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Surgical Treatment of Hyperinsulinism During the Course of Pancreatic Cancer (Insulinoma) - One Center Experience

100%
Grygiel K., Szmidt J., Jeleńska M., Pawlak K.
Polish Journal of Surgery
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2012
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vol. 84
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issue 1
31-36
EN
Endogenic hyperinsulinism is mainly caused by neuroendocrine tumors (insulinomas) which autonomously secrete insulin. Because the symptoms are often aspecific, a considerably delay in diagnosis occurs. The treatment consists of operative removal of the tumor from the pancreas, preceded by pre-operative localization. In this article we describe our experience with surgical removal of insulinomasMaterial and methods. We retrospectively analyzed all patients with insulinoma which were treated in our center. Definitive diagnosis was made using a 72-hours glucoses fasting test. We describe the symptoms, localization techniques and the outcomes after surgery.Results. Between January 2002 and May 2011, 45 patients (35.6% men and 64.4% female) were treated in our center. The most prevalent symptoms were altered consciousness and general malaise. The combination of CT-scan and endoscopic ultrasound had the highest (90%) sensitivity to localize tumors pre-operatively. During surgery, in 40 patients (89%) the tumor could be removed by enucleation. In the other five patients partial pancreas resection was required. In 22 patients (49%) we used intra-operative insulin level measurements to confirm complete tumor resection. Within the first month after surgery, two patients (4.4%) developed acute pancreatitis, four patients (8.8%) developed a pancreatic fistula. One patient died of multi-organ-failure. All patients were free from symptoms of hyperinsulinism after the surgery and after a median follow-up of 4.5 years.Conclusions. Based on the experience with 45 patients, surgical removal, aided by pre-operative localization with CT and endoscopic ultrasonography, is an effective and safe treatment for insulinomas.
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Influence of Suprarenal Stentgraft Fixation on Renal Function in Patients After Abdominal Aortic Aneurysm Endovascular Exclusion

52%
Gałązka Z., Szmidt J., Rowiński O., Jakimowicz T., Nazarewski S., Grochowiecki T., Grygiel K., Wojtaszek M., Pietrasik K., Chudziński W., Pacho R.
Polish Journal of Surgery
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2007
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vol. 79
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issue 1
4-11
EN
Currently, there are two methods of stentgraft implantation considering patients with abdominal aortic aneurysms (AAA) undergoing endovascular repair: the suprarenal and infrarenal fixation. It has been suggested that suprarenal fixation may lead towards impaired kidney function.The aim of the study was to assess the influence of suprarenal stentgraft fixation on kidney function in patients after endovascular repair of abdominal aortic aneurysms.Material and methods. The inclusion criteria were fulfilled by 118 patients who were subjected to endovascular treatment, due to abdominal aortic aneurysms. They were consequently divided into two groups - suprarenal (NN) or infrarenal (PN) - based on the stentgraft system used. Both groups were compared on the basis of co-morbidities, operative risk (ASA score), and volume of contrast medium used intraoperatively. The creatinine concentration (cr) and creatinine clearance (Cr.cl) were assessed during the preoperative period, between the 3-rd and 7-th postoperative day, and after 3 months.Results. Increased creatinine level during the first postoperative week was observed in 12 of 118 patients (10.1%): in the suprarenal group - 7 of 66 (10.6%), and in the infrarenal group 5 of 52 (9.96%). During the 3-rd postoperative month the increase (cr > 1.5 mg/dL) was present in 3 of 118 patients (2.5%): in the suprarenal group - 2 of 66 (3.03%) and in the infrarenal group-1 of 52 (1.9%). The difference between both groups was statistically insignificant. Furthermore, there was no statistically significant difference between creatinine clearance levels considering both groups.Conclusions. In case of patients undergoing endovascular repair for AAA, implantation of a suprarenal device is a safe method, which does not significantly impair postoperative renal functioning. This increases the number of patients eligible for AAA treatment by means of stentgraft implantations.
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