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Breathing patterns were recorded by impedance pneumograph or pneumotachograph and capnograph in 227 patients in a neurosurgical unit; most had recent head injury, intracranial tumor, or ruptured aneurysms. The site of brain damage was determined from clinical investigation or autopsy, and the outcome three months later was classified. Abnormal patterns were recorded at some time in 60% of patients. Periodic breathing, irregular breathing, and tachypnea were equally common. All patients with a lesion in the medulla had abnormal patterns; medullary and pontine lesions were frequently associated with irregular breathing. Only gross irregularity of breathing was of localizing value in these acutely brain damaged patients, by contrast with previous reports of other associations in more chronic neurological disorders. Tachypnea (frequency >25/min) and hyperventilation (arterial carbon dioxide pressure

Deficiencies in quality of therapy in multiple areas, were demonstrated during a longterm surveillance program. Both training in and present methods of clinical monitoring were inadequate. One-third of patients were significantly under/over ventilated, pressures were used in a rote manner and respiratory rate control was lacking. Feedback to the physician was missing. These problems were correctable, once identified; example: reduction in incidence of tachypnea 21 to 8 percent and hypoventilation 27 to 14 percent. Correction required routine respiratory measurements, intensive inservice education, appropriate staff changes and improved physician liaison. Additionally, patients’ actual ventilatory requirements must be established, in which physicians must become more directly involved. Finally, unless the quality of intermittent positive pressure breathing (IPPB) provided is uniformly maintained, there will be no way that response to therapy can be accurately assessed.

PRESENTATION OF CASE A three-day-old girl was admitted to the hospital because of tachypnea. The child was the product of a vaginal delivery after an uncomplicated, full-term gestation in a gravida...

THE commonly recognized causes of respiratory distress during infancy are pulmonary or tracheobronchial pathology, cardiac failure, and cerebral disease. The various mechanisms by which cardiac disease may produce increased respiratory effort are not, however, generally appreciated, with resultant confusion in the management of the underlying problem. The major pathological physiologic disturbances producing respiratory distress (in association with heart disease) are pulmonary edema and severe metabolic acidosis. Pulmonary edema occurs either in left ventricular failure or in association with lesions resulting in an obstruction of the pulmonary venous return. Metabolic acidosis is related to severe hypoxia which is the major manifestation of several types of cardiac anomaly. The respiratory pattern associated with pulmonary edema is that of tachypnea to rates of 60-100/min, with initially only mild increased effort. Rales are not usually heard until a considerable amount of fluid has entered the alveoli; thus absence of this clinical sign does not exclude the diagnosis. In advanced pulmonary edema, marked air hunger appears and in young infants head retraction with gasping respiration may occur, presenting an appearance of an obstructed airway. Cyanosis is usually only of mild degree unless associated with cyanotic congenital heart disease. Left ventricular failure and pulmonary venous congestion are far more frequently observed in heart disease in infancy than right-sided failure. It is surprising that most descriptions of heart failure in infancy stress hepatomegaly as one of the earliest signs of failure. However, respiratory distress as manifested by tachypnea and dyspnea is usually the first evidence of cardiac failure in infancy, and hepatomegaly and other evidences of right-sided failure occur much later.

The ventilatory response to isocapnic hypoxia was studied in anesthetized dogs during normothermia and thermally induced panting. In the normothermic dog, minute ventilation (E), tidal volume (VT) and respiratory frequency (f) did not vary significantly with changes ofPaO2 above 80–90 mm Hg. Below this value, these three parameters increased substantially with progressively decreasingPaO2. During panting the ventilatory response was triphasic: 1. withPaO2 values above 90 mm Hg ventilation remained unaffected; 2. whenPaO2 progressively decreased from 90 to 45 mm Hg, ventilation increased significantly over the levels of ventilation reached in response to heat alone; 3. withPaO2 under 45 mm Hg ventilation abruptly decreased as compared to the second phase of the response.VT increased significantly during the second and third segments as compared to the first. Respiratory frequency progressively decreased whenPaO2 was under 60 mm Hg Isocapnic hypoxia suppressed thermally induced panting (tachypnea) but led to reduction of evaporative heat loss only at the lowest values ofPaO2.

Premedical and chronic changes in several organs and the preventive measures of them are discussed briefly at the level of causative agents. 1) It has been experienced that too much intake of animal food is accompanied by a high incidence of diabetes mellitus. This disease is prevalent among persons of manager class or of wealth but seldom among ordinary people in Japan. Moderate intake of animal food appears to have to be advised. 2) Old people living at the intake level of 1500 Cal. and 40g. total protein, of which less than 10g. is from animal source, are many in Japan. They are characterized by marked body weight reduction. The situation is linked with the intake level among young people. Calory and animal protein have to be encouraged to increase for these people. 3) There are many kinds of highly salted (10s30%) food in Japan. They are routinely consumed with insufficient mastication. Highly salted food causes damage in stomach membrane through many folds of normal osmotic pressure. Health education for the Japanese appears to be needed to advise them to mince or desalt before eating or to masticate enough to desalt in the mouth. 4) Repeated cold stimuli, which are very often to be seen in everyday life of the Japanese, have been reported to be linked with hypertension and cerebral apoplexy, that are very prevalent in Japan. Cold stimuli in the living conditions have to be sought and evaluated individually from the viewpoint of preventing the diseases. 5) Energy consumption for going up the stairs is very large. Repeated tachycardia accompanies enlargement of the heart, when it becomes weakened. Tachycardia and tachypnea in ordinary life are good measures for screening weakend heart and for preventing its aggravation by avoiding the symptoms. 6) Health hazards and poisoning from environmental conditions should be avoided by the estimation and by the improvement of the environment before any sign of disease can be recognized. The present measures adopted in Japan are not necessarily suitable.

SummaryReport of a case of hysterical dyspnea in a female of 21 years, with moderate tachypnea and pseudo-spasm of the larynx. The patient was cured by isolation.Clinical and physiological analysis of the case prove the occurence of moderate overventilation of strictly limited sectors of the lungs (apex). Light and chronic acapnia and alcalosis result therefrom.To account for absence of cyanosis and true dyspnea, redistribution of the blood’s circulation within the lungs has been postulated

SummaryRats treated with nicotinic acid or its amide were found to survive until they reached a barometric pressure of 75 mm Hg (equivalent altitude, 53,800 feet); untreated controls died at an average pressure of 93 mm Hg (49,275 feet). Statistically, the differences are probably significant.The tachypnea developing at low barometric pressure is much less in treated than in untreated rats. Preliminary injection of 1 mg nicotinic acid was followed by an increase in respiratory rate of only 22% at 300 mm Hg as opposed to approximately 80% in untreated controls. Differences of comparable magnitude were noted at pressures of 300 and 250 mm Hg following the administration of nicotinamide. Statistical analyses indicate that these differences are highly significant.

Fifteen guinea pigs were sensitized with Candida albicans and exposed to the aerosol of the polysaccharide fraction (PS) or protein fraction (Prot) from the extracts of the organisms. A definite decrease in respiratory conductance was seen immediately after the inhalation of PS. When the pigs were exposed to Prot or crude extracts, two types of reactions in the respiratory tract were observed in each. The first was an immediate decrease in conductance following inhalation, and the second was a delayed tachypnea occurring at 24 hours after exposure. Our previous study on guinea pigs immunized with egg albumin or killed tubercle bacilli showed that exposure to the former provoked an immediate decrease in conductance and exposure to the latter caused a delayed tachypnea. The transferability of the former reaction with serum and the latter via cells was demonstrated. Taking this into consideration, it may be suggested from the present investigation that PS has antigenic activity provoking an allergic reaction of the immediate type and Prot has the ability to elicit dual reactions of the immediate and delayed type in the respiratory tract of guinea pigs immunized with the organism. Histologic studies support this view.

As demonstrated by this work, thyroxin given in low doses (0.007 mg/100 g of weight) augmented the cholinergic reactions-intensified the negative chrono-and dromotropic effect of acetylcholine and especially of proserine. Threshold doses of proserine become fatal in these conditions. Against the low doses of thyroxin, adrenalin and ephedrine produce a vagal effect-a negative chronotropic effect. High doses of thyroxin (160–220 mg/100 g of weight) caused a rise in sympathicoadrenal activity (tachycardia, shortening of P-Q, QRST intervals, tachypnea, and loss of weight); cholinergic reactions in these conditions are also intensified as compared to control tests but not to such an extent as after low thyroxin doses. The role of increased cholinergic activity as a condition provoking intensification of sympathoadrenal reactions in hyperthyroidism is suggested.

During continuous spirometric recording of breathing, 75–μ glass bead emboli were delivered selectively to single lungs or lung lobes while the remaining lung areas were maintained functionally intact and free of emboli. Postmortem digestion of the lungs revealed the distribution of the emboli and demonstrated complete localization within single lungs or lobes in 12 of 16 experiments. In all instances the frequency of breathing increased and tidal air decreased in a pattern indistinguishable from that attending bilateral multiple minute pulmonary embolism. These effects were abolished by vagotomy but survived inhalation of pure oxygen. Comparison of the quantitative relationship between emboli dose and magnitude of response in localized with that in generalized pulmonary embolization suggests that, within limits, the intensity of the tachypnea is determined by the number of emboli injected regardless of the identity of the gross lung area in which they lodge or the degree of their concentration or dispersion within areas in which they lodge and seems not to favor associated hemodynamic factors as the agency initiating the reflex. Submitted on January 3, 1961

SUMMARY Estimations of plasma catecholamine levels, pH, Pco2 and HCO3 and measurements of respiratory rate, tidal volume and minute volume were carried out in ten healthy adults during a control state of nitrous oxide-oxygen anaesthesia and during the inhalation of 1 per cent trichloroethylene. There were no significant changes in plasma catecholamine levels and the arterial blood pressure was unaltered during trichloroethylene anaesthesia. Even though there was a statistically significant reduction in tidal volume and an increase in the respiratory rate and minute volume, the acid-base status of the patients was within normal limits. The mean respiratory rate of 32 b.p.m. suggests that the use of a narcotic like pethidine would not have been necessary for the control of tachypnoea. It is concluded that the potent analgesic effect of trichloroethylene facilitates the use of concentrations that do not upset cardiovascular or respiratory homeostasis.

1. 1. Oral and intravenous glucose tolerance tests were done in the third trimester of pregnancy in 39 women with a history of diabetes in the family or obstetric or pediatric findings frequently associated with diabetes. Similar studies were made in 10 women with a negative history. The infants of these mothers as well as of 9 patients with overt diabetes were investigated. 2. 2. Eighteen of the 39 mothers (45 per cent) showed abnormal glucose tolerance in both tests and were classified as gestationally diabetic. 3. 3. Twelve (67 per cent) of these mothers had infants above the seventy-fifth percentile of weight for gestational age as compared with 100 per cent for the infants of mothers with overt diabetes, 39 per cent for the suspect controls, and 20 per cent for the nonsuspect controls. 4. 4. Ten (55 per cent) of the 18 infants showed plethoric, balloon-cheeked facies as compared with 100 per cent for the infants of mothers with overt diabetes and none for the two control groups. 5. 5. Eight of 9 (89 per cent) infants born to overtly diabetic mothers had tachypnea as compared with 27 per cent in the infants of mothers with gestational diabetes and none in the controls. 6. 6. Five of 9 (55 per cent) infants born to overtly diabetic mothers had jitteriness as compared with 16 per cent in the infants of gestationally diabetic mothers, 4 per cent in the infants of mothers in the suspect control group, and none in the normal controls.

Pulmonary hemorrhage occurred in seven patients with disseminated intravascular coagulation (DIC) and was produced in three monkeys when an experimental model for DIC was used. The syndrome was either the chief complaint for which patients entered the hospital, appeared with other coexisting complications of DIC, or occurred just prior to death. Because the onset of dyspnea, tachypnea, hemoptysis, rales, and a diffuse infiltrate on chest x-ray film were usually interpreted as infectious processes, therapy for DIC was withheld and the patients’ conditions worsened. Pulmonary hemorrhage was the immediate cause of death in almost all patients. It is suggested that the pulmonary hemorrhage syndrome has features in common with other respiratory distress syndromes such as hyaline membrane disease (HMD), pulmonary hypoperfusion, and shock lung.

The liquid which occupies the potential air spaces of the fetal lung is, at birth, displaced by air and removed by the pulmonary blood and lymphatic circulations. Delayed resorption of this liquid from the interstitial spaces may be associated with decreased lung compliance and be the cause of the syndrome "transient tachypnea of the newborn." Chest roentgenograms of these infants have shown the presence of alveolar and interstitial edema and pleural effusions which cleared during the first few days of life. We chose to test the possibility that a delay in clearance of lung liquid might occur and be associated with tachypnea and radiologic evidence of pulmonary edema in newborn lambs. Serial chest radiographs were obtained in 18 newborn lambs delivered at term by Caesarean section. The radiographs demonstrated the presence of lung liquid which gradually cleared in an average time of 2 hours following onset of breathing. Lung weight—body weight ratios obtained following sacrifice at various stages of clearing—decreased as pulmonary aeration increased. Microscopic examination of the lungs showed no evidence of inflammatory exudate or squamous debris but distension of perivascular tissues with liquid was demonstrated. An association between increasing lung aeration and decreasing respiratory rates was found.

The pattern of respiration during anesthesia, characterized by small tidal volumes with rapid respiratory frequencies, has been attributed to increased activity of the Hering-Breuer reflex, following sensitization of pulmonary stretch receptors by the drugs. This thesis was tested by crease the FRC

The effect of amitriptyline on pulmonary ventilation and mechanics in both intact and vagotomized dogs was investigated. Injection of amitriptyline, 2.5 mg/kg i.v., caused bronchodilation of short duration and marked inhibition of serotonin- or histamine-induced bronchoconstriction for a period up to two hours. This inhibitory effect persisted after vagotomy. Tachypnea followed each injection of amitriptyline and this was abolished by vagotomy. The mechanism of the different actions of the drug on the respiratory system is discussed.

It has been shown that phendimetrazine retains the anorexigenic activity of phenmetrazine in experimental animals and has similar acute toxicity values. However, the two compounds differ in their action on the cardiorespiratory system. Tachycardia, tachypnea, and electrocardiographic changes seen after intravenous phenmetrazine in the dog were not observed with phendimetrazine. These differences may be due to the methyl group on the nitrogen and to the fact that phendimetrazine is a d-isomer whereas phenmetrazine is a racemic mixture.

Forty-one experiments with positive and negative atmospheric ions were performed on 19 children, of whom 13 were suffering from asthmatic (spastic) bronchitis. The results of these experiments indicate that the atmospheric ions have the following effects. Negative ions 1. Shorter duration of the spastic attack as compared with duration of the attack in children receiving the conventional therapeutic treatment. 2. Reduction of tachypnea in cases of spastic bronchitis and bronchopneumonia. 3. Termination of spastic attacks induced by positive ionization. 4. The effect of negative ions on respiratory spasticity usually becomes obvious about 8 hours after the beginning of the ionization. 5. When the negative ionization is stopped, a moderate rebound of spasticity and tachypnea was noticed in several cases. Positive ions 1. Induce spastic attacks in normal infants. 2. Cancel the therapeutic effects of negative ions on patients with spastic bronchitis. 3. Cause tachypnea in infants. 4. On the average, the effects of these ions on respiratory spasticity becomes evident about 10 hours after the beginning of ionization.

In eight non-uremic patients with malignant hypertension and moderate azotemia who were treated with ganglionic blocking agents and hydralazine, extreme tachypnea developed. On postmortem examination they were found to have fibrinous pneumonitis resembling so-called "uremic pneumonia." Pyrexia, relative tachycardia and leukocytosis, without uremia, alkalosis or hyponatremia, characterized their terminal clinical episode. Previous control of the hypertension had been poor, with high average diastolic pressures and extreme fluctuations in systolic pressure despite large doses of ganglionic blocking agents. The microscopic pulmonary lesions were studied in twenty-seven patients with a primary anatomic diagnosis of arteriolar nephrosclerosis who had received methonium salts and in sixtyseven such patients who had not been treated. Fibrinous pneumonitis was (1) significantly more frequent in methonium-treated patients than in untreated patients, (2) qualitatively similar anatomically in these two groups of patients, and (3) rare in non-uremic patients except those treated with hexamethonium. Fibrinous pneumonitis was not pronounced in any of the thirty-nine patients with mitral stenosis who also were studied; this tends to eliminate increased pulmonary venous pressure secondary to left heart failure as an important pathogenetic factor. These data suggest that methonium salts may exert effects similar to those of the nitrogen retention products of the uremic state in the pathogenesis of fibrinous pneumonitis.

Arteriovenous aneurysm of the vein of Galen is a rare malformation. This paper presents the pathologic and clinical features of an additional case. These findings are compared with the data of previous cases in the literature. Report of a Case This white male infant was 6 weeks old when he was admitted to Montefiore Hospital on March 2, 1959. The mother's pregnancy, labor, and delivery had been normal. The child weighed 8 lb. 10 oz. (3,910 gm.) at birth but was persistently cyanotic. In the second week of life an episode of dyspnea and tachypnea occurred. The patient was admitted to another hospital, where a roentgenogram of the chest showed focal atelectasis of the upper aspects of both lungs and increased aeration of the right lower lung. An ECG revealed right axis and right ventricular preponderance. Family history was significant in that a distant maternal cousin died of congenital heart

A rapid intravenous dose (10 mg.) of edrophonium was administered to 24 patients with a variety of supraventricular tachycardias. Four with rapid sinus tachycardia showed transient sinus slowing. In 6 patients with rapid atrial flutter and in 3 with atrial fibrillation, edrophonium transiently increased atrioventricular block, and the atrial flutter or fibrillation waves became evident at the slowed ventricular response. In 11 patients with 12 episodes of paroxysmal atrial tachycardia, edrophonium converted the arrhythmia to normal sinus rhythm on six occasions. No complications were noted with the use of this drug, though minor side effects such as transient salivation, perspiration and tachypnea did occur. Edrophonium is a safe and useful pharmacologic agent in the differentiation of supraventricular tachycardias and in the conversion of paroxysmal atrial tachycardia to normal sinus rhythm.

Trilene is a nonflammable, easy-to-inhale anesthetic agent that provides the excellent signs of anesthesia needed to administer light surgical anesthesia with the precise control required for use on an outpatient basis. Trilene's potent analgesic action, plus the limited degree of other properties one expects from a general anesthetic, makes it an ideal agent for oral surgical procedures on the pediatric outpatient. Endotracheal intubation is not desirable for outpatient anesthesia, and its use should be limited to emergency situations. A nasopharyngeal tube provides a valuable aid for dealing with upper airway obstructions and has few of the hazards of endotracheal intubation. If light surgical anesthesia is employed, Trilene has very few complications, of which tachypnea is the most common. The rapid breathing is a sign of an overdose and is easily corrected by decreasing the concentration of the anesthetic agent. Because of its depressant effect on the myocardium and its tendency to produce arrhythmias, catecholamines should not be used during Trilene anesthesia. The reaction of Trilene with alkali absorbents limits its use to a non-rebreathing system. Preoperative medication is seldom necessary unless a belladonna drug is to be used to control the flow of secretion. Also, a complete blood count and urinalysis are valuable in determining the preoperative physical status of the patient. When administered by a qualified anesthetist with prior training in both hospital and outpatient anesthesia, Trilene provides an excellent anesthetic for oral surgical procedures on pediatric outpatients.

A reaction was observed following the administration of macroaggregated albumin (MAA) for a nadionuclide perfusion lung scan in a patient with widespread tumor emboli to the lung. The reaction consisted of faintness, cyanosis, agitation, diaphoresis, tachypnea, a fall in blood pressure and engorged neck veins immediately after intravenous injection of the MAA.This response suggests that in some patients with pulmonary disease, the safety factor for the MAA lung scan may be decreased and suggestions are presented to minimize the hemodynamic hazards in such individuals.

Severe pulmonary vascular obstruction in the absence of obvious pulmonary parenchymal pathology was found in 5 full-term neonates and was characterized clinically by cyanosis and tachypnea. Cardiac catheterization and cineangiography at age 32 to 55 hours revealed pulmonary hypertension with right-to-left shunt through the ductus arteriosus in each instance. One infant died and autopsy revealed only a patent ductus arteriosus and marked medial hypertrophy of the muscular pulmonary arteries. Clinical resolution of pulmonary vascular obstruction occurred within 4 weeks in the survivors; this was confirmed in one infant by recatheterization. The possible causes of the persistence of pulmonary vascular obstruction are discussed.

A severe illness characterized by high fever, tachypnea, myalgia, prostration, and an atypical exanthem occurred after exposure to measles in children previously immunized with killed measles vaccine. Laboratory and epidemiological data were suggestive of recent measles infection. Other previously immunized children had local reactions at the site of injection of live measles vaccine. The host response to subsequent challenge with live measles virus is apparently sometimes altered by prior vaccination with inactivated measles vaccine, but the exact mechanisms remain obscure.

1.1. When patients on a hospital ward were studied to determine the range of blood lactate concentrations to be found, the values varied from 0.430 to 26.42 mM/L. 2.2. A very small part of this variation was caused by the imperfect sampling technics necessary for bedside use. 3.3. Only a very small part of the variation could be accounted for by muscular contractions in any patient who was lying still in bed. 4.4. However, great elevations of blood lactate occasionally occurred in resting patients. These were encountered in a variety of clinical states which seemed to have nothing in common, and other patients with similar diseases showed no similar lactatemia in association with the disease itself. 5.5. The patients with hyperlactatemia had variable blood pyruvate concentrations; in some patients the elevated pyruvate level accounted for the elevated lactate, through its effects in the lactic dehydrogenase system, while in other patients there appeared to be a major accumulation of lactate in excess of this and due to some other cause. On this basis the patients were divided into groups 1 and 2. 6.6. Since the only other cause of a steady state of lactate accumulation is cellular hypoxia, data on circulation and respiration were collected. On this basis group 2 was further subdivided into groups A and B, the former including all patients with hypoxemia or circulatory failure. 7.7. All patients with hyperlactatemia except the small group 2B were found to exhibit the various known causes of lactate accumulation consistent with the accompanying changes in blood pyruvate but often only indirectly and incidentally related to the "disease" for which hospital admission was required. 8.8. Group 2B could not be satisfactorily explained in any clinical terms or in relation to other laboratory findings, but the group was nevertheless clinically distinct. All the patients were acidotic and all died.

Presentation of Case A four-day-old boy was admitted to the hospital because of tachypnea and cyanosis. The child was the product of a normal pregnancy, labor and delivery of a 28-year-old, gravida...

An infant, 5½ months of age, died after a brief acute illness characterized by irritability and somnolence leading terminally to coma, and by excessive sweating, abdominal distension, tachypnea and tachycardia. Acidosis and azotemia were marked. He was found at necropsy examination to have pathologic findings compatible with both beriberi and Wernicke's encephalopathy. Investigation of the dietary history and analysis of the formula fed the patient confirmed the suspicion of deficient intake of thiamine. This is the first case report in which the coexistence of these two pathologic conditions in a child proven to have had an inadequate diet, has been documented. It lends further support to the thesis that Wernicke's encephalopathy is caused by nutritional deficiency. The importance of vitamin supplementation of restricted diets used in the therapy of infantile eczema is emphasized.

C A s E 1, a 1,0.25 Gm. male infant, was born at another hospital at 30 weeks' gestation to an 18-year-old, primigravida, B, Rhpositive mother, who had eclampsia and premature separation of the placenta. Labor lasted two hours and 36 minutes, and the delivery was spontaneous. The Apgar score was 9. Upon arrival in the nursery the child had tachypnea and slight intercostal retractions. Serum calcium determinations varied between 5.2 and 6.4 rag. per 100 ml., and the serum phosphorus was 5.8 mg. per 100 ml. The child was given 10 per cent dextrose in water and sodium bicarbonate by umbilical vein catheter. Retractions continued and were accompanied by grunting. Despite being placed in oxygen, the infant was "cyanotic, although active" and soon had an apneic spell, from which he was resuscitated by positive-pressure oxygen administered by mask. Shortly thereafter, the blood pH was 7.15, Paco2 (CO2 tension) 50 mm. Hg, standard bicarbonate 15 mEq. per liter, Pa02 16 mm. Hg; and 0 2 saturation 14 per cent. Six milliequivalents of sodium bicarbonate was administered, and the pH rose to 7.22. Because of persistent cyanosis--his physicians

Effective compliance, average flow resistance and mechanical work were measured by intraesophageal pressure technic in following subjects: 14 normals, 14 cardiacs, 11 emphysematous and 6 patients with pulmonary fibrosis. The influence of respiratory rate on these values and gradient of alveolar N2 fraction by single breath analysis were also studied, and results were as follows. (1) In cardiacs, compliances were significantly decreased, and flow resistances and viscous work were moderately increased, while total work was markedly increased. In changing respiratory rate, compliances and mechanical works remained stable. Gradients of alveolar N2 fraction were in normal range. (2) In emphysematous patients, compliances were widely scattered and the difference from normal subjects was not significant, though markedly decreased in tachypnea. Flow resistances and mechanical works were markedly elevated. In changing respiratory rate from resting state, marked elevation of mechanical works was noted. Gradients of alveolar N2 fraction were markedly elevated. (3) In patients with pulmonary fibrosis, decrease in resting compliance and moderately increased flow resistance and mechanical workswere noted. Effect of changing respiratory rate on mechanical values was not marked. Gradients of alveolar N2 fraction were moderately elevated. (4) These results indicated that the mechanical behavior in cardiacs and patients with pulmonary fibrosis made sharp contrast with that in the patients with emphysema.

In the period from April through August, 1967, 20 newborn infants in a small hospital developed an unusual illness characterized by profuse, generalized diaphoresis, fever, tachycardia, tachypnea, hepatomegaly, and acidosis. Nine of these infants were severely ill and 2 died. Toxic levels of pentachlorphenol were found in the serum from one patient and autopsy tissues from another. Epidemiologic studies indicated the illness arose only after 5 or more days of hospitalization. Review of hospital practices disclosed that the laundry was misusing a laundry product which contained sodium pentachlorophenate, the sodium salt of pentachlorophenol. High concentrations of this chemical were found in the nursery linens, which provided a source for the percutaneous absorption of sodium pentachlorophenate.

Presentation of Case* A three-day-old white male infant was referred to the hospital because of tachypnea. The patient was the product of a full-term, normal delivery and weighed 3.5 kg. (7 pounds, 11 1/2 ounces) at birth. He cried spontaneously and had a good color. Feedings were taken well, and the vital signs were normal until the day of admission, when the temperature rose to 101°F., the respirations increased to 120, and irritability and crying were observed. A lumbar puncture revealed 700 red cells and 4 mononuclear cells per cubic millimeter in the cerebrospinal fluid; the glucose content was 66 . . .

One hundred and fifty documented episodes of cardiac arrest were reviewed in 137 unselected patients hospitalized in a general hospital. Mental confusion (87 percent) and tachypnea (55 percent) were early warning signs. In 18 percent of patients, respiratory arrest preceded cardiac arrest. Ventricular fibrillation and cardiac standstill were the most common electrocardiographic mechanisms of arrest but none of the patients with ventricular asystole ultimately survived. Although 48 padents were successfully resuscitated after the first episode of cardiac arrest, only 14 (10 percent) were permanent survivors. There were no permanent survivors after resuscitation in patients who had a second episode of cardiac arrest.

Nine rats were exposed to 0.8 ppM NO/sub 2/ and allowed to live out life-span of up to 33 months. There were 12 control animals. No emphysema or other overt changes were noted due to exposure. The animals were also normal otherwise except for an increase in respiration rate of about 20% (tachypnea).

The injection of 5 cc. of metallic mercury into a leg vein of adult unanesthetized dogs produces a marked dilatation of the right heart chambers a very few minutes after reaching the right heart and arterial side of the pulmonary circuit. There is a great disproportion between the objective symptoms and the severity of the lesions wrought in the thoracic viscera. The first symptoms that usually follow the above procedure are gastro-intestinal in nature; vomiting and defecation occur, usually within one-half hour or hour after the administration of the metal. Tachypnea or dyspnea rarely appear early, and frank respiratory symptoms are usually in abeyance for some hours. The survival period of more than 20 animals averages 35 hours.The electrical axes computed from synchronous leads and from single axial leads that satisfy the Einthoven formula do not show significant axis deviation. There is an anomalous wide splitting of the T-wave in many curves. Paroxysmal auricular fibrillation was noted in the electro...

Observations were made at the Soviet antarctic station, “Vostok”. Tachypnea and considerable hyperventitation were observed during the first days after arrival at the station. With acclimatization, the frequency of respiration restored to the normal, pulmonary ventilation decreased, reaching the lowest level during the polar night period (however, even during that period it is 1 1/2 times greater than the normal value); the depth of respiration increased considerably. During the whole period of stay in Antarctica every individual had Cheyne-Stokes respiration, especially during sleep. Dyspnea increased considerably, even during slight physical strain. Composition of alveolar an became stabilized at a new level corresponding to a partial oxygen pressure of 53–56 mm Hg and to CO2 pressure of 26–29 mm Hg. The blood oxygenation during quiet respiration was 80–87%, increasing with voluntary hyperventilation to 85–94%. Hypoxemia rose considerably with voluntary breath holding and physical strain.

Intracerebral injection of 0.5-1.0 µ g. of neostigmine or eserine in the conscious mouse causes the following effects: tachypnea followed by bradypnea, piloerection, lacrimation, salivation, exophthalmos, micturition, defecation, muscle spasms and tremors, loss of control of the fore limbs and generalized depression. The central sites of action producing these peripheral effects are discussed.

Apparently healthy, unanesthetized dogs weighing 12.3 ± 1.8 kg were caused to pant by the warming effect of incandescent lamps. Panting frequency was recorded and found to be 5.33 ± 0.7 cycles/sec. The natural frequency of the respiratory system of each of the animals was then determined, the mean being 5.28 ± 0.3 cycles/sec. The increased effectiveness of panting at the resonant frequency of the respiratory system is discussed in terms of respiratory impedance and maximum volume flow with least effort. The impracticality of panting at other frequencies is shown by calculation. Submitted on August 2, 1961

Impedance pneumography was used to monitor respiratory rates and patterns in 49 patients with acute ischemic cerebral vascular disease. Nine patients had clinical evidence of bilateral ischemic cerebral disease. In one of these, normal respiratory pattern was present at all times; in five, there was intermittent Cheyne-Stokes respiration; in two, there were variants of Cheyne-Stokes pattern, and one patient eventually developed sustained tachypnea with probable hyperpnea. Twenty-eight patients had unilateral cerebral infarct. In five of these, normal respiratory pattern was present at all times; in 15, there was intermittent Cheyne-Stokes respiration; six had a variant of Cheyne-Stokes respiration; two had sustained tachypnea with probable hyperpnea. In 12 patients with brainstem infarcts, Cheyne-Stokes respiration was intermittently present in four, Cheyne-Stokes variant patterns were observed in two, and sustained tachypnea with probable hyperpnea developed in six. Abnormalities of respiratory patterns occurred more frequently during sleep, in the presence of a depressed sensorium, and in patients with severe neurological deficits. Respiratory alkalosis of variable degree was present in all patients with Cheyne-Stokes respiration or sustained tachypnea with probable hyperpnea. Cheyne-Stokes respiration was not always related to bilateral cerebral lesions. Intermittent Cheyne-Stokes respiration was not closely related to immediate prognosis. Sustained tachypnea with respiratory alkalosis was associated with the highest mortality rate among patients with respiratory pattern abnormalities.

Five syndactylous and five control female cattle were subjected to standardized, moderate temperature stress in a climate chamber. All syndactylous cattle developed clinical signs of hyperthermia including elevated rectal temperatures (41.5 to 45C), tachycardia, and tachypnea. Three syndactylous females became recumbent and paralyzed, and two subsequently died. One died without premonitory signs after 96h exposure. Blood chemical changes were slight except for preterminal hyperglycemia in two syndactylous cows. Total leucocyte count changed little; however, relative and absolute eosinopenia and lymphopenia and neutrophilia occurred in the syndactylous cattle. Gross pathologic lesions were widespread parenchymatous degeneration, cerebral and cerebellar edema, and degeneration. Thus, syndactyly, a hereditary morphological defect, is correlated with a functional defect, hyperthermia.

Twelve pigs were divided into 2 groups: the 1st group of seven and the 2nd group of five. Each of them was given orally with 1.7×106 sporulated Toxoplasma oocysts, which had been isolated from the feces of an unwanted cat and identified as those of Iosopora bigemina. All the pigs were examined for body temperature and symptoms every day. The 2nd group was fed a ration containing 500 ppm sulfamonomethoxine (6-methoxy-4-pyrimidinyl sulfanilamide monohydrate) and 25 ppm pyrimethamine (2, 4-diamino-5-(p-chlorophenyl)-6-ethylpyrimidine) for 7 consecutive days before the inoculation of oocysts and the following 58 days. All the pigs of the untreated 1st group showed an increase in body temperature, loss of vigor, anorexia, ocular discharge, coughing, tachypnea, diarrhea and cyanosis. All of them except one which was killed for pathological examination on the 7th day after inoculation died some time between the 9th and 15th day after inoculation. Histological examination of the 1st group revealed necrotic foci in some visceral organs, including lymph nodes and intestine, and encephalitis and inflammatory edema in both lungs. Suoh lesions as these were seen in no pigs of the 2nd group. Toxoplasma was detected from the pigs of the 1st group, but not from these of the 2nd group, and identified by Giemsa's staining and the mouse inoculation test.

ALTHOUGH inadequate alveolar ventilation occurs in numerous systemic diseases, only rarely has it been described occurring as the presenting system complex resulting from a motor system disease. Recently we studied a patient who presented with fatigue, somnolence, and periodic respiratory signs ascribed to alveolar hypoventilation and its consequent blood gas abnormalities. In the absence of pathologic examination of the nervous system of our patient we feel clinical evaluation of his motor system disease would best place it in the category of amyotrophic lateral sclerosis (ALS). Report of Case The patient (U.H. 19-64-73), a 49-year-old Caucasian businessman was hospitalized for medical survey because of increasing tiredness. For approximately five years there was gradual progression of fatigability and lethargy with physical activity provoking exhaustion without dyspnea. Drowsiness was frequent although he slept poorly at night. His wife noted an irregular respiratory pattern, notably nocturnal, which varied cyclically from near apnea to tachypnea.

An experimental model which closely resembles the respiratory distress of clinical fat embolism has been developed. The clinical picture of tachypnea, hypoxemia, and loss of lung compliance are reproducible in the experimental animal following injection of oleic acid. All animals tested died of acute respiratory failure secondary to hypoxemia. Circulatory hemodynamics remained stable until respiratory arrest occurred. The pathological findings of diffuse hemorrhage, congestion, and edema are similar to changes seen in the lungs of patients dying from fat embolism, shock, and trauma. This experimental model is a useful tool in the investigation of therapeutic regimens used in the treatment of clinical fat embolism.

Summary Patients with an atypical patent ductus arteriosus can be identified and treated safely during infancy with the aid of the special diagnostic modalities of cardiac catheterization and retrograde aortography. The clinical syndrome of tachypnea, dyspnea, repeated respiratory infections, easy fatigability and growth failure presented by these children has been described, and the summaries of six cases seen by us have been presented. Three patients were described in detail, to illustrate specific points and to demonstrate clearly the value of early diagnosis and treatment.

A 2-year-old girl, who at birth exhibited lingual malformation, Polydactyly, and tachypnea and who subsequently developed severe psychomotor retardation, is described. The syndrome corresponds to the Mohr syndrome and is compared with the oral-facial-digital (OFD) syndrome from a clinical and genetic point of view.

Rats were exposed to 0, 0.8, or 12 ppm NO/sub 2/ continuously for their life-span or to 4 ppm for 16 weeks. No differences in weights were observed for 4 or 0.8 ppm, but 12 ppm rats had heavier lungs. Rats that had received 25 ppm in a previous experiment gained weight when put in control environment; weights approached those of controls. Resting animals at 0.8 and 4 ppm exposure rates had faster breathing rates than controls, usually about 20% higher. Acute tachypnea was noted in animals exposed to 25 ppm before removal to air but dropped to near-normal levels (20% high) post-exposure. (Normal respiration rate decreases for the first several months of age but increases with old age.) Of 15 rats exposed to 12 ppm, 13 developed pulmonary disease; weights were lower and respiration rate was elevated 50% when approaching death. Respiratory pattern was consistent with obstructed air-flow; covert emphysema was observed as with higher rates. Below 50 ppm, free alveolar edema was not present. 100 ppm caused acute lethal pulmonary edema. Somewhat gross dose-effect was observed; e.g., 4 ppm rats showed some evidence of early histopathologic changes.