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A 73-year-old woman with a pelvic tumor of nerve cell origin who presented with recurrent episodes of hypoglycemia was demonstrated to have inappropriately elevated plasma insulin and hypoglycemia. The tumor contained Insulin (RIA)*, proinsulin and secretory type of granules. Removal of the tumor promptly produced hyperglycemia. Also no islet cell tumor was found in the pancreas, suggesting the tumor as the site of ectopic insulin production. Cancer 49:1920-1923, 1982. HILE THE PATHOPHYSIOLOGY of the insulin-mediated hypoglycemia in insulinoma is well established , there is much controversy about the mechanism of hypoglycemia in extrapancreatic neoplasms.

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Summary:During the year 1991, 43 patients with upper gastrointestinal bleeding and one with severe epigastric pain associated with intake of non-steroidal anti-inflammatory drugs were admitted for emergency endoscopy to our unit. Fourteen patients (33%) had been treated with 100-325 mg aspirin daily, 11 ofthem for at least one year. The mean age ofthis group was 71. Only two patients had a previous history of peptic ulcer. Five patients used anticoagulants or antiplatelet drugs concomitantly with aspirin. The endoscopic diagnosis of the sources of bleeding was erosive gastritis in eight patients, gastric ulcer in four, duodenal ulcer in five and oesophageal ulcer in one. Our results support findings by other groups, showing that doses of aspirin as low as 75 mg daily should be used in the management of elderly patients with thrombo-embolic disease.

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