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A fifty-nine-year-old, asymptomatic woman with anomalous origin of the right coronary artery from the main pulmonary artery is presented. The diagnosis was established by catheterization and angiocardiography. The indications for surgery in this condition are discussed, with special reference to asymptomatic patients. In this patient, surgery was not undertaken, because of the absence of signs of impairment of left ventricular perfusion and function. The patient remains asymptomatic after eight years of observation.

Echocardiographic quantitative assessment of the atrioventricular plane displacement (AVPD) in systole towards the apex has been used to estimate global left ventricular (LV) function. The study population consisted of 106 patients with coronary artery disease (CAD) with or without previous myocardial infarction and 40 age-matched healthy subjects. The AVPD was recorded from the apical four- and two-chamber views at four sites corresponding to the septal, lateral, anterior and posterior walls of the left ventricle. A mean displacement (AVmean) was calculated from the above sites. AVmean was significantly decreased in patients with CAD compared to healthy subjects (P less than 0.001). In patients in whom the left ventricular ejection fraction (LVEF) was calculated from cineangiograms a good correlation between AVmean and LVEF was found (r = 0.89, P less than 0.001, SEE = 6.4). Selecting an AVmean of 10 mm or more to define a normal LVEF (greater than or equal to 55%) resulted in a sensitivity of 92% and a specificity of 87% in predicting a normal versus abnormal left ventricular systolic function. It is concluded that the ease of recording the AVPD by echocardiography provides a simple and valuable noninvasive method to assess global left ventricular function in patients with CAD.

Spirometry in both sitting and supine position was performed before and 3-5 days after elective upper abdominal surgery in 53 men, aged 41-72 years. The results were related to postoperative respiratory complications as defined by chest radiography and to measurements of the arterial oxygen tension. Preoperative total lung capacity (TLC), functional residual capacity (FRC) and wash-out volume (WOV) were lower in both positions among patients who were to develop major chest X-ray abnormalities than among patients with normal chest radiographs postoperatively. All patients who developed major chest X-ray abnormalities had a negative value for FRC - closing capacity (CC) in the supine position preoperatively, indicating 'airway closure' during tidal breathing. Preoperative WOV and lung clearance index (LCI) were higher in both sitting and supine positions in patients who developed postoperative hypoxaemia than in patients who did not. The postoperative decrease in TLC, FRC and WOV in the sitting position was greater among patients with major X-ray abnormalities and/or arterial hypoxemia postoperatively than among patients without these complications. According to our results, conventional spirometry in the supine position is not superior to conventional spirometry in the sitting position as part of pre- or post-operative assessment of patients. On the other hand, both preoperative 'airway closure' and arterial oxygen tension, measured in the supine position, showed a correlation with postoperative chest X-ray abnormalities.

210 patients were screened for pulmonary embolism after total hip replacement with chest radiography and perfusion-ventilation scintigraphy using a new, dry 99mTc-microaerosol and a detailed system for coding scintigraphic abnormalities. Chest radiography did not contribute significantly to the diagnosis of pulmonary embolism. In spite of careful evaluation, false-negative and false-positive scintigraphic diagnoses of PE are still possible.

Two different iodized oil emulsion have been intravascularly injected into rabbits, one with a particle size of 15 mum or more and one with a size of about 1 mum. The effects of the emulsions have been evaluated on the brain, the heart, the kidney, the liver and the circulation. The reactions to the small particle emulsion was minor, especially if administered slowly. The injection site was of critical importance. The safest place for injection was the superior mesenteric artery. If supplied directly to the brain or the heart the emulsions were often deleterious, particularly the coarse one.

Angiography and 99Tcm-scintigraphy were performed in 100 adult patients with suggested primary or secondary liver malignancy. The results were compared to the final diagnosis obtained by biopsy, surgery, autopsy or long term clinical follow up. The reasons for false positive and negative diagnoses are discussed in detail.

Intravenous arteriography may be used as an alternative to translumbar or transaxillary angiography in cases with occlusion or severe stenosis of the aorta or iliac arteries, to determine the extension of the disease. During a 10-year period the method was used in 117 patients. For the examination, 80 to 100 ml of contrast medium was injected into the right atrium and after a delay of 10 to 20 seconds the lumbar aorta, iliac and femoral arteries were demonstrated. The quality of the examination was excellent or good in 92 per cent. No complications occurred. In 19 patients a continuous pressure recording was made in the main pulmonary artery. The pulmonary artery pressure increased to a significantly higher degree after contrast medium injection than after injection of the same amount of isotone saline. In all patients the pressure returned to normal within 4 minutes.

Selective bronchial angiography was performed in 26 patients with bronchogenic carcinoma in connection with intraarterial infusions of cytostatic drugs. The angiographic extension of the tumor was correlated to data obtained at surgery, mediastinoscopy or autopsy. Bronchial angiography is not suitable as a routine procedure in the preoperative evaluation of patients with bronchogenic carcinoma but may contribute to a more precise staging of the tumor.

The experience of percutaneous transluminal angioplasty (PTA) in 66 patients (71 stenoses) with arteriosclerotic lesions in the pelvic and lower extremity arteries is reported. The PTA was technically successful in 70 stenoses. Complications were seen in eleven patients. The follow-up time was 19 months (2-44). The frequency of recurrencies was clearly related to the location of stenosis, the more distal the lesion the higher the recurrency rate. The immediate roentgenologic result had no prognostic value to protect recurrencies. To conclude PTA is an alternative to surgery in patients with short stenoses in the iliac arteries, but very strict indications should be used when lesions are localized below the inguinal ligament.

Seven patients with advanced gallbladder carcinoma were given intraarterial infusions of 10 to 15 mg mitomycin C with 10 to 24 days' interval, 3 received intravenous infusion (10 mg/m2) with median 3 weeks' interval. Stationary disease was obtained in 4 patients, progressive disease in 4, and treatment failures in 2. The median survival after mitomycin C treatment was 4 months (range 1-23 +). Irreversible thrombocytopenia occurred in 2 patients and a severe gastrointestinal bleeding episode in one.

The clinical consequences of postoperative complications as defined by signs and symptoms, chest radiography and measurements of the arterial oxygen tension were studied in 53 men, aged 40-75, who were electively operated for peptic ulcer or gallbladder disease. Clinical signs of a respiratory complication were detected in 4 patients. Of the 28 patients with chest X-ray abnormalities and 23 with arterial hypoxemia only 2 had clinical signs of a disordered pulmonary function. None of the remaining patients with arterial hypoxemia and/or chest X-ray abnormalities required any specific treatment. Hospital stay was not prolonged in patients with respiratory complications. Arterial hypoxemia and chest X-ray abnormalities in patients without clinical signs of a disordered pulmonary function had no influence on postoperative course or rehabilitation and were in all cases reversible without treatment.

Short-term intra-arterial Mitomycin C treatment of hepatic metastases from various malignancies was performed in 24 evaluable patients. An objective regression was obtained in 12 patients. The median survival of responders was 11 months compared with 3 months in nonresponders. No complication of the technical procedure occurred and the treatment was well tolerated. The only side effect of clinical importance was thrombocytopenia, which occurred at a median dose of 45 mg of Mitomycin C.

Among 240 consecutive patients subjected to total hip replacement, 206 underwent perfusion scintigraphy in screening for pulmonary embolism 10 to 14 days after surgery. All patients with perfusion abnormalities (n = 77) also underwent ventilation scintigraphy with a dry 99Tcm microaerosol. The scintigraphic abnormalities were classified according to a detailed coding system and in 50 patients pulmonary angiography was performed within 24 hours for correlation. Emboli were diagnosed in 19 patients at angiography. All patients with ventilated segmental (n = 6) or larger (n = 5) perfusion defects or multiple subsegmental defects larger than half a segment (n = 2) had emboli. Two of 8 patients with abnormally ventilated subsegmental perfusion defects larger than half a segment had emboli. Four of 21 patients with wedge-shaped subsegmental perfusion defects smaller than half a segment or defects with a rounded border towards the hilum and a peripheral extension equal to or less than that of a segment had emboli. In one of them the site of the emboli correlated to the site of the perfusion defect but occurred in normally perfused areas in the remaining 3. Ventilation scintigraphy was of no value in this group of patients. No emboli were found in patients who had areas with decreased but not totally lost perfusion (n = 8). No emboli were diagnosed in 27 lungs with a normal perfusion.

Bronchial angiography and intraarterial infusion of mitomycin-C were successfully performed in 39 of 47 patients with bronchogenic carcinoma. More than one course was given to several patients. No neurologic complications occurred and the side effects were insignificant. The pertinent anatomy of the bronchial and spinal arteries is summarized and a comprehensive description of the angiography and infusion technique is given. It is important that the infused artery is not occluded by the catheter and that the drug is properly diluted to avoid complications. The method appears to be of therapeutic value in the treatment of pulmonary carcinoma.

Examination of more than 30 cases of bronchopleural fistula (BPF), of diverse causes, including 6 following resectional surgery, revealed a distinctive configuration of air/fluid collections in the pleural space. Maler in 1940 independently observed that loculated BPF pockets conform in shape to the adjacent chest wall. With the most common posterior costophrenic angle location, there is a wide air-fluid level in the frontal view, but on lateral films the anteroposterior diameter is narrow. In contrast, abscess cavities tend to be spherical and farther from the ribs. Use of these plain film criteria permits earlier and more confident diagnosis.

Bronchial artery infusion of mitomycin C might be very effective in treating minor tumors but, as a rule, less effective in the treatment of larger tumors. In order to achieve improved effect of treatment, 21 cases (stage II-III/TNM) were given supplementary chemotherapy with bleomycin or vincristine-bleomycin. Preoperative treatment was given to 11 cases in which indications for surgical treatment were primarily uncertain or absent. The other group consisted of 10 patients with inoperable lesions. Combined treatment has proved to have a strong but mainly local effect. Repeated courses (up to 5 times) were more effective than a single one. The regional effect, i.e: on overgrowth onto the mediastinum, pericardium or thoracic wall was weak. The system effect was negligible. Penetrating data about objective response are given.

Twelve patients with small-cell anaplastic carcinoma of the lung were treated with vincristine 1 mg/m2 i.v. day 1, adriamycin 50 mg/M2 i.v. day 1, cyclophosphamide 1,000 mg/m2 i.v. day 1, and etoposide 80 mg/m2 i.v. day 2, 4, 6 given on an outpatient basis and repeated at 3-week intervals. As consolidation therapy seven patients received two courses of BCNU median 29 mg/m2 (range 24-73 mg/m2) short term intraarterial infusion in the bronchial artery with 2 to 3-weeks intervals. One patient with limited disease had no evidence of disease for 13+ months and one patient complete remission for 3+ months. Four of ten patients with extensive disease had complete remission for median 5 months (range 2+ to 5+ months) and four patients had partial remission for median 5 months (range 4 to 5+ months). Despite side effects the chemotherapy was well tolerated by the patients. The results correspond to those obtained with other effective regimens in small-cell anaplastic carcinoma of the lung.

A 70-year-old man developed symptoms compatible with the Eaton-Lambert syndrome, and a small cell bronchogenic carcinoma was diagnosed. During treatment with cytostatics his muscular strength was restored and the lung tumour as well as the electrophysiologic findings characteristic of the Eaton-Lambert syndrome disappeared. To our knowledge, it has not been reported before that chemotherapy alone of a small cell bronchogenic carcinoma has resulted in clinical, roentgenologic, and electrophysiologic remission of the Eaton-Lambert syndrome.

In eight patients with inoperable obstructive jaundice, an endoprosthesis was inserted percutaneously through the obstruction to allow internal drainage of bile to the bowel. The method offers several advantages over external percutaneous drainage and is warranted in selected cases.

Fifty-six patients with previously untreated, unresectable squamous cell carcinomas of the head and neck region were treated with repeated intra-arterial chemotherapy with mitomycin C using a selective or super-selective angiographic technique, and bleomycin given i.v., followed by radical radiotherapy. In addition, restricted tumour-reductive surgery was done in 18 of these patients. The response rate (CR + PR) after completion of the integrated treatment was 89%, with 63% of the patients showing CR. The toxicity of this regimen was, however, far from negligible. The median survival for this series of patients with advanced head and neck cancers is 19 months, and 17 are still alive after 16 + -66 + months.

Two groups (n = 10 in each) of adult sheep were exposed to hemorrhagic shock resulting in mean arterial pressure (MAP) below 25 mmHg for 10 min. Following that, group A received crystalloids (8% of body wt) during one hr together with supraceliac intraaortic balloon tamponade during the first 30 min, while group B (controls) received crystalloids only. The central circulation was rapidly restored in group A, as indicated by increased MAP and increased systemic vascular resistance (SVR). After deflation of the balloon MAP dropped to the same value as in the control group, while cardiac index increased gradually with volume replacement and was significantly higher at the end of the resuscitation period (60 min) than in the control group (P less than 0.05). Despite a more rapid restoration of central hemodynamics in group A, lactic acidosis was more severe, acute renal failure and neurological complications more frequent, and mortality higher than in the control group. It was concluded that continuous supraceliac aortic occlusion for 30 min had deleterious effects on organs dependent on aortic blood flow distal to the aortic tamponade and may contribute to the development of multiple organ failure after resuscitation from hemorrhagic shock. Further studies are needed to evaluate the effects of intermittent intraaortic balloon tamponade in hemorrhagic shock.

Bronchial angiography was performed in 9 patients with squamous cell carcinoma of the lung. The tumor-feeding vessel was identified and infused with 10 mg of mitomycin-C (MMC) diluted in saline. At operation after 28 to 48 days complete remission of the tumor had occurred in 2 patients, almost complete in one, partial remission in 2 and a marked regression in 2. In 2 patients no change was noted. No side effects except moderate malaise and slight fever occurred.

The incidence of postoperative chest X-ray abnormalities, arterial hypoxemia and clinically recorded pulmonary complications was studied in fifty-two 40-75-year-old men admitted for elective surgery for peptic ulcer or gallbladder disease. Twenty-eight (54%) patients had an abnormal chest X-ray and twenty-three (43%) arterial hypoxemia, whereas only four patients (8%) were identified with clinical signs and symptoms of respiratory complications. Forty-one patients (79%) were found with pulmonary complications by at least one of the three methods. Twelve patients had both an abnormal chest X-ray and arterial hypoxemia. Only two of these were identified with clinical signs indicating pulmonary complications. The great discrepancy between results based on clinical signs and symptoms noted in the patients' records and results based on postoperative chest X-ray and measurements of the arterial oxygen tension, respectively, should be of great importance when comparing the incidence of pulmonary complications after different forms of surgery and when assessing risk factors and clinical consequences of respiratory complications.

Bronchial angiography was performed in 17 patients with advanced non-oat cell bronchogenic carcinoma. The patients were treated 1 to 5 times with infusions of 10 mg of mitomycin-C (MMC) into the tumor-feeding bronchial artery. All but 2 patients received in addition small doses of vincristine (intravenously) and bleomycin (intramuscularly) or only bleomycin to potentiate the effect of MMC. No major side effects occurred and the systemic toxicity was insignificant. An objective tumor reponse was encountered in 11/17 patients. Intraarterial chemotherapy is strictly local and therefore effective especially in patients with limited or locally advanced disease. In patients with more extensive disease an adjunctive therapy of a more regional or systemic modality must be given.

Two patients with leiomyosarcoma of the suprarenal inferior vena cava are presented. In one case the tumour was misinterpreted as intrahepatic at angiography. In the second case an extrahepatic location was suggested after repeated angiography. The diagnosis should be borne in mind when a large hypovascular mass appears to be located centrally in the liver at coeliac angiography and when ultrasound examination has revealed its solid nature.

Combination chemotherapy in advanced squamous carcinoma of the head and neck resulted in objective remission in 5 of 8 patients, with a median duration of 9 months. In 4 patients, the intravenous chemotherapy was supplemented by regional intra-arterial short-time infusion chemotherapy, by which one patient obtained a partial remission and 3 a static disease. The most important results of the methods used were the subjective improvements of the patients. The side-effects were acceptable, and no serious complications were observed.

Celiac and/or superior mesenteric angiography was done routinely in association with renal angiography on 115 patients with renal cell carcinoma. Metastases were demonstrated in 20 patients on extended angiography. In 10 of these patients no other signs of metastatic disease were noted at diagnosis. In the total clinical diagnostic stydy metastatic spread was present in 41 patients.

A technique is described for repeated superselective angiographic infusion of anticancer drugs into advanced malignant tumours of the head and neck region. The technique allows for a high concentration of the drug in the tumour and, furthermore, it is possible to ensure that the infused anticancer drug adequately reaches the tumour. Mitomycin C was given to 15 patients with advanced malignant tumours of the head and neck region. In 16 patients a partial remission was seen, and in another 5 patients a subjective improvement was reported. No complications were observed.

Angiography was performed in connection with intra-arterial chemotherapy in 110 patients with bronchogenic carcinoma. All tumors were supplied from at least one ipsilateral bronchial artery. A double systemic arterial supply was found in 12 patients, the additional blood supply coming from a second ipsilateral bronchial artery in 3 patients, from the ipsilateral internal mammary artery in 4, from intercostal arteries in 4 and from the subclavian artery in one patient. All patients with tumor supply from a non-bronchial artery had direct tumor spread to the chest wall or to the mediastinum. A complete angiographic examination may therefore be of prognostic significance and necessary before intra-arterial chemotherapy, which mainly has a local effect.

Selective bronchial angiography and short term intra-arterial infusions of Mitomycin C were performed in 70 patients with bronchogenic carcinoma. The courses were given 1--5 times with a median interval of 2 weeks. The angiograms were compared with chest radiograms and data obtained at bronchoscopy, mediastinoscopy, surgery or autopsy. The effect of therapy was evaluated with chest radiography and bronchoscopy. Among our first 36 patients an objective response was registered in 18/27 patients with squamous cell carcinoma, in 4/7 with adenocarcinoma and in 2/2 with small cell cancer. These results warrant further studies. Though not suitable as a routine procedure in the diagnostic work up of a patient with possible bronchogenic carcinoma bronchial angiogrpahy may contribute to a better staging when used e.g. in connection with intraarterial chemotherapy.

Angiography after liver puncture was performed at different intervals in 51 patients. Fourteen cases had abnormalities believed to be caused by the puncture. Most of these were small but there were also 4 cases with large liver hematomas and 1 case with an abscess between the liver and the abdominal wall, none requiring acute surgery. No certain correlation between the severity of the injury and the diameter of the puncture instrument could be assessed.

A new method for intermittent hepatic arterial flow arrest has been used in combination with intraarterial 5-fluorouracil (5-Fu) for the treatment of secondary liver neoplasms in 12 patients. Polysaccharide microspheres with a half-life of 1 h were infused together with 5-Fu via a percutaneously introduced catheter into the hepatic artery. There were no significant side effects to the treatment. Clinical effects and overall survival were comparable to those of hepatic artery ligation.