Delayed gastric emptying after classical Whipple or pylorus-preserving pancreatoduodenectomy: a randomized clinical trial (QUANUPAD).

PURPOSE: Pylorus-preserving pancreatoduodenectomy (PPPD) has been the gold standard for pancreatic head lesion resection for several years. Some studies have noted that it involves more delayed gastric emptying (DGE) than classical Whipple (i.e., pancreatoduodenectomy with antrectomy). Our working hypothesis was that the classical Whipple has a lower incidence of DGE. We aimed to compare the incidence of DGE among pancreatoduodenectomy techniques. METHODS: This pragmatic, randomized, open-label, single-center clinical trial involved patients who underwent classical Whipple (study group) or PPPD (control group). Gastric emptying was clinically evaluated using scintigraphy. DGE was defined according to the International Study Group of Pancreatic Surgery (ISGPS) criteria. The secondary endpoints were postoperative morbidity, length of hospital stay, anthropometric measurements, and nutritional status. RESULTS: A total of 84 patients were randomized (42 per group). DGE incidence was 50% (20/40, 95% confidence interval (95% CI): 35-65%) in the study group and 62% (24/39, 95% CI: 46-75%) in the control group (p = 0.260). No differences were observed between both groups regarding postoperative morbidity or length of hospital stay. Anthropometric measurements at 6 months post-surgery: triceps fold measurements were 12 mm and 16 mm (p = 0.021). At 5 weeks post-surgery, triceps fold measurements were 13 mm and 16 mm (p = 0.020) and upper arm circumferences were 26 cm and 28 cm (p = 0.030). No significant differences were observed in nutritional status. CONCLUSION: DGE incidence and severity did not differ between classical Whipple and PPPD. Some anthropometric measurements may indicate a better recovery with PPPD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03984734.

Nonlinearity characterization of temperature sensing systems for integrated circuit testing by intermodulation products monitoring.

This work presents an alternative characterization strategy to quantify the nonlinear behavior of temperature sensing systems. The proposed approach relies on measuring the temperature under thermal sinusoidal steady state and observing the intermodulation products that are generated within the sensing system itself due to its nonlinear temperature-output voltage characteristics. From such intermodulation products, second-order interception points can be calculated as a figure of merit of the measuring system nonlinear behavior. In this scenario, the present work first shows a theoretical analysis. Second, it reports the experimental results obtained with three thermal sensing techniques used in integrated circuits.

Heterodyne lock-in thermal coupling measurements in integrated circuits: Applications to test and characterization.

Heterodyne strategies can be used to characterize thermal coupling in integrated circuits when the electrical bandwidth of the dissipating circuit is beyond the bandwidth of the thermal coupling mechanism. From the characterization of the thermal coupling, two possible applications are described: extraction of characteristics of the dissipating circuit (the determination of the center frequency of a low-noise amplifier) and the extraction of the thermal coupling transfer function.

Tumor sólido pseudopapilar de páncreas: diagnóstico y tratamiento curativo / Solid pseudopapillary tumors of the pancreas: diagnosis andcurative treatment

Objetivos: dar a conocer a través de una serie de casos clínicosuna entidad poco frecuente, con una presentación clínica yunos hallazgos radiológicos concretos, que permiten establecer undiagnóstico y un tratamiento que será en la mayoría de los casoscurativo.Pacientes y métodos: se realizó un estudio descriptivo y retrospectivode los casos diagnosticados y tratados quirúrgicamenteen una Unidad Pancreático-Biliar de un hospital universitario, duranteel periodo comprendo entre marzo de 1999 y septiembrede 2005.Resultados: la incidencia fue de 6 pacientes mujeres, con unaedad media de 33,5 años (rango 11-72). La clínica más comúnfue la de dolor y masa abdominal palpable. La tomografía computerizadafue diagnóstica en tres de las pacientes, en las tres restantesse estableció el diagnóstico diferencial con el tumor neuroendocrino.El tratamiento quirúrgico fue individualizado a cadapaciente según los hallazgos y las imágenes visualizadas en la tomografíacomputerizada. El estudio anatomopatológico confirmóel diagnóstico de presunción, informándose de un caso de carcinomasólido-pseudopapilar de páncreas. La estancia hospitalariafue de 18,16 días (rango 8-30). Mortalidad de 0%. En el seguimientocon una media de 46,3 meses (rango 12-76), no existenrecidivas.Conclusiones: la presencia en una mujer joven de una lesiónvoluminosa en el páncreas, debe hacernos pensar en el tumor sólidopseudopapilar. Debido a su bajo potencial de malignidad y ala existencia de unos patrones radiológicos concretos, su diagnósticodebe ser preciso, ya que el tratamiento quirúrgico radical escurativo

Objectives: to highlight an infrequent occurrence using a seriesof clinical cases with symptoms and signs, and specific radiologicalfindings allowing its diagnosis and treatment, which is inmost cases successful.Patients and methods: a descriptive and retrospective studyof patients diagnosed by computed tomography scanning andthen treated with surgery in the Pancreas and Biliary Unit of aUniversity Hospital from March 1999 to September 2005.Results: there were 6 female patients with a mean age of33.5 years (range 11-72). Most common signs included pain anda palpable mass in the abdomen. Three patients were diagnosedby computed tomography scanning, and a differential diagnosiswith a neuroendocrine tumor was performed for the remainingthree subjects. Surgical treatment was adapted to each patient accordingto the findings and images seen in their computed tomographyscans. Biopsy results confirmed the presumed diagnoses,and showed one case of solid pseudopapillary carcinoma of thepancreas. Average hospital stay was of 18.16 days (range 8-30).Mortality rate was 0%. No recurrences occurred during follow-upfor 46.3 months on average (range 12-76).Conclusions: the presence of a huge mass in the pancreas ofa young female should prompt suspicion for a solid pseudopapillarytumor. Given its low malignant potential, and the presence ofspecific radiographic patterns, its diagnosis should be accurate, asradical surgical treatment is effective

Solid pseudopapillary tumors of the pancreas: diagnosis and curative treatment.

OBJECTIVES: To highlight an infrequent occurrence using a series of clinical cases with symptoms and signs, and specific radiological findings allowing its diagnosis and treatment, which is in most cases successful. PATIENTS AND METHODS: A descriptive and retrospective study of patients diagnosed by computed tomography scanning and then treated with surgery in the Pancreas and Biliary Unit of a University Hospital from March 1999 to September 2005. RESULTS: There were 6 female patients with a mean age of 33.5 years (range 11-72). Most common signs included pain and a palpable mass in the abdomen. Three patients were diagnosed by computed tomography scanning, and a differential diagnosis with a neuroendocrine tumor was performed for the remaining three subjects. Surgical treatment was adapted to each patient according to the findings and images seen in their computed tomography scans. Biopsy results confirmed the presumed diagnoses, and showed one case of solid pseudopapillary carcinoma of the pancreas. Average hospital stay was of 18.16 days (range 8-30). Mortality rate was 0%. No recurrences occurred during follow-up for 46.3 months on average (range 12-76). CONCLUSIONS: The presence of a huge mass in the pancreas of a young female should prompt suspicion for a solid pseudopapillary tumor. Given its low malignant potential, and the presence of specific radiographic patterns, its diagnosis should be accurate, as radical surgical treatment is effective.