Diagnostic evaluation of suspected insulinoma - comparison of different diagnostic methods

Inzulinomi pripadaju neuroendokrinim tumorima te potječu od β stanica gušterače. Ovi rijetki tumori su hormonski aktivni te pojačano luče inzulin. Zbog hiperinzulinemije, javljaju se simptomi hipoglikemije, kao što su kao vrtoglavica, dvoslike, zamagljen vid, konfuznost ili gubitak svijesti. Inzulinomi su u većini slučajeva benigne naravi, te se nakon kirurškog odstranjenja očekuje potpuno izlječenje. U ovom radu analizirana je medicinska dokumentacija devet pacijenata koji su bili liječeni na KBC-u Zagreb od 2010.-2015. godine. Kod svih ispitanika dijagnoza inzulinoma je postavljena biokemijskim testovima gdje je dokazana endogena hiperinzulinemija. Ispitanici su nakon toga prošli radiološku dijagnostiku radi predoperativnog utvrđivanja lokalizacije tvorbe. Cilj rada bio je utvrditi uspješnost pojedinih slikovnih metoda u lokalizaciji inzulinoma te usporediti dobivene podatke s podacima iz literature. Rezultati su pokazali kako je najmanju osjetljivost imao abdominalni ultrazvuk, nakon njega endoskopski ultrazvuk s osjetljivošću od 33 %. Nešto bolju osjetljivost koja iznosi 62,5 % imala je kompjuterizirana tomografija. Sljedeća po uspješnosti bila je magnetska rezonancija, a najboljom se pokazala selektivna arterijska stimulacija kalcijem. Podaci su odgovarali podacima nađenim u literaturi. Uzevši u obzir ograničenja rada, od kojih je najvažniji mali broj ispitanika došli smo do zaključka da kod kliničke sumnje na inzulinom možemo kao prvu metodu odabrati CT ili MR, ovisno o dostupnosti, a nakon toga napraviti nešto invazivniju pretragu kao što je selektivna arterijska stimulacija kalcijem.Insulinoma is a neuroendocrine tumor derived from pancreatic β cells. This rare tumor is hormonally active and produces extra insulin. Symptoms of hypoglycemia occur because of hyperinsulinemia. These symptoms include vertigo, diplopia, blurred vision, confusion and loss of consciousness. Insulinomas are usually benign tumors, and after surgical removal, total recovery is expected. In this paper we analyzed medical documentation of nine patients who were treated at the Clinical hospital center Zagreb from 2010 – 2015. All of the participants were diagnosed with insulinoma by biochemical findings which proved endogenus hyperinsulinemia. The patients then underwent a radiological examination in order to determine the preoperative localization of the tumor. The aim of this paper was to determine the success rate of different diagnostic methods and compare them with the information from the existing literature. The results showed that the abdominal ultrasound had the least sensitivity rate, followed by endoscopic ultrasound with sensitivity rate of 33 %. CT showed greater sensitivity of 62, 5 %, followed by MRI. Selective arterial calcium stimulation was found to be the most successful. The success rate data was similar to those found in literature. Considering the limitations of this paper, such as small number of participants, we came to the conclusion that after clinical suspicion of insulinoma, CT or MRI can be performed, depending on availability, followed by more invasive procedures, such as selective arterial calcium stimulation

Diagnostic evaluation of suspected insulinoma - comparison of different diagnostic methods

Inzulinomi pripadaju neuroendokrinim tumorima te potječu od β stanica gušterače. Ovi rijetki tumori su hormonski aktivni te pojačano luče inzulin. Zbog hiperinzulinemije, javljaju se simptomi hipoglikemije, kao što su kao vrtoglavica, dvoslike, zamagljen vid, konfuznost ili gubitak svijesti. Inzulinomi su u većini slučajeva benigne naravi, te se nakon kirurškog odstranjenja očekuje potpuno izlječenje. U ovom radu analizirana je medicinska dokumentacija devet pacijenata koji su bili liječeni na KBC-u Zagreb od 2010.-2015. godine. Kod svih ispitanika dijagnoza inzulinoma je postavljena biokemijskim testovima gdje je dokazana endogena hiperinzulinemija. Ispitanici su nakon toga prošli radiološku dijagnostiku radi predoperativnog utvrđivanja lokalizacije tvorbe. Cilj rada bio je utvrditi uspješnost pojedinih slikovnih metoda u lokalizaciji inzulinoma te usporediti dobivene podatke s podacima iz literature. Rezultati su pokazali kako je najmanju osjetljivost imao abdominalni ultrazvuk, nakon njega endoskopski ultrazvuk s osjetljivošću od 33 %. Nešto bolju osjetljivost koja iznosi 62,5 % imala je kompjuterizirana tomografija. Sljedeća po uspješnosti bila je magnetska rezonancija, a najboljom se pokazala selektivna arterijska stimulacija kalcijem. Podaci su odgovarali podacima nađenim u literaturi. Uzevši u obzir ograničenja rada, od kojih je najvažniji mali broj ispitanika došli smo do zaključka da kod kliničke sumnje na inzulinom možemo kao prvu metodu odabrati CT ili MR, ovisno o dostupnosti, a nakon toga napraviti nešto invazivniju pretragu kao što je selektivna arterijska stimulacija kalcijem.Insulinoma is a neuroendocrine tumor derived from pancreatic β cells. This rare tumor is hormonally active and produces extra insulin. Symptoms of hypoglycemia occur because of hyperinsulinemia. These symptoms include vertigo, diplopia, blurred vision, confusion and loss of consciousness. Insulinomas are usually benign tumors, and after surgical removal, total recovery is expected. In this paper we analyzed medical documentation of nine patients who were treated at the Clinical hospital center Zagreb from 2010 – 2015. All of the participants were diagnosed with insulinoma by biochemical findings which proved endogenus hyperinsulinemia. The patients then underwent a radiological examination in order to determine the preoperative localization of the tumor. The aim of this paper was to determine the success rate of different diagnostic methods and compare them with the information from the existing literature. The results showed that the abdominal ultrasound had the least sensitivity rate, followed by endoscopic ultrasound with sensitivity rate of 33 %. CT showed greater sensitivity of 62, 5 %, followed by MRI. Selective arterial calcium stimulation was found to be the most successful. The success rate data was similar to those found in literature. Considering the limitations of this paper, such as small number of participants, we came to the conclusion that after clinical suspicion of insulinoma, CT or MRI can be performed, depending on availability, followed by more invasive procedures, such as selective arterial calcium stimulation

Tomina jama kod Krvavca u dolini rijeke Neretve

Tomina jama cave was explored and preliminary research conducted from 2015 to 2019. Tomina jama is currently the only known anchialine cave in the Neretva River area. At this time, the cave has been explored up to 58 m with the last 23 to 25 m submerged. Tomina jama is a typical anchialine cave system with a freshwater lens at the surface and seawater layer at the bottom. Salinity in the cave increased from 0 at the surface to 33 at a depth of 22 m, whereas dissolved oxygen concentrations decreased from 9.1 mg/L to anoxic conditions at depth. The hypoxic/anoxic zone extended for more than 10 m. Water temperature ranged from 14.8°C at the surface to 17.2°C at the bottom while pH decreased with depth from 7.74 to 6.86. Redox sensitive trace metals (i.e. Mo and U) deviated from salinity driven conservative mixing behavior. The upper freshwater layer was characterized by low Mo and U concentrations, 6.5 and 2.1 nmol/L, respectively. As salinity increased with depth, Mo and U concentration also increased (65.0 and 8.1 nmol/L, respectively). Of interest however, as depth continued to increase to the bottom salt layer (salinity 33) the Mo and U concentrations were significantly lower than for open ocean (~115 and ~13.5 nmol/L, respectively) implying removal process of Mo and U within the anoxic bottom waters. Further investigation of possible Mo and U enrichment within the cave sediment and porewaters is needed in order to establish possible linkages between the water and porewater chemistry (i.e. especially sulphide concentration, a trigger for Mo water column exhaustion) and the removal processes of Mo and U within the water column. Within the anoxic bottom waters, increased concentrations of Fe and Mn were observed indicating the formation of reduced Fe and Mn minerals within. Several stygobionts were discovered in the freshwater layer including serpulids Marifugia sp. and crustaceans of the genera Monolistra, Troglocaris and Niphargus. Most notable is the finding of the endemic serpulids, which is the first record of this animals for an anchialine cave. Prior to this discovery, Marifugia has only been found in freshwater caves from Dinaric karst region. Preliminary DNA results indicate that this specimen might not belong to Marifugia cavatica species and may be a new species. Below the halocline, the cave walls and bottom were covered with a significant bacterial mat. Samples were collected for future microbiome analyses

Tomina jama kod Krvavca u dolini rijeke Neretve

Tomina jama cave was explored and preliminary research conducted from 2015 to 2019. Tomina jama is currently the only known anchialine cave in the Neretva River area. At this time, the cave has been explored up to 58 m with the last 23 to 25 m submerged. Tomina jama is a typical anchialine cave system with a freshwater lens at the surface and seawater layer at the bottom. Salinity in the cave increased from 0 at the surface to 33 at a depth of 22 m, whereas dissolved oxygen concentrations decreased from 9.1 mg/L to anoxic conditions at depth. The hypoxic/anoxic zone extended for more than 10 m. Water temperature ranged from 14.8°C at the surface to 17.2°C at the bottom while pH decreased with depth from 7.74 to 6.86. Redox sensitive trace metals (i.e. Mo and U) deviated from salinity driven conservative mixing behavior. The upper freshwater layer was characterized by low Mo and U concentrations, 6.5 and 2.1 nmol/L, respectively. As salinity increased with depth, Mo and U concentration also increased (65.0 and 8.1 nmol/L, respectively). Of interest however, as depth continued to increase to the bottom salt layer (salinity 33) the Mo and U concentrations were significantly lower than for open ocean (~115 and ~13.5 nmol/L, respectively) implying removal process of Mo and U within the anoxic bottom waters. Further investigation of possible Mo and U enrichment within the cave sediment and porewaters is needed in order to establish possible linkages between the water and porewater chemistry (i.e. especially sulphide concentration, a trigger for Mo water column exhaustion) and the removal processes of Mo and U within the water column. Within the anoxic bottom waters, increased concentrations of Fe and Mn were observed indicating the formation of reduced Fe and Mn minerals within. Several stygobionts were discovered in the freshwater layer including serpulids Marifugia sp. and crustaceans of the genera Monolistra, Troglocaris and Niphargus. Most notable is the finding of the endemic serpulids, which is the first record of this animals for an anchialine cave. Prior to this discovery, Marifugia has only been found in freshwater caves from Dinaric karst region. Preliminary DNA results indicate that this specimen might not belong to Marifugia cavatica species and may be a new species. Below the halocline, the cave walls and bottom were covered with a significant bacterial mat. Samples were collected for future microbiome analyses

P62dok, a Negative Regulator of Ras and Mitogen-Activated Protein Kinase (Mapk) Activity, Opposes Leukemogenesis by P210bcr-abl

p62dok has been identified as a substrate of many oncogenic tyrosine kinases such as the chronic myelogenous leukemia (CML) chimeric p210bcr-abl oncoprotein. It is also phosphorylated upon activation of many receptors and cytoplamic tyrosine kinases. However, the biological functions of p62dok in normal cell signaling as well as in p210bcr-abl leukemogenesis are as yet not fully understood. Here we show, in hemopoietic and nonhemopoietic cells derived from p62dok−/− mice, that the loss of p62dok results in increased cell proliferation upon growth factor treatment. Moreover, Ras and mitogen-activated protein kinase (MAPK) activation is markedly sustained in p62dok−/− cells after the removal of growth factor. However, p62dok inactivation does not affect DNA damage and growth factor deprivation–induced apoptosis. Furthermore, p62dok inactivation causes a significant shortening in the latency of the fatal myeloproliferative disease induced by retroviral-mediated transduction of p210bcr-abl in bone marrow cells. These data indicate that p62dok acts as a negative regulator of growth factor–induced cell proliferation, at least in part through downregulating Ras/MAPK signaling pathway, and that p62dok can oppose leukemogenesis by p210bcr-abl