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INTRODUCTION: We report the case of a 77-year-old female patient with the diagnosis of pancreatic head insulinoma, in whom we used near infrared light (NIR) to detect synchronous pancreatic tumors and potential secondary lymph node or liver involvement. The patient presented with hypoglycemia manifesting by lipothymia. With the diagnosis of secretory neuroendocrine tumor (insulinoma) of the pancreatic head, cephalic pancreatoduodenectomy with the preservation of the pylorus was performed after NIR visualization of the pancreatic tumor mass. At 6, 12, 18 months postoperatively, the patient no longer had hypoglycemia and her general state was good. CONCLUSION: NIR with indocyanine green (ICG) evidences pancreatic neuroendocrine tumors, as well as possible synchronous tumors and secondary lymph node or liver involvement.
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Surgery remains the gold standard for the treatment of patients with echinococcosis, despite significant economic costs, advances in medical treatment and interventional radiology; in the past decades there has been a tendency toward laparoscopic surgery. We present a 66-year-old patient, from a rural area, who was admitted to our service complaining of spontaneous and palpatory pains in the right hypocondrium, headaches and dizziness. Abdominal CT scan highlighted 2 round calcified tumors, one of 7.2 cm diameter (VIII(th) segment) with liquid densities, and the other one localized higher, with a diameter of 2.3 cm (IV(th) segment). Under general anesthesia, after the neutralization of the content of the cyst with hypertonic saline irrigation, we performed laparoscopic partial pericystectomy of the VIII(th) segment liver cyst and total laparoscopic cystectomy of the IV(th) segment liver cyst. Postoperative evolution was favorable without biliary fistula formation, postoperative infections or cystic cavities abscesses. Laparoscopic surgery seems to be effective and safe for uncomplicated cysts in accessible segments of the liver, combined with adjuvant albendazole therapy to reduce complications and postoperative morbidity, but the procedure has its own disadvantages such as a limited area of surgical manipulation.
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The effects of the neurotrophic compound Cerebrolysin (Cere) on cognitive performance, evaluated with the ADAS-cog, and on qEEG activity were investigated in forty one patients with mild to moderate severe probable vascular dementia (VaD) according to NINDS-AIREN criteria, included in a placebo-controlled pilot study. Patients received i.v. infusions of Cere (10 or 30 ml) or placebo (normal saline) 5 days/week for 4 weeks. Mean score of change from baseline in the ADAS-cog and percent change from baseline in slow to fast EEG power ratio (PR) scores were the two primary endpoints. Correlations between cognition and qEEG were also evaluated for both baseline scores and for scores of change from baseline in ADAS-cog and in qEEG parameters, including EEG power ratio (PR) as an index of EEG slowing. Baseline ADAS-cog scores showed significant positive correlations with delta power, theta power and PR scores, and correlated negatively with alpha activity. These correlations indicating that an increased EEG slowing is associated with a worst cognitive performance in VaD patients. Cere treatment improved cognitive performance significantly at the 10 ml dose and reduced EEG slowing with both 10 and 30 ml dosages. A significant positive correlation between PR and ADAS-cog scores of change from baseline was observed in Cere-treated patients. According to results of this pilot study, it is concluded that Cere improves cognitive performance and reduces EEG slowing in patients with VaD, and that there is a positive relationship between changes in cognition and qEEG activity induced by Cere. The conduction of further regular clinical trials is required to confirm the potential utility of Cere in the treatment of VaD suggested by the present results.
