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Objective To compare the role on determining the functional location of primary hyperaldosteronism (PHA)by multi-slice spiral CT (MSCT)and by adrenal vein sampling (AVS),and to discuss the reasonable method to use MSCT and AVS in localization diagnosis of PHA.Methods Clinical data of 78 patients with PHA were analyzed retrospectively.These patients were diagnosed in our department from June 2014 to June 2018.There were 27 male and 51 female patients.With mean age of (47.5 ± 11.2) years old.The mean systolic blood pressure was (190 ± 24)mmHg and mean diastolic blood pressure was (111 ± 16) mmHg.The mean history of hypertension was (6.0 ± 6.0) years.The mean serum potassium was (2.4 ± 0.6) mmol/L.The mean plasma aldosterone concentration (PAC) was (415.7 ± 235.4) pg/ml.The mean plasma renin activity (PRA) was (3.2 ± 5.7) ng/(ml · h).The mean aldosterone/renin ratio (ARR) was 409.0 ± 434.9.All PHA patients underwent MSCT and AVS,the accuracy on determining the functional location of PHA by MSCT and by AVS were evaluated based on the pathological results and clinical outcomes.The influence of adrenal size and character on the accuracy of determining the functional location of PHA by MSCT were analyzed.Results The rate of accuracy of determining the location of PHA by AVS was higher than that by MSCT[100.0％ (78/78) vs.71.8％ (56/78),P ＜ 0.05].When MSCT indicated:adrenal hyperplasia,adrenal tumor volume less than 1 cm,1 cm ＜ adrenal tumor volume ≤ 2 cm,adrenal tumor volume ＞ 2 cm,the rate of accuracy in localization diagnosis with MSCT was 50.0％ (4/8),81.0％ (17/21),92.9％ (26/28),100.0％ (9/9) respectively.Its trend has statistical significance (P ＜ 0.05).The diagnostic accuracy rate of MSCT for aldosterone adenoma was 79.6％ (43/54),while that of adrenal hyperplasia was 58.3 ％ (7/12).There was no statistical significance between two diagnostic accuracy rate of MSCT(P ＞ 0.05).Conclusions AVS is the gold standard for localization diagnosis.When MSCT indicates that there is no obvious abnormality in the adrenal gland,adrenal hyperplasia,small tumor (≤ 2 cm),and bilateral adrenal lesions,AVS should be examined at the same time,which can be considered as the gold standard for localization diagnosis.For isolated adrenal tumor (＞ 2 cm) in PHA,the accuracy of localization diagnosis in MSCT is very high and the AVS is unnecessary.
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The insulinoma, which is the most common pancreatic neuroendocrine tumor, can be misdiagnosed and mistreated easily.Recently, the misdiagnosis rate has decreased significantly owing to the establishment of diagnosis and treatment system.However, the misconception about its diagnosis and treatment still exists because the diagnosis and treatment level varies greatly among different centers.This article aims to summarize the experience in the diagnosis and treatment of insulinoma in Peking Union Medical College Hospital, and introduce the qualitative and localization diagnosis, surgical and interventional treatment and perioperative management about insulinoma, so as to standardize the diagnosis and treatment procedure in China.
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[Summary] A 47 years old female presented with palpitation, tremble, sweaty, and weight gain. Insulinoma was suspended and confirmed with hypoglycemia caused by endogenous hyperinsulinemia. The CT scan was failed to localize the tumor. MRI and ASVS showed inconsistent results. A nutrient arterial was found by arterial angiography and explained the different results. Robert assistant surgery successfully removed the tumor and the patient was well recovered.
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Objective To explore the differences of biological markers level between upper urinary tract infection(UUTI) and lower urinary tract infection(LUTI) in children for providing help for localization diagnosis of urinary tract infection(UTI).Methods One hundred and nine children with UTI hospitalized in Children's Hospital of Tianjin from May 2010 to Jan.2012 were divided into UUTI group (18 cases) and LUTI group (91 cases).The clinical information (sex,age,onset symptoms),laboratory test including blood urea nitrogen and creatinine,biological markers including serum cystatin C(CysC),procalcitonin(PCT),β2-microglobulin (β2-MG),urine microalbumin(mAlb),transferrin (TF),α1-microglobulin (α1-MG),β2-MG and N-acetyl-β-D-glucosaminidase (NAG) were recorded.Then SPSS 17.0 software was used to analyze the data.Results UUTI children showed higher level of serum CysC,PCT,urine mAlb,TF,α1-MG,β2-MG and NAG than LUTI children did.The area under ROC curve of the 7 biological markers were all between 0.71 and 0.87.Logistic regression test was used to do multiple regression analysis and establish the multiple regression model.The standard of eliminating or screening variables was 0.05.CysC,PCT,NAG were identified as influence factors.Combining test result of CysC,PCT,NAG could improve diagnostic value so that the sensitivity could reach 90％ and the specificity could reach 88.9％.Conclusions Both of serum CysC,PCT and urine mAlb,TF,α1-MG,β2-MG,NAG can be used for the positioning diagnosis of UTI,and the diagnostic value of joint test of serum change of CysC,PCT,urine NAG is higher than any single biological marker.
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Objective To improve the positivity for insulinoma localization by imaging before surgery.Methods The clinical data of 119 patients with insulinoma who had been admitted to Chinese PLA General Hospital from January 1985 to April 2008 were retrospectively reviewed. Results One hundred patients with hypoglycemia who had been operated and most of them (98/100) diagnosed as insulinoma pathologically were analyzed. They had undergone various methods of localization by imaging before surgery. The positive rates for tumor localization were 22.9% (17/74) by uhrasonography (US), 55.2% (48/87) by CT, 58.8% (10/17) by MRI,76.6% (49/64) by digital subtraction angiography (DSA) ,93.3% (42/45) by endtoscopic ultrasonography (EUS)and 94.7% (18/19) by uhrasonic contrast (UC). While the rates of accuracy for tumor localization were 88.2% (15/17) by US ,87.5% (42/48) by CT, 90.0% (9/10) by MR1,100.0% (49/49) by DSA, 85.7% (36/42) by EUS and 83.3% (15/18) by UC. The rates of accuracy in patients with one,two and three positive images were 88.9% (24/27), 96. 9% (32/33) and 94. 7% (18/19), respectively. The positive rates in patients with combination of two images were 47.6% (30/63) by CT and US ,75.5% (40/53) by CT and DSA ,89.2% (33/37)by CT and EUS,90.0% (27/30) by EUS and DSA ,78.6% (11/14) by DSA and UC ,92.3% (12/13) by CT and UC, and 90.9% (10/1 i) hy EUS and UC, respectively. Conclusion The positive rates and accuracy of localization for insulinoma were increased by combining at least two images, and the combinations of any two of four images including CT, DSA, EUS and UC are suggested. While considering both the cost and effect, we recommend CT combined either with EUS or UC.
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Insulinoma (islet β-cell tumor) is one of the most common pancreatic endocrine tumors. It has a typical clinical manifestation called Whipple's triad. And so far, surgical treatment is the only curative method. But the localization diagnosis of insulinoma is difficult. Recently, with advances in diagnostic tech-niques, the localization diagnosis of insulinoma accuracy has markedly improved. This paper makes a brief overview of the progress in diagnosis and treatment of insulinoma.
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Objective To compare the value of EUS and DSA in the preopreation localization of insulinomas.Methods Twenty-three cases were examined by ultrasonography(US)and spiral computed tomography(CT),of whom 17 cases were examined by endoscopic ultrasonography(EUS),18 cases were examined by digital subtracation angiography(DSA).The preoperative accurate rates of localizing insulinomas were compared among four methods.Results The detective rate of four methods was 13.3% of US,50.0% of CT,73.9% of EUS and 80.0% of DSA.The sensitivity of EUS was significantly higher than US and CT(P
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100 were found in 8,7 and 9 patients respectively.(3)The positive rate in detection of insulinoma by ultrasonography,CT scan and intraoperative palpation was 30%,60% and 100% respectively.Conclusion Typical symptoms and laboratory examinations are main evidence in diagnosis of insulinoma.Intraoperative ultrasound and palpation are more useful for localization diagnosis of insulinoma.Operations should be considered in patients with typical clinical characteristic and negative imageology.
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Objective To assess the clinical value of low-frequency mini - probe sonography ( LFMPS) in preoperative localization of pancreatic endocrine tumors comparing with other imaging methods. Methods Twenty one cases with suspected pancreatic endocrine tumors were enrolled from June 2000 to June 2002, we compared the diagnostic results of LFMPS, transcutaneous ultrasonography ( US) , helico-computed tomography ( HCT) and magnetic resonance imaging (MRI) with surgical localization and histopathological results by using Fujinon 7. 5 MHz miniature probe and SP-701 ultrasonic system. Results Sixteen pancreatic insulinomas and 1 extra pancreatic VIPoma (vesoactive intestinal polypeptide tumor) were confirmed by surgery and histopathological examination in 17 of the 21 patients, and the rest 4 patients didn't receive surgical procedure because of the negative results in all imaging studies. Among pancreatic lesions, they located on head, body and tail in 9, 3 and 4 cases respectively; the average diameter of all 17 lesions was 2. 02cm. LFMPS correctly localized the tumor in 14 of 17 patients (82. 4% ) while CT in 15 of 17 patients (88. 2% ) , MRI in 12 of 17 patients (70. 6% ) and US in 9 of 17 patients (52. 9% ). Besides, the diagnostic accuracy of LFMPS in detection of small size (