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, , 643-653. The histopathology of the lungs from four human cases of paraquat poisoning is described. In two of them there was a dense mass of fibroblastic tissue which obliterated the lung architecture, and one of these showed an extensive deposit of collagen with honeycomb change. In a third case pulmonary fibrosis was less severe and could be demonstrated exclusively within the alveolar spaces. The fourth showed earlier lesions of capillary congestion, alveolar oedema, and hyaline membrane formation. We suggest that paraquat produces the same effect on the lung in man as in the rat, namely a diffuse, cellular, fibrosis. The intra-alveolar origin of this fibrosis is often obscured in the advanced stage of the disease and has been misinterpreted as fibrosing alveolitis. This fibrosis is associated with a pulmonary vascular disease. In assessing the histopathology of the lung in paraquat poisoning a history of oxygen therapy must be taken into account, for prolonged exposure to this gas may in itself induce pulmonary fibrosis. [ABSTRACT FROM PUBLISHER]

Neurological findings are described in 200 consecutive cases of suicidal ingestion of organophosphorous insecticides. Miosis is almost universal. We found impairment of consciousness in 10%, fasciculations in 27%, convulsions in 1%, toxic delirium in 50%, and paralysis in 26%. Toxic delirium was attributed to treatment with atropine. Paralytic signs were divided into type 1 signs (present on admission) and type 2 signs (appearing later while on atropine treatment). Type 1 signs, chiefly impaired consciousness and bilateral pyramidal tract signs, respond to atropine. The most common type 2 signs are proximal limb weakness, areflexia, and cranial nerve palsies. EMG studies during type 2 paralysis show a myasthenic response in some cases. Of 36 cases with type 2 signs 15 died from respiratory paralysis after a variable period of artificial respiration. Twenty-one recovered and no residual neurological deficit has been noted. Atropine did not influence type 2 paralysis. It is claimed that type 2 signs differ significantly from those described before as `delayed neurotoxicity' and may represent an alternative mode of human toxicity with organophosphorous compounds. [ABSTRACT FROM AUTHOR]

Pulmonary insufficiency is frequently associated with a peptic ulceration that has a high incidence of explosive complications necessitating surgery in spite of the hypoxia and hypercapnia that occurs during the preoperative, operative and postoperative periods. Undetected and untreated hypoxia and/or hypercapnia results in acidosis and its hypotension, decreased cardiac output, ventricular arrythmia and cardiac standstill. Both may simulate anesthetic narcosis and can only be identified early by serial pH and arterial gas studies. Treatment consists of adequate airway, O2 by head tent or controlled ventilation and intravenous buffers for marked acidosis or persistent narcosis. [ABSTRACT FROM AUTHOR]

The pathophysiology of pulmonary and extrapulmonary respiratory changes which follow trauma are reviewed and simple diagnostic measures given for their early bedside recognition. Posttraumatic respiratory insufficiency which has become the major cause of death of patients in shock develops primarely on the basis of ventilation-perfusion inequalities: e.g. shunt, deadspace and silent unit. Daily measurements of the alveoloarterial oxygen gradient (AaDO) in severely ill patients helps to recognize shunt flow by simple means in an early state when therapeutic measures are still successful. The deadspace to tidal volume relation (V/V) increases after injury as result of plateletaggregation and hemorrhage. Transcapillary fluid loss is often a consequence of beginning left heart failure, hypoproteinemia (hemodilution due to excessive administration of colloid free solutions), aspiration and high positive airwaypressures or oxygen concentrations during artificial respiration. Deficiences in oxygen transport have lately been discussed with increasing emphasis. Some remarks regarding 2,3 DPG-levels of stored blood and viscosity changes after volume replacement are added. [ABSTRACT FROM AUTHOR]

The use of the ECG to assess the presence of pulmonary disease in hospital patients has been well established in the literature. Numerous criteria involving nearly all aspects of the electrical complex have been presented. In 472 unselected working adults, this investigation demonstrated that a vertical tendency in the mean frontal plane P wave axis greater than or equal to plus 60° was related to an abnormal one second forced expiratory volume. There was no relationship between a vertical P axis and an abnormal vital capacity. Thus, the EGG may be a useful tool in screening for pulmonary obstructive disease by disclosing verticalization of the P axis. [ABSTRACT FROM AUTHOR]

Some toxic effects of trichloracetates have been investigated using a strain of Chlorella vulgaris which grows readily in the dark with glucose as the source of carbon. Cell division was retarded to the same extent by similar concentrations of toxicant under photosynthetic and non-photosynthetic culture conditions, At concentrations exceeding approximately 0.01 M, cell division was retarded, and the proportion of phosphorus compounds which were 'acid-soluble' increased in the growing cells. The uptakes of external glucose, phosphorus and nitrogen by a concentrated suspension of Chlorella were all depressed by concentrations above 0.06 M, such that the final ratio of cell phosphorus to nitrogen was independent of the trichloracetate concentration. Respiration, as measured by uptake of oxygen, was not reduced by concentrations of trichloracetate below 0.4 M, above which non-specific osmotic effects were probably the cause of respiratory failure. In contrast, 0.001 M trichloracetic acid decreased respiration of old cells appreciably in an unbuffered medium. [ABSTRACT FROM AUTHOR]

Six cases of flail chest injury were studied for changes in blood gases and acid-base status before and during respiratory management. Metabolic acidosis and mild to severe hypoxemia were found in most patients with flail chest at the time of admission, and there was a relationship between manifestation of paradoxical respiration and hypercarbia. Serial blood gas determinations are extremely important in assessment of the adequacy of the therapy, particularly in management of flail chest with continuous IPPB therapy. [ABSTRACT FROM AUTHOR]

Fifty patients aged 11 to 78 years with untreated idiopathic scoliosis were studied. An increased frequency of respiratory impairment was found, especially in patients with a severe degree of scoliosis. Seven patients under 60 years were unable to work and all had thoracic curves exceeding 100°. None of the patients between 20 and 65 years of age was engaged in hard work and 22% had a disability pension, all because of respiratory impairment. A tendency to increased shortness of breath was noted with increasing curves as well as age. Dynamic and static spirometry was performed and airway closure was studied with the xenon-133 bolus technique. With increasing degrees of scoliosis there was a reduction in all lung volumes. Seventeen of 40 patients showed evidence of airway closure at lung volumes greater than functional residual capacity; 6 of these patients were under 40 years of age, and all had thoracic scoliosis exceeding 90°. [ABSTRACT FROM PUBLISHER]

Two cases of acute Wegener's granulomatosis are described. The first ended fatally after an illness of only two weeks. In the second a remission of three years has been obtained with heavy doses of steroid. At present there is evidence of impaired pulmonary gas transfer and also chronic glomerulonephritis, but the patient is asymptomatic. When the disease presents with pulmonary cavitation it may be confused with pulmonary neoplasm, tuberculosis, or lung abscess, and the diagnosis is made by biopsy. The Rose-Waaler was strongly positive in the case tested. [ABSTRACT FROM PUBLISHER]

One hundred patients with chronic airway obstruction, 50 in Chicago and 50 in London, were studied by standardized techniques in 1961. The results of the initial studies, previously reported, showed that the patients in the two cities were similar; using clinical and physiological criteria based on pathological studies, the patients were divided into three types—emphysematous type A, bronchial type B, and an indeterminate type X. The patients were studied again in succeeding years, 1962-65. During this time 26 died, 19 due to their respiratory disease; these 19 patients were initially more breathless, had a higher incidence of cor pulmonale, and had more severe airway obstruction and higher carbon dioxide pressures than the remainder. Type B patients (mortality 36%) had a worse prognosis than either type A (15%) or type X (12%). Of the measurements made, high carbon dioxide pressures were most closely related (<0·001) to mortality. During the period of follow-up about one-third of the patients who did not die became more short of breath and developed more severe airway obstruction and carbon dioxide retention: about 10% showed definite improvement in symptoms and pulmonary function. The F.E.V. declined on average by 46 ml./year, 4·8% of the initial value; V.C. declined by 120 ml./year, 4·0% of the initial value; mixed venous increased 1 mm. Hg/year. The changes that occurred during this time confirmed the previously reported similarity between the patients attending the two clinics. Although the incidence of bronchitic exacerbations was similar in the two cities, such illnesses in the London patients led to more frequent and more prolonged incapacity. [ABSTRACT FROM PUBLISHER]

The article offers information on the physiological problems associated with space exploration. It reports the respiratory problems connected with space flight, and mentions the situation of extremely reduced pressure faced by the space explorers. It also mentions the distances between earth, moon and other planets of the solar system, and discusses the solutions for the problems associated with weightlessness, air pollution, and gravitational forces. Also discussed are the topics that need further research and biological explanation including the effects of silence, acceleration-deceleration, acoustic energy, and vibrations on men in the space.

The article discusses the research that examines the association of the localization of symptoms to the chest with depression. Information on previous and family histories, together with personality development and certain reactive factors, was collected from two groups of 33 patients with depression. Three psychological questionnaires were completed by each patient in examining the link between hypochondriasis and the obsessional personality. It was found that organic respiratory disease, health conscious obsessional personality, and lower respiratory tract disease were factors in the presence of localized symptoms to the chest in depression.

This paper reports two cases of acute pulmonary edema successfully treated, when medical management failed, with continuous positive airway pressure (CPAP) and spontaneous breathing. The clinical, laboratory, and radiological findings indicate that this technic offers an alternative to mechanical ventilation when respiratory failure complicates pulmonary edema in infants. [ABSTRACT FROM AUTHOR]

Progress in anesthesiology and surgery has allowed partial and total correction of cardiovascular lesions previously considered inoperable. Based on definite criteria, half of the patients two years and under develop respiratory failure immediately before or alter operation (fewer when those with uncomplicated PDA are included). Many of those in respiratory failure may be saved by mechanical ventilation through a suitable airway such as an orotracheal, nasotracheal, or tracheostomy tube. The problems common to all artificial airways are here discussed in detail. [ABSTRACT FROM AUTHOR]

The article presents information about the transient, migratory, patchy atelectasis and pneumonitis encountered in the management of respiratory failure in two children with the Guillain-Barré syndrome. In this syndrome the progression of muscular weakness may be rapid and respiratory failure may develop without adequate warning. With the use of a positive-pressure respirator the patient should be ventilated manually several times every two hours to minimize the tendency toward patchy atelectasis. This can be accomplished by holding in the hand timer until a large tidal volume is delivered. With more resistant cases, bronchoscopy may be required to aspirate plugs of mucus. To minimize the development of acute pulmonary infections, hand-washing cleansing must be antlered to stringently. Each catheter should be discarded after only one suctioning. The number of hospital personnel and visitors must be kept to a minimum. Despite the above measures, respiratory failure with or without pulmonary infection is a very serious complication of this syndrome and has been reported to account for up to 44 percent of all deaths.

Focuses on a study which examined bacterial endocarditis in heroin addicts in Chicago, Illinois. Complications of endocarditis; Information on the infecting microorganisms; Treatment.

Examines the degree to which arterial oxygen pressure is affected by increasing the inspired oxygen concentration. Relationship between the arterial oxygen pressure of a subject breathing ambient air and certain indexes of ventilation-perfusion; Measurement of the arterial oxygen pressure on air breathing; Importance of the relationship between alveolar ventilation and perfusion on gas exchange in the lung.

Describes several case reports on the clinical, radiological, pathophysiological and morphological features of patients with chronic airways obstruction characterized by chronic cough and expectoration. Controversy surrounding the morphologic abnormalities underlying respiratory failure in chronic airway obstruction; Medical profile of the patients; Relationship between airway obstruction and the failure of gas exchange.

Two hundred and eighty-eight hospitalized patients were monitored during and after 317 courses of sodium colistimethate therapy to determine incidence and manifestations of adverse reactions. Adverse renal reactions occurred during 20.2% of colistin utilizations and were generally reversible. Acute tubular necrosis occurred during 1.9% of utilizations, manifestations of colistin neurotoxicity developed during 7.3%. Respiratory insufficiency and apnea were seen in 2.1% of patients. Adverse effects of colistin therapy contributed to the death of 13 (4.5%) patients. Adverse effects of colistin therapy contributed to the death of 13 (4.5%) patients treated with the drug. Sixty-four percent of adverse reactions to colistin became manifest during the first 4 days of therapy, and 95% occurred in patients who received no more than the recommended dose. For any given mean dally dose per pound, reaction rates increased markedly with patient weight. Colistin dosage proportional to the square root of patient weight might avoid the excess reaction rate in heavy patients and produce more effective blood levels in light patients. [ABSTRACT FROM AUTHOR]

Complications during treatment of 146 patients with 239 episodes of acute respiratory failure were studied over a 4-year period. All the patients had previous chronic respiratory insufficiency. Acute necrotizing pneumonia, the hyperventilation alkalosis syndrome, acute myocardial infarction, and cardiac arrhythmias were the commonest fatal complications. Eighteen patients had necrotizing pneumonia; 4 had pneumonia and pulmonary edema; 12 had hyperventilation alkalosis; 8 had errors of airway management; 12 had myocardial infarctions; 11 had ventricular arrhythmias; and 7 others had vascular catastrophies. Frequent sterilization of equipment, aseptic techniques for handling equipment used in airways, and regular bacteriological cultures from equipment were important to decrease nosocomial infections. Frequent careful monitoring of ventilation prevented the alkalosis syndrome. Maintaining good oxygenation and normal hydrogen ion levels in arterial blood reduced the frequency of arrhythmias. Thus, survival of patients can be improved by the prevention or early and effective treatment of complications that cause their premature death. [ABSTRACT FROM AUTHOR]

Two hundred thirty-nine episodes of acute respiratory failure were studied prospectively in 146 patients with chronic respiratory insufficiency during 4 years. Survivors were followed from 6 to 48 months. Patients survived 68% of episodes. Sixty percent of patients survived the initial episodes of respiratory failure, and 55% were alive after 6 months. During the next 2 years the mortality of these patients was high so that only 20% survived 30 months, and the same percentage survived 40 months. The plateau of the survival of these patients after 30 months strongly suggested that the survivors had either stable or slowly progressive disease. In contrast, those patients who had insufficiency from progressive pulmonary disease died within 30 months. Obese patients and bronchitic patients without emphysema survived more frequently than patients with emphysema alone or those with chronic diffuse infiltrative disease. Surviving patients were younger, without recent losses of body mass, edema, or anemia. They had less reduction of expiratory flow rates and vital capacities, less hypercapnia, and mild acidosis and hypoxia. Patients with a poor prognosis were elderly, with decreased body mass, weight below 110 lb, with edema and anemia. They had lower midexpiratory flow rates and vital capacities, more severe hypoxia (P[subao[sub2] < 40 mm Hg), or severe hypercapnia (P[suba]co[sub2] 80 mm Hg) with acidosis (H ion > 60 nmoles/1, pH < 7.22). [ABSTRACT FROM AUTHOR]

Presents information on a study which examined the effect of low-flow oxygen administration on patients with respiratory failure. Methodology; Results; Discussion.

Examines the role of acute lower respiratory infection in causing pulmonary insufficiency in bronchiectasis. Methodology; Results of the study; Discussion of findings.

Investigates the respiratory function in patients with cervical cord injuries. Incidence of chronic alveolar hypoventilation within a year after injury; Mechanisms underlying chronic respiratory insufficiency; Causes of alveolar hypoventilation.

Evaluates the effect of ethamivan in a series of patients with acute respiratory failure due to barbiturate intoxication and chronic respiratory failure due to chronic obstructive emphysema or the cardio-pulmonary syndrome of obesity. Consideration of ethamivan as a central nervous system stimulant; Vital statistics on pulmonary function data in emphysematous and obese patients.

Sixty-four infants and children showing signs of decerebrate rigidity admitted to a paediatric unit have been studied. Cases of head injury, myelomeningocoele, and tumours were excluded from the series. The aetiological factors causing decerebration in the remainder fell into four main groups: infections, hypoxia, metabolic disease, and intracranial haemorrhage. Increased intracranial pressure was diagnosed in 87%. Defects in homeostasis occurred in 75%, respiratory abnormalities were present in 66%, cardiovascular in 33%, hypothermia in 30%, and hyponatraemia in 17%. Early recognition and treatment of raised intracranial pressure and defects in homeostasis are of the utmost importance if morbidity and mortality are to be minimized. There was a 31% mortality from the acute illness: 30% of the survivors were normal at follow-up examination; the remainder showed varying degrees of handicap. The severity of decerebration showed no correlation with aetiology or prognosis. The study shows that a wide range of disorders can lead to the clinical picture of decerebration in the young child, and that the prognosis is probably much better than in adults showing the same symptoms and signs. [ABSTRACT FROM AUTHOR]

Discusses a study which determined the incidence of atypical bronchial epithelium and decreased maximum midexpiratory flow rates in cigarette-smoking college students in the U.S. Method used in selecting the study population; Comparison between the bronchial epithelium and breathing efficiency of smokers and nonsmokers; Changes in the smoking habits of test subjects.