DIMEFLINE, A NEW RESPIRATORY ANALEPTIC. PNEUMOTACHOGRAPHIC STUDIES ON PATIENTS WITH RESPIRATORY INSUFFICIENCY.
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Non-respiratory factors, especially circulating hormones, have been emphasized to contribute to circadian variations in pulmonary functions. Herein, these relationships are reviewed, along with data from my department. Cosinor summary of urinary adrenaline and noradrenaline excretion revealed that they were similar to that of PEFR and DLCO, respectively. The acrophase of serum triiodothyronine (T3) was at 10PM in asthmatics, suggesting that serum T3 may affect the increase in bronchial reactivity at night, because a previous study showed a significant positive correlation between the serum T3 concentration and the slope of airway conductance measured by methacholine inhalation tests. There was no significant difference between normal and asthmatic rhythms of plasma cortisol. In addition to circulating hormones, a number of non-respiratory factors have been assumed to collaborate in nocturnal exacerbation of asthma. However, the exact cause of circadian variations of pulmonary functions is far from understood. Further examinations are required in this field to establish the theoretical ground for the chronotherapy of asthma.
This study was undertaken to compare postsurgical respiratory function after employing cold blood or cold crystalloid cardioplegia during open heart surgery. Fourty patients were divided into two groups for the difference of the cardioplegic solutions. Preoperatively, left ventricular stroke work index (LVSWI) and respiratory function test was evaluated. Postoperatively, A-a DO2 and respiratory index (RI) as functional parameters of oxygenation capacity, LVSWI and dosage of dopamine were monitored at 3, 6, 12, 18, 24 hours after cardiopulmonary bypass and at extubation period. The recovery of respiratory function and cardiac performance were superior in blood cardioplegia with a less accumulation of water in the pulmonary interstitium as a result of hemodilution effect.
The Pulmonary Medicine Section of the Department of Pediatrics of the University of Arkansas for Medical Sciences has recently developed an association with the Muscular Dystrophy Association Clinic held at Arkansas Children's Hospital. The slowly progressive, insidious onset of pulmonary problems associated with Duchenne-type muscular dystrophies and other degenerative muscle disorders indicated a need for a aggressive monitoring and treatment plan for these children and their caregivers. We have developed a Respiratory Care Handbook for families with information on the pulmonary consequences of these diseases including pathophysiology, pulmonary function tests, respiratory treatments including mechanical ventilatory support, and anticipation and prevention of pulmonary crises. In addition, we have introduced for the physician a formal monitoring and treatment regimen driven by changes in the vital capacity lung volume. The substance of this plan is presented in this manuscript.
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The authors define small airways disease and then describe its anatomical characteristics. In the early stage bronchial inflammation is found along with arterial lesions. As the disease develops, there are multiple bronchial and vascular alterations, often accompanied by emphysema. The few existing studies of the morphology/lung function test correlation show a relationship between small airways disease and abnormal respiratory function tests. One of the aims was to find the most sensitive and specific tests using the smoker as a model. However, as only 25% of smokers develop clinical abnormalities, the main problem is probably not early screening, but finding the parameter with the highest prognostic value. This should be the FEVI, measured at about age 40. At a younger age, the information is still too incomplete. More studies are needed to justify early screening. Finally, the authors discuss the procedure to be followed when abnormalities are detected, and its possible consequences on lung function and behaviour.
The diagnosis of hypersensitivity lung diseases in an agricultural, urban or occupational environment is established in two stages: (a) the environmental allergens likely to affect the alveoli and interstitial tissue are identified, and (b) the disease is diagnosed by clinical and radiological examinations but also by methods exploring respiratory function and immune mechanisms. Respiratory function tests show alveolar lesions, and the frequent involvement of the small bronchi is demonstrated by studies of respiratory mechanics. An important component of routine diagnosis is the presence in the serum of precipitating antibodies directed against the causative allergen and above all, bronchoalveolar lavages, which explore the deep lung, reveal distinctive cytological features (infiltration by T-lymphocytes) and lipidic features (fall in lecithins and increase in phosphatidyl-inositol and phosphatidyl-ethanolamine). High microviscosity of the alveolar fluid can be demonstrated by fluorescence polarization methods. A more rational treatment and, most important, measures aimed at preventing the development of a disabling and irreversible pulmonary fibrosis can be based on these findings.