Daniel J. Stone

Fatal pulmonary insufficiency due to radiation effect upon the lung

Abstract 1. 1. Five patients with radiation pneumonitis and fibrosis leading to severe pulmonary insufficiency are presented. Correlated clinical, functional and pathologic findings indicated that impaired diffusion across the alveolar-capillary membrane played an important role in the functional abnormality in each instance. 2. 2. Steroid therapy, utilized in four patients, failed to alter the course of the acute syndrome.

Precipitation by pulmonary infection of acute anoxia, cardiac failure and respiratory acidosis in chronic pulmonary disease: Pathogenesis and treatment☆

T HE occurrence of acute fatal anoxia in chronic pulmonary disease is well recognized. Unfortunately the pathogenesis of this clinical picture and the role of infection are not always clearly understood. Furthermore, a lack of appreciation of the disturbed physiologic state often results in unsound or, at best, inadequate therapy. In the past few years the danger of oxygen therapy in the management of acutely ill patients who have underlying pulmonary disease has been stressed. The mechanisms leading to carbon dioxide retention and respiratory acidosis have been previously elucidated and modes of therapy, including artificial respiration, have been successfully applied.’ We have been impressed with a group of patients presenting the picture of chronic pulmonary insufficiency, with superimposed bronchial infection, acute anoxia and cardiac failure. The tendency to regard these patients simply as cases of cardiac failure or pulmonary infarction served as a stimulus to investigate them in order to elucidate the pathogenesis of the acute anoxia and a physiologic basis for therapy. The purpose of this paper is to present several cases of chronic pulmonary disease illustrating the effect of infection and bronchial obstruction in producing acute anoxia; to show by physiologic studies the danger of oxygen therapy without some form of artificial respiration; and, finally, to present a therapeutic outline which has as its objectives relief of anoxia, control of infection and avoidance of decompensated respiratory acidosis.

A long-term study of sarcoid and its modification by steroid therapy: Lung function and other factors in prognosis

Abstract A long-term appraisal of the course of sarcoidosis is presented. The high incidence of pulmonary insufficiency and complications from system manifestations deserve emphasis. The study clearly indicates the fallacy of attempting to appraise the course of this disease in a group of patients followed for relatively short periods of time. The factors which help in prognosis have been defined in terms of objective assessment of pulmonary function, the presence of distinctive roentgenographic features, and the presence of extrapulmonary manifestations. It is concluded that although steroid therapy may be beneficial in isolated instances, there is no conclusive evidence that it alters the long-term prognosis.

The effects of proprandolol and histamine on the ventilation response to carbon dioxide inhalation in normal subjects.

AbstractA method was developed to measure the oxygen cost of ventilation during CO2 rebreathing. In 20 healthy normal subjects SGaw, MMEF, and FEV1 were measured prior to and following the infusion of propranolol. In five of the same subjects airway constriction was induced by inhalation of histamine. The use of both agents was followed by a significant decrease in the ventilation response to carbon dioxide inhalation. Even more significantly, the oxygen cost of the increase in ventilation measured during CO2 rebreathing rose significantly following either propranolol or histamine.

Right-sided aortic arch

Abstract A case of a right-sided aortic arch is presented with angiocardiographic confirmation of the exact type of right-sided arch present.

Comparison of the ventilation response to CO2 rebreathing in healthy smokers and nonsmokers and subjects with bronchitis.

A comparison of ventilatory tests and the response to carbon dioxide rebreathing was made in healthy smokers, nonsmokers, and in subjects with bronchitis. The response to carbon dioxide (CO2) rebreathing was the same in the healthy population but diminished in the bronchitic group. Effects of smoking on maximal expiratory flow rates did not correlate with the results of carbon dioxide rebreathing. A consistent pattern of relationship of ventilation response to carbon dioxide and age of the subject was apparent.

A Prospective Study of Serially Performed Pleural Biopsies.

Excerpt The study was designed to evaluate the usefulness of performing pleural biopsy in every patient with pleural disease, regardless of the presence of fluid. A total of 211 biopsies were perfo...