PULMONOLOGY

CORRELATION OF PLASMA ZINC AND CLINICAL STATUS IN CHI1DNIC RESPIRATORY ACIDCGIS D3ES NOT EFFECT PsC02 t 1741 PATIENTS WITH CYSTIC FIBROSIS. Jane D. Carver, James 1744 ESTIMATI~OF P co won J. e,(Span. by ~ary M. Sherman (Spon. by Barness) College of Medicine, Ellen Wohl) . ~e$ar&ri ~ewbornmdicine, Brigham Univ. of So. Florida, Oept. of Pedatrics, Tampa, FL & Warren's Hospital and Division of Respiratory Diseases, Plasma zinc levels have been variably reported as low or nor- Children's Hospital, Boston, MA. mal in patients with cystic fibrosis (CF). Zinc is a co-factor To determine whether Phonic respiratory acidosis effects for more than 60 enzymes including the A6 desaturase enzyme, and the accuracy of transcutaneous estimation (P C02) of P C02, 27 may be required for the mobilization and transport of vitamin A, paired masur-nts were obtained from 21 su8jects wig Cystic reported to be low in patients with CF. Zinc is also important Fibrosis (CF) and 4 subjects with other chronic lung diseases. in immune function. For these reasons, zinc is a potentially 8 subjects with CF were chronically hypercarbic PC02 (man+sd)= important mineral in patients with CF. We measured zinc and vit- 55.6 torr+8.4, mean pH =7.40. ~ge(mean+sd) was 25 yr.+9.9 and amin A levels in 25 patients with CF (ages 5-29) and compared 20k8.3 fo: hyper- and %nn>carbic subjeccs respectively; age them to controls. CF patients have significantly lower plasma range: 10-44 yr. Blccd was obtained under local anesthesia zinc, 70.12 + 2.66 and vitamin A, 30.13 f 1.51, than do controls frm the radial artery, iced, and analyzed within 4 hour. P C02 (94.11 2 3.21 and 47.85 f 4.41, respectively, p10.001, p<0.001). was measured at 45O using a prototype 02/C02 combined sen& Plasma zinc but not vitamin A levels corresponded to the degree (Severinghaus/Radimter) with corrections made for temperature of pulmonary involvement (normal or mildly affected 78.72 + 4.34, and mtabolic effects. PsCO2/P,CO2 (meaesd) was 0.98+0.03 moderately to severely affected 63.65 ? 1.89, p<0.001), but not and 1.03N. 04 for normo- and hypercarbic subjects. Linear to the presence of pancreatic insufficiency. Six patients were regression of P CO on P CO - P CO : = 1.05 P C02 - 2.27, supplemented with zinc gluconate for 6 weeks with 3 mg/kg/day. (Syx-1.58, ~xx=2175.41).a "ging &e$e data, es%nFtces of P C02 Plasma zinc levels rose signficantly, although there was no ob- (P=CO,) from a new P-CO, measurement may be made. (See Tabye). vious change observed in their clinical status. Plasma copper levels, which have a reciprocal relationship with plasma zinc, decreased significantly but remained within the normal range. A longer period of supplementation may be required to bring about a change in clinical status. Previous conflicting reports of 30 30.7 Tl.0 zinc status in CF may reflect heterogeneity of pulmonary invol- Chronic respiratory acidosis has clinically important vement between groups of patients studied. m effect on PsCOZ estimation of PaC02.

TREATMENT OF AIDS ASSOCIATED LYMPHOID INTERSTITIAL THE HYPERCARBIC VENTILATORY RESPONSE TEST: NEAR- PNEuMoNITIs WITH INTRAVENOUS GAwGLoBuLIN AND 1745 MISS SIDS, SIBLINGS OF SIDS, AND SUBSEQUENTAPNEA. 1742 PREDNISONE. Morris Charytan, Ben Zion Krieger, Michael Coleman, Christine A. Reardon, Mark C. Mam- Andrew Wiznia, Larry Bernstein, Bernard Silverman, and mel, Stephen J. Boros, Children's Hospital, St. Paul, MN Arye Rubinstein, Albert Einstein College of Medicine, Department Hypercarbi c ventilatory response (HVR) tests were administered of Pediatrics, Microbiology and Immunology, Bronx, New York. to 65 near-miss SIDS victims, 78 siblings of SIDS victims, and 31 6 children with Acquired Immunodeficiency Syndrome and controls. HVR values were compared, then correlated with the in- biopsy proven lymphoid interstitial pneumonitis were treated on cidence of subsequent apnea. HVR tests used a steady-state, a protocol of intravenous gammaglobulin and corticosteroids. breath-by-breath technique. HVR results were expressed as Indications for therapy were a clinical history of severe and/or changes in exhaled minute volume per change in PACO (ml/min/kg/ recurrent episodes of respiratory distress responsive to mnHg PACO ). Twenty-three near-miss SIDS victims (35%) had sub- intravenous antibiotics and hypoxemia persisting after sequent ainea; one died of SIDS. Seven siblings of SIDS victims resolution of the acute illness. Hypoxemia was defined as a (9%) eventually developed apnea; two died of SIDS. HVR values p02C70 torr on three determinations. Therapy consisted of an were similar in the three patient groups. HVR values were not initial period of loading with intravenous gammaglobulin. different from controls in either those infants with previous Duration and dosage of loading varied with the severity of the apnea or those who developed subsequent apnea. Surprisingly, clinical circumstances. Corticosteroids were then initiated resting PACO values were lower in the mear-miss group (P 1.05). at 1-2 mg/kg/day and tapered to 0.75-l.Omg/kg on alternate When all infgnts who developed subsequent apnea (both near-miss days within 6-8 weeks. Prior to therapy the mean alveolar- and siblings) were compared to all those who did not, those with arterial oxygen gradient (AaD02) was 47 torr and the mean pO2 subsequent apnea also had lower PAC02 values (P 10.001) along was 52 torr. After one month of therapy the mean AaD02 was 21 with higher HVR values (P c.05). torr and pOg was 80 torr. At three months follow-up AaD02 was Conclusions: 1) HVR values were not depressed in near-miss 15 torr and p02 79 torr. In the two patients treated for SIDS or siblings of SIDS victims; 2) Resting PAC02 values were twelve months, AaD02 and pOg remained stable at 16 torr and lower in near-miss SIDS victims; 3) Infants who developed sub- 89 torr respectively. In vitro immunologic responses were not sequent apnea had higher HVR values and lower PAC02 values than suppressed by the alternate day corticosteroid treatment. those who did not.

MECONIUM FREE FATTY ACIDS INDUCE ALVEOLAR COLLAPSE. MORPHOMETRY OF OLIGOHYDRAMNIOS-INDUCED FETAL LUNG 1743 David A. Clark, Gary F. Nelman, Jeffrey E. Thompson, HYPOPLASIA. Mar aret H. Collins, Adrien Moessin er, Andy M. Paskanik, John E. Rokahr, Carl E.Brendenberg Jerome Kleinermz, William Blanc. Coll. of P &8S, Departments of Pediatric and Surgery, Upstate Med. Ctr.Syracuse, Columbia Univ., Presb. Med. Ctr., Depts. Path. & Pediatr.; N.Y., Neonatal ICU, Westchester Co. Med. Ctr., NYMC, Valhalla, Mt. Sinai Sch. Med., Dept. Path., ~ewYork. N.Y..(Spons. by Harry S. Dweck). In fetal guinea pigs oligohydramnios (OH) causes lung hypo- Free fatty acids of meconium alter surface tension of lung ex- plasia which is more severe the earlier the onset and the longer tract in vitro. We examined meconium and its primary free fatty the duration of OH (Ped. Res. 1833368, 1984). We have quanti- acids (oleic, palmitic, stearic) instilled in vivo into the tated the structural alterations in the lungs of fetal guinea trachea of 15 experimental and 8 control mongrel. dogs who were pigs subjected to OH from 45 to 50 days gestation (term 67 days). anesthetized, placed on a piston ventilator and subjected to a OH fetuses (n=5) compared to littermate controls (n=4) have: left thoracotomy. The lungs were lavaged with meconium alone, a ---OH Control P petroleum ether extract of meconium, or a suspension of free Lung/Body Weight Ratio (~lo-') 2.8 3.2 c.006 fatty acids in saline. Cardiac output, venous and arterial b1.ood Lung Volume (ml) 1.17 1.34 c.04 gases and femoral, pulmonary and ].eft atrial. pressures were Volume Density Parenchyma .83 .90 1.025 monitored for two hours. Static lung compliance was calculated. Total Number of Saccules ~10~)46 69 >.05 Mean airway pressure increased and static lung compliance de- Internal Surface Area (cm1 ) 698 974 c.04 creased in both meconium and meconium extract groups. (p<.05). Total Length Parenchymal P 0, decreased significantly (p<.01) without recovery to the Elastic Tissue (M) 504 974 C.0025 bzseline in all experimental groups. There were no changes in pH Length Elastic Tissue (~/mm~) .51 .81 c.025 P 0, or any hemodynamic parameter. The dogs were sacrificed and tte surface tension of lung extract was measured in a Wilhelmy Even a brief period of OH during the late canalicular-early balance. Although atelectesis and copious airway foam were seen, saccular phases of lung development is sufficient to markedly the surface tenslon minimum of crude lung extract and airway reduce fetal lung growth and to cause profound structural foam was less than 10 dynes per centimeter. We conclude on the changes. The disproportionate effect of OH on elastic tissue may basis of the signifrcant changes in Lung compliance, increased be related to the fact that this tissue first appears in the airway pressure and decreased P 0, that the free fatty acids of parenchyma of the fetal guinea pig lung on day 45; this adverse meconium may induce alveolar co7lapse by displacing surfactant effect might impede the ability of the lung to recover and could from the alveolus. have long term sequelae.