Abstract:
INTRODUCTION:Insulinoma is a rare, but curable, endocrine tumour. The ability to localise the tumour accurately before or during surgery is an important factor in the management of these elusive lesions, which has been extensively debated. We have reviewed our experience of these lesions to establish the role of localisation tests. PATIENTS AND METHODS:The medical records of 20 consecutive patients who had surgery for sporadic insulinomas since 1985 at this institution were retrospectively reviewed. All the patients had a definite biochemical diagnosis of endogenous hyperinsulinism. Results of pre-operative and intra-operative localisation tests were compared with the final outcome. RESULTS:Of the 20 patients with sporadic insulinomas reviewed, 17 patients (85%) had multiple pre-operative localising investigations. Overall accuracy of pre-operative localisation tests was 33%. Non-invasive pre-operative localisation tests (ultra-sonography, CT, MRI) had a combined localisation rate of 25% with MRI having the highest sensitivity of 71%. Invasive tests (angiography, transhepatic portal venous sampling [THPVS], endoscopic ultrasound) detected 48% of lesions with THPVS being most sensitive (67%). THPVS was particularly helpful in localising lesions before re-operation. Intra-operative inspection and palpation localised the lesions correctly in 91% and intra-operative ultrasound in 93% of cases. All 5 occult tumours (indeterminate anatomical site before operation) were palpable at surgery and four of these were also correctly identified by intra-operative ultrasound. Site and size of tumour correlated poorly with pre-operative localisation. Operative procedure did not influence outcome with three patients needing re-operation. One patient died (5% mortality) and 9 patients (45%) had complications. Normoglycaemia has been obtained in all but one patient. CONCLUSIONS:Insulinomas can be readily localised by systematic operative exploration. Non-invasive pre-operative investigations (ultrasonography/MRI) may help identify the location of tumour to determine the appropriate surgical procedure. Invasive pre-operative localisation tests like angiography and THPVS may be a valuable adjunct for re-operations. This also helps reduce the costs.
journal_name
Ann R Coll Surg Engljournal_title
Annals of the Royal College of Surgeons of Englandauthors
Ravi K,Britton BJdoi
10.1308/003588407X179008subject
Has Abstractpub_date
2007-04-01 00:00:00pages
212-7issue
3eissn
0035-8843issn
1478-7083journal_volume
89pub_type
杂志文章abstract::INTRODUCTION Often, left-sided colorectal surgery requires splenic flexure mobilisation (SFM) to allow a tension-free anastomosis to be carried out. This step is difficult and not without risk. We investigated a system of anatomical siting of the splenic flexure using computed tomography (CT). METHODS The Shrewsbury S...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2016.0298
更新日期:2017-03-01 00:00:00
abstract::Eleven patients underwent primary mandibular reconstruction following resection of a head and neck squamous cell carcinoma. Reconstruction consisted of a free rib graft and a pectoralis major myocutaneous flap. One rib graft failed and one graft, although successful, required removal during a wider resection for tumou...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1995-07-01 00:00:00
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journal_title:Annals of the Royal College of Surgeons of England
pub_type: 临床试验,杂志文章
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更新日期:1995-01-01 00:00:00
abstract:INTRODUCTION:Much literature reports on selective nerve root blocks (SNRBs) in cases of lumbosacral radiculopathy. Unfortunately, authors only inconsistently reveal the exact needle tip position relative to the causative pathology at the time of injection. Different injection sites may provide different symptomatic ben...
journal_title:Annals of the Royal College of Surgeons of England
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doi:10.1308/003588413X13629960048073
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abstract::Seatbelt associated blunt trauma to the rectum is a rare but well recognised injury. The exact mechanism of hollow visceral injury in blunt trauma is unclear. Stress and shear waves generated by abdominal compression may in part account for injury to gas containing structures. A 'seatbelt sign' (linear ecchymosis acro...
journal_title:Annals of the Royal College of Surgeons of England
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journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
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更新日期:1991-05-01 00:00:00
abstract::Introduction Patients with large ptotic breasts undergoing immediate implant-based reconstruction often require skin-reducing mastectomy to optimise the aesthetic outcome. However, healing complications, especially at the resulting inverted T-junction, leading to wound dehiscence, infection, skin necrosis, implant exp...
journal_title:Annals of the Royal College of Surgeons of England
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journal_title:Annals of the Royal College of Surgeons of England
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abstract::Arterial disease changes the shape of Doppler ultrasound waveforms recorded noninvasively from arteries in the lower limbs. These changes can be described numerically by computer analysis of waveforms, and techniques currently in use are pulsatility index, Laplace transform and principal component analysis. These wave...
journal_title:Annals of the Royal College of Surgeons of England
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更新日期:1986-03-01 00:00:00
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journal_title:Annals of the Royal College of Surgeons of England
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更新日期:1993-03-01 00:00:00
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journal_title:Annals of the Royal College of Surgeons of England
pub_type: 临床试验,杂志文章
doi:
更新日期:1995-09-01 00:00:00
abstract::During a 10-year period (December 1984 to December 1994), 1500 cases of frostbite were treated at a tertiary care medical facility. They were all males with their ages ranging from 17 to 43 years. All the patients sustained the frostbite injury in the northeastern part of Pakistan known as the Karakoram range of mount...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1998-03-01 00:00:00
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journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1993-01-01 00:00:00
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更新日期:2011-11-01 00:00:00
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journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1986-09-01 00:00:00
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更新日期:2012-10-01 00:00:00
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更新日期:2005-07-01 00:00:00
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journal_title:Annals of the Royal College of Surgeons of England
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更新日期:1975-03-01 00:00:00
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journal_title:Annals of the Royal College of Surgeons of England
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更新日期:1985-05-01 00:00:00
abstract::A simple technique is presented for the control of bleeding from the posterior aspect of an aortic end-to-end anastomosis. ...
journal_title:Annals of the Royal College of Surgeons of England
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更新日期:2001-11-01 00:00:00
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journal_title:Annals of the Royal College of Surgeons of England
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更新日期:1992-09-01 00:00:00
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更新日期:2020-04-01 00:00:00