Abstract
Surgery for insulinoma represents one of the best examples of the application of the principles of physiology and pathology in therapeutics. Seven new cases of insulinoma are presented. New diagnostic tests including radioimmunoassay double antibody insulin levels and a diagnostic trial of diazoxide, an anti-insulin agent, were used. Six lesions were benign; four were treated by enucleation and two by distal pancreatectomy. The remaining patient had palliative cholecystojejunostomy for malignant insulinoma followed by chemotherapy with streptozotocin. Selective celiac angiography can now demonstrate the majority of insulinomas. With refinements in technic more nonpalpable lesions will be demonstrated, thus simplifiying the operative approach. Since 1958, 527 cases have been reported in the literature. Tabulation of nonpalpable lesions reveals that 53 per cent were located in the head of the pancreas, the remainder in the body and tail. These figures suggest that if no lesion can be located by arteriography or palpation, blind distal pancreatectomy should be performed. At this point, if no hyperglycemic response is obtained and serial frozen sections give negative results, subtotal pancreatectomy (95 per cent) will remove 90 per cent of these occult tumors.
| Original language | English |
|---|---|
| Pages (from-to) | 231-239 |
| Number of pages | 9 |
| Journal | American Journal of Surgery |
| Volume | 125 |
| Issue number | 2 |
| DOIs | |
| State | Published - 1973 |
| Externally published | Yes |
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All Science Journal Classification (ASJC) codes
- Surgery
Cite this
Diagnosis and management of insulinoma. / Filipi, Charles; Higgins, George A.
In: American Journal of Surgery, Vol. 125, No. 2, 1973, p. 231-239.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Diagnosis and management of insulinoma
AU - Filipi, Charles
AU - Higgins, George A.
PY - 1973
Y1 - 1973
N2 - Surgery for insulinoma represents one of the best examples of the application of the principles of physiology and pathology in therapeutics. Seven new cases of insulinoma are presented. New diagnostic tests including radioimmunoassay double antibody insulin levels and a diagnostic trial of diazoxide, an anti-insulin agent, were used. Six lesions were benign; four were treated by enucleation and two by distal pancreatectomy. The remaining patient had palliative cholecystojejunostomy for malignant insulinoma followed by chemotherapy with streptozotocin. Selective celiac angiography can now demonstrate the majority of insulinomas. With refinements in technic more nonpalpable lesions will be demonstrated, thus simplifiying the operative approach. Since 1958, 527 cases have been reported in the literature. Tabulation of nonpalpable lesions reveals that 53 per cent were located in the head of the pancreas, the remainder in the body and tail. These figures suggest that if no lesion can be located by arteriography or palpation, blind distal pancreatectomy should be performed. At this point, if no hyperglycemic response is obtained and serial frozen sections give negative results, subtotal pancreatectomy (95 per cent) will remove 90 per cent of these occult tumors.
AB - Surgery for insulinoma represents one of the best examples of the application of the principles of physiology and pathology in therapeutics. Seven new cases of insulinoma are presented. New diagnostic tests including radioimmunoassay double antibody insulin levels and a diagnostic trial of diazoxide, an anti-insulin agent, were used. Six lesions were benign; four were treated by enucleation and two by distal pancreatectomy. The remaining patient had palliative cholecystojejunostomy for malignant insulinoma followed by chemotherapy with streptozotocin. Selective celiac angiography can now demonstrate the majority of insulinomas. With refinements in technic more nonpalpable lesions will be demonstrated, thus simplifiying the operative approach. Since 1958, 527 cases have been reported in the literature. Tabulation of nonpalpable lesions reveals that 53 per cent were located in the head of the pancreas, the remainder in the body and tail. These figures suggest that if no lesion can be located by arteriography or palpation, blind distal pancreatectomy should be performed. At this point, if no hyperglycemic response is obtained and serial frozen sections give negative results, subtotal pancreatectomy (95 per cent) will remove 90 per cent of these occult tumors.
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U2 - 10.1016/0002-9610(73)90033-0
DO - 10.1016/0002-9610(73)90033-0
M3 - Article
VL - 125
SP - 231
EP - 239
JO - American Journal of Surgery
JF - American Journal of Surgery
SN - 0002-9610
IS - 2
ER -