PAO2-PaO2 relationship for the entire therapeutic range of oxygen in acute respiratory failure

The PAO2-PaO2 relationship was studied for the entire therapeutic range of oxygen in patients and animals in acute respiratory failure. The method is based on the assumption that the steady state values of PaO2 may be obtained as a mean of the two PaO2 values at an identical F1O2, one obtained 6 min after the F1O2 was raised from a lower level, the other obtained 6 min after the F1O2 was reduced from the higher level. We found that the shunts were large in the low F1O2 range (170 mmHg and below), took a minimum value in the moderate PAO2 range (170 to 300 mmHg), and increased again in the high PAO2 range (300 to 700 mmHg). A similar pattern was observed in the animal experiments, two or more hr following experimentally produced produced aspiration pneumonitis. In contrast, the dogs with bilateral pneumothorax showed a pattern which followed the isoshunt line closely. It was concluded that patients with acute respiratory failure requiring artificial ventilation have two componenents of the pulmonary shunt, one parallel with and the other inversely related with the PAO2. Possible mechanisms for the former were discussed.

Electron microscope studies on the relationship between mitochondria and inclusion body in spheroid alveolar epithelial cell after vital staining with acidic and basic dyes

Electron microscope observations were conducted on the relationship between mitochondria and inclusion body in mice spheroid alveolar epithelial cells after injection of trypan blue, an acidic dye and Alcian blue 8GS, a basic dye, by vital staining procedures. When both dyes were injected, the mitochondria of the spheroid alveolar epithelial cell became degenerated; however, in injection of only trypan blue, the cristae showed an increase in electron density. In injection on only Alcian blue 8GS, the cristae showed negative contrast. In most cases the trypan blue particles did not enter into mitochondria, whereas particles of Alcian blue 8GS sometimes entered into the mitochondria. When trypan blue particles entered mitochondria, deposits were not evident in the inclusion body, whereas when Alcian blue particles entered mitochondria deposits were seen in the inclusion body. In both of these cases only a few inclusion bodies were formed so that only traces or no inclusion bodies with vacuolar appearance were observed. From these findings it is suggested that mitochondria maybe convert to inclusion bodies.

Electron microscopic studies of various cells in the alveolar wall of mice with special reference to spheroid alveolar epithelial cells after intravenous injection of squid-ink (sepia-melanin) solution

The effect of an intravenous injection of squid-ink (sepia-melanin) solution on adult mouse spheroid alveolar epithelial cells was observed by the electron microscope. Sepia-melanin particles were seen in all alveolar wall cells examined that seems to suggest the entrance of sepia-melanin particles into the spheroid alveolar epithlial cells from the alveolar blood capillary. In cases of large penetrations of sepia-melanin particles into spheroid alveolar epithelial cells, a greater increase was found in the intramitochondrial granules. In addition, the so-called inclusion body believed to be formed by the degeneration of mitochondria had very high electron density and its quantity was abundant. On the contrary, in cases where the quantity of sepia-melanin entrance into the spheroid alveolar epithelial cell was small, neither an increase of intramitochondrial granules, an increase of the electron density nor an increase in the quantity of specific inclusion body was found.

Electron microscope study on the relationship between macrophages of the alevolar space and spheroid alveolar epithelial cells on mice after injection of squid-ink (sepia-melanin) solution into the trachea

The relationship between alveolar macrophages and spheroid alveolar epithelial cells was studied with the electron microscope after injection of squid-ink solution into the trachea of the mouse. At 20 hours after injection of squid-ink solution slight degeneration was evident in alveolar macrophages with sepia-melanin particles being phagocytized with partial digestion by lysosmes. Furthermore, hardly any changes were seen in mitochondria and inclusion bodies of the spheroid alveolar epithelial cells. In contrast, at one week after injection of squid-ink solution, almost all alveolar macrophages were degenerated with destruction of the ectoplasm in which the ingested sepia-melanin particles were digested by lysosomes into fine particles, and the mitochondria of spheroid alveolar epithelial cells were degenerated and the inclusion bodies were hardly formed. At three weeks after injection of squid-ink solution, alveolar macrophages as well as speroid alveolar epithelial cells showed almost complete recovery of functional structure. As the phagocyte in the alveolar space, neutrophile leucocytes were also observed in addition to the so-called alveolar macrophage.

The effects of stellate ganglion block on the idiopathic prolongation of the Q-T interval with cardiac arrhythmia (the Romano-Ward syndrome)

The association of a prolonged Q-T interval, congenital deafness, and syncopal attacks due to ventricular fibrillation following emotional or physical stress is known as the Jervell-Lange-Nielsen syndrome. Absence of the congenital deafness characterizes the otherwise identical Romano-Ward syndrome. Both conditions have a high mortality rate and are recognized as contributing to sudden death in children. Although the pathogenetic factors are not yet completely elucidated, the condition is well enough understood to permit effective treatment. The authors performed a left stellate ganglion block in a 12-year-old girl with a mild form of the Romano-Ward syndrome, shortening the Q-T interval and eliminating the ventricular tachyarrhythmia. The left stellete ganglion block should be considered by anesthesiologists as an emergency measure, effective in interrupting the attack.

Thyroxine deiodination associated with NADPH-dependent lipid peroxidation in a submicrosomal system

A lipoprotein present in trypsin-treated microsomes can be oxidized with formation of malondialdehyde in a system which contains NADPH, ferric ion-ADP complex, NADPH-cytochrome c reductase and a factor. This factor, a mixture of peptides, can be isolated from hepatic microsomes by trypsin digestion and successive gel filtration through Sephadex G-100 and G-25 columns. Lipid peroxidation in this system catalyzes the deiodination of thyroxine, as does NADPH-dependent lipid peroxidation in fresh hepatic microsomes. Thyroxine inhibits lipid peroxidation as it is deiodinated in this system.

Normal hemoglobin-oxygen affinity

Hemoglobin-xoygen affinity is known to vary in a number of disease states. The authors measured the continuous affinity of blood from healthy subjects and, using mathematical data reduction techniques, calculated coefficients for rational function models of average normal affinity, plus or minus 2 standard deviations, and 95 per cent confidence limits. Average normal P50 was 27.10 torr, with a two-standard-deviation range of 25.85 to 28.35; P50s of the 95 per cent confidence limits were 26.69 and 27.53 torr. The affinity usually accepted as standard lay between or very near to the 95% confidence limits of normal throughout its range. It is concluded that the range of normal affinity is narrow and that, for most practical purposes, standard affinity adequately represents normal affinity. There should be little difficulty in distinguishing from normal the shifts that occur in certain disease conditions.