[Diagnostics and treatment in functional pancreatic neuroendocrine tumours]. / Diagnostik und Therapie bei funktionell aktiven pankreatischen neuroendokrinen Tumoren.

Pancreatic neuroendocrine tumours (PNET) are rare entities with an annual incidence of < 100,000. About 1 - 2 % of pancreatic neoplasias are neuroendocrine tumours. About one third of these tumours secrete biologically active substances that lead to development of specific clinical syndromes. PNET may occur sporadically or in association with hereditary syndromes, such as multiple endocrine neoplasia type 1 (MEN1). Among the functional PNET, insulinomas and gastrinomas are the most common entities. In contrast, vasoactive intetinale peptide (VIP)-secreting tumours, glucagonomas, serotonin-secreting carcinoid tumors, and tumours with secretion of ectopic hormones, such as calcitonin, are extremely rare. Once diagnosis has been established on the basis of clinical and laboratory findings, localization of the source of pathologic hormone secretion is warranted. Imaging methods frequently used for localization of PNET comprise anatomical imaging modalities, computed tomography, and magnetic resonance imaging, endoscopic ultrasound, selective arterial catheterization with hepatic venous sampling, DTPA-octreotid scintigraphy and DOTA-D-Phe(1)-Tyr(3)-octreotid positron emission tomography. Therapy is based on the specific tumour entity and the extent of the disease. In the majority of patients, even in the case of malignant disease, a surgical approach is warranted, eventually combined with a medical treatment.

Association of somatostatin receptor 2 immunohistochemical expression with [111In]-DTPA octreotide scintigraphy and [68Ga]-DOTATOC PET/CT in neuroendocrine tumors.

In the absence of preoperative somatostatin receptor ( SST) scans, knowledge of immunohistochemical SST2 tumor expression may help predicting the success of somatostatin analogue-based follow-up studies and treatment of neuroendocrine tumors (NET). We studied the association between SST immunostaining and tracer uptake in [(111)In]-DTPA octreotide (DTPAOC) scintigraphy and [(68)Ga]-DOTA-D-Phe(1)-Tyr(3)-octreotide (DOTATOC) positron emission tomography (PET)/computed tomography (CT). Retrospective analy-sis of 36 NET patients was carried out. In 40 tumors, immunohistochemical SST2, SST3, and SST5 expressions were analyzed using a pathological scoring, applying monoclonal ( SST2) or polyclonal antibodies (SST3, SST5). In 14 lesions, [(111)In]-DTPAOC uptake was assessed by a semiquantitative score. In 26 tumors, [(68)Ga]-DOTATOC PET/CT was quantified using an uptake score and maximal standard uptake value (SUV(max)). Combined and separate qualitative analysis of SST scans revealed significant associations between increased tracer uptake and immunohistochemical SST2 detection (combined: rho=0.56, p=0.0002, [(111)In]-DTPAOC: rho=0.63, p=0.0152, and [(68)Ga]-DOTATOC: rho=0.52, p=0.0065, respectively). In contrast, SST3 and SST5 immunostaining was not associated with tracer uptake (all p>0.14). The semiquantitative immunohistochemical score for SST2 was associated with the [(68)Ga]-DOTATOC uptake score and SUV (max) values (rho=0.67, p=0.0002 and rho=0.63, p=0.0010, respectively), but not with the [(111)In]-DTPAOC uptake score (rho=0.24, p=0.4). In patients without preoperative SST scans, knowledge of immunohistochemical SST2 expression may help estimating the value of SST imaging in the clinical follow-up, in particular in those lesions with positive SST2 immunostaining. Negativity for SST2, however, does not rule out tracer uptake in some patients, with heterogeneous SST2 expression within the tumor as a potential explanation.

[A rare cause of hypoglycaemia in a patient with type 2 diabetes]. / Seltene Ursache für eine Hypoglykämie bei einem Patienten mit Typ-2-Diabetes mellitus.

BACKGROUND: Insulinomas are rare neuroendocrine tumours with an incidence of four cases per million a year. Only few cases of insulinoma in patients with preexisting diabetes mellitus have been reported. CASE: We present a 50-year-old male with type 2 diabetes mellitus who suffered from recurring hypoglycemia. He had gained 20 kilograms of weight in five years. 72-hour fast revealed hypoglycaemia in the presence of inadequately high C-peptide and insulin levels. Magnetic resonance imaging and selective arterial calcium stimulation test confirmed a mass in the body of the pancreas. The tumor was removed surgically. Pathological examination demonstrated a benign insulinoma. Postoperatively, blood glucose levels were within the therapeutic range. The HbA (1c) value was 6.8 % three months after the intervention. CONCLUSION: Clinicians should be alert to insulinoma as a, though rare, differential diagnosis of hypoglycaemia in diabetes, in particular in patients with recurrent, otherwise unexplained hypoglycaemia.

Effects of semi-rigid arch-support orthotics: an investigation with potential ergonomic implications.

For many years, arch-support orthotics have been prescribed for individuals with discomfort and/or abnormal skeletal alignments in the structures of the lower extremity. Recently there has been an increased interest in promoting semi-rigid orthotics as an ergonomic aid for asymptomatic workers who must stand all day at their workplace. A laboratory study was performed to assess the biomechanical impact of prefabricated semi-rigid orthotics on asymptomatic individuals. Ten subjects wore semi-rigid arch-support orthotics (experimental condition) for two months and flexible polyurethane/Sorbothane shoe inserts (control condition) for two months. Throughout this 18-week testing period, the subjects returned to the lab to perform a battery of assessment tests at regularly scheduled intervals. These tests examined subject strength, standing posture, stability, fatigue effects, and body part discomfort. The results of this study showed no significant changes in the strength, posture, or stability as a function of insert type. The subjects reported a reduction in low-back discomfort along with an increase in foot discomfort during a fatiguing exertion task while wearing the semi-rigid orthotics as compared to the control condition.