Supported in part by grants from the American Heart Association, and from the National Heart Institute (H-328), U.S. Public Health Service. Patient Selection and MethodsThe patients studied were undergoing diagnostic catheterization of the left heart by the transbronchial4 or percutaneous dorsal5 route, and simultaneous right heart catheterization via an antecubital vein. The majority had rheumatic lesions of the mitral or aortic valve; individual diagnoses are listed in table 1. All gave a history of cardiopulmonary symptoms. None showed signs of congestive failure at the time of this study.Patients were studied after fasting at least 4 hours, and were usually given 10 mg. of morphine sulfate intramuscularly, and in some cases 100 mg. of pentobarbital, 1 hour prior to the procedure. Measurements were made with the patient supine.A no.-7 cardiac catheter was positioned in the pulmonary artery just beyond the valve by standard methods of intravenous right heart catheterization. The left atrium was catheterized with polyvinyl (I.D. 0.51 mm.) or polyethylene (I.D. 0.58 mm.) tubing passed through the puncture needle. Pressures were recorded by Statham P23-D or P23-A manometers* and a model DR-8 recorder.t Mean pressures were measured at end-expiration by electronic integration. The zero reference level for pressure measurement was a plane parallel to the top of the catheterization table, at a distance above it equal to two thirds the sagittal diameter of the thorax at the sternal angle.Dilution curves from the brachial or femoral artery following injection of indocyanine green ("Cardiogreen")t were recorded by continuous samnpling through a euvette densitometer (Model 103).* The methods used for injection, sampling, recording, and calibrating have been described in detail elsewhere.6When the catheters were in place and control blood samples were drawn, a dye injection was made into the left atrium and the arterial dilution curve was recorded. As soon as the primary curve was recorded, the sampling syringe was replaced, a new control blood sample was taken, and a pulmonary artery injection was made, with less than 5 minutes intervening between the 2 injections. Since the dye leaves the circulation rapidly, the

CLINICAL and radiologic evidence suggests that the volume of blood in the pulmonary vascular bed varies considerably under different circumstances, and the development of methods for measuring pulmonary blood volume in man in vivol' 2 makes it possible to examine these variations quantitatively. In an effort to identify the factors that determine the amount of blood in the pulmonary bed, and their role in rheumatic valvular disease and other abnormalities of the heart, we have measured the volume of blood between pulmonary artery and left atrium in 37 patients with cardiovascular disease and five hemodynamically normal subjects in the course of diagnostic catheterization of the right and left heart chambers. The effects of isoproterenol on pulmonary blood volume and hemodynamics have been studied in seven subjects to test the responsiveness of the pulmonary vascular bed as a whole to a drug that is thought to dilate the pulmonary arterioles.3 Methods Of the 42 patients studied, 14 were male and 28 female. Subjects with cardiovascular shunts or under 16 years of age were excluded. Ages ranged from 16 to 63 years, with an average of 41 years. Some data on 18 of the subjects with heart disease were included in an earlier report.1The patients were classified as to diagnosis on the basis of both clinical and hemodynamic criteria. Five subjects were considered to be hemodynamically normal because there was no ineasurable diastolic gradient across the mitral valve, pulmonary vascular resistance was less than 3.5 units (R.U.M.2), and no evidence of mitral regur- gitation, abnormality of other valves, or coronary artery disease was found. Three of these five subjects were judged to have functional murmurs; one had a grade 1 diastolic murmur suggesting aortic regurgitation but no other clinical or laboratory evidence of disease; one had undergone mitral valvotomy 6 years prior to this examination, with no residual hemodynamiic abnormality. These individuals are clearly not normal subjects, but are the most nearly normal available in a routine diagnostic laboratory.Eighteen patients had uncomplicated mitral stenosis. The severity of the mitral obstruction was gaged by the mnitral valve area, calculated by the method of Gorlin and G-orlin,4 and by direct evaluation at the time of surgery when possible. Five of the 18 were considered to have minimal mitral stenosis (calculated diastolic area of the mitral orifice greater than 1.9 cm.2), and 13 had moderate to severe mitral stenosis (valve area less than 1.9 cm.2).Combined insufficiency and stenosis of the mitral valve was present in eight cases, and pure mitral insufficiency in four cases. Mitral and aortic stenosis were both present in four cases, the aortic lesion being predominant in each patient. Three patients had arteriosclerotic heart disease and no valvular lesion. Each of these three had recently suffered from congestive heart failure, but all were compensated at the time of study.The method used to measure pulmonary blood volume has been described previously.1 Cons...

The factors influencing survival for patients with cancer of the liver were studied by reviewing the records of 414 patients operated on in a private oncology practice. Approximately half (47%) had colorectal metastasis; 17% had metastatic breast carcinoma, 14% had malignant hepatoma, 5% had metastatic melanoma, and the remainder had a variety of primary cancers. Eighty-two per cent of all patients had advanced liver disease when first diagnosed. One quarter of the patients had some type of resection; the remainder had abdominal exploration plus insertion of an infusion catheter into the hepatic artery. The postoperative mortality rate after liver resection for 108 patients was 6.5%. After resection, the most important prognostic factor influencing survival was the presence or absence of extrahepatic metastases. When possible, resection was by far the best treatment available, and the best results were seen in patients who had resection of a solitary lesion. For advanced disease, when resection was not possible, intra-arterial chemotherapy, primarily with 5-fluorouracil (5-FU), was associated with response rates of 36% for colorectal cancer, 45% for breast cancer, 13% for hepatocellular cancer, 12% for melanoma, and 14% for metastases from other primary sites. The patients who responded to infusion lived longer than those who did not respond. For example, at 18 months, 26% of the responders with colorectal cancer were alive, as were 50% of the responders with breast cancer and 40% of the responders with hepatocellular cancer. In contrast, at 18 months, there were no survivors among the nonresponders with colorectal, breast, or hepatocellular cancer. For those patients treated solely by infusion chemotherapy, the extent of disease in the liver was the most reliable factor in predicting the length of survival. However, very few patients treated in this manner lived longer than 3 years.