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Insulinoma is rare a tumor of the islet cell of the pancreas that produces excessive amounts of insulin, inappropriately to plasma glucose levels. The average age of onset 40-50 years .The typical symptoms that patients complain about are related to the development of hypoglycemia. Patients with insulinoma usually develop neuroglycopenic symptoms (confusion, headache, visual difficulties, irrational behavior and extremely, coma) particularly with exercise or fasting. Severe hypoglycemia may result in seizures, coma, and eventually neurological damage. Symptoms resulting from the catecholaminergic response to hypoglycemia (i.e., tremulousness, palpitations, tachycardia, sweating, hunger, anxiety) are not uncommon. Weight gain is sometimes observed and not uncommonly the patient might become massively obese. Insulinomas are small in 90% <2cm, solitary >90 %, and 5-10% malignant. They are almost invariably occur in the pancreas and distributed equally in head, body and tail. Insulinoma should be suspected in all patients with hypoglycemia, especially those with attacks provoked by fasting or with a family history of MEN-1. The diagnosis of an insulinoma is usually made biochemically with low blood glucose, elevated insulin, C-peptide levels and proinsulin, by a 72-hour fasting under close supervision, and confirmed by localizing the tumor by computed tomography, MRI, or transabdominal and endoscopic ultrasonography. Sometimes detection of lesions might be challenging and ancillary tests are occasionally required. The definitive treatment is surgical removal of the tumor, and laparoscopic surgery for localized lesions is increasingly reported. Medical treatment is reserved for unresectable tumors, preoperative preparation or for unsuitable candidates for surgery.

Fermentation of foods had been dated to early human life on the planet far more before civilization. The transition from hunting and gathering to the agricultural lifestyle might have triggered task of food fermentations, nowadays this task is carried on industrial level. Many parts of the human body; the skin, oral cavity, gut, and vaginal canal are populated by huge numbers of microbes. At birth, human gut is a sterile environment, however it will start to be colonized instantly after birth. Factors such as diet (formula or breast feeding) and type of delivery (either vaginal birth or abdominal) can both impact the colonization patterns. The pioneer microbes inhabiting the gut make permanent adaptations and thus determining the metabolic, physiological, behavioral, and immune development which will encourage vulnerability to diseases. Because Age and lifestyle are associated with alteration in microflora, therefore are of some causes of diseases. Latest research has shown that microbiota composition is remarkably different in diseases such as obesity and periodontal diseases with healthy individuals usually showing diverse, distinct, and temporary stable microbiota communities at these sites in comparison with individuals manifesting disease.

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To define primary hypothyroid patients into two distinctive categories according to the presence or absence of clinical demonstrable serous effusion and determination of the etiology and the contributory risk factor for the presence or the absence of serous fluid and edema fluid accumulation. Patients and Methods22 women were studied. They have been referred from consultation clinic of Marjan Teaching Hospital and private clinic. Their age is ranging from 26-62 years. Their mean age is 42 years.