In a randomized controlled trial, 30 pigs were orally treated with histamine (60 mg). In addition, half of the animals underwent a specific blockade of the enzyme diamine oxidase (DAO), which is the main histamine catabolising enzyme in the intestinal tract. Only these DAO-blocked animals exhibited severe clinical symptoms (e.g. hypotension, flush, vomiting) and, in parallel, showed tremendous elevations of plasma histamine levels of up to 160 ng/ml. 3 out of 15 animals in this group died within the experimental period. In contrast, the control animals neither exhibited plasma histamine levels above 5 ng/ml nor had any clinical reactions. These results contradict the current opinion that oral histamine intake in food is not clinically relevant, especially since many commonly used drugs are DAO-inhibitors and approximately 20% of our population take these drugs. Apart from drugs, some other factors (alcohol, spoilt food etc.) can also function via a blockade of DAO as an additional risk. DAO-blockade is therefore a real epidemiological problem. Evidence is presented here for the new disease concept: Food-Induced Histaminosis.
Intraoperative ultrasound (IOUS) was performed in 21 patients with 22 endocrine tumors of the pancreas. Seventeen patients suffered from an organic hyperinsulinism, 4 had Zollinger‐EUison syndrome. One patient with an insulinoma had a pancreatic‐polypeptide‐producing adenoma (PPoma) as a second tumor. Fifteen of the insulinomas investigated by IOUS were visible and palpable. In 2 patients no tumor was found during initial operation. At reoperation 1 tumor was detected by IOUS only, the reoperation in the other patient is planned. The PPoma was an incidental finding during IOUS.
In 4 patients with Zollinger‐Ellison Syndrome, 1 gastrinoma was localized in the pancreas and 2 in the duodenal wall by palpation. In 1 patient we found no gastrinoma by either surgical exploration or by IOUS. In 1 of the positive cases the tumor was demonstrable by IOUS. In the other patient it was too small for imaging. Two of these patients had liver metastases, which could be demonstrated by IOUS only. We conclude that IOUS should be performed routinely in operations for pancreatic APUDomas.
Fifteen patients with a total of 16 islet-cell tumors 7-20 mm in diameter (average, 12 mm) were examined preoperatively by computed tomography (CT) and ultrasound. Seven out of 16 tumors were detected by CT and 9 out of 15 by ultrasound. Marked contrast enhancement was seen on dynamic CT scans following a bolus injection, while a circumscribed, hypoechoic mass was seen on ultrasound. Tumors of the tail of the pancreas and those outside the pancreas were difficult to detect. Ultrasound is recommended as the initial step for locating islet-cell tumors, followed by CT; angiography and transhepatic venous sampling should be restricted to tumors which are not detectable by other methods. Intraoperative ultrasound was successful in 3 patients and may facilitate the operative search.
A total of 42 islet-cell tumors were examined between 1972 and 1984. Problems of localization were only encountered in 31 tumors less than 2 cm in diameter. Of 31 small tumors, 27 were correctly localized using a combined diagnostic approach: ultrasound was successful in 12/20 tumors, CT in 9/21, angiography in 20/31, intraarterial digital subtraction angiography in 1/2, and pancreatic venous sampling in 13/16. The smallest tumor found by ultrasound and CT was 7 mm in diameter. Intraoperative ultrasound demonstrated all 9 insulinomas examined. Currently, the most useful techniques for localizing small islet-cell tumors are ultrasound, CT, and angiography. CT is particularly useful for tumor staging. Improvement of non-invasive diagnostic techniques will obviate the need for transhepatic blood sampling.
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