By Jonathan R. Webb MB, MRCP (auth.), Jonathan R. Webb MB, MRCP (eds.)
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Extra resources for Assessment of a Patient with Lung Disease
3 kPa (100 mm Hg), even though oxygen requirements vary from as much as two to three litres/min during strenuous exercise to as little as 100 ml/min during sleep. Alterations in respiration are reflected in changes of the Pao2 and Pac02 and fall into four main categories. These categories are partially interdependent and pulmonary or other disease may well lead to abnormal blood gases by one or more of the following: 1. Change in alveolar ventilation. 2. Venous to arterial shunting. 3. Impaired diffusion.
I I Pepsin cleavage ............... I I ~ I I I I StS I Papain cleavage --------+--- Light chain I ~ Fe sts r I I I I Fd I I I I •I I• B A I • Fab I I I •• •• I B Plate 6. Immunoglobulin structure (after Porter). Papain cleava~e (dashed line) produces two Fab portions and one Fe portion. Pepsin cleavage (dotted line) produces F(ab')X. Disulphide bond reaction produces two light and two heavy chains. The amino acid sequences at the NH. terminal (dotted) ends of the chains are variable and form the region carrying specific combining sites.
The ratio may even be high as the FEV1 is relatively well maintained because of the increase in elastic recoil. The transfer factor and Kco are reduced for complex reasons. Loss of surface area of alveoli, impairment of ventilation perfusion ratios and, to a lesser extent, an increase in resistance to diffusion across I "I Plate 1. Sputum. Gram positive cocci from a case of pneumococcal pneumonia. Plate 2. Sputum. Gram negative cocco-bacilli (Haemophilus influenzae) from a patient with an acute exacerbation of chronic bronchitis.