Abstract:

The authors report of 126 patients with organic hyperinsulinism operated on in 1998-2004 (84 males, 42 females, mean age 44,5-4,2 years). Insulinoma was found in 114 patients (90,5%), beta-cells hyperplasiaand microadenomatosis in 12 (9,5%), solitary tumor in 106, and multiple tumors in 8 cases. 46 of 125 insulinomas (36,8%) were localized in pancreatic head, 45 (36,0%) in the body, and 34 (27,2%) in the tail of pancreas.

Angiography (highly selective contrast injections to celiac artery, its branches and upper mesenteric artery) with digital subtraction and magnification was performed in all cases. Selective intra-arterial injection of Calcium Gluconate (1,8-3,6 mg) with sampling of right hepatic vein immunoreactive insulin (30 sec, 1 min, 2 min and 3 min after stimulation) was done to 110 patients. Sensitivity of the angio-graphic method was as high as 79,9%. Intra-arterial Calcium stimulation test helped to regionalize 108 of 121 «sources of hyperinsulinism». Combination of angiography and Calcium stimulation test shown to be effective in 96,8% cases. 

References

1.     Boden G. Glucagonomas and insulomas.Gastroenterol. Clin. N. Amer. 1989; 18:831-845.

2.     Service F. J. Hypoglycemic disorders. N. Engl.J. Med. 1995; 332: 1144-1152.

3.     Уголев А.М., Радбиль О.С. Гормоны пищеварительной системы. М.: Медицина, 1995;101-115.

4.     Reznik Y., Coffin С, Courtheoux P. et al. Topographical diagnosis of insulinoma of the pancreas. Value of the test of intra-arterialcalcium infusion. Presse Med. 1997; 26:848-851.

5.     Brown C.K., Bartlett D.L., DoppmanJ.L. et al.Intraarterial calcium stimulation and intraoperative ultrasonography in the localizationand resection of insulinomas. Surgery. 1997;122: 1189-1193.

6.     Semelka R.C., Cumming M.J., Shoenut J.P.et al. Islet cell tumors: comparison of dynamic contrast enhanced CT and MR imagingwith dynamic gadolinium enhancementand fat suppression. Radiology. 1993; 186:799-802.

7.     Service F.J., McMahon M.M., O'Brien P.C.,Ballard D.J. Functioning insulinoma - incidence, recurrence, and long-term survivalof patients: a 60-year study. Mayo Clin. Proc.1991; 66: 711-719.

8.     Антонов А.В. Возможности и клиническоезначение топической диагностики инсулином. Автореф. дис. канд. мед. наук. М.1981; 21.

9.     DoppmanJ.L., Chang R., Fraker D. L. et al.Localization of insulinomas to regions of the-pancreas by intra-arterial stimulation with calcium. Ann. Intern. Med. 1995; 123: 269-273.

10.   Galiber A.K., Reading C.C., Charbonneau J.W.et al. Localization of pancreatic insulinoma: comparison of pre- and intraoperative US with CT andangiography. Radiology. 1988; 166: 405-408.

11.   Grosembacher L., Garcia Monaco R., Sivori E.et al. A new methodology for the preoperative-localization of occult insulinomas. Medicina(B. Aires). 1997; 57: 651-656.

12.   Junginger Тh., Bottger Тh., Beyer Т., ThelenM. Der organische Hyperinsulinismus. Dtsch.-Arzteblatt. 1990; 44: 341-343.

13.   Pitre J., Soubrane O., Dousset B. et al. [Pancreatic echoendoscopy and preoperative-localization of insulinomas] [article inFrench]. Ann. Chir. 1998; 52; 369-373.

14.   Hiramoto J.S., Feldstein V.A., LaBergeJ.M., Norton J.A. Intraoperative ultrasoundand pre operative localization detects alloccult insulinomas. Arch. Surg. 2001; 136:1020-1025.

15.   Roche A., Raisonier A., Gillon-Savouret M.C.Pancreatic venous sampling and arteriography in localizing insulinomas and gastrinomas: procedure and results in 55 cases.Radiology. l982; 145: 621-627.

16.   Марков И.Н., Привезенцева Т.В. Ангиография в диагностике инсулином поджелудочной железы. Хирургия. 1981; 11: 6-10.

17.   Doppman J.L., Shawker T.H., Miller D.L.Localization of islet cell tumors. Gastrointest.Clin. North. Am. 1989; 18: 793-804.

18.   Yamauchi H., Miyagava K., Maeda M. et al.Surgical management of insulinoma: diagnosis of tumor location and high incidence ofmalignancy. Jpn.J. Surg. 1986; 1: 8-15.

19.   Кондрашин С.А., Егоров А.В. Сочетаннаяангиографическая диагностика инсулином. Мед. радиол. 1996; 6: 23-25.

20.   Мадан А. Ангиография и артериально-стимулированный забор крови в топической диагностике органического гиперинсулинизма.Афтореф. дис. канд. мед. наук. М. 1999; 23.

21.   Brunt L.M., Veldhuis J.D., Dilley W.G. et al.Stimulation of insulin secretion by a rapid-intravenous calcium infusion in patients with beta-cell neoplasms of the pancreas. J. Clin.-docrinol. Metab. 1986; 62: 210-216.

22.   Doppman J.L., Miller D.L., Chang R. et al.Insulinomas: localization with selective-intraarterial injection of calcium. Radiology.1991; 178: 237-241.

23.   Paivansalo M., Makarainen H., Siniluoto T.et al. Ultrasound compared with computed-tomography and pancreatic arteriography in detection of endocrine tumours of the pancreas. Eur.J. Radiol. 1989; 9: 173-178.

24.   Rossi P., Baert A., Passariello R. et al. CT offunctioning tumors of the pancreas. Am. J.-Roentgenol. 1985; 144: 57-60.

25.   Angeli E., Vanzulli A., Castrucci M. Et al.Value of abdominal sonography and MRimaging at 0.5 T in preoperative detection ofpancreatic insulinoma: a comparison withdynamic CT and angiography. Abdom. Imaging.1997; 22: 295-303.

26.   Lo C.Y., Lam K.Y., Kung A.W. et al. Pancreaticinsulinomas. A 15-years experience. Arch.Surgery. 1997; 132: 926-930.

27.   Pereira P.L., Roche A.J., Maier G.W. et al.Insulinoma and islet cell hyperplasia: value ofthe calcium intraarterial stimulation testwhen finding of other preoperative studiesare negative. Radiology. 1998; 206: 703-709.

28.   Defreyne L., Konig K., Lerch M.M. et al.Modified intra-arterial calcium stimulation-with venous sampling test for preoperativelocalization of insulinomas. Abdom. Imaging.1998; 23: 322-331.

29.   Baba Y, Miyazono N., Nakajo M. et al. Localization of insulinomas. Comparison of conventional arterial stimulation with venoussampling (ASVS) and superselective ASVS.Acta Radiol. 2000; 41: 172-177.

30.   Pedrazzoli S., Pasquali C., Miotto D. et al.Transhepatic portal sampling for preoperative localization of insulinomas. Surg. Gynecol.Obstet. 1987; 165: 101-106.

31.   Won J.G., Tseng H.S., Yang AH. et al. Intraarterial calcium stimulation test for detectionof insulinomas: detection rate, responses ofpancreatic peptides, and its relationship to differentiation of tumor cells. Metabolism. 2003;52:1320-1329.

32.   Sung Y.M., Do Y.S., Shin S.W. et al. Selective intra-arterial calcium stimulation with hepatic-venous sampling for preoperative localizationof insulinomas. Korean J. Radiol. 2003; 4: 101-108.

33.   O'Shea D., Rohrer-Theurs A.W., Lynn J.A.et al. Localization of insulinomas by selective intra-arterial calcium injection. J. Clin.Endocrinol. Metab. 1996; 81: 1623-1627.

34.   Lee W.L., Won J.G., Chiang J.H. et al. Selective intra-arterial calcium injection in the-investigation of adult nesidioblastosis: acase report. DiabetMed. 1997; 14: 985-988.

35.   Ito K., Takada T., Amano H. et al. Localization of islet-cell hyperplasia: value of pre- and intra operative arterial stimulation and venous sam pling./ Hepatobiliary Pancreat. Surg. 2004; 11:203-206.

Article exists only in Russian.

Abstract:

Radiofrequency (RF) ablation is a minimally invasive method. Application of RF ablation allowed to expand indications for more radical treatment of kidney tumors in patients, whom traditional nephrectomy or kidney resection are impossible, due to extremely adverse somatic status

Efficiency and safety of RF ablation are significantly increased if preceded in combination with superselective occlusion of blood vessels, supplying the tumor. We possess the experience of application of superselective embolization in combination with RF ablation of two patients with kidney tumors. In both cases a good result of combined treatment has been observed.

This combination (superselective embolization + RF ablation) can be an alternative to open operation on kidney in number of patients, expanding the arsenal of modern minimally invasive kidney tumor's treatment methods. 

Reference 

1.    Pavlov AJu., Klimenko A. A., Momdzhan B.K., Ivanov S.A. Radiochastotnaja intersticial'naja termoabljacija (RChA) raka pochki. [Radiofrequency interstitial termal ablation of renal cancer]. Jeksperimental'naja i klinicheskaja urologija. 2011; 2(3): 112-113 [In Russ].

2.    European Network of Cancer Registries. Eurocim version 4.0. European incidence database V2.3, 730 entity dictionary (2001). Lyon, 2001.

3.    Zlokachestvennye novoobrazovanija v Rossii v 2008 g. (zabolevaemost' i smertnost'). [Malignant neoplasms in Russian Federation in 2008 (morbidity and mortality)]. Pod red. V.I. Chissova, V.V. Starinskogo, G.V. Petrovoj. M. FGU «MNIOI im. P.A. Gercena Rosmedtehnologij». 2010 [ In Russ].

4.    Chow W.H., Devesa S.S., Warren J.L., Freumeni J.FJr. Rising incidence of renal cell carcer in the United States. JAMA. 1999; 281:1628-31.

5.    Nguyen M.M., ill I.S., Ellison L.M. The evolving presentation of renal carcinoma in the United States: trends from the Surveillance, Epidemiology, and End Results program. J. Urol. 2006; 176: 2397-400; discussion 2400.

6.    Kummerlin I.P., ten Kate F.J., Wijkstra H., de la Rosette J.J., Laguna M.P. Changes in the stage and surgical management of renal tumours during 1995-2005: an analysis of the Dutch national histopathology registry. BJU Int. 2008; 102 (8): 946-51. Epub 2008 Jun 28.

7.    Ankem M.K., Nakada S.Y. Needle-nephron-sparing surgery. BJU Int. 2005; 95 (2): 46-51.

8.    Havranek E., Anderson C. Future prospects for nephron conservation in renal cell carcinoma. In: Kirby R.S., O’Leary M.P., editors. Hot topics in urology. Amsterdam. The Netherlands: Elsevier. 2004; 227-38.

9.    Marberger M., Mauerman J. Energy ablation nephron-sparing treatment of renal tumors. AUA Update Series. 2004; 23:178-83.

10.  Reddan D.N., Raj G.V., Polascik TJ. Management of small renal tumors: an overview. Am. J. Med. 2001; 110: 558-62.

11.  Weld K.J., Landman L. Comparison of cryoablation, radiofrequency ablation and high-intensity focused ultrasound for treating small renal tumors. BJU Int. 2005; 96:1224-9.

12.  Uzzo R.G., Novick A.C. Nephron sparing surgery for renal tumors: indications techniques and outcomes. J. Urol. 2001; 166:6-18.

13.  Dolgushin B.I., Kosyrev VJu., Ramprabanant S. Radiochastotnaja ablacija v onkologii. Prakticheskaja onkologija. 2007; 8(4): 219-227 [In Russ].

14.  Vogl TJ., Helmberger T.K., Mack M.G., Reiser M.F. (Eds.) Percutaneous Tumor Ablation in Medical Radiology. ISBN 978-3-540-22518-8 Springer. Berlin. Heidelberg. New York. 2008.

15.  Winthrop H. Hal, John P. McGahan, Daniel P. Link and Ralph W. deVere White. Combined Embolization and Percutaneous Radiofrequency Ablation of a Solid Renal Tumor. AJR. 2000; 174:1592-1594.

16.  Yamakado K., Nakatsuka A., Kobayashi S., Akeboshi M., Takaki H., Kariya Z., Kinbara H., Arima K., Yanagawa M., Hori Y., Kato H., Sugimura Y., Takeda K. Radiofrequency ablation combined with renal arterial embolization for the treatment of unresectable renal cell carcinoma larger than 3.5 cm: initial experience. Cardiovasc. Intervent. Radiol. 2006; 29(3): 389-94.

17.  Klingler H.C., Marberger M., Mauermann J. et al. ’Skipping’ is still a problem with radiofrequency ablation of small renal tumours. BJU Int. 2007; 99: 998-1001.

18.  Goldberg S.N., Gazelle G.S., Mueller P.R. Thermal ablation therapy for focal malignancy: A unified approach to underlying principles, techniques and diagnostic imaging guidance. Am. J. Roentgenol. 2000; 174: 323-31.

19.  Lee M. Ellis, Steven A. Curley, Kenneth K. Tanabe. Radiofrequency Ablation for Cancer.Current Indications, Techniques, and Outcomes. 2004; Springer-Verlag New York, Inc.

20.  Salagierski M., Salagierski M. Radiofrequency ablation partial nephrectomy: a new method of nephron-sparing surgery in selected patients. Int. J. Urol. 2006; 13(11): 1456-9.

21.  Veltri A., Garetto I., Pagano E., Tosetti I., Sacchetto P., Fava C. Percutaneous RF termal ablation of renal tumors: is US guidance really less favorable than other imaging guidance techniques? Cardiovasc. Intervent. Radiol. 2009; 32(1): 76-85. Epub 2008 Aug 15.

22.  Schirmang T.C., Mayo-Smith W.W., Dupuy D.E., Beland M.D., Grand D.J. Kidney neoplasms: renal halo sign after percutaneous radiofrequency ablation-incidence and clinical importance in 101 consecutive patients. Radiology. 2009; 253(1): 263-9. Epub 2009 Jul. 31.

Abstract:

We have studied the influence of catheterization technique on the quality of contrast imaging, on the base of 94 digital subtraction (DSS) and 30 analog sialograms (AS) in 83 patients. It has been established that catheter depth must be 10 mm. In case of deeper catheter inserting - some artifacts may appear. In case of DSS such problem could be corrected, but during AS such situation can ead to incorrect interpretation and diagnostic mistakes.

References 

1.    Кадочников Б.Ф. К вопросу о сиалографии. Стоматология. 1960; 6: 64-65.

2.    Язукявичюс Л.А. Электрорентгеносиалография в диагностике заболеваний слюнных желез. Стоматология. 1987; 66 (3): 39-41.

3.    Мингазов Г.Г., Шестаков Ю.М., Кузнецов О.Е. Использование полиэтиленовых катетеров для сиалографии. Вестник    рентгенологии    и    радиологии. 1989; 2: 67.