1/14. The iowa follow-up of chemically sensitive persons.Clinical symptoms and self-reported health status in persons reporting multiple chemical sensitivities (MCS) are presented from a 9-year follow-up study. Eighteen (69%) subjects from a sample of 26 persons originally interviewed in 1988 were followed up in 1997 and given structured interviews and self-report questionnaires. In terms of psychiatric diagnosis, 15 (83%) met DSM-IV criteria for a lifetime mood disorder, 10 (56%) for a lifetime anxiety disorder, and 10 (56%) for a lifetime somatoform disorder. Seven (39%) of subjects met criteria for a personality disorder using the personality Diagnostic Questionnaire-IV. Self-report data from the illness behavior Questionnaire and Symptom checklist-90-Revised show little change from 1988. The 10 most frequent complaints attributed to MCS were headache, memory loss, forgetfulness, sore throat, joint aches, trouble thinking, shortness of breath, back pain, muscle aches, and nausea. Global assessment showed that 2 (11%) had "remitted", 8 (45%) were "much" or "very much" improved, 6 (33%) were "improved", and 2 (11%) were "unchanged/worse". Mean scores on the SF-36 health survey showed that, compared to U.S. population means, subjects reported worse physical functioning, more bodily pain, worse general health, worse social functioning, and more emotional-role impairment; self-reported mental health was better than the U.S. population mean. All subjects maintained a belief that they had MCS; 16 (89%) acknowledged that the diagnosis was controversial. It is concluded that the subjects remain strongly committed to their diagnosis of MCS. Most have improved since their original interview, but many remain symptomatic and continue to report ongoing lifestyle changes.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/14. Beneficial effect of cibenzoline on left ventricular pressure gradient with sigmoid septum.An 83-year-old woman with hypertension was admitted to hospital with episodes of dyspnea on effort after having breakfast. physical examination revealed a systolic murmur at the left sternal border in the third to fourth intercostal space. Cross-sectional echocardiography showed a sigmoid-shaped interventricular septum markedly protruding into the left ventricle, concentric left ventricular hypertrophy, systolic anterior motion of the mitral valve, and a resultant left ventricular outflow tract obstruction with a pressure gradient of 121.8 mmHg. She began daily treatment with 60 mg metoprolol. However, the chest symptoms were not relieved and the left ventricular outflow tract obstruction was still visible on echocardiography. She was then given 200 mg daily of cibenzoline, in addition to 40 mg metoprolol, and the left ventricular pressure gradient significantly decreased and she was free of symptoms without any complications. This case shows that cibenzoline may be useful in the treatment of left ventricular outflow tract obstruction caused by sigmoid septum.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/14. eucalyptus as a specific irritant causing vocal cord dysfunction.BACKGROUND: vocal cord dysfunction (VCD) is a well-recognized clinical entity that frequently mimics asthma and is characterized by inappropriate adduction of the vocal cords during inspiration. The pathogenesis of VCD has not yet been defined. The only previous report suggested that respiratory irritants may trigger paradoxical motion of the vocal cords. OBJECTIVE: To report the case of a 46-year-old woman with VCD precipitated by eucalyptus exposure. methods: A masked flexible fiberoptic nasolaryngoscopy was performed to confirm whether VCD occurred with eucalyptus and not with other known respiratory irritants. The patient underwent inhalation challenges consisting of water, ammonia, pine oil, and a combination of eucalyptus (dried leaves) and ammonia. Two independent observers before patient challenge could not identify eucalyptus. RESULTS: Vocal cord dysfunction occurred within minutes of exposure to eucalyptus. This is the first report to prospectively document that a specific irritant, eucalyptus, can precipitate VCD. Negative skin prick test results, total IgE level, and negative IgE eucalyptus-specific antibodies support a nonimmunologic mechanism. CONCLUSIONS: A new pathogenic mechanism for this clinical entity is supported by our observations. Furthermore, a nonimmunologic mechanism in which respiratory irritants may induce VCD is suspected. Future studies to elucidate this mechanism need to be performed in individuals with irritant-specific VCD.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/14. Whole lung lavage in the treatment of pulmonary alveolar proteinosis.Although a rare condition, pulmonary alveolar proteinosis (PAP) can be a very devastating diagnosis with life-altering consequences. This case study follows the path of a young woman who is currently undergoing whole lung lavage as treatment for pulmonary alveolar proteinosis. The entire concept of flooding a lung with large quantities of saline as a treatment for lung disease is contrary to normal respiratory care. Caring for the patient with PAP provides many challenges for the perianesthesia nurse. Management of the postanesthesia airway, oxygen administration and maintenance of oxygen saturation, and pain relief skills are all of high importance to the patient with PAP. These skills plus the emotional support provided by the experienced perianesthesia nurse can ensure a safe recovery from this unusual procedure.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/14. Inspiratory muscle training in exercise-induced paradoxical vocal fold motion.The purpose of the study was to determine if inspiratory muscle training (IMT) would result in increased inspiratory muscle strength, reduced perception of exertional dyspnea, and improved measures of maximal exercise effort in an athlete with exercise-induced paradoxical vocal fold motion (PVFM). The participant, an 18-year-old woman, had a 2-year history of acute dyspnea with exertion during soccer games. spirometry, transnasal flexible laryngoscopy, and patient history supported a PVFM diagnosis. The ABAB within-subject withdrawal design study comprised IMT treatment and withdrawal phases, each lasting 5 weeks. The participant trained 5 days per week, completing five sets of 12 breaths at 75% maximum inspiratory pressure (MIP) per session. Data consisted of MIP, exertional dyspnea ratings, and maximal exercise measures. IMT resulted in increased MIP and decreased dyspnea ratings across both treatment phases. No change in MIP or dyspnea ratings occurred in response to treatment withdrawal. The maximal exercise test revealed minimal changes across phases. At end of the study, the participant reported experiencing no PVFM symptoms when performing the outcome measurement tasks and when playing soccer. Transnasal flexible laryngoscopy, after strenuous exercise and during rapid breathing and phonation tasks, revealed normal laryngeal findings. The findings suggest that IMT may be a promising treatment approach for athletes with exercise-induced PVFM.- - - - - - - - - - ranking = 5keywords = motion (Clic here for more details about this article) |
6/14. Inspiratory muscle training in Morquio's syndrome: a case study.We reported a case of MPS IV A presented with dyspnea on exertion and respiratory muscle weakness. The patient underwent inspiratory muscle training (IMT) using threshold loading for 18 weeks. After 6 weeks of initial IMT, aerobic exercise training consisting of walking was added to the treatment program. Inspiratory muscle strength increased 70%, and 6-minute walk test (6MWT) distance increased to 47 m. With the inclusion of aerobic exercise training, additional increases in inspiratory muscle strength (7%) and 6MWT distance (26.5 m) were obtained. Exertional dyspnea improved from severe to slight after 6 weeks of IMT, and to very slight after additional 12 weeks of combined aerobic training and IMT. Health-related quality of life improved especially in social function, emotional function, vitality, and physical role. In conclusion, inspiratory muscles can be trained with the improvement of muscle strength in a patient with Morquio's syndrome.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/14. Unexplained severe pulmonary hypertension in two brothers.Unexplained pulmonary hypertension of nearly simultaneous onset is reported in two brothers, aged 17 and 26 yrs. echocardiography revealed right ventricular hypertrophy and dilatation, paradoxical septal motion and an enlarged main pulmonary artery. In the right catheterization highly elevated pulmonary arterial pressures (107/58 and 84/46 mmHg) were seen. Doppler echocardiography showed significant leakage of the pulmonary and tricuspid valves in the younger brother, who died suddenly three weeks later. An initial decline in pulmonary arterial systolic pressure was achieved in the older brother by drug therapy. Eight months later, however, the pressure had risen to the pretreatment level. Dyspnoea increased and the patient underwent heart-lung transplantation but subsequently died. In the family study a third brother, father and mother were healthy.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/14. Pulsus alternans with alternation of mitral flow and motion patterns.A 41-year-old man with dilated cardiomyopathy had persistent pulsus alternans on physical examination and on cardiac catheterization. On M-mode echocardiography patterns of mitral valve diastolic motion showed alternation such that the E phase was longer and the A phase shorter after stronger ventricular contractions. At faster rates the A peak was apparently absent in alternate diastoles. Doppler recordings of mitral flow exhibited alternation such that the peak velocity and duration of early diastolic flow were larger after stronger ventricular contractions; diastolic mitral regurgitation was noted only in such (alternate) diastoles.- - - - - - - - - - ranking = 5keywords = motion (Clic here for more details about this article) |
9/14. Athletic training in chronic obstructive pulmonary disease.Chronic obstructive pulmonary disease (COPD) is a common and very debilitating disease in the united states. COPD is characterized by plugging of airways with secretions, impaired airway integrity with airway collapse with effort, bronchospasm, frequent infections, destruction of alveolar tissue, and ventilation-to-perfusion inequality. This results in abnormalities in pulmonary mechanics and respiratory gas exchange, all of which make hyperventilation much less effective. However, research has shown that the pulmonary patient can improve work capacity in an exercise training program. Training also alleviates the severe emotional problems of anxiety, depression, and social isolation frequently present in COPD sufferers. Even the lowest level patient can frequently improve in a training program, and guidelines for the implementation of such a therapeutic regimen are provided.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/14. Relation of dyspnea to left ventricular wall motion disturbances in a population of 67-year-old men.dyspnea, a potential early symptom of coronary artery disease and congestive heart failure, was evaluated to establish its relation to left ventricular wall motion abnormalities. A group of 67-year-old men, drawn from the general population of Gothenburg, sweden, was studied. Acceptable studies by 2-dimensional echocardiography were obtained from 42 of 49 men with dyspnea of presumed cardiac origin, and from 45 randomly selected nondyspneic control subjects. Both groups originated from a random population sample of 644 men. All men with akinesia, not limited to the basal inferolateral segment, were dyspneic. Akinesia (inferolateral segment only) was found in 4 of 45 control subjects (9%). Six of 20 men (30%) with low-grade dyspnea and 5 of 5 men with the most severe grade of dyspnea had 1 or more akinetic segments. The severity of dyspnea was related to regional wall motion disturbances (as classified in 11 anatomic segments [p less than 0.02 to p less than 0.0001]) and to presence and number of akinetic segments (p less than 0.0001). The degree of dyspnea was correlated to anterior (p less than 0.0001) but not inferior akinesia. The regional wall motion disturbances measured by echocardiography still contributed significantly to the explanation of dyspnea when taking into account the presence or absence of clinical coronary artery disease determined from a 12-lead electrocardiogram, the history of angina pectoris and myocardial infarction, and the findings on chest x-ray films. Thus, presumed cardiac dyspnea is a sensitive marker of regional wall motion disturbances. Furthermore, the location of these disturbances may be of importance for the hemodynamic changes leading to cardiac dyspnea.- - - - - - - - - - ranking = 8keywords = motion (Clic here for more details about this article) |
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