[The assessment of cardiopulmonary insufficiency].
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Biomedical subjects
Publications and source records attributed to R Keller.
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Adherent, predominantly phagocytic effector cells which have previously been shown to occur in a large number of tissues of mice and rats have the spontaneous capacity to kill a variety of syngeneic, allogeneic and xenogeneic target cells in vitro. The present work shows that 89Sr treatment of mice suppressed this spontaneous cytotoxicity, thus indicating that the effector cells pass a substantial part of their life in the bone marrow. In contrast, the capacity to mobilize mononuclear phagocytes and to enhance cytotoxicity in response to an appropriate stimulus were not consistently impaired.
Norepinephrine has a strongly lateralized distribution in the human thalamus. In the pulvinar region the left hemisphere is rich in norepinephrine, whereas in the somatosensory input area the right hemisphere has a higher concentration of this catecholamine. Such naturally occurring left-right differences in concentration of a neurotransmitter represent a new aspect of hemispheric specialization.
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Several lung function tests are capable of detecting typical functional abnormalities in pulmonary emphysema, such as reduced elastic recoil of lung tissue, elevation of intrathoracic gas volumes, expiratory bronchial collapse or uneven patterns of ventilation. The measurement of elastic recoil by means of an esophageal catheter also seems to be a reliable technique for detecting early stages of emphysema, but its use for routine clinical investigations remains impracticable. The elevation of intrathoracic gas volumes determined by body plethysmography or helium dilution technique may sometimes be influenced by reversible bronchial obstructions or additional restrictive ventilatory defects. Expiratory collapse of the intrathoracic airways, however, proves to be a regular finding in advanced pulmonary emphysema. It results from decreased stability of the peripheral and central bronchial wall as well as from a shifting of bronchial and transmural pressure gradients to the peripheral airways. The occurrence of a pressure dependent expiratory stenosis can easily be demonstrated by the spirometric flow-volume curve during forced expiration, thus differentiating patients with asthma from those with chronic bronchitis and emphysema. The minimal program for detection and evaluation of emphysematous alterations of the lung by functional tests should consist in the measurement of intrathoracic gas volumes, recording of the forced expiratory volume and the analysis of the flow-volume curve.
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Thoracic epidural analgesia (EA) is described as an alternative to controlled ventilation in patients presenting with multiple rib fractures. Lung mechanics were especially studied in 6 patients selected from a total of 49. The average ICU stay for this group was 4.5 days (2-11) and the mean age 55.7 years. The EA group was compared with 51 patients primarily ventilated who had an average stay in the ICU of 9.8 days and a mean age of 44.7 years. Mean number of rib fractures of the ventilated group at 6.5 was almost equal to the mean of 6.8 in the EA group. There was a difference in the number of associated fractures, 98 in the ventilated group compared to 35 in the EA group. Severe pulmonary and cerebral contusion were the two most important factors in enforcing the need to ventilate. The success of the method is evidenced by the increase in functional residual capacity (FRC), dynamic lung compliance (Cdyn), vital capacity (VC), the decrease of airway resistance (R) and a significantly increase of PaO2 (p less than 0,001) for the EA group with a balanced fluid therapy. All this accounts for the clinical observation of diminishing paradoxical movement of the flail segment.
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Adherent, predominantly phagocytic, mononuclear cells expressing spontaneous cytotoxic activity against diverse target cells in vitro were present in various tissues of different strains of rats and mice. Cells with such natural killer capacity were thus everywhere readily available for mobilization and activation. The inherent spontaneous killer capacity of adherent mononuclear phagocytes can be abrogated by silica particles in vitro, and can be considerably enhanced by appropriate stimuli in vivo. Spontaneous cytolysis mediated by unstimulated mononuclear phagocytes was consistently manifested only after a lag phase of 12-20 h and was quite nonspecific; there was no cogent correlation between susceptibility to lysis and transformation.
Adherent, predominantly phagocytic mononuclear cells from various rat tissues express spontaneous cytoxicity against diverse target cells in vitro. The extent to which cytotoxicity was expressed by effector cells depended on the age of donors. Cytolytic effector-cell capacity was already fully developed a few days after birth, and persisted over many months, but was clearly reduced in senescence. Similarly, the ability to intensify natural cytotoxicity by peptone in vivo was already fully manifested in the newborn, but was significantly diminished in old rats.
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Disorders of the respiratory tract account for about 13 percent of overall mortality in Switzerland, for about 50 percent of all hospital admissions and for about 7 percent of the nursing days. Cases of obstructive respiratory disease, pneumonia and carcinoma of the lung predominate. Morbidity regarding newly discovered cases of tuberculos is still 0.5 percent and 40 percent of the population are still positive reactors. BCG vaccination of newborns and of all tuberculin-negative schoolchildren is the approved prophylactic procedure. Periodic mass radiography of adults on a voluntary basis, aimed at the early diagnosis of pulmonary disorders, shows an incidence of 0.4/1 000 and of 0.3/1 000 for new cases of tuberculosis and lung cancer respectively. Cases of chronic obstructive respiratory disease who require hospitalization for above-average length and are frequently on sick leave present special sociomedical problems.