Intraoperative Doppler ultrasound: A reliable diagnostic method in insulinoma

A 44-year-old woman was admitted with obvious symptoms of hypoglycemia and Whipple's triad during a 6-month period. The glucose level was as low as 32mg/dL and insulin/glucose ratio greater than 0.5 after fasting. Abdominal magnetic resonance imaging (MRI) studies revealed a pancreatic mass at the head, 2cm in diameter that was not suggesting because of hypointensity. Selective angiography and somatostatin-receptor scintigraphy did not reveal insulinoma. During laparotomy the tumor was palpated on the ventral surface of pancreas and intraoperative ultrasound accurately localized it. Doppler ultrasound examination clearly revealed the hyper-vascularity of the tumor, which was suggesting an insulinoma. After the tumor enucleation, blood glucose level increased to normal ranges. Histopathological examination revealed benign, well differentiated neuroendocrine tumor, insulinoma. The postoperative recovery was uneventful and the patient is still symptom free during a follow-up period of 6 months. Doppler ultrasound may be a simple but efficient tool for the differential diagnosis of insuhnoma. If the clinical symptoms and findings suggest clearly an insulinoma, intraoperative Doppler ultrasound examination seems to be a simple but the most sensitive diagnostic method

Kinematic analysis and palaeoseismology of the Edremit Fault Zone: evidence for past earthquakes in the southern branch of the North Anatolian Fault Zone, Biga Peninsula, NW Turkey

The Edremit Fault Zone (EFZ) forms one of the southern segments of the North Anatolian Fault Zone (NAFZ) at the northern margin of the Edremit Gulf (Biga Peninsula, South Marmara Region, Turkey). Stratigraphic, structural and kinematic results indicate that basinward younging of the fault zone, in terms of a rolling-hinge mechanism, has resulted in at least three discrete Miocene to Holocene deformational phases: the oldest one (Phase 1) directly related to the inactive Kazda Detachment Fault, which was formed under N-S trending pure extension; Phase 2 is characterised by a strike-slip stress condition, probably related to the progression of the NAFZ towards the Edremit area in the Plio-Quaternary; and Phase 3 is represented by the high-angle normal faulting, which is directly interrelated with the last movement of the EFZ. Our palaeoseismic studies on the EFZ revealed the occurrence of three past surface rupture events; the first one occurred before 13178 BC, a penultimate event that may correspond to either the 160 AD or 253 AD historical earthquakes, and the youngest one can be associated with the 6 October 1944 earthquake (M-w=6.8). These palaeoseismic data indicate that there is no systematic earthquake recurrence period on the EFZ