Sarcopenia assessed using a questionnaire can predict in-hospital mortality in older patients with pulmonary tuberculosis

BACKGROUND & AIMS

Pulmonary tuberculosis is a severe disease with a high mortality rate. However, whether sarcopenia is a risk factor for in-hospital mortality remains unclear. The SARC-F (five items: strength, assistance in walking, rising from a chair, climbing stairs, and falls) is a questionnaire developed to screen for sarcopenia. This study aimed to determine whether the high risk of sarcopenia, assessed using the SARC-F questionnaire, affects in-hospital mortality in older patients with pulmonary tuberculosis.

METHODS

This was a retrospective, observational study. We included patients with active pulmonary tuberculosis aged ≥65 years who required inpatient treatment between 30 April 2021 and 30 November 2022. We assessed sarcopenia using SARC-F, and SARC-F ≥ 4 points at admission was defined as a high risk of sarcopenia. The primary outcome was all-cause mortality during hospitalisation. We extracted information on age, sex, body mass index, comorbidities, blood and biochemical tests, modified Glasgow Prognostic Score, calf circumference, geriatric nutritional risk index, physiotherapy, and length of hospital stay from medical records.

RESULTS

We included 147 patients (mean age: 83.0 ± 7.8 years; males: 61.9%). Ninety-three (63.3%) patients had a high risk of developing sarcopenia. Patients with a high risk of sarcopenia were significantly older (mean: 85.0 ± 7.1 years), had a lower body mass index (median: 18.1 kg/m2, range: 16.1-20.5 kg/m2), had a higher modified Glasgow Prognostic Score (median: 2, range: 2-2), and had a lower calf circumference (mean: 26.8 ± 3.6 cm), had a lower geriatric nutritional risk index (mean: 72.2 ± 12.9) than those without high-risk sarcopenia. More patients with a high risk of sarcopenia underwent physiotherapy (93.5%) than those without high-risk sarcopenia (P < 0.01, all). Kaplan-Meier survival curves showed that patients with a high risk of sarcopenia had significantly lower overall survival than those without high-risk sarcopenia (log-rank test, P = 0.001). Logistic regression analysis for in-hospital mortality showed that a high risk of sarcopenia significantly affected in-hospital mortality (odds ratio [OR]: 6.425, 95% confidence interval [CI]: 1.399-47.299). In addition, logistic regression analysis for each item of SARC-F showed that assistance in walking (OR: 3.931, 95% CI: 1.816-9.617) and rising from a chair (OR: 2.458, 95% CI: 1.235-5.330) significantly affected in-hospital mortality.

CONCLUSION

A high risk of sarcopenia, as assessed using SARC-F at admission, was a risk factor for in-hospital mortality in older patients with pulmonary tuberculosis. Among the SARC-F items, assistance in walking and rising from a chair were the risk factors for in-hospital mortality.

Influence of kinesiophobia with pregnancy-related lumbopelvic pain at late pregnancy on postpartum depressive symptoms

OBJECTIVE

To investigate whether kinesiophobia with pregnancy-related lumbopelvic pain at late pregnancy influenced depressive symptoms at 1 month after delivery.

METHOD

Final participants were 43 pregnant women who experienced pregnancy-related lumbopelvic pain at late pregnancy and completed self-reported questionnaires at late pregnancy and 1 month after delivery. The Tampa Scale for Kinesiophobia was used to evaluate kinesiophobia, and depressive symptoms were assessed using the Self-Rating Depression Scale. We divided participants into two groups (depression and no-depression) using the score of the Self-Rating Depression Scale at 1 month after delivery. Univariate analysis and multiple logistic regression analysis identified kinesiophobia at late pregnancy as an independent predictor of depression at 1 month after delivery.

RESULTS

In univariate analysis, kinesiophobia at late pregnancy was significantly higher in the depression group than in the no-depression group (P= .033). In multiple logistic regression analysis, kinesiophobia at late pregnancy were significantly associated with depression at 1 month after delivery even after adjusting for confounding factors (Odds Ratio, 1.25; 95% Confidence Interval, 1.03-1.52).

CONCLUSION

Results found that kinesiophobia at late pregnancy negatively influenced depressive symptoms at 1 month after delivery, suggesting that approaches to treat kinesiophobia at late pregnancymight reduce the risk of onset of postpartum depressive symptoms.

Daily physical activity is associated with increased sonographically measured bone status during lactation

Objectives:

The purpose of this cross-sectional study was to investigate the association between daily physical activity and sonographically measured bone status among women during the lactation period.

Methods:

Final participants were 152 women 4 months after childbirth. Bone status of the participants was measured using quantitative ultrasonometry of the calcaneus (speed of sound). Daily physical activity was assessed using the Japanese version of International Physical Activity Questionnaire short version. After getting the International Physical Activity Questionnaire results, we classified participants into three categories (low/moderate/high) according to a protocol. Participants categorized into the low group according to the International Physical Activity Questionnaire were considered to be in the low physical activity group and those categorized into the moderate and high groups were considered to be in the moderate to vigorous physical activity group.

Results:

Speed of sound was significantly higher in the moderate to vigorous physical activity group (moderate to vigorous physical activity versus low physical activity, 1533 m/s versus 1523 m/s, p = 0.03). Daily physical activity was significantly associated with speed of sound, even after adjustment for confounding factors and prognosticators (β = 0.195, p = 0.02).

Conclusion:

Sonographically measured bone status was significantly higher in women who were physically active than in those who were physically inactive, suggesting that daily physical activity might help to maintain good bone status.

Lower physical activity is associated with daytime sleepiness in children aged 9-12 years

This study clarified the prevalence of daytime sleepiness in fourth-, fifth-, and sixth-grade children and examined the association between physical activity (PA) and daytime sleepiness in children aged 9-12 years. This cross-sectional study included 314 children (mean age ± standard deviation: 10.5 ± 1.0 years; male: 52.9%) enrolled in two public elementary schools in Kobe, Japan. PA was assessed using the Physical Activity Questionnaire for Older Children. The outcome was self-reported daytime sleepiness. The prevalence of daytime sleepiness in fourth-, fifth-, and sixth-grade children were 10.8%, 25.2%, and 28.6%, respectively. In univariate analysis, subjects with reported daytime sleepiness had lower PA levels than those without daytime sleepiness (odds ratio (OR) = .67; 95% confidence interval (CI) = .47-.95). Multiple logistic regression analysis demonstrated that lower PA was significantly associated with daytime sleepiness after adjusting for multiple confounders (OR = .54; 95% CI = .37-.81). The prevalence of daytime sleepiness in fifth and sixth grades was higher than fourth grade. Furthermore, this study clarified the significant association between PA and daytime sleepiness and suggested that PA could be one of the factors to prevent daytime sleepiness in children aged 9-12 years.

Association Between Objectively Measured Physical Activity and the Number of Chronic Musculoskeletal Pain Sites in Community-Dwelling Older Adults

OBJECTIVE

Physical inactivity is recognized as a pandemic health problem. The association of pain with physical activity, particularly when measured objectively, in older adults is unclear. This study investigates the association of number of chronic musculoskeletal pain sites and pain severity with objectively measured physical activity in community-dwelling older adults.

DESIGN

Observational study.

SETTING

Community.

SUBJECTS

We analyzed 267 community-dwelling older adults (mean age = 75.3 years, 67.0% women).

METHODS

Number of chronic musculoskeletal pain sites and pain severity were measured using a self-reported questionnaire. Mean steps per day and mean minutes of light physical activity per day and moderate to vigorous physical activity per day were measured using an accelerometer. Linear regression models were applied to analyze the association of number of chronic musculoskeletal pain sites and pain severity with physical activity.

RESULTS

The results suggest that a higher number of chronic musculoskeletal pain sites is associated with lower step count (beta = -333.5, 95% confidence interval = -655.9 to -11.0, P < 0.05) and moderate to vigorous physical activity (beta = -2.5, 95% confidence interval = -4.7 to -0.4, P < 0.05) even after adjustment for age, gender, years of schooling, obesity, alcohol habits, smoking status, number of comorbidities, recent surgery, and depressive symptoms.

CONCLUSIONS

Our results suggest that the number of chronic musculoskeletal pain sites is associated with low physical activity in older adults. Therefore, low physical activity due to chronic musculoskeletal pain should not be overlooked.

Association Between Public Transportation Use and Loneliness Among Urban Elderly People Who Stop Driving

Aim: To examine the association between public transportation use and loneliness in urban elderly who stop driving. Methods: In this cross-sectional study, we assessed 31 community-dwelling older adults who had stopped driving. Public transportation use was assessed by using frequency and divided into two groups. The users group was participants who used public transportation more than once a week and the nonusers group was participants who used public transportation less than once a week. Loneliness was measured using the Japanese version of the UCLA Loneliness Scale version 3 (UCLA.LS.ver3), with a higher score indicating greater loneliness. The independent t test was used to compare the UCLA.LS.ver3 scores between users and nonusers group. A multiple linear regression model was used with the UCLA.LS.ver3 score as the objective variable and public transportation use as the explanatory variable. Results: The UCLA.LS.ver3 score was significantly higher in the nonusers group than in the users group (nonusers group: 12.7 ± 1.9; users group: 10.1 ± 2.9, p = .017). After adjustments, public transportation use was significantly associated with lower loneliness (β = −2.55, p = .029). Conclusion: Public transportation use might have important role to prevent loneliness in older adults who stop driving.

Reliability and Validity of the Japanese Version of the Physical Activity Questionnaire for Older Children

Objectives

This study aimed to examine the reliability and validity of the Japanese version of the Physical Activity Questionnaire for Older Children (PAQ-C) in Japanese children aged 9 to 12 years.

Methods

A total of 210 children aged between 9 and 12 years participated. Internal consistency and test-retest reliability were evaluated using Cronbach alpha coefficient and intraclass correlation coefficient (ICC), respectively. Validity was evaluated using athletic competence (AC), self-efficacy (SE), body mass index (BMI), body fat percentage (%BF), cardiovascular fitness (CVF), and World Health Organization Health Behavior in School-aged Children (WHO HBSC) physical activity questionnaire.

Results

Internal consistency was acceptable (alpha = 0.80) and test-retest reliability showed excellent agreement (ICC = 0.83). The PAQ-C score was significantly correlated with AC (r = 0.41), SE (r = 0.65), %BF (r = 0.19), and CVF (r = -0.32). The PAQ-C score of the active group classified by the WHO HBSC physical activity questionnaire (mean score ± standard deviation [SD] = 3.03 ± 0.57) was significantly higher than that of the inactive group (mean score ± SD = 2.27 ± 0.63, P < .01).

Conclusions

The PAQ-C had acceptable reliability and validity. The PAQ-C is a useful instrument to evaluate physical activity for Japanese children aged 9 to 12 years.

[The role of postoperative radiotherapy in non-small cell lung cancer; a retrospective analysis of our experience]

Sixty-one patients with completely resected non-small cell lung cancer followed by postoperative radiotherapy were retrospectively reviewed. Forty-six patients were male and 15 were female. Ages ranged 34-79 (median 64) years. Squamous cell carcinoma (scc) in 28, adenoca. in 31, large cell ca in 1 and adenoid cystic ca. in 1. Pathological stage was IIA in 1, IIB in 9, IIIA in 41 and IIIB in 10. Over-all 5-year survival rate (OS) was 56.0%, and 5-year disease-free survival rate (DFS) was 39.7%. For IIB, IIIA, IIIB patients, OS were 77.8%, 55.4%, 24.0% respectively. According to purpose of radiotherapy, patients divided into 3 types as local invasion (LI) group (T3-4N0-1, n = 12), lymphnode metastases (LN) group (T1-2N2-3, n = 38) and both advanced (BA) group (T3-4N2-3, n = 8). OS were 71.6%, 50.7%, 46.9% and DFS were 68.6%, 31.0%, 42.9% respectively. In LN group, half of patients with scc had no relapse, but about half of non-scc had distant metastases. All N2 patients divided 2 types as single-station N2 and multi-station N2. OS were 71.8%, 40.0% and DFS were 53.5%, 21.1% respectively. DFS was significantly different (p = 0.04). The advantage was remarkable in patients with scc-single-station N2 (OS was 88.9%, DFS was 77.8%). The effectiveness of postoperative radiotherapy is not showed, but our results suggest the possibility for existence of subgroup benefited from postoperative radiotherapy.

[Recurrence and pulmonary metastasis of extradural paraganglioma in thoracic vertebral canal: report of a case]

A 70-year-old female was operated on for extradural spinal cord tumor in 1982. Microscopic examination revealed the tumor as paraganglioma. Tumor recurred at paravertebral twice in 1985 and 1989, and they were also resected. In 1995, her chest X-ray film showed round tumor in the right upper field. Exploratory open lung biopsy was performed in 1996, and right upper lobectomy was performed according to for malignant lung tumor because intra-operative microscopic findings showed carcinoid or lung metastasis of paraganglioma. Chest wall tumor at paravertebral was resected at the same time. Postoperative microscopic examination revealed the tumors were same as operated paraganglioma. The 2nd thoracotomy was done in 1999, and two chest wall tumors and a pulmonary nodule in right S8 segment were resected. They were recurrence and pulmonary metastasis of paraganglioma. Now 18 years after initial operation, she is out of hospital in tumor free.

Bronchioloalveolar carcinoma arising in a bronchogenic cyst

We report the case of a 37-year-old woman with a radiographically cystic lung lesion. Lobectomy was performed. Histopathologic examination showed a bronchioloalveolar carcinoma arising in a bronchogenic cyst. This suggests that epithelial cells of bronchogenic cysts can undergo malignant transformation. It may be prudent to recommend complete resection of any bronchogenic cyst.

Imaging of optical disc using reflection-mode scattering-type scanning near-field optical microscopy

A phase-change optical disc was observed using a reflection-mode scattering-type scanning near-field optical microscope (RS-SNOM). In an a.c.-mode SNOM image, the 1.2 microm x 0.6 microm recording marks were successfully observed although the data were recorded on the groove. In contrast, no recording marks could be resolved in a d.c.-mode SNOM image. These results are in good agreement with those from a numerical simulation using the finite difference time domain method. The resolution was better than 100 nm with a.c.-mode SNOM operation and the results indicate that recording marks in phase-change optical media can be directly observed with the RS-SNOM.

[Pulmonary veno-occlusive disease developed in a man given long-term treatment with anticancerous agents]

A 67-old man was referred to our hospital because of dyspnea on exertion and severe hypoxia. He had been given, tegafur and OK 432 for seven years following an operation for gastric cancer. Pulmonary hypertension was noted by right heart catheterization. The findings of a transbronchial lung biopsy resulted in a diagnosis of pulmonary veno-occlusive disease. Pulmonary hemodynamic studies were performed for five different agents: nifedipine, beroprast sodium (PGI2), nitroglycerin, theophylline, and isosorbide dinitrate. However, none of these agents showed significant effects on pulmonary arterial pressure or pulmonary vascular resistance. Treatment with glucocorticoid relieved the patient's symptoms without any apparent effect on pulmonary hemodynamics. The long-term administration of anticancerous agents (tegafur) were thought to have caused pulmonary veno-occlusive disease to develop in this patient.

[Excision of a chronic expanding hematoma developing after thoracoplasty: a case report]

The patient was a 56-year-old woman who had undergone thoracoplasty for right pulmonary tuberculosis 31 years previously. She consulted her local physician complaining of right shoulder pain. Chest X-rays revealed a mass of the thoracic wall, and the patient was referred to our department. Because of the difficulty in making a diagnosis by needle biopsy and of increased pain, operation was done. The mass was covered by a fibrous capsule, and its center was composed of structure-less material including fibrin and blood cells. A diagnosis of chronic expanding hematoma developing after thoracoplasty was made. Beneath the hematoma, a 5 mm diameter hole communicated with the thoracic cavity. Chronic inflammation at this site appeared to have caused the hematoma.

[Retroperitoneal fibrosis with involvement up to the mediastinal space]

A 60-year-old man presented with sudden palpitations in September 1993, and was admitted to hospital with a diagnosis of atrial fibrillation and heart failure. The patient was suspected of having collagen disease, because of a positive test for antinuclear antibodies and a high sedimentation rate. He was referred to lou hospital. Chest radiographic findings were suggestive of cardiomegaly and cardiac murmurs were audible, which indicated the presence of heart disease. A chest Ct scan revealed a lesion surrounding the intramediastinal large vessels and the heart from the level of the confluence of the left brachiocephalic vein and the superior vena cava. Suspicion of a mediastinal tumor led the patient to be admitted to the respiratory department. Percutaneous needle biopsy with a Trucut needle revealed non-specific chronic inflammation. An abdominal CT scan showed that the lesion surrounding the descending aorta traversed the diaphragm, reached the renal pelvis along both renal arteries, and caused narrowing of the ureter and left hydronephrosis. Based on these findings, retroperitoneal fibrosis was diagnosed. Treatment with steroids caused the lesion to shrink.

[A case of multiple inthorathoracic neurilemmoma with cutaneous lesions]

A 33-year-old man with right inguinal mass was admitted to our hospital because of an abnormal shadow on his chest X-ray film. Surgery was performed. These tumors originating from the right 7th, 8th intercostal and right cutaneous femoralis nerve were removed. Histologically, excised tumors were diagnosed as neurilemmoma. There had been only 4 cases of inthorathoracic multiple neurilemmoma with skin lesion, in Japan. We reviewed and discussed the Japanese literature.

Mucociliary clearance in pulmonary vascular disease

The mucociliary clearance function was studied by radioaerosol inhalation lung cinescintigraphy and its quantification in 8 patients with pulmonary vascular diseases; pulmonary embolism, 5 cases, and right pulmonary artery hypoplasia, pulmonary arteriovenous fistulas, aortitis syndrome, 1 case each. The mucociliary clearance function was found to be well maintained in pulmonary vascular diseases unless ventilation was disturbed. There was no difference in the mucociliary clearance function between pulmonary embolism and other pulmonary vascular diseases.

Effect of bronchodilation on the deposition and clearance of radioaerosol in bronchial asthma in remission

Radioaerosol inhalation lung cine-scintigraphy and lung function tests were performed on ten patients with bronchial asthma in remission before and after inhalation of salbutamol following intravenously administered aminophylline. Radioaerosol inhalation lung cine-scintigraphy was very useful in revealing the changes not only in the deposition patterns of inhaled aerosol in the lungs but also in the dynamic transport of mucus on the airways. The bronchodilating effect of the combined treatment was significant; the inhaled aerosol deposited more homogeneously and less centrally in the lungs, the "penetration index" and the alveolar deposition ratio (ALDR) increased from 31 +/- 3 to 49 +/- 7%, and from 29 +/- 2% to 39 +/- 1%, respectively, while the airway deposition ratio (ADR) decreased from 72 +/- 2 to 61 +/- 1% immediately after the treatment. Lung function data including FVC, FEV 1.0, FEV 1.0%, MMF, V50 and Vp significantly improved after the treatment. There was, however, little visual or quantitative improvement in mucociliary clearance after the treatment.

Effect of oral salbutamol on mucociliary clearance mechanisms in the lungs

The purpose of the study was to investigate whether or not orally administered salbutamol would affect mucociliary clearance function in the lungs. Salbutamol, 4 mg, was given orally 3 times a day for 7 days to 10 and 9 patients with various chest diseases in stable stage, respectively; the former were also currently taking other medications and the latter, none. Lung function tests, chest x-rays and radioaerosol inhalation lung cine-scintigraphy were performed before and after the administration of salbutamol. There was little qualitative or quantitative difference in mucociliary clearance function in either group before and after the administration of oral salbutamol, although it induced some increases in VC and FEV1.0 and a decrease in RV/TLC ratio in the former and some increases in FEV1.0, FEV1.0% and MMF in the latter. Oral salbutamol seems little to affect the mucociliary clearance function in the lungs.

Estimation of a drug effect by a simplified radioaerosol inhalation lung cine-scintigraphy: bromhexine on mucociliary clearance mechanisms

A proposed simplification of radioaerosol inhalation lung cine-scintigraphy, namely 60 min measurement of radioactivity without repeating measurement at 24 hr later and calculation of alveolar deposition ratio (ALDR) by the regression formula of ALDR = -48.08 + 0.47 X FEV1.0% + 0.59 X LRR60, was found useful and applicable even to the evaluation of a drug on mucociliary clearance mechanisms. The simplified method indicated a very similar evaluation of the effect of bromhexine on airway clearance efficiency with those actually revealed by the original method.

Mucociliary clearance mechanism in interstitial lung disease

To evaluate mucociliary clearance mechanisms of the lungs, 14 patients with pulmonary interstitial fibrosis and 8 with sarcoidosis were studied by lung function tests and radioaerosol inhalation lung cine-scintigraphy. Although all these patients showed interstitial densities on chest x-rays, only the patients with pulmonary interstitial fibrosis indicated restrictive and diffusion abnormalities by lung function tests and those with sarcoidosis did not show either of these functional abnormalities. Mucociliary clearance mechanisms were well maintained qualitatively and quantitatively in these patients with interstitial lung disease.

Estimation of alveolar deposition ratio of inhaled radioaerosol

The lung retention ratio (LRR) and the alveolar deposition ratio (ALDR) are mandatory to calculate the other three indices for quantitatively evaluating mucociliary clearance function of the ciliated airways; the airway deposition ratio (ADR), the airway retention ratio (ARR) and the airway clearance efficiency (ACE). According to our original method, the LRR required 2-hr continuous measurement of radioactivity in the thorax and the ALDR a repeat measurement at 24-hr after radioaerosol inhalation. The 2-hr continuous measurement is, however, too long for a clinical examination and the 24-hr repeat measurement cumbersome. The purpose of the study was to find a way to get the ALDR by calculation without repeating the 24-hr measurement and by counting radioactivity for the shortest possible period and yet without sacrificing the visual evaluation by compiling radioaerosol inhalation lung cine-scintigraphy. By using the derived formulae listed in Table 1, the ALDR was calculable. Forced expiratory volume (FEV) in one sec divided by FEV in per cent (FEV1.0%), the initial 60 min measurement of radioactivity without repeating 24-hr measurement, and smoking history were the minimum requirements to calculate the ALDR. The calculated ALDR appeared reliable enough to estimate the other indices.

Lung clearance mechanisms in obstructive airways disease

Using radioaerosol inhalation lung cinescintigraphy, pulmonary clearance mechanisms were studied in 21 patients with obstructive airways disease. In none of them did we find homogeneous deposition of inhaled radioaerosol in the lungs, or a steady, constant, axial, and cephalad transport of radioactivity in the major airways. Of the 21 patients, 14 showed temporary but frequent stopping and starting of radioactivity in the airways in the course of lung clearance; in ten there was reversal of flow; in five migration of radioactivity from one bronchus into the opposite, bypassing the trachea and often followed by shuttling between right and left bronchi; and in four there was spiral or zigzag transport of radioactivity. The overall lung retention ratio in the first 2 hr was not abnormal, but the airway deposition ratio was significantly above normal, and airway clearance efficiency was below. The alveolar deposition ratio was also significantly smaller in these patients.

Mucociliary clearance mechanism in smoking and nonsmoking normal subjects

Mucociliary clearance mechanisms were evaluated in 17 normal subjects visually and qualitatively by radioaerosol inhalation cinescintigraphy of the lung, and quantitatively by calculating the following indices: (a) overall or regional lung retention ratio; (b) airway deposition ratio; (c) airway retention ratio; (d) airway clearance efficiency; and (e) alveolar deposition ratio. The inhaled aerosol deposited homogeneously throughout the lungs, and mucus transport was always cephalad in direction and constant in velocity, although a temporary stasis of mucus was seen in smokers. Overall lung retention ratio was significantly smaller and airway deposition ratio was significantly larger in the smokers than in nonsmokers, but there was no difference between the groups in airway retention ratio or airway clearance efficiency. There was an inverse relationship between alveolar deposition ratio and cigarette consumption. Mucociliary clearance mechanisms were well maintained in the normal subjects, but in the smokers inhaled aerosol tended to deposit more proximally.

[Clinical trial of butorphanol tartrate in cancer patients: evaluation for analgesic effects and safety on the basis of long term administration]

Twenty-eight cancer patients were treated with intramuscular butorphanol tartrate, a new non-narcotic analgesic, for investigating its clinical benefits in controlling cancer pain. Remarkable analgesic effects were observed approximately 30 minutes after administration by the single dose of either 1 or 2 mg of butorphanol. The effects lasted actively for 3 to 4 hours. Tolerance or drug dependency was rarely recognized even in the cases receiving repeated injections of the drug. Adverse effects, such as dizziness, nausea, thirst, numbness of the hands etc, observed in 5 patients were transient and required no medication. The above results may warrant a long-term administration of the drug for controlling varieties of pain in the cancer patients.

Radioaerosol inhalation lung cine-scintigraphy: a preliminary report

"Radioaerosol inhalation lung cine-scintigraphy", a cinematographic display of the lungs following radioaerosol inhalation has been found to be extremely helpful not only to the visual assessment of mucociliary clearance in the lungs but also to the setting of regions of interest and to the interpretation and analysis of clearance curves over the regions of interest in the lungs. It is expected that this procedure offers an important means to the study of mucociliary clearance in health and disease in man.

Effect of isoproterenol on regional pulmonary perfusion and its blockade by propranolol

Effects of isoproterenol and propranolol on regional pulmonary perfusion were assessed in the dog. In each experiment the right upper lobe was isolated in vivo by a balloon catheter and artificially ventilated with nitrogen, air or 60% oxygen in nitrogen before and after administration of the medicaments listed above. The rest of the lungs kept breathing air spontaneously. Following administration of isoproterenol regional pulmonary perfusion increased in the hypoxic right upper lobe induced by artificial ventilation with nitrogen, but the increase was not observed when isoproterenol was administered following pretreatment with propranolol. Administration of propranolol alone did not induce any change in regional pulmonary perfusion distribution. When artificial ventilation was done in the right upper lobe either with air or 60% oxygen in nitrogen, thus inducing regional less hypoxia or hyperoxia, no change in regional perfusion was observed with any of the medication. Thus isoproterenol reversed regional hypoxic pulmonary vasoconstriction, but its action was blocked by pretreatment with propranolol. Propranolol per se, however, showed no effect on pulmonary vascular responses to the different alveolar oxygen tensions.

Effect of dopamine on regional pulmonary perfusion

Dopamine effect on regional pulmonary perfusion in the right upper lobe was studied in 6 dogs in which the lobe was isolated by a balloon catheter and artificially ventilated with nitrogen, air or 60% oxygen in nitrogen, while the rest of the lungs was allowed spontaneous air respiration. Dopamine was administered at the rate of 20 micrograms/kg/min. Each dog served as its own control. There was no change in the regional vascular responses to the different alveolar oxygen tensions in the right upper lobe before and after dopamine administration.