Newton's Law to the rescue: therapeutic effects of gravity aiding the management of a migratory venous foreign body--a case report.

The management of intravascular metallic foreign bodies (FB) can be difficult and challenging. We report a case of a migrating FB, initially within the femoral vein which subsequently migrated to the intrahepatic vena-cava. Following a change of posture, the metallic FB moved with gravity against the normal venous blood flow to the left renal vein. It was finally fixed in position in a peripheral branch of the renal vein using an intravascular stent. Employing gravity as a therapeutic intervention and the technique used in isolating the FB has not, to our knowledge, been reported before. A case is described, and the literature is reviewed.

Delayed presentation of arteriovenous fistula 20 years after blunt renal trauma.

Delayed hematuria following blunt trauma is rare but can be significant. We describe an unusual delayed presentation of renal arteriovenous fistula following blunt trauma.A gentleman presented with hematuria and clot colic. Following initial investigations, renal arteriography showed an arteriovenous fistula in the mid-pole of the right kidney. The fistula was successfully occluded by super-selective coil embolization. Although this case is an unusual presentation, AV fistulae must be ruled out in management of patients of hematuria.

Use of inferior vena cava filters in thromboembolic disease during labor: case report with a literature review.

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.

Radio-frequency ablation for symptom control in a patient with metastatic pancreatic insulinoma.

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.