory, expiratory, and upper airway muscles, is the major cause of morbidity and mortality. Dyspnea, swallowing difficulties, sialorrhea, and impaired cough are all symptoms that can be palliated with pharmacological and nonpharmacological methods. Noninvasive positive pressure ventilation (NPPV) in particular is a technique to assist ventilation that not only relieves dyspnea and ameliorates respiratory failure but may also extend the lives of patients with this disease. It should be offered to all ALS patients with a forced vital capacity of less than 50%.
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Patients with Parkinson's disease are at risk for pulmonary complications as a consequence of both the underlying disease pathology and the side effects of medication. Degeneration of the substantia nigra and subsequent loss of do...
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Patients with Parkinson's disease are at risk for pulmonary complications as a consequence of both the underlying disease pathology and the side effects of medication. Degeneration of the substantia nigra and subsequent loss of dopaminergic neurons may produce changes in ventilatory parameters. Upper airway obstruction and chest wall restriction are both common, and both may respond to levodopa. However, therapy for Parkinson's may also contribute to pulmonary morbidity. Overtreatment with levodopa causes respiratory dyskinesia that may be difficult to differentiate from complications of the disease itself. Therapy with ergot derivatives may cause pleuropulmonary fibrosis. Pneumonia resulting from the respiratory complications remains a significant cause of morbidity and mortality in Parkinson's disease.
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Purpose: Chemoradiation therapy (CRT) is recommended as standard care for stage III non-small cell lung cancer (NSCLC), but some patients experience local recurrence after the treatment. Surgical resection after CRT involves high ...
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Purpose: Chemoradiation therapy (CRT) is recommended as standard care for stage III non-small cell lung cancer (NSCLC), but some patients experience local recurrence after the treatment. Surgical resection after CRT involves high surgical risk, but is expected to increase the curability. This study was performed to investigate the impact of presurgical CRT on the postoperative outcome, focusing especially on the effect of radiation therapy. Methods: Twenty-six patients with stage III (N2 or T3-4) NSCLC underwent pulmonary resection after CRT. A radiation dose up to 40-70 Gy was given with concurrent chemotherapy. The morbidity, mortality and survival after surgical resection were examined. Results: Lung resection was performed as lobectomy (73 %) or pneumonectomy (19 %). Postoperative complications occurred in 12 patients (morbidity 46.1 %). The overall 5-year survival of the entire cohort was 69.7 %. The factors associated with favorable long-term survival included a pathological complete response (CR) and mediastinal node negative condition after CRT, and microscopic complete resection. Conclusion: Surgical resection for stage III patients after CRT may provide a survival benefit with acceptable morbidity. The surgical morbidity may be increased by prior radiation therapy, thus, surgeons should be familiar with the available countermeasures to reduce the surgical risk.
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We assessed critical factors for development of radiation pneumonitis in 66 patients, who received radiation therapy with a total dose of more than 30 Gy for primary lung cancer and were followed for more than 3 months during the ...
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We assessed critical factors for development of radiation pneumonitis in 66 patients, who received radiation therapy with a total dose of more than 30 Gy for primary lung cancer and were followed for more than 3 months during the period from September 1997 to December 1999 in our department. Thirteen cases were diagnosed as having radiation pneumonitis. Radiation pneumonitis occurred more frequently in cases receiving chemoradiotherapy than in those receiving irradiation only. The incidence was significantly higher among patients with small cell lung cancer, especially when radiation and chemotherapy were administered concurrently (p<0.01). In concurrent chemoradiotherapy cases there was a significant differece in the duration of the administation of granulocyte-colony stimulating factor (G-CSF) between the pneumonitis cases (mean-7.3 days) and the non pneumonitis cases (mean-2.1 days) (p<0.01). The duration of G-CSF administration during irradiation was presumed to be a critical factor contributing toradiation pneumonitis.
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Background. Hypercalcemia is a common complication of lung cancer patients, especially in advanced disease. Parathyroid hormone-related protein (PTHrP) is one of the tumor products that play an important role for the formation of ...
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Background. Hypercalcemia is a common complication of lung cancer patients, especially in advanced disease. Parathyroid hormone-related protein (PTHrP) is one of the tumor products that play an important role for the formation of this pathological condition. We report herein a case of PTHrP-producing lung cancer associated with secondary diabetes insipidus (DI) due to hypercalcemia. Case. A 67-year-old man was admitted in May, 1999 because of cough and abnormal shadow on chest X-ray. Advanced lung cancer in the left lower lobe was diagnosed and he underwent 3 courses of chemotherapy consisting of cisplatin and docetaxel. A total of 52 Gy radiation therapy was administered to the left hilum to improve the obstruction of the left main bronchus invaded by the tumor 8 months later. He was readmitted in November, 2000 because of progression of the disease. Chest CT scan showed regrowth of the tumor and complete atelectasis of the left lung. Polydipsia and 3,000-5,000 ml/day polyuria were present during hospitalization. There was no evidence of bone or brain metastasis. Hypercalcemia and high serum levels of C-terminal PTHrP were observed, which strongly suggested secondary DI due to humoral hypercalcemia of malignancy (HHM). Pamidronate disodium was administered of a dose of 30 mg, and the hypercalcemia improved immediately. He died due to respiratory failure caused by multiple lung metastasis a month later. We examined the expression of the PTHrP antigen immunohistochemically in the section from the autopsy specimen. Immunoreactivity was measured in the cytoplasm of the tumor cells. Conclusion. We encountered a case of PTHrP-producing lung cancer associated with secondary DI. Treatment with pamidronate disodium alone was effective for HHM in this patient with cardiopulmonary hypofunction.
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We describe a patient with a chronic case of pulmonary involvement of Takayasu's arteritis in the resected lung. A 49-year-old woman was first diagnosed with Takayasu's arteritis at age 30 years. On her first admission, she presen...
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We describe a patient with a chronic case of pulmonary involvement of Takayasu's arteritis in the resected lung. A 49-year-old woman was first diagnosed with Takayasu's arteritis at age 30 years. On her first admission, she presented with Takayasu's arteritis and pneumonia with cavitation in the left lung. After recovering from pneumonia, she was treated initially with prednisolone, 30 mg/day, and remained well until she developed hemoptysis at age 34 years. Findings suggesting aspergilloma were found in the same lobe on chest x-ray film when she was 46 years of age. By age 49 years, the hemoptysis became massive, and she was admitted for surgery. Left upper lobectomy and partial resection of S6 and S8 pulmonary segments were performed. Histologic analysis of the resected lung revealed typical pathologic findings of pulmonary artery involvement in Takayasu's arteritis, such as stenosis recanalization and a vessel-in-vessel feature, but not active vasculitis. Infection probably occurred in the cavity ofthe infarcted tissue. Pulmonary artery involvement is common in Takayasu's arteritis, but the aspergilloma in this corticosteroid-treated patient is an uncommon complication.
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Purpose: Complementary and alternative medicine (CAM) use has been increasing among cancer patients. This study characterizes the use of CAM among patients with thoracic malignancies. Methods: This cross sectional study was conduc...
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Purpose: Complementary and alternative medicine (CAM) use has been increasing among cancer patients. This study characterizes the use of CAM among patients with thoracic malignancies. Methods: This cross sectional study was conducted at a National Cancer Institute-designated comprehensive cancer center among adult patients diagnosed with thoracic malignancies. The primary outcome was a self-reported use of CAM, defined as the use of any type of CAM beyond routine vitamin/mineral supplementation alone. A logistic regression model was developed to explore predictors of CAM use. Results: A total of 108 patients completed a standardized survey (59 % response rate). Overall, 42 % of respondents reported the use of at least one type of CAM. Users and non-users of CAM did not differ based upon demographics, diagnosis, staging, smoking status, quality of life, or perceived understanding of cancer diagnosis. In the multivariate analysis, patients who reported feeling fearful about their future were four times more likely to be CAM users when compared to those who did not specify this emotion (odds ratio=4.18; 95 % CI=1.23-14.12; p=0.02). Commonly cited reasons for CAM use were to support one's self, boost immunity, and for improvements in emotional and/or spiritual well-being. Conclusions: Prevalence of CAM use among cancer patients in this study was similar to the general US population. Feeling fearful about the future was associated with CAM use. Results suggest that patients may be turning to CAM as a therapeutic adjunct to actively cope with emotional distress surrounding the cancer experience.
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