PubMed Health⌕ Search

Biomedical subjects

M Lertzman

Publications and source records attributed to M Lertzman.

18 recordsLinked to original sources
PubMed2001

Dyspnea in cancer patients: prevalence and associated factors.

The objectives of this study were to determine the prevalence of dyspnea in the general cancer population, the intensity of the symptom as perceived by the patient, and the patient characteristics associated with the presence of dyspnea. Nine hundred and twenty-three cancer outpatients completed visual analogue scales (VAS) and verbal rating scales (VRS-D) to assess the intensity of their dyspnea. Baseline data included variables that were known covariates of dyspnea. Forty-six percent of the patients had some shortness of breath. Only 4% had a diagnosis of lung cancer and 5.4% lung metastases. Risk factors found to be significantly related to the presence of dyspnea were history of smoking; asthma or chronic obstructive pulmonary disease (COPD); lung irradiation; or a history of exposure to asbestos, coal dust, cotton dust or grain dust (P values from 0.001 to 0.038). The prevalence of dyspnea was strongly related to the number of risk factors a patient had (P < 0.0001). The VAS and VRS-D were significantly correlated, establishing concurrent validity for the VRS-D.

Canada↗
PubMed2001

Physiological changes and clinical correlations of dyspnea in cancer outpatients.

The purposes of this cross-sectional study of 75 outpatients of a general oncology clinic were to assess the subjective and objective factors associated with dyspnea in cancer patients and to characterize factors that might contribute to respiratory muscle weakness demonstrated in a previous study. Patients with moderate to severe shortness of breath completed visual analogue scales (VAS) of shortness of breath (SOB) and anxiety; other data were acquired from pulmonary function tests, including maximum inspiratory pressure (MIP) and expiratory pressures; chest radiography; arterial blood gases; measurement of hemoglobin, serum potassium, phosphate, calcium, albumin, and magnesium; and ultrasound study of the diaphragm for thickness and excursion. The correlation coefficient between SOB VAS and anxiety VAS was 0.26 (P = 0.03). In stepwise multiple regression analyses, only the regression coefficient for anxiety remained significant at P < 0.05 in the multivariate model with SOB VAS as the dependent variable. The multivariate model using MIP (a measure of respiratory muscle strength) as the dependent variable, found significance for total diaphragmatic excursion, hemoglobin, phosphate, residual volume over total lung volume, vital capacity, percent predicted total lung capacity, oxygen saturation, and forced vital capacity. The regression coefficients for these variables were significant at P < 0.05 and the model accounted for 58% of the variance of MIP.

Adult↗
PubMed1998

Dyspnea in the advanced cancer patient.

Optimal management of dyspnea in terminal cancer patients requires an understanding of the responsible pathophysiological mechanisms. This prospective study assessed visual analogue scales (VAS) of shortness of breath (SOB) and anxiety, bedside spirometry, maximum inspiratory pressure (MIP), chest radiography, arterial blood gases, hemoglobin, and electrocardiogram, if indicated, in 100 terminally ill cancer patients. Forty-nine percent of the patients had lung cancer. The median VAS scores for SOB and anxiety were 53 mm and 29 mm, respectively. Spirometry was abnormal in 93% of patients, with 5% having obstructive, 41% restrictive, and 47% mixed patterns. The median MIP was 16 cm H2O. Sixty-five percent of the patients had parenchymal or pleural involvement on chest radiograph. Twenty-nine percent had evidence of cardiac ischemia, recent or current myocardial infarction or atrial fibrillation. Patients had a median of five different abnormalities that could have contributed to their shortness of breath. Only anxiety (p = 0.001), a history of smoking (p = 0.02), and pCO2 levels were statistically significantly correlated with SOB VAS scores. The potentially correctable causes of dyspnea included hypoxia (40%), anemia (20%), and bronchospasm (52%). The finding of very low MIPs suggests severe respiratory muscle weakness may contribute significantly to dyspnea in this patient population. Further studies are needed to confirm this finding and characterize the underlying pathophysiology.

Adult↗
PubMed1997

Direct administration of charcoal into the lung and pleural cavity.

We report the inadvertent administration of activated charcoal in water into the right lung and pleural cavity of a 51-year-old man being treated for a salicylate overdose. A mild chemical pneumonitis developed, as did a sterile empyema. Charcoal-stained fluid drained through a thoracostomy tube for 8 weeks. The patient was discharged in good condition but died 4 days later after taking another overdose. Direct administration of charcoal into the lungs is best prevented by radiographic confirmation of the location of the tube. Charcoal in water may cause less severe pulmonary injury than charcoal in sorbitol.

Aspirin↗
PubMed1989

Recurrent bronchial carcinoid tumor.

Bronchial carcinoid tumors are considered to be of low grade malignancy, and if completely resected, to be cured. A patient with resection of a bronchial carcinoid presented 18 years later with superior vena caval obstruction, and carcinoid syndrome due to a recurrence. There was an excellent response to radiation.

Adult↗
PubMed1987

The effect of excessive ethanol ingestion on sleep in severe chronic obstructive pulmonary disease.

The effect of a moderately intoxicating dose of ethanol on sleep was evaluated in five patients with severe emphysematous chronic obstructive pulmonary disease (COPD) (mean FEV1 0.83 L, PaO2 75 mm Hg). Mean serum ethanol before sleep was 129 mg/dl. With alcohol, total sleep time per night decreased from a mean of 293 to 238 min. Relative sleep time per stage also changed; NREM time increased, and REM time decreased greater than 50%. Alcohol caused significant O2 desaturation; group mean sleep arterial oxygen saturation (SaO2) decreased from 90.6 to 87.7% with alcohol. Although the decrease in SaO2 was not uniform across all sleep stages, no individual sleep stage accounted for the desaturation. The fall in SaO2 with alcohol was not explained by increasing apneas or hypopneas. Mean heart rate increased significantly from 71.8 to 77.1 with alcohol, with premature ventricular contractions increasing in two subjects. Excessive alcohol ingestion in severe COPD alters total sleep time and stage distribution, decreases SaO2 without significant change in apneas, and increases heart rate. Prior to sleep, patients with severe COPD should strictly limit ingestion of alcohol.

Aged↗
PubMed1985

Breathing during sleep in patients with interstitial lung disease.

Patients with interstitial lung disease (ILD) have a rapid shallow breathing pattern while awake that is thought to be due to activation of lung reflexes. We wondered whether sleep would result in changes in respiratory control and thus cause hypoxemia and poor sleep quality. Eleven patients with ILD (5 men and 6 women) and 11 age- and sex-matched control subjects were studied during sleep. Sleep quality was worse in patients with ILD, with more time in Stage 1 (33.7% of total sleep time (TST) versus 13.5%) and less time in REM sleep (11.8 versus 19.9% TST) than found in control subjects, and more fragmentation of sleep (13.7 +/- 3.1 arousals/h and 24.3 +/- 6.0 sleep stage changes/h versus 6.9 +/- 1.0 and 12.7 +/- 1.4, respectively). Patients with ILD with awake SaO2 less than 90% had greater abnormalities in sleep structure than did those with SaO2 greater than 90%. The incidence of apneas and hypopnea periods in patients with ILD was low (apnea plus hypoventilation index of 1.3 +/- 0.45 versus 2.9 +/- 0.82 in control subjects, p = NS). Oxygen saturation dropped during REM sleep in patients, especially in those with more severe awake hypoxemia. Expiratory time (Te), inspiratory time (Ti), and their sum (Ttot) were shorter in the patients, whereas Ti/Ttot was the same as in control subjects. No systematic changes during sleep were seen in these variables. The variability of inspiratory volume index, Ti, Te, and Ti/Ttot was similar to that in control subjects, and was lowest during NREM sleep. The incidence of snoring was comparable in patients and control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Home oxygen in remote areas.

Delivering long-term oxygen therapy in the homes of persons who live in remote areas can be a problem. Four isolated areas in North America--rural Manitoba, Canada; the Northwest Territories of Canada; Alaska; and the Colorado mountains--have home oxygen programs that illustrate that these problems can be overcome. The indications for home oxygen in remote areas are the same as elsewhere, and the local physicians must be educated in the indications for such therapy. An oxygen exchanger should be used wherever electricity is available. Patients in remote areas should also be supplied with a large standby oxygen cylinder and an E cylinder for mobility. Installation of home oxygen equipment can be done by a respiratory therapist, by an equipment dealer, or by the patient or a trained relative. Maintenance of the equipment can also be performed by these persons, as well as by a nurse or paramedic.

Home Care Services↗
PubMedDate not supplied

Cystic angiomatosis of the bone appearing as intrathoracic lung masses.

A rare case of cystic angiomatosis of the bone (CAB) manifesting as bilateral intrathoracic masses is described. In 1996, a 47-year-old woman was referred to the chest clinic at St Boniface Hospital for evaluation of chronic cough, and her chest radiograph showed large, bilateral pleural-based intrathoracic masses. Ten years before, she had been diagnosed with CAB following bone biopsies of her hip and knee. Computed tomography revealed two chest wall masses with internal septations of bone. CAB is a rare, multicentric disease characterized by involvement of the vascular and lymphatic systems, producing diffuse cystic lesions in the skeleton. Although the ribs are frequently involved, the presentation with intrathoracic masses is uncommon.

Angiomatosis↗