Frank W. Lovejoy

Pulmonary Function in Diaphragmatic Paralysis

Orthopnoea as an outstanding symptom in weakness of the respiratory muscles was reported by Comroe, Wood, Kay and Spoont in 1951. We have had the opportunity of studying three patients with diaphragmatic paralysis from different causes, and orthopnoea was the chief complaint in all three. Paralysis or weakness of respiratory muscles is probably seen most commonly in poliomyelitis, when there is usually involvement of diaphragms and intercostal nerves. In the three cases reported here, the diaphragm was affected exclusively in one; in the other two, although some weakness of intercostal nerves could not be excluded, there was objective evidence of diaphragmatic weakness only.

Studies of pulmonary hypertension. VI

Abstract During the past 3 years physiologic studies of patients with mitral stenosis have been reported from various laboratories. 1–17 Most of these patients tend to have decreased cardiac output, elevated pulmonary “capillary” and pulmonary artery pressures, and increased pulmonary resistance. Many show increased work of the right ventricle against pressure and physiologic evidence of right ventricular failure. Pulmonary hypertension correlates well with the degree of disability. It is the purpose of this paper (a) to present physiologic data of forty-three patients with predominant mitral stenosis, (b) to correlate various determinants related to pressure and flow in the pulmonary circuit, and (c) to emphasize the importance of pulmonary “capillary” pressure and its relation to other factors.

Pulmonary hypertension: III. Physiologic studies in three cases of carbon dioxide narcosis treated by artificial respiration

Abstract 1.1. Three patients with severe pulmonary insufficiency who developed coma following the administration of oxygen have been presented. Coma was associated with severe hypercapnia and respiratory acidosis. 2.2. Mechanical ventilation in the Drinker respirator resulted in recovery in two instances. 3.3. The course of each patient was followed by serial arterial blood gas analyses and pH determination. 4.4. Cardiac catheterization in one case prior to therapy revealed severe pulmonary hypertension associated with marked hypoxemia, hypercapnia and respiratory acidosis. Cardiac catheterization following treatment in each case demonstrated moderate pulmonary hypertension and increased total pulmonary resistance associated with a normal cardiac index.

Measurement of gas trapped in the lungs during acute changes in airway resistance in normal subjects and in patients with chronic pulmonary disease

Abstract Measurements of airway resistance and functional residual capacity (plethysmographic method), functional residual capacity (helium dilution method), various partitions of the lung volume, and the maximal mid-expiratory flow rate were performed in fourteen normal subjects and fourteen patients with chronic pulmonary disease before and after the inhalation of constricting aerosols (aluminum dust and carbachol) and a dilating aerosol. The normal subjects and patients were equally divided into two groups, one breathing carbachol and the other aluminum dust. Increases in airway resistance were produced in every instance in both normal subjects and patients by both constricting aerosols. On the average, the rise was double the control value. This was accompanied by significant accumulation of trapped air (difference in volume of functional residual capacity by the two methods) in thirteen of the fourteen patients. Significant trapping occurred in half of the normal subjects. The vital capacity was little affected in the normal persons but the average reduction from control values was 0.6 L. in patients breathing carbachol and 1.1 L. in those breathing aluminum dust. Inhalation of a sympathomimetic aerosol restored all measurements towards the control value or better. A second inhalation of approximately the same number of breaths of the constricting aerosols demonstrated a protective effect of the sympathomimetic aerosol. This time significant elevations in any of the measurements occurred in only three instances. Two of the three exceptions were patients who received twice the number of breaths of carbachol on the second administration. Continuous analysis of nitrogen in the expired air of several other normal subjects during oxygen breathing showed marked changes of intrapulmonary gas mixing associated with elevated airway resistance and probable trapping. The nitrogen washout curves returned to normal subsequent to inhalation of a sympathomimetic aerosol and remained normal after repeat inhalation of the constricting aerosol. The amounts of intrapulmonary gas trapped, the reasons for the validity of the trapping measurements, and some of the probable mechanisms involved in its production are discussed.

AN UNUSUAL CASE OF MASSIVE PERICARDIAL EFFUSION WITH HEMODYNAMIC STUDIES

Excerpt Despite clinical and pathologic investigations of many patients with pericardial effusion,1-5few such patients have been studied by cardiac catheterization.6, 7It is the purpose of this man...

Importance of particle size in aerosol therapy.

Summary Comparison of effects of 2 aerosols of the same sympathomimetic drug was made. Administration in the usual therapeutic amount of 1 aerosol produced by standard, commercially available, nebulizer caused tachycardia and blood pressure elevation in 4 normal subjects. The other aerosol from a D-30 generator which previously had been shown to relieve bronchoconstriction (5), when breathed in the same manner, failed to have systemic effects. Lack of undesirable side effects from the latter was presumably due to submicroscopic particles emanating from the D-30 generator. They produced a larger surface area to dose ratio and were able to reach areas in the lung where they are locally most effective even though total dose from generator was 30 times less than from the standard nebulizer for a given number of breaths.

Relationships of Vital Capacity and Ventilatory Measurements to Physical Fitness in Patients with Cardio-Respiratory Diseases.

Summary Simultaneous analyses of various ventilatory measurements in 44 randomly selected patients with cardio-respiratory diseases have been assembled. A significant relationship was found between the physical fitness index and the percentage ratio of the observed to predicted vital capacity. The limitations of this relationship, as well as other relationships of physical fitness score to various ventilatory measurements, are discussed.

Cromolyn Sodium Trial in Perennial Asthmatics.

Excerpt Cromolyn sodium (disodium cromoglycate), an inhibitor of antigen-antibody-induced mediator release, has been shown to prevent acute asthma in allergic subjects when inhaled prior to challen...

Relationships of Availability of Oxygen to Physical Fitness in Patients with Cardio-respiratory Diseases.

Summary Significant correlations were obtained in patients with diverse cardio-respiratory diseases, and varying disability, between the oxygen gradient of the lungs, the oxygen tension of the peripheral tissues during rest, and the physical fitness index of exercise tolerance. Working capacity is proportional to the availability of oxygen to the tissues, and the limiting factor is circulatory in nature.