Using preset diagnostic criteria, the etiology of each pleural effusion was determined, and the best discriminating level of the serum-effusion albumin gradient between transudates and exudates was established. Materials and Methods The subjects were adult consecutive inpatients from the general medicine service or intensive care unit at Nladigan Army Medical Center who had a diagnostic…
Distinguishing an exudate from a transudate is the cornerstone of the evaluation of pleural effusions. The criteria proposed by Light et al in 1972 have become the standard method of making this distinction. These criteria were retrospectively designed to be close to 100 percent sensitive in identifying exudates, since these effusions imply pleural pathology that…
Because of this, the lack of correlation between lactate concentration and VE does not exclude the possibility that excessive lactate production may be associated with increased ventilatory requirement in some patients. Premature muscle lactic acidosis may also be involved in exercise intolerance in COPD, impairing muscle contractility and contributing to muscle fatigue .
From this discussion, it can be hypothesized that the deterioration in functional status from normal subjects to class D patients may be associated with a gradual reduction in the level of daily activity and consequently in peripheral skeletal muscle oxidative capacity . This, in turn, could account for the increase in La/VO2 steepness that occurred…
Exercise intolerance is one of the most devastating consequences of COPD. This has been traditionally attributed to dyspnea and to limitation in ventilation and in gas exchange. Recently, Jones and Killian have shown that for a given level of airflow obstruction, exercise tolerance varies markedly among individuals . Although we found a significant decline in…
Although inappropriately low oxygen delivery, due to exercise-induced right ventricular dysfunction, impaired left ventricular function and/or oxygen desaturation, may have modified the increase in arterial lactic acid in patients, we do not think that these factors played a predominant role. The end-exercise oxygen saturation was similar among the different classes of patients, while the increase…
Finally, a decrease in lactate degradation has also been reported to influence the increase in blood lactate during exercise . Several factors may have contributed to the greater exercise-induced increase in blood lactate observed in COPD patients. However, several lines of evidence suggest that abnormal lactate kinetics in patients are related to poor skeletal muscle…
In this study, the relationship between the arterial lactate concentration and VO2 during exercise was obtained in a large group of COPD patients with a wide range of functional status and compared with that of normal subjects of similar age. We found that the increase in lactate was abnormally high in the majority (70%) of…
Group mean values for resting and exercise arterial plasma lactate concentration, and for parameters a and b are shown in Table 3. Resting lactate concentrations were similar in normal subjects and patients. Although lactate concentration increased significantly with exercise for each subgroup, the peak lactate concentration achieved was progressively smaller as the functional status worsened.
The individual values for b are shown in Figure 1. Parameter b was considerably greater in COPD patients compared with normal subjects (4.49±1.72 versus 2.66±0.47, respectively, P<0.005). As indicated by the dotted line, in 30 of 46 patients, parameter b was greater than the upper value obtained in the normal group.
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