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Historical Perspective

Discovery

• In 1869, Paul Langerhans first described pancreatic islet cells, when he was still a medical student.
• In 1902, Nicholls discovered the first adenoma of pancreatic islets.
• In 1922, Frederick Banting and Charles Best were the first to discover insulin from a dog’s pancreas.
• In 1926, Wilder-et-al associated hyperinsulinism and functional islet tumor after a surgery on a person who had hypoglycemia and found an islet cell cancer with liver metastasis.

• In 1927, William J Mayo was the first to discover the association between hyperinsulinism and a functional pancreatic islet cell tumor. In 1927, the insulinoma was first described in Mayo clinic, which was dissected in 1929 in Toronto.

• In 1929, the first surgical cure was performed by Roscoe Graham.

• In 1935, Whipple suggested a diagnostic criterion for the diagnosis of insulinoma called as Whipple's triad.

Risk assessment table

Scoring criteria for risk assessment*
Scoring system	Score	Risk
IMPROVEDD Associative Score	0	0.4% predicted VTE risk through 3 months
	1	0.6% predicted VTE risk through 3 months
	2	0.8% predicted VTE risk through 3 months
	3	1.2% predicted VTE risk through 3 months
	4	1.6% predicted VTE risk through 3 months
	5-10	2.2% predicted VTE risk through 3 months
Padua Score	< 4	Low risk for VTE
	≥ 4	High risk for VTE
IMPROVE score	0	0.5% predicted VTE risk through 3 months
	1	1.0% predicted VTE risk through 3 months
	2	1.7% predicted VTE risk through 3 months
	3	3.1% predicted VTE risk through 3 months
	4	4% predicted VTE risk through 3 months
	5-8	11% predicted VTE risk through 3 months
IMPROVE bleeding risk score	<7	Not elevated risk of bleeding
	≥7	Elevated risk of bleeding
IMPROVE Associative score	0-1	Low risk for VTE
	2-3	Intermediate risk for VTE
	4-10	High risk for VTE
Caprini score	0-1	Low risk of VTE
	2	Moderate of VTE
	3-4	High risk of VTE
	≥ 5	Highest risk for VTE