Albert H. Niden

Patterns of Cardiovascular Dysfunction in Chronic Obstructive Lung Disease

Abstract A longitudinal seven-year study of 50 patients with chronic airway obstruction, whose cardiovascular function had been evaluated by cardiac catheterization when their condition was stable, showed that their survival was inversely related to pulmonary vascular resistance. Fourteen patients with high vascular resistances showed two different patterns of cardiovascular abnormality. Nine had relatively normal blood gases, low cardiac outputs, and near normal resting pulmonary-artery pressures; they had an emphysematous type of lung disease. The five with more severe blood gas abnormalities who had a more bronchitic type of disease, had well maintained cardiac outputs and more severe pulmonary hypertension. They more regularly presented the classic clinical and electrocardiographic features of cor pulmonale. Left ventricular dysfunction appeared to be an important determinant of pulmonary hypertension in only one patient.

Bronchiolar and Large Alveolar Cell in Pulmonary Phospholipid Metabolism

The nonciliated bronchiolar cells (Clara cells) lining the terminal airways actively secrete a phospholipid. In contrast, the large alveolar epithelial cells (type II, granular pneumonocyte) are active phagocytic cells. It is proposed that the Clara cell is the main source of pulmonary phospholipid production (presumably surfactant) while the large alveolar cell is responsible for its subsequent breakdown.

Effects of Drugs on the Pulmonary Circulation and Ventilation as Reflected by Changes in the Arterial Oxygen Saturation

The effect of: l-epinephrine, acetylcholine, histamine, aminophylline, and serotonin on Ihe pulmonary circulation and ventilation was studied in anesthetized dogs. The following observations were noted: Serotonin produced an increase in arterial oxygen saturation, the other drugs a decrease. Although reduced, the effect was not eliminated by controlling the volume of ventilation or by the inhalation of 25 or 30 percent oxygen. The administration of 100 percent oxygen eliminated the response in all dogs studied. The effect was not abolished by controlling blood flow in addition to ventilation. Changes in the over-all ventilation/perfusion ratio appeared of major importance. In addition, these drugs apparently produced local changes in ventilation/perfusion ratios (physiologic shunting) and/or in the degree of anatomic intrapulmonary shunting of blood. The effects of changes in pulmonary blood flow on peripheral arterial oxygen saturation were also investigated. With the volume of ventilation constant, the following was observed: Increasing pulmonary blood flow by whatever means decreased SaO2; decreasing blood flow resulted in an increase in SaO2.

NON-UNIFORM PULMONARY DIFFUSION AS DEMONSTRATED BY THE CARBON MONOXIDE EQUILIBRATION TECHNIQUE: EXPERIMENTAL RESULTS IN MAN

Available evidence indicates that pulmonary diffusion is distributed in a non-uniform manner throughout the lung; the pertinent literature was reviewed briefly in the preceding paper of this series (1). Conventional methods for measuring the pulmonary diffusing capacity do not allow a quantitative assessment of this non-uniformity, and, in the presence of uneven diffusion, may yield erroneous values for total DL.1 This prob-

NON-UNIFORM PULMONARY DIFFUSION AS DEMONSTRATED BY THE CARBON MONOXIDE EQUILIBRATION TECHNIQUE: MATHEMATICAL CONSIDERATIONS*

It is now well established that both ventilation and perfusion are distributed unevenly throughout the lung. Inert gas washout curves have consistently revealed non-uniformity of ventilation/lung volume (VA/VA) ratios (1-3); study of the respiratory exchange ratios in different parts of the lung has provided evidence of uneven ventilation/perfusion (VA/Qc) ratios (4, 5), and both bronchospirometric studies (6) and measurements of physiological dead space (7) have supported these findings.1 Analysis of single

Goiter and myxedema due to iodide administration.

Excerpt The syndrome of goiter and/or myxedema due to administration of iodide preparations has been reported in more than 30 cases since 1945.1-14Despite these observations, most of them single ca...