Duodenal gastrinoma - case report.

INTRODUCTION: In our text, we want to highlight a rare diagnosis. CASE REPORT: A 54-year-old obese, hypertensive male smoker had been investigated for intermittent abdominal pain for 12 years. The first gastroscopy for a bleeding ulcer was conducted in 2010. In the subsequent years, repeated gastroscopies revealed variable involvement from the esophagus to the duodenum. Capsule enteroscopy did not provide further specification of the diagnosis. The patient underwent colonoscopy and MRI enterography multiple times, with no unequivocal pathological findings. In May 2022, he was admitted to our department for abdominal pain and vomiting. This time, gastroscopy revealed multiple small ulcers in the duodenum and jejunum with clots causing a mechanical obstruction. Chromogranin A was elevated, raising suspicion of gastrinoma. However, somatostatin receptor-based imaging (Octreoscan) was negative. Only the 68Ga-DOTATOC PET (positron emission tomography with the radiopharmaceutical DOTA, labeled with gallium-68) identified a lesion in the subhepatic region, which had no correlation on CT. We concluded the diagnosis as gastrinoma with the Zollinger-Ellison syndrome. Endoscopically, a 1cm tumor was found in the duodenum. In October 2022, the patient underwent an excision of the duodenal wall, and the pathology assessment confirmed our diagnosis of gastrinoma. CONCLUSION: With this case report, we want to emphasize the importance of taking into account neuroendocrine tumors in our differential diagnostic considerations. At the same time, we want to highlight that, according to ESMO recommendations, we should preferentially use 68Ga-DOTATOC PET/CT for the diagnosis instead of scintigraphic examination (111In-Octreoscan).

[Cecal herniation through the foramen of Winslow as a rare cause of ileus]. / Herniace céka do foramen Winslowi jako vzácná prícina ileózního stavu.

UNLABELLED: Internal abdominal hernias present an infrequent surgical diagnosis and are usually encountered accidentally during surgery. They are generally considered as an extremely rare cause of ileus. In our article we present the case of a 69-year-old healthy female who was operated for suspected gastric volvulus as suggested by the CT scan; however, upon surgery, herniation of the right-sided colon into the omental bursa with subsequent cecal dilation and bowel wall necrosis was revealed to be the true culprit. KEY WORDS: internal hernia - foramen of Winslow - bowel obstruction.

The dose response of granulocyte-macrophage colony stimulating activity (GM-CSA) for sera of "Swiss" mice after endotoxin "lipopolysaccharide B" Escherichia coli (0127: B8) intraperitoneal administration.

The effect of different doses of endotoxin (Lipopolysaccharide B) on Granulocyte-Macrophage Colony Stimulating Activity (GM-CSA) in the sera of "Swiss" male mice was measured by granulocyte-macrophage "in vitro" colony formation. The highest GM-CSA was found to be present 3-4 hours after 200 micrograms of endotoxin intraperitoneal injection.

[So-called presclerosis (developing cerebral ischemia)]. / Die sogenannte Präsklerose.

The complaints of 400 patients who were sent by their general practitioners to our hospital are enumerated in table 1 according to thier frequency (33 items). Three groups of complaints stand out: a) disturbances of memory and concentration b) nervousness - inward restlessness - increased irritability c) fatigue - decrease of performance. In the earlier literature similar syndromes were described as signs of the diminution of cerebral performance. If they appeared in old persons they were considered as an expression of a (physio-logical?) decrease of neurons. In middle-aged men the same syndrome was considered as sign of a premature cerebral arteriosclerosis. Recent investigations have shown that a decrease of cerebral performance is often due to a degenerative process of Alzheimer's type. In many cases it is difficult to decide concerning which of the three basic processes we have to take into consideration if a diminution in cerebral performance occurs. Presented are: Cues for diagnosis, differential diagnosis and treatment of the syndrome often seen in general practice today.