Document 44MEwxzQ6pLO8mRRd9bKEjaop

610 INDUSTRIAL HYGIENE AND OCCUPATIONAL MEDICINE of arterial blood (table 2) showed an appreciable increase in oxygen partial pressure and oxygen saturation and a slight fall in alveolar-arterial oxygen difference. Two months after the course of ACTH treatment the patient was readmitted and died within 24 hours, apparently of rapidly progressive heart failure. Postmortem 11 examination revealed extensive and severe fibrotic changes in the lungs, with emphysematous blebs. In Table 3 (case 4).--Data Concerning Pulmonary Function of Patient L. H. as Studied by Bruce and Associates12 in 1948 Vital capacity, L........................................................................................ Residual volume, L.................................................................................... Respiratory dead space, L.,................................................................. Alveolar ventilation,' L./min.................................................................. Arterial pOa, mm. He........................................................................ Arterial PCO2, mm. He.................................................................................. Alveolar-arterial difference ........................................................................... Mean pulmonary artery pressure, mm. Hg...................................... 2.09 1.97 0.189 5.49 42 47 23.5 68 Table 4 (case 4).--Results of Studies oj Pulmonary Function Patient L. H., man Age, 28 yr. Height, 173 cm. Weight, 62.2 Kg. Body surface area, 1.74 M.2 All respiratory volumes, BTPS Minute volume, L./min............ ................. .................... ........ ......... Respiratory rate, resp./min...................................................... ......... Tidal volume, L........................................................................... Inspiratory reserve volume, L.............................................. ......... Expiratory reserve volume, L...,......................................... Vital capacity, L..................................... ............................. -.. Expected vital capacity, L..................................................... Residual volume, L.................................................................... Residual volume -4- total volume, %.................................. ......... Alveolar ventilation, L./min.................................................. ......... Respiratory dead space, L..................................................... ......... Maximum breathing capacity, L./min................................ ......... Expected maximum breathing capacity, L./min............ ......... Total capacity, L........................................................................ Aug. 23, 1950 11.12 24 1.27 55.3 5.67 0.22 94 125 Alveolar pOz, mm. Hg......................................................:... Arterial PO2, mm. Hg............................................. ................. Arterial pOOa, mm. Hg........................................................... Alveolar-arterial difference, mm. Hg................................ . ......... Serum CO2, vol. %................................................................... 49 Arterial blood CO2 content, vol. %................................... ......... Arterial blood O2 content, vol. %...................................... ......... Arterial blood O2 capacity, vol. %...................................... ......... Arterial blood 62 saturation, %......................................... ' 43A8' 20.41 22.12 Diagnosis: Pulmonary granulomatosis of beryllium worker Sept. 6, 1950 15.40 23 0.67 1.59 0.28 2.54 4.24 3.48 58.0 7.14 0.36 104 125 6.02 Jan. 22, 1951 10,16 20 0.51 1.58 0.56 2.65 4.24 2.02 43.3 6.94 0.21 80 . 125 4.67 March 5, 1951 10.35 25 0.415 1.76 0.616 2.80 .4.24 2.74 50.0 5.24 0.197 100 125 5.54 120 72 34 48 7.47 20.43 21.94 92.0 122 80 29 42 47.13 7.47 38.43 21.10 21.43 97.3 110 86 36 24 51.29 7.41 42.04 20.35 21.42 94.0 I. -,Therapy: ACTH 8/25/50--25 mg./day; .8/26/50-9/4/50--100 mg./day: 9/5/50--50. mg./day. Eosinophil count: 0-17/mm.2 II. Therapy: ACTH 2/16/51-2/27/51--100 mg./day. Eosinophil count: 162/mm.3 before ACTH; 0/mm.3 during ACTH. .......................... 17-Ketosterolds excretion: 8.9-6.3 mg./24 hr. some areas the only recognizable tissue was bronchial or bronchiolar epithelium, the alveoli and alveolar septums having been completely replaced by fibrotic tissue. There were atheromatous plaques in the pulmonary artery. The myocardium showed peculiar granulomatous changes with giant cells, lymphocytes, monocytes and fibrous tissue. The lesion was sarcoid-like but was not typical of sarcoid. 11. Reported through the courtesy of the: Department of Pathology, Peter Bent Brigham Hospital.