Fast-growing pancreatic neuroendocrine carcinoma in a patient with multiple endocrine neoplasia type 1: a case report

<p>Abstract</p> <p>Introduction</p> <p>Predictive genetic screening and regular screening programs in patients with multiple endocrine neoplasia type 1 are intended to detect and treat malignant tumors at the earliest stage possible. Malignant neuroendocrine pancreatic tumors are the most frequent cause of death in these patients. However, the extent and intervals of screening in patients with multiple endocrine neoplasia type 1 are controversial as neuroendocrine tumors are usually slow growing. Here we report the case of a patient who developed a fast-growing neuroendocrine carcinoma within 15 months of a laparoscopic distal pancreatic resection.</p> <p>Case presentation</p> <p>We followed a group of 45 patients with multiple endocrine neoplasia type 1 by an annual screening program in the Department of Visceral, Thoracic, and Vascular Surgery at the University Hospital Marburg in cooperation with the Department of Radiology and the Division of Endocrinology. A man with multiple endocrine neoplasia type 1 who was diagnosed with a recurrent primary hyperparathyroidism underwent a distal pancreatic resection for a non-functional neuroendocrine tumor. In the context of our regular screening program, a large non-functional neuroendocrine tumor was diagnosed in the pancreatic head 15 months after the first pancreatic surgery. Therefore, we performed an enucleation and regional lymph node resection. At histology, the diagnosis of a neuroendocrine carcinoma with one lymph node metastasis was established. There was no evidence of recurrence 9 months after re-operation.</p> <p>Conclusion</p> <p>Fast-growing neuroendocrine tumors are rare in patients with multiple endocrine neoplasia type 1. The intervals, both postoperative and in newly diagnosed pancreatic lesions, in patients with multiple endocrine neoplasia type 1 should be reduced to 6 months to establish the early diagnosis of rapidly progressive disease in a small subset of patients.</p

Att se och tänka med ritual: kontrakterande ritualer i de isländska släktsagorna

To make it possible to classify an action as a ritual act we need to know exactly what constitutes it. In this thesis I try, with the aid from literature of the field called ritual studies and the sagas of Icelanders, to sort out what these constituent elements best should consist of if we want to use the term ritual as an analytical tool in the production of knowledge with scientific criteria. Rituals have a transformative capacity to change the social status of people or objects. Perhaps the most obvious example of the transformative quality of a ritual is the circumcision of boys. In the thesis I will proceed from the sagas of Icelanders, and especially Njáls saga, to discuss the possibility of sorting out ritual actions that establish a social contract. Three rituals of contracts are in focus, the oath, the handshake and giving gifts. The ritual acts in the sagas of Icelanders established a social contract between people with a moral and a political duty to fulfil. When discussing the sagas of Icelanders I will also show how rituals, alliances, contracts, places, and important social values interact in an intricate way in the society of the saga. When focusing on rituals in social sciences, one needs to know what a ritual is, and hopefully this thesis will be a small contribution to that purpose