Exertional Dyspnea as a Symptom of Infrarenal Aortic Occlusive Disease

Advanced atherosclerosis of the aorta can cause severe ischemia in the kidneys, refractory hypertension, and claudication. However, no previous reports have clearly associated infrarenal aortic stenosis with shortness of breath. A 77-year-old woman with hypertension and hyperlipidemia presented with exertional dyspnea. Despite extensive testing and observation, no apparent cause for this patient's dyspnea was found. Images revealed severe infrarenal aortic stenosis. After the patient underwent stenting of the aortic occlusion, she had immediate symptomatic improvement and complete resolution of her dyspnea within one month. Twelve months after vascular intervention, the patient remained asymptomatic. In view of the distinct and lasting elimination of dyspnea after angioplasty and stenting of a nearly occluded infrarenal aortic lesion, we hypothesize that infrarenal aortic stenosis might be a treatable cause of exertional dyspnea. Clinicians should consider infrarenal aortic stenosis as a possible cause of dyspnea. Treatment of the stenosis might relieve symptoms.

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Covid-19 Associated Subdural Hematoma: A Case Report Intracranial Hemorrhage in the Setting of Covid-19

10.47363/jpmrs/2021(3)137 ◽

2021 ◽

pp. 1-2

Author(s):

Kirill Alekseyev ◽

Keyword(s):

Mental Status ◽

Intracranial Hemorrhage ◽

Subdural Hematoma ◽

Altered Mental Status ◽

Shortness Of Breath ◽

Intracranial Hemorrhages ◽

Angiotensin Converting Enzyme 2 ◽

Global Spread ◽

Thrombotic Complications ◽

Possible Cause

Coronavirus disease 2019 (COVID-19) is a pandemic that began in December 2019 as a result of the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We frequently associate COVID-19 with symptoms of fever, shortness of breath, and pneumonia; however, we are slowly uncovering the fact that systems other than the respiratory are being affected. We present a 60-year-old female who presented with altered mental status and was found to have COVID-19 induced subdural hematoma. Although intracranial hemorrhages are extremely rare in the setting of COVID-19, it is known that the affinity of SARS-CoV-2 to the angiotensin-converting enzyme 2 receptors, in addition to the cytokine storm, predisposes infected individuals to intracranial hemorrhages. Thus, it is crucial to consider intracranial hemorrhage as a possible cause of altered mental status in patients infected with COVID-19 and weigh the potential risk versus benefits of utilizing anticoagulants when managing the thrombotic complications of this virus.

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Pulmonary comorbidity in chronic lymphoproliferative diseases: realities of the problem in the Dnipro region

Medicni perspektivi (Medical perspectives) ◽

10.26641/2307-0404.2021.4.248090 ◽

2021 ◽

Vol 26 (4) ◽

pp. 62-67

Author(s):

K.Yu. Gashynova ◽

G.V. Usenko

Keyword(s):

Respiratory Function ◽

Chronic Respiratory Disease ◽

Community Acquired Pneumonia ◽

Chronic Obstructive ◽

Shortness Of Breath ◽

Lymphoproliferative Diseases ◽

Obstructive Pulmonary Disease ◽

Pulmonary Pathology ◽

Chronic Lymphoproliferative Diseases ◽

Possible Cause

The prevalence of the chronic lymphoproliferative diseases is increasing worldwide with increase of the population age. It is known that the presence of comorbidities in such patients plays an important role in predicting treatment outcomes. The aim of the work was to study the prevalence and determine the structure of respiratory symptoms and comorbid pulmonary pathology in patients with chronic lymphoproliferative diseases (CLPD) in the Dnipro region of Ukraine. After analyzing 986 cards of inpatients of the hematology department, whose average age was 65 (56; 69) years, it was determined that 9.0% of patients had at least one chronic respiratory disease, the most common among which were chronic bronchitis, chronic obstructive pulmonary disease, as well as community-acquired pneumonia. Dyspnea and tachypnea are also common among patients with CLPD without established respiratory comorbidity, cardiovascular disease, or anemia. Based on the data obtained, we can recommend a study of the respiratory function and pulse oximetry, as well as a thorough collection of anamnesis of smoking and analysis of the results of chest computed tomography in all patients with CLPD in order to identify the possible cause of shortness of breath and establish the presence of respiratory comorbidity.

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A case of worsening pulmonary arterial hypertension and pleural effusions by bosutinib after prior treatment with dasatinib

Pulmonary Circulation ◽

10.1177/2045893217733444 ◽

2017 ◽

Vol 7 (4) ◽

pp. 808-812 ◽

Cited By ~ 10

Author(s):

Karan Seegobin ◽

Amit Babbar ◽

Jason Ferreira ◽

Brittany Lyons ◽

James Cury ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Kinase Inhibitors ◽

Symptomatic Improvement ◽

Cor Pulmonale ◽

Chemotherapeutic Agents ◽

Shortness Of Breath ◽

Pleural Effusions ◽

Pulmonary Arterial ◽

One Year

A 52-year-old man with a past medical history of chronic myeloid leukemia (CML) in remission developed progressive shortness of breath over a two-month period. He was initially treated with dasatinib for four years, until developing pulmonary arterial hypertension (PAH) with pleural effusions. His symptoms improved after stopping dasatinib. He was then switched to bosutinib for approximately one year, which was then stopped before admission due to worsening shortness of breath. His initial workup showed bilateral pleural effusions with severe PAH and cor pulmonale. He had symptomatic improvement with PAH-specific therapy following discontinuation of the bosutinib. The life expectancy of CML patients has increased in the era of the tyrosine kinase inhibitors (TKIs), and managing adverse events (AEs) of the TKIs and improving quality of life are becoming more important. Pulmonary hypertension (PH) and pleural effusions are rarely reported AEs of bosutinib. More reports with PH and pleural effusions arising after bosutinib use in patients previously treated with dasatinib is furthermore concerning. In this era with novel chemotherapeutic agents, physicians ought to be weary of the significant morbidity implicated by these agents in the lives of patients.

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Surgical and endovascular venous arterialization for treatment of critical limb ischaemia

VASA ◽

10.1024/0301-1526/a000669 ◽

2018 ◽

Vol 47 (1) ◽

pp. 17-22 ◽

Cited By ~ 6

Author(s):

Michael Lichtenberg ◽

Michiel A. Schreve ◽

Roberto Ferraresi ◽

Daniel A. F. van den Heuvel ◽

Çagdas Ünlü ◽

...

Keyword(s):

Life Expectancy ◽

Bypass Surgery ◽

Present Review ◽

Critical Limb Ischaemia ◽

Limb Ischaemia ◽

Final Phase ◽

Vascular Intervention ◽

Endovascular Interventions ◽

History Of ◽

Angioplasty And Stenting

Abstract. Patients with critical limb ischaemia have a poor life expectancy. Aggressive revascularization is accepted in order to preserve their independence in the final phase of their lives. Bypass surgery and more recently endovascular interventions with angioplasty and stenting have become the treatment of choice to prevent amputation and to resolve pain. However, as many as 20 % of patients with critical limb ischaemia are unsuitable candidates for a vascular intervention because of extensive occlusions of outflow in the crural and pedal vessels. Such “no-option critical limb ischaemia” may be treated with venous arterialization. In the present review, we discuss the history of the venous arterialization procedure, the mechanisms, the different techniques, and complications of venous arterialization.

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THE RELATIONSHIP BETWEEN VITAMIN D AND THE CRANIOFACIAL AND DENTAL ANOMALIES OF THE SUPRAVALVULAR AORTIC STENOSIS SYNDROME

PEDIATRICS ◽

10.1542/peds.43.1.12 ◽

1969 ◽

Vol 43 (1) ◽

pp. 12-18

Author(s):

William F. Friedman ◽

Loren F. Mills

Keyword(s):

Vitamin D ◽

Aortic Stenosis ◽

Supravalvular Aortic Stenosis ◽

Dental Anomalies ◽

Enamel Hypoplasia ◽

Vitamin D Metabolism ◽

Aortic Lesion ◽

The Relationship ◽

Craniofacial Complex ◽

Aortic Lesions

There is evidence that a derangement in vitamin D metabolism on the part of the mother, the fetus, or both may be responsible for supravalvular aortic stenosis, especially when the latter is associated with infantile hypercalcemia. It has been shown that the offspring of rabbits given large amounts of parenteral vitamin D throughout pregnancy may be born with aortic lesions resembling supravalvular aortic stenosis as seen in man. The present study was designed to explore experimentally the relationship between exposure to excessive amounts of vitamin D during pregnancy and the development of the craniofacial complex and dentition because children with the multiple system abnormalities of the supravalvular aortic stenosis syndrome (SASS) share a characteristic craniofacial appearance and exhibit, in common, many abnormalities of dentition. Examination of their jaws and teeth reveals hypoplasia of the mandible, congenital absence of teeth (usually the lateral incisors and second premolars of the maxilla), microdontia, dysgnathia, enamel hypoplasia, and a narrowed occlusal table. In the present study, analogous findings were observed in rabbit offspring whose mothers received large amounts of vitamin D during pregnancy. The most marked functional accompaniment of these abnormalities was severe malocclusion of the teeth. Peculiar facies, premature closure of the cranial bones, strabismus, odd shaped ears, and a low birth weight were additional features of SASS that were noted in many test animals. Buphthalmos was also noted occasionally, probably related to maldevelopment of the bony ocular orbits. Thus, these experimental observations suggest that the cranial, facial, and dental peculiarities as well as the aortic lesion of the supravalvular aortic stenosis syndrome may be related to a derangement in vitamin D metabolism during pregnancy.

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Disease-driven symptoms and response to chemotherapy in treatment-naive patients with advanced non-small cell lung cancer (NSCLC).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9118 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9118-9118

Author(s):

Desiree Jones ◽

Elisabeth G. Vichaya ◽

Xin Shelley Wang ◽

Tito R. Mendoza ◽

Gary M. Mobley ◽

...

Keyword(s):

Lung Cancer ◽

Advanced Nsclc ◽

Intrinsic Value ◽

Symptomatic Improvement ◽

Cancer Center ◽

Shortness Of Breath ◽

Symptom Profile ◽

Response To Chemotherapy ◽

Treatment Naïve ◽

Md Anderson

9118 Background: The disease-driven symptoms of treatment-naïve patients with advanced NSCLC have not been the primary focus of previous studies. One reason for this gap in the literature is that randomized trials typically lack an opportunity to capture the symptom profiles of patients who are truly treatment-naïve. To address this need, this study sought to: (i) characterize the symptom profile of treatment-naïve patients with advanced NSCLC, and (ii) describe patients’ response to chemotherapy. Methods: The study sampleconsisted of43 treatment-naïve patients (no prior treatment by surgery, radiation, or chemotherapy) with a primary diagnosis of advanced NSCLC from the MD Anderson Cancer Center, and was derived from a larger study (Cleeland et al. J Clin Oncol 29:2859-65, 2011). Patients’ symptoms were assessed pre-chemotherapy, and then prospectively at 6, 12, and 18 weeks from initiation of chemotherapy using the MD Anderson Symptom Inventory Lung Cancer module. Results: The top symptoms reported by patients, in order of severity, were shortness of breath, fatigue, distress, sadness, drowsiness, and pain. Chemotherapy did not significantly improve shortness of breath, drowsiness, pain, disturbed sleep, lack of appetite, coughing, and constipation in this sample of patients, and was associated with a significant increase in levels of fatigue and numbness (mean difference in fatigue at 12 weeks from baseline = 2.8; 95% CI, 0.5–2.9; p = .01; and in numbness from baseline = 1.1; 95% CI, 0.2–2.0; p = .02). Conclusions: This study characterizes the disease-driven symptoms of truly treatment-naïve patients with advanced NSCLC. Knowledge of these symptoms is of intrinsic value in the clinical management of advanced NSCLC as it provides the critical reference point against which symptom palliation must be measured. Patients’ lack of symptomatic improvement from chemotherapy in this study suggests that this sub-set of patients may have had rapidly progressing disease and that chemotherapy may have prevented symptoms levels from worsening. Consistent with literature, transient but significant increase in both fatigue and numbness are chemotherapy-related toxicities.

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Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.117.006580 ◽

2017 ◽

Vol 10 (12) ◽

Cited By ~ 10

Author(s):

Rasmus Carter-Storch ◽

Jacob E. Møller ◽

Nicolaj L. Christensen ◽

Akhmadjon Irmukhadenov ◽

Lars M. Rasmussen ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Symptomatic Improvement ◽

Reverse Remodeling ◽

Normal Flow

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Supraglottic laryngeal sarcoidosis masquerading as supraglottitis

BMJ Case Reports ◽

10.1136/bcr-2019-232369 ◽

2020 ◽

Vol 13 (1) ◽

pp. e232369 ◽

Cited By ~ 1

Author(s):

Samuel Robert Leedman ◽

Thomas Hendriks ◽

Travis William Leahy ◽

David Hall

Keyword(s):

Differential Diagnosis ◽

Granulomatous Inflammation ◽

Mycobacterial Infection ◽

Symptomatic Improvement ◽

Shortness Of Breath ◽

Unknown Aetiology ◽

Multisystem Disorder ◽

Surgical Biopsy ◽

Pale Pink ◽

Laryngeal Involvement

Sarcoidosis is a rare multisystem disorder of unknown aetiology characterised by non-caseating granulomas in involved organs; it is a diagnosis of exclusion. Laryngeal involvement affects only 0.5%–5% of those with sarcoidosis. It is an uncommon but important cause of supraglottic inflammation and oedema and should be considered in the differential diagnosis in patients with supraglottitis. This case describes a 30-year-old man who presented with stridor and shortness of breath. Flexible nasendoscopic examination revealed a grossly oedematous, pale pink, diffusely hypertrophied epiglottis. Surgical biopsy revealed non-caseating granulomatous inflammation. In the context of exclusion of hepatitis, anti-neutrophil cytoplasmic antibody (ANCA) positivity, malignancy and mycobacterial infection, the diagnosis of supraglottic laryngeal sarcoid was made. He is being treated with azathioprine immunosuppression with symptomatic improvement.

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