Albert Frans

Diabetes mellitus induces a thickening of the pulmonary basal lamina.

Long-term diabetes mellitus (DM) is characterized by widespread alterations of basal lamina (BL). The purpose of the present work was to verify whether the lung is also a target organ damaged in DM. Electron microscopy was performed on lung and kidney samples (autopsic material) from 6 diabetics and 6 control subjects studying the thickening of BL of different structures (alveolar epithelial BL, endothelial capillary BL, both fused BL, BL of the glomerular capillary endothelium and BL of the renal tubules). The results were as follows: (1) alveolar epithelial BL (mean ± SD) = 121 ± 11 nm in controls and 176 ± 27 nm in diabetics (p < 0.01), (2) endothelial capillary BL = 164 ± 14 nm in controls and 223 ± 27 nm in diabetics (p < 0.001), (3) both BL fused = 222 ± 23 nm in controls and 316 ± 62 nm in diabetics (p < 0.01), (4) BL of the glomerular capillary endothelium = 374 ± 44 nm in controls and 626 ± 249 in diabetics (p < 0.05) and (5) BL of the renal tubules = 602 ± 94 nm in controls and 1,083 ± 376 nm in diabetics (p < 0.05). All parts of the lung are equally affected by DM. The thickening of BL is of the same magnitude in lung and kidney. There is no relationship between the thickening of the lung BL and the known duration and type of DM.

Effect of alveolar volume on the interpretation of single breath DlCO

Single-breath carbon monoxide diffusing capacity in the whole lung (DLCO) and per unit alveolar volume (DLCO/VA), as expressed in percentage of normal values, gave discordant results when VA of the patients was abnormal. It was hypothesized that normal reference values were inappropriate to interpret data collected in such patients. To substantiate this hypothesis, DLCO and DLCO/VA were measured in four groups: (1) normal volunteers in whom both indices were measured at five different VA; (2) patients with high VA; (3) emphysematous patients; and (4) patients with diffuse interstitial lung diseases (DILD). In normal subjects, DLCO increased and DLCO/VA decreased with VA. In patients with overinflated lungs, the percentage of DLCO was more increased than DLCO/VA. In the emphysematous patients, both indices were equally decreased. In patients with DILD, DLCO was significantly more decreased than DLCO/VA in those suffering from a restrictive pattern. Theoretical values were re-calculated taking into account their true VA and using the relationships observed between DLCO, DLCO/VA and VA. The divergences between DLCO and DLCO/VA were strongly minimized. Therefore, the authors suggest the need to correct theoretical formulas in the presence of a restrictive pattern.

Comparative study of the oxyhaemoglobin dissociation curve of four mammals: Man, dog, horse and cattle

1. The entire oxygen dissociation curve (ODC) and the effects of temperature, pH and 2,3-diphosphoglycerate (DPG) on this curve, have been compared in four mammalians: man, dog, horse and cattle. 2. If the oxyphoric capacities are similar between these species (around 1.39 ml O2/gHb), their P50, measured in standard conditions, i.e. at pH 7.4; pCO2 40 mmHg and T 37 degrees C, varies between 23.8 (+/- 0.8) mmHg for the horse, 25.0 (+/- 1.4) mmHg for cattle, 26.6 (+/- 1.2) for man and 28.8 (+/- 2.6) mmHg for the dog. 3. The higher dispersion of the dogs P 50 is due to difference between breeds; in seven breeds investigated, the P 50 ranges from 25.8 (spaniel) to 35.8 (hound). 4. We noted no sex difference in the four species. 5. The DPG level is confirmed to be low in cattle (< 1 mumol/gHb) as compared to man (13.5 +/- 2.1 mumol/gHb), horse (16.9 +/- 1.1 mumol/gHb) and dog (19.4 +/- 2.8 mumol/gHb). 6. The oxygen exchange fraction defined as the difference in vol% between a pO2 of 80 and 35 mmHg is, respectively, 3.6 (+/- 0.6) vol% for cattle, 4.0 (+/- 0.4) vol% for the horse, 5.5 (+/- 0.5) vol% for man and 6.6 (+/- 1.7) vol% for the dog. 7. The position and shape of the ODC, as well as T, DPG and pH effects, indicate that the haemoglobin of man and dog seem better adapted to O2 delivery as compared to the horse and cattle.

Impairment of ventilatory function and pulmonary gas exchange in non-smoking coalminers.

Indices of ventilatory function and pulmonary gas exchange in 32 non-smoking coalminers (mean age 38.1) were compared with those of 34 non-smoking steelworkers of similar age. The coalminers had significantly lower forced expiratory volume in 1 s (FEV1) and maximum expiratory flow rates and significantly higher residual volume, but similar vital capacity and indices derived from the single-breath test. Pulmonary diffusing capacity for CO and indices of CO2 exchange were similar in both groups. Arterial partial pressure of O2 (PaO2) was significantly lower and alveolar-arterial O2 difference was significantly higher in coalminers than in controls, both at rest and during exercise. There was no relation between lung function and radiological signs of simple pneumoconiosis (10 coalminers had pneumoconiosis). The differences in FEV1 (0.42 l) and in PaO2 (10 mm Hg) between the two groups are the same or larger than those usually found between smokers and non-smokers. Exposure to coaldust may result in biologically significant alterations of lung function even in the absence of pneumoconiosis.

Effect of Phosphate On Oxygen-hemoglobin Affinity, Diphosphoglycerate and Blood-gases During Recovery From Diabetic-ketoacidosis

The effects of intravenous phosphate administration on the hemoglobin-oxygen affinity, the 2,3 diphosphoglycerate level and blood gases were investigated in twenty severe diabetic patients with ketoacidosis in the intensive care unit. Ten received phosphate (mean total amount for each patient = 300 mEq) and the others did not. The only significant difference noted in all indices measured during the recovery period of eight days was seen to occur after 48 h; the P50 in vivo (Torr) was slightly higher in the group who received phosphate (22.5±1.6 vs 20.5±2.2) and for the Hill coefficient (2.4±0.2 vs 2.2±0.1). This drop in the oxygen affinity of hemoglobin may be useful in subjects at risk of hypoxia, for example those with cardiac or respiratory failure and justifies the use of phosphate in the first 48 h of treatment of patients with diabetic ketoacidosis.

Effects of two inotropic drugs, dopamine and dobutamine, on pulmonary gas exchange in artificially ventilated patients.

AbstractThe inotropic agents, dopamine (DP) and dobutamine (DB), both decrease PaO2, probably by a resistribution of the

Effects of Gas-density On Pulmonary Gas-exchange of Normal Man At Rest and During Exercise

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The Effects of Hypertonic Saline in Healthy and Diseased Animals

ratio. The aim of this study was to assess the effect of both drugs on the