No abstract

subintimal angioplasty can reasonably be performed outside major teaching institutions. There is a short learning curve associated with the procedure.

Thromboembolic diseases during pregnancy are usually managed by conventional anticoagulation and patients are at high risk of pulmonary embolism. Inferior Vena Cava (IVC) filters can be used in cases of documented pulmonary embolism (PE) where anticoagulation is contraindicated or has failed. In our case the patient was diagnosed as having a deep vein thrombosis (DVT) and was started on anticoagulant therapy. Twenty four hours afterwards she went into labor and an IVC filter was inserted due to the risk of pulmonary embolism. She was managed successfully during labor and postpartum period. This shows that IVC filters can be used during labor to try and prevent pulmonary emboli.

No abstract

Malignant insulinomas are very rare endocrine tumours with a variable clinical course. We describe a 51-year-old man who had two large insulinomas resected from the body of the pancreas and 19 years later, having again become symptomatic, was found to have hepatic metastases. Medical treatment with diazoxide and octreotide failed to control his symptoms, but repeated hepatic embolization effected both symptomatic and biochemical improvements for a further 5 years. When symptoms recurred but further embolization failed to control his symptoms the hepatic metastases were treated by outpatient percutaneous radio-frequency ablation. He remains symptom-free 18 months later and levels of insulin and pro-insulin have nearly normalized. The survival, with liver metastases, for 27 years in a man with a malignant insulinoma has not been described previously. Malignant insulinoma may follow a rather indolent course and symptoms respond well to locally destructive therapies. Hepatic embolization is less traumatic than hepatic lobe resection and radio-frequency ablation offers an alternative if vascular access to the tumour is no longer possible.