Selective parathyroid venous sampling in patients with complicated hyperparathyroidism.

Objective: The role of preoperative localisation of abnormal parathyroid glands remains controversial but is particularly relevant to the management of patients with recurrent or persistent hyperparathyroidism and familial syndromes. We report our experience of the use of selective parathyroid venous sampling (PVS) in the localisation of parathyroid disease in such patients.

Design: We report a retrospective 10-year experience (n = 27) of the use of PVS in complicated primary hyperparathyroidism and contrast the use of PVS with neck ultrasound, magnetic resonance imaging (MRI), computed tomography (CT) and sestamibi imaging modalities.

Detection of occult renovascular disease in unexplained chronic kidney disease.

Atherosclerotic renal artery stenosis (RAS) is a recognized cause of renal impairment. RAS is often overlooked in unexplained chronic kidney disease (CKD). A retrospective analysis of renal angiograms was performed to determine the prevalence of occult renovascular disease in 64 (M:F, 46:18; ages 21-81 years [median 60 years]) patients with unexplained CKD.

Is ovarian and adrenal venous catheterization and sampling helpful in the investigation of hyperandrogenic women?

Objective: To audit our practice of performing ovarian and adrenal venous catheterization and sampling in hyperandrogenic women who fail to suppress their elevated androgen levels following a 48-h low-dose dexamethasone suppression test (LDDST). We considered the technical success rate of catheterization, the extra information obtained in addition to the standard biochemical tests and imaging findings, and the impact of sampling on management decisions.

Design: A retrospective analysis of the results of all ovarian and adrenal venous catheterizations performed at St Bartholomew's Hospital, London, in the years 1980-1996.

Relative contributions of inferior petrosal sinus sampling and pituitary imaging in the investigation of children and adolescents with ACTH-dependent Cushing's syndrome.

Selective transsphenoidal microadenomectomy is the first line treatment of childhood Cushing's disease, with accurate preoperative localization of the corticotroph adenoma an important step in its investigation. Inferior petrosal sinus sampling (IPSS) for ACTH after CRH stimulation is a recognized investigation in adults, but there are few data in the pediatric age range. We report the relative contributions of IPSS and pituitary imaging in 11 patients, aged 10.

Recurrent varicose veins of both lower limbs due to bilateral ovarian vein incompetence.

A case of a 43-year-old female patient with mild pelvic pain and bilateral recurrent varicose veins due to incompetence of both ovarian veins is presented here. Ovarian vein incompetence was suspected from the presence of vulva varicosities and was confirmed by transvaginal ultrasound and descending ovarian venography. Treatment with transcatheter embolization of the ovarian veins was followed by local excision of the leg varices.

A critical analysis of the value of simultaneous inferior petrosal sinus sampling in Cushing's disease and the occult ectopic adrenocorticotropin syndrome.

The clinical, biochemical, and radiological features of pituitary ACTH-dependent Cushing's syndrome (CS) [Cushing's disease (CD)] are often indistinguishable from those of occult ectopic ACTH-dependent CS (oEAS). We have evaluated, retrospectively, the results of simultaneous bilateral inferior petrosal sinus (IPS) ACTH sampling before and after CRH stimulation in 128 patients with ACTH-dependent CS: 107 patients with CD, 6 with oEAS, 1 with an adrenal adenoma, 1 with a pituitary gangliocytoma, and 1 with Nelson's syndrome; while, in the remaining 12, the source remains unclear. One hundred seven patients received human-sequence CRH (hCRH), and 11 received ovine CRH; another 6 patients underwent stimulation with desmopressin and hCRH, and 4 with desmopressin alone.

Relative value of computed tomography scanning and venous sampling in establishing the cause of primary hyperaldosteronism.

The purpose of this study was to evaluate the relative merits of the postural stimulation test, adrenal computed tomography (CT) and venous sampling in the differential diagnosis of patients presenting with primary hyperaldosteronism. The records of 20 patients presenting with primary hyperaldosteronism were reviewed retrospectively. There were 15 patients with a unilateral aldosterone-producing adenoma (APA), four patients with idiopathic hyperaldosteronism (IHA) and one patient with primary adrenal hyperplasia (PAH).

Natural history of paroxysmal nocturnal hemoglobinuria.

Background: Paroxysmal nocturnal hemoglobinuria (PNH), which is characterized by intravascular hemolysis and venous thrombosis, is an acquired clonal disorder associated with a somatic mutation in a totipotent hematopoietic stem cell. An understanding of the natural history of PNH is essential to improve therapy.

Methods: We have followed a group of 80 consecutive patients with PNH who were referred to Hammersmith Hospital, London, between 1940 and 1970.

The significance of ipsilateral leg ischaemia after renal transplantation.

We present three renal transplant patients who have been investigated for leg ischaemia on the side of the transplant. All were men aged between 50 and 57 years. Two had an iliac stenosis proximal to the transplant kidney and were treated successfully by percutaneous transluminal angioplasty.

Primary hyperaldosteronism due to an adrenal adenoma in a 14-year-old boy.

Conn's syndrome due to an adrenal adenoma is very rare in children. This paper reports a 14-year-old boy with primary hyperaldosteronism due to an adrenal adenoma. His biochemistry data were compatible with either bilateral adrenal hyperplasia or an adrenal adenoma.

The value of interventional techniques in the management of symptomatic leg ischaemia complicating transfemoral cardiac procedures.

During a 4 year study period, 3169 coronary arteriograms and 733 coronary angioplasties were carried out at this institution using the percutaneous femoral approach. Seven (0.18%) patients developed symptomatic ischaemia in the leg of the transfemoral access, two (0.

Imaging islet cell tumours.

The localization of islet cell tumours presents a challenge to the radiologist and requires meticulous attention to detail in both technique and interpretation. As several imaging techniques are capable of demonstrating the tumour and none is absolutely accurate, a rational approach to the localization of these tumours requires a careful consideration of cost, sensitivity and the availability of special expertise. In almost all cases, initial imaging is performed with a combination of transabdominal ultrasound and CT.

Technical report: use of a 3 French catheter for transbrachial evaluation of surgically-created arteriovenous fistulae in dialysis patients.

Surgically-created arteriovenous fistulae (SCAVF) are widely used for the management of patients with chronic renal failure. Satisfactory function of the SCAVF is essential for adequate haemodialysis. Complications, although relatively uncommon, may occur and assessment of the SCAVF is essential before surgical revision of the fistula, thrombolysis or percutaneous transluminal angioplasty can be undertaken.

Bilateral phaeochromocytomas in von Hippel-Lindau disease: diagnosis by adrenal vein sampling and catecholamine assay.

Three unrelated patients with von Hippel-Lindau disease had phaeochromocytomas diagnosed as a result of screening in their third decade. All had raised 24-h urinary noradrenaline levels and obvious unilateral adrenal tumours on ultrasound scanning and computed tomography. The contralateral adrenal appeared either normal or equivocally abnormal using the same imaging techniques.

The radiological investigation of occult ectopic ACTH-dependent Cushing's syndrome.

The radiological features of 14 patients with Cushing's syndrome due to 'occult' ectopic ACTH syndrome have been reviewed. In 11 of the 14 patients (79%), the ACTH-producing tumour was located in the thorax. Bronchial carcinoid tumours (eight patients) were the single most common source of 'occult' ectopic ACTH production with thymic carcinoid tumours (two patients) and mediastinal metastases from a medullary carcinoma of the thyroid gland (one patient) accounting for the other intrathoracic tumours.

Laser-assisted angioplasty for arterial occlusion of the lower limb: initial results and follow-up.

A flashlamp-pumped pulsed dye laser operating at either 480 or 504 nm, coupled to an integral ball-tipped optical fibre, was used to recanalize occluded lower limb arteries. All channels created by the laser were augmented with balloon dilatation. We have treated 78 limbs in 71 patients; 46 limbs (59 per cent) had rest pain and 22 (48 per cent) of these had tissue loss.

The value of percutaneous transluminal angioplasty of the profunda femoris artery in threatened limb loss and intermittent claudication.

Percutaneous transluminal angioplasty (PTA) has been performed on 29 profunda femoris artery stenoses in 26 limbs of 25 patients. Seventy per cent of the 27 atheromatous stenoses involved the origin or proximal 4 cm of the profunda. One patient had two strictures of a common femoral-profunda femoris vein graft.

The use of venous catheterization in the diagnosis and localization of bilateral phaeochromocytomas.

Objective: The purpose was to assess the value of venous catheter sampling as a method for the location of phaeochromocytomas, particularly when imaging techniques have been equivocal or ambiguous.

Design: Venous catheter sampling was carried out in cases of suspected phaeochromocytoma, and compared with samples obtained from other patients without phaeochromocytomas undergoing adrenal venous catheterization.

Patients: Three patients had phaeochromocytomas (subsequently confirmed by histology); five patients had no clinical or biochemical evidence of phaeochromocytoma but were being investigated for other conditions.

A new approach to percutaneous transluminal angioplasty of profunda femoris origin stenosis.

We describe 3 patients in whom percutaneous transluminal angioplasty (PTA) of a stenosis at the origin of the profunda femoris artery was carried out successfully using a retrograde approach. Unfavorable anatomy precluded profunda femoris PTA via either the ipsilateral antegrade or the contralateral approach. Retrograde profunda femoris PTA offers an alternative approach when other percutaneous routes of access are precluded.

Validity of the mean parenchymal transit time as a screening test for the detection of functional renal artery stenosis in hypertensive patients.

Functional significance of renal artery stenosis (RAS) was assessed by 99Tcm-DTPA radionuclide scintigraphy, using the mean parenchymal transit time (MPTT) of the tracer as an index of renovascular disorder. Two groups of subjects were investigated retrospectively: eight normal live kidney donors; and 11 patients with hypertension, six with and five without significant RAS. MPTT was 171 +/- 11 s in the kidney donors, and there was a significantly prolonged MPTT in patients with RAS, 313 +/- 27 s (p less than 0.

Role of computed tomography in evaluating asbestos related lung disease.

To find how computed tomography (CT) may be effectively used in individuals with suspected asbestos related lung disease 30 men with a history of exposure to asbestos were studied. All subjects underwent high kilovoltage posteroanterior and left lateral chest radiographs and chest CT. Eighteen were randomly selected asbestos workers referred for routine surveillance.