BACKGROUNDAlthough chest radiography is a useful examination tool, it has limitations. Because not all chest conditions can be detected on a radiograph, radiography cannot necessarily rule out all irregularities in the chest. Therefore, further imaging studies may be required to clarify the results of a chest radiograph, or to identify abnormalities that are not readily visible. The aim of this study was to compare traditional chest radiography with acoustic-based imaging (vibration response imaging) for the detection of lung abnormalities in patients with acute dyspnea.

METHODSThe current investigation was a pilot study. Respiratory sounds throughout the respiratory cycle were captured using an acoustic-based imaging technique. Consecutive patients who presented to the emergency department with acute dyspnea and a normal chest radiograph on admission were enrolled and underwent imaging at the time of presentation. Dynamic and static images of vibration (breath sounds) and a dynamic image score were generated, and assessments were made using an evaluation form.

RESULTSIn healthy volunteer controls (n = 61), the mean dynamic image score was 6.3 ± 1.9. In dyspneic patients with normal chest radiographs (n = 51) and abnormal chest radiographs (n = 48), the dynamic image scores were 4.7 ± 2.7 and 5.1 ± 2.5, respectively (P < 0.05). The final assessment of the vibration images indicated abnormal findings in 15%, 86% and 90% of the participants in the above groups, respectively (P < 0.05).

CONCLUSIONSIn patients with acute dyspnea who present with normal chest radiographs, respiratory sound analyses often showed abnormal values. Hence, the ability of acoustic-based recordings to offer objective and noninvasive measurements of abnormal sound transmission may be useful in the clinical setting for patients presenting with acute dyspnea.

Adult ; Dyspnea ; physiopathology ; Emergency Service, Hospital ; Female ; Humans ; Lung ; physiopathology ; Male ; Middle Aged ; Respiratory Sounds ; physiopathology

Cough ; diagnosis ; physiopathology ; Dyspnea ; diagnosis ; physiopathology ; Female ; Humans ; Hyperparathyroidism, Primary ; diagnosis ; physiopathology ; Middle Aged

OBJECTIVES: Dyspnea and palpitation are common features of pregnancy. While several theories have been put forward to explain the etiology of gestational dyspnea and palpitation, there have been few systemic studies of its incidence, severity and time-course in a group of normal women. METHODS: We interviewed postpartum women, within 3 days after delivery, about dyspnea and palpitation. Separately from this interview, we performed 24-hour ECG monitoring for obstetric patients with palpitation before delivery. RESULTS: The subjects interviewed were 261 women, of whom 37.5 percent and 11.5 percent experienced dyspnea and palpitation, respectively. These symptoms had a tendency to increase to term. The presence of arrhythmias could be documented in only 22% of patients having 24-hour Holter monitoring. CONCLUSION: Dyspnea and palpitation were common among normal pregnant women and had a tendency to increase to term.
Adult ; Arrhythmia/*physiopathology ; Dyspnea/*physiopathology ; Electrocardiography, Ambulatory ; Female ; Human ; Pregnancy ; Pregnancy Complications/*physiopathology ; Time Factors

BACKGROUNDThe Borg scale is most commonly used to measure dyspnea in China. However, many patients that find it is difficult to distinguish the labeled numbers corresponding to different dyspnea scores. We developed a new method to rate dyspnea, which we call the count scale (CS). It includes the count scale number (CSN) and count scale time (CST). The aims of the present study were to determine the reproducibility and sensitivity of the CS during exercise in patients with chronic obstructive pulmonary disease (COPD).

METHODSFourteen male patients with COPD (aged 58.00 ± 7.72 years) participated in this study. A progressive incremental exercise and a 6-minute constant work exercise test were performed every 2 to 3 days for a total of 3 times. The CS results were evaluated at rest and at 30% and 70% of maximal workload (Wmax) and Wmax. The Borg scales were obtained during exercise.

RESULTSNo significant differences occurred across the three trials during exercise for the CS and Borg scores. The CSN and CST were more varied at Wmax (coefficient of variation (CV) = (22.28 ± 16.96)% for CSN, CV = (23.08 ± 19.11)% for CST) compared to 30% of Wmax (CV = (11.92 ± 8.78)% for CSN, CV = (11.16 ± 9.96)% for CST) and 70% of Wmax (CV = (9.08 ± 7.09)% for CSN, CV = (12.19 ± 12.32)% for CST). Dyspnea ratings with either CSN or CST tended to decrease at the higher workload compared to the lower workload. CSN and CST scores were highly correlated (r = 0.861, P < 0.001). CSN was negatively correlated with Borg scores (r = -0.363, P = 0.001). Similar results were obtained for the relationship between CST and Borg scores (r = -0.345, P = 0.003).

CONCLUSIONWe concluded that the CS is simple and reproducible when measuring dyspnea during exercise in patients with COPD.

Aged ; Dyspnea ; diagnosis ; Exercise ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; Reproducibility of Results

Aged ; Aortic Aneurysm, Thoracic ; physiopathology ; Dyspnea ; etiology ; Humans ; Male ; Oxygen ; blood ; Supine Position ; physiology

OBJECTIVETo retrospectively review the perioperative management for primary tracheal malignant tumors resected under cardiopulmonary bypass.

METHODSThe data of 6 patients with primary tracheal malignant tumors who underwent surgery under cardiopulmonary bypass from December 1999 to August 2003 were reviewed. Cardiopulmonary bypass was established through right femoral vessels in 2 patients for emergency operation, through right atrium and ascending aorta in 4 patients. Sleeve tracheal resections in 3 patients, carinal resections and carina reconstructions in 2, and local enucleation in 1 were performed. Respiratory airway was kept patent by coughing and expectorating sputum.

RESULTSAll patients' dyspnea were relieved remarkably. The postoperative mechanic ventilation assistance lasted from 10 hours to 7 days. There was no perioperative mortality.

CONCLUSIONResection of primary tracheal malignant tumors with severe tracheal obstruction under cardiopulmonary bypass is practicable. Keeping respiratory airway patent perioperatively is very important and helpful to postoperative recovery.

Adult ; Carcinoma, Adenoid Cystic ; physiopathology ; surgery ; Cardiopulmonary Bypass ; Dyspnea ; surgery ; Female ; Humans ; Male ; Middle Aged ; Perioperative Care ; Respiration, Artificial ; Retrospective Studies ; Tracheal Neoplasms ; physiopathology ; surgery ; Tracheotomy ; methods

Diagnosis, Differential ; Dyspnea, Paroxysmal ; etiology ; physiopathology ; Humans ; Infant, Newborn ; Male ; Meningocele ; complications ; diagnosis ; diagnostic imaging ; physiopathology ; Nasopharynx ; abnormalities ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVETo investigate the effects of inspiratory muscle training followed by non-invasive positive pressure ventilation in patients with severe chronic obstructive pulmonary disease (COPD).

METHODSThis investigator-initiated randomized, controlled trial recruited 88 patients with stable GOLD stage IV COPD, who were randomized into 4 equal groups to continue oxygen therapy (control group) or to receive inspiratory muscle training followed by non-invasive positive pressure ventilation (IMT-NPPV group), inspiratory muscle training only (IMT group), or noninvasive positive pressure ventilation only (NPPV group) for at least 8 weeks. The outcomes of the patients were assessed including the quality of life (SRI scores), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), dyspnea (MRC scores), 6-min walking distance (6MWD) and lung function.

RESULTSs Compared to baseline values, SRI scores, 6MWT and MRC scores increased significantly after 8 weeks in IMT-NPPV, IMT and NPPV groups, and the improvements were significantly greater in IMT-NPPV group than in IMT and NPPV groups (P<0.05 for all). In IMT-NPPV and IMT groups, MIP and MEP increased significantly after the training (P<0.05), and the improvement was more prominent in IMT-NPPV group (P<0.05). No significant changes were found in pulmonary functions in the groups after 8 weeks of treatment (P>0.05).

CONCLUSIONInspiratory muscle training followed by non-invasive positive pressure ventilation, compared with inspiratory muscle training or non-invasive positive pressure ventilation alone, can better enhance the quality of life, strengthen the respiratory muscles, improve exercise tolerance and relieve the dyspnea in patients with COPD.

Dyspnea ; therapy ; Exercise Tolerance ; Humans ; Lung ; physiopathology ; Noninvasive Ventilation ; Physical Conditioning, Human ; Positive-Pressure Respiration ; Pulmonary Disease, Chronic Obstructive ; therapy ; Quality of Life ; Respiratory Muscles ; physiopathology

AIMTo study the relationships between dyspnea and respiratory drive or respiratory muscle function in COPD.

METHODSThirty-one patients with COPD and 26 normal subjects were involved in the study. Routine pulmonary function, pulmonary diffusing capacity, P0.1, PI(max) were measured at rest. Oxygen consumption (VO2), carbon dioxide production (VCO2), minute ventilation (VE) etc were observed during exercise test. Dyspnea was assessed with Borg Scale (BS) simultaneously. Arterial blood gas measured before and after exercise.

RESULTS(1) PI(max) of COPD (5.33 +/- 1.95) kPa decreased compared with the normal subjects (7.02 +/- 2.53) kPa, P < 0.05, P0.1 of COPD (0.37 +/- 0.12) kPa increased compared with the normal subjects (0.26 +/- 0.09) kPa, P < 0.05, inspiratory drive efficacy (V(T)/P0.1) of COPD (1.6 +/- 0.31) L/kPa decreased than that of the normal subjects (2.1 +/- 0.53) L/kPa, P < 0.05. P0.1/PI(max) of COPD (0.069 +/- 0.021) was higher than that of the normal individuals (0.037 +/- 0.009), P < 0.01. (2) Peak exercise dyspnea was correlated with dyspnea at rest and P0.1/PI(max) (r = 0.41, P < 0.05 and r = 0.48, P < 0.05, respectively), and P0.1/PI(max) was also positively correlated with the change in BS from rest to maximal exercise (deltaBS) (r = 0.44, P < 0.05) in COPD patients.

CONCLUSIONIn COPD, breathlessness during exercise is not simply related to hyperinflation and the damaged gas exchange, but also to the relatively increased respiratory drive and dysfunction of respiratory muscle.

Adult ; Case-Control Studies ; Dyspnea ; etiology ; physiopathology ; Exercise Test ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; Respiratory Function Tests

BACKGROUNDChronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are two chronic diseases that affect negatively the functional condition and quality of life of patients. We assessed the effect of symptoms and clinical variables on the functional capacity and quality of life in COPD and CHF patients.

METHODSThe study included 42 COPD and 39 CHF patients. In both patient groups, dyspnea was assessed using Borg scale; functional capacity by shuttle-walk and cardiopulmonary exercise test and quality of life by short form-36 (SF36).

RESULTSNo statistically significant difference was found in neither of the two disease groups regarding the dyspnea score, shuttle-walk test and the majority of subgroup scores of SF36 (P > 0.05). A statistically significant difference was observed in peak VO2 in favor of COPD group (P < 0.05). No significant relationship was established between dyspnea score and forced expiratory volume in one second (FEV1) in COPD patients, and left ventricular ejection fraction (LVEF) in CHF patients (P > 0.05). A significant negative correlation was observed between dyspnea score and functional capacity tests in both disease groups (P < 0.05). On the other hand, no relationship was found between LVEF and FEV1 and quality of life and functional capacity (P > 0.05).

CONCLUSIONSIt was revealed that symptoms have an impact on functional capacity and quality of life in both disease groups, however, objective indicators of disease severity do not show a similar relationship. Therefore, in addition to the objective data related to the disease, we recommend that symptoms should also be taken into consideration to assess cardiopulmonary rehabilitation program and during following-up.

Adult ; Aged ; Dyspnea ; psychology ; Female ; Forced Expiratory Volume ; Heart Failure ; physiopathology ; psychology ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; psychology ; Quality of Life ; Ventricular Function, Left