The American review of respiratory disease
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Am. Rev. Respir. Dis. · Feb 1983
Bleomycin-induced changes in pulmonary microvascular albumin permeability and extravascular albumin space.
Pulmonary microvascular permeability to serum albumin and the extravascular albumin space (EAS) were measured in rat lungs 5 days after intratracheal instillation of bleomycin. The albumin permeability-surface area product (PS) was measured using a new method: lungs were removed and perfused with Ringer's solution; they were then perfused for 3 min with Ringer's containing [125I]albumin, followed by 3 min with plain Ringer's to clear the vascular space. The PS was calculated from the 125I activity in perfusate and homogenized lung tissue. ⋯ Compared with control rats, the injected animals showed a slight, but significant, increase in PS, and a doubling of the EAS. In previous work, using other techniques, the EAS increase was interpreted as an increased PS. Our new method for PS measurement is easy and more accurate than those previously used, and shows that the acute pulmonary response to intratracheally administered bleomycin involves significant interstitial changes with little alteration in the microvascular endothelium.
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Am. Rev. Respir. Dis. · Jan 1983
Small airways in severe panlobular emphysema: mural thickening and premature closure.
Histological measurements in cases of severe paniobular and centrilobular emphysema and in normal lungs disclosed a generalized thickening of the walls of small airways in the panlobular group. With mathematical models, this was depicted as a potential basis for airway closure at higher than normal lung volumes and trapping of air. ⋯ Bronchiolar thickening is one such general process. Present findings suggest that this is prone to be linked to emphysema with a panlobular pattern.
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Am. Rev. Respir. Dis. · Dec 1982
Case ReportsDynamic hyperinflation and ventilator dependence in chronic obstructive pulmonary disease.
In advanced chronic obstructive pulmonary diseases, functional residual capacity (FRC) can be markedly increased by dynamic mechanisms involving expiratory flow limitation. We studied respiratory mechanics in a seated ventilator-dependent patient with such changes. Relaxed expiration was flow-limited; pressures of 9 to 27 cm H2O (varying with lung volume) could be applied to the airway opening (Pao) without decreasing expiratory flow rate. ⋯ More importantly, recoil pressures at end inspiration and end expiration, respectively, were 6.5 and 1.5 cm H2O for the lung, 33 and 11 cm H2O for chest wall, and 38 and 12 cm H2O for the respiratory system. Thus the chest wall recoiled inward at all times, pleural pressure was always substantially positive (11 to 33 cm H2O), expiratory flow was maximal, and jugular veins were always full and nonpulsating. Inspiratory work was about 0.27 kg-m per breath (7 times normal), most of it elastic work done on the chest wall.
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Am. Rev. Respir. Dis. · Dec 1982
Case ReportsBlastomyces dermatitidis and the adult respiratory distress syndrome. Case reports and review of the literature.
The adult respiratory distress syndrome (ARDS) developed in 2 patients with blastomycosis. In one, ARDS apparently followed the rupture of an infected subcarinal lymph node into a bronchus. ⋯ Four additional cases of blastomycosis with definite or presumed ARDS are reviewed. The clinical course of these 6 patients was characterized by a prolonged prodrome (median, 36 days), consistent with pulmonary blastomycosis, and a rapid demise (median, 5 days) associated with ARDS.
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Am. Rev. Respir. Dis. · Nov 1982
A simple method for assessing the validity of the esophageal balloon technique.
The validity of the conventional esophageal balloon technique as a measure of pleural pressure was tested in 10 subjects in sitting, supine, and lateral positions by occluding the airways at end-expiration and measuring the ratio of changes in esophageal (delta Pes) and mouth pressure (delta Pm) during the ensuing spontaneous occluded inspiratory efforts. Similar measurements were also made during static Mueller maneuvers. ⋯ No appreciable phase difference between delta Pes and delta Pm was found. We conclude that by positioning the balloon according to the "occlusion test" procedure, valid measurements of pleural pressure can be obtained in all the tested body positions.