Eight patients with acute respiratory failure secondary to chronic bronchitis were studied for up to 5 consecutive days following admission; cardiac output and intravascular pressures, blood volume, arterial blood gas tensions, and body weight were measured. These observations were also compared with further measurements made some weeks later just before the patient was discharged. The effects of oxygen and acetylcholine on the pulmonary circulation were also studied. Pulmonary arterial pressure was raised in all patients during their acute illness and had fallen substantially after recovery. The pulmonary arterial pressure throughout the study correlated directly with the arterial carbon dioxide and inversely with the arterial oxygen tensions. The inhalation of 24% and 28% oxygen and the infusion of acetylcholine into the pulmonary artery resulted in a fall in pulmonary arterial pressure, often to levels close to those subsequently seen after recovery from the acute illness. No significant change in cardiac output was observed. It is suggested that the acute pulmonary hypertension seen in these patients is due primarily to pulmonary vasoconstriction resulting from hypoxia.
ADDITIONAL KEY WORDS hypoxic pulmonary vasoconstriction chronic bronchitis acetylcholine oxygen• Cournand and his colleagues have demonstrated that patients with acute respiratory and congestive failure secondary to chronic bronchitis and emphysema have, in general, a higher pulmonary arterial pressure than similar patients who are not in congestive failure (1). This pulmonary hypertension is associated with a lower oxygen saturation and an increased carbon dioxide tension in arterial blood. However, when these patients recover from their acute illness, the pulmo-
Salmonella mycotic aneurysms of the thoracic aorta are exceedingly rare. We describe what we believe is only the third reported case involving the aortic arch. The patient was treated with surgical intervention and a prolonged course of antibiotics, which resulted in long-term survival. We review 13 previously reported cases of salmonella mycotic aneurysms of the thoracic aorta. The overall outcome was abysmal, with 10 of 13 patients dying within 1 month after the diagnosis was made. We discuss the pathogenesis, clinical presentation, diagnostic approach, and management (including surgical intervention and duration of antibiotic therapy) of this condition on the basis of the findings in these cases.
Plasma beta-endorphin (BE) levels (8.6 +/- 0.8 pmol/l) (mean +/- SE) were lower in the third trimester than in non-pregnant controls (14.8 +/- 1.1 pmol/l) (P less than 0.001), increased during labor, to 29.3 +/- 4.4 pmol/l (P less than 0.005) and decreased, 72 h after delivery, to 3.5 +/- 0.4 pmol/l (P less than 0.001). BE levels were found to correlate significantly with uterine muscle contraction (r = 0.966, P less than 0.05) and with cervical effacement (r = 0.974, P less than 0.05) during labor.
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