Management of congenital arteriovenous malformations.

Over a 6-year period, 12 patients with 14 congenital arteriovenous malformations were considered for a staged approach to include afferent vessel ligation (AVL) and/or intra-arterial embolization (IAE) and surgical excision where possible. Patients were followed for a period ranging from 3 to 60 months. Two patients had localized lesions which were completely excised. Five patients were treated by IAE followed by excision with a successful outcome in four. One patient had a transmetatarsal amputation for failed IAE. Two patients had both IAE and AVL before excision of the lesion. In one patient AVL alone was followed by a recurrence. Two patients with multiple lesions were kept under observation. It would appear that IAE and excision of an arteriovenous malformation can achieve cure or excellent palliation in most patients.

Breast ductography--its role in the diagnosis of breast disease.

Breast ductography is a safe and simple technique to outline the duct system of the breast with contrast medium in patients with nipple discharge. The results of 60 successful ductograms are presented and an assessment of its clinical usefulness is made.

The effect of traffic noise on sleep of young adults in their homes.

The disturbance of sleep by traffic noise is a major problem area in noise pollution. Extensive laboratory tests using multichannel electroencephalograms (EEG) have been carried out by many workers to determine the general response of people when exposed to noise during sleep. An experimental technique for obtaining results in people's homes has been developed using a simplified one-channel EEG. The responses of six people in the age range 19-24 were measured. A significant correlation was found between sleep disturbance and traffic noise when the noise is expressed in EPNdB. In the home experiments the subjects appeared to be approximately 10 dB less sensitive to noises than laboratory subjects for similar noise exposure. There also appeared to be some adaptation to the noise exposure; however, only one subject was tested for a period of 20 days and was insufficient to give definite results on adaptation.

Pre-operative localisation of parathyroid tumours using neck vein catheterisation and radioimmunoassay for parathyroid hormone: the Glasgow experience.

Reliable pre-operative localisation of parathyroid tumours can be of value in surgery for primary hyperparathyroidism, and particularly so where re-exploration of the neck is required. Neck vein catheterisation and parathyroid hormone radioimmunoassay have been suggested as a sensitive means of tumour localisation, and we report our experience of the technique over the last five years. A total of 46 patients with primary hyperparathyroidism had 50 studies performed with positive localisation and a pre-operative prediction made on 38 occasions (76%). Forty-two operations were carried out and a parathyroid tumour confirmed in 39 cases for a localisation efficiency of 69 per cent. No negative neck exploration followed a positive localisation. Twelve studies were performed in patients with renal osteodystrophy and localisation to a single site was achieved on only three occasions. It is concluded that neck vein catheterisation and parathyroid hormone assay can correctly localise parathyroid tumours in most cases of primary hyperparathyroidism, but it is suggested that its use be restricted to selected cases such as those subjects with previous negative neck exploration or patients for whom prolonged or repeated surgery may be a particular hazard.

The localisation of parathyroid tumours--a comparison of computed tomography with cervical vein hormone assay.

Computed tomography has been employed for the localisation of parathyroid tissue in 26 patients with primary hyperparathyroidism. In 14 of these selective venous catheter studies with parathyroid hormone assay were also undertaken. Computed tomography proved unreliable, identifying only 39 per cent whereas the cervical venous hormone assay studies localised 69 per cent of lesions correctly--a figure which is in agreement with several other groups. On balance our results suggest that neither technique should be routinely employed pre-operatively but that, following unsuccessful parathyroid surgery, the most useful localisation technique remains venous hormone assay.

The importance of cadmium as a factor in calcified upper urinary tract stone disease--a prospective 7-year study.

The non-essential trace metal cadmium may cause major pathological effects on the kidneys. A group of coppersmiths who have been chronically exposed to cadmium poisoning was systematically studied over a 6-year period. The stone prevalence in the group is now just under 40% as compared with 3.5% in a general population. The blood cadmium levels have remained persistently elevated despite removal of the cadmium source. The measurement of cadmium as a means of monitoring chronic poisoning has been undertaken in terms of the prospective study in the coppersmiths and also in its relationship to other trace metals, namely serum zinc and copper. Urologists should be aware of the possibility of cadmium poisoning.

Management of tumors of the liver. Combined use of arteriography and venography in the assessment of resectability, especially in hilar tumors.

Twenty-five primary and secondary malignant tumors involving the liver were assessed preoperatively by combined hepatic arteriography and portal venography. The resectability of the lesions as judged by these radiographic techniques was compared with the operative findings. Only 1 of 6 peripheral nonhilar tumors was unresectable, in contrast to 11 of 19 tumors involving the hilus In every case the operative findings confirmed the preoperative radiologic data. Of the patients with hilar lesions, four had isolated unilateral involvement of either the main trunk or a major secondary branch of the lobar artery and vein and were all resectable. None of the 11 hilar lesions with bilateral or stem involvement of the vasculature were resectable. It is suggested that hepatic angiography not only yields information on diagnosis, anatomic abnormalities and concurrent disease, but also is important in assessing tumor resectability. For this purpose, both selective hepatic arteriography and splenic venography are necessary.

The application of the 99Tcm phosphate bone scan to the study of breast cancer.

Comparison of the gamma camera bone scan and radiological survey in 190 patients with breast cancer has confirmed the superiority of the bone scan in the positive diagnosis of skeletal metastases. In 47 patients with known (X-ray positive) bony metastases the scan was positive in all but 2, and in 24 (50 per cent) the scan showed more lesions than the X-ray had indicated. In 60 patients with a clinical suspicion of bone metastases but negative X-rays, the scan was positive in 29 (48 per cent). Eighty-three patients with primary breast cancer were studied at the time of initial presentation. All had a normal radiographic skeletal survey but 24 (27 per cent) had scan evidence of occult metastases. It is concluded that a bone scan is indicated in all patients with breast cancer where skeletal metastases are suspected. Repeated bone scans may introduce new therapeutic possibilities, by providing an earlier objective index of progression of metastatic disease and also by providing a quantitative method of assessing the response to therapy.