Cemil Emirgil

Pulmonary function in alcoholics

Abstract Twenty-three chronic alcoholics were investigated by means of pulmonary function studies. All 23 patients had respiratory symptoms. Clinically, 21 (91 per cent) of 23 patients were diagnosed as having chronic bronchitis, and 14 patients (60 per cent) had dyspnea. The maximal mid-expiratory flow and single breath diffusing capacity for carbon monoxide (SBDCO) were abnormal in 16 (70 per cent) and 14 (61 per cent) patients, respectively. Twenty-two of 23 patients had one or more abnormal function. The total lung capacity, residual volume, vital capacity, 1 second forced expiratory volume and SBDCO progressively declined with increasing alcohol consumption. An attempt was made to separate the pulmonary effects of alcohol from (1) the effects of previous pulmonary infections, (2) the effects of cigarette smoking, and (3) the effects of cirrhosis of the liver. The data suggest that either alcohol itself through some unknown mechanism may be a causative agent in producing lung disease or that alcohol makes a higher percentage of the population susceptible to the harmful effects of cigarette smoking.

A study of the long-term effect of therapy in chronic obstructive pulmonary disease☆

Abstract The effects of three forms of therapy, namely (1) antibiotics and nebulized bronchodilators, (2) intermittent positive pressure breathing (IPPB) and (3) breathing exercises, were evaluated in three comparable groups of patients with chronic bronchitis and emphysema. None of the thirty-one subjects in the three groups had been treated previously with any form of therapy. The results of serial pulmonary function studies and clinical observations showed no difference in the response to the three forms of therapy. No group showed significant improvement. In general, there was slight deterioration in most measured functions, but the changes were very small with only a few attaining statistical significance. For all practical purposes function did not change significantly during the one year follow-up period, a result in accord with reported studies in which casually or intermittently treated patients were evaluated. It would therefore appear that the three most commonly used forms of therapy do not influence the long-term course of chronic bronchitis and emphysema.

Gaseous Diffusion from Alveoli to Pulmonary Vessels of Considerable Size

Thirty patients have been presented in whom the appearance of inhaled hydrogen gas at an electrode in the wedge position of a pulmonary artery was seen to occur within two seconds. In 13 of these patients the appearance of hydrogen occurred with equal or nearly equal rapidity in a pulmonary artery at least 3 mm in diameter. In 11 patients increasing alveolar oxygen tension by the inhalation of a single breath of 100% oxygen or by voluntary hyperventilation produced a rapid response at the wedge position as well. It is concluded that the rapid appearance of hydrogen and oxygen is due to direct diffusion of the inhaled gas from the alveoli to the pulmonary arterial blood.

Long-term course of chronic obstructive pulmonary disease: A new view of the mode of functional deterioration

Abstract Ninety-one patients with chronic obstructive pulmonary disease were followed up for periods ranging from two to thirteen years (average, five years). All ventilatory functions deteriorated significantly in nearly all the patients. In all patients followed up for four years or longer the maximum mid-expiratory flow (MMF) decreased. The rate of deterioration of the MMF was constant for patients with mild, moderate or severe disease. However, this constancy refers not to the absolute rate of fall but to the per cent of deterioration per year, i.e., the rate of fall is exponential. The average rate of fall of the MMF was 11.4 per cent per year. Stated in another way, the MMF halved every 7.1 years. Thus the average time from the onset of the disease to the level of severe impairment (MMF

Long-term study of pulmonary sarcoidosis: The effect of steroid therapy as evaluated by pulmonary function studies

Abstract The results of serial pulmonary function studies over a 12-yr period in 16 untreated and 22 steroid treated patients are presented. The average duration of steroid therapy was 28 months. Based on the diffusing capacity and vital capacity 9 per cent of the Steroid Group and 31 per cent of the Untreated Group deteriorated while 25 per cent of the Untreated Group and 60 per cent of the Steroid Group improved. These observations suggest that steroid therapy may be beneficial for patients with severely impaired function. However, because of frequent relapses when therapy was discontinued, steroid therapy must continue for many years, perhaps indefinitely. Two new and important observations were made. (1) In untreated patients if the disease is to worsen it will most likely do so within the first 2 yr of its onset. Significant deterioration of function during this period may be an indication for therapy. (2) Patients with the most severely impaired function at the time of the initial study improved substantially on steroid therapy and are living relatively well 6–10 yr afterward. This observation strongly suggests that very severe impairment of pulmonary function does not necessarily indicate a grave prognosis.

Routine pulmonary function studies as a key to the status of the lesser circulation in chronic obstructive pulmonary disease

Abstract Eighteen subjects with chronic obstructive pulmonary disease, selected in such a way as to eliminate all causes of obstruction with the exception of chronic bronchitis and/or emphysema, were investigated by means of routine pulmonary function studies and cardiac catheterization. Correlation of lesser circulation dynamics and ventilatory function was generally poor with the exception of the per cent predicted first-second volume. Oxygen saturation and exercise diffusing capacity correlated very well with pulmonary vascular resistance during exercise. A correlation of 0.97 was achieved using the multiple correlation of exercise oxygen saturation, steady state exercise diffusing capacity and pulmonary vascular resistance during exercise. It is suggested that this relationship is sufficiently good to permit prediction of the exercise pulmonary vascular resistance in the individual case merely from a knowledge of the other two functions. Factors other than arterial blood gas abnormalities also play a role in the pathogenesis of elevated pulmonary vascular resistance in chronic obstructive pulmonary disease.

Valvular insufficiency occurring during cardiac catheterization

Abstract Eleven patients are presented who had neither clinical nor hemodynamic evidence of valvular insufficiency. When a double platinum electrode technic was used with the electrodes straddling the valve and with a downstream injection of ascorbic acid or hydrogen, 7 of the subjects showed evidence of valvular insufficiency. It is suggested that the catheter passing across a valve will produce sufficient distortion to cause some incompetence and invalidate this technic for the detection of insufficiency.

The response to bronchodilator in asthmatic subjects as assessed by pulmonary function tests

Abstract The purpose of this study is to indicate the variable response to the administration of aerosol bronchodilator to asthmatic subjects. None of the subjects was in an acute attack of asthma at the time of study. Only one of the 21 subjects studied failed to improve in one or more parameters tested following the administration of the aerosol. Those measures of flow rate which are volume dependent, i.e., the maximal mid-expiratory flow and the first-second per cent of the forced vital capacity, are poor indicators of improvement. On the other hand, the first-second volume and the forced vital capacity provided a much better index of improvement and were more in keeping with the findings by body plethysmography.

Veno-arterial shunting without oxygenation in experimental pulmonary embolism☆

Abstract The effects of veno-arterial shunting without oxygenation on pulmonary embolism have been studied in the dog. Simple veno-arterial pumping significantly prolonged survival time, as shown by the control group.

A modification of the Dotter-Lukas catheter☆

Abstract Because of a high incidence of cardiac perforations with the Dotter-Lukas catheter a modification of the Dotter-Lukas triple-lumen balloon catheter is presented. The advantages include a more flexible tip, a larger balloon, and a platinum electrode to warn of impingement against the endocardium during passage of the catheter as well as to insure complete occlusion by the balloon by the hydrogen-gas or ascorbic-acid technique.