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| 1 | A gist of gastrointestinal stromal tumors: A review显示文摘Gastrointestinal stromal tumors (GISTs) have been recognized as a biologically distinctive tumor type, different from smooth muscle and neural tumors of the gastrointestinal tract (GIT). They constitute the majority of gastrointestinal mesenchymal tumors of the GIT and are known to be refractory to conventional chemotherapy or radiation. They are defined and diagnosed by the expression of a proto-oncogene protein detected by immunohistochemistry which serves as a crucial diagnostic and therapeutic target. The identification of these mutations has resulted in a better understanding of their oncogenic mechanisms. The remarkable antitumor effects of the molecular inhibitor imatinib have necessitated accurate diagnosis of GIST and their distinction from other gastrointestinal mes-enchymal tumors. Both traditional and minimally invasive surgery are used to remove these tumors with minimal morbidity and excellent perioperative outcomes. The revolutionary use of specific, molecularlytargeted therapies, such as imatinib mesylate, reduces the frequency of disease recurrence when used as an adjuvant following complete resection. Neoadjuvant treatment with these agents appears to stabilize disease in the majority of patients and may reduce the extent of surgical resection required for subsequent complete tumor removal. The important interplay between the molecular genetics of GIST and responses to targeted therapeutics serves as a model for the study of targeted therapies in other solid tumors. This review summarizes our current knowledge and recent advances regarding the histogenesis, pathology, molecular biology, the basis for the novel targeted cancer therapy and current evidence based management of these unique tumors. | Ashwin Rammohan Jeswanth Sathyanesan Kamalakannan Rajendran Anbalagan Pitchaimuthu Senthil-Kumar Perumal UP Srinivasan Ravi Ramasamy Ravichandran Palaniappan Manoharan Govindan | 2013 | World Journal of Gastrointestinal Oncology2013，5，6： | 27 |
| 2 | Embolization of liver tumors:Past,present and future显示文摘Curative therapies for hepatocellular carcinoma(HCC),such as resection and liver transplantation,can only be applied in selected patients with early tumors.More advanced stages require local or systemic therapies.Resection of HCC offers the only hope for cure.Even in patients undergoing resection,recurrences are common.Chemoembolization,a technique combining intraarterial chemotherapy with selective tumor ischemia,has been shown by randomized controlled trials to be efficacious in the palliative setting.There is now renewed interest in transarterial embolization/transarterial chemoembolization(TACE) with regards to its use as a palliative tool in a combined modality approach,as a neoadjuvant therapy,in bridging therapy before transplantation,for symptomatic indications,and even as an alternative to resection.There have also been rapid advances in the agents being embolized trans-arterially(genes,biological response modifiers,etc.).The current review provides an evidence-based overview of the past,present and future trends of TACE in patients with HCC. | Ashwin Rammohan Jeswanth Sathyanesan Sukumar Ramaswami Anand Lakshmanan Perumal Senthil-Kumar Ulagendra Perumal Srinivasan Ravi Ramasamy Palaniappan Ravichandran | 2012 | World Journal of Radiology2012，4，9： | 11 |
| 3 | Neuroendocrine carcinoma of the ampulla of Vater:a clinicopathologic evaluation显示文摘BACKGROUND:Only 105 cases of neuroendocrine tumor(NET)of the ampulla of Vater have been described, mostly as single case reports.The incidence of NET is rising.The changes in incidence may result from changes in detection.This study was to determine the relative incidence and clinicopathological characteristics of high- grade neuroendocrine carcinoma(small cell carcinoma and large cell carcinoma)of the ampulla of Vater at a single institution. METHODS:Sections from paraffin blocks of tumors of the ampulla of Vater taken from 45 patients who underwent Whipple's procedure and 6 patients who underwent palliative bypass between September 2003 and January 2007 were subjected to immunohistochemical analysis.The clinical and pathological data from 5 patients diagnosed with NET of the ampulla of Vater were analyzed. RESULTS:The patients were 3 men and 2 women,ranging in age from 39 to 47 years(mean 44 years).Operative procedures included Whipple's procedure in 4 patients and palliative bypass in 1 patient.Histopathological examination revealed large-cell neuroendocrine carcinoma in 2 patients,small cell carcinoma in 2,and carcinoid in 1.Three patients with high-grade neuroendocrine carcinoma who had undergone Whipple's procedure died at postoperatively 7,11,and 13 months.The patient who had undergone palliative triple bypass died 3 months after surgery.CONCLUSIONS:The relative incidence of high-grade neuroendocrine carcinomas of the ampulla of Vater is higher than that generally expected.The tumors behave aggressively and have a dismal prognosis despite aggressive treatment. | Eswaran Selvakumar Shanmugasundaram Rajendran Tirupporur Govindaswamy Balachandar Devy Gounder Kannan Satyanesan Jeswanth Palaniappan Ravichandran Rajagopal Surendran | 2008 | Hepatobiliary & Pancreatic Diseases International2008，7，4： | 7 |
| 4 | Long-term outcome of gastric access loop in hepaticojejunostomy显示文摘BACKGROUND:The incidence of hepaticojejunostomy stricture is 4%-10% in experienced centres. Many access loops have been designed and used to facilitate endoscopic intervention for this complication of hepaticojejunostomy. In this study, we investigated the effectiveness and safety of gastric access loop. METHODS:A retrospective analysis was conducted on 13 patients who had undergone hepaticojejunostomy with gastric access loop between June 1999 and September 2003. Eleven patients were followed up for a mean period of 51 months (range 20-81 months). Two patients were lost to follow up. RESULTS:On follow-up, 8 patients had patent jejuno- gastrostomy (end to side anastomosis between Roux loop of jejunum and stomach) and hepaticojejunostomy. Three patients developed stricture of jejunogastrostomy at 41 months, 63 months and 81 months of follow-up. Among these 3 patients, one also had hepaticojejunostomy stricture. In the patient with hepaticojejunostomy stricture, dilatation of jejunogastrostomy stricture was attempted but failed. None of the patients had any evidence of bile gastritis/cholangitis. There was no procedure related morbidity/mortality. CONCLUSIONS:Further studies involving large numbers of patients are required before wide application of gastric access loop in hepaticojejunostomy though it is a safer option than percutaneous transhepatic manipulations or revision surgery. | Eswaran Selvakumar Shanmugasundaram Rajendran Tirupporur G. Balachandar Devy Gounder Kannan Satyanesan Jeswanth Palaniappan Ravichandran Rajagopal Surendran | 2008 | Hepatobiliary & Pancreatic Diseases International2008，7，2： | 6 |
| 5 | Incidental gall bladder cancers:Are they truly incidental?显示文摘AIM: To seek and analyze features suggestive of gallbladder cancer(GBC) on preoperative imaging and intraoperative findings in patients diagnosed as having incidental GBC(IGBC). METHODS: The study was conducted on 79 patients of IGBC managed in our department over a 10-year period(2003-2012). Review of preoperative imaging and operative notes was done to ascertain any suspicion of malignancy-in-retrospect.RESULTS: Of the 79 patients, Ultrasound abdomen showed diffuse thickening, not suspicious of malignancy in 5 patients, and diffuse suspicious thickening was seen in 4 patients. Focal thickening suspicious of malignancy was present in 24 patients. Preoperative computed tomography/magnetic resonance imaging was done in 9 patients for suspicion of malignancy. In 5 patients, dif-ficult Cholecystectomy was encountered due to dense/inflammatory adhesions. Intraoperative findings showed focal thickening of the gallbladder and a gallbladder mass in 9 and 17 patients respectively. On overall analysis, 37 patients had preoperative imaging or intraoperative findings suggestive of malignancy, which was either a missed GBC or an unsuspected/unexpected GBC. In 42(53.2%) patients, there was no evidence suggestive of malignancy and was an unanticipated diagnosis.CONCLUSION: Our study highlights a potential and not-so-rare pitfall of Laparoscopic Cholecystectomy. A greater awareness of this clinical entity along with a high index of suspicion and a low threshold for conversion to open procedure, especially in endemic areas may avert avoidable patient morbidity and mortality. | Ashwin Rammohan Sathya D Cherukuri Jeswanth Sathyanesan Ravichandran Palaniappan Manoharan Govindan | 2014 | World Journal of Gastrointestinal Oncology2014，6，12： | 5 |
| 6 | Predictors of malignancy in chronic calcific pancreatitis with head mass显示文摘AIM: To prospectively analyse the clinical, biochemical and radiological characteristics of the mass lesions arising in a background of chronic calcific pancreatitis (CCP). METHODS: Eighty three patients, who presented with chronic pancreatitis (CP) and a mass lesion in the head of pancreas between February 2005 and December 2011, were included in the study. Patients who were identified to have malignancy underwent Whipple' s procedure and patients whose investigations were suggestive of a benign lesion underwent Frey's procedure. Student t-test was used to compare the mean values of imaging findings [common bile duct (CBD), main pancreatic duct (MPD) size] and laboratory data [Serum bilirubin, carbohydrate antigen 19-9 (CA 19-9)] between the groups. Receiver operating characteristic curve (ROC curve) analysis was done to calculate the cutoff valves of serum bilirubin, CA 19-9, MPD and CBD size. The sensitivity, specificity, positive predictive valve (PPV) and negative predictive value (NPV) were calculated using these cut off points. Multivariate analysis was performed using logistic regression model. RESULTS: The study included 56 men (67.5%) and 27 women (32.5%). Sixty (72.3%) patients had tropical calcific pancreatitis and 23 (27.7%) had alcohol related CCP. Histologically, it was confirmed that 55 (66.3%) of the 83 patients had an inflammatory head mass and 28 (33.7%) had a malignant head mass. The mean age of individuals with benign inflammatory mass and those with malignant mass was 38.4 years and 45 years respectively. Significant clinical features that predicted a malignant head mass in CP were presence of a head mass in CCP of tropics, old age, jaundice, sudden worsening abdominal pain, gastric outlet obstruction and significant weight loss (P ≤ 0.05). The ROC curve analysis showed a cut off value of 5.8 mg/dL for serum bilirubin, 127 U/mL for CA 19-9, 11.5 mm for MPD size and 14.5 mm for CBD size. CONCLUSION: Elevated Serum bilirubin and CA 19-9, and dilated MPD and CBD were useful in predicting malignancy in patients with CCP and head mass. | Senthilkumar Perumal Ravichandran Palaniappan Sastha Ahanatha Pillai Vimalraj Velayutham Jeswanth Sathyanesan | 2013 | World Journal of Gastrointestinal Surgery2013，5，4： | 4 |
| 7 | Outcome of severe acute pancreatitis: Is there a role for conservative management of infected pancreatic necrosis?显示文摘BACKGROUND: Infected pancreatic necrosis is associated with high morbidity and mortality and is mandatory for surgical or radiological intervention. A selected group of patients with CT evidence of infected pancreatic necrosis and a comparatively lower APACHE score may be clinically stable throughout the course of their illness. METHODS: Case records of 52 patients with severe acute pancreatitis admitted from October 2000 to September 2005 were retrospectively analysed to assess the feasibility of conservative management of infected pancreatic necrosis. CT evidence of retroperitoneal air pockets, deteriorated clinical condition, sepsis and positive blood culture were used to diagnose infected pancreatic necrosis. RESULTS: In the 52 male patients reviewed, 24 patients had infected pancreatic necrosis. Eighteen patients who had progressively deteriorated clinical conditions required surgical intervention; five patients of whom (27.8%) died. Six patients with transient end organ dysfunction and stable clinical conditions were treated with prolonged administration of antibiotics and ICU support. All these patients recovered and discharged from the hospital, and no symptoms or readmission happened during follow-up of 6-44 months. CONCLUSIONS: Selected patients with infected pancreatic necrosis who are clinically stable with transient end organ dysfunction can be treated conservatively with a favourable outcome. Necrosectomy associated with high morbidityand mortality in these patients can be avoided. The need for intervention should be individualized and based on clinical conditions of the patients. | Amarapathy Sivasankar Devy Gounder Kannan Palaniappan Ravichandran Sathyanesan Jeswanth Tirupporur Govindasamy Balachandar Rajagopal Surendran | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，4： | 3 |
| 8 | Implications of the presence of an aberrant right hepatic artery in patients undergoing pancreaticoduodenectomy显示文摘AIM:To analyze the differences in outcomes and the clinical impact following pancreatoduodenectomy(PD)in patients with and without aberrant right hepatic artery(aRHA).METHODS:All patients undergoing PD between January 2008 and December 2012 were divided into two groups,one with aRHA and the other without.These groups were compared to identify differences in the intraoperative variables,the oncological clearance and the postoperative morbidity,mortality and hospital stay.RESULTS:A total of 225 patients underwent PD,of which 43(19.1%)patients were found to have eitheraccessory or replaced right hepatic arteries(aRHA group).The aRHA was preserved in 79%of the patients.There was no significant difference in the intraoperative blood loss but operative time was prolonged,reflecting the complexity of the procedure[420±44(240-540)min vs 480±45(300-600)min,P<0.05)].There were no differences in the incidence of postoperative complications(pancreatic leak,pancreatic fistula,delayed gastric emptying and mortality)and hospital stay.Oncological clearance in the form of positive resection margins[13(7.1%)vs 3(6.9%)]and lymph node yield were also similar in the two groups.CONCLUSION:An aRHA is found in approximately one fifth of patients undergoing PD.Preservation is technically possible in most patients and can increase the operative complexity but does not negatively affect the safety or oncological outcomes of the procedure. | Ashwin Rammohan Ravichandran Palaniappan Anbalagan Pitchaimuthu Kamalakannan Rajendran Senthil Kumar Perumal Kesavan Balaraman Ravi Ramasamy Jeswanth Sathyanesan Manoharan Govindan | 2014 | World Journal of Gastrointestinal Surgery2014，6，1： | 3 |
| 9 | Is bactibilia a predictor of poor outcome of pancreaticoduodenectomy?显示文摘BACKGROUND:Although bile infection has been proposed to increase infective complications following pancreaticoduodenectomy,its association with infective complications and non-infective complications like pancreatic fistula is still controversial.METHODS:Seventy-six patients who had undergone pancreaticoduodenectomy between July 2007 and December 2008 were included in a prospective database and their data analyzed.In all patients intraoperative bile from the bile duct was cultured.Preoperative,intra-operative,and post-operative variables were recorded and analyzed.RESULTS:Bile culture showed positive growth in 35 patients and negative growth in 41.Twenty patients in the positive group underwent ERCP and stenting.The patients with a positive bile culture had a higher incidence of infective complications including intra-abdominal abscess (n=8),wound infection (n=27),bacteremia (n=10),and renal insufficiency (n=9).There was no increase in the rate of non-infective complications of pancreaticoduodenectomy including pancreatic fistula (n=7),delayed gastric emptying (n=9),and post-operative hemorrhage (n=3).The hospital stay was significantly prolonged in the patients with a positive bile culture (P=0.0002).CONCLUSIONS:Pre-operative biliary drainage is significantly associated with bile infection,and bile infection increases the overall rates of infective complications and renal insufficiency.Because of the high incidence of complications is associated with infected bile,routine intra-operative bile culture is recommended in patients undergoing pancreaticoduodenectomy.Pre-operative prophylaxis is dependent on sensitivity of cases to perioperative antibiotics and intraoperative bile culture report.Because of its significant association with infected bile,biliary stenting should be used in strictly selected cases. | Sivanpillay Mahadevan Sivaraj Velayutham Vimalraj Palanichamy Saravanaboopathy Shanmugasundaram Rajendran Sathyanesan Jeswanth Palaniappan Ravichandran Rosy Vennilla Rajagopalan Surendran | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，1： | 2 |
| 10 | Retention mucocele of distal viable remnant tip of appendix:An unusually rare late surgical complication following incomplete appendectomy显示文摘一个 67 年的老人与周期性的恰好更低的象限的 6 瞬间历史被介绍腹的疼痛。在体格检查上,一个含糊的团在恰好腰部的区域是摸得出的。他的平淡的实验室测试是正常的。Ultrasonography 与内部回响和液体部件在对正确的肾前面的恰好腰部的区域显示出低亚硫酸钠拟声损害。腹的提高对比的计算断层摄影术(CECT ) 显示出明确的低亚硫酸钠对上升冒号 / 盲肠侧面的稠密的膀胱的集体损害,不与冒号 / 盲肠的腔交流。在膀胱的集体损害的完全的开的切除以后,粗野病理学的检查表明阑尾的残余的浮肿的膀胱的膨胀充满了粘蛋白的材料。在组织病理学说的检查上,附录的粘蛋白的包囊腺瘤被证实。我们在远侧的可行阑尾的残余报导粘液囊肿形成的这稀罕不平常的迟了的复杂并发症,它是剩余物列在后面不完全后退阑尾切除术。这不平常的复杂并发症没在文学被描述,我们报导它以便加亮临床、放射学的怀疑的一个高索引为在已经经历了阑尾切除术周期性的腹的疼痛地介绍的一个病人从远侧的可行阑尾的残余产生的粘液囊肿的诊断是必要的事实。 | Maria Antony Johnson Damodaran Jyotibasu Palaniappan Ravichandran Satyanesan Jeswanth Devy Gounder Kannan RajagopalSurendran | 2006 | World Journal of Gastroenterology2006，12，3： | 2 |
| 11 | Transabdominal Modified Devascularization Procedure with or without Esophageal Stapler Transection—An Operation Adequate for Effective Control of a Variceal Bleed. Is Esophageal Stapler Transection Necessary?显示文摘 | M. Johnson FRCS S. Rajendran MCh T.G. Balachandar D. Kannan MCh S. Jeswanth MCh P. Ravichandran MCh R. Surendran MCh | 2006 | World Journal of Surgery2006，，8： | 1 |
| 12 | Case matched comparison study of the necrosectomy by retroperitoneal approach for necrotizing pancreatitis in patients with CT severity score of 7and above显示文摘 | Senthil KP Ravichandran P Jeswanth S | 2012 | Int J Surg2012，10，10： | 1 |
| 13 | A case of recurrent biliptysis显示文摘 | Vimalraj V Jeswanth S Selvakumar E | 2007 | J Thorac Cardiovasc Surg2007，133，6： | 1 |
| 14 | Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Cancer: Can It Be Diagnosed Preoperatively?显示文摘 | Ashwin Rammohan Sathya D. Cherukuri Jeswanth Sathyanesan Ravichandran Palaniappan Manoharan Govindan Gianfranco D. Alpini | 2014 | Gastroenterology Research and Practice2014，，： | 1 |
| 15 | Percutaneous ultrasound-guided fine-needle aspiration of portal vein thrombi as a diagnostic and staging technique for hepatocellular carcinoma显示文摘 | Ashwin Rammohan S. Jeswanth R. Sukumar L. Anand P. Senthil Kumar U. P. Srinivasan R. Ravi P. Ravichandran | 2013 | Abdominal Imaging2013，，5： | 1 |
| 16 | Inflammatory pseudotumour secondary to spilled intra-abdominal gallstones显示文摘 | Rammohan A Srinivasan UP Jeswanth S | 2012 | IntJ Surg Case Rep2012，3，7： | 1 |
| 17 | Role of plasmapheresis in early allograft dysfunction following deceased donor liver transplantation显示文摘The role of plasmapheresis in liver failure and hepatic encephalopathy is undefined and its use as a strategy to salvage patients with severe allograft dysfunction after liver transplantation remains investigational. We present a case of early allograft dysfunction following deceased donor liver transplantation(DDLT) where plasmapheresis was effective as a bridge to recovery and possibly avoiding a retransplantation. A 16 years old boy, known to have decompensated Wilson's disease underwent DDLT at our Public Sector Hospital. He received a healthy liver from a brain-dead donor, whose liver was considered too large for the boy. The graft was reduced in situ to a left lobe graft. Surgery was uneventful and the recipient was well for the initial 96 h. On Doppler and further computed tomography scan, a partial portal vein thrombus was noted. He was reexplored and a Fogarty endothombecteomy was performed. Following the second surgery, he developed severe allograft dysfunction with a peak bilirubin of 40 mg/d L. He underwent imaging to rule out technical causes for the dysfunction, followed by a liver biopsy, which revealed acute cellular rejection. Multiple cycles of plasmapheresis were initiated. Over the next two weeks, the graft demonstrated a gradual recovery. He was discharged on the 30 th postoperative day, with a serum bilirubin of 5.5 mg/d L. He remains well on follow-up, with the liver function tests improving further. Our report demonstrates the beneficial effect of plasmapheresis, which appears to be an effective treatment option for early allograft dysfunction following liver transplantation and may obviate the need for retransplantation. | Ashwin Rammohan Deepti Sachan Satish Logidasan Jeswanth Sathyanesan Ravichandran Palaniappan Mohamed Rela | 2017 | World Journal of Hematology2017，6，1： | 0 |
| 18 | Large cell neuroendocrine carcinoma of the ampulla of Vater显示文摘BACKGROUND: Neuroendocrine tumors of the ampulla of Vater are extremely rare, and few cases of large cell neuroendocrine carcinoma (LCNEC) of the ampulla have been reported. METHODS: A 48-year-old male with obstructive jaundice was admitted to our hospital. On examination the patient was found to have a periampullary growth and subsequently underwent the Whipple’s procedure. RESULTS: Histopathological examination and immunohistochemistry revealed features of LCNEC of the ampulla of Vater. The patient developed multiple liver metastases 6 months after Whipple’s procedure. CONCLUSION: LCNEC of the ampulla of Vater is rare and highly aggressive, with a dismal prognosis. | Eswaran Selvakumar Velayutham Vimalraj Shanmugasundaram Rajendran Tirupporur G.Balachandar Devy G.Kannan Satyanesan Jeswanth Palaniappan Ravichandran Arunachalam Sundaram Rajagopal Surendran | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，3： | 0 |
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