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Background: Sensory qualities of dyspnea are known to differ by diagnosis. Less is known about whether sensory qualities vary with changes in health status in a given diagnosis., Purpose: The goal of this study was to evaluate the reliability, validity, and factor structure of dyspnea sensory quality descriptors in patients with heart failure (HF) treated in an emergency department (ED) and to investigate whether change in sensory quality influences HF patients to seek care in an ED., Methods: HF patients (N = 57) treated in an ED were interviewed retrospectively. Open-ended characterizations of dyspnea at the time of the ED visit were analyzed qualitatively. A subset of subjects (n = 34) rated the intensity of 13 dyspnea descriptors (0 = not endorsed; 1= very mild; 10 = very severe) as the descriptors applied to the time at which they decided to come to the ED (Decision) and a week before the visit (Week Before). Descriptor ratings were analyzed for congruence with open-ended characterizations, endorsement frequency, internal consistency, factor structure, and correlations (by descriptor and within subjects) between the 2 time frames., Results: Open-ended characterizations of dyspnea provided support for the content validity of most descriptors. Internal consistency of numerical ratings was high (alpha >0.90) in both recalled time frames. Factor analysis of descriptor ratings was unifactorial for Week Before, but suggested multiple sensory quality factors at Decision (suffocation, air hunger, effort/impedance, and, possibly, rate). Within-subject concordance and descriptor-by-descriptor correlations across time frames were mostly low, suggesting change in sensory quality from Week Before to Decision. Correlations in descriptor ratings were lowest among subjects who reported duration of dyspnea (as severe as at Decision) of 3 days or less. Subjects who recalled a duration of 6 days or more gave highly concordant ratings across both time frames., Conclusion: Sensory quality descriptor-based ratings were internally consistent and content valid. Low correlations in ratings of sensory quality for most subjects across recalled time frames suggest that change in sensory quality may be an aspect of perceived increases in dyspnea severity before an ED visit. Results require replication and extension with larger samples and other diagnoses.

Records of final diagnoses based on necropsies performed on dogs and cats over a 4.5-year period at a university teaching hospital were examined for the diagnosis of acute or subacute myocardial necrosis. Clinical findings signaling the occurrence of myocardial necrosis were often not specific, due to simultaneously occurring disease processes. However, of 28 animals identified, dyspnea occurred frequently (17/28; 61%) and in some cases in the presence of minimal pulmonary pathology (2/3; 66%) or otherwise unexplained pulmonary edema (4/4; 100%). Elevations in serum aspartate aminotransferase (10/10; 100%) and creatine kinase (5/9; 55%) were also frequent. Disease processes associated with thrombus formation were present for each case in which a coronary artery thrombus occurred (5/28; 18%).

Astragalus lusitanicus is a toxic legume grown in Morocco and in some other Mediterranean countries. In small ruminants, poisoning by this plant is dominated by nervous signs characterized by many cycles of excitement-depression. Macroscopic examination of poisoned animals showed congestive lesions and oedema in the brain and lungs. Microscopic lesions consisted mainly of vacuolar degeneration in neurons, hepatocytes and in spleen and kidney cells. Serum activity of AST and CK as well as blood glucose and urea were increased as a result of poisoning. However, serum activity of alpha-mannosidase was not modified as is the case in locoism. Chemical investigations showed that A. lusitanicus does not contain swainsonine or miserotoxin and its selenium concentration is very low. However, this legume contains indolizidin alkaloids and a first compound was purified and identified.

A 6-year-old, 420-kg quarter horse gelding was presented with a 2-month history of difficulty swallowing and dyspnea. The horse was diagnosed with a right guttural pouch empyema with many large chondroids. Two surgeries were required to completely remove all the chondroids from what proved to be a primary distension of the guttural pouch lateral compartment.

In this work, alveolar lesions induced after systemic administration of cocaine (30 mg/kg per day, i.p.) to rats were evaluated both by light microscope analysis for morphological assessment as well as by measurement of the alveolar area as a quantitative index of the alveolar damage. Rats were examined after different times of exposure: 7, 15, 30, 45, 60 and 75 days. The histopathological evaluation of cocaine-treated rats revealed a remarkable thickening in some interalveolar septa, with interstitial hemorrhages, progressive thrombosis and transformation of reticular and elastic fibers into diffuse fibrosis. A significant decrease of the alveolar area was also observed. These findings are indicative of severe changes in capillaries, alveoli and bronchiole after cocaine exposure, which in turn may progressively disrupt the general function of the lungs. Differential mechanisms of systemic toxicity after cocaine exposure are discussed.

A 64-year-old man presented with progressive dyspnea. The symptom of severe hypoxia requiring mechanical ventilator, and bilateral pulmonary infiltrates on the chest film led to the clinical diagnosis of adult respiratory distress syndrome. Autopsy demonstrated widespread cryptococci and mucinous material in alveoli with mild inflammatory response.

Background: In a previous FONICAP trial, the combination of doxorubicin (D) and cisplatin (P) yielded an objective response rate of 25% and a subjective response rate of 50% in patients with mesothelioma. In human mesothelioma cell lines, mitomycin (M) showed a synergic activity with P and in a recent randomized study, the combination of M and P showed slightly superior activity when compared with the PD regimen., Methods: The authors tested the activity and toxicity of a combination chemotherapy regimen including P, 60 mg/m2, D, 60 mg/m2, and M, 10 mg/m2, all by intravenous infusion on Day 1 every 28 days in a Phase II study., Results: Twenty-four chemotherapy-naive mesothelioma patients were enrolled in the study. Patient characteristics were the following: the median age was 58 years; the median performance status was 1; there were 6 Stage I patients, 15 Stage II patients, 2 Stage III patients, and 1 Stage IV patient; and 10 patients had previous asbestos exposure. All patients had pretreatment symptoms: 13 had chest pain, 9 had pleural effusion, and 7 had dyspnea. A total of 78 cycles of chemotherapy were administered. The only significant side effect was myelosuppression, with only 9.5% of patients having Grade 4 toxicity. Among 23 patients evaluable for response, 5 achieved a partial response (20.8%; 95% confidence interval, 7.1-42.1%), 9 had stable disease, and 9 had progressive disease (including 1 early death). One patient was not evaluable because of treatment refusal. A clinical improvement was observed in 7 of 24 patients (29%)., Conclusions: The combination of PDM in patients with pleural mesothelioma is feasible and moderately active. However, the observed level of activity is similar to that obtained with other two-drug regimens.

Coronary arteriography was performed on 18 asymptomatic, apparently healthy adults with elevated coronary calcium scores. To extend the range of observation to subjects with low calcium scores, arteriograms from 18 patients with exertional dyspnea and/or valvular heart disease and low calcium scores were also analyzed; these 18 patients were considered asymptomatic from the point of view of coronary artery disease (CAD). For the comparison of symptomatic and asymptomatic persons, 3 age and sex-matched symptomatic patients were also selected for each of the original 18 asymptomatic subjects. Arteriograms were analyzed by computer-assisted quantitative coronary arteriography at a remote site without knowledge of the calcium score or any other patient characteristics. In the 18 asymptomatic subjects with elevated calcium scores, the mean calcium score was 573 +/- 504 (Agatston method) and the mean worst stenosis was 45% +/- 16%. For all 36 patients without symptoms of CAD, worst stenosis was closely correlated with the square root of the calcium score (r = 0.85, p <0.0001). Patients with symptomatic coronary disease and calcium scores < 1,000 had stenoses more severe than asymptomatic persons with similar calcium scores. Most asymptomatic adults with elevated calcium scores have nontrivial, nonobstructive CAD or preclinical obstructive CAD, and the relation between coronary calcium score and severity of stenosis is highly significant. These data indicate that electron beam tomography can be used to estimate the severity of CAD in asymptomatic persons.

Hepatocellular carcinoma (HCC) can give multiple different initial clinical presentations. To the author's knowledge, however, dyspnea has not yet been recorded as an initial clinical presentation of HCC. A 39-year-old woman who had dyspnea for 2 months because of HCC is, therefore, reported herein. A chest X-ray revealed reticulonodular infiltration of lungs which led to antituberculous treatment. She died 3 months after initial dyspnea. An autopsy demonstrated a HCC, 1.5 x 2 x 2 cm, at the edge of the left lobe of the liver with widespread intravascular metastases to the lungs. The patient, moreover, had hypertrophy of the right cardiac ventricle being compatible with cor pulmonale. These pulmonary and cardiac findings are regarded to have produced dyspnea in this case.

Mucociliary dysfunction can be caused by the absence of cilia or by abnormalities in their ultrastructure. A family in which some members were suffering from respiratory morbidity due to lack of cilia is described.

Fat embolism of necrotic bone marrow could be a frequent cause of acute chest syndrome (ACS) in sickle cell syndromes (SC), as suggested by postmortem findings. To check this hypothesis in living patients, we evaluated the presence of fatty macrophages recovered by bronchoalveolar lavage (BAL) in ACS. We investigated 20 consecutive cases of ACS by BAL, and identification of alveolar cells containing fat droplets was performed using oil red O (ORO), a specific neutral fat stain. The specificity of the method was determined on control groups, including eight SC patients without acute chest syndrome and 15 non-SC patients. A cut-off of > 5% of alveolar macrophages containing fat droplets was determined from the control groups to assess the diagnosis of fat embolism. In 12 ACS episodes, BAL exhibited > 5% of fatty macrophages, ranging from 10% to 100% (median value 46.5%). In 11 cases, fat embolism was associated with proven (n = 8) or probable (n = 3) bone marrow infraction, which mostly predated ACS. Eight ACS episodes were associated with a low percentage (< or = 5%) of fatty alveolar macrophages and could be related to a cause other than fat embolism in six episodes, such as sepsis, in-situ thrombosis, or rib infarcts generating hypoventilation. This study supports the diagnostic yield of BAL for fat embolism, which can be incriminated in 60% of cases of ACS in this adult population.

Acute exposure to sublethal doses of chlorine gas resulted in persistent pulmonary symptoms in 3 patients who had no past history of respiratory disease. The patients complained of intermittent dyspnea in association with respiratory irritants and physical exertion for more than 2.5 years postexposure. Four months after the accident bronchoalveolar lavage showed an inflammatory cell reaction, whereas 16 months later the differential cytology proved nearly normal. Moderate to severe nonspecific bronchial hyperresponsiveness was assessed in intervals of 4, 20 and 30 months after the accident. All patients showed the typical features of the reactive airways dysfunction syndrome defined as an asthma-like occupational illness after an acute exposure to highly concentrated respiratory irritants. We conclude that a single high exposure to chlorine gas may lead both to acute respiratory injury and to long-term reactive airway dysfunction with typical symptoms of inflammatory changes of the airways and nonspecific bronchial hyperresponsiveness.

To examine the nature and the degree of airway inflammation in chronic bronchitis during exacerbations, bronchial biopsies and sputum were obtained in 11 subjects with chronic bronchitis examined during an exacerbation, and in 12 subjects with chronic bronchitis examined under baseline conditions. All subjects were nonatopic. Lobar bronchial biopsies were assessed using histochemical and immunohistochemical techniques, and sputum was examined for differential cell counts of leukocytes. Subjects with bronchitis during exacerbations had, on average, 30-fold more eosinophils in their bronchial biopsies than did those examined under baseline conditions (p < 0.001). Although to a lesser extent, the numbers of neutrophils (p < 0.01), T-lymphocytes (CD3) (p < 0.05), VLA-1-positive cells (p < 0.01), and TNF-alpha positive cells (p < 0.05) were also increased during exacerbations. By contrast, the T-lymphocyte subpopulations (CD4 and CD8) and the numbers of macrophages, mast cells, IL-2R-positive cells, and IL-1 beta-positive cells were similar in the two groups of subjects, as well as the percentages of ICAM-1- and E-selectin-positive vessels. Eosinophils were also increased in sputum of subjects with exacerbations when compared with those examined under baseline conditions (p < 0.05). In conclusion, exacerbations of chronic bronchitis are associated with a marked airway eosinophilia and with a milder increase in the number of neutrophils, activated T-lymphocytes, and TNF-alpha-positive cells in the bronchial mucosa.

Objective: To evaluate the clinical and radiographic features of pulmonary aspergillosis as they present in AIDS patients; in particular, to determine similarities and differences between Aspergillus infection in patients with AIDS vs those without AIDS., Subjects and Methods: Six new cases of confirmed or probable pulmonary aspergillosis were discovered during a search of hospital records. These are reviewed with 30 previously reported cases with special attention to radiographic appearance of disease and how radiographic appearance influences clinical outcome., Results: Symptoms of pulmonary aspergillosis in AIDS were nonspecific, most often including fever, cough, and dyspnea, and less commonly, chest pain or hemoptysis. Major risk factors for the development of pulmonary aspergillosis in patients with AIDS were steroid administration and neutropenia. Neutropenia was often a complication of therapies for AIDS, in particular, ganciclovir and zidovudine. Radiographic appearance of disease could be divided into three general categories. One third of the patients (13/36) presented with cavitary upper lobe disease resembling noninvasive or chronic necrotizing aspergillosis. Fatal hemoptysis occurred in 42 percent of patients with this form of disease. Twenty-two percent (8/36) of the cases presented as a nondescript focal alveolar opacity similar to invasive aspergillosis. In several patients, the focal infiltrate remained stable for several months, a feature that is unusual for aspergillosis in non-AIDS patients. The air crescent sign was present in none of the 36 reported cases. Patients with only focal disease had the best prognosis of patients with pulmonary aspergillosis. Bilateral alveolar or interstitial disease similar to invasive aspergillosis was present in 23 percent (9/36) of the patients. Bilateral disease appears to be a marker for disseminated infection and was associated with a high mortality due to aspergillosis. Two new forms of bronchial aspergillosis (5/36 cases) have been described previously. These patients presented with either obstructing fungal casts or bronchial pseudomembranes demonstrated bronchoscopically. In some patients with the bronchial forms of aspergillosis, transient alveolar opacities were seen on chest radiographs. These opacities may represent regions of atelectasis due to airway obstruction. One patient who had bilateral pneumothoraces without parenchymal opacities did not correspond to any of the three previously mentioned categories. Mortality due to aspergillosis was greater than 50 percent among AIDS patients. Death was subsequent to fatal hemoptysis or widespread pulmonary or systemic infection., Conclusion: Unlike other risk groups that tend to contract only one form of pulmonary aspergillosis, AIDS patients can develop the whole spectrum of aspergillosis-related pulmonary disorders, including chronic cavitary, invasive, and bronchial forms of aspergillosis. Clinical symptoms are nonspecific and major risk factors include neutropenia, which is often a side effect of various therapies for AIDS, and steroid administration. Patients with the chronic cavitary form of disease have an unusually high mortality due to fatal hemoptysis. Patients with bilateral pulmonary infiltrates and aspergillosis have a high mortality due to disseminated infection.

In the present study the consequences of administration of low-dose (0.5 mg) OKT3 for respiratory side-effects and pulmonary sequestration of labelled granulocytes are compared with the known effects of 5 mg OKT3. Ten renal transplant patients were studied, of whom five were treated with 0.5 mg OKT3 and five with 5 mg OKT3. None of the patients in the 0.5 mg group and two of the patients in the 5 mg group experienced dyspnoea. Sequestration of labelled granulocytes in the lungs was significantly lower in the patients receiving 0.5 mg OKT3 compared with the patients receiving 5 mg OKT3. The simultaneously occurring peripheral blood granulocytopenia was significantly more severe in the 5 mg group than in the 0.5 mg group. We suppose that this sequestration of circulating granulocytes in the lungs is at least partly mediated by complement activation products. In vitro it is demonstrated that fixation of complement activation products on peripheral blood lymphocytes depends on the concentration of OKT3 present in the culture medium. We conclude that respiratory side-effects shortly following infusion of OKT3 are related to complement-induced pulmonary leucostasis, the degree of which is dependent on the administered dose of OKT3.

Four women with a chronic respiratory illness characterized by chronic cough, dyspnea, mild to severe physiologic abnormalities, relatively normal chest radiographs, and lack of response to bronchodilators or prednisone were identified and prospectively evaluated. Constrictive bronchiolitis, defined as concentric narrowing of the bronchiolar lumen, mural scarring, smooth muscle hyperplasia, and mucus stasis, was the major histologic finding on open lung biopsy in all cases. Each presented with an illness clinically distinct from asthma, connective tissue disorders, occupational or environmental lung disease, bronchiectasis, diffuse panbronchiolitis, cystic fibrosis, and emphysema. None of the patients smoked cigarettes. None had clinical evidence of a recent viral lower respiratory tract infection. The physical examinations were normal except for rales heard on chest examination in two patients. Chest radiographs showed increased bronchovascular markings in three patients. Lung function was normal in one patient, two of the patients had a reduced diffusing capacity associated with moderate hypoxemia and an obstructive ventilatory defect, and one patient exhibited a mixture of restrictive and obstructive defects. None have experienced significant progression of their disease over 1 to 5 yr of follow-up. However, complete return to normal function did not occur. We hypothesize that patients with the constellation of findings described represent a distinct and definable clinicopathologic entity and further clarifies the spectrum of "small airways disease." Establishing the diagnosis appears important for prognostic and possibly therapeutic reasons.

Laryngeal papillomatosis is the commonest benign tumour affecting the larynx. Two forms are found i.e. juvenile onset and adult onset. Typically the juvenile onset form has a greater rate of recurrence and often remits with the onset of puberty (Corbitt et al., 1988). The human papilloma virus (HPV) is the causative agent (Abramson et al., 1987; Corbitt et al., 1988), specifically types HPV6 and 11. Attempts have been made to correlate the clinical behaviour of these two modes with the viral serotype and other aetiological factors such as smoking and hormonal factors (Abramson et al., 1987; Rimmel et al., 1992). Studies, however have shown that there is considerable variation in behaviour (Steinberg et al., 1983; Corbitt et al., 1988; Crissman et al., 1988). It is widely accepted that the disease 'burns' itself out, particularly with respect to the juvenile form. It is interesting and unusual therefore when the disease reappears after many years of remission. The following case report illustrates this point.

We report the histological and histochemical features of core fibers present in respiratory muscles obtained from autopsy since 1980. Fifty autopsy cases of adults without neuromuscular disease were examined. "Central core" structure was present in 38 cases and absent in 12 cases. The duration of D.O.E. was greater than 1 month in 81.8% of core positive cases. In core negative cases, the duration of D.O.E. was less than 3 months. "Central core" structure were present in 80.0% of chronic respiratory failure cases and 41.7% of non-chronic cases. It is suggested that central core in respiratory muscles develops less than 3 months after the onset of D.O.E.

The case is reported of a young woman with the Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI) who presented with rapidly progressive dyspnoea due to mitral stenosis. Mitral valve replacement was performed and the appearance of the valve was typical of mucopolysaccharide infiltration. Dyspnoea in patients with the Maroteaux-Lamy syndrome may be due primarily to cardiac valve involvement, and in this setting, valve surgery is safe and effective.

The chest roentgenogram in a 46-year-old woman with dyspnoea for several months revealed global cardiac enlargement. Echocardiography demonstrated a tumour in the right atrium, about 4 x 5 cm, as well as circular pericardial effusion. Septic temperatures occurred in the further course, and blood cultures grew Staphylococcus aureus. Recurrent pulmonary emboli and cerebral emboli with hemiparesis, especially of the brachiofacial region, occurred despite heparinization. Shortly after hospitalization a chest roentgenogram revealed a round shadow, about 1 cm in diameter, in the left upper lobe. The patient died in cardiogenic shock on the 16th hospital day. Autopsy showed the tumour to be a poorly differentiated round-cell sarcoma, originating from the wall of the right atrium, infiltrating the myocardium through to the epicardium and extending to the tricuspid orifice. The foramen ovale was open, making paradoxical emboli at atrial level possible.

Seventeen patients with early systemic sclerosis (SSc) underwent high resolution computed tomography (HRCT) of the chest to evaluate dyspnea and/or abnormal pulmonary function tests (PFT). All patients were assigned a dyspnea score and each had routine chest radiography (CXR). Bronchoalveolar lavage (BAL) was performed on 10 patients. HRCT was abnormal in 15 patients (88%), while CXR was abnormal in only 10 patients (59%). Mediastinal lymphadenopathy was detected in 7 patients (41%). Disease duration, dyspnea score, and forced vital capacity (FVC) did not correlate with HRCT score. However, trends toward higher total BAL cell counts and higher BAL neutrophil counts were noted in patients with ground glass opacities on HRCT, and BAL lymphocyte counts were significantly higher in such cases. HRCT is superior to CXR for detecting early interstitial lung disease in SSc, but patient history and FVC correlate poorly with HRCT findings. Ground glass opacities on HRCT may reflect active alveolitis, and mediastinal lymphadenopathy associated with SSc lung disease may be a consequence of pulmonary inflammation.

Eleven adult goats and 32 adult outbred mice were inoculated IV with Cowdria ruminantium-infected blood (Kwanyanga isolate), monitored clinically, then serially euthanatized. Predominant clinical signs of disease in goats were depression, head tremors, seizures, and dyspnea. In mice, dyspnea and depression were the only clinical signs of disease noticed. Tissues were examined histologically and immunohistochemically for C ruminantium colonies or antigen. In goats, C ruminantium was detected only in endothelial cells of the brain, even though gross and microscopic lesions were confined to the thorax. In mice, C ruminantium was detected only in endothelial cells of the heart and lungs.

The purpose of this study is to detect the existence of eventual relations between position and dimensions of tongue and pharynx soft tissues and vertical growth of face. The population is made up of 50 children of 9 to 11 years old with sucking habits and difficulties in breathing. The documents are teleradiographies in norma lateralis made when the patient is in rest position. This study expounds vertical facial characteristics of this population through a statistical descriptive analysis and then through a correlative approach of those characteristics and some soft tissues measurements.

Orthodeoxia--arterial desaturation accentuated by the upright position and improved by recumbency--has been described earlier with true pulmonary vascular shunts and intracardiac shunts. This phenomenon has been described in some parenchymal lung diseases, but has not been reported with interstitial fibrosis. We describe 2 patients with predominantly basal interstitial fibrosis, disabling dyspnea, and severe hypoxemia who demonstrated this positional oxygenation change. Large or surgically correctable arteriovenous malformations (AVM), or intracardiac shunts, were not demonstrated in either patient. This finding has important implications for oxygen prescription and the explanation of positional dyspnea.