Localization of pancreatic insulinoma: comparison of pre- and intraoperative US with CT and angiography

Methods of preoperative radiologic localization of insulinoma were compared in 52 patients, 44 of whom had solitary tumors. Examinations performed in these 44 patients were preoperative ultrasonography (US) in 28, angiography in 26, and computed tomography in 23. Prospective sensitivities were 61%, 54%, and 30%, respectively. Imaging sensitivities were lower for the eight patients with multiple insulinomas. In 28 of the 44 patients, intraoperative US was performed without the examiner being aware of the surgical findings. The sensitivity was 84%. Four insulinomas were not palpable but were visualized sonographically. The combined sensitivity of intraoperative US and surgical palpation for detecting solitary insulinomas was 100%. High-frequency intraoperative US is valuable for detecting occult solitary insulinomas and considerably useful for determining the proximity of insulinomas to the pancreatic and bile ducts.     

Determination of serum angiotensin-converting enzyme in sarcoidosis

Summary Serum angiotensin-converting enzyme activity was measured in 72 patients with sarcoidosis and in 50 normal controls by a radiochemical assay. SACE levels were examined with respect to the ‘activity’ of the disease, based on clinical, radiographic and physiological assessment. SACE activity in 34 patients with clinical sarcoidosis (147±44.3 nmol/min/ml) was significantly high (p<0.001) when compared to that of 38 patients who had recovered from sarcoidosis (113.9±26.4 nmol/min/ml) and 50 normal subjects (97.8±21 nmol/min/ml). SACE levels were significantly different (p<0.01) between 15 subjects with ‘active’ disease (173.9±51.9 nmol/min/ml) and those with ‘inactive’ disease (126.1±26.3 nmol/min/ml). It is concluded that there is a strict correlation between SACE levels and ‘activity’ of sarcoidosis if multiple criteria (clinical, radiographic and physiological) are employed.