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Insulin-secreting pancreatic tumors and insulin-like growth hormone-secreting non-islet cell tumors can cause hypoglycemia. However, insulin-releasing paraganglioma or pheochromocytoma has almost never been reported. A 67-year-old female patient was admitted to our hospital because of headache, palpitation, perspiration, faintness, frequent sense of hunger and absent-mindedness. These intermittent symptoms had begun approximately a year before admission. On physical examination, she had high blood pressure of 150/90 mm Hg. Hormonal studies demonstrated increased urinary norepinephrine levels, and hyperinsulinemic hypoglycemia was confirmed while the patient was symptomatic. Abdominal MRI revealed a retroperitoneal mass measuring 4.5 cm in the pancreatic region. She was treated with an alpha-blocking agent to control blood pressure preceding the removal of the mass. Histopathological diagnosis was paraganglioma, and immunohistochemically insulin staining in the neoplastic cells was demonstrated. Her blood pressure normalized and hypoglycemia relieved after the operation. The patient did not have recurrence of hypoglycemia after a year of follow-up. Paraganglioma is a rare tumor of the neural crest, and co-secretion of insulin and catecholamines has been reported only by a single case report in the literature. The present patient is another case with this co-secretion. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: To examine whether CO2 pneumoperitoneum and positive end expiratory pressure (PEEP) in mechanical ventilation affect the systemic spread of intraabdominal infection. Methods: Sprague-Dawley male rats weighing 200- 300 g were allocated to three groups of 12 animals in each. All rats received mechanical ventilation under general anesthesia. An intraabdominal infection model was established by injecting with 1 ml of Escherichia coli (109 CFU/mL) intraperitoneally. Half of the animals in each group were exposed to PEEP (10 cmH2O). CO2 pneumoperitoneum at 13 mmHg was applied to the rats in group 1. Group 2 rats underwent laparotomy. Group 3 served as controls. In addition, TNF-α serum levels were measured at baseline and 3 h. A peritoneal specimen for histopathological examination were obtained after the rats were killed at the end of 3 h. For the assessment of data, descriptive statistical methods (mean, standard deviation) as well as Friedman test for repeated measurements in multiple groups, Kruskal-Wallis test for intergroup comparisons, Dunn's multiple comparison test for subgroup comparisons, Mann-Whitney U test for comparisons between paired groups, chi-square and Fisher's exact test for comparison of qualitative data, and McNemar's test for assessment of changes in group variables over time were used. The results were considered statistically significant if probability (p) values were < 0.05. Results: Grades of peritonitis in group 1 and 2 were seen to differ nonsignificantly. In group 1, baseline blood cultures were not included in the assessment between the subgroups that received PEEP or not, as there was no growth in any of the subgroups. No significant difference was detected between growth in blood cultures at 1, 2, and 3 h (p > 0.05). Aplication of PEEP in subgroups did not alter the blood culture results (p > 0.05). Significant differences were seen between the initial and final TNF-α values of groups (KW: 18.94, p < 0.0001). The values in control group were observed to be significantly lower than those in groups 1 and 2 (p < 0.01, p < 0.001). Bacteremia and systemic spread of the intraabdominal infection did appear to be different according to the PEEP application. After the assessments of ventilation parameters in our study, significant reductions in pH and HCO3 levels were detected in group 1 as a result of pneumoperitoneum, which was consistent with the literature. There is a significant difference between pH values at baseline and at the end of 1 h because of pneumoperitoneum (Fr: 10.01, p < 0.05). PEEP application in subgroups did not create significant differences in terms of respiratory parameters (p < 0.01). Conclusion: No difference was found between the applications of CO2 pneumoperitoneum and laparotomy with regard to bacteremia and infection-induced peritonitis. it was determined that pneumoperitoneum along with PEEP application had neither a positive nor a negative impact on intraabdominal infection. [ABSTRACT FROM AUTHOR]

Objective: Graves’ disease (GD) with sarcoid involvement of the thyroid gland has rarely been reported. Method: We report a case of GD with thyroid sarcoidosis in a 28-year-old woman. Thyroid function was assessed by triiodothyronine (T[sub 3] ), thyroxine (T[sub 4] ), thyroid-stimulating hormone (TSH) and TSH receptor antibodies (TSH-R Ab). Thyroid scintigraphy, ultrasound and fine-needle aspiration biopsy were performed. The patient underwent surgery. Result: The patient had a nodular goiter. Serum T[sub 3] , T[sub 4] and TSH-R Ab levels were elevated with suppressed TSH level. Scintigraphy showed diffuse activity as seen in GD, and ultrasound revealed that parenchyma was heterogenous. Sarcoidosis was discovered on routine chest X-ray. Although no sarcoid involvement was found on specimen, the thyroid gland showed non-caseating granulomas on histology. Conclusion: Since sarcoid involvement of the thyroid gland can cause hypofunction, we report the uncommon infiltration of sarcoidosis with hyperthyroidism.Copyright © 2003 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease, especially Crohn's disease, demonstrates many extraintestinal manifestations. As a result, various dermatological lesions that have a different etiopathogenesis can be seen. In the case of metastatic Crohn's disease, extraintestinal granulomatous lesions may be observed in the orofacial and perianal regions, either accompanying bowel symptoms or as the first sign of disease. We report on a 30-year-old woman with sacral metastatic Crohn's disease who was initially treated with topical corticosteroid therapy and then underwent excision of the lesion followed by reconstruction utilizing bilateral advancement flaps. [ABSTRACT FROM AUTHOR]

Castleman's disease, a lymphoproliferative disease of unknown etiology, rarely causes a neck mass and may mimic granulomatous, inflammatory and metastatic lymph nodes, or lymphoma with its nonspecific imaging findings. Definitive diagnosis and treatment is possible with complete surgical resection. Imaging findings of a case with Castleman's disease detected during multinodular goiter surgery and later verified through excisional biopsy are presented. This report, as far as we know, is the first evaluation of the disease with sonography, Doppler sonography, CT, MR imaging, and digital subtraction angiography (DSA) findings. [ABSTRACT FROM AUTHOR]