Summary
The present study has been performed in order to evaluate the usefulness of the artificial pancreas in the surgical management of previously not localized insulinomas. In the 4 patients studied, blood glucose was maintained both overnight and during surgery up to a preselected individualized level in order to avoid hypoglycemia. During surgery, only one patient required dextrose infusion. The continuous intrasurgical monitoring of blood glucose in the 4 cases examined showed that: (1) anesthesia induction, surgical incision and viscera mobilization were accompanied by a rise in blood glucose (10–30 mg/dl), reaching the highest levels 30–40 min after the start of the operation; (2) adenoma manipulation was followed by a drop in blood glucose (10–40 mg/dl), reaching the lowest level after 30–40 min; (3) adenoma resection was followed by a rise in blood glucose (25–40 mg/dl), particularly evident after 30–40 min. It is concluded that the artificial pancreas is certainly useful during surgery of insulin-producing tumors, allowing continuous monitoring of glycemia and avoiding dangerous blood glucose excursions: however, when the insulinoma is not identified during surgery, the periods elapsing between the surgical phases and the blood glucose changes observed can be too prolonged to ensure successful conservative serial pancreatectomy in all cases.
References
Brunetti P., Santeusanio F., Puxeddu A., Massi-Benedetti M., Calabrese G., Angeletti G., Bueti A., Scionti L., De Angelis M.: Artificial beta-cell application in two cases of insulinoma: a different pattern in beta-cell adenoma and carcinoma — Hormone Metab. Res.8 (Suppl.), 173, 1979.
Karam J. H., Lorenzi M., Young C. W., Burns A. D., Prosser P. R., Grodsky G. M., Galante M., Forsham P. H.: Feedback-controlled dextrose infusion during surgical management of insulinomas — Amer. J. Med.66, 675, 1979.
Kaspar L., Kritz H., Denk H., Irsigler K.: Biostator GCIIS application for surgery (insulinoma, open-heart, and vascular surgery). In: Workshop on artificial beta-cell in diabetes research and management, Heviz, Hungary, 1979; p. 35.
Kudlow J. E., Albisser A. M., Angel A., Langer B., Yip L. C., Zinman B., Stokes E.: Insulinoma resection facilitated by the artificial pancreas — Diabetes27, 774, 1978.
Landor J. H., Klachko D. M., Lie T. H.: Continuous monitoring of blood glucose during operating for islet cell adenomas — Ann. Surg.171, 394, 1970.
Massi-Benedetti M., Noy G., Johnston I.D.A., Worth R., Alberti K. G. M. M.: Glucose controlled insulin infusion system (Biostator) application during surgery for a presumed pancreatic microinsulinoma — Diabète et Métab.7, 41, 1981.
Neuhaus Ch., Kerner W., Beischer W., Heinze E., Herfarth Ch., Pfeiffer E. F.: Continuous blood glucose monitoring and feedback controlled dextrose infusion with an artificial beta cell in diagnosis and treatment of organic hyperinsulinism. In: Workshop on artificial beta-cell in diabetes research and management, Heviz, Hungary, 1979; p. 36.
Saibene V., Alberetto M., Dossi G., Andreoni B., Cordaro C., Vegeto G., Dabandi M.: Glucose-clamp by artificial pancreas in the study and management of a patient with insulinoma — Acta diabet. lat.18, 183, 1981.
Schnelle N., Molnar G. D., Ferris D. O., Rosevear J. W., Moffitt E. A.: Circulating glucose and insulin in surgery for insulinomas — J. Amer. med. Ass.217, 1072, 1971.
Stefanini P., Carboni M., Patrassi N.: Surgical treatment and prognosis of insulinoma - Clin. Gastroent.3, 697, 1974.
Stefanini P., Carboni M., Patrassi N., Basoli A.: The surgical treatment of occult insulinoma: a review of the problem - Brit. J. Surg.6, 1, 1974.
Williams R. H. (Ed.): Textbook of endocrinology. Saunders Co., Philadelphia; p. 653.
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Trovati, M., Cavalot, F., Vitali, S. et al. To what extent does the artificial pancreas facilitate the surgery of preoperatively not localized insulinomas?. Acta diabet. lat 19, 385–390 (1982). https://doi.org/10.1007/BF02629262
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DOI: https://doi.org/10.1007/BF02629262