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Biomedical subjects

H Ramesh

Publications and source records attributed to H Ramesh.

9 recordsLinked to original sources
PubMed1992

Surgery in tropical pancreatitis: analysis of risk factors.

Over a 7-year period, 91 patients with tropical pancreatitis underwent operation for intractable pain. Univariate and multivariate analyses were performed to identify factors correlating with mortality, major complications, poor pain relief and associated malignancy. Patients with benign disease (group 1, n = 72) had longer survival than those with superimposed malignancy (group 2, n = 19). Pain relief was better in group 1 (59 patients compared with none, P less than 0.01). Age above 40 years, short duration of symptoms, mass lesions on ultrasonography and main pancreatic duct obstruction on endoscopic retrograde pancreatography were associated with a high risk of cancer. After reoperation major complications (four of ten) or death (three of ten) occurred more commonly than after primary procedures (seven of 81, P = 0.019 and five of 81, P less than 0.05, respectively). Poor pain relief in group 1 patients was more common after incomplete clearance of main duct stones (four of 13 versus three of 53, P less than 0.01) and after short length ductotomy (three of eight versus four of 58, P less than 0.01). Tropical pancreatitis has a high association with pancreatic adenocarcinoma. Wide ductotomy, stone clearance and drainage gave good symptomatic results in patients with benign disease. Overall results were poor in patients with cancer.

Adolescent↗
PubMed1992

Is tropical pancreatitis premalignant?

Pancreatic adenocarcinoma occurred in 22 of 266 patients with tropical pancreatitis presenting over an 8-yr period (8.3%). We compared the data on three groups: group 1, patients with tropical pancreatitis (benign, n = 82); group 2, tropical pancreatitis with super-imposed malignancy (n = 22), and group 3, those with de novo cancer (n = 76). Factors associated with high risk for cancer in tropical pancreatitis were age greater than 40 yr, short symptom duration, weight loss, mass on ultrasound, and ductal block on endoscopic retrograde cholangiopancreatography. Tropical pancreatic cancers had distinct differences from de novo cancers: younger mean age (47 vs. 61 yr), calculi in all (vs. none in group 3), diabetes in 16 of 22 (73%) versus 18 of 76 (24%), and tumors in body and tail in 16 of 22 (73%) versus 26 of 76 patients (34%). In group 2, survival was poorer (10 vs. 17 months, p less than 0.01) than in group 3 (those with de novo cancer). Two of five resected specimens in group 2 showed features of dysplasia, in addition to cancer. Tropical pancreatitis has a high association with cancer. Malignancy occurring in tropical pancreatitis is distinct from de novo cancer. When considered in the light of the low incidence of pancreatic cancer in southern India, the above evidence suggests a possible etiological relationship.

Adenocarcinoma↗
PubMed1990

Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy.

Nineteen consecutive patients, 7 male and 12 female, underwent pancreaticoduodenectomy for malignancy during the 3-year period 1985-88. The pancreatic remnant in the first 12 patients (Group I) was managed alternately by pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). Patients undergoing PJ and PG (6 each) were comparable in age, biochemical parameters and nature and extent of disease. Three patients, all in the PJ subgroup, died (25% mortality) due to pancreatic leak, biliary leak and hepatocellular failure. In view of the high complication rate following PJ, the remaining 7 patients (Group II) underwent PG. For patients undergoing PG, the hospital stay was shorter, complications were fewer and there was no anastomotic leak or death (0% mortality). This study represents the first attempt at comparison of PJ with PG in reconstruction following the Whipple procedure by the same team. The results suggest that PG deserves wider application.

Adult↗
PubMed1990

Functioning neorectum.

Seventeen patients (15 males, 2 females) underwent restorative proctocolectomy during the 4 year period 1983-87. Twelve patients had familial adenomatous polyposis. Two of these had superimposed malignancy--one each in the cecum and transverse colon. Five patients had ulcerative colitis. Ten pouch procedures were of the J type, six of the S type and one of W configuration. There was one death (mortality 6%). Mean stool frequency was 4.2 per day at one year after surgery and all patients were totally continent at this time. The ileal pouch-anal anastomosis provided a functioning neorectum with low stool frequency and complete continence. The J pouch was found to be functionally superior though the numbers were too small to allow statistical comparison.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Observations and surgical management of tropical pancreatitis in Kerala and southern India.

This article describes the surgery of tropical pancreatitis as practiced in a region of high incidence, based on the experience at 2 centers: the Department of Surgical Gastroenterology and Proctology, Government General Hospital, Madras, Tamilnadu (a tertiary-care referral unit) where 52 patients were diagnosed and 40 were operated on between 1982 and 1987; and the Department of Gastroenterology, Deva Matha Hospital, Koothattukulam (a specialized center located in the main endemic area of Kerala), where 116 patients were diagnosed and 33 operated on between 1983 and 1988. The latter series is described in detail with emphasis on the preoperative imaging, operative findings, surgical procedures, complications, and results of surgery. The experience of other centers in southern India is summarized and discussed. The disease is obviously different from chronic pancreatitis in the West. Special problems of tropical pancreatitis, particularly the management of diabetes and the association of pancreatic carcinoma at a young age, are discussed.

Adolescent↗