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Incidental gall bladder cancers:Are they truly incidental?

World Journal of Gastrointestinal Oncology 2014年第12期6卷 441-443页

作者： Ashwin Rammohan Sathya D Cherukuri Jeswanth Sathyanesan Ravichandran Palaniappan manoharan govindan The Institute of Surgical Gastroenterology and Liver Transplantation Centre for GI Bleed Division of HPB diseases Stanley Medical College Hospital Stanley Medical College Hospital

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 ***: 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 ***: 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.

关键词： Incidental gallbladder cancer Preoperative detection Imaging

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A gist of gastrointestinal stromal tumors: A review

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World Journal of Gastrointestinal Oncology 2013年第6期5卷 102-112页

作者： Ashwin Rammohan Jeswanth Sathyanesan Kamalakannan Rajendran Anbalagan Pitchaimuthu Senthil-Kumar Perumal UP Srinivasan Ravi Ramasamy Ravichandran Palaniappan manoharan govindan The Institute of Surgical Gastroenterology and Liver Transplantation Centre for GI Bleed Division of HPB Diseases Stanley Medical College Hospital

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.

关键词： Gastrointestinal stromal tumors c-KIT Imatinib mesylate Surgery Review

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Implications of the presence of an aberrant right hepatic artery in patients undergoing pancreaticoduodenectomy

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World Journal of Gastrointestinal Surgery 2014年第1期6卷 9-13页

作者： Ashwin Rammohan Ravichandran Palaniappan Anbalagan Pitchaimuthu Kamalakannan Rajendran Senthil Kumar Perumal Kesavan Balaraman Ravi Ramasamy Jeswanth Sathyanesan manoharan govindan The Institute of Surgical Gastroenterology and Liver Transplantation Centre for GI Bleed Division of HPB diseases Stanley Medical College Hospital

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 *** groups were compared to identify differences in the intraoperative variables,the oncological clearance and the postoperative morbidity,mortality and hospital ***: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 *** 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 *** 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 ***:An aRHA is found in approximately one fifth of patients undergoing *** 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.

关键词： Pancreatoduodenectomy Aberrant right hepatic artery Arterial anomalies Outcomes

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Molecular characterization and antibacterial effect of endophytic actinomycetes Nocardiopsis sp. GRG1 (KT235640) from brown algae against MDR strains of uropathogens

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Bioactive Materials 2016年第2期1卷 140-150页

作者： govindan Rajivgandhi Ramachandran Vijayan Marikani Kannan Malairaja Santhanakrishnan Natesan manoharan Department of Marine Science Bharathidasan UniversityTiruchirappalli 24Tamil NaduIndia School of Life Sciences Jawaharlal Nehru UniversityNew Delhi 67India Department of Microbiology VHNSN CollegeVirudunagar 01Tamil NaduIndia Department of Marine and Coastal Studies Madurai Kamaraj UniversityMadurai 21Tamil NaduIndia

Our study is to evaluate the potential bioactive compound of Nocardiopsis ***1(KT235640)and its antibacterial activity against multi drug resistant strains(MDRS)on urinary tract infections(UTIs).Two brown algae samples were collected and were subjected to isolation of endophytic actinomycetes.100 strains of actinomycetes were isolated from algal samples based on observation of morphology and physiological characters.40 strains were active in antagonistic activity against various clinical *** the strains,10 showed better antimicrobial activity against MDRS on *** secondary metabolite of Nocardiopsis ***1(KT235640)has showed tremendous antibacterial activity against UTI pathogens compared to other *** of various growth parameters were used for synthesis of secondary metabolites,such as optimum pH 7,incubation time 5e7 days,temperature(30C),salinity(5%),fructose and mannitol as the suitable carbon and nitrogen *** 100 μg/ml concentration MIC of Nocardiopsis ***1(KT235640)showed highest percentage of inhibition against Proteus mirabilis(85%),and ***,Staphylococcus auerues,Psuedomonas aeroginasa,Enterobactor sp and Coagulinase negative staphylococci 78e85%respectively.

关键词： Endophytes Multi-drug resistant strains Urinary tract infections Minimal inhibitory concentration

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