Pleural liquid pressure (Ppl) was measured by the micropipette servo-nulling method. In anesthetized, paralyzed, and mechanically ventilated rabbits, windows were made by dissecting away the intercostal muscle layers, exposing the parietal pleura over the right caudal lung lobe. Repeated measurements of Ppl were made at the windows by puncturing the parietal pleura with micropipettes during apnea at functional residual capacity. In five supine rabbits, Ppl relative to atmospheric pressure averaged -3.32 +/- 1.22 (SD) cmH2O at a distance of 5.64 +/- 0.34 (SD) cm above the lung base and -1.64 +/- 0.79 cmH2O at a distance of 2.35 +/- 0.64 cm above the lung base; the vertical Ppl gradient was 0.51 cmH2O/cm height. Ppl interpolated to midlung height was equal in absolute magnitude to mean lung static recoil (Pst) of 2.00 cmH2O. In prone rabbits, Ppl measured near the dorsal surface, 3.9 cm above the lung base, averaged -1.32 +/- 0.46 cmH2O on the costal surface, not statistically different in magnitude from mean Pst of 1.59 +/- 0.09. In contrast, Ppl measured at the same vertical height off the edge of the caudal lung in the costo-diaphragmatic recess was -4.64 +/- 0.65 cmH2O. We concluded from these data that Ppl was equal to pleural surface pressure over the costal surface and that the vertical gradient in Ppl was not hydrostatic, except in large fluid spaces off the sharp edges of the lung.
End-expiratory thoracic cavity volume (Vthx) was measured in eight volunteers lying supine by three-dimensional X-ray computed tomography using the Dynamic Spatial Reconstructor. Untrapped end-expiratory pulmonary gas volume at functional residual capacity (FRC) was determined by nitrogen clearance. Both measurements were done before and after induction of anesthesia-paralysis. After induction of anesthesia-paralysis, Vthx and FRC were consistently and significantly (P less than 0.01) reduced by 0.28 +/- 0.22 (SD) and 0.59 +/- 0.24 liter, respectively. The reduction of FRC was larger than the reduction of Vthx (delta Vthx) in six of the eight subjects, a finding suggesting that intrathoracic fluid (blood) plus trapped gas volume (Vtt) increased. Changes in Vthx were partitioned into volume changes from the thoracic rib cage (delta Vrc) and from shape and/or position changes of the diaphragm (delta Vdi). delta Vrc contributed significantly (0.17 +/- 0.15 liter, P less than 0.02) to delta Vthx, whereas delta Vdi contributed only in four of the eight subjects. We conclude that delta Vrc, delta Vdi, and delta Vtt contribute to the reduction of FRC after induction of anesthesia-paralysis in humans; the relative contribution of them varies among subjects.
Experiments in anesthetized open-chest dogs indicated that blood from the canine bronchial circulation may drain into both the arterial and venous sides of the alveolar drain into both the arterial and venous sides of the alveolar vessel bed. Evan's blue dye injected into the systemic circulation appeared in the effluent from a left lower lobe pulmonary arterial segment in which inflow was stopped with a snare and outflow through the alveolar vessel bed was stopped by maintaining zone 1 conditions. To determine the influence of mean systemic arterial pressure on lobar bronchial flow, flows from arterial and venous cannulas were measured at different mean systemic arterial pressures (lung volume history constant). Influence of lung volume and transpulmonary pressure (Ptp) change were each examined utilizing the hysteresis characteristics of the lung pressure-volume curve. Mean total flows ranged from 2.26 to 5.26 ml/min with 43.61% draining through the arterial side. Flow decreased with lower systemic arterial pressure, high Ptp, and higher lung volume. Distribution of flow was influenced only by lung volume changes. Results indicate that the communication sites contributing to the arterial drainage are located within the alveolar vessel bed. Since bronchial flow drains to both sides of the alveolar vessel bed, it must be considered when interpreting results from "isolated" pulmonary circulation preparations.
Micropipettes (2-5 microns), in conjunction with a servo-nulling system, were used to measure liquid pressure (Pliq) in subpleural alveoli of lobes of dog lungs made edematous by perfusing with plasma to a constant extravascular weight gain (W). Pliq was measured at fixed transpulmonary pressure (Ptp) in lungs whose W was more than 0.5 that of the initial weight (Wi). In six lobes at W/Wi = 0.6, Pliq, relative to alveolar pressure (Palv), was -2.6 +/- 0.4 cmH2O (mean +/- SE), -11.8 +/- 0.6, and -17.5 +/- 1.7 at deflation Ptp values of 5, 15, and 25 cmH2O, respectively. The Pliq increased to -2, -7, and -13.7, respectively, at W/Wi = 2.8. Based on a mean alveolar radius of 50 micron at Ptp at 25 cmH2O and values of Palv - Pliq, values for alveolar surface tension (tau) at W/Wi = 0.6 were 6, 30, and 44 dyn/cm at Ptp of 5, 15, and 25 cmH2O, respectively. In five other lobes at W/Wi = 0.5 and at 65 and 84% total lung capacity, tau was much higher on lung inflation than on deflation. If pericapillary interstitial fluid pressure (Pi) and Pliq were identical under edematous conditions, tau would be the main determinant of Pi.
The effectiveness of iloprost, a prostacyclin derivative, was assessed in a placebo-controlled multicentre trial on 101 patients with chronic arterial disease, stage IV. All patients were on a basic local treatment, 53 randomly being assigned to the iloprost group, 48 to the placebo one. Both groups received identical saline infusions, one with the other without iloprost. Infusions were given on 28 consecutive days, iloprost being added at a dose of up to 2 ng/kg.min over six hours. At the end of the treatment period, 32 of 52 patients (61.5%) of the iloprost group and eight of the 47 in the placebo group (17%) had partial or complete healing of ulcers (P less than 0.05), the treatment effect persisting in both groups for a mean duration of at least one year. Iloprost was well tolerated, once individual dosages had been appropriately adjusted. Facial flushes, headache and nausea were the most common side effects. Heart rate and blood-pressure variations did not differ between the two groups.
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