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Anatomical backgrounds on gas exchange parameters in the lung

World Journal of Respirology 2019年第2期9卷 8-29页

作者： Kazuhiro Yamaguchi Takao Tsuji Kazutetsu Aoshiba Hiroyuki Nakamura Shinji Abe Department of Respiratory Medicine Tokyo Medical University Department of Respiratory Medicine Tokyo Medical University Ibaraki Medical Center

Many problems regarding structure-function relationships have remained unsolved in the field of respiratory physiology. In the present review, we highlighted these uncertain issues from a variety of anatomical and physiological viewpoints. Model A of Weibel in which dichotomously branching airways are incorporated should be used for analyzing gas mixing in conducting and acinar airways. Acinus of Loeschcke is taken as an anatomical gas-exchange *** it is difficult to define functional gas-exchange unit in a way entirely consistent with anatomical structures, acinus of aschoff may serve as a functional gas-exchange unit in a first approximation. Based on anatomical and physiological perspectives, the multiple inert-gas elimination technique is thought to be highly effective for predicting ventilation-perfusion heterogeneity between acini of aschoff under steady-state condition. Changes in effective alveolar P_(O2), the most important parameter in classical gas-exchange theory, are coherent with those in mixed alveolar P_(O2) decided from the multiple inert-gas elimination technique. Therefore, effective alveolar-arterial P_(O2) difference is considered useful for assessing gas-exchange abnormalities in lung ***, one should be aware that although alveolar-arterial P_(O2) difference sensitively detects moderately low ventilation-perfusion regions causing hypoxemia, it is insensitive to abnormal gas exchange evoked by very low and high ventilation-perfusion regions. Pulmonary diffusing capacity for CO (D_(LCO))and the value corrected for alveolar volume (V_(AV)), i.e., D_(LCO)/V_(AV) (K_(CO)), are thought to be crucial for diagnosing alveolar-wall damages. D_(LCO)-related parameters have higher sensitivity to detecting abnormalities in pulmonary microcirculation than those in the alveolocapillary membrane. We would like to recommend four categories derived from combining behaviors of D_(LCO) with those of K_(CO) for differential diagnosis on anat

关键词： Secondary lobule of miller Acinus of Loeschcke Acinus of aschoff Convection Gas-phase diffusion(stratification) Aqueous-phase diffusion Ventilationperfusion heterogeneity

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Severe mitral annular calcifi cation in rheumatic heart disease:A rare presentation

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World Journal of Cardiology 2012年第3期4卷 87-89页

作者： Rajesh Vijayvergiya Kim Vaiphei Sandeep S Rana Department of Cardiology Post Graduate Institute of Medical Education and Research Department of Histopathology Post Graduate Institute of Medical Education and Research Department of Cardio-thoracic Surgery Post Graduate Institute of Medical Education and Research

Severe mitral annular calcification(MAC)is frequently seen in patients with advanced age and chronic kidney disease,but it is rare in rheumatic heart disease(RHD).We hereby report a case of 45-year-old female with chronic RHD,who had severe MAC and mitral *** revealed a "crown"-like severe calcification of the mitral *** of the heart revealed a calcified posterior mitral annulus,fused commissures,and calcified nodules at the atrial aspect of the mitral valve.

关键词： Mitral annular calcif ication Rheumatic heart disease Mitral regurgitation Autopsy aschoff nodule

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