The
Mid-Maximum
A Simplified
M.
MORI,
M.D.,
Flow
Method
Expiratory
J.
F.C.C.P,,**
of
HE
DETERMINATION
imum
flow
from
the
forced
spirometric
OF
rate
expiratory
tracing
THE
CANTO,
M.D.j’
of
volume
(FEV)
calibrated
in
*Supported
time
in
part
Auxiliary,
Grant
the Department
The
writing
in-
dle
of
recording
(abscissa)
by
the
Mount
64-1,
and
of Health,
ap-
the
paper
and
volume
Sinai
Women’s
Grant
Education,
25-14A.65
and
**Trainee,
tMedical
American
Trainee,
ftDirector,
College
Mount
Cardio-Pulmonary
FIGURE
maximum
1:
rate
tedious
one
considerably
cent)
Wel-
by
applied
be
applying
a
same
other
midcurve.
as
can
This
to
the
FEV
calculations
E.
Collins,
flMcKesson
Appliance
Medical
Inc.,
Co.,
Instrument
outshort-
simple
technique
expiratory
expiratory
volume
Braintree,
Toledo,
Co.,
t3
forced
from
of the
of
accuunit.
trac-
ings.i4,
Mount
of
the
manufacturers
principle.
ti
representation
reproduces
of
chore
ened
be
paper
per
by
§Jones
Diagrammatic
flow
F.C.C.P.ff
is calculated
(50
lined
can
of
Hospital.
to
M.D.,
characteristics
MMFR
half
Warren
setts.
of Cardiology.
Sinai
Hospital.
Department,
Forced
GRISMER,
geometric
fare.
Sinai,
the
The
manufacturer
graphic
the
which
rately
strument.
Usually,
the
paratus
supplies
T.
(ordinate)
is derived
a direct
J.
AND
on
Minnesota
MID-MAX-
(MMFR)
(MMFR)
Measurement
Volume
Curve*
Minneapolis,
T
Rate
MassachuOhio.
Chicago,
Illinois.
t4
(FEV)
and
the
(MMFR).
44
Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21450/ on 06/14/2017
t5
derivation
of
mid-
Volume
32, No.
1967
Juiy,
A
MID-MAXIMUM
simulated
curve
forced
is diagrammed
is graduated
ml
lines
are
vals
(t0,
The
equally
t1,
the
(maximum
in 50
the
vertical
time
as one
second
inter-
in
ml
vertical
parallel
of
extended
expiration).
on the line
the
line
FEV
line
tal lines
is rep-
(AA’
at
the
the
CD
from
are
drawn
point
middle
50
point
which
50
per
E and
F and
middle
AA’
CD
Points
and
point
point
C
BB’
B
and
D
respec-
is dissected
segments
by the
middle
half of this
A line
and
through
and
GIANT
INTERNAL
vertical
segment
into
time
(t1-
cent.
G,
intersect
H
the
FEV
respectively
per
cent
On
horizondefin-
volume
of the
MAMMARY
CHRONIC
is drawn
through
is the
MMFR
be
reported
vertical
distance
liter/second
(i.e.
The
final
either
IJ’
the time
is defined.
in
0.210L/sec).
MM
FR
liters/second
ters/minute
can
(as
determined)
(multiply
For
reprints,
please
Hospital,
Minneapolis.
by
write:
as
or
II-
60).
Dr.
Grismer,
Mt.
Sinai
CYST
such
cyst.
The
finding
of Intrapericardlal
extracardiac mass
by angiography,
If associated
with
layered
or
semilunar
calcium,
would
appear
to be
quite
specific
for
intrapericardial
bronchogenic
cyst.
LEAGUS,
C.
J.,
GREGORSKI,
it.
F., CIUTrENDEN,
J. J.,
JOHNSON.
W.
D. AND LEPLEY,
D.: “Giant
intrspericardiai
bronchogenic
cyst,’
J. Thor.
and
Cardiova.rc.
Ssrg.,
52:
1966.
IMPLANTATION
variation
of technique
showed
patency,
branching
in the tunnel
and
myocardial
communications.
The
creation
of ischemia
in the myocardium
greatly
increased
the
magnitude
of patency
and
the
extent
of branching
and
communications.
MARUYAMA,
Y.,
WARREN,
R., MCCOMDS,
H. L.. VICKERY,
C. M. AND BRENRR,
B. J.: “Morphologic
observations
of
internal
Gynec.
OBSTRUCTIVE
cur
in
normalities,
they
show
a rapid,
shallow
breathing
pattern.
Hypercapneic
patients
with
chronic
airways
obstruction
also
show
lower
lung
compliances
than
patients
without
carbon
dioxide
retention.
It is suggested
that
this
is one
determinant
of their
rela-
points,
The
ARTERY-MYOCARDIAL
chronic
obstructive
lung
distendency
to develop
alveolar
to a “waste”
of ventilation
and
a markedly
limited
yencapacity.
Present
studies
Indicate
that
frank
dioxide
retention
is especially
likely
to
ocsuch
patients
when,
in addition
to these
ab-
two
across
IJJ’
BRONCHOGENIC
Patients
with
severe
ease
have
a general
underventilation
due
on unperfused
alveoli
these
F and
H, and
extended
lines.
A right
angle
triangle
INTRAPERICARDIAL
Internal
mammary
artery-myocardial
Implants
were
performed
In 40 dogs
which
were
later
studied
by angiography,
flow
determinations
and
histologic
examinations
at
eight
weeks
and
at
six
months.
Implants
were
performed
using
both
the artery
alone
and
the
pedicle
technique.
In some
of both
types.
branches
were
left open
in the tunnel
and
In some
they
were
tied.
In terms
of patency
and
branching.
the
majority
of the
Implants
performed
by
each
carbon
represents
the
ing
A case
report
of a giant
symptomatic
Intrapez’lcardial
bronchogenlc
cyst
in a 60-year-old
man,
successfully
treated
surgically,
Is presented.
A review
of the literature
revealed
18 reported
cases
of intrapericardial
bronchogenic
cysts,
six
of which
were
treated
surgically.
The
histopathology
of an intrapericardial
bronchogenic
cyst
is presented,
along
with
a brief
explanation
regarding
the
etiology
of381,
tilatory
t3)
curve
between
distance
lines
inspiration)
so that
equal
The
paper
volume
45
RATE
FEy.
volume
respectively)
tively,
1. The
into
. . .t0).
t2
total
(maximum
are defined
four
lines.
spaced
volume
Fig.
Similarly,
resented
by
the
horizontal
BB’
in
horizontally
increments.
A
expiratory
FLOW
mammary
and
Obsiel.,
LUNG
artery.myocardisi
Surg.,
implantation,”
1966.
123:799.
DISEASE
tive
taehypnea
and
small
tidal
volume.
In addition,
they
show
an elevated
inspiratory
as well
as expiratory
pulmonary
resistance.
Patients
with
relatively
low
lung
compliances,
shallow
respirations,
high
inspiratory
resistances
and
hypercapnia
show
clinical
and
physiologic
features
which
suggest
that
bronchitis
and
parenchymal
inflammatory
changes
are
important
In the
pathogenesis
of
their
disease.
BuaRows,
hon
dioxide
tive
lung
B.,
F.
SAKSENS,
tension
disease,”
and
Ann.
B.
AND
ventilatory
Intern.
DIENER.
mechanics
Mcd.,
Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21450/ on 06/14/2017
65:685,
c.
F.: “Car.
in obstruc.
1966.