Lung lymph flow during volume infusions

We investigated the effect of intravenous isotonic crystalloid solution infusion on lung lymph flow. Tracheobronchial lung lymph vessels were cannulated in 13 anesthetized dogs. The lymph flow rate was measured 1) with the lymph flowing against atmospheric pressure (QL), and 2) with the pressure at the outflow end of the lymph cannula equal to systemic venous pressure (QLV). QL and QLV were measured alternately in each lymph vessel. In one group of nine dogs, the base-line QL and QLV were 18 +/- 9 and 13 +/- 6 (SD) microliter/min, respectively (P less than 0.05). QL increased by 4.8 +/- 1.4-fold, and QLV increased by 3.5 +/- 2.1-fold during a 4-h infusion of 25 ml X kg-1 X h-1 of Ringer solution. QLV was significantly less than QL at all times. The increases in lymph flow were caused primarily by a reduction in the effective resistance of the lymph vessels with little rise in the pressure driving lymph from the lungs. Because QLV flowed against systemic venous pressure, the increase in QLV was blunted by a 3.1 +/- 2.3 cmH2O rise in venous pressure during the infusions. In the remaining four dogs, we infused Ringer solution rapidly in order to raise venous pressure to greater than 15 cmH2O. This caused QL to increase by 25 +/- 7-fold; however, QLV decreased to zero. We conclude that elevations in venous pressure which occur during volume infusions oppose lung lymph flow and lead to accumulation of excess fluid in the lungs.

Maturity of ego defenses in relation to DSM-III axis II personality disorder

Independent raters assessed a cohort of 307 inner-city men on three dimensions of psychosocial dysfunction: the Health-Sickness Rating Scale (HSRS), axis II of DSM-III, and dominant choice of ego mechanisms of defense. Two thirds of the 74 men with personality disorders and three fourths of the 55 men with the low scores (0 to 65) on the HSRS primarily used immature defense mechanisms (ie, projection, schizoid fantasy, passive aggression, dissociation, hypochondriasis, and acting out). Only 10% of men without personality disorders and only 10% of men with HSRS scores of over 70 were noted to favor such defenses.

A validity study of axis II of DSM-III

The authors examine DSM-III personality disorders in a longitudinally followed community sample of middle-aged inner city men. Eighty-six (23%) of the subjects received an axis II diagnosis of personality disorder. Although these men received relatively little psychiatric attention, they were severely impaired in terms of how they felt about themselves, how others saw their global mental health, and their ability to work and to love. When the strong overlap with alcoholism was controlled for, personality disorder was clearly related to adaptive problems that manifested by early adolescence. The evidence suggests that early deficiencies of biology, environmental support, and ego strength contribute to the development of personality disorder.

Suicide attempts associated with akathisia

The authors report two cases of impulsive suicide attempts associated with akathisia. In both cases, suicidal ideation appeared suddenly, concurrent with neuroleptic-induced akathisia, and disappeared when the akathisia was treated.

Effect of cardiac output on extravascular lung water estimates made with the Edwards lung water computer

The Edwards lung water computer system uses the thermal-dye indicator technique to estimate the lung extravascular fluid volume (EVLW). The authors tested the effect of changes in cardiac output (CO) on EVLW estimates made with the lung water computer in six dogs anesthetized with halothane. Baseline CO was 2.5 +/- 1.3 l/min (mean +/- SD); CO subsequently was increased either by 220% or decreased by 70% by either giving 0.5 mg/kg of isoproterenol or increasing the inspired halothane (1-4%), respectively. There was a significant correlation between the estimated EVLW and CO in each animal (P less than 0.05) such that a 50% decrease in CO from baseline caused an approximately 40% increase in estimated EVLW. Postmortem examination showed that the lungs were not edematous, even though the lung water computer data indicated that severe pulmonary edema had developed at reduced COs. At increased COs, estimated EVLW decreased. The authors conclude that the Edwards lung water computer overestimates lung water, possibly because the thermal indicator diffuses into nonpulmonary as well as pulmonary tissue. The overestimate is greatest at low cardiac outputs.

Surfactants identified in lung lymph and their ability to act as abhesives

Phospholipid has been extracted from pulmonary lymph collected from 10 dogs. Thin-layer chromatography was used to identify phosphatidylcholine (PC) 55.6 +/- 2.9%, sphingomyelin 21.3 +/- 1.7%, phosphatidylethanolamine 11.2 +/- 4.9%, and lysophosphatidylcholine 5.9 +/- 0.8%. All extracts proved highly surface active, reducing the surface tension of saline to 27.7 +/- 0.7 dyn/cm upon 80% film compression and increasing the maximum contact angle on glass (theta) from 7 +/- 1 to 47.4 +/- 1.4 degrees. The hydrophobic properties induced on glass were further demonstrated by the ability to cause saline to withdraw and expose a dry surface. A standard adhesion test was used to measure the "tack" produced by the major proteins in lymph. However, when the surface energy of the hydrophilic glass surfaces was reduced by a monolayer of lymph phospholipid extract or an equivalent mixture of synthetic surfactants, the adhesive force was reduced by 79 +/- 4% for albumin and 55 +/- 4% for globulin. As a 0.1% liposomal suspension, PC gave 55% release with albumin. Reversible bonding of the lumen of lymph vessels by the "tacky" proteins present is discussed as a possible factor contributing to the large changes in flow resistance known to occur in the pulmonary lymphatic system.

Effect of lymphatic cannula outflow height on lung microvascular permeability estimations

Estimates of the pulmonary microvascular membrane reflection coefficient (sigma) and permeability-surface area product (PS) are frequently made with the assumption that a percent change in transmicrovascular fluid flux (Jv) will be represented by an equal percent change in the lymph flow rate (QL) from a single cannulated lung lymph vessel. To test this, we measured QL in seven anesthetized dogs with the outflow end of the lymph cannula set at several heights (H) above and below the lung hilus. The left atrial pressure was then elevated to increase Jv, and QL was again measured at several H's. The percent increase in QL at elevated left atrial pressure depended on H. We used the QL data and lymph and plasma protein concentrations to estimate sigma and PS with a modified form of the Kedem and Katchalsky equations. The calculated values varied considerably with H. Our results indicate that changes in Jv are not represented by equal changes in QL. Therefore, techniques for estimating permeability that depend upon QL as an estimate of Jv may lead to erroneous estimates of sigma and PS.

Suicide among schizophrenics. Who is at risk?

Schizophrenic patients are at high risk for suicide. Most of the clinical features of the illness which have been associated with suicide remain speculative. This study provides an empirical test of hypothetical risk factors from the literature. Results indicate that schizophrenic patients who kill themselves have high internalized standards of performance which are often congruent with past educational attainments. They are also realistically aware of the effects of their illness, feel inadequate in relation to their goals, and fear further mental disintegration. Their affect is depressed, and they express hopelessness about the future. Suicidal ideation and explicit suicide threats often precede death. These results can be used to assess suicide risk among schizophrenic patients.

Effect of endotoxin on lung fluid balance in unanesthetized sheep

We used a gravimetric technique to test for increased pulmonary capillary permeability after Escherichia coli endotoxin infusion in unanesthetized sheep. The sheep were chronically prepared with cannulas placed into the left atrium and pulmonary artery 1-2 wk before the experiments. We estimated pulmonary capillary pressure (Pc) as the average of pulmonary arterial and left atrial pressures, and used the modified method of Pierce to estimate the ratio of extravascular fluid weight (EVF) to blood-free dry weight. In 15 sheep we inflated a left atrial balloon to raise Pc to -10.7, 5, 10, or 15 mmHg above plasma oncotic pressure (IIc) for 3 h, then measured EVF. EVF averaged 4.0 +/- 0.2 (base line), 4.3 +/- 0.1, 4.5 +/- 0.1, and 5.1 +/- 0.5 (SD), respectively, for the four levels of Pc - IIc. We gave seven additional sheep 1 microgram/kg of E. coli endotoxin (0127:B8) and measured EVF after 3 h of stable Pc. Endotoxin increased Pc in each sheep. EVF was higher than control for the endotoxin sheep with Pc - IIc greater than -1. This finding is consistent with an increase in pulmonary capillary permeability caused by endotoxin. However, EVF was not elevated in the endotoxin sheep with Pc - IIc less than 1 mmHg. This shows that the increased permeability was insufficient to cause edema unless Pc was elevated. Thus endotoxin may cause edema by two mechanisms, 1) an increase in capillary permeability, and 2) an increase in Pc.

Pulmonary microvascular permeability after coronary arterial ligation in dogs

Recent studies have indicated that pulmonary microvascular permeability may be increased after coronary arterial ligation. We tested this by estimating the pulmonary microvascular reflection coefficient (delta) in six anesthetized control dogs and in six dogs in which we ligated the left anterior descending coronary artery. We cannulated lung lymph vessels and measured the lymph and plasma protein concentrations (CL and CP, respectively). The left atrial pressure was increased to decrease CL to a minimum. We used the minimum CL to estimate delta as 1 -CL/CP. delta for the control [0.70 +/- 0.03 (SD)] and coronary artery ligated groups (0.70 +/- 0.04) were almost identical. This data indicates that coronary artery ligation does not increase pulmonary microvascular permeability.

Relationship between weight gain and lymph flow in dog lungs

Lung weight is a useful indicator of increases in lung extravascular volume. In addition, the lung lymph flow rate (QL) is an important factor in lung fluid balance. We have studied the weight and QL responses to elevations in capillary pressure (Pc) in intact dog lung lower left lobes. We measured lobe weight continuously. We also measured QL from small lymph vessels from the same lobes. The base-line QL was 1.7 +/- 1.5 microliter/min, and the weight was constant. After we increased Pc by 8-20 cmH2O, both weight and QL increased transiently. In most lungs the weight reached a new steady state. When we increased Pc further, weight increased continuously; however, QL reached a plateau. The continuous weight gain was due to edema. These results show that weight and QL respond similarly in nonedematous lungs; however, the weight and QL responses in edematous lungs may be different.

Effect of Escherichia coli endotoxin on dog lung fluid balance

Endotoxin may cause an increase in pulmonary capillary permeability and thus promote edema formation. We used a gravimetric technique to estimate the pulmonary capillary filtration coefficient (KF) and the maximum capillary pressure at which the lung could maintain a constant weight (Pccritical) in dogs after intravenous administration of Escherichia coli (E. coli) endotoxin. KF should be increased and Pccritical should be decreased by an increase in permeability. Four groups of three to four dogs were given 1, 10, 1,000, or 3,000 micrograms/kg of endotoxin. A fifth group of five dogs, which served as controls, was given no endotoxin. KF was significantly (P less than 0.05) greater than control [0.049 +/- 0.031 (SD) ml . min-1 . mmHg-1] in only the 1-micrograms/kg group (0.100 +/- 0.027), indicating a possible increase in permeability. However, changes in capillary surface area may have affected KF. Pccritical was not significantly different from control (20.7 +/- 2.4 mmHg) in any of the E. coli groups. We conclude from these results that E. coli endotoxin may have caused a slight increase in permeability; however, the lung retained its ability to resist edema formation.

Dog lymph flow in increased capillary permeability states

The lung lymph flow rate (QL) is increased in edema caused by an increase in lung microvascular permeability. This increase in QL could be caused by either a decrease in the effective resistance of the lymph vessels (RL), or by an increase in the effective lymph driving pressure (PL), or by a change in both RL and PL. We estimated PL and RL from the linear relationship between QL and the pressure at the outflow end (PO) of five cannulated dog lung lymph vessels (RL = - delta Po/delta QL and PL = the PO at which QL = 0). We increased lung microvascular permeability by giving the dogs 100 mg/kg of alloxan and found that QL increased from 24.5 +/- 8.9 microliters/min to 112 +/- 41 microliters/min (mean +/- SD). RL decreased from 0.35 +/- 0.12 to 0.11 +/- 0.04 cm H2O min/microliters and PL increased from 8.5 +/- 1.5 to 15.9 +/- 2.7 cm H2O. We then increased the capillary pressures from 18.3 +/- 3.8 to 41.3 +/- 7.3 cm H2O and QL increased to 169.9 +/- 47.8 microliters/min. PL increased by an additional 6.3 cm H2O but RL decreased by only an additional 0.02 cm H2O min/microliters. These results show that the QL vs PO relationship is changed in edema secondary to an increase in microvascular permeability, and that this change can be represented as changes in RL and PL. In terms of these parameters, QL increased in edema as a result of a decrease in RL and an increase in PL.

Dealing with suicide on a psychiatric inpatient unit

Suicide on an inpatient unit can cause severe trauma among patients and staff. Consequently both groups may revert to less adaptive coping styles. In general, staff's recovery is gradual and natural and may yield an opportunity for emotional growth; however, prolonged disability may also occur. The authors interviewed 23 staff members who had worked on an inpatient unit during a 16-month period when four patients committed suicide. On the basis of these interviews, the authors have developed a framework for understanding the three phases of staff reaction to suicide and guidelines for helping staff through the recovery process. They recommend that ward administrators monitor and facilitate the group process by providing protection and support during the initial phase of shock, appropriate channels and limits for the intense feelings that occur during the second phase, and constructive forums for more mature coping activities during the third phase, as staff regain their equilibrium.

A feedback system to control blood flow in dog lung lobes

We have developed an electromechanical feedback system to control blood flow to the lower left lung lobe of dogs. Blood flow is measured with an electromagnetic flowmeter. The feedback system compares the blood flow signal to an adjustable reference voltage and causes a motor to turn. The direction of motor rotation depends on the relative magnitude of the flow signal and the reference. The motor pushes the plunger of a syringe that is attached to a balloon in the right pulmonary artery. Inflation of the balloon causes increased blood flow to the lower left lobe. We have used the system to control lobe blood flow in three dogs.

Effect of outflow pressure upon lymph flow from dog lungs

The pulmonary lymph flow rate (QL) should be a function of the lymph vessels' resistance and the pressure gradient along the vessels. We attempted to study how these factors affect lymph flow. We assumed that the lymph system could be represented by a single pressure generated within the lung (PL) and a single resistance (RL). Thus, QL should be a function of the lymph vessel outflow pressure (Po): QL = (PL - Po)/RL. We cannulated tracheobronchial lymph vessels in eight anesthetized dogs and varied Po by raising the outflow end of the cannula. QL decreased linearly when we increased Po. We estimated RL as - delta Po/ delta QL and PL as the extrapolated Po at which QL = 0. At baseline PL = 7.7 +/- 2.7 (SD) cm H2O and RL = 0.36 +/- 0.25 cm H2O. min/microliters. After we increased capillary pressure to produce edema, PL and RL averaged 22.8 +/- 8.8 and 0.14 +/- 0.12, respectively. After we reduced the capillary pressure to baseline in the edematous lungs, PL and RL averaged 11.6 +/- 2.8 and 0.08 +/- 0.09, respectively. All changes in PL and RL were significant (P less than 0.05). These results show that (1) lymph flow rate depends upon lymph vessel outflow pressure, and (2) the QL vs. Po relationship is changed by edema. PL may be equal to the pressure causing lymph to flow and RL may equal the lymph vessel resistance.

Geochronology of Type Uquian (Late Cenozoic) Land Mammal Age, Argentina

Mammal faunas collected from the Uquía Formation at Chucalezna and Esquina Blanca in Jujuy Province, northwest Argentina, are calibrated by potassium-argon age determinations and paleomagnetic polarity data. The sediments range in age from 2.5 million years old to perhaps as young as 1.5 million years, from late Pliocene through early Pleistocene, and correspond in time to late Blancan and early Irvingtonian land mammal age faunas in North America.

First Radioisotope (Potassium-Argon) Age of Marine Neogene Rionegro Beds in Northeastern Patagonia, Argentina

An average age of 9.41 million years was obtained from radioisotope (potassium-argon) age determinations of three glass concentrates of a tuff from the upper part of the marine Rionegrense at Punta Cracker in Golfo Nuevo, Argentina. This age correlates with the Tortonian marine stage of Europe and the Chasicoan Land Mammal Age of South America.

Calibration of the Beginning of the Age of Mammals in Patagonia

Beds of the Rio Chico Formation containing the earliest known land mammals in Patagonia, southern Argentina, were calibrated by potassium-argon age determinations and paleomagnetic polarity data. The Riochican land mammal age encompasses the middle and late Paleocene and corresponds in time with Torrejonian and Tiffanian land mammal faunas in North America.

Errors in calculated oncotic pressure of dog plasma

Several equations to calculate plasma oncotic pressure (pi) from the total protein concentration (C) have been previously described. These equations were derived empirically from samples with a wide range of C obtained by diluting or concentrating normal plasma samples. To test these equations over a range of naturally occurring C, we measured C and pi of plasma samples from 40 dogs. C ranged from 5.3 to 8.7 g/dl and averaged 6.5 +/- 0.1 (mean +/- SE) and pi averaged 17.9 +/- 0.3 mmHg. The regression equation was pi = 78.14 + 1.67 C (r = 0.74). pi increased with C much less than predicted with the commonly used equations. The albumin-to-globulin concentration ratios (A/G), determined in 27 of the dogs, decreased with increasing C (A/G = 1.56-0.128 C, r = 0.62). The lower A/G at the higher C's could cause the lower than predicted increase in pi with C, because the equations were developed from data in which A/G was constant.

Effect of histamine and alloxan on canine pulmonary vascular permeability

We estimated the pulmonary capillary membrane filtration coefficient (Kf) and the maximum capillary pressure (PCcritical) at which the lung could maintain a constant weight in 1) 5 control experiments in anesthetized open-chested dogs, 2) 7 experiments in which the dogs were given 3.6-8.3 microgram . kg-1 . min-1 of histamine phosphate, and 3) in 6 experiments after 75-100 mg/kg of alloxan. In additional experiments, pulmonary lymph flow (QL) and protein concentration (CL) were measured during the infusion of histamine and alloxan. After histamine, Kf averaged 0.045 +/- 0,008 ml . min-1mmHg-1 (SE) and PCcritical was 22.1 +/- 1.1 mmHg. These values were not significantly different from the control Kf and PCcritical (0.036 +/- 0.006 and 22.5 +/- 2.3, respectively). After alloxan, Kf (1.43 +/- 0.69) was larger and PCcritical (12.4 +/- 1.3) was significantly less than control (P less than 0.05). Histamine caused no significant change in QL or CL; however, both were increased after alloxan. These results show that Kf, PCcritical, QL, and CL are all changed by an increase in capillary membrane permeability caused by alloxan. Because none of these factors as significantly affected by histamine, dog lung capillary membrane permeability may not be affected by histamine.