Fibre-optic endoscopic study of the upper gastrointestinal tract in patients with diabetic keto-acidosis

Fifteen diabetic patients complicated with ketoacidosis complaining of various upper gastrointestinal symptoms, shortly before and during the attack and ten controlled diabetic patients were studied by fibreoptic endoscopy and biopsies were taken for histology and histochemical study. Radiology with barium for upper gastrointestinal tract was done. The results revealed occult blood and manifested in the stool of 5 patients. The endoscopic examination showed normal findings in two patients and different abnormalities in the motility as hyperperistalsis, incompetent esophago-gastrie function, pylorus or pylorospasms and biliary reflux. Structural macosal abnormality varies from hyperaemia, oedema, erosions and even acute ulceration of the esophagus, stomach and duodenum. Candida infection of the esophagus was present in one patient. The histopathology and histochemistry of mucosal biopsy revealed marked inflammatory reactions, with increased histochemical activity of acid phosphatase enzyme. Ten days after controlling the keto-acidosis most of these changes subsided and gastrointestinal symptoms improved. There was a relation between the severity of ketoacidosis and the extent in the pathological changes in motility and structural changes. These changes of upper gastrointestinal tract functions or structure may be attributed to the metabolic derangement, presence of ketonemia and ketoacidosis as well as the electrolyte disturbances

Pulmonary function study in mitral valve disease before and after mitral valve replacement

Lung function studies were performed to forty-one patients with mitral valve disease of different ages and sexes. The main findings were: reduced vital capacity, reduced maximal expiratory flow rates, increased airway resistance, impaired carbon monoxide diffusing capacity and low arterial oxygen tension. The pulmonary functions were studied for eight weeks, six months and one year after successful open heart surgery for mitral valve replacement in sixteen patients. Comparing the results before and after the operation, there were no significant changes

immediate effect of salbutomol on lung function in asthma: the difference in response in different age groups

The immediate effect of salbutamol on forced vital capacity, peak expiratory flow rate, maximal flow rate, airway resistance and intrathoracic gas volume was studied in forty-six asthmatic patients. There was significant increase in the forced vital capacity, peak expiratory flow rate and maximal expiratory flow rates, while there was significant decrease in the airway resistance and intrathoracic gas volume. A remarkable observation on the response to salbutamol in different age groups was seen. Patients up to forty years of age showed high significant increase in the maximal expiratory flow rates [especially V[max]50] in-spite of low significant decrease in the total airway resistance. The patients above forty years showed insignificant change in the maximal expiratory flow rates despite the high significant reduction in their airway resistance. This observation was attributed to the change in the elastic recoil properties of the lung with age and/or long standing asthma. It can also be attributed to irriversible narrowing of the small airways in old patients with long standing asthma

Pulmonary function study in idiopathic pulmonary fibrosis

Lung volumes, capacities, expiratory flow rates, diffusing capacity, airway resistance and arterial blood gases were determined in nineteen patients with clinical and radiological evidences of diffuse idiopathic pulmonary fibrosis. The lung volumes and capacities were found to be reduced. The diffusing capacity for carbon monoxide and arterial blood PaO[2] were also reduced, confirming the clinical and radiological diagnosis of the interstitial fibrosis. The study revealed also increased resistance to air flow in the small airways. The increased airway resistance is consistent with structural changes in the airways that accompany pulmonary fibrosis

Effect of posture on pulmonary ventilation

The effects of posture on pulmonary ventilation were studied in eighteen conscious medical and nursing students. The study was carried out in the standing, sitting, supine, lithotomy, lateral and prone positions using the Vitalograph spirometer. Ventilation was found to be reduced most in the prone position, less in the lithotomy position and least in the lateral position. No significant change was observed in the other positions