Sensitivity and specificity of detection of mitral regurgitation was assessed by range-gated Doppler echocardiography. The degree of mitral regurgitation was also estimated by the depth and width of the regurgitant jet detected with Doppler and compared with that assessed by left ventriculography. Of 47 patients with an adequate Doppler study, 24 had no mitral regurgitation by ventriculography. All but one were also negative for mitral regurgitation by Doppler, for a specificity of 96%. Of 23 cases with mitral regurgitation documented by ventriculography, Doppler detected mitral regurgitation in 21, for a sensitivity of 92%. Two cases with mitral regurgitation undiagnosed by Doppler had mild mitral regurgitation due to papillary muscle dysfunction. All cases with rheumatic mitral regurgitation were detected. The degree of mitral regurgitation estimated with Doppler had a high correlation with that determined by ventriculography (r = 0.88, p less than 0.01).
In a 20-year period between 1960 and 1979, 3,438 resections were done for primary cancer of the lung, the standard operation being either lobectomy or pneumonectomy in more than 90% of the cases. In 261 cases (7.4%) sleeve lobectomy was performed as an alternative to pneumonectomy in order to conserve pulmonary function as far as possible, provided the operation assured as equally radical a removal of the tumor as pneumonectomy. Long-term results could be evaluated for 113 cases operated before 1974. Fifty-seven (50%) were alive at least 5 years after operation, the follow-up being 100%. The postoperative mortality was 7.3% (19 cases). Indications for sleeve resection as well as some aspects of anesthesia and surgical technique are discussed.
SUMMARYExperience in performing 267 selective coronary arteriograms by both the exposed brachial artery and percutaneous femoral artery techniques has proved the latter to be the technique of choice.The percutaneous femoral artery approach obviates the need for performing a cutdown over the small caliber brachial artery with the associated difficulties of catheter manipulation from this vessel. On the other hand, we were impressed by the ease with which the left coronary artery could be entered inadvertently or intentionally during retrograde left heart catheterization via the femoral artery. For this reason, we attempted to design catheters which would allow selective intubation of both the left and right coronary arteries from the leg.
MethodCatheters for a "left coronary" and a "right coronarv" artery are shown in figures 1 and 2. The catheters are currently made by hand of medical grade radiopaque polyethylene tubing,* with an
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