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Summary A double blind controlled trial of a house mile fortified house dust vaccine was carried out in forty-two asthmatic patients between the ages of 6 and 15 years. Improvement in height and weight was shown in eight of twenty-one children receiving the active therapy compared with one of twenty-one children receiving placebo injections. No difference between the two groups was shown by respiratory function testing or chest examination.

The anal papillae of Elodes minuta and Cyphon palustris exhibit the essential fine structural features of transporting epithelia, their primary function probably being the osmoregulatory absorption of electrolytes from the freshwater environment. In contrast to C. palustris , the anal papillar epithelium of E. minuta is equipped with irregularly distributed tracheoles, suggesting a secondary respiratory function as tracheal gills. However, when compared to the tracheal gills of Elmis baugei (Coleoptera: Elminthidae) whose fine structure is comparatively described in this paper, this function appears to be quantitatively of little importance.

Summary: A patient with diffuse interstitial pneumonitis attributed to methotrexate therapy is reported. Respiratory function tests revealed restrictive lung disease and marked impairment of diffusing capacity. The histological diagnosis was established by open lung biopsy. There was considerable relief of symptoms after administration of corticosteroids, the radiographic abnormalities cleared and tests of lung function showed some improvement. However, residual changes were present when the lungs were examined at autopsy following his death three months later.

Midline fixation of the bilateral vocal cords occurs on rare occasions. This condition has been described as bilateral abductor or posticus paralysis. However, the term of midline fixation or immobilization in median position is more adequate. During the past 17 years, 32 cases having this condition were seen in our clinic. Surgery for this condition and its functional results were discussed. To relieve dyspnea, Woodman's operation and the widening of anterior glottis operation were performed. On performing laryngoplastic surgery, we have to succeed on the first attempt, using a meticu lous technique. Important points are not to fracture the thyroid or arytenoid cartilage and not to damage the laryngeal mucosa. Postoperatively, the patients' voice remained rather in intelligible condition. Postoperative respiratory function tests showed that improvement of lung volumes exceeded that of ventilation tests with a time factor. There were some discrepancies between the laryngoscopic findings and the results of postoperative respiratory function tests.

1. 1. The musculus pulmonum proprius and ventral diaphragm of frogs from the family, Pipidae, Xenopus laevis and Pipa pipa , are muscles of an uncertain function, but a respiratory role has been suggested. 2. 2. They have unusual anatomical connections between either the ilium or femur, and the lungs and other abdominal organs. 3. 3. In this study anatomical and physiological evidence is presented that establishes a respiratory function for these muscles. 4. 4. The evolutionary implications of these specialized muscles are discussed with reference to respiratory mechanisms in other salientia as well as to the mammalian diaphragm.

Thirty-four patients with hiatus hernia, divided into two groups, were operated upon by the transthoracic and transdiaphragmatic approach. In half of the patients (group I), the diaphragmatic incisions were made without the guidance of the nerve stimulator. In the other half (group II), the line of diaphragmatic incisions was guided by the nerve stimulator in order to avoid injury to the phrenic nerve. The pre- and postoperative respiratory function, arterial blood gas tensions, and diaphragmatic functional tests were statistically analysed in both groups. In group I, significant reductions in regional ventilation, perfusion and volume of the left lung, particularly the left basal field, were associated with a high incidence of diaphragmatic paralysis (10/17). Application of the nerve stimulator in group II resulted in significant improvement in the regional lung function after surgery and the diaphragmatic paralysis could be almost avoided (1/17). No statistical differences in the spirometric values coul...

A total of 178 patients with obstructive airways disease were studied between 1966 and 1972, a period which followed a substantial fall in atmospheric pollution in Sheffield. Compared with patients from an earlier study of the same age and smoking habits they had less productive cough, fewer winter illnesses, less severe breathlessness, and only one-third of the rate of decline of forced expiratory volume (FEV). The analysis of the change in the annual loss of FEV was complicated. There were virtually no sudden steep falls of respiratory function, and patients with very low values of FEV survived for long periods. The predominant cause of death was cor pulmonale. Chronic hypoxia may be more of a problem in the next few years than bronchial infection. I believe that the clean air policy has effected an improvement and that the nature of chronic bronchitis with severe obstructive airways disease is changing, but further studies will be needed to confirm this.

Experiments were done in which the oxygen and carbon dioxide tensions could be changed in a medium containing nematodes in order to examine the hypothesis that air swallowing in saprozoic nematodes might have a respiratory function. In these experiments, alternating high and low oxygen and low and high carbon dioxide tensions were produced in a liquid medium containing nematodes by perfusing the medium with pure oxygen gas on the one hand and with pure nitrogen gas or a gas mixture (80 % N2 + 15 % CO2 + 5 % O2) on the other. When applying oxygen and nitrogen alternately, a slight but significant increase in air swallowing occurred with nitrogen treatments compared with oxygen (table I). If the gas mixture was used instead of nitrogen thereby producing a low oxygen tension combined with an elevated CO2-tension, the increase in the frequency of air swallowing was much more pronounced (Table II). In control experiments in which nitrogen or the gas mixture were used continually, no regular changes in frequencies of air swallowing were observed (Table III). The results presented are interpreted as supporting the hypothesis that air swallowing has a respiratory role in Mesodiplogaster lheritieri.

Since the introduction of β-adrenergic receptor blocking (β-blocking) drugs there have been numerous reports of their producing severe bronchospasm in asthmatic patients. Further experimental investigation has convincingly shown that all β-blocking drugs can induce some degree of bronchoconstriction in susceptible patients.

Gibson, G. J. and Davis, P. (1974).Thorax, 29, 726-731. Respiratory complications of relapsing polychondritis. The respiratory function of a patient with relapsing polychondritis is described. He had severe airflow obstruction due to disease of both the extra and intrathoracic large airways. Evidence of small airways disease was lacking. The airflow obstruction was probably due to a combination of structural narrowing and an enhanced dynamic effect. Despite the severity of his disease the patient's exercise capacity was only slightly reduced but he developed carbon dioxide retention on exercise. Involvement of the airways is a common feature of this rare disease and demands full physiological and radiographic assessment if tracheostomy or other surgical procedure is contemplated.

Connective tissue disorders may present with various otolaryngologic symptoms. The manifestations may represent vasculopathy, arthopathy, neuropathy or a combination of pathological processes. Rheumatoid arthritis may involve the middle ear, temporomandibular joints and larynx with mild symptoms or may be life-threatening in instances of cricoarytenoid arthritis. Dermatomyositis with its cutaneous and muscular symptoms prevalent in the head and neck is frequently associated with malignancy in patients over 40. Scleroderma not only affects the gastrointestinal tract but can also produce significant limitations of respiratory function. Systemic lupus erythematosus, polyarteritis modosa, Wegener's granulomatosis and giant cell arteritis produce numerous vascular changes in structures of otolaryngologic significance. In this puzzling group of disorders, protean symptoms may precede the development of a fulminant, widespread and fatal disease.

The beta receptor-stimulating drugs used for the treatment of bronchospasm were studied on patients after acute myocardial infarction and having serious cardiac disorders with arrhythmia and tachycardia. The undesirable dangerous effects of sympathomimetic drugs on the cardiovascular system were investigated with a non-invasive haemodynamic method. A decrease of peripheral resistance was observed after salbutamol. The advantage of salbutamol over isoproterenol was found in asthmatic patients with myocardial infarction. The value of selective beta-adrenergic drugs is discussed.

A follow-up study of the effect of exposure to hemp dust on respiratory function over a 10-year period (1963–1973) was conducted in 24 female non-smoking hemp workers. The prevalence of byssinosis in 1973 (70.8%) was found to be significantly higher than 10 years earlier in 1963 (33%) (P

Some aspects of the anatomy, histology and physiology of the swimbladder of Notopterus have been studied, with special reference to its behaviour in aerial respiration. The large swimbladder with a wide pneumatic duct is reported to function as an accessory respiratory organ. Circulation of blood is modified to discharge this function. The network of blood capillaries covered by a single layer of epithelium apparently facilitates the diffusion of gases between the blood and the swimbladder. Notopterus is able to survive for long periods in foul water, if allowed to reach the surface to take in air. There is a regular exchange of gases between the cavity of the swimbladder and the exterior. The frequency and extent of aquatic and aerial respiration in Notopterus under different conditions have been determined. They throw considerable light on the double respiratory mechanism in the fish. Under normal condition, the mean value of oxygen is 11 per cent and that of carbon dioxide 3 per cent in the “alveolar air” of the swimbladder. The result of analysis of gases from the swimbladder of Notopterus under adverse experimental conditions clearly establishes the remarkable capacity of the swimbladder of the fish to function as an efficient respiratory organ. The presence of a high percentage of carbon dioxide (6.5 per cent) in the swimbladder is of interest and suggests high resistance of the blood of the fish to carbon dioxide. The air-breathing habit of Notopterus is probably a secondary adaptation to its life in ponds and puddles under tropical conditions.

I N recent years there has been increasing interest in the respiratory complications of cerebral trauma as well as the role of the cerebrospinal fluid (CSF) in respiration. 9 Published reports have concentrated on the respiratory, acid-base, and blood gas alterations seen in more severe forms of cranial trauma where the comparability of the level of injury was questionable, and multiple injuries were frequently involved. The question then arises: What part of the devastating effects of respiratory disturbance after cranial trauma is precipitated by primary neurogenic factors and what part follows as secondary effects of airway obstruction and pulmonary insufficiency? Ducker and associates have helped to elucidate part of this problem in their study of the role of raised intracranial pressure and the Cushing reflex in the genesis of pulmonary edema after head injury. ~,~,21 In an attempt to separate the primary central nervous system derangements from those caused by secondary airway and pulmonary factors, we have begun a study of respiratory function, blood, and CSF pH and gas tensions after experimental cerebral concussion (ECC). This model of head injury represents our baseline of minimal and reversible brain trauma wherein the physiopathology of blunt head injuries may be analyzed, and on which studies of more severe injury may be built. The criteria for concussion and the biomechanical aspects of the trauma were developed for the Rhesus monkey, as previously described by Ommaya, et al. ~,6,17,~8

The effect of long-term therapy with corticotropin and cortisone on the pulmonary function of eight patients with bronchial asthma has been studied. Four patients showed normal pulmonary function at the end of the study, three were normal with the exception of an elevated residual volume, and one showed no change. In three cases in which the residual volume remained elevated, symptoms of asthma were only incompletely relieved. It was found that there was a rapid improvement in the vital capacity, maximum breathing capacity, and index of intrapulmonary mixing with treatment but the residual volume required somewhat longer periods of therapy to return to normal. It is believed that the changes in pulmonary function found in bronchial asthma are due to hyperinflation of the lungs occasioned by the bronchospasm cncountered in this disease and that, with treatment sufficient to completely remove the bronchospasm, these changes are reversible.

SUMMARY The steroidal neuromuscular blocking agent, dipyrandium iodide, reduced respiratory minute volume in anaesthetised horses. Concomitant changes in cardiovascular function were either slight, or absent, and cardiac arrhythmias did not occur. The respiratory depressant actions of dipyrandium were antagonised by the anticholinesterase agent, neostigmine. In conscious horses somewhat larger doses of dipyrandium were required to produce loss of skeletal muscle tone, which was associated with a fairly prolonged period of apnoea and serious abnormalities of cardiac rhythm. In one animal death from primary cardiac arrest occurred. Doses of dipyrandium which were too small to produce paralysis of limb muscles in the conscious horse, did not cause significant changes in cardiac or respiratory function. Clinical and pharmacological aspects of the work are discussed in comparison with the properties of suxamethonium.

Yeast membrane vesicles are formed when packed yeast are ground manually in a porcelain mortar and pestle with glass beads (0.2 mm diameter). These vesicles can be separated from the other components of the grinding mixture by a combination of centrifugation steps and elution from a column of the same glass beads (0.2 mm diameter). Isolated vesicles are osmotically sensitive, contain cytoplasmic components, and have energy-independent transport function. They are unable to metabolize glucose, but have respiratory function which is thought to be associated with intravesicular mitochondria. Invertase and oligomycin-insensitive adenosine triphosphatase are present in lysed vesicle preparations, and the appropriateness of these enzyme activities as membrane markers is discussed.

1. The forced expiratory volume (FEV0·75) was measured at increasing mouth pressures in twenty-seven patients with obstructive airways disease. Attempts were made to divide the patients on clinical grounds into emphysematous, bronchitic or asthmatic categories; there was no evidence from the (FEV/mouth pressure) plots that their airways functioned differently during forced expiration. 2. Static elastic recoil was measured in twelve patients. There was no evidence that this factor alone caused the loss of FEV in any patient. 3. It is suggested that the use of the FEV as a test of respiratory function during the natural history of obstructive airways disease should be considered in three stages. There is an initial phase when peripheral airways disease develops with little or no alteration of the FEV. In the second phase the FEV decreases from normal values to below 1·0 litre, and at this stage is considered a sensitive indicator of peripheral airways resistance. In stage 3 the FEV is low and further changes can only be small. But airways resistance continues to increase and could be a more sensitive measurement of further airways disease.

1. 1. Endogenous aerobic respiration rates of the plerocercoids of Schistocephalus solidus from the body cavity of sticklebacks were measured at a range of temperatures in winter and in summer. Respiration rates of adult worms at 40°C were also determined. 2. 2. Respiration rate is proportional to the power −0·478 ± 0·009 of the dry body weight. The relationship is not influenced by temperature or season and is the same for adult worms. 3. 3. Respiration rate of plerocercoids increases with temperature and is at a maximum at 40°C. This is thought to be a preadaptation for respiratory function at the elevated body temperatures of the definitive host. 4. 4. Q10 of respiratory rate decreases at temperatures up to 30°C but then increases from 30 to 40°C, suggesting that at higher temperatures alternative enzyme pathways are utilized. 5. 5. Respiration rate displays thermal acclimation on a seasonal basis; it is higher in winter than in summer and the Q10 is lower in winter than in summer. 6. 6. It is calculated that the aerobic respiration rate is significantly lower than the standard rate for free living poikilotherms.

Blood samples from a yak, llama, camel, deer, and African elephant were analyzed for oxygen capacity, "standard bicarbonate" content, oxygen dissociation curve, and the magnitude of the Bohr and Haldane effects. These parameters of the respiratory function of the blood have been related to the morphology of the red cells, to the weights of the animals, and to the most important electrolytes in the erythrocytes and in the plasma. The high affinity for oxygen described previously for llama blood is shared by its relative, the camel. Both these animals have a high concentration of hemoglobin within their erythrocytes. Blood from the African elephant showed the greatest affinity for oxygen among the subjects studied.

The author reviews a series of biological aspects of the study of oxygenable hematinoproteids, particularly with respect to evolution and adaptation. After a statement of some fundamental concepts of comparative biochemistry and of possible evolutionary relations between oxidation catalysts and oxygen carriers, the natural distribution of hemoglobins is reviewed and their specific characters are enumerated. A review is made of the data relating to the shape of the oxygen-dissociation curves and to the affinity of haemoglobin for oxygen. It appears, generally speaking, that hyperbolic or almost hyperbolic curves and high affinity for oxygen are characteristic of primitive or embryonic haemoglobins. A study of the function of haemoglobin in the respiratory cycle of several animal species shows the vital importance of the oxygen carrier as well as the adaptation of the shape and position of the dissociation curve to the character of the respiratory function in the animal considered. The function of haemoglobin in invertebrates, as oxygen carrier as well as providing a store of oxygen, is emphasized by a review of experimental data. The function of oxygen in the transport of carbon dioxide is reviewed from the standpoint of comparative biochemistry, and the lack of our knowledge is deplored. The characteristics of chlorocruorin show it to be a chemical mutation of an Annelid haemoglobin. Our lack of knowledge in the field of the comparative biochemistry of haemoglobin and chlorocruorin metabolism is pointed out.

The phospholipid composition of various strains of the yeast, Saccharomyces cerevisiae, and several of their derived mitochondrial mutants grown under conditions designed to induce variations in the complement of mitochondrial membranes has been examined. Wild type and petite (cytoplasmic respiratory deficient) yeasts were fractionated into various subcellular fractions, which were monitored by electron microscopy and analyzed for cytochrome oxidase (in wild type) and phospholipid composition. 90% or more of the phospholipid, cardiolipin was found in the mitochondrial membranes of wild type and petite yeast. Cardiolipin content differed markedly under various growth conditions. Stationary yeast grown in glucose had better developed mitochondria and more cardiolipin than repressed log phase yeast. Aerobic yeast contained more cardiolipin than anaerobic yeast. Respiration-deficient cytoplasmic mitochondrial mutants, both suppressive and neutral, contained less cardiolipin than corresponding wild types. A chromosomal mutant lacking respiratory function had normal cardiolipin content. Log phase cells grown in galactose and lactate, which do not readily repress the development of mitochondrial membranes, contained as much cardiolipin as stationary phase cells grown in glucose. Cytoplasmic mitochondrial mutants respond to changes in the glucose concentration of the growth medium by variations in their cardiolipin content in the same way as wild type yeast does under similar growth conditions. It is concluded that cardiolipin content of yeast is correlated with, and is a good indicator of, the state of development of mitochondrial membrane.

Summary Starting with an analysis of the respiratory function and of the way it automatically connects the living organism with the physical milieu without any conscious or voluntary effort, Dr De Greeff then asserts that, on the Psychological level, similar basic mechanisms connect the individual with the social environment, and more generally with the Cosmos. Typical disorders of these mechanisms are to be seen in melancholic depressions and in the feelings of strangeness and loneliness they bring about. These mechanisms have a neural basis in the diencephalic region and may be influenced by shock therapies. On the other hand, cerebral surgery shows that the frontal lobe intervenes to adjust these connecting mechanisms to the external world in its concrete structure, present and future. The author then criticizes the freudian conception, as he understands it, and proposes to substitute to the Instinct-Reality dichotomy the antagonism of two internal attitudes, which are basic, automatic, and nearly organic, in the sense defined above: the sympathy-attitude, which results in valorisation of and subordination to the object, and the defence-attitude, which manifests itself in aggression and aims at annihilating the object. These attitudes are complementary and any awakening of one of them supposes the inhibition of the other one. But such an inhibition never reaches the stage of an absolute suppression. So much for the instinctive, unconscious and diencephalic basis of action. What kind of new developments do the cerebral cortex and the higher mental functions bring about? They make the individual aware of his basic attitudes, or, more exactly, of the way the object is affected by them so as to appear pleasant or unpleasant, lovable or threatening. They give him the possibility of accepting or refusing the first movements of instinct, and of stabilizing, delaying or inhibiting the corresponding reactions. They are the basis of temporal dimension and integration, of choice, liberty and morality.

Pulmonary embolism is now known to be a common disorder, but it is often difficult to diagnose, particularly when recurrent embolization gradually leads to the development of obstructive pulmonary hypertension. The abnormalities of pulmonary function produced by emboli have been the subject of several recent reports ; many of these studies, however, have been performed in the acute phase following an embolus, and in patients with complicating heart or lung disease or recovering from major operations. As pulmonary function may be dis turbed by these conditions, the extent to which the abnor malities found were related to the effects of embolism alone has often been uncertain. In the present work some aspects of pulmonary function have been studied, with particular emphasis on the response to exercise, in a group of patients suffering from thromboembolic pulmonary hypertension or recovering from one or more emboli. In order to establish the extent to which abnormal function reflects the severity of the disease, the results have been related to the findings at cardiac catheterization and to the angiographie appearances.

This is a correlative study of the clinical, electrocardiographic and respiratory function data in twenty-one subjects with respiratory symptoms and abnormal pulmonary perfusion scans as a result of pulmonary thromboembolic disease; sixteen subjects had subsequent functional studies and the duration of observation was up to three years. Two causal factors in the production of arterial hypoxaemia were recognized: ventilation-perfusion ratio nonhomogeneity and pulmonary arteriovenous shunting. Ventilation-perfusion ratio nonhomogeneity was the most important factor. In more than half of the patients reversible regional pulmonary vasoconstriction was demonstrated by a rise in the V D :V T ratio on breathing oxygen. The range of the steady state pulmonary diffusion capacity (D L CO) and the fractional carbon monoxide (CO) uptake was wide, but in the absence of other cardiovascular or respiratory diseases a reduction in the D L CO and fractional carbon monoxide uptake was unusual. The D L CO in pulmonary thromboembolic disease was usually normal, but there were unreal high and negative values. The vital capacity was reduced in about half of the patients, but the clinical and spirometric evidence of airways obstruction was infrequent.

1. Four Merino wethers were exposed to dry bulb temperatures ranging from approximately 20 to 60 degrees C, and the concurrent changes in respiratory frequency, tidal volume, respiratory minute volume, alveolar ventilation, dead space ventilation, carbon dioxide output, rectal temperature, and arterial and mixed venous blood, CO(2) content, CO(2) partial pressure and pH were established.2. The respiratory response to heat exposure showed two phases. Respiratory minute volume was initially increased by a rise in the respiratory frequency, while tidal volume decreased. After more prolonged exposure there was a second phase in which respiratory minute volume was further increased by an increase in the tidal volume; respiratory frequency was now slower than in the first phase but was still well above control values.3. The increase in respiratory minute volume during the first phase of the response was restricted almost entirely to the respiratory dead space; changes in blood CO(2) and pH were slight. In the second phase, respiratory minute volume showed a much greater increase, and a change of alveolar ventilation to about 5 times the control level resulted in severe respiratory alkalosis.4. Contrary to findings in cattle, the slower, deeper form of respiration could be elicited even with rectal temperature in the normal range. This change in respiration appears to be the result of either peripheral thermoreceptor function or mechanical demands of the respiratory system. The neglect of control of acid-base balance during the second phase indicates the existence of a dominant thermal stimulus or modification of respiratory control mechanisms.

A study has been made of three neighbouring populations living at 1500, 3000 and 3700 m in the northern Simien of Ethiopia. The environments of these populations not only differ in many climatic elements, but also probably in nutritional factors and exposure to infections. The growth and physique of the people vary with altitude and the lowlanders (at 1500 m) tend to have a more linear body build. Differences in chest dimensions can be related to functional differences in respiratory physiology, since the highland groups, both male and female, have larger forced expiratory volumes and forced vital capacities as compared with the lowlanders. The relationships between these measures of respiratory function and age, stature and weight also tend to be dependent on altitude, but in all the Ethiopian groups there is a closer relationship between body weight and respiratory capacity than in other populations. This distinctiveness is probably due to the characteristics of Ethiopian physique. A slight polycythaemia and elevated packed cell volume are evident in the highland groups but, unexpectedly, there is some evidence that at least at the time of the expedition the haemoglobin concentrations were lower. The highlanders also show a raised systolic blood pressure. Blood-group and demographic data suggest that the various populations are probably genetically very similar, and the findings are discussed in terms of physiological and developmental adaptability.

It was claimed by Davy as early as 1862 that the haemoglobin in the blood of the earthworm has a respiratory function, but subsequent studies have given conflicting results. In the more recent investigations advantage has been taken of the fact that haemoglobin has a greater affinity for carbon monoxide than for oxygen; the oxygen consumption of normal worms is compared with that of worms whose haemoglobin has been put out of action by saturation with carbon monoxide. Using this method, Jordan & Schwarz (1920) concluded that haemoglobin functions as a transporter of oxygen only at low pressures of oxygen (23–30 mm. mercury).2Dolk & van der Paauw (1929) criticized this work on the grounds that the pure carbon monoxide to which the worms were subjected for some hours might have affected the respiratory enzymes as well as the haemoglobin, and that because of individual .variation it was not possible to compare directly the oxygen consumption of normal and carbon monoxide-treated worms. They repeated the work with modifications, and again found that haemoglobin was functional as an oxygen transporter only at low pressures of oxygen, below 57 mm. mercury. Their work was done on narcotized animals, and was therefore criticized by Thomas (1935), who, moreover, considered that the conclusions drawn by Dolk & van der Paauw were not justified by the experimental data they published. Thomas reinvestigated the matter, and came to the conclusion that haemoglobin has no respiratory function at oxygen pressures lower than 114 mm., for the oxygen consumption of normal and carbon monoxide-treated worms was the same. Above 114 mm. oxygen pressure the oxygen uptake of normal worms rose sharply, while that of carbon monoxide-treated worms remained constant, but Thomas did not attribute this difference in behaviour to haemoglobin, and one is left with the impression that in the earthworm haemoglobin is functionless as an oxygen transporter at all pressures of oxygen. Thomas’s results must, however, be accepted with reserve, for he gives data of experiments on only two normal worms and three carbon monoxide-treated worms.

The author studied the influence of nasal obstruction on the efficiency of work. Conclusions were as follows: 1. In those with nasal obstruction, there were obvious subjective symptoms and these were aggravated by the labor. 2. Subjective feeling of fatigue was influenced by the nasal obstruction. 3. In postoperative cases, those without improvement of nasal obstruction had more fatigue feeling than those with improved nasal obstruction. 4. Those with nasal obstruction showed higher value in flicker fatigue test even before the start of the work and the value remarkably became higher compared with those in normal in- dividuals. Effect of mental work was not great as that of muscular work. 5. These evidences were re:ognized also in experimental acute nasal obstruction. 6. Decreased repiratory function was observed in 30% of the case with chronic nasal ob- struction. 7. Decreased respiratory function was seen among those with postoperative residual nasal obstruction in similar frequency among the non-surgical patients with nasal obstruction. In those without nasal obstruction, the respiratory function was within normal limits. 8. Blood chemistry of those with nasal obstruction showed generally, low oxygenation, low oxygen saturation, and also slight decrease of total carbon dioxide and alkali reserve. 9. From above mentioned evidences, it seems like easy fatiguability in those with nasal obstruction is mainly due to anoxic anoxia caused by decreased respiratory function.

There have been already many investigations on the circulatory effects of Valsalva maneuver, and especially with regard to the change of pulmonary circulation it has been made clear that the venous return to right heart during straining is blocked by the increased intrathoracic pressure, and then by the sudden fall of the intrathoracic pressure after release of straining the blood remaining stagnant in the face and extremities suddenly flows into the right heart and the stroke volume of the right ventricle increases compared with that at rest and there is a transient rise of the pulmonary arterial pressure and the net pulmonary capillary pressure. The purpose of this report is to present the electrocardiographic changes by the Valsalva maneuver in patients of chronic broncho-pulmonary diseases in an attempt to detect any specific electrocardiographic changes in pulmonary hypertension or latent cor pulmonale and to discuss their clinical significance. Materials and Methods: (1) One hundred and eleven cases have been chosen for this study, including 76 cases of chronic respiratory diseases, 15 cases of non-cardiopulmonary diseases, 5 cases of neurocirculatory asthenia and 15 cases of healthy adults. The 76 cases of respiratory diseases consists of 35 cases of pulmonary tuberculosis (including 12 cases of after operation and 6 cases of severe pleural involvement), 10 cases of pulmonary emphysema, 8 cases of bronchiectasis, 20 cases of chronic bronchitis and bronchial asthma and 3 cases of lung tumor. (2) First the routine electrocardiogram at rest was recorded, and then, during and following the Valsalva maneuver at lead I, II, III, V1 and V5. The Valsalva maneuver was performed by having each subject maintained an expiratory pressure of at least 40mm.Hg for about 10 seconds by blowing into a aneroid sphygmomanometer. Next, of 20 cases including 10 cases taken at random out of the patients of severe broncho-pulmonary diseases and another 10 cases of healthy adults and in-patients without cardiopulmonary diseases, the author recorded their electrocardiogram at rest and following Valsalva maneuver at a speed of 50mm per second, photographically enlarged it, and observed the changes in the ventricular activation time and QRS amplitude at V1, studying the measured values of both groups in comparison. The respiratory function was judged from the ventilatory function measured with a 9.0 L or 13.5 L Bendict-Roth type respirometer.

Ommochromes are well known for their redox-behaviour in vitro, the oxidized from being yellow or brown, the reduced one being red. Whether this change does occur in vivo and whether it may have a respiratory function is investigated here. Larvae of Cerura vinula contain in epidermal cells of certain areas, especially the ‘saddle patch’, the ommochrome xanthommatine. This pigment may be withdrawn from the cells or reformed; it thus remains subject to pigment metabolism. In most of the larval instars the xanthommatine is hidden by the melanin of the cuticle. The distribution of pigments suggests that the ability to incorporate melanin into the cuticle is restricted to cells containing ommochrome. The melanin is shed with the cuticle at every ecdysis. Both the brown and the red form of xanthommatine may be present simultaneously in different parts of the skin. Before the pigment is withdrawn entirely from some part of the skin, its brown form is always converted to the red one. This occurs in the ‘saddle patch’ sooner or later during pupal development, the exact timing depending on temperature conditions. It may also be evoked during every larval instar by raising the temperature to 35°C, and it then takes about 24 hr. During this reddening, which is a local response, the ommochrome content decreases by about one-third. If afterwards the larvae are transferred to 20°C, the ommochrome becomes brown again very slowly within several days, and its amount increases, by 20% to 60%. Usually the brown colour manifests itself clearly only after the next ecdysis. If the larvae suffer from total lack of oxygen, the brown ommochrome containing parts of the skin will also become red within 24 hr, but without significant change of ommochrome content. Plugging some of the tracheal spiracles causes the ommochrome to redden only in the part of the body thus asphyxiated. Cyanide or carbon monoxide does not evoke this colour change. On the other hand, reddening caused by high temperature cannot be inhibited by these poisons, nor by pure oxygen. The experiments show that redox behaviour of ommochrome in vivo is an effect of certain metabolic situations. During lack of oxygen the xanthommatine is reduced to red dihydro-xanthommatine, thus serving as a hydrogen-acceptor. But since both oxidation and reduction in vivo are very slow, they seem very unlikely to have any significance for the respiratory metabolism of the whole animal. However, they may sustain the metabolism of those epidermal cells, which themselves contain ommochrome, during short periods of local lack of oxygen assumed to occur in insect epidermis.

In myasthenia gravis respiratory function is often disturbed in the night, especially during REM sleep, despite of normal daytime respiratory function. Nevertheless, nocturnal respiratory problems are rarely diagnosed. Sleepiness, concentration and memory problems can be symptoms of a sleep related breathing disorder. Reports of reduction of REM sleep, memory dysfunction, and detection of acetylcholine receptor (AchR)-antibodies in the cerebrospinal fluid have lead to the hypothesis of a central nervous system involvement in myasthenia gravis. Possible mechanisms are centrally acting AchR-antibodies, unspecifically acting cytokines and hypoxia, possibly the most important influence upon REM sleep reduction and impaired cognitive function. In a patient presenting possible CNS-involvement (cephalea, fatigue, concentration and memory problems), a polysomnographic investigation should therefore be performed to detect a sleep related breathing disorder.

In chronic experiments on dogs using roentgenoangiogr aphic, macroscopic, and microscopic methods, changes in the coronary, pulmonary, and bronchial arteries were studied after ligation of the descending branch of the left coronary artery or the left pulmonary artery. In {;he early periods after ligation of the arteries intervascular anastomoses are insufficient for restoring the disturbed circulation. ECG changes characteristic of antero-apicaI infarcts thereupon arise. As a result of disturbance of the external respiratory function, hypoxic hypoxia and various other disorders develop. By the 14th-35th day, as a collateral " circulation develops in the heart and lungs, the indicies of cardiopulmonary functien return toward their initial value. Structural changes in the numerous arteries of the heart and lungs during a disturbance of the circulation in these organs have received comparatively little study [1, 3, 5]. However, dynamics of the indices of function alone are insufficient for assessment of the plasticity of the collateral circulation [2,4,7]. In the present investigation, structural changes in the arterial system of the heart and lungs were compared with physiological indices during adaptation to disturbance of the coronary and pulmonary circulation.

Alterations in cellular and fibrous tissue reaction due to cortisone and A.C.T.H. have been demon strated in human beings by several workers such as Freeman, Fershing, Wang, and Smith (1950), and by Cavallero, Sala, Amira, and Borasi (1951) in the carbon tetrachloride necrosis of rats' livers. The influence of cortisone on the phagocytic action of the reticulo-endothelial system on carbon particles was studied by Spain, Molomut, and Haber (1950) and on intraperitoneally injected silica particles by Policard and Tuchmann-Duplessis (1951). In both experiments the migration of dust laden phagocytes was retarded. Kennedy, Pare, Pump, Beck, Johnson, Epstein, Venning, and Browne (1951), working in the Department of Professor J. S. L. Browne of Montreal, treated two patients with chronic beryllium granulomatosis and obtained temporary subjective and objective im provement as judged both by respiratory function studies and x-ray films of the lungs. Since chronic berylliosis is characterized by gross fibrosis of the lungs, these workers were encouraged to experi ment with the treatment of silicosis by the same means. It is difficult to believe that the densely fibrous nodules which are scattered throughout the lung in silicosis could be influenced to resolve or regress ; and this, indeed, was found to be the case by Kennedy and his colleagues, who were unable to observe any change in the x-ray appearance of the lungs of the patient they treated. Nevertheless some relief of his clinical condition was claimed. The cough and sputum disappeared and dyspnoea was relieved. As a result of the reports of these experiments the Cortisone and A.C.T.H. Sub-Committee of the Industrial Pulmonary Diseases Committee of the Medical Research Council asked us and Professor J. Gough of Cardiff to undertake investigations of the effect of cortisone on the production of experi mental silicosis in animals. While, as noted above, it seems improbable that the hormone could have any effect on the established lesions of silicosis, it nevertheless appeared possible that the production of fibrous tissue might be retarded by the admini stration of cortisone, or that there might be some effect on the movement of dust-laden phagocytes into focal areas of accumulation with a consequent slowing up of the fibrotic response. Professor Gough's results have been reported separately (Magarey and Gough, 1952), and an account of our own investigation is given in the present communi cation. Whereas we have found the predominant effect of cortisone to be on the movement of dust laden phagocytes, Schiller (1951, 1952), Magarey and Gough (1952), and Curran (1952) have demon strated both an inhibition of fibrosis and an altera tion in the mobility of macrophages when quartz dust was injected into the peritoneal cavity. Table 1 SIZE DISTRIBUTION OF POWDERED QUARTZ*

Tracheal stenosis is a rare but serious complication of tracheostomy. The frequency of manifest stenosis with interference of respiratory function was 2% in 259 surviving cases of tracheostomy at our hospital 1960–1964. In order to investigate if minor degree of stenosis develope after tracheostomy without being noticed, X-ray examination has been done on patients who have had tracheostomy at the hospital during 1965. The results are given and discussed.

We present a modification of Asai's technique which may offer a new approach to reconstruction of the larynx after laryngectomy and full surgical rehabilitation of the laryngectomized. Yet great persistence is needed to achieve the goal of restoring to the patient a satisfactory vocal, deglutional and respiratory function, and thus leading to psychological rehabilitation.

Twenty-seven patients with dumping complaints after partial gastrectomy for peptic ulcer were examined before and during dumping provocation with hypertonic glucose solution.A continuous and simultaneous registration of EEG and respiration, including spirography and capnography, was performed. The stage of wakefulness, the breathing pattern, and the sensitivity to carbon dioxide were studied and related to the symptoms experienced by the individuals examined.The dumping cases showed a lower mean standard threshold of ventilatory response to carbon dioxide than that found in a group of normals.Following glucose a two-phasic change in respiration as well as in level of wakefulness was found. During the first twenty minutes after dumping provocation with hypertonic glucose a disturbed irregular ventilatory pattern was usually present, in severe cases even marked hyperventilation. At the same time there were signs of increased wakefulness resembling that during tense alertness. It was followed by a successive...

Continuous exposure to 10 and 5 ppm nitrogen dioxide (NO2) for one and two months, respectively, increased the susceptibility of squirrel monkeys to airborne Klebsiella pneumoniae as demonstrated by mortality and reduced lung clearance of viable bacteria. The respiratory function was also affected by NO2 exposure. Infectious challenge with influenza virus 24 hours before exposure to 10 ppm was fatal to all monkeys within three days. Infected controls showed symptoms of viral infection but did not succumb to the infection. Exposure to 5 ppm after viral infection produced death in one of three monkeys.

The haemoglobin molecule is insensitive to replacements of most amino-acid residues on its surface, but extremely sensitive to even quite small alterations of internal non-polar contacts, especially those near the haems. Replacements at the contacts between α and β-subunits affect respiratory function.

Homologous transplantation of the lung was performed in a human subject with bilateral bronchiectasis. This patient presented the added difficulty of persistent hemoptysis associated with low pulmonary function. Operation was performed using the uninvolved lower lobe removed from a patient with pulmonary cancer of the upper lobe of the left lung after resection of the recipient's lingula and lower lobe of the left lung from which the hemoptysis was presumed to have originated. It was necessary, however, to remove the transplanted lung again because of pulmonary edema which developed on the eighteenth day after transplantation although the remaining lung had expanded well by this time. Radiocirculogram of the lung using RISA, angiography, and analysis of blood gas confirmed the maintenance of pulmonary blood flow and respiratory function of the transplanted pulmonary lobe at the time pulmonary edema developed. We also learned that the rejection reaction was not histologically identified in the tissue of the transplanted pulmonary lobe. This report of homologous transplantation of the lung in a human subject is believed to represent the first case from Japan and the fourth case in the world. It may be considered the first case in the world from the viewpoint of transplantation of the pulmonary lobe used as a temporary supplement to pulmonary function. This case suggests another clinical application of homologous lung transplantation at present time.

Tests of respiratory function based on spirometry have hitherto proved of limited value in the assessment of asthmatic children in the interval phase. In an attempt to provide more information on this subject, respiratory function studies using a body plethysmograph were carried out in 106 asthmatic children aged 13 to 15 years during an asymptomatic period. The children were selected to cover the whole spectrum of asthma in childhood; they were divided into 4 grades on clinical criteria, and the results of the physiological studies compared with the clinical gradings. Results indicated that maximum expiratory flow volume curves, when combined with an estimation of lung volumes, provided the best assessment of the severity of a child's asthma. Using this test of respiratory function, most children in whom asthma had been a trivial complaint had virtually no abnormality, but a small number had mild airways obstruction. Those with chronic continuing asthma had evidence of severe airways obstruction and pulmonary hyperinflation. In children with episodic asthma, the degree of abnormality was variable and the frequency of the attacks seemed to be a major factor in determining this. It is concluded that respiratory function studies are a valuable tool in evaluating asthma in childhood, particularly when the clinical history is difficult to assess.