OBJECTIVETo analyze the causes and the clinical characteristics of the neonatal inspiratory dyspnea; so to raise the diagnosis and cure rate of the disease.

METHODSEleven new born infants with severe inspiratory dyspnea were investigated from March, 2001 to June, 2004 in Shenzhen children's hospital. Six infants were male and 5 were female. The average age was 7.2 days ( range from 8 hours to 28 days). Four cases were hospitalized with trachea intubation. Three of them can not cry, and 2 cases were diagnosed as bilateral vocal cord paralysis, 1 case as multiple cranial nerve palsy with direct laryngoscopy. Two cases couldn't drink milk continuously and accompanied with deteriorated inspiratory dyspnea, and were diagnosed as congenital adenoid hypertrophy and neonatal rhinitis respectively with compute tomography and magnetic resonance imaging. Among the 6 cases with persistent inspiratory dyspnea, four of them were diagnosed as congenital laryngocele by direct laryngoscope, one case was diagnosed as subglottic stenosis by tracheoscopy and one case was confirmed to be thoracic tracheostenosis when tracheotomy performed.

RESULTSFour congenital laryngoceles and one case congenital adenoid hypertrophy were cured with surgery. Two bilateral vocal cord paralysies and one case of subglottic stenosis received tracheotomy. One neonatal rhinitis case applied 0.25% ephedrine. One case of thoracal tracheostenosis died. The parents of the infant with multiple cranial nerve palsy refused to accept any treatment.

CONCLUSIONSThe laryngoscope examination is recommended for patients with neonatal inspiratory dyspnea. It is necessary for patients with persistent dyspnea to be examined by tracheoscopy as early as possible.

Malignant pleural mesothelioma (MPM) is an aggressive, treatment-resistant, and generally fatal disease. A 68-year-old male who was diagnosed with MPM at another hospital came to our hospital with dyspnea. We advised him to take combination chemotherapy but he refused to take the treatment. That was because he had already received chemotherapy with supportive care at another hospital but his condition worsened. Thus, we recommended photodynamic therapy (PDT) to deal with the dyspnea and MPM. After PDT, the dyspnea improved and the patient then decided to take the combination chemotherapy. Our patient received chemotherapy using pemetrexed/cisplatin. Afterwards, he received a single PDT treatment and then later took chemotherapy using gemcitabine/cisplatin. The patient showed a survival time of 27 months, which is longer than median survival time in advanced MPM patients. Further research and clinical trials are needed to demonstrate any synergistic effect between the combination chemotherapy and PDT.
Aged ; Drug Therapy* ; Drug Therapy, Combination ; Dyspnea ; Humans ; Male ; Mesothelioma* ; Photochemotherapy* ; Pleura

Medically unexplained dyspnea refers to a group of patients presenting marked dyspnea without structural alterations of organs/systems after thorough examinations. This clinically neglected group of patients accounts for about 14% of patients with dyspnea in secondary health care. They appear very difficult to manage clinically. In this paper an organized approach used to diagnose medically unexplained dyspnea is presented. Breathing re-training is recommended as a therapy for those "difficult to treat patients".
Breathing Exercises ; Diagnosis, Differential ; Dyspnea ; diagnosis ; psychology ; therapy ; Humans ; Psychophysiologic Disorders ; diagnosis ; therapy

OBJECTIVETo study the rehabilitation effects ergometry on COPD patients.

METHODSThirty COPD out-patients in our Hospital were randomly divided into 2 groups. Rehabilitation group, 15 patients, performed leg ergometry exercise of 80% peak Watt x 30min/d x 3d/w x 12w. Another 15 patients were control group without exercise. All patients received conventional therapy. Pulmonary function testing (PFT), cardiopulmonary exercise testing (CPET), arterial blood gas analysis (ABG), Borg and CAT sores were done at both baseline and 12 w.

RESULTSThere was no statistically difference in lung function testing, blood gas analysis and cardiopulmonary exercise test when pre- exercises between 2 sub-groups. The IC, peak VO2 and peak, W of rehabilitation group significantly increased (P < 0.05); and Borg and CAT.scores significantly decreased (P < 0.05) from baseline; and other PFT and ABG did not change (P > 0.05). While there was no difference in control group (P > 0.05).

CONCLUSIONLeg submaximal ergometry rehabilitation improves health condition and ameliorate dyspnea symptoms in COPD patients.

Pleuropulmonary blastoma (PPB) is a rare primary malignant neoplasm with poor prognosis in children. PPB originates from the lung, the pleura, or the mediastinum. Histologically, it is characterized by a primitive, mixed blastematous, sarcomatous appearance and the absence of epithelial cell. Initial presenting symptoms are cough, fever and dyspnea. We experienced two cases of PPB (type I and type II). Complete surgical removal is always required for the treatment and chemotherapy and radiotherapy is needed as adjuvant therapy. We report two cases of pleuropulmonary blastoma treated with surgical removal, chemotherapy (vincristine, actinomycin D, cyclophosphamide) and radiotherapy.
Child* ; Cough ; Dactinomycin ; Drug Therapy ; Dyspnea ; Epithelial Cells ; Fever ; Humans ; Lung ; Mediastinum ; Pleura ; Prognosis ; Radiotherapy

A 76 year-old female who was diagnosed with multiple myeloma (IgG, lambda) had received bortezomib, melphalan and prednisolone as first-line treatment. After completing six cycles of chemotherapy, her serum monoclonal protein level decreased from 7.28 g/dL to 0.65 g/dL, indicating a partial response. However, at the next scheduled visit she complained of slowly progressing dyspnea. On chest X-ray, newly developed pleural effusion was found, and rapidly progressing extramedullary plasmacytoma was detected in the anterior mediastinum on chest computerized tomography. However, there was no change in her serum monoclonal protein level. In Korea, extramedullary involvement is encountered in 5% of patients with multiple myeloma. However, evaluation of treatment response using solely the serum monoclonal protein level may not accurately reflect disease status in these patients.
Drug Therapy ; Dyspnea ; Female ; Humans ; Korea ; Mediastinum ; Melphalan ; Multiple Myeloma* ; Plasmacytoma* ; Pleural Effusion ; Prednisolone ; Thorax ; Bortezomib

Choriocarcinoma associated with a normal pregnancy is rare. Especially, choriocarcinoma coexistent with a viable pregnancy is even rarer and commonly presents with widespread metastatic disease. We experienced a patient at 34th week of pregnancy with dyspnea and sputum production due to pulmonary metastasis of choriocarcinoma. The serum B-hCG level was extremely elevated and the placenta had multifocal choriocarcinoma. After vaginal delivery, the patient was successfully treated with combination chemotherapy (EMA-CO). The patient is receiving follow up with monthly measurement of hCG values. We report one case of metastatic choriocarcinoma with viable pregnancy with review of literature.
Choriocarcinoma* ; Drug Therapy, Combination ; Dyspnea ; Female ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Placenta ; Pregnancy ; Pregnancy* ; Sputum

Tracheal papillomatosis is rare. When the disease starts during childhood, it usually appears to be self-limiting if properly managed. In adults, however, the disease sometimes rims a more protracted course with a higher risk of developing cancer. The tumors are derived from the tracheal surface epithelium and tracheal mucous glands and usually grow exophytically. Treatment has traditionally been with repeated endoscopic resection. However, in view of its viral origin, attempts have been made to control the disease with interferon. A67 years-old man was presented with exertional dyspnea. He was treated for bronchial asthma at another hospital. There was no improvement in his symptom. lie was referred to this hospital, and a bronchoscopic biopsy showed tracheal papillomatosis. lie was undergone bronchoscopic laser therapy with symptomatic improvement.
Adult ; Airway Obstruction* ; Asthma ; Biopsy ; Dyspnea ; Epithelium ; Humans ; Interferons ; Laser Therapy ; Papilloma*

Bronchoscopy ; adverse effects ; methods ; Dyspnea ; diagnosis ; therapy ; Female ; Humans ; Infant ; Infant, Newborn ; Male

Pericardial drainage is an important diagnostic and therapeutic option in the symptomatic patient with large amount of pericardial effusion (PE). However, when the amount of PE is relatively small, physicians are often reluctant to perform the invasive drainage of the fluid due to the increased risk of causing myocardial injury during the procedure. Even in some cases of suspected pericarditis with small amount PE, an initial empirical anti-inflammatory therapy is often recommended. A 65-year-old woman presented with mild dyspnea for two weeks. The echocardiography revealed small amount of PE. A careful fluoroscopy-guided pericardiocentesis, subsequent pericardial fluid cytology, and thorough whole body check-up demonstrated adenocarcinoma with no proven primary site. After the palliative chemotherapy, she had survived for 15 months until her death due to asphyxia. Although pericardiocentesis is considered dangerous in small amount of PE, a prompt and careful drainage may provide early detection of hidden malignancy and better survival outcome.
Adenocarcinoma* ; Aged ; Asphyxia ; Drainage ; Drug Therapy ; Dyspnea ; Echocardiography ; Female ; Humans ; Pericardial Effusion* ; Pericardial Fluid ; Pericardiocentesis* ; Pericarditis