An upper abdominal operation has a profound effect on pulmonary mechanical function. This effect occurs in those who do not develop atelectasis, but patients with atelectasis show a greater and more persistent impairment of ventilatory function and, unlike normals, often develop reversible airways obstruction during the first three post-operative days as shown by increases in the peak expiratory flow rate after the inhalation of a bronchodilator drug (Palmer, 1961 Dill and Forbes (1941) with correction for pH and temperature. Arterial whole-blood carbon dioxide content (T.CO2 mM/l.) was measured with a Van Slyke manometric apparatus, and the pH of the arterial blood was measured with a capillary glass electrode system reading to 0.005 pH unit. After the haematocrit had been measured, the arterial Pco2, the plasma bicarbonate (HCO,-)p, and whole-blood buffer base were derived from the nomogram of Singer and Hastings (1948). Portable chest radiographs were taken before the operation and at daily intervals afterwards for five days. Throughout the period of the experiment the usual routine treatment for the prevention of atelectasis was given. This consisted of physiotherapy and assisted coughing. Where atelectasis developed, mucolytics, intensive bronchodilator therapy, and antibiotics were also given. ResultsFor analysis the patients are separated into two main groups as follows:Group A is the normal or uncomplicated group in which there were 14 patients (11 men and 3 women). The mean age was 47.8 years. Seven were cigarette smokers, and 5 (35.50%) smoked 20 or Arterial blood samples were obtained before spirometry, from the brachial or femoral artery in a 10-ml. heparinlubricated Luer-lok syringe. The blood was allowed to fill the syringe under its own pressure during one to two minutes. During this period the patient was encouraged to relax and breathe naturally. The more a day. Three (21.4%) were bronchitic, bronchitis being defined as a productive cough occurring on most days for three months in the year during at least two years (Ciba Symposium, 1959 Seven, patients in group B developed a severe pulmonary complication with atelectasis, leading to bronchopneumonia and fever with much cough and purulent sputum. All were male, the mean age was 43.1 years, all smoked over 20 cigarettes a day, and all gave a history of persistent productive cough, wheezing, dyspnoea on exertion, and there were rhonchi on physical examination, so that in this group there was bronchitis with airways obstruction. The remaining 11, although there was definite clinical and radiological evidence of atelectasis, did not develop bronchopneumonia.
2 Carstensen JM, Axelson 0. Changes in non-smoking related lung cancer with special reference to mortality trends in Swedish wvomen. In: Davis DI_. Hocl DG, eds. 7rendts tii catcer sInrtalitv ill industritl coubtni's. New York: New
Sixty patients with acute myocarditis or pericarditis or a combination of the two lesions, without endocarditis, were encountered by the authors in hospital and domiciliary consulting practice over a period of seven years. Similar cases have been reported under a variety of names; e.g. Coxsackie myopericarditis, acute nonspecific pericarditis, Bornholm disease, isolated myocarditis, Fiedler's myocarditis, and cardiomyopathy of pregnancy. The clinical presentation fell into 4 groups. I: I9 patients presented with classical symptoms of acute pericarditis. II: 24 presented as coronary mimics, with severe substernal pain unaffected, or only slightly affected, by respiration, posture, or movement. III: 3 presented with progressive heart failure. IV: I4 presented with miscellaneous symptoms, most frequently resembling influenza. Evidence of concurrent viral illness was found in IS patients, 9 being Coxsackie infections. Other specific diseases were identified in 3 patients; but in 42, including 3 who died and were examined at necropsy, the nature of the disease could not be established. Three patients died of heart failure, and in IO others the electrocardiogram remained abnormal over 3 months after the onset; the remaining patients made a complete recovery. Nine patients relapsed, 7 of them being in the group presenting with acute pericarditis. No specific treatment was found to be of value.
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