Improvement In Dyspnea Research Articles

Long-term quality-adjusted survival following therapeutic bronchoscopy for malignant central airway obstruction

BackgroundWhile therapeutic bronchoscopy has been used to treat malignant central (CAO) airway obstruction for >25 years, there are no studies quantifying the impact of therapeutic bronchoscopy on long-term quality-adjusted survival.MethodsWe...

Serial changes in exercise capacity, quality of life and cardiopulmonary responses after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Background and ObjectivesPatients with chronic obstructive pulmonary disease (COPD) often have poor health-related quality of life (HRQL), exercise capacity and cardiopulmonary function. Pulmonary rehabilitation (PR) is beneficial to improve exercise capacity and HRQL. However, series changes of these parameters remain unclear. MethodsForty-three subjects participated in a 3-months PR program. Subjects were evaluated at baseline and at 8, 16, and 24 sessions after PR. ResultsAfter 8 sessions, there were significant improvements in the SGRQ-symptom domain, exertional dyspnea, and oxygen pulse (all p < 0.05). Maximal VO2, SGRQ-activity and SGRQ-impact domains, and respiratory muscle strength were significantly improved after 16 and 24 sessions (all p < 0.05). ConclusionsEight sessions of exercise training lead to improvement of symptoms and exertional dyspnea. 16 to 24 sessions result in further improvement. We suggest patients receive 16 to 24 sessions of PR.

Outcome of pulmonary rehabilitation in patients with stable chronic obstructive pulmonary disease at Chest Department, Zagazig University Hospitals (2014\u20132016)

ContextChronic obstructive pulmonary disease (COPD) is a very disabling disorder that is accompanied by some extrapulmonary manifestations. Pulmonary rehabilitation (PR) is outlined to enhance both physical and psychological condition of patients with chronic chest diseases.AimsWe aimed at evaluating the effectiveness of 8 weeks of outpatient PR on improving breathlessness, quality of life, exercise tolerance, and functional ability in patients with stable COPD.Settings and design A randomized controlled clinical study was conducted.Patients and methodsThe current study was carried out on 80 patients with stable COPD who were classified into group 1, where 40 patients were subjected to usual pharmacological therapy for COPD and PR for 8 weeks, and group 2, where 40 patients were subjected to usual pharmacological therapy only. Both groups were assessed regarding spirometric pulmonary function, arterial blood gases, 6 min walk test, dyspnea score (modified-Medical Research Council), and health-related quality of life [Saint George respiratory questionnaire (SGRQ)]. SPSS 20.0 for windows and MedCalc 13 for windows were used for statistical analysis.ResultsApproximately 50% of patients in group 1 showed improvement in dyspnea, whereas only 25% of patients were improved in group 2. Moreover, there was a statistical significance difference between both patient groups regarding the post-treatment improvement in 6 min walk distance (6MWD) and the post-treatment improvement in the three components of SGRQ score and also in the total SGRQ score (P<0.001). The improvement in 6MWD showed significantly inverse correlation with the baseline age, modified-Medical Research Council, and SGRQ scores, whereas the improvement in 6MWD was significantly directly correlated with the baseline forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity, PaO2, and baseline 6MWD.ConclusionPR for patients with stable COPD is an effective tool for improving quality of life, exercise capacity, and dyspnea score.

Rigid dilatation of pediatric laryngotracheal stenosis as an adequate alternative to balloon dilatation.

Endoscopic balloon dilation (EBD) is the mainstay of endoscopic therapy for laryngotracheal stenosis (LTS), although there is no evidence that it achieves better results than traditional rigid laryngeal dilators. Rigid bougie dilators are less expensive and easier to use, and confer the advantage of providing tactile information about the stenosis to the surgeon. We analyzed the outcome of endoscopic rigid bougie dilatation of LTS in a large series of children and compared it to the reported results of EBD in the same setting. All cases of pediatric LTS treated by endoscopic rigid dilatation in a tertiary referral center between 2006 and 2015 were retrospectively studied. They were divided into a primary dilatation group (PDG) and a post-reconstruction dilatation group (PRG). The PDG children had no history of reconstructive airway surgery, and dilatation was the major treatment approach. The PRG children underwent dilatations after airway reconstruction surgery as part of routine postoperative management. A successful primary outcome was defined as improvement of dyspnea and achievement of a functional airway without reconstructive laryngotracheal surgery or need for a tracheostomy at final follow-up. Sixty-two children (68 cases, mean age 5.1 years, range 0.7-17.2) underwent 156 endoscopic rigid dilatations. Successful outcome was achieved in 48 cases (70.6%), 73.0% in the PDG and 67.7% in the PRG. There were no procedure-related adverse events. Endoscopic rigid dilatation is a relatively inexpensive and efficacious tool in endoscopic management of pediatric LTS. Its success rates are in the same range as those of EBD.

Best mode of inspiratory muscle training in heart failure patients: a systematic review and meta-analysis.

Objectives The objective of this study was to evaluate the effects of inspiratory muscle training on inspiratory muscle strength, functional capacity and dyspnoea for patients with chronic heart failure, by summarising the published research on the effects of inspiratory muscle training. To identify the best mode of intervention in terms of: the load of maximal inspiratory pressure; the frequency of sessions; and the total duration of intervention. Methods A relevant literature research using the PubMed database, Cochrane and references of published studies, from 1998 to 2016, was conducted. Out of 65 randomised controlled trials, seven were considered as potentially relevant and were retrieved for detailed analysis. The methodological quality of each randomised controlled trial was rated using the physiotherapy evidence database scale. Results The included seven studies contained data on 203 patients. Typical training protocols involved training three, six or seven times per week with intensity ranging from 30% to 60% and for a duration ranging from 6 to 12 weeks. Maximal inspiratory pressure, walking distance and dyspnoea were improved in all studies and especially in those who set a load of 60% in their maximal inspiratory pressure, and have trained patients six times per week for 12 weeks. Conclusion In chronic heart failure patients, inspiratory muscle training results in a marked improvement in inspiratory muscle strength, walking distance and dyspnoea, notably when training patients at 60% of maximal inspiratory pressure, six times per week and for 12 weeks. A small number of studies and heterogeneity among studies may limit the findings of the present study.

P923Association of intra-abdominal pressure changes with early diuretic response and improvement of dyspnea in patients with acute heart failure

P923Association of intra-abdominal pressure changes with early diuretic response and improvement of dyspnea in patients with acute heart failure

Lung volume reduction surgery or bronchoscopic lung volume reduction: is there an algorithm for allocation?

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world with the annual number of deaths increasing every year. Alterations in chest wall mechanics, respiratory muscle mechanics, and impaired cardiac function that result from increased air-trapping are well known sequelae of COPD and contribute to increased morbidity and mortality. A reduction in hyperinflation can improve cardiopulmonary function. In selected patients with COPD and an emphysema phenotype, lung volume reduction surgery (LVRS) has demonstrated improvements in symptom burden and mortality. Minimally invasive bronchoscopic techniques that reduce end-expiratory lung volume have shown improvements in lung function, dyspnea and quality of life. In this review, we review selection criteria, risks, and benefits of surgical and bronchoscopic lung volume reduction (BLVR). Recommendations are provided to guide treatment decisions based on the current literature.

Efficacy analysis of five-year experience of vaccination with conjugate pneumococcal vaccine in patients with chronic obstructive pulmonary disease

This study was aimed at analysis of 5-year clinical efficacy and pharmacoeconomic effectiveness of conjugate pneumococcal vaccine in patients with chronic obstructive pulmonary disease (COPD). Methods. Male patients with COPD (n = 394) were involved in the study. Primary endpoints were changes in MMRC score, FEV1, number of exacerbations and hospitalizations, and a rate of pneumonia. The BODE index was calculated. Drug therapy of all patients was analyzed. 13-valent conjugate pneumococcal vaccine PCV13 and 23-valent polysaccharide vaccine PPV23 were used for vaccination. Results. Vaccination with PCV13 resulted in improvement in dyspnea and lung function both for short-term and 5-year follow-up. Therefore, PCV13 could be considered as a part of the basic therapy along with bronchodilators. Vaccination with PCV-13 could reduce risk of unfavorable events in the course of COPD and improve the patients’ survival. Conclusion. Vaccination with PCV13 in patients with COPD could reduce number of exacerbations, incidence of pneumonia, and the need in healthcare resources due to maintaining the effect during 4 years. Budget savings could reach 409.9 million rubles per a year.

Intrathoracic Axial Osteosarcoma

Background: Bone tumors have a challenging diagnosis and treatment. Osteosarcoma is the name given to a heterogeneous group of malignant, agressive and invasive tumors that often determine bone lysis. Almost all of the animals develop lung metastases, progressing to death. Usually affect the appendicular skeleton, but can also occurs in others areas, although these presentations are rare. Prognosis is always poor. The aim of this paper is to report a case of a dog with osteoblastic osteosarcoma of the sternum, which was diagnosed by computed tomography and histopathologic analysis after excisional biopsy.Case: A male Cocker Spaniel dog, weighing 25 kg, elderly, was examined at the Veterinary Hospital. As main complaint was reported soft swelling on the ventral cervical region causing dyspnea. The patient had previously been medicated with dexamethasone with a significant decrease in the swelling, however recurrence was observed with the cessation of the treatment. Due to the presence of heart murmur, patient underwent to chest radiography and eletrocardiography. Images showed a tumor in the sternal lymph node region, displacing the heart caudally, trachea and esophagus dorsally, causing cranial edema due to a compression of the venous return by the cranial vena cava and subsequent dyspnea. Furosemide (Lasix®) was administered during ambulatorial treatment and prescribed to home, with satisfactory results, with decreased edema and consequent improvement of respiratory symptoms. It was decided to perform computed tomography to better design of the chest structure. The structure located in cranial thoracic region measured about 10.5 cm long x 5.8 cm high x 8.4 cm wide. The patient was undergone to sternotomy to remove the mass that was closely adhered to the sternum and pericardium. The pericardectomy and sternum removal were not performed due to animal being old and present metabolic and cardiopulmonary conditions. Some samples were collected for histological examination resulting in osteoblastic osteosarcoma. After surgical treatment, the patient showed improvement of dyspnea, more active and no signs of pain at the surgical site. Due to the unfavorable result of the histopathological analysis, it was decided to star chemotherapy. The protocol chosen was carboplatin (Carboplatino®) as a single drug, every 21 days totalizing four applications as recommended by literature. Two cycles of carboplatin were done as adjuvant chemotherapy. The patient supported the treatment very well without any clinical or laboratory abnormality. Any radiographic signs of pulmonary metastasis or local recurrence was seen, however, after 18 months of survival, the patient died of non-related cause.Discussion: Osteosarcoma is the most commonly diagnosed bone tumor in dogs. Intense dyspnea and the swelling in the submandibular region was due to the compression of thoracic structures by the size of the tumor and the internal location within the chest. The cranial swelling is due to the syndrome caval that is rare in veterinary medicine and is describe in some specific conditions. Computed tomography was performed to better tumor delineation, as it is an important tool to assess the extent of the tumor and other characteristics, allowing optimal surgical planning for each case. Histophatological diagnosis of osteoblastic osteosarcoma is characterized by new bone formation that appears radiographically with increased radiopacity, as observed in all images. Gold standard treatment of neoplasms is the association of surgical excision followed by chemotherapy, which was effective in this case reported, since it provided quality of life during 18 months, three times higher than the majority of cases reported in the literature, being death due to causes unrelated to the tumor.

Fentanyl treatment for end-of-life dyspnoea relief in advanced cancer patients.

We assessed the effects of subcutaneous-endovenous fentanyl on dyspnoea in a cohort of advanced cancer patients. We performed a retrospective study in a cohort of advanced cancer patients with dyspnoea at rest who received subcutaneous or intravenous fentanyl. Patients with no shortness of breath at rest or at minimal exertion, no rescue doses per 24h, were deemed to be responders to fentanyl. The period of assessment was 6days from the beginning of fentanyl treatment. Seventy-two patients were evaluated: 65% males, 50% ≥ 75years, Palliative Performance Scale (PPS) median of 30%. Seventy-six percent of the patients were responders to fentanyl. Fentanyl efficacy was not statistically related to age, gender, cancer type, previous opioid treatment, steroid and midazolam doses and PPS. The median fentanyl dose in responders was 25mcg/h (interquartile range 12-70). It was significantly related to age (37 vs 12mcg/h, for ≤ 75 vs > 75years, respectively; p = 0.02). There was not a significant difference between fentanyl doses of responders and non-responder patients. Thirty-six, 23 and 15 patients had sustained improvements in dyspnoea over 48, 72 and 96h. Fentanyl had no significant toxicity. The length of inclusion in the study and exclusion were related to low performance status (hazard ratio 0.961; 95%CI 0.927-0.996; Cox-regression) but not to fentanyl doses (hazard ratio 0.875; 95%CI 0.620-1.234; Cox-regression). Our preliminary data suggest that subcutaneous-endovenous fentanyl may be associated with dyspnoea relief in dying patients. Further research is needed to confirm these findings.

Effect of continuous intravenous oxycodone infusion in opioid-naïve cancer patients with dyspnea.

Dyspnea is among symptoms that decrease quality of life for terminal cancer patients. There are few reports of the positive effects of oxycodone for the treatment of dyspnea, and no studies have focused on opioid-naïve patients. This study aimed to determine the efficacy and safety of continuous intravenous oxycodone infusion for opioid-naïve cancer patients with dyspnea. Eligible patients were opioid-naïve cancer inpatients who received continuous oxycodone infusion as a treatment for dyspnea under the care of the palliative care team at Komaki City Hospital between November 2013 and December 2016. We retrospectively investigated the improvement of dyspnea following continuous oxycodone infusion from the medical records. This study included 19 patients, and the response rate to oxycodone infusion for dyspnea was 68.4%. Most participants were terminal cancer patients with performance status 3 or 4. Median survival of participants following continuous oxycodone infusion was 6 (range 1-377) days. No serious adverse events such as respiratory depression or somnolence were noted. Continuous oxycodone infusion could be a reasonable treatment option in the management of dyspnea in opioid-naïve cancer patients.

Serelaxin, recombinant human relaxin-2, for heart failure patients: A systematic review and meta-analysis.

Background:Serelaxin, recombinant human relaxin-2, is a hormone with vasodilatory and end-organ protective effects. Recently, it has been licensed to treat acute decompensated heart failure. Here, a systematic review and meta-analysis on randomized controlled trials (RCTs) was performed to assess the effect of serelaxin on mortality and dyspnea improvement in patients with heart failure.Methods:RCTs comparing serelaxin treatment to other heart failure treatments were searched in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. The main endpoints were mortality and dyspnea improvement. Pooled data were assessed by using a random effects model.Results:A total of 451 studies were identified, of which 8 studies (8477 participants) were eligible and included in our analysis. Compared with other heart failure treatment group, serelaxin group had no effect on 30-day, 60-day, and 180-day mortality (OR, 0.79; 95% CI, 0.65–0.96). Compared with control group, there was no effect on dyspnea improvement.Conclusion:Serelaxin treatment is irrelevant with the mortality, and it cannot improve dyspnea of heart failure patients.

Acute Effects of Mechanical Insufflation-Exsufflation on the Breathing Pattern in Stable Subjects With Duchenne Muscular Dystrophy.

Duchenne muscular dystrophy (DMD) is characterized by progressive degeneration, wasting, and weakness of skeletal musculature, including respiratory muscles. Cough is also compromised with disease progression. Among cough-augmentation techniques, mechanical insufflation-exsufflation (MI-E) has demonstrated several clinical benefits in patients with chronic airway secretion obstruction and muscular weakness. In clinical practice, the use of MI-E in DMD patients is also suggested when they are stable with no airway infections. However, there is a paucity of studies that consider the effect of MI-E specifically on stable DMD patients who have adapted to the use of MI-E. Twenty subjects with DMD with no active upper airway or lung infections, who used MI-E device regularly at home, were enrolled. They received a single MI-E treatment consisting of 5 cycles of 5 insufflations-exsufflations with their customary settings. Volume variations during quiet breathing, vital capacity, and cough before and after treatment were measured with optoelectronic plethysmography (OEP). A decrease in breathing frequency (P = .001) and the rapid shallow breathing index emerged (P = .007), while cough peak flow (Spirometer P = .86, OEP P = .58), vital capacity (Spirometer P = .78, OEP total chest wall P = .57), and end-expiratory volumes (Total chest wall P = .97, Ribcage P = .14, Abdomen P = .10) were not affected by the treatment. An increment of the chest wall volume variation during the expiratory cough phase was identified (P = .001), particularly due to an increase in abdominal expansion (P = .005). A single treatment of MI-E in subjects with stable DMD already adapted to the device can provide beneficial changes in breathing pattern through a significant decrease in breathing frequency and rapid shallow breathing. These findings suggest an improvement in short-term dyspnea, although there were no changes in lung-volume recruitment or unassisted cough peak flow.

A Systematic Review and Narrative Synthesis to Explore the Effectiveness of Exercise-Based Interventions in Improving Fatigue, Dyspnea, and Depression in Lung Cancer Survivors.

Lung cancer survival rates are increasing; however, lung cancer survivors' mental and physical well-being can suffer from experiencing symptoms of fatigue, dyspnea, and depression. Exercise can improve these symptoms. However, no studies have examined the effects of different exercise interventions on these symptoms. This review aims to examine the evidence on the effects of exercise interventions on fatigue, dyspnea, and depression in lung cancer survivors. PRISMA guidelines were followed. CINAHL, MEDLINE, EMBASE, and Cochrane databases were searched between 2000 and May 2017. Gray literature was searched. All identified studies were screened for inclusion. Quantitative data were narratively synthesized. From 852 records retrieved and screened, 10 full-text articles were included. Seven studies had a high risk of bias, 2 had an unclear risk, and 1 study had a low risk, limiting the robustness of findings. Exercise interventions included pulmonary rehabilitation, aerobic exercise, resistance training, exercise and balance programs, and medical qigong. Six studies reported statistically significant reductions in fatigue; 2 reported significant improvements in dyspnea, and one a significant reduction in depression postintervention. Exercise interventions may be effective and are unlikely to cause harm for lung cancer survivors. However, evidence quality is limited. More rigorous study designs are required to provide guidance about which interventions may help lung cancer survivors self-manage these symptoms. Health professionals should provide comprehensive, customized exercise screening and treatment plans to lung cancer survivors to complement their lifestyle needs and ensure appropriate recommendations aimed at improving symptom control are communicated to them.

Safety and efficacy of airway stenting in patients with malignant oesophago-airway fistula.

Close anatomical relationships between the oesophagus and the bronchial tree can lead to the formation of oesophageal fistula particularly in patients with advanced lung or oesophageal carcinoma. Stenting is a most often used treatment in such patients, but data regarding the relative value of unilateral (US) vs. double stenting (DS) are scarce. Retrospective analysis of hospital records of patients with oesophageal fistula who underwent stenting between 2008 and 2016. In those in whom airway stenosis was >30%, double stenting (oesophagus and bronchial tree) was performed, whereas in those with lesser airway stenosis unilateral stenting (i.e., oesophagus only) was performed. In all patients, the degree of dysphagia, the degree of dyspnoea and the quality of life were assessed before and after the stenting. There were 46 patients, analysed, including 26 who underwent DS and 20 patients who underwent US. Both, DS and US resulted in significant improvement of dysphagia (2.72 vs. 1.2, P=0.0001 and 2.65 vs. 1.0, P=0.0001), dyspnoea (2.89 vs. 0.34, P=0.0001 and 1.71 vs. 0.09, P=0.0001) and performance score (53.2 vs. 66.3, P=0.0001 and 54.3 vs. 62.38, P=0.0001). Neither fistula type, nor stenting method, weight loss and gain, and BMI, had an effect on survival (P=0.34). Disease progression and recurrence of fistula requiring re-intervention occurred in 9 patients (19.5%). Double and unilateral stenting is an effective measure to alleviate dysphagia and dyspnoea in patients treated with malignant oesophageal fistula. In those with airway stenosis of ≤30%, stenting of the oesophagus only, instead of DS, is a safe method of treatment.

Inflammatory and Metabolic Responses to Different Resistance Training on Chronic Obstructive Pulmonary Disease: A Randomized Control Trial.

Background: Low-grade inflammation can be present in chronic obstructive pulmonary disease (COPD), which may affect the regulation of muscle protein and body metabolism. Regular exercise show improvement in muscle strength and dyspnea in patients with COPD, however, the response to training on inflammatory and metabolic disorders is unclear. In this study, we compared the effects of resistance training using weight machines and elastic resistance (bands and tubes) on the inflammatory and metabolic responses in patients with COPD.Methods: Patients with COPD were randomized into three groups: elastic band group (EBG), elastic tube group (ETG), and weight machines equipment group (MG). EBG and ETG were analyzed together [elastic group (EG)]. The participants were evaluated for pulmonary function (spirometry), peripheral muscle strength (digital dynamometry), IL-6, TNF-α, IL-10, IL-15 (Immunoassay), glucose, triacylglycerol, total cholesterol, HDL-c, and albumin levels (Enzymatic colorimetric). Blood samples were collected to assess the acute and chronic exercise responses after 12 weeks of training protocol.Results: The patient's mean age was 71.53 ± 6.97 years old. FEV1 (percent predicted) was 50.69 ± 16.67 and 45.40 ± 15.15% for EG and MG, respectively (p = 0.28). All groups increased muscle strength (p < 0.05) with no differences between groups. The acute response to exercise after 12 weeks of training showed improvement of inflammation when compared to baseline. Regarding the chronic effects, it was observed a decrease of all cytokines, except IL-10 (p < 0.05). After 12 weeks of training, the analysis of the metabolic profile presented a reduction in glucose concentration (p < 0.01), with no differences between groups (p = 0.30) and a decrease in triacylglycerol for the EG (p > 0.01).Conclusions: Training with elastic resistances or conventional weight machines showed improvement of inflammation response after 12 weeks of training. Chronically, both training groups showed anti-inflammatory effects, with the EG showing a strong tendency to improve IL-10/TNF-α ratio and IL-10 levels.Trial registration : RBR-6V9SJJ.

Unusual Clinical Manifestation of Laryngeal Edema in a Case of DRESS Syndrome

Unusual Clinical Manifestation of Laryngeal Edema in a Case of DRESS Syndrome

Early Changes in eDiary COPD Symptoms Predict Clinically Relevant Treatment Response at 12 Weeks: Analysis from the CRYSTAL Study

ABSTRACTEarly detection of treatment response is important in the long-term treatment and management of patients with chronic obstructive pulmonary disease (COPD). This analysis evaluated whether early improvement in symptoms, recorded in the first 7 or 14 days via an electronic diary (eDiary) compared with baseline, can predict clinically meaningful treatment responders at 12 weeks.CRYSTAL was a 12-week, randomized, open-label study that demonstrated the increased effectiveness of indacaterol/glycopyrronium (IND/GLY) or glycopyrronium (GLY), after a direct switch from on-going baseline therapies, in patients with symptomatic COPD and moderate airflow obstruction. The co-primary endpoints were trough forced expiratory volume in 1 second (FEV1) and transition dyspnea index (TDI) at Week 12. Patients' symptom status was recorded daily in an eDiary. Of 4,389 patients randomized, 3,936 and 3,855 reported symptoms on Days 7 and 14, respectively. Patients who reported an early decrease in symptoms on Day 7 or 14 were more likely to achieve the minimal clinically important difference of ≥100 mL in trough FEV1 or ≥ 1 point in TDI at Week 12. Using stepwise multivariate regression models we identified as best predictors of FEV1 responders the decrease in wheeze on Day 7, and nighttime symptoms and wheeze on Day 14; best predictors of TDI responders were decrease in nighttime symptoms and wheeze on Day 7, and nighttime symptoms, sputum and wheeze on Day 14. Early symptom improvement at Day 7 or 14, especially wheeze and nighttime symptoms, may identify patients with clinically important improvement in lung function and dyspnea at Week 12.

Focused cardiac ultrasound as a predictor of readmission in acute decompensated heart failure.

Acute decompensated heart failure (ADHF) is a common reason for admission to the hospital, and readmission is frequent. Multiple factors contribute to rehospitalizations, but inadequate assessment of volume status leading to persistent congestion is an important factor. We sought to determine if focused cardiac ultrasound (FCU) of the inferior vena cava (IVC), as a surrogate of volume status, would predict readmission of ADHF patients after index hospitalization. Patients admitted with a primary diagnosis of ADHF were prospectively enrolled. All patients underwent FCU of the IVC on admission and then daily. 82 patients were enrolled. Patients demonstrated improvement in heart failure physical examination findings and symptoms during the hospitalization. There was a reduction in the size of the IVC and a significant increase in patients with small collapsible vena cava. Logistic regression analysis of physical examination, patient symptoms, and IVC parameters at discharge demonstrated IVC collapsibility and patient reported dyspnea improvement as the only significant variables to predict readmission or emergency department visit. FCU assessment of IVC size and collapsibility may be useful in patients with ADHF to predict risk of being readmitted within 30days of hospital discharge.

Sclérodermie systémique : efficacité des immunoglobulines intraveineuses pour l’atteinte cardiaque sévère ?

BackgroundThe heart involvement in systemic sclerosis is frequent and can touch various sites. The prognosis in the presence of heart disease is poor, but few data are available about its management. CaseWe report the case of 48 years old woman with systemic sclerosis which presented severe heart involvement. She has severe heart failure, supraventricular arrhythmias and symptomatic pericarditis, which required surgical intervention and immunosuppressive drugs (steroids with rituximab). Despite this treatment, she has persistent severe heart impaired function and intravenous immunoglobulins have been initiated. She experienced progressively the improvement of dyspnea, of heart systolic ejection fraction and decrease of Rodnan scale. ConclusionOur case illustrates a severe heart involvement in systemic sclerosis which have been improved by intravenous immunoglobulins.