Objective-To examine the use of balloon angioplasty in the treatment of native adult aortic coarctation.Design-Haemodynamic and angiographic studies to establish the diagnosis of aortic coarctation were established before carrying out the procedure in all patients.Setting-All the studies and angiographic procedures were performed in a large district general hospital within the departments of cardiology and radiology. There was careful perioperative monitoring. The mean hospital stay was three days.Patients-15 adult patients (with clinical, haemodynamic, and angiographic evidence of native aortic coarctation) were considered for this treatment. 13 were offered balloon angioplasty. One was excluded, as there was no significant gradient across the lesion. One patient had complete atresia at the site of the coarctation.Interventions--Percutaneous transluminal balloon angioplasty was carried out with balloon catheters diameter 2 mm less than the diameter of the aorta immediately below the left subclavian artery to minimise the possibility of tearing the aortic wall.Main outcome measures-Abolition or significant reduction of the preoperative gradient was achieved in all 13 patients treated. shed work suggests that the older the child at angioplasty the less is the likelihood of restenosis, and in one adult series of eight cases, the results at one year follow up were good (0% restenosis).2 We describe our experience with 15 adults. This is the first series reported by a British centre. Patients and methodsBetween March 1987 and March 1991 angiography with a view to angioplasty was performed on 15 patients (10 men and five women) with native aortic coarctation. The age range was 16 to 60 (mean 35 53) years. The first five patients underwent diagnostic catheterisation with angioplasty as a separate procedure, whereas we offered our last 10 patients angiography and angioplasty as a combined procedure.Eleven (73%) of the 15 patients presented with hypertension, one (6-6%) with breathlessness, one (6-6%) with a possible hypoplastic

No abstract

No abstract

a logical approach. If an insulinoma is suspected a means of confirming the diagnosis would be to take three morning plasma samples after an overnight fast. In a subject who has fasting hypoglycaemia an amended ratio of more than 50 AU/ mg, in the absence of very severe obesity, is strongly suggestive of an insulinoma, and a ratio of more than 200 ,uU/mg would appear to be diagnostic. Very occasionally patients with extreme obesity, pregnancy, or liver disease with a portosystemic shunt might give "false-positive" results; in most doubtful cases an ethanol infusion could be performed as described elsewhere (Turner et al., 1971).It has recently been shown that insulinomas secrete a high proportion of proinsulin (Melani et al., 1970a). This does not invalidate the examination of fasting insulin levels as a diagnostic measure, as a high level of immunoreactive insulin relative to the plasma glucose is the diagnostic feature-any cross-reacting proinsulin from an insulinoma would exaggerate an abnormal ratio.

case ventilatory depression returns. The use of a larger dose of naloxone, given either intravenously or intramuscularly, is being investigated to determine whether the action of naloxone can be usefully prolonged.We thank the midwives, obstetricians, and paediatricians of the University Hospital of Wales for their help and co-operation in the study. There was no significant difference in the peak levels or pattern of enzyme increase. The incidence of cardiac failure and reinfarction was similar in the two groups, but major arrhythmias were less common in those on streptokinase (P <0 05). In the streptokinase group there were 36 minor and six more serious haemorrhagic com- References