Insulinoma: diagnostic features and treatment management

Background. Insulinoma is the most common functional pancreatic neuroendocrine tumor originating from β-cells, with unregulated insulin production and rarely associated with MEN-I syndrome. Diagnosis and treatment of insulinoma are a challenge in the practice of endocrinologist. Aim. To determine on the basis of retrospective analysis the optimal approaches to the management of patients with organic hyperinsulinism. Material and methods. Medical records of 72 patients admitted with suspected organic hyperinsulinism had been screened and medical histories of patients with a confirmed diagnosis of organic hyperinsulinism were included into the analysis. Anamnesis, results of objective, laboratory and instrumental examinations, methods and results of the treatment were analyzed. Results. The diagnosis of insulinoma was confirmed in thirty two cases. Hypoglycemia was achieved within the first 48 hours after the start of the 72-hour fasting test in 100% of cases. Study results showed that in 50% of cases the size of the pancreatic neoplasm was more than 1.4 cm. Inverse correlation between tumor size and plasma glucose concentration at the time of hypoglycemia was found (r=–0.45; р=0.02). Surgical treatment was carried out in thirty out of 32 patients. Surgical enucleation of insulinoma was performed in 12 (40%) cases, distal pancreatectomy — in 18 (60%). Insulinoma was confirmed in 27 cases, while in three patients diagnosis of non-insulinoma pancreatogenous hypoglycemia («nesidioblastosis») was established according to histological findings. Positive clinical result was achieved after all surgeries. In postoperative period patients were discharged within 11—30 days. Patients without post-operative complications were discharged 13.0±1.4 days after surgery. Twelve (40%) patients developed post-operative complications. The duration of hospital stay in these cases was significantly longer 20.1±1.9 (р<0,01). Conclusion. Obtained data confirmed that comprehensive approach including 72-hours fasting test, use of modern imaging techniques and application of high-tech treatment methods, is crucial for successful diagnosis and treatment of insulinoma.

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Can diagnostic changes caused by cone beam computed tomography alter the clinical decision in impacted lower third molar treatment plan?

Dentomaxillofacial Radiology ◽

10.1259/dmfr.20200412 ◽

2020 ◽

pp. 20200412

Author(s):

Lucas Moreira Mendonça ◽

Hugo Gaêta-Araujo ◽

Pedro Bastos Cruvinel ◽

Ingrid Wenzel Tosin ◽

Marcelo Rodrigues Azenha ◽

...

Keyword(s):

Computed Tomography ◽

Logistic Regression ◽

Cone Beam Computed Tomography ◽

Treatment Plan ◽

Third Molar ◽

Clinical Decision ◽

Cone Beam ◽

Diagnostic Features ◽

Operative Complications ◽

Post Operative Complications

Objectives: This study observed whether changes in diagnosis caused by analysis of three-dimensional images can lead to alterations in the treatment plans of impacted lower third molars (ILTMs). Methods: Sets of panoramic (PAN) – cone beam computed tomography (CBCT) of 218 patients were assessed for ILTM classification, contact with mandibular canal, contact and resorption of the lower second molar (LSM), intraoperative planning and post-operative expectations. Results: Percentage agreement and McNemar test compared PAN vs CBCT assessments. Logistic regression analyzed the dependency of change in surgical planning considering the changes in diagnostic features; descriptive statistics was used to observe the expectation of post-operative complications and paresthesia. Differences were found between PAN vs CBCT for classification of impaction and positioning, LSM relationship, choice for crown and root sectioning and expectation of post-operative complications (all with p < 0.001). Logistic regression indicated that the change in diagnosis caused by CBCT examination did not change the clinical decision to extract ILTM but altered the planning of intraoperative steps such as osteotomy, crown sectioning and relaxing incision. The expectation of post-operative complications decreased when professionals planned the ILTM removal using tri-dimensional images. Conclusions: We concluded that changes in the diagnosis after CBCT examination can lead to alterations in the treatment plan of impacted lower third molar.

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Post-operative Complications of Patients Underwent Mastoidectomy at Tertiary Care Hospital

10.53350/pjmhs211561394 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1394-1396

Author(s):

M. W. Saleem ◽

S. Ali, L. Wajid

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Case Series ◽

Open Cavity ◽

Care Hospital ◽

Case Series Study ◽

Study Results ◽

Operative Complications ◽

Prolonged Discharge ◽

Post Operative Complications

Aim: To analyze the post mastoidectomy complications in patients presenting at tertiary care hospital. Methods: This case series study was conducted at Department of ENT, DG Khan Hospital, DG Khan from March 2020 to September 2020 over the period of 6 months. Total 65 patients came for open cavity mastoidectomy either male or female having age between 20-60 years were selected for this study. Results: In present study 65 patients had undergone open cavity mastoidectomy. Mean age of the patients was 39.95 ± 12.57 years. Out of 65 patients, cavity complications was found in 20 (31%) patients. Among the 20 patients who had cavity problems, the most common problem was prolonged discharge found in 19 (95%) patients followed by accumulation of wax in the cavity was found in 5 (25%) patients, Vertigo persisting beyond the immediate postoperative period was found in 3 (15%) patients, perichondritis of pinna was seen in 1 (5%) patients, development of facial palsy was found in 5 (50%) patients, recurrent cholesteatoma was found in 3 (15%) patients and wound infection was found in 2 (10%) patients. Conclusion: Results of present study showed higher rate of post operative complications after mastoidectomy. Sclerotic mastoid was most common. Higher rate of complications was seen after 40th decade of life. Most of the patients were male as compared to female. Prolonged discharge was the most common problem. Keywords: Mastoidectomy, Cavity, Meatoplasty, Pneumatisation, Cholesteatoma

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Pelvic Canal Narrowing Caused by Triple Pelvic Osteotomy in the Dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633130 ◽

1994 ◽

Vol 07 (03) ◽

pp. 110-113 ◽

Cited By ~ 6

Author(s):

D. L. Holmberg ◽

M. B. Hurtig ◽

H. R. Sukhiani

Keyword(s):

Postoperative Complications ◽

Pelvic Osteotomy ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Canal Width ◽

Operative Complications ◽

Post Operative Complications

SummaryDuring a triple pelvic osteotomy, rotation of the free acetabular segment causes the pubic remnant on the acetabulum to rotate into the pelvic canal. The resulting narrowing may cause complications by impingement on the organs within the pelvic canal. Triple pelvic osteotomies were performed on ten cadaver pelves with pubic remnants equal to 0, 25, and 50% of the hemi-pubic length and angles of acetabular rotation of 20, 30, and 40 degrees. All combinations of pubic remnant lengths and angles of acetabular rotation caused a significant reduction in pelvic canal-width and cross-sectional area, when compared to the inact pelvis. Zero, 25, and 50% pubic remnants result in 15, 35, and 50% reductions in pelvic canal width respectively. Overrotation of the acetabulum should be avoided and the pubic remnant on the acetabular segment should be minimized to reduce postoperative complications due to pelvic canal narrowing.When performing triple pelvic osteotomies, the length of the pubic remnant on the acetabular segment and the angle of acetabular rotation both significantly narrow the pelvic canal. To reduce post-operative complications, due to narrowing of the pelvic canal, overrotation of the acetabulum should be avoided and the length of the pubic remnant should be minimized.

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