摘要:

A good result from the heart-lung transplantation depends on the quality of the preservation of cardiopulmonary transplants. To determine the functional and pathological status of the heart-lung block after preservation for several hours, we performed 10 heterologous heart-lung transplantations in Beagle dogs (weight 13.5 kg) under extracorporeal circulation. Weight and length compatibility between donor and receiver was ensured. Measurements of hemodynamics, lung mechanics and blood gases were performed in the donor and in the receiver before the transplantation, and in the receiver after heart-lung reimplantation. Histological studies were carried out by biopsy on the heart and on the lung of the donor before removal, at the beginning of the preservation at low temperature, after 3 h of ischemia in cold, and every hour after recir-culation in the heart-lung block. Myocardial preservation was conducted with cold cardioplegia at 4°C (Ringer lactate solution with high potassium). Lung preservation was achieved by injecting a Euro-Collins solution at 4°C, with addition of dog plasma, into the pulmonary artery; during the whole ischemic phase, the lung parenchyma was maintained at O°C, and inflated at a 10 cm H2O pressure. After transplantation, we observed that cardiac output was low in all cases, with normal or subnormal pulmonary arterial pressure. Dynamic lung compliance was very low immediately after transplantation, and increased when restarting the circulation, but deteriorated again after several hours. At the same time alveolo-arterial O2 pressure difference and arterio-alveolar CO2 pressure difference progressively increased, due to the extensive gas exchange impairment. These disturbances were corroborated by histological examinations, which showed interstitial edema developing towards alveolar and myocardial edema. We did not observe a correlation between the heart-lung ischemia duration (2.30–5.45 h) and the survival time (2–5

ISSN:0025-7931    

DOI:10.1159/000195406

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Dopamine (DA) has rarely been administered at low dosage to stable patients with pulmonary hypertension (PAH) secondary to chronic obstructive lung disease (COLD). Since L-dopa (L-DA) is metabolized into DA, it might be an oral source of DA. After informed consent 10 patients with PAH, secondary to COLD underwent right catheterization to allow measurements of pressures and cardiac output (CO) as well as arterial and mixed venous oxygen levels before and then 30 and 60 min after the beginning of intravenous DA at a rate of 4 µg/kg/min. A week later, the same parameters were remeasured in 5 of these patients after a single oral intake of 1.5 g L-DA. At low doses both DA and L-DA increased CO and decreased pulmonary vascular resistances, suggesting a pulmonary vasodilator effect. They also enhanced oxygen delivery and PvO2 without decreasing PaO2·A correlation was observed between cardiac index and plasma DA level. Thus though they do have some immediate adverse side effects and their long-term effects are unknown, inotropic and vasodilator drugs may have positive effects on pulmonary circulatio

ISSN:0025-7931    

DOI:10.1159/000195407

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Serum angiotensin-converting enzmye (ACE) activity is known to be elevated in various granulomatous conditions such as sarcoidosis, whose characteristic epithelioid cells are thought to belong to the macrophage series. It was recently shown that alveolar macrophages had ACE activity in their sonicated and homogenate forms. We investigated ACE activity of human alveolar macrophages in the intact form using a sensitive radioimmunoassay of generated angiotensin II. We also investigated the effect of smoking on ACE activity of alveolar macrophages using this method. Alveolar macrophages generated angiotensin II (218 ± 106 pg/20 min/105 cells). More angiotensin II was generated in smokers (246 ± 119 pg/20 min/105 cells) than in nonsmokers (160 ± 50 pg/20 min/105 cells) (p < 0.05). These data showed that ACE activity of macrophages is higher in smokers than nonsmoke

ISSN:0025-7931    

DOI:10.1159/000195408

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Gender differences in resting ventilation and hypoxic ventilatory response (HVR) have been reported. Ventilation and HVR are closely related to changes in metabolic rate in men. However, it is unclear whether there is a comparable relationship between metabolic rate and ventilation or HVR in women. We studied 13 men and 12 women to determine whether exercise-induced increases in metabolic rate influenced ventilation, HVR, and hypercapnic ventilatory response (HCVR) differently in men and women. Minute ventilation per unit metabolic rate was higher (lower end-tidal PCO2) in women than men during rest and mild exercise. Resting HVR values were similar in men and women. With mild, exercise-induced increases in O2 consumption (24 ± 4% in men and 27 ± 2% in women, p = NS), HVR increased in men (p < 0.05) but not in women. Moderate exercise-induced increases in O2 consumption (313 ± 13% in men and 330 ± 13% in women, p = NS), raised hypoxic responses in both sexes. HCVR values were similar in men and women at rest and during mild exercise. Moderate exercise increased HCVR equally in the sexes. Thus the higher resting ventilation and lesser change in HVR during mild exercise suggested that women were less sensitive to mild metabolic rate stimulation than

ISSN:0025-7931    

DOI:10.1159/000195409

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

The compliance of the respiratory system (Crs) has been measured by an airway occlusion technique in 78 healthy newborn infants [gestational age (GA) 36.2 ± 2.9 weeks, range 28–41 weeks; birth weight (BW) 2.418 ± 0.879 kg, range 0.830–4.350 kg; body height (BH) 45.2 ± 4.4 cm, range 33–52 cm in the first 8 h after birth (206.2 ± 100.8 min, range 45–480 min). The prediction equations were (Crs, ml/cm H2O): Crs = 0.087 GA -1.173 (r = 0.49, p < 0.0001), Crs = 0.372 BW +1.067 (r = 0.62, p < 0.0001), Crs = 0.076- BH -1.493 (r = 0.61, p < 0.0001). The Crs values were very similar to the values measured in curarized newborn infants and quoted in the literature. There was only one newborn infant with a Crs of less than 1 ml/cm H2O (GA = 34 weeks, BW = 0.830 kg, BH = 33 cm, Crs = 0.909 ml/cm H

ISSN:0025-7931    

DOI:10.1159/000195410

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

We describe the clinical, physiological and pathological features of 23 subjects with early stage idiopathic pulmonary fibrosis. Thirteen subjects who had no symptoms had been fortuitously recruited by a routine chest radiograph, whereas the 10 other subjects complained of dyspnea. Twenty-one subjects showed only light to moderate extent of abnormalities on the chest radiograph. Fourteen subjects had a reduced vital capacity whereas 16 and 17 showed a reduced pulmonary compliance and an increase in lung elastic recoil, respectively. Transfer factor was significantly reduced in 18 subjects. Evidence for significant airway obstruction, mainly located at the peripheral level, was demonstrated by a reduced specific lung conductance and upstream conductance in 13 subjects. Airway obstruction was not associated with smoking habits. Bronchial hyper-responsiveness was noted in 50% of the 18 subjects studied. Although fibrosis was mild to moderate in 15 instances, it was only focal, i.e. at least one zone of normal parenchyma in the lung specimen in 17 subjects. Peribronchial fibrosis was established in 8/11 satisfactory biopsy specimens. Significant correlations were observed between rales, the radiological score, some functional indices and the characteristics of fibrosis. We conclude that small airway obstruction documented by physiological and pathological means is frequent in early stage idiopathic pulmonary fibrosis.

ISSN:0025-7931    

DOI:10.1159/000195411

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Published reports have indicated that patients with Kartagener’s syndrome (dextrocardia, sinusitis and bronchiectasis) have no significant lung mucociliary clearance. With a radioaerosol technique we measured over a 6-hour observation period the tracheobronchial clearance of 8 patients with dextrocardia, chronic bronchial sepsis and chronic sinusitis (DC). The tracheobronchial clearance of these patients was significantly reduced (p < 0.02) compared with that of 29 healthy subjects of similar age. However, even when allowance was made for productive coughing during the observation period, the reduced clearance was much better than anticipated from published reports in patients with Kartagener’s syndrome, which confined their observations to a 2-hour period. The tracheobronchial clearance of the DC patients, adjusted for productive coughing, was as bad as that found in an older group of patients with chronic obstructive airways disease who refrained from expectorating during the equivalent test period. Our study implies one or more of the following possibilities: (a) a spectrum of mucociliary impairment in patients with DC; (b) an effective cough clearance deeper in the lung than hitherto believed, and (c) two-phase flow of mucus cephalad as an effective clearance mechanism in patients with

ISSN:0025-7931    

DOI:10.1159/000195412

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

To assess the contribution of thoracoscopy in the management of spontaneous pneumothorax (SP) 101 consecutive cases treated in our department were reviewed. The patients were divided into two groups: group 1 was treated conservatively; in group 2 thoracoscopy was performed and in case of an idiopathic SP, pleurodesis was carried out with iodinated talcum. Group 1 consisted of 51 patients of whom 28 were considered to have a symptomatic SP (1A) and 23 an idiopathic SP (1B). The recurrence rate was 46 and 26%, respectively. Group 2 consisted of 50 patients of whom 12 had a symptomatic SP (2A) and 38 an idiopathic SP (2B). In group 2A, thoracoscopy provided the indication for primary surgical intervention in 3 patients. Patients in group 2B were treated by chemical pleurodesis with iodinated talcum. In only 1 did a recurrence occur. Complications of thoracoscopy and/or pleurodesis were not observed. We conclude that thoracoscopy enables accurate assessment of the type of pneumothorax, and can play an important role in the management of SP. Chemical pleurodesis causes a significant reduction of the recurrence rate in the treatment of idiopathic SP.

ISSN:0025-7931    

DOI:10.1159/000195413

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

An unusual case of acute muscular atrophy in a patient with a severe exacerbation of asthma requiring mechanical ventilation is reported. High doses of pancuronium bromide and 6-methylprednisolone were administered. It is suggested that the conditions of mechanical ventilation increase in some way the potential of corticosteroids to cause myopathy. The possible implication of myorelaxant drugs in the development of this complication is also suggested.

ISSN:0025-7931    

DOI:10.1159/000195414

出版商:S. Karger AG    

年代:1988

数据来源: Karger

ISSN:0025-7931    

DOI:10.1159/000195415

出版商:S. Karger AG    

年代:1988

数据来源: Karger