Test de estimulación intraarterial selectiva con calcio en el diagnóstico de localización de insulinomas: Casos clínicos / Selective intra arterial calcium stimulation for the localization of insulinomas: Report of two cases

Insulinoma is the most common neuroendocrine tumor. Its clinical manifestations are frequently confounded with neuropsychiatric symptoms, and definitive diagnosis can be delayed for a long time. These tumors are usually small, of less than 2 cm. Thus, their preoperative localization is difficult. We report two patients with a clinical diagnosis of insulinoma, in whom the preoperative imaging study was negative. Both fulfilled diagnostic criteria, with high serum insulin levels in the presence of a blood glucose of less than 45 mg/dl. The imaging study, including abdominal computed tomography and pancreatic endoscopic ultrasonography did not disclose the location of the tumor. A pancreatic angiography with selective stimulation with intra arterial calcium and venous sampling for insulin measurements, was performed in both patients. This test allowed the exact localization of the tumors and their successful excision. A review of other localization diagnostic tests is done (Rev Méd Chile 2004; 132: 71-5).

Remisión parcial del hipercortisolismo en una enfermedad de Cushing posterior a una apoplejia hipofisiaria: caso clínico / Partial remission of Cushing disease after pituitary apoplexy: report of 1 case

ACTH secreting macroadenomas and pituitary apoplexy are unusual in Cushing disease. In the few cases reported in the literature, they have been found in long term hypercortisolism. We communicate a 43 yr old woman with a 4 year evolution Cushing syndrome, who developed sudden cephalea and oftalmoplejia. A Computed Tomography of the pituitary fossa disclosed a macroadenoma with intracapsular hemorrhage and suprasellar expansion. In the functional tests, serum cortisol was suppressed with dexamethasone in a dose of 1 and 8 mg and responded to the desmopressin stimulus. Nevertheless, cortisol levels were lower than those observed in Cushing syndrome of similar magnitude. The tumor was resected by transphenoidal surgery and immunohistochemistry to ACTH was positive. In this case, the laboratory results suggest a partial remission of the hypercortisolism after pituitary apoplexy

Endocarditis infecciosa: factores pronósticos de mortalidad en 131 casos / Infectious endocarditis: prognostic factors of mortality in 131 cases

We followed during their hospital stay, 129 patients aged 14 to 74 years old, who had 131 episodes of infective endocarditis. Clinical assessment, echocardiography and microbiological study was done to all patients. Surgical indications were those derived from complications. Thirty three patients died during hospital stay (25.2 percent). There were no differences between survivors and deceased patients in the lapse between onset of symptoms and hospital admission, presence of fever, dyspnea or heart murmurs. Skin and mucosal septic manifestations occured with higher frequency in deceased patients (57.1 and 24.3 percent respectively). Blood cultures were positive in 55 percent in survivors and 48 percent in those who died. The most frequent infecting organisms were staphilococci and streptococci. Vegetations were found with greater frequency in aortic position in both groups of patients. Deceased patients had a higher frequency of cardiac failure (84 and 65 percent respectively) and embolic episodes (77 and 46 percent respectively) than survivors. Antimicrobial treatment was successfull in 94 percent of survivors and 15 percent of those who died. Forty percent of survivors and 54 percent of deceased patients were subjected to surgical procedures. The most important predictor of hospital mortality in this series of patients with infective endocarditis was antimicrobial treatment failure