Lois T. Ellison

Pulmonary Compliance Following Open-Heart Surgery and Its Relationship to Ventilation and Gas Exchange

Pulmonary function was studied preoperatively and postoperatively in 71 patients undergoing 41 open-heart operations, ten thoracic operations not requiring cardiopulmonary bypass, ten intra-abdominal, and ten peripheral procedures. After operation total respiratory compliance was significantly reduced below the preoperative value for ten days in the open-heart group. Decreases of lesser degree and of shorter duration were noted in the thoracic and intra-abdominal patients with no significant reduction in the peripheral cases. Tidal volume decreased proportionately to the decrease in compliance, and respiratory rate increased, while total ventilation usually remained the same or was slightly increased. Oxygen uptake was significantly increased after open-heart operations, and there was a significant negative correlation between oxygen uptake and compliance. Abnormal venous admixture, not corrected by oxygen inhalation, was observed after cardiopulmonary bypass with a return to preoperative level coinciding with that of compliance. Cardiac output did not correlate with any other measurement.The data suggest that the postoperative breathing pattern after open-heart surgery is a compensatory adjustment to decreased compliance and that reduced compliance is one of the causes of the increased work of breathing and oxygen demands after open-heart surgery.

Soft-palate pigmentation in lung disease, including cancer

A study of patients in whom soft-palate pigmentation appeared to be associated with pulmonary disease has been reported. A significant number of these patients had diagnosed or suspected bronchogenic carcinoma. The possibility that this oral finding may be predictive of the presence of lung cancer, or of a high degree of probability of future development of lung cancer, indicates a need for additional investigation. At this point the evidence strongly suggests that when soft-palate pigmentation is seen in a patient with lung disease, cancer should be suspected until it is definitely ruled out. The paucity of patients in whom this sign is seen suggests the need for study by other investigators. ACTH levels should be evaluated, as should plasma zinc values, which have been demonstrated to decrease in lung cancer as well as other diseases. Following the patients prospectively certainly is indicated. In conjunction with the Department of Laboratory Medicine, limited initial additional investigations have been made of the carcinoembryonic antigen (CEA) levels on three of the outpatients reported. These assays used the hemagglutination-inhibition technique and are limited to investigational use by the Food and Drug Administration. In this laboratory the normal CEA level is 5.2 +/- 1.6 ng./ml. Results in two patients with known chronic obstructive pulmonary disease were 5.5 and 5.6 ng./ml. The third patient with soft-palate pigmentation and an undiagnosed pulmonary problem had a CEA level of 10.2 ng./ml. She also had clubbing of the fingers. The senior author would be particularly interested in establishing a registry of similar cases observed by others.

The Metabolic Acidosis Resulting from Intravenous Tetracycline Administration

Summary The metabolic acidosis resulting from acute toxic doses of parenterial tetracycline was studied in dogs and compared to the acidosis produced by equivalent amounts of ascorbic acid and HCl found in the parenterial preparations. A severe metabolic acidosis developed which could be only partially corrected by buffering with THAM. A large portion of the acidosis could not be accounted for by lactic, pyruvic, or metabolites of ascorbic acid. This work was supported in part by the National Institutes of Health, USPHS, Bethesda, MD, Grant Nos. HE-11782 and HE-05432.

Role of Atelectasis in Surfactant Abnormalities Following Extracorporeal Circulation A Clinical and Experimental Study

Surface activity of lung extracts was determined in 36 patients and 28 dogs following extracorporeal circulation. Normal results were usually found. Abnormal surface tension was demonstrated only in a few samples obtained from grossly atelectatic or congested portions of lung, normal surface tension being present in adjoining areas of the same lung. Sources of error in surface-tension measurements and factors to be considered in the interpretation of results are discussed. A possible explanation for the discrepancies in results obtained by various investigators is presented.

Natural History of Pulmonary Hypertension in Surgically Treated Patent Ductus Arteriosus

One hundred consecutive surgically treated patients with patent ductus arteriosus underwent preoperative and/or pulmonary artery and aortic pressure measurements at the time of surgery, prior to and following temporary occlusion or division of the ductus. Patients with persistent elevation in pressure following division of the ductus subsequently underwent single or multiple catheterizations at various intervals ranging between one and four years following surgery.Pulmonary hypertension prior to division was present in 35 patients (35%). This was mild in 19, moderate in nine, and severe in seven. The pressure returned to normal immediately after division of the ductus in 13, indicating that in this group the pressure elevation was hyperkinetic. In 22, the pressure remained elevated immediately after division, pulmonary hypertension being mild in seven, moderate in eight, and severe in seven. In the mild group, the pressure subsequently returned to normal in all but one. In the moderate group, the pressure failed to return to normal in six out of eight, indicating the presence of vaso-occlusive changes in the pulmonary bed. The pressure usually exceeded 60 mm Hg systolic. In seven patients with severe pulmonary hypertension, division was performed in four. Two died in the immediate postoperative period, and two survived. Follow-up cardiac catheterization showed a return of pressure to normal in one and persistent elevation in the other. Of three patients in whom division was not performed, two are living and well two and seven years later, respectively, and one has been lost to follow-up.Although the rate of blood flow and vaso-constriction contributed considerably to the elevation of pulmonary arterial pressure, the blood pressure failed to return to normal in the majority of patients whose systolic pressure was elevated in excess of 60 mm Hg after division of the ductus, indicating pathological pulmonary vascular alterations.