Louis J. Kettel

Patterns of Cardiovascular Dysfunction in Chronic Obstructive Lung Disease

Abstract A longitudinal seven-year study of 50 patients with chronic airway obstruction, whose cardiovascular function had been evaluated by cardiac catheterization when their condition was stable, showed that their survival was inversely related to pulmonary vascular resistance. Fourteen patients with high vascular resistances showed two different patterns of cardiovascular abnormality. Nine had relatively normal blood gases, low cardiac outputs, and near normal resting pulmonary-artery pressures; they had an emphysematous type of lung disease. The five with more severe blood gas abnormalities who had a more bronchitic type of disease, had well maintained cardiac outputs and more severe pulmonary hypertension. They more regularly presented the classic clinical and electrocardiographic features of cor pulmonale. Left ventricular dysfunction appeared to be an important determinant of pulmonary hypertension in only one patient.

The Surfactant System of the Lung

It is startling to realize that since the observations of von Neergaard (1929) and Pattle (1955) a book of this length, with 328 references, can be compiled on the surfactant system of the lung. Emile M. Scarpellis work does this and more. Assuming that the reader has little prior knowledge of the subject the author has produced a comprehensive yet readable monograph for students, practicing physicians, and investigators in the science of pulmonary surfaces. The book includes sections on lung mechanics and surface phenomena, morphology, histochemistry, biochemistry, biosynthesis, and physical characteristics of the surfactant system. Unique is the chapter on comparative anatomy and physiology of the system. Quite properly, the studies of fetal and newborn lung surface phenomena receive a detailed and large amount of attention. Clinical application and pathology appropriately follow the background material developed by the basic review. The tables, graphs, and charts supporting each chapter are mostly