In this paper, a novel methodology, based on fuzzy logic, for the tuning of proportional-integral-derivative (PID)

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Insulinomas comprise 1-2% of all pancreatic tumours and their small size coupled with non-specific symptomatology and an uncanny ability to go undetected on conventional imaging techniques makes preoperative localisation a diagnostic challenge. The objective is to evaluate the utility of imaging modalities and to analyse the presentation and surgical outcomes. Twenty consecutive operated cases of Insulinomas were reviewed retrospectively & prospectively over a 10year period from March 2011 to February 2021. Elevan were female & 9 male, median age was 37± 16.2 (range 21 to 50) years. The most common presentation was pre-prandial hypoglycaemia with symptomatic improvement on sugar ingestion. Biochemical diagnostic criteria used were, fasting blood glucose levels <50 mg/dl with synchronous insulin levels of >3.0 μU/ml and C-peptide levels of >0.6 ng/ml. Tumour localisation was done using a combination of CT, MRI and/or EUS in most patients and a Ga68-DOTATATE in some patients. The size ranged between 1-2 cm and their distribution was as follows: 10 in tail, 5 in body, 4 in the head of pancreas and 1 in the uncinate process. Enucleation was done in 12 patients and in 8 patients, distal pancreatectomy with/without splenectomy was done. All patients recovered uneventfully and were asymptomatic on an average follow-up of 2 years, except for one patient who developed a peripancreatic collection, detected 2 months after surgery and managed conservatively. Additionally, 2 patients had similar symptoms but were found to have nesidioblastosis and presacral soft tissue tumour. Keywords: Insulinoma, Whipple’s triad, hypoglycaemia, neuroglycopenic symptoms, enucleation.

Background: Gastrointestinal stromal tumours (GISTs) are rare mesenchymal tumours located commonly in the stomach. A complete and radical surgery is needed in most cases. GISTs near the gastro-esophageal junction are more challenging as compared to those situated in the pylorus, because of the complex surgical management. In our case we attempted an organ sparing surgery for a tumour located on the lesser curvature, which was close to cardia, thus avoiding a radical gastrectomy.Methods: A midline laparotomy followed by creation of a sleeve of the greater curvature was done. The cardio-oesophageal junction was divided and the tumour along with stomach adjacent to the lesser curvature resected using gastro-intestinal anastomotic linear staplers. Once vascularity of remnant stomach was confirmed, the greater curvature remnant was anastomosed to the oesophagus, thus restoring anatomic continuity.Results: Post-operative recovery was uneventful. A contrast study done on post-operative day 8 showed no leak. Patient was started on orals and was discharged on day 10 after adequate oral intake. Final histopathology report revealed a spindle cell GIST with resection margins and lymph nodes uninvolved. Immunohistochemistry study was positive for C-Kit and DOG-1 and negative for desmin and S-100. Tablet Imatinib was started and on a six month follow up patient showed no evidence of recurrence.Conclusions: GIST of lesser curvature close to cardia, can be treated with organ sparing surgery in selected patients, provided adequate tumour free resection margins and vascularity of remnant stomach is possible. It avoids a radical surgery and its associated complications.