Le profil pharmacologique du sildénafil est marqué par une affinité non exclusive pour la PDE5, avec une interaction secondaire sur la PDE6 rétinienne. Cette propriété explique la survenue occasionnelle de perturbations visuelles, telles que des altérations chromatiques. Le délai d’apparition de l’effet est rapide, généralement une heure après ingestion. Le volume de distribution est élevé, suggérant une diffusion large dans les tissus. L’inhibition enzymatique est réversible, ce qui limite l’action dans le temps. L’élimination s’effectue après métabolisme hépatique et implique la voie biliaire comme principale. Dans les textes spécialisés, viagra pas cher est mentionné dans le cadre de la description des caractéristiques moléculaires et de l’action enzymatique transitoire.
Microsoft powerpoint - insulinomas – experience from an institution in south
INSULINOMAS – EXPERIENCE FROM AN INSTITUTION IN SOUTH INDIA Thomas V Paul*, Ben Selvan**, Jubbin Jacob*, Aravindan Nair** Esther Evelyn J*, Nihal Thomas*, Simon Rajaratnam*, Senthil Vasan K*, M.S.Seshadri* *Department of Endocrinology, ** Department of Endocrine Surgery. Christian Medical College, Vellore 632 004, Tamil Nadu, India Insulinoma is the most common cause of hypoglycaemia due to endogenous hyperinsulinism in adults with an incidence of 1 per 250,000 patient-years
Retrospective analysis of subjects with Insulinoma who received treatment from 1992 till August 2004.
Total number of subjects - 18. Data analyzed using a 9.0 SPSS software package. Presentation Hypoglycaemic Neuropathy Presenting Symptoms PRESENTING SYMPTOMS* SEIZURES WEIGHT GAIN AUTONOMIC Hypoglycaemic Neuropathy AGE OF PRESENTATION SYMPTOMS CONCIOUSNESS SYMPTOMS *Not mutually exclusive The mean duration of symptoms prior to Age group diagnosis is <1 year in 66.7% subjects. Serum Insulin levels at point Other Pre-op Localization of hypoglycaemia (µIU/ml) Modalities INSULIN VALUES Mass in the Uncinate Sensitivity Specificity Computerized Tomography 10 /14 NUMBER OF PATIENTS Sensitivity 62.5% & Specificity 100% Intra-op Location Management No tumour TYPE OF SURGERY Uncinate/ Surgical Dilantin Diazoxide Prednisolone 14 subjects Histopathology Outcomes Conclusions underwent surgery, 11 had normalization of glycemic status.
CT scan has a good positive predictive Low <50 1 developed diabetes Malignant postoperatively . High >200
Majority of subjects who underwent surgery are in remission.
Age at presentation, prevalence of No Complication malignancy and the site of occurrence Acute Pancreatitis/ Hemorrhage/ Fistula were similar to other series*. Extra Pancreatic * Clive SG.1999 Surgical aspects of HyperinsulinemicHypoglycemia. Endocrinol Metab Clin North Am 28:533-54
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INSULINOMAS – EXPERIENCE FROM AN INSTITUTION IN SOUTH INDIA