4-Nitro-2-phenoxy-aniline.

In the title compound, C(12)H(10)N(2)O(3), the oxygen atom bridging the two aromatic rings is in a synperiplanar (+sp) conformation. The dihedral angle between the aromatic rings is 71.40 (12)°. In the crystal, mol-ecules are linked by inter-molecular N-H⋯O hydrogen bonds.

Early adipocere formation: a case report and review of literature.

Adipocere has a long history of frightening and fascinating mankind, from so called "incorruptible saints" to the famous "iceman" and its formation on human remains has long been known and feared. Adipocere formation replaces the putrefactive changes, when the body lies buried in shallow, moist, clay, soiled grave or it is thrown into cess pools or submerged in water. As the progression of putrefaction is arrested, the facial features and wounds are preserved without much alteration, thereby aiding the identification and to certain extent, the cause of death. The time required for the formation of adipocere is a subject of controversy. Here we present a case of early adipocere formation within 3 days and the review of literature pertaining to it.

Sudden death due to pulmonary aspergillosis.

Sudden death due to respiratory pathology is not uncommon and tuberculosis with its complications is well known to cause death. We report a case of a male, train passenger, who started coughing out blood and died on reaching the hospital. Medicolegal autopsy confirmed the sudden unexpected death to be due to pulmonary aspergillosis in the person with past medical history of tuberculosis.

Skeletal asymmetry.

Bilateral variations in dimensions of upper and lower limb bones are attributable to difference in mechanical stress and strain that the bones are subjected to during bone growth, and is referred to as directional asymmetry. This skeletal asymmetry in the upper limbs is usually prominent on the dominant side while in lower limbs on the other side, possibly due to supportive contra lateral muscle contractions, that influence the bone growth. This contra lateral dominance in upper and lower limbs is known as cross-symmetry pattern. During skeletal remains examination, variations in different dimensions of long bones of an individual can result in erroneous opinion regarding number of individuals, especially in case of mass disasters. A case report of skeletal remains examination with review of relevant literature is presented where the different dimensions of right and left limb elements are measured and compared.

Circulatory response to repeated exercise in patients with chronic lung disease.

The pulmonary and systemic circulatory response to repeated exercise has been studied in 24 patients with chronic lung disease, mainly chronic bronchitis. The exercise consisted of supine bicycling at a constant low load (from loadless pedalling to 30 W) for 10 min with a 20 min rest period between exercises. Cardiac output was similar during the first (E1) and the second (E2) exercise periods, as well as pulmonary vascular resistance. Systemic arterial pressure, however, was lower during E2 than during E1, and this difference was significantly correlated with lung function (VC% predicted, FEV1 and FEV1% predicted) and blood gases at rest and during exercise. The patients with PaO2 below 65 mm Hg showed a larger increase in systemic arterial pressure during E1 and a smaller increase during E2 than the others. The larger increase might be due to a vasoconstrictor effect of hypoxemia and/or of the functional residual capacity increase observed in such patients with exercise. Whatever the mechanism involved, these results show that the systemic circulation is modified in patients with chronic lung disease. Results after some intervention have to be interpreted with caution if the protocol includes two exercise periods.

Variability of the pulmonary vascular response to acute hypoxia in chronic bronchitis.

Hypoxic pulmonary vasoconstriction is considered as one of the factors leading to pulmonary hypertension in patients with chronic bronchitis, but the magnitude and the variability of the pulmonary vascular response to hypoxia in these patients have not been well established. We investigated the pulmonary hemodynamic changes induced by breathing two hypoxic mixtures (FIO2 = 0.15 and 0.13) in 26 patients with chronic bronchitis with airway obstruction (FEV1/VC = 49 +/- 14 percent). Results show that there is a wide variability of the pulmonary vascular response to acute hypoxia in chronic bronchitis patients, but it is not possible to say whether such differences play a role in the natural history of the disease.

Haematological and hormonal responses to dynamic exercise in patients with chronic airway obstruction.

The influence of exercise on hormonal and total white blood cells (WBC), lymphocytes (L). Granulocytes (GR), and platelet (P) count responses was studied in: twenty-five patients with chronic airway obstruction (CAO, 47 +/- 1.8 years, mean +/- SEM) and thirteen normal subjects (N, 36 +/- 2.6 years). They performed a submaximal (40 W) and a maximal exercise (VO2max). Arterial blood samples were taken at rest, 40 W, and VO2max. [H+], PaCO2, PaO2 haematocrit (Hct), [Hb], P, total platelet volume (TPV), WBC, GR, L, and total red blood cells (RBC) were measured. At rest, WBC, GR, P and TPV were higher in CAO patients, whilst PaO2 and cortisol were lower. At 40 W, when compared to values obtained at rest, WBC, GR, L, P and TPV were increased in both groups; WBC, GR, P and TPV were higher in CAO patients. VO2max of CAO patients represented 54% of that of controls. At VO2max, Hct, [Hb] and RBC were approximately 10% higher than at rest in both groups, whilst changes were more significant in normals for WBC (CAO = 55%, N = 76%), lymphocytes (CAO = 83%, N = 105%), GR, (CAO = 37%; N = 51%), platelets (CAO = 23%, N = 29%), TPV (CAO = 25.4%, N = 35%), [H+] (CAO = 43%, N = 38%) and ACTH (CAO = 82%, N = 139%). PaO2 and cortisol did not differ between groups. PaCO2 and platelets however, were higher in the CAO group.(ABSTRACT TRUNCATED AT 250 WORDS)

Leukocyte, lymphocyte and platelet response to dynamic exercise. Duration or intensity effect?

The influence of work intensity and duration on the white blood cell (WBC), lymphocyte (L) and platelet (P) count response to exercise was studied in 16 trained subjects (22 +/- 5.4 years, means +/- SD). They performed three cyclo-ergospirometric protocols: A) 10 min at 150 W followed by a progressive test (30 W/3 min) till exhaustion; B) constant maximal work (VO2max); C) a 45 min Square-Wave Endurance Exercise Test (SWEET), (n = 5). Arterial blood samples were taken: at rest, submaximal and maximal exercise in A; maximal exercise in B; 15th, 30th and 45th min in the SWEET. Lactate, [H+], PaCO2, PaO2, [Hct], Hb, cortisol, ACTH, total platelet volume (TPV), total blood red cell (RBC), WBC, L and P were measured. At 150 W, WBC, L, P, and TPV increased. VO2max did not differ between A and B, but a difference was found in total exercise time (A = 25 +/- 3 min; B = 7 +/- 2 min, p less than 0.001). In A, at VO2max, the increase was very small for Hct, [Hb], and RBC (10%), in contrast with large changes for WBC (+93%), L (+137%), P (+32%), TPV (+35%), [H+] (+39%), lactate (+715%), and ACTH (+95%). At VO2max there were no differences in these variables between A and B. During the SWEET: WBC, L, P, TPV and ACTH increased at the 15th min as much as in VO2max, but no difference was observed between the 15th, 30th and 45th min, except for ACTH which continued to rise; the lactate increase during the SWEET was about half (+341%) the value observed at VO2max, and [H+] did not vary with respect to values at rest.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypercapnia during maximal exercise in patients with chronic airflow obstruction.

The pattern of breathing during maximal oxygen uptake (Vo2max) was studied in 26 patients with chronic airflow obstruction (CAO), in whom the vital capacity (VC), forced expiratory volume in 1 s (FEV1) and residual volume (RV) were measured. The patients performed, on a cycle ergometer, in a sitting position, a submaximal (A) and a maximal (B) exercise in a single session during which three arterial blood samples (pH, PaCO2, PaO2, lactate) were taken: the first at rest, the second at the 10th min of steady-state 40 W exercise, and the third at maximal VO2. VE, VCO2, VO2, respiratory rate (RR) and VT were measured with an open circuit. Physiological dead space (VD) and alveolar to arterial O2 pressure differences (A-aPO2) were computed. According to the measured value of PaCO2 at maximal exercise, the patients were divided in non-hypercapnic (NH; PaCO2 less than 44 mmHg; n = 17) and hypercapnic (H; PaCO2 greater than 44 mmHg; n = 9) groups, and were compared with a group of normal subjects (N; n = 11). At rest, VC, FEV1, FEV1/VC ratio, TLC and PaO2 were more decreased in H than in NH patients. However, RV, VE, RR and VT did not differ between H and NH patients. PaCO2 at rest was comparable in N and H subjects but was significantly lower in NH patients. During B exercise, VE, VO2 and PaO2 were lower in H patients. With both A and B exercises, the H patients showed a lower VT and VT/VC ratio with a higher VD/VT ratio, while A-aPO2 were the same in NH and H patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Maximal ventilation at rest and exercise in patients with chronic pulmonary disease.

74 subjects of different ages: normal children, 19 boys (A) and 7 girls (C) aged between 11 and 15 years; asthmatic boys (n = 7, group B) and girls (n = 7, group D), with similar ages; normal male adult subjects (n = 10, group E) and pulmonary patients with restrictive (n = 8, group G) or obstructive (n = 16, group F) ventilatory impairment, were submitted to measurements of vital capacity (VC), forced expiratory volume in 1 s, (FEV1), maximal voluntary ventilation (MVV), maximal peak expiratory (PEF) and inspiratory (PIF) flows at rest, and two maximal exercise stress tests in which the ventilation at maximal exercise (MEV) were retained. Indirect MVV was obtained by multiplying the FEV1 by 35 and 37.5. The correlation coefficients between MVV and VC, FEV1, PEF and PIF were always as high as r greater than 0.76. (p less than 0.001), with a discrepancy between the calculated and measured MVV. The average ratio MVV/FEV1 always exceeds 39 and is much higher in groups B, C and G. The mean percent values of the ratio MEV/MVV were 0.63 in normal men and 0.74 in normal boys. In patients, this ratio is higher than in adult normals: F = 0.81 and G = 0.88, and is not due to methodological errors, but seems to correspond to several physiological features playing only a role during exercise (MEV). This work shows the difficulty in predicting correctly the MVV at rest and in assessing the ventilatory reserve during maximal exercise in chronic pulmonary patients.

Oxygen uptake at maximal exercises in chronic airflow obstruction.

In order to gain a better understanding of maximal oxygen uptake in patients with chronic airflow obstruction, we compared the results of three different cyclo-ergospirometric protocols: progressive (30 W/3 min), constant and trapezoidal (10 min of 40 W + 30 W/3 min), in 26 male chronic bronchitis from 30 to 65 years of age. Eleven normal subjects of similar ages served as a control group. VE, VCO2, VO2, respiratory rate (RR) and VT were measured with an open circuit. The electrocardiogram was continuously monitored. Arterial lactate was measured at the end of the trapezoidal test in 20 patients. There were excellent correlations between the individual values of VO2 during the three maximal exercises and a low coefficient of variation of the differences between each paired measurement. There was great variability in VO2 between individuals, with values ranging from 14.7 to 46.2 ml X kg-1 X min-1 (control group : 29.5 to 54.4 ml X kg-1). A "levelling-off" in VO2 was observed in 22 patients who carried out, for 1 or 2 min, the exercise level immediately above the last step maintained for the full 3 min of the progressive test, i.e. the increase in VO2 was smaller than the average one for the preceding levels. In 14 patients, VO2 max was obtained as evidenced by the following criteria : heart rate = 220- age, respiratory quotient greater than 1.1 and arterial lactate greater than 7 mmol X l-1. In the remaining 12 patients, all these criteria were not achieved. After the progressive test, 61% of the patients said they could have performed better. However, in the subsequent maximal tests, these patients reached the same maximal VO2 values. All patients complained of pain in the legs at the end of the exercises, but only 8 of the 26 complained of breathlessness.(ABSTRACT TRUNCATED AT 250 WORDS)