This retrospective follow-up studied lung function and reconvalescence in 38 young patients without primary lung disease, who suffered from severe ARDS and survived by means of extracorporeal lung assist (ELA) treatment. Over a period of 3, 6, 9 and 12-20 months dynamic and static lung volumes and the results of X-ray and CT scan of the thorax were studied. Within the third and sixth month the forced vital capacity, FEV1, and arterial blood gases reached the lower range of normal values. Obvious relative emphysema RV/TLC was observed at the time of discharge from hospital and during the first four months. This was found to reverse during the following months. After a period of 12-20 months all patients had an abnormal diffusion capacity (TLCO) but with normal transfer coefficients (TLCO/VA). Even though ARDS did not induce obstructive changes, the diminished diffusion capacity and the slightly reduced expiratory peak flow in 25-75% of FVC (FEF 25-75) indicates slight changes in the small airways. Following up the X-ray and CT results we found extraordinary morphological restitution. Spiroergometry results showed a normal cardiopulmonary pattern for untrained individuals. 36 of the 38 patients were integrated in normal working and social life within 12-20 months.
Studies to detect disorders of pulmonary function were performed on 42 workers at a poultry farm All the subjects were exposed to organic dusts and sensitised to poultry antigens Typical signs of bird fancier's lung were recorded in two of them.Included in all examinations were immunological diagnosis by means of counterimmunoelectrophoresis, systematic interviewing for case histories, and registration of respiratory symptoms.Pulmonary function was recorded by means of the following techniques: analysis of ventilation (flow-volume indices), respiratory mechanics of the larger airways and lung (body box plethysmography, oesophago-balloon technique), respiratory mechanics of the small airways (closing volume), distributional analysis, diffusion analysis, and blood gas analysis.A disorder of pulmonary function was recordable in 40 sensitised individuals. Such disorder being characterised by obstruction of the larger airways and slight inhomogeneity The small airways were not narrowed No restriction nor disturbed diffusion were established The severity of obstruction was found to be related to the degree of sensitisation.The following more clearly pronounced changes in terms of functional diagnosis were recordable from two poultry workers with allergic alveolitis: obstruction of larger airways with concomitant restriction, marked inhomogeneity, and disorder of diffusion.The disorders, relatively discrete, led to mild PO 2-reduction in sensitised individuals, whereas mild hypoxaemia was recorded from subjects with allergic alveolitis.
We investigated 109 persons exposed and sensitized against organic antigens. 46 of them (group I) are affected with the typical clinical and roentgenological signs of allergic alveolitis. The other 59 subjects (group II) were sensitized only. Included in all examinations were immunological diagnosis by means of counterimmunoelectrophoresis, systematic interviewing for case histories, and registration of respiratory symptoms. Pulmonary function was recorded by means of the following techniques: analysis of ventilation (flow-volume indices), respiratory mechanics of the larger airways and lung (body plethysmography, esophageal balloon technique), respiratory mechanics of the small airways (closing volume, amplitude of cardiogenic oscillations), distributional analysis, diffusion analysis, blood gas analysis, and right heart catheterization. Extrinsic allergic alveolitis caused changes in lung mechanics, in airways as well as in lung tissue. The most impressive findings in allergic alveolitis are mechanical inequalities of ventilation. These inequalities may be caused by changed mechanics of overall airways indicated by obstruction parameters and by changed structure of lung tissue reflected in decreased compliance, transfer factors and increased pulmonary arterial pressure. Not only a restrictive but also an obstructive disturbance of ventilation is found. Impairments are less in sensitized persons. We find slight mechanical and ventilatory inhomogeneities. An overall airway obstruction is obvious but not to such a large extent as in allergic alveolitis. On the contrary, here the lung tissue is not affected. Compliance and diffusion are within the normal range. There is no typical functional pattern specific for the diagnosis of allergic alveolitis
Conclusions and summaryAn extensive investigation of the coagulation mechanism was performed in 21 patients suffering from a congenital heart failure and exposed to surgical treatment with the aid of extra-corporeal circulation. The results have been discussed and suggestions given for the preoperative and postoperative mode of investigation in future. Only three factors may be considered a possible contraindication for the operation, namely1. a persistent and marked thrombocytopenia,2. fibrinogenopenia and3. a high degree of fibrinolysis.Before a final decision to operate is taken an attempt should be made to restore the impaired coagulation mechanism. The necessity of a preoperative analysis and a close cooperation between the surgeon and the coagulationist before, during and after the operation have been stressed.
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