ACTA ENDOCRINOLOGICA (BUC)

Objective. This study was undertaken to examine prognostic factors in patients with pancreatic neuroendocrine tumors (PNET) undergoing surgical treatment to evaluate the prognostic value of recently introduced immunohistochemical staining methods of CD10 and cytokeratin 19. Materials and Methods. Tumors were classified on the basis of 2004 WHO Classification Guidelines and European Neuroendocrine Tumor\r\nSociety (ENETS) grading system. Immunohistochemical staining with Ki- 67, CD10 and cytokeratin 19 was performed. Results. A total of 36 patients with a mean age of 53.7 ? 12.0 years were included. Overall, 33 patients had a long-term follow-up with 10 patients (30.3%) experiencing recurrence. Seven\r\npatients (21.1%) died. Clinical parameters that were associated with recurrence included liver metastasis at the time of surgery and extra-pancreatic invasion (p < 0.005). Positive surgical margins, extra-pancreatic invasion, and multi-focal disease were associated with reduced survival (p < 0.05). In addition, there was an association between\r\nsurvival and WHO 2004 classification (p < 0.05).\r\nConclusions. Although vascular and peripancreatic invasion showed increased risk of recurrence, they were unrelated to survival. Of the histopathological examinations, Ki-67\r\nand mitotic activity showed a correlation with both recurrence and survival, while immunohistochemical\r\nstaining with cytokeratin 19 and CD 10 did not provide adequate prognostic information.

Context. This is the first case of proton pump induced hypomagnesemia and hypocalcemia, accompanied with increased parathormone levels. Objective. The proton pump inhibitors are widely used medications. They are considered safe, however, they have some side effects. One of these side effects is hypomagnesemia. Here we report a case with severe hypocalcemia and hypomagnesemia due to long term proton pump inhibitor. Case. A 73 years old woman, admitted to emergency room due to generalized tonic-clonic seizures. She had a previous history of muscle cramps and paresthesia for 4 months. She had a medical history of peptic ulcer and she was taking omeprazole for 7 years. Her laboratory evaluation showed marked hypomagnesemia [0.5 mg/dL (normal: 1.7-2.55 mg/dL)] and hypocalcemia [6.2 mg/dL (8.8-10.2 mg/ dL)] with extremely low urinary calcium (Ca) and magnesium (Mg) excretion [0.01 gr/24 h (normal:0.05-0.3 gr/24 h), <1.22 mg/24 h (normal: 9.7-12.20) respectively]. Her vitamin D level was normal [35 ng/ mL (normal:30-80 ng/mL)] and PTH was increased [129 pg/mL (normal: 15-65 pg/ mL)] in accordance with the secondary hyperparathyroidism. Symptoms resolved with the intravenous supplementation of calcium gluconate and magnesium sulphate. However, despite high levels of oral replacement, Mg levels remained low. With omission of omeprazole two months after the admission, her ion levels returned to normal without any replacement. Conclusion. Especially elderly patients with long term proton pump inhibitor therapy, should be monitored for the symptoms of hypocalcemia and hypomagnesemia.