ALTHOUGH relatively rare, adenoma of the pancreas associated with hypoglyczmia has been recorded in a sufficient number of cases for the clinical syndrome to be well recognized, and for the value of operative treatment to be appreciated. In this short communication, therefore, no attempt will be made to summarize the literature. Those who are interested in this aspect will do well to study Whipple's masterly artic1e.l In his monograph the clinical aspects of the subject are well reviewed, and our case is of interest in that it stresses this well-defined clinical picture and the rapidity with which the symptoms can be alleviated, and thus the diagnosis established, by the administration of glucose. In Whipple's article and in other published papers, attention has been directed to the fact that in many cases, although the symptoms seemed definite, no adenoma could be found at operation, in which case the consensus of opinion seems to be that the tail and body of the pancreas should be removed, partly in the belief that this portion of the gland is more likely to contain the adenoma, and partly in the hope that if the adenoma is left behind, the removal of this amount of the normal gland may be sufficient to control the hypoglycaemia. A search of the literature has failed to reveal to us any case in which the adenoma has been found unattached to the pancreas, and the fact that in our patient it was so situated, stresses the importance at the operation, of conducting a search around the pancreas, and this is perhaps the more emphasized in that in our case, the mass which ultimately proved to be the tumour was removed more in hope than in certainty. CASE REPORTL. W., a soldier aged 29, was admitted to a military hospital on March 30, 1941, at 10.30 a.m. The only history was that of four fits in the afternoon previous to admission, after which he had lapsed into stupor, from which he could just be roused. At 2.30 p.m. the ward medical officer called in one of us (T. N. R.) into consultation. The patient was then deeply unconscious, was flushed, and showed Cheyne-Stokes respirations. His pupils were moderately contracted, but reacted to light : the corneal reflexes were absent, the fundi were normal. All the limbs were rigid and extended, with a marked increase of extension tone and tendon reflexes. He was incontinent of urine and in a drenching sweat. His heart and lungs were normal; blood-pressure 120-70. The abdomen was relaxed and no tumour was palpable. There were two operation scars in the right iliac fossa and evidence of hernial repairs. The urine contained no albumin or sugar. A lumbar puncture gave cerebrospinal fluid under normal pressure, which on examination was found to contain 2 cells per c.mm., protein 50 mg. per cent, Wassermann and Lange negative.A tentative diagnosis of post-epileptic coma was made. The possibility of a hypoglyclemic state was considered, but no insulin injection marks were seen. A blood-sugar estimation was, unfortunately, not carried out at this time.At 7.30 p.m. the coma had deepen...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.