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Pulmonary vascular topography has been studied at our Institute over the last two years to evaluate more adequately the pulmonary vasculature in obstructive lung disease. This investigation has stressed comparison studies of the various parameters of pulmonary function, full chest laminagraphy, pulmonary angiography and more recently lung scanning. To our knowledge this type of correlation has not been previously reported. Evaluation by lung scanning was made in a preliminary fashion as a further detailed study is in progress.The twofold purpose of this study was: (1) to determine whether there was a correlation of the clinical picture, pulmonary function studies, chest laminagraphy, pulmonary angiography and lung scanning in order to differentiate more adequately bronchial asthma and emphysema, and (2) to delineate more effectively regional impairments of circulation in obstructive lung disease, namely: (a) local (one area-lobe or segment), (b) regional (more than one lobe), (c) unilateral lesions, involving most or all of the one lung and (d) diffuse involvement, with approximately an equal degree of impairment throughout both lungs.By differentiating bronchial asthma from emphysema, we hope to determine more adequately both the diagnosis and prognosis of the types of obstructive lung disease. This is particularly important in younger individuals, in whom the diagnosis of obstructive lung disease is extremely valuable in longterm management. Moreover, by a more exact definition of the extent of abnormal ventilation and perfusion, earlier and more vigorous therapy can be instituted which might possibly prevent or minimize cardiopulmonary complications. Consequently, a greater number of patients might be rehabilitated or maintained as productive workers. Preliminary reports from two medical centers have already lent support to this newer concert.

We evolved a nomogram for guiding and standardizing intravenous theophylline therapy in hospitalized patients. It provides rapid calculation of a loading dose based on body weight and previous therapy and a maintenance infusion rate related to three categories of expected metabolic activity. The guidelines were prospectively used in the treatment of 72 patients, mainly in a respiratory care unit. The nomogram was successfully used to attain near-steady-state serum concentrations in the therapeutic range of 8 to 20 mg/litre in 72% of patients, with only two patients outside of the range of 5 to 25 mg/litre. These guidelines facilitate initial theophylline dosage in older patients with liver and cardiac disease and provide a rational basis for interpreting serum concentration measurements and adjustment of drug therapy.