- Email: [email protected]
Functional Potentials of the Lung
544
CONSTANT AND CARLISLE
cular hypertrophy in the aged, Ronenbyo aap J Ceriat), 4:631,1960 8 Constant J, Schiller NB, and Lippschutz EJ: Venbicular dilatation or volume overload diagnosed by QRS relationships of V4, V5, and V6, Amer J Moo Sci, 253:61, 1967 9 Ban TA, and St Jean A: Effect of phenothiazines on ECG, Modem Moo, November, 23, 1964, p 124 10 Millar K, and Abildskov JA: Notched T waves in young persons with central nervous system lesions, Circulation, 31:591, 1968
11 Roch M: Der alkololismus in der medizinischen KliniJc genf in der jahren, Geneva Hospital Study, Schweiz Med Wschr, 69:772, 1933-1938 12 Nolan JP: Alcohol as a factor in the illness of university service patients, Amer J Med Sci, 2:249, 1965 13 Morin YL, and Daniel P: Quebec beer drinkers' cardiomyopathy: 48 patients, Canad Moo Ass J 47:926, 1961
Reprint requests: Dr. Constant, 100 High Street, Buffalo, New York 14203
FUNCTIONAL POTENTIALS OF THE LUNG In addition to their own clinical investigations dealing with pneumonectomy, Moulder and Adams (Gordon, B.L., Carleton, R.A., Faber, L.P.: Clinical Cardiopulmonary Physiology (3rd ed), Grone & Stratton, New York, 1969) recorded observations of others concerning competency of the lung remaining after pneumonectomy in children under 12 years of age. It was noted on periodic observations of these subjects, over a period of several years, that surgical removal of one lung was compatible with subsequent normal physical activities. Alveolar oxygen--carbon dioxide transfer was normal at rest and the vital capacity and total lung capacity of the remaining lung were increased by 25 to 40 percent. A comparable situation may exist in some instances of congenital eventration (ectopia) of the diaphragm first described by Petit in 1744. Because of the physiologically adequate function of one lung, individuals with this condition may pass through life and reach old age, without being aware of it. In others, eventration of the diaphragm is discovered because gastrointestinal symptoms, such as anorexia, heartburn, upper abdominal discomfort, belching, regurgitation of food, vomiting or pain on swallowing prompt them to get medical attention. Still others may seek treatment for the relief of palpitation and/or anginoid pain. As to its incidence, Beeler (Thesis, Graduate School. University Minnesota, 1950) recorded three in 10,000 x-ray films of the chest of 500,000 patients at the Mayo Clinic. It is found from seven to ten times more often on the left side than on the right. It is known that some newborn infants with this type of congenital malformation of the diaphragm manifest cyanosis and dyspnea or even respiratory distress. The degree of respiratory
difficulties is influenced by the extent of the abnormal cephalad position of the diaphragm, shifting of the mediastinum toward the opposite side, with consequent compression of the contralateral lung, and dislocation of the heart. Surgical intervention in the form of plication of the diaphragm is followed, as a rule, by immediate and lasting improvement. Eventration of the diaphragm may be associated with other congenital anomalies, such as ectopia of the kidney, intralobar pulmonary sequestration, skeletal and gastrointestinal abnormalities. On physical examination, one notes shifting of the trachea toward the uninvolved side, displacement of the heart, and absence of breath sounds over the implicated hemithorax. Also, on inspiration, there may be increased rise of the respective costal margin and undue traction of the epigastric area toward the involved side. Fluoroscopic and radiographic examinations are indispensable for correct diagnosis. It is well to take anteroposterior, lateral and oblique roentgenograms in upright and recumbent positions. One can thus visualize the anomalous hemidiaphragm as a sharply delineated narrow arc high in the thorax, extending from the costal limits to the mediastinum. In about 50 percent of cases, the respiratory motion of this structure is identical in timing and direction with that of the normal hemi diaphragm. In others, respiratory motion is absent or it is paradoxic (Kienboeck phenomenon). To find abdominal structures, stomach, colon and loops of small intestine high in the chest cavity is a most impressive experience. Use of radiopaque material is of great value in diagnosis. Andrew L. Banyai, M.D.
CHEST, VOL. 57, NO.6, JUNE 1970
CONSTANT AND CARLISLE
cular hypertrophy in the aged, Ronenbyo aap J Ceriat), 4:631,1960 8 Constant J, Schiller NB, and Lippschutz EJ: Venbicular dilatation or volume overload diagnosed by QRS relationships of V4, V5, and V6, Amer J Moo Sci, 253:61, 1967 9 Ban TA, and St Jean A: Effect of phenothiazines on ECG, Modem Moo, November, 23, 1964, p 124 10 Millar K, and Abildskov JA: Notched T waves in young persons with central nervous system lesions, Circulation, 31:591, 1968
11 Roch M: Der alkololismus in der medizinischen KliniJc genf in der jahren, Geneva Hospital Study, Schweiz Med Wschr, 69:772, 1933-1938 12 Nolan JP: Alcohol as a factor in the illness of university service patients, Amer J Med Sci, 2:249, 1965 13 Morin YL, and Daniel P: Quebec beer drinkers' cardiomyopathy: 48 patients, Canad Moo Ass J 47:926, 1961
Reprint requests: Dr. Constant, 100 High Street, Buffalo, New York 14203
FUNCTIONAL POTENTIALS OF THE LUNG In addition to their own clinical investigations dealing with pneumonectomy, Moulder and Adams (Gordon, B.L., Carleton, R.A., Faber, L.P.: Clinical Cardiopulmonary Physiology (3rd ed), Grone & Stratton, New York, 1969) recorded observations of others concerning competency of the lung remaining after pneumonectomy in children under 12 years of age. It was noted on periodic observations of these subjects, over a period of several years, that surgical removal of one lung was compatible with subsequent normal physical activities. Alveolar oxygen--carbon dioxide transfer was normal at rest and the vital capacity and total lung capacity of the remaining lung were increased by 25 to 40 percent. A comparable situation may exist in some instances of congenital eventration (ectopia) of the diaphragm first described by Petit in 1744. Because of the physiologically adequate function of one lung, individuals with this condition may pass through life and reach old age, without being aware of it. In others, eventration of the diaphragm is discovered because gastrointestinal symptoms, such as anorexia, heartburn, upper abdominal discomfort, belching, regurgitation of food, vomiting or pain on swallowing prompt them to get medical attention. Still others may seek treatment for the relief of palpitation and/or anginoid pain. As to its incidence, Beeler (Thesis, Graduate School. University Minnesota, 1950) recorded three in 10,000 x-ray films of the chest of 500,000 patients at the Mayo Clinic. It is found from seven to ten times more often on the left side than on the right. It is known that some newborn infants with this type of congenital malformation of the diaphragm manifest cyanosis and dyspnea or even respiratory distress. The degree of respiratory
difficulties is influenced by the extent of the abnormal cephalad position of the diaphragm, shifting of the mediastinum toward the opposite side, with consequent compression of the contralateral lung, and dislocation of the heart. Surgical intervention in the form of plication of the diaphragm is followed, as a rule, by immediate and lasting improvement. Eventration of the diaphragm may be associated with other congenital anomalies, such as ectopia of the kidney, intralobar pulmonary sequestration, skeletal and gastrointestinal abnormalities. On physical examination, one notes shifting of the trachea toward the uninvolved side, displacement of the heart, and absence of breath sounds over the implicated hemithorax. Also, on inspiration, there may be increased rise of the respective costal margin and undue traction of the epigastric area toward the involved side. Fluoroscopic and radiographic examinations are indispensable for correct diagnosis. It is well to take anteroposterior, lateral and oblique roentgenograms in upright and recumbent positions. One can thus visualize the anomalous hemidiaphragm as a sharply delineated narrow arc high in the thorax, extending from the costal limits to the mediastinum. In about 50 percent of cases, the respiratory motion of this structure is identical in timing and direction with that of the normal hemi diaphragm. In others, respiratory motion is absent or it is paradoxic (Kienboeck phenomenon). To find abdominal structures, stomach, colon and loops of small intestine high in the chest cavity is a most impressive experience. Use of radiopaque material is of great value in diagnosis. Andrew L. Banyai, M.D.
CHEST, VOL. 57, NO.6, JUNE 1970