Diagnostic challenge and surgical management of multiple pancreatic neuroendocrine tumors - A case report.

Insulinoma is the most common functional solitary, benign pancreatic neuroendocrine tumor. In this paper, we share our experience of triple pancreatic insulinomas, with an idea to highlight the fact that despite the high frequency of solitary insulinoma, there is the possibility of multiple lesions and point out the need for a systematic and detailed radiographic and clinical examination. A 33-year-old woman was admitted to our clinic due to chronic fatigue, sweating, sporadic episodes of palpitations, unsteady hands, and blurred images, which resolve spontaneously after a few minutes. A comprehensive radiological examination revealed two lesions in the pancreatic tail, highly indicative of neuroendocrine tumor - insulinoma, so we elected for surgical treatment. Intraoperative exploration by manual palpation and ultrasonography revealed two more lesions. In the case of sporadically distributed lesions in the pancreas and if it is not possible to accurately differentiate those that represent the insulinoma for sure, the surgical procedure should be delayed. Additionally, tests such as selective arterial calcium stimulation testing should be carried out, and then, with more information in hands, make a re-plan of the potential surgical treatment which should be made.

p21 does not protect cancer cells from apoptosis induced by nongenotoxic p53 activation.

p21(Waf1/Cip1) is a p53 transcription target implicated in both major functions of the tumor suppressor--cell cycle arrest and apoptosis. It is a potent inhibitor of the key cyclin-dependent kinases (CDK1-4), and has been thought to be the main mediator of p53-dependent G1 and G2 arrest. However, an increasing body of information suggests that in addition to its cell-cycle inhibitory activity, p21 can affect p53-dependent apoptosis. These data have been obtained from experiments in which p53 is activated primarily by genotoxic stress. In this study, we use the selective MDM2 antagonist, nutlin-3a, as a nongenotoxic p53 activator and show that the cell-cycle arrest function of p21 is dependent on the cellular context. In most cancer cell lines, p53-dependent p21 induction is essential for cell-cycle arrest, but in some, p21 is dispensable. Depletion of p21 did not increase the apoptotic response to nutlin-3a in all seven cancer cell lines tested and p21 overexpression did not protect apoptosis-sensitive lines from death. p21 was found to mediate nutlin-induced p53-dependent downregulation of another antiapoptotic protein, survivin, without significantly affecting the apoptotic outcome. Taken together our results suggest that p21 induction does not affect the apoptotic response to nongenotoxic p53 activation.

Oscillatory behavior of critical amplitudes of the Gaussian model on a hierarchical structure.

We studied oscillatory behavior of critical amplitudes for the Gaussian model on a hierarchical structure presented by a modified Sierpinski gasket lattice. This model is known to display nonstandard critical behavior on the lattice under study. The leading singular behavior of the correlation length xi near the critical coupling K=K(c) is modulated by a function which is periodic in ln/ln(K(c)-K)/. We have also shown that the common finite-size scaling hypothesis, according to which for a finite system at criticality xi should be of the order of the size of the system, is not applicable in this case. As a consequence of this, the exact form of the leading singular behavior of xi differs from the one described earlier (which was based on the finite-size scaling assumption).

[Radioprotective agents in the decontamination of rats poisoned with percutaneously administered mustard gas]. / Dekontaminacija pacova perkutano trovanih S-iperitom pomocu radioprotektora.

The efficacy of rat skin decontamination by radioprotective agents AET and cystamine were tested. Results were compared to standard decontaminants-alcoholate, clay and fuller's earth. It was found that all the animals decontaminated with standard decontaminants had survived 4 LD50 of poison for 21 days. All the animals poisoned by 6 LD50 had survived for 1 day except for those decontaminated with alcoholate where 50% survived throughout the observation period. Alcoholate and clay protected all, and fuller's earth 70% of animals poisoned by 12 LD50, but no longer than 24 h. AET and cystamine protected all rats from 1.7 LD50 for 3 days, from 1 LD50 for 2 days, and from 2 LD50 for 1 day. When higher doses of poison were used (1.7-6.8 LD50) only partial protection was achieved. Our results support the conclusion that radioprotective agents could be convenient means for improvised decontamination of persons poisoned by sulfur mustard, so additional investigations are necessary.

[The effect of sodium cyanide and its antidotes on the isolated perfused rat heart]. / Dejstvo natrijum cijanida i njegovih antidota na izolovano perfundovano srce pacova.

The experiments were performed to investigate the effects of cyanide and several antidotes (sodium nitrite, DMAP, sodium thiosulfate and phentolamine) on isolated perfused rat heart to further elucidate the mechanism of action of cyanide and its antidotes. Sodium cyanide (40, 50 and 60 mg/ml) produced maximum effects on amplitude, heart rate and coronary flow, after 3 min, regardless of the event recorded. Some dose-dependence was noted, especially on the heart rate, somewhat less on amplitude and almost none on the coronary flow up to 15 min, but notable afterwards. Some spontaneous recovery occurred in each event, the most significant being that of the heart rate. Antidotes per se did not differ significantly in their action on isolated rat heart. All values, with some variations, were maintained within 10-20% of control. Antidotes, injected 1 min after sodium cyanide produced the most evident effects on amplitude and heart rate -- all antidotes practically and almost instantly neutralized the depressant effect of cyanide. Nitrite and particularly DMAP, were the most effective on coronary flow while other antidotes, although effective up to 3 min, did not much differ from cyanide alone throughout the rest of observation.

[Decontamination with clay or alcoholate of pigs percutaneously poisoned with VX and soman]. / Dekontaminacija svinja, perkutano trovanih VX-om i somanom, pomocu gline ili alkoholata.

The efficacy of clay or alcoholate as decontaminants in pigs percutaneously poisoned with 6 LD50 of O-ethyl S-2-diisopropylaminoethyl methylphosphonothioate (VX) and 3 LD50 of 1,2,2-trimethylpropyl methylphosphonofluoridate (soman) nerve gases was tested. It was assessed by the time of onset of the first signs of poisoning and death, as well as by the activity of blood cholinesterase (ChE). No toxic signs or fatalities were observed in decontaminated pigs, regardless of the decontaminant used. In VX poisoning up to 240 min. both decontaminants kept ChE values at normal level. Twenty four hours later, ChE activity in pigs decontaminated with clay was 71%, significantly higher than in pigs decontaminated with alcoholate (49%). In soman poisoning the activity in control group was maintained at almost normal level up to 60 min, followed by rapid fall to 58%. Further readings were impossible due to the death of all animals. No significant difference between decontaminants could be noticed throughout the observation of 24 hr. The values were kept between 80 and 100%, with the trend of rising after 120 min.

The efficacy of different decontaminants in rats and pigs percutaneously poisoned with organophosphates.

The efficacies of clay or alcoholate as decontaminants and a polyethylene glycol + oxime N-octylpyridium-4-aldoxime bromide (OPAB) protective ointment were evaluated in rats and pigs percutaneously poisoned with O-ethyl S-2-diisopropylaminoethyl methylphosphonothioate (VX) and soman (GD) nerve gases. The use of protective ointment per se or combined with the decontaminants protected all rats poisoned with GD, regardless of the experimental procedure. No poisoning or fatalities were observed in pigs decontaminated 2 min later with clay or alcoholate, while the protective ointment delayed the onset of poisoning and even prevented death. The application of protective ointment, with or without the use of decontaminants, significantly postponed the onset of poisoning in animals contaminated with VX. There was no significant difference between procedures. Decontamination was very satisfactory and dependent on the duration of exposure, being somewhat more efficient if performed by 30 min after exposure.

The efficacy of different formulations of protective-decontaminating ointments based on polyethylene glycol in rats percutaneously poisoned with highly toxic organophosphates.

Protective-decontaminating ointments based on polyethylene glycols (PEG) of different molecular weights were tested alone or with oxime N-octylpyridinium-4-aldoxime bromide, against percutaneous poisoning by the nerve gases 0-ethyl S-2-diisopropyl methylphosphorothiolate and soman in rats after 60 min exposure. PEG-based ointments consisting of higher PEG combined with the oxime proved the most efficient for both poisons. The combination of lower and medium PEG was somewhat less efficient, while the formulation consisting of mostly lower PEG exerted protective effects only in soman poisoning.

[Efficacy of alcoholates and clay in percutaneous contamination of rats with highly toxic organophosphorus compounds]. / Efikasnost alkoholata i gline kod perkutane kontaminacije pacova visoko toksicnim organofosfornim jedinjenjima.

Efficacy of decontamination by alcoholate and clay has been examined in animals percutaneously poisoned by nerve war gases (VX, soman) and organophosphorous insecticides (parathion, dichlorvos, terbufos) at exposure of 2, 5 and 60 minutes. High efficacy was achieved after two minutes using alcoholates which, except for VX, was lower for 50% after 5 minutes. The similar results were also achieved with clay in nerve war gas poisoning, however, the efficacy of this material was somewhat lower. By delayed decontamination (after 60 minutes) in animals poisoned by parathion and terbufos somewhat lower but still satisfying efficacy was achieved (ZI = 3.3, that is, 11.5). The results obtained have shown that efficacy of decontamination, except for the used materials, depends also on duration of the procedure.

[The effect of the oxime HI-6 on miosis induced by topical administration of sarin and VX in the rabbit eye]. / Delovanje oksima HI-6 na miozu oka kunica, izazvanu lokalnom primenom sarina i VX-a.

Effect of oxime HI-6 to rabbit miosis induced by the topical sarin and VX administration is presented. It has been found that effects of both toxins are better antagonized by parenteral than by topical HI-6 administration. The sarin antagonizing effect was found more effective. It has been also confirmed that there was no significant difference concerning the oxime HI-6 effect when topically administered either as 2.5% hypertonic or isotonic solution. Opposite to PAM-2, HI-6 effect was better in parenteral and topical administration of isotonic solutions, and less effective in local administration of hypertonic solutions.

[High doses of Streptase in the treatment of deep venous thrombosis of the lower extremities]. / Visoko dozirana Streptaza u lecenju duboke venske tromboze donjih ekstremiteta.

We apply the high dosed Steptase in last 10 months, and we find that there are the following advantages compared with the conventional application of Streptase: in 81,20% of cases we had had good results; it reduces the frequency of the complications-bleeding occurred in only 6.20% of the treated patients; it simplifies the application and reduces the lasting of the hospitalisation; In 12 of our 13 patients the treatment was one or two days; in only one case the treatment was repeated the third day.

[Heat thrombosis of burned skin]. / Zur Hitzethrombosierung verbrannter Haut.

The vital reaction to heat-induced thrombosis is discussed here using a case of sudden death in the Sauna. The dead body was lying for about one hour in the heat (90 degrees C). Beside the beginning formation of bubbles there was subcutaneous blood vessel exposition, especially in parts outside of the Livor mortis. The cause of death was viral infection with florid Myocarditis.