Subject(s)
Carcinoma, Hepatocellular/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Aged , Carcinoma, Hepatocellular/pathology , Contrast Media/administration & dosage , Fatal Outcome , Humans , Liver Neoplasms/pathology , Male , Polysaccharides/administration & dosage , Rupture, Spontaneous , Ultrasonography, Doppler, ColorABSTRACT
BACKGROUND: Adequate surgical treatment of hypoglycemia caused by benign diffuse islet cell disease (BDICD) is not associated with predictable results. Arterial stimulation and venous sampling (ASVS) has been reported to establish the diagnosis of BDICD, as well as serve as a guide to resection. The purpose of this study is to determine the efficacy of this method for the treatment of benign diffuse islet cell disease. METHODS: We retrospectively reviewed 38 adults with symptomatic hyperinsulinemic hypoglycemia treated by a single surgeon from 1982 to 1998. Nine of them had pathologic evidence of BDICD. We demonstrated the clinical presentations, serum level of fasting blood sugar, insulin and C-peptide before and after operations, pathological results, and outcomes of distal pancreatectomy in 5 patients and ASVS-guided pancreatectomies in 4 patients with BDICD. RESULTS: Five patients (4 females and 1 male) who received distal pancreatectomy (Group 1) were aged from 19 to 75, and were culled from a group of 30 patients with spontaneous hyperinsulinemic hypoglycemia. Two had the multiple endocrine neoplasia (MEN) 1 syndrome. The follow-up was from 7 to 16 years. Three patients (including 1 MEN 1 patient) became diabetic. Another 1 is euglycemic, and the other MEN 1 patient developed recurrent disease. Four patients (2 males and 2 females, Group 2), found in a group of 8 patients with hyperinsulinemic hypoglycemia, had ASVS-guided pancreatectomies. Their ages ranged from 29 to 69 years. The area of the pancreas supplied by the splenic artery was removed in all patients. Follow-up from half to 2 years showed that all the patients had normal fasting levels of glucose, normal levels of insulin and C-peptide, and no more hypoglycemic attacks. CONCLUSIONS: Arterial stimulation venous sampling is a useful guide for pancreatectomy to treat adult patients with BDICD. Data from this small sample of patients suggest that the results may be superior to those obtained by "blind" distal pancreatectomy.
