Harold A. Lyons

Arterial-Blood Gas Tension in Asthma

Abstract Arterial oxygen and carbon dioxide tensions, pH and forced expiratory volumes were measured in 101 asthmatic patients during acute attacks of bronchospasm. Hypoxemia was observed in 91 subjects. The cause of the depressed oxygen tensions was found to be an alteration in ventilation-perfusion ratios. Overall alveolar hypoventilation and increased venous admixture were found to contribute to the hypoxemia in some patients with very severe levels of airway obstruction. Seventy-three subjects had hypocarbia and respiratory alkalosis. Carbon dioxide retention (observed in 11 patients) occurred only at extreme degrees of obstruction. Age, history of asthma and duration of the acute attack were unrelated to the alterations in blood gas tensions, pH or severity of airway obstruction.

The mechanism of action of suggestion in the induction of acute asthma attacks.

&NA; Asthmatic subjects inhaling nebulized physiologic saline solution were told that the substance was an allergen which each subject had indicated as the cause of his asthmatic attacks. Utilization of whole body plethysmography revealed that 15 subjects developed significant increases in airway resistance, but 14 did not. In repeat studies, 13 of the 15 reactors continued to respond with significant changes in airway resistance, while all of the nonreactors remained unaffected. Intravenous atropine sulfate, 1‐2 mg., prevented the bronchoconstriction response to suggestion. These observations demonstrate that a significant number of asthmatic subjects can respond to psychological stimuli with significant changes in airway resistance. This phenomenon is mediated through activation of efferent cholinergic pathways.

Therapeutic use of progesterone in alveolar hypoventilation associated with obesity

Abstract A study was made of eight very obese patients, average body weight 325 pounds, with the alveolar hypoventilation syndrome. Initial treatment included a low calorie intake, the administration of digitalis and diuretics, and intermittent positive pressure breathing. After a stable level of improvement was reached, within five to twenty-three days, 100 mg. of progesterone was given daily by intramuscular injection. Progesterone therapy increased alveolar ventilation by an additional 29.3 per cent and total minute ventilation by 20.6 per cent. Arterial blood gas tensions and pH were returned toward normal and respiratory acidosis was abolished. Abnormal ventilatory-carbon dioxide response curves were restored to normal by progesterone therapy. Progesterone is thus an effective agent for improving ventilation in patients with the obesity-hypoventilation syndrome. The site and mode of action of progesterone is unknown. Respiratory control was normal during progesterone administration, but reappearance of an abnormal state recurred within a month after progesterone therapy was discontinued.

Further observations on tuberculin reactions in active tuberculosis

One hundred patients with active tuberculosis were tested for tuberculin reactivity within 24 hours of their admission to the hospital. Commercial intermediate tuberculin, Tween stabilized intermediate tuberculin and the Tine test as well as a mumps antigen were applied simultaneously. False negative reactions were obtained in 28 per cent with Tine testing and in 21 per cent with Tween stabilized as well as plain tuberculin. These nonreactors were clinically identifiable as seriously ill with manifestations primarily attributable to protein depletion as a result of their illness. This is not specifically related to the effects of tuberculosis itself, but can be demonstrated in patients suffering the same sequelae of other debilitating illness. After two weeks of protein supplementation via a high calorie, high protein, hospital diet, skin reactivity was restored in the vast majority of these nonreactors. It is concluded that the lack of tuberculin reactivity on hospital admission probably results from impaired lymphocyte function in patients suffering serious protein depletion as a result of their illness; it is not attributable to deficiencies in the tuberculin test itself.

THE DIAGNOSIS AND CLASSIFICATION OF MEDIASTINAL MASSES. 1. A STUDY OF 782 CASES

Excerpt The problem posed by the discovery of a mediastinal mass is becoming of more frequent concern to the physician. Widespread employment of the routine chest roentgenogram in various surveys a...

Pulmonary Dysfunction in Systemic Lupus Erythematosus

ABNORMALITIES of respiratory function have been observed in scleroderma.1 2 3 4 5 However, little attention has been paid to the study of the pulmonary function of patients with systemic lupus eryt...

Pleural involvement in sarcoidosis

Abstract A review of the records of 227 patients with biopsy proved sarcoidosis disclosed roentgenographic evidence of pleural reactions (pleural effusion and/or pleural thickening) in 23 (10.1 per cent). Pleural effusions were noted in 15, and in all of these the disease process showed signs of progression to stage 2 or beyond. Transudative effusions were found in eight patients. Pleural biopsies in seven patients with effusion disclosed noncaseating granulomas consistent with sarcoidosis. An extensive evaluation for other underlying disease processes, in all cases was negative. The effusions resolved, but in two patients serial roentgenographic studies showed progression to chronic pleural thickening. Pleural thickening was observed initially in eight patients and was always associated with an advanced stage of sarcoidosis. Biopsies performed in five of these patients showed thickened fibrotic pleura interspersed with noncaseating granulomas. On review of lung biopsy specimens from 11 patients with no roentgenographic indication of pleural reactions, noncaseating granulomas in simultaneously obtained pleura were found in four. The pleura is affected in sarcoidosis more frequently than has been recognized. The occurrence of pleural involvement and reaction is a consequence of sarcoidosis and appears to be associated with the progression of the disease process.

Primary drug-resistant tuberculosis. Report of an outbreak.

Abstract In an outbreak of tuberculosis, a strain of Mycobacterium tuberculosis isolated from the source case, before the administration of any chemotherapy, was highly resistant to isoniazid, streptomycin and para-aminosalicylic acid. All 23 members of the immediate household were found to be positive tuberculin reactors, and in six of them active tuberculous disease developed. Evidence of spread of this infection into the local community was indicated by a significant increase in the rate of tuberculin reactors among the non-household contacts of the source case. Physicians seem to be unaware that tuberculosis still exists in certain segments of our population. Careful and persistent follow-up observation of tuberculin reactors is extremely important and may avert disaster. The drug susceptibility pattern of the source case should be reported to the chest clinic or health agency checking the contact cases. Isoniazid-resistant strains may present a problem in chemoprophylaxis.

ATRIAL SEPTAL DEFECT IN THE AGED

Excerpt An atrial septal defect is now recognized as one of the most common forms of congenital heart disease. This lesion may permit the patient to live to old age without producing any appreciabl...

Silo filler's disease: Clinical, physiologic and pathologic study of a patient☆

Abstract A case of silo fillers disease is reported, resulting from exposure to silage six weeks after it was stored. Pulmonary function studies and lung biopsy specimens were obtained in the acute stage and during the period of convalescence. Pulmonary function studies showed the acute disturbance to be one of impaired diffusion of oxygen across the alveolar-capillary membrane. The initial lung biopsy showed a bronchiolitis. Following therapy with corticosteroids the alveolar diffusion capacity became normal, but the pulmonary function studies as well as the biopsy indicated that a mild degree of pulmonary hyperinflation resulted.