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Because of the high local recurrence rate associated with surgical resection alone, patients with diffuse intraarticular pigmented villonodular synovitis were treated with surgical resection followed by colloidal chromic P32 synoviorthesis. The medical records of nine consecutive patients treated in this manner were reviewed retrospectively to determine the recurrence rate of pigmented villonodular synovitis. All patients had either one or two surgical resections (arthroscopy in one patient, open resection in seven, arthroscopy and open resection in one). The involved joints included six knees and one each, ankle, elbow, and hip. Eight of the nine patients remained recurrence free at a mean followup of 38 months (range, 19-60 months) after surgery. One patient had a suspected asymptomatic recurrence documented by magnetic resonance imaging 29 months after surgery. Seven patients reported their normal activities as unrestricted. Five reported improved activity levels, one reported the activity level remained the same, and one reported activity as the same or better. None reported reduced activity levels. In these patients synoviorthesis with colloidal chromic P32 following gross resection of all obvious pigmented villonodular synovitis provided local disease control in all but one.

There is some increase in the pulmonary artery pressure in many patients with mitral stenosis and this pressure may rise considerably on exercise as was first shown by Hickam and Cargill (1948). have described a method of calculating the area of the mitral orifice in life and Gorlin et al. (1951 a and b) have attempted to evaluate the factors causing this pulmonary hypertension at rest and on exercise. Although in these cases, the stenosed mitral valve must be the primary cause, other changes that may occur in the pulmonary vasculature or in the pulmonary blood volume may also be of importance. Lagerlof et al. (1949) and Borden et al. (1949) using the Hamilton method, injecting dye directly into the pulmonary artery, showed no increase in the pulmonary blood volume in patients with mitral stenosis at rest. Kopelman and Lee (1951) verified these findings with dye injected into an antecubital vein and also showed no significant increase in the intrathoracic blood volume in mitral stenosis even when in congestive cardiac failure. This was in contrast with patients in left ventricular failure who showed a well marked increase in intrathoracic blood volume.The Hamilton dye method has been used in a further study of patients with mitral stenosis to determine the changes in cardiac output and intrathoracic blood volume that occur during mild exercise.MATERIAL AND METHODS Sixteen patients with mitral stenosis were investigated. Some of these had auscultatory signs of aortic valve involvement but mitral stenosis was considered to be the predominant lesion. None had clinical signs of congestive cardiac failure at the time of the investigation. Previous experience has shown that the presence of a giant left atrium or of tricuspid regurgitation prevents a reliable result with the method used, and no patient investigated had either of these conditions. Nine subjects without evidence of cardiovascular disease were similarly investigated.The Hamilton dye method consists of the injection of a known amount of dye (Evans Blue T 1824) into an antecubital vein and the collection of rapidly timed arterial samples. From these a time-concentration curve can be constructed and the cardiac output and mean circulation time calculated as described by Hamilton et al. (1932). By the application of Stewart's formula (1921) the volume of blood between injection and sampling points can be determined and this has been referred to as the " intrathoracic blood volume."In a series of five duplicate tests at rest, the coefficient of variation for the intrathoracic blood volume was found to be 6-5 per cent: although the number is small, changes in the intrathoracic blood volume of more than 13 per cent are probably significant. Similarly changes in the cardiac output of the same order are probably significant, the summation of errors in the technique being 6 per cent (Hamilton et al., 1948;Kopelman and Lee, 1951). It has been found that the cardiac output obtained by this method corresponds *

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A m d i e d method for the carbon and oxygen isotope analysis of 'small samples' (