Endocrinology in Anaesthesia and Surgery by H. Breuer (auth.), Prof. Dr. Horst Stoeckel, Prof. Dr.

By H. Breuer (auth.), Prof. Dr. Horst Stoeckel, Prof. Dr. Tsutomu Oyama, Doz. Dr. Guido Hack (eds.)

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Organic Hyperinsulinism; localisation studies 1. 2. 3. 4. 5. 6. 7. 8. 9. Barium G-I -series Hypotonic duodenography LV. cholangiography Pancreatic scintiscan (seleno-methionine) Sonography Computer tomography Endoscopic retrograde pancreatography Pancreatic vein catheterisation Selective arteriography That leaves selective pancreatic arteriography as the best method with an accuracy of up to 90% [12]. Treatment The only treatment of an insulinoma is its surgical removal before morbid obesity develops or cerebral damage becomes permanent.

O ~ '" 15 10 J ones. 15' 30' 45' op. R post op 1day Fig. 2. Plasma aldosterone levels during and after anaesthesia and surgery Secretion of aldosterone is enhanced by the falling plasma sodium and rising potassium levels. However, it seems unlikely that changes in plasma electrolyte levels are a major regulatory mechanism during anaesthesia and surgery, since it appears that the changes must be relatively large before any stimulating effect is seen. According to Ganong [6], in the dog the plasma potassium level must rise by at least 1 mEq/L or the plasma sodium fall by about 20 mEqJL.

Fulton RE, Sheedy PF, Mc Ilraith DC (1975) Preoperative angiographic localization of insulinproducing tumors of the pancreas. Am J Roentgenol123: 367 38 M. Trede 13. Geelhoed G, Doppmann JL (1978) Embolization of ectopic parathyroid adenomas: A percutaneous treatment of hyperparathyroidism. Am Surg 44:2 14. Grimelius L, Johansson H, Lindquist B, Thor~n L, Werner 1(1973) Normocalcemic primary hyperparathyroidism. Acta Chir Scand 139:42 15. Herrmann J (1978) Neuere Aspekte in der Therapie der thyreotoxischen Krise.

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