[Fibrinolytic therapy of lung embolism].
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Biomedical subjects
Publications and source records attributed to K Klink.
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1. In patients with chronic cor pulmonale there is a regression dependence between the amount of exercise-induced increase in pulmonary arterial pressure and the level of resting value. 2. Hemodynamics during exercise are influenced by the patient's position in a certain degree. 3. The exercise-induced increase in pulmonary arterial pressure in chronic cor pulmonale is not influenced by the patient's age. 4. The time course of pressure fall during recovery depends on the amount of pressure increase during exercise, it depends less evidently on the level of the resting values. 5. Tachycardia is not a compulsory symptom of chronic cor pulmonale.
Parameters of pulmonary mechanics were measured at rest and during physical effort in patients with silicosis and normal subjects. Between normal subjects and patients with silicosis of stage I a significant difference could not be found. However, a decrease of dynamic compliance and an increase of elastic work of breathing were found in patients with silicosis III during exercise. The PT/VT-quotient is already high at rest. These results are not in agreement with the subjective symptom "dyspnea". The feeling of dyspnea appears when the PT/VT-quotient is enhanced signifcantly during exercise in comparison with the value at rest. Therefore, only the PT/VT-quotient is a suitable parameter indicating dyspnea.
The effect of inhalation of Novodrin (beta-receptor-stimulus), Phenylephrine (alpha-receptor-stimulus) and of a mixture of both was tested in patients with chronic nonspecific respiratory syndrome. There was no significant difference of pulmonary arterial mean-pressure. Forced expiratory volume and vital capacity rose both after inhalation of Novdrin and after inhalation of the mixture. Nevertheless inhalation of the mixture can not be recommended because of a significant decrease of arterial oxygen-tension.
11 laboratories of the working group "Pathophysiology of Breathing" cooperated with standardized methods to obtain generally admitted practical criterions for the definition of respiratory insufficiency. Function parameters of 2800 examined persons in different diagnostic groups were tested by manual statistical analysis and computed by data processing system. which were assessed with regard to their usefulness as criterions for respiratory insufficiency. The arterial O2-partial pressure proved to be the most crucial criterion of respiratory insufficiency permitting objective evidence of a manifest respiratory insufficiency by hypoxeamia under standard efforts with a bicycle-ergometer. The screening parameters of ventilation such as vital capacity and forced exspiratory volume are suitable as subjective rapid methods for a quantitative estimation of one type of respiratory insufficiency: the ventilation disturbance. Investigations, which were carried out with a higher apparatus expense like the estimation of residual volume, the functional residual capacity, and the arterial CO2-partial pressure permit the further differentiation of causes of the respiratory insufficiency and the separation between respiratory partial- and global insufficiency. The parameters of gas exchange: O2-consumption, respiratory quotient, and the screening parameter of cardiocirculation heart rate are not or only limited useful as criterions of respiratory insufficiency alone.
In patients with mitral valvular defects as well as with chronic cor pulmonale there exists an ascertained relation between the pulmonary-arterial pressure in rest and the increase of blood pressure under easy physical load. Patients with high initial value or strong increase of blood pressure reveal a retarded return of the blood pressure of the pulmonary artery to the initial value.
Mechanics of breathing as studied in patients with different stages of silicosis in rest and during exercise show the following: dynamic compliance and work against elastic and viscous resistances could not be found to be decisive indices of exertion dyspnea. Evidence of exertion dyspnea could only be achieved by means of the ration VT/PT (VT equals tidal volume, PT equals tidal esophageal pressure). Exertion dyspnea was observed at less than 0,081 VT per cm H20 PT. In accordance with Campbell and Howell, dyspnea is seen as an inappropriateness between ventilation and pressure needed.
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