The subdivisions of the lung volume, pulmonary mechanics, and resting steady state pulmonary transfer factor were measured in 31 patients with bronchographically proven bronchiectasis. In seven patients the process of gas exchange was further investigated by fractionating the total alveolar-arterial oxygen tension gradient into diffusion, distribution, and true shunt components.A restrictive type of ventilatory defect with varying degrees of airway obstruction was observed in a majority of the patients; the airway obstruction was partially reversed by a bronchodilator. Dynamic compliance was usually decreased and the pulmonary resistance increased.Pulmonary transfer factor was decreased in proportion to the number of segments involved. Vital capacity, maximum breathing capacity, and dynamic compliance bore a less significant correlation with the extent of disease. The degree of airway obstruction, as judged by pulmonary resistance, was independent of the extent of disease.All the patients were hypoxaemic and some had hypercapnia as well. The alveolar-arterial oxygen tension gradient was widened primarily because of distributional abnormalities and, to some extent, by the presence of true right-to-left shunts. The latter amounted to 13-6% of the total cardiac output.Surgical resection of the affected lobe or segments resulted in a further deterioration of all the parameters of pulmonary function tested.
The clinical and pathological features of acute pulmonary oedema of high altitudes have been the subject of several recent reports (Houston, 1960;Hultgren et al., 1961; Penialoza, 1962;Arias-Stella and Kruger, 1963;Nayak, Roy, and Narayanan, 1964;Menon, 1965;Singh et al., 1965), but the haemodynamic effects of the illness are not well delineated (Fred et al., 1962;Hultgren et al., 1964). The purpose of this communication is to present data on the circulatory and respiratory parameters observed in (1) 6 subjects with high altitude pulmonary oedema studied at 3658 metres within 24 hours of the onset of the illness, and (2) 3 subjects restudied 5 times after recovery.
SUBJECTS AND METHODSClinical History. Cases 1, 2, and 3 (Table I)
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