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). The postural stimulation test was based on measurements of plasma aldosterone and renin activity at 08.00 h and at noon after 4 h of ambulation. The CT scans of the adrenals were reviewed by a single radiologist. Bilateral venous sampling of adrenal veins was attempted in all patients and blood collected for aldosterone and cortisol assay. Plasma aldosterone concentration increased after 4 h of standing in all cases of hyperplasia but was also demonstrated in 10/15 patients with a surgically-proven APA. If one defines a significant postural rise as being greater than 30%, then 8/15 patients with APA can be considered as being posturally responsive. Computed tomography scanning correctly identified all 15 cases of APA and also classified correctly the remaining five cases of hyperplasia (four cases of IHA and one case of PAH). Venous sampling failed technically in 4/15 cases of APA and in one case of IHA: a total of 5/20 (25%,). A correct diagnosis of APA or IHA was established in all the remaining cases. However, the one case of PAH was treated successfully by adrenalectomy following venous sampling, which suggested a unilateral adrenal lesion: this one result was the only instance where venous sampling altered clinical decision-making. Computed tomography scanning may be used alone to confirm the cause of hyperaldosteronism where postural studies suggest an adrenal adenoma, and such patients may be considered for early surgery. Venous catheterization studies are not necessary routinely. but may still be useful in selected patients, particularly when CT scanning shows no clear lesion.

A review of the statistical analysis used in papers published in Clinical Radiology and British Journal of Radiology

Statistical analysis such as significance testing have become essential features of published medical studies. This has resulted in an increased frequency with which statistics are used, making the interpretation of scientific publications more difficult. There is an extensive array of tests and techniques. The aim of this study is to identify which statistical tests are used in radiology publications. All major articles published in Clinical Radiology and British Journal of Radiology in one year were reviewed. The frequency of statistical methods used was as follows: no statistical method or descriptive statistics only 103 (47%), one type of statistical method 67 (31%), and two or more methods 47 (22%). Statistics dealing with basic inference, decisions, contingency tables or correlation/regression techniques were found in 124 (53%) in which a procedure had been used. Advanced statistics including receiver operating characteristics (ROC), odds ratio, regression techniques, multiway ANOVA, and nonparametric ANOVA studies accounted for only 41 (19%) in which a procedure had been used. We conclude that descriptive analysis and basic statistical techniques account for most of the statistical tests reported. Physicians should concentrate on improving their understanding of basic statistics but advice should be sought from professionals in the fields of biostatistics and epidemiology as to whether the use of more advanced techniques would be more appropriate.

Neurological illness following treatment with fludarabine

Fludarabine is a comparatively new drug for the treatment of low-grade lymphoid malignancy. This report describes five cases of unusual neurological illnesses occurring after treatment with fludarabine. These suggest that caution should be exercised in patients receiving fludarabine who develop neurological abnormalities, with prompt investigation and if necessary cessation of the drug.

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 (0.06%) after coronary arteriography, four (0.55%) after coronary angioplasty, and one after intraaortic balloon pump insertion for complications during coronary arteriography. Of the three patients with acute leg ischaemia within 24 h of the cardiac procedure, two required emergency surgery and the other was managed by systemic heparinization. Four patients developed intermittent claudication on mobilization after the procedure but referral for angiography was after an interval of 6 days to 12 months. One patient was treated by intra-arterial thrombolysis and three by percutaneous transluminal angioplasty. On follow-up, at 12-36 (mean 20) months, only one patient (who had been treated surgically) had residual symptoms of ischaemia in the leg of the transfemoral access. We conclude that interventional techniques have a useful role to play in the management of symptomatic leg ischaemia complicating transfemoral cardiac procedures.

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. Numerous arteriographic methods for evaluating SCAVF in the arm have been reported. We describe a new method involving percutaneous retrograde catheterization of the brachial artery proximal to the SCAVF with a commercially available 3 F intra-arterial digital subtraction angiography catheter set (Cook [UK] Limited).

Cloned mouse cells with natural killer function and cloned suppressor T cells express ultrastructural and biochemical features not shared by cloned inducer T cells

We have examined the morphology, cytochemistry, and biochemistry of mouse leukocyte subsets by analyzing cloned leukocyte populations specialized to perform different immunologic functions. Cloned cells expressing high-affinity plasma membrane receptors for IgE and mediating natural killer (NK) lysis and cloned antigen-specific suppressor T cells contained prominent osmiophilic cytoplasmic granules similar by ultrastructure to those of mouse basophils. Both clones also incorporated 35SO4 into granule-associated sulfated glycosaminoglycans, expressed a characteristic ultrastructural pattern of nonspecific esterase activity, incorporated exogenous [3H]5-hydroxytryptamine, and contained cytoplasmic deposits of particulate glycogen. By contrast, cloned inducer T cells lacked cytoplasmic granules and glycogen, incorporated neither 35SO4 nor [3H]5-hydroxytryptamine, and differed from the other clones in pattern of nonspecific esterase activity. These findings establish that certain cloned cells with NK activity and cloned suppressor T cells express morphologic and biochemical characteristics heretofore associated with basophilic granulocytes. However, these clones differ in surface glycoprotein expression and immunologic function, and the full extent of the similarities and differences among these populations and basophils remains to be determined.

Structure and microdistribution of components of gold alloys

SYNOPSIS IN INTERLINGUA STRUCTURA E MICRODISTRIBUTION DEL COMPONENTES DE ALLIGATOS DE AURO.-Specimens de fusible alligatos de auro dental esseva subjicite a un varietate de analyses, incluse le sondage electronic e le quantitative microscopia televisional. Esseva trovate que certe areas de inclusion esseva componite de oxydos de metallo, durante que alteres consisteva de materiales de investimento o de politura. Es postulate que inhomogeneitates contribue possibilemente al migration de iones metallic ad in dur e molle tissus oral.