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Biochemical and immunochemical (ELISA) assays were used concurrently to monitor the rat plasma concentration of a recently identified 60 kDa oncofetal protein. Both the biochemical and antigenic activities increased and decreased in parallel during the growth and after surgical removal, respectively, of a solitary transplantable tumor. These activities also responded similarly in response to the specific induction of the 60 kDa factor in the rat by chemical carcinogens. The data indicate that both assays give similar results and provide further evidence for the specificity of the 60 kDa factor as a marker for carcinogenesis and tumorigenesis.

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Thirty-three patients with peripheral pulmonary malignancies contiguous with a pleural surface were evaluated for chest wall invasion by computed tomography (CT). CT criteria included pleural thickening adjacent to the tumor, encroachment on or increased density of the extrapleural fat, asymmetry of the extrapleural soft tissues adjacent to the tumor, apparent mass invading the chest wall, and rib destruction. The CT scans were classified as positive, negative, or equivocal for invasion, and a decision matrix was constructed comparing CT results with pathologic data. The sensitivity of CT was 38%, specificity was 40%, and accuracy was 39% for evaluation of invasion if equivocal CT results were counted as radiologic errors. CT scanning has low accuracy in assessing chest wall invasion in patients with peripheral lung cancers.

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The effects of experimental right ventricular (RV) pressure overload and RV hypertrophy on coronary vasodilator reserve in young animals is not well established. Therefore, we measured coronary vasodilator reserve in the right ventricle of dogs from 7 to 12 months old with moderate RV hypertrophy due to pulmonary artery banding performed 3 to 7 days after birth. In the 5 dogs with pulmonary artery banding, substantial RV hypertension developed (RV pressure at rest, 73 +/- 11 mm Hg) as did RV hypertrophy (ratio of RV free wall/left ventricular free wall weight, 1.86 +/- 0.41 gm/kg). The reactive hyperemic response following brief coronary occlusions was used as an index of coronary vasodilator reserve. The ratios of peak reactive hyperemic response to resting flow, however, were not significantly different in the 5 banded dogs compared with 7 control animals (3.6 +/- 1.0 versus 2.6 +/- 0.6); this implies that the extent of vasodilator reserve was similar with or without moderate RV hypertrophy. In addition, myocardial blood flow, as determined using radioactive microspheres, was not significantly different at rest: 0.57 +/- 0.09 ml/min per gram in the banded dogs versus 0.48 +/- 0.12 ml/min per gram in the controls. Uniform transmural distribution of blood flow was maintained during infusion of isoproterenol, which was used to increase myocardial oxygen requirements in both groups. Minimum coronary vascular resistance was significantly lower in the banded than the control dogs (1.5 +/- 0.6 versus 6.2 +/- 2.3; p less than 0.01). This difference suggests that the cross-sectional area of the right coronary vascular bed increased with the development of RV hypertrophy.

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Ectopia cordis is a challenging congenital anomaly that generally has defied repair because of the magnitude of the deformity and the associated defects, particularly the intracardiac anomalies. We were fortunate to be presented with a boy who had successfully undergone an operation on the day of his birth to provide skin coverage over his bare ectopic heart. Subsequent studies disclosed no intracardiac anomalies. This paper describes the second stage of his repair designed to place the heart within the thorax and construct a bony shield anterior to it.

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Two infants had large communications between the right coronary artery just distal to its origin and the cavity of the left ventricle. The findings were essentially those of aortic insufficiency. In the first patient operation was delayed until there was secondary aortic insufficiency resulting from dilatation of the aortic root. The second patient was operated upon in infancy, and abolition of the fistula has relieved the clinical situation. Surgeons should recognize that isolated congenital aortic valve insufficiency has not been reported to our knowledge. Therefore, infants who appear to have this condition should undergo thorough angiographic studies which likely will reveal a remediable situation. A surgical approach for the type of fistula described herein is presented.

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Acquired tracheoesophageal fistulas are rare and for the most part are due to a malignant tumour. Acquired nonmalignant fistulas, even more rare, are most commonly the result of trauma or infection. The authors describe two such cases seen at the Royal Victoria Hospital in Montreal, one in 1968, the other in 1978. Both patients were successfully treated by surgical excision of the fistula. The authors review the literature with respect to the cause, symptoms, diagnosis and treatment and conclude that acquired nonmalignant tracheoesophageal fistulas may be treated successfully by operation with minimal morbidity and mortality.

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