R Peset

INFLUENCE OF PLATINUM-INDUCED RENAL TOXICITY ON BLEOMYCIN-INDUCED PULMONARY TOXICITY IN PATIENTS WITH DISSEMINATED TESTICULAR-CARCINOMA

Pulmonary function tests, including T1CO, and renal function tests were performed and GFR and ERPF measured in 18 patients with disseminated testicular non-seminoma before and after remission induction according to the Einhorn regimen. We found a significant positive correlation between delta GFR and delta T1CO (p less than 0.05). No significance could be demonstrated between delta ERPF and delta T1CO. It is concluded that caution should be exercised in administrating bleomycin to patients with severely impaired renal function.

Changes in pulmonary function during and after bleomycin treatment in patients with testicular carcinoma

SummaryPulmonary function tests, including spirometry, transfer factor of the lungs for carbon monoxide (TlCO), and the two components of TlCO, the diffusing capacity of the alveolocapillary membrane (Dm) and pulmonary capillary blood volume (Vc), were carried out in a group of patients with testicular carcinoma during and after treatment with the Einhorn regimen. The lung function parameters of patients who developed bleomycin-induced pneumonitis were compared with those recorded in a group of patients who did not develop this syndrome.We suggest that bleomycin-induced damage to the pulmonary capillary vasculature can be monitored by measuring Vc and that ensuing fibrosis can be measured by recording Dm. The decrease in Dm is probably compensated for by an increase in Vc, leading to a smaller change in TlCO.

Determination of the functional residual capacity during exercise

A rebreathing technique is described for measuring FRC during exercise. Good agreement was found between this technique and a standard helium dilution method using a water spirometer at rest. Measurements of FRC in ten volunteers showed a significant decrease of FRC at the onset of progressive exercise. The FRC remained significantly smaller than the resting value up to loads of 150 W.

LUNG MECHANICAL PROFILES IN ACUTE RESPIRATORY-FAILURE - DIAGNOSTIC AND PROGNOSTIC VALUE OF COMPLIANCE AT DIFFERENT TIDAL VOLUMES

The mean airway pressure difference within a respiratory cycle at end-inspiration was measured at different tidal volumes (Vt) in 59 patients treated with mechanical ventilation, and plotted in a pressure-volume (P-V) diagram. Regression analysis revealed three types of regression lines which were clearly correlated with clinical pulmonary condition and outcome. The slope of such regression lines may be a more realistic representation of lung elasticity than conventional total static compliance, which is measured at only one Vt, and the intercept of these lines may be a more appropriate reflection of operating lung volume than functional residual capacity. Ventilator settings should put the patients lungs on the steepest part of the P-V curve with the smallest intercept, while maintaining acceptable arterial blood gas tensions.

Central venous versus esophageal pressure changes for calculation of lung compliance during mechanical ventilation.

Esophageal and CVP changes were measured simultaneously during mechanical ventilation in 12 patients with acute respiratory failure (ARF). The results of these measurements were different and showed no correlation. Values of transpulmonary pressure changes and calculated lung compliances correlated well, because of the higher airway pressure changes. It is concluded, therefore, that measurements of esophageal and CVP changes are equally well suited for these calculations. For practical purposes, there is no need to measure a representant of intrapleural pressure changes, because during mechanical ventilation total static compliance calculations can be used to monitor changes in lung compliance, provided the thoracic cage compliance is not reduced substantially and does not change during the course of the studies. Clinical awareness of factors influencing thoracic cage compliance is important. The difference in transpulmonary and transthoracic pressure relationships during mechanical ventilation and during spontaneous breathing is emphasized. In spontaneous breathing, intrapleural pressure changes are determined primarily by the elastic properties of the lungs; in mechanical ventilation, on the other hand, by the elastic properties of the thoracic cage.

Comparison of Methods to Calculate Regional Lung Volume and Specific Alveolar Ventilation from Xenon-133 Wash-in Curves

Wash-in curves for physiologically inert gases are usually described by a mono-exponential function of the type N(t) = N∞(l−e−kt). N∞ is related to lung volume and K is the specific alveolar ventilation, or alveolar ventilation per unit lung volume. Determination of the specific alveolar ventilation therefore recess takes an estimate of ? from the measured curve. Compared with other gases Xenon-133 is fairly soluble in blood (blood-gas partition coefficient λ = 0.152). This gives rise to multiexponential curves3.