Browsing by Author "Ariyaratne, M.H.J."

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Audit on quality of care given to the patients who attended the professorial surgical clinic
(Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Ariyaratne, M.H.J.; Perera, W.A.T.M.N.; Wanigasekera, H.L.A.C.R.
INTRODUCTION The large number of patents attending the professorial surgical clinic overwhelms the facilities available. An audit was designed to evaluate the quality of care given to the patients. The parameters assessed were, treatment given, drugs given, dose appropriateness and whether unnecessary treatment was administered. METHODOLOGY Every 3rd patient (N=112) who attended the clinic of University Surgical Unit, NCTH, Ragama was included in the study, from June 2009 to August 2009. Each patient was assessed by a single examiner (a senior registrar), and a pre tested profoma was completed. RESULTS Majority was females 68(60.7%). 78(69.65%) were due to variety of diseases including breast pathology. 34(30.35%) were due to thyroid pathology. 76(67.85%) have received a diagnosis card. 108(96.42%) have got the correct treatment. 4(3.57%) have received unnecessary drugs, in 12(10.71%)the dosage of the drugs were not appropriate. 8(7.14%) patients could be discharged from the clinic. CONCLUSION Overall care given in the professorial surgical unit was satisfactory. A few people were receiving unnecessary drugs, improper dosage. Some have not received a diagnosis card and there were few unnecessary follow-ups. We should make the doctors aware of those issues to improve the quality of care given to the patients.
Biofeedback with and without surgery for fecal incontinence improves maximum squeeze pressure, saline retention capacity and quality of life
(Springer India, 2008) Munasinghe, B.N.L.; Rathnayaka, M.M.G.; Parimalendran, R.; Kumarage, S.K.; de Zylva, S.; Ariyaratne, M.H.J.; Deen, K.I.
Clinically benign breast lumps - how often are they malignant?
(12th Annual Research Symposium, University of Kelaniya, 2011) Jayatunge, D.N.U.; Pinto, M.D.P.; Ariyaratne, M.H.J.
Breast cancer in women is a major public health problem throughout the world. One in ten of all new cancers diagnosed worldwide each year is a cancer of the female breast. Diagnosis of breast cancer is done by triple assessment considering clinical/cytological and radiological behaviour of a breast lump. First encounter of patients with a breast lump is commonly with a primary care physician in our clinical practice. The objective of this study is to assess the case load of carcinoma of the breast presenting as clinically benign breast disease. Retrospective analysis of data from the breast cancer registry (1999-2011) of the Professorial Surgical Unit, NCTH was done. Examination findings of all the patients in the registry were analyzed. Patients who presented a single, well defined, firm, freely mobile breast lump with no nipple discharge or palpable axillary lymph nodes were considered to be clinically benign. Study population consisted of 145 patients (n=145) with a mean age of 53.23 years and a range between 30-84 years. 12 (8.27%) patients with a mean age of 48.33 years presented with above mentioned criteria. With completion of triple assessment, all of them were diagnosed to have carcinoma of the breast. In our setting about 1 in 10 patients with a carcinoma of the breast may present as having a benign breast lump clinically. Thus it is important to conduct cytological and radiological assessment in all patients presenting with a breast lump especially after the age of 40.
Complications of loop ileostomy and ileostomy closure and their implications for extended enterostomal therapy: A prospective clinical audit
(Pergamon Press, 2008) Rathnayake, M.M.; Kumarage, S.K.; Wijesuriya, S.R.E.; Munasinghe, B.N.L.; Ariyaratne, M.H.J.; Deen, K.I.
INTRODUCTION: Patients who have a temporary loop ileostomy have impaired quality of life. Complications associated with a loop ileostomy orileostomy closure will impair patients' quality of life further and require extended enterostomal therapy. We performed a prospective audit of loop ileostomy to ascertain the nature of the workload that may be created with ileostomy-related complications. PATIENTS AND METHODS: One hundred and forty patients (67 males, 73 females, median age 50 years, range 5-90 years) who received a temporary loop ileostomy were analysed after completion of proformas on a prospective basis between 1999 and 2006. RESULTS: Operation was performed for rectal cancer 100 (71%), familial adenomatous polyposis 14 (10%), ulcerative colitis 21 (15%) and for trauma or Hirchsprung's disease 5 (3%). Complications of loop ileostomy were: retraction 1 (0.7%), ileostomy flux 11 (8%), stomal prolapse 1 (0.7%), parastomal hernia 1 (0.7%), paraileostomy abscess 4 (3%) and severe skin excoriation 9 (6%). The loop ileostomy was reversed in 117 (83%) at a median (range) of 13 weeks (1-60). Ileostomy closure-related complications were: small bowel fistula 1 (0.9%), small bowel obstruction 5 (4.3%) and a stitch sinus in 1 (0.9%). Five women developed recto-vaginal fistula (n=3; 2.6%), pouch-vaginal fistula (n=1; 0.9%) and pouch-anal fistula (n=1; 0.9%) that required extended enterostomal therapy, after loop ileostomy reversal. CONCLUSION: Nineteen percent of patients following creation of a loop ileostomy and 10.5% of patients after reversal of the ileostomy requiredextended enterostomal care by a specialized enterostomal therapist, which supported resumption of a normal life.
Cost accounting in a surgical unit in a teaching hospital--a pilot study
(Sri Lanka Medical Association, 2003) Malalasekera, A.P.; Ariyaratne, M.H.J.; Fernando, R.; Perera, D.; Deen, K.I.
INTRODUCTION: Economic constraints remain one of the major limitations on the quality of health care even in industrialised countries. Improvement of quality will require optimising facilities within available resources. Our objective was to determine costs of surgery and to identify areas where cost reduction is possible. PATIENTS AND METHODS: 80 patients undergoing routine major and intermediate surgery during a period of 6 months were selected at random. All consumables used and procedures carried out were documented. A unit cost was assigned to each of these. Costing was based on 3 main categories: preoperative (investigations, blood product related costs), operative (anaesthetic charges, consumables and theatre charges) and post-operative (investigations, consumables, hospital stay). Theatre charges included two components: fixed (consumables) and variable (dependent on time per operation). RESULTS: The indirect costs (e.g. administration costs, 'hotel' costs), accounted for 30%, of the total and were lower than similar costs in industrialised nations. The largest contributory factors (median, range) towards total cost were, basic hospital charges (30%; 15 to 63%); theatre charges fixed (23%; 6 to 35%) and variable (14%; 8 to 27%); and anaesthetic charges (15%; 1 to 36%). CONCLUSION: Cost reduction in patients undergoing surgery should focus on decreasing hospital stay, operating theatre time and anaesthetic expenditure. Although definite measures can be suggested from the study, further studies on these variables are necessary to optimise cost effectiveness of surgical units
Current concepts in management of chronic wounds
(College of Surgeons of Sri Lanka, 2010) Chandrasinghe, P.C.; Ariyaratne, M.H.J.
No Abstract Available
Demographic details, mode of presentation, contributory factors and outcome of trauma patients who visited North Colombo Teaching Hospital, Ragama from 1st April 2009 to 1st July 2009
(Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Ariyaratne, M.H.J.; Wanigasekera, H.L.A.C.R.; Rupasinghe, G.N.; Dilesha, W.A.L.
Introduction Trauma is one of the main causes of hospital morbidity and mortality. Material and methods Descriptive study which included 110 consecutive patients who presented to the Professorial Surgical Unit ,NCTH, Ragama as the first contact hospital following trauma during the period of 3 months from 1st of April 2009 to 1st of July 2009 Data was collected by interviewer administered questionnaire from the day of admission to day of discharge. Results • Demographic details The mean age of trauma victim was 34 (17-68) years and 71% (n=78) were males. 11.5% (n=23) victims were daily paid manual workers. Among all victims of trauma 77% (n=70) were to be educated up to O/L or more. 42% (n=46) were single. • Mode of presentation of all admissions The analysis revealed 56% (n=61) of trauma were due to road traffic accidents and 13.5% (n=14) due to occupational hazards. 39.1% (n= 43) had head injury and 12% (n=11) had hand injury. • Contributory factors At the time of admission13.5% (n=13) were under the influence of alcohol, 66.5% (n=73) had sleep deprivation(less than 6 hours of sleep), 65.4% (n=68) of trauma were high velocity injuries, 57.6% (n=60) had not used protective devices. • Other factors influencing the outcome 57.7% (n=60) had not had first aid and 15.7% (n=15) had delay for more than 2 hours in reaching the hospital. • Outcome 65.4% (n=68) of trauma victims were discharged before 7 days after admission and 1.9% (n=2) died and 1.9 % (n=2) ended up with amputation. Discussion and conclusion Our study shows the importance of wearing protective devices, controllable speed, avoidance of sleep deprivation and abstinence from intoxicating liquor as primary prevention and practicing first aid measures, early access to medical facility as secondary preventive measures in order to achieve SAFE TOMORROW.
Exploring infections as an aetiological agent of breast carcinoma
(College of Surgeons of Sri Lanka, 2012) Ariyaratne, M.H.J.
Breast cancer currently enjoys the position of being the commonest cancer in females worldwide [1] and indeed in Sri Lanka. In 2005 breast cancer contributed to 14.3% of all cancers reported island wide and 25.4% of all female cancers [2]. Many aetiological factors have been discovered with a strong focus on hereditary forms of breast cancer [3]. However, these contribute only to 5-10% of breast cancers overall. Environmental, socio-economic, hormonal and radiation factors have also been shown to contribute to the aetiology. An emerging area of interest is the role of infectious agents in breast cancer aetiology. The global burden of infectious agents causing cancer is 16- 18% [4]. Most of these infection related cancers occur in developing countries and are due to treatable infections caused by Hepatitis B virus (HBV), Hepatitis C virus (HCV), Human Papilloma virus (HPV), Helicobacter pylori,Epstein Barr virus (EBV) and Cytomegalovirus (CMV). The aim of this article is to give an overview of infectious agents linked to carcinomas and their association with breast cancer.
Extent of patient delay and its clinical implications among breast cancer patients of the professorial surgical unit, NCTH, Ragama
(Research Symposium 2010 - Faculty of Graduate Studies, University of Kelaniya, 2010) Dharmasiri, K.B.V.S.V.T.; Perera, H.A.S.S.; Nusliha, A.; Ariyaratne, M.H.J.
Introduction Delay in diagnosis of breast cancer results in poor outcome. Objective The aim of the study was to assess the extent of patient delay and its association with presenting complains, breast self-examination, stage of breast cancer at presentation and time of presentation. Method Retrospectively analyzed the data from the breast cancer registry (March 1999- December 2009) maintained at professorial surgical unit, NCTH, Ragama. All patients of the registry included in the study. Patients who detected by screening test (except breast self-examination) were excluded. Patient delay was defined as time from onset of first symptoms to first consultation of a doctor. Patient delay of >3 month considered as late presentation and <3 month early presentation. Results Of the study population (n=134, median age 52, range 30-88years) majority was late presenters (88, 65.6%). The median patient delay was 170days (range 1- 72days). A palpable lump in the breast was the commonest presenting complain among both early (28, 60.8%) and late (48, 54.5%) presenters. Of the early presenters 11 (23.9%) and of the late presenters 12(13.6%) performed breast self-examination. Twenty-seven (47.8%) of the early presenters 32(36.3%) of the delayed presenters had early stage breast cancer at presentation. There have been 36 (72%) late presenters among first 5patients and 29(58%) late presenters among last 5patients of the breast cancer registry. Conclusion Most of the patients are late presenters but duration of patient delay has improved with time. Health conscious patients who performed breast self-examination seem to present early for medical advice. Early presentation may improve the patient outcome because majority has early stage breast cancer.
Inflammatory pseudotumour of the liver caused by a migrated fish bone
(Sri Lanka Medical Association, 2007) Perera, M.T.P.R.; Wijesuriya, S.R.E.; Kumarage, S.K.; Ariyaratne, M.H.J.; Deen, K.I.
No Abstract Available
Natural course of acquired undescended testis in boys
(Wiley, 2003) Siriwardana, P.N.; Satheeshan, B.; Ariyaratne, M.H.J.; Deen, K.I.
Comment On Br J Surg 2003; 90: 728-731. No Abstract Available
Natural course of undescended testis in boys
(2003) Siriwardana, P.N.; Satheeshan, B.; Ariyaratne, M.H.J.; Deen, K.I.
No Abstract available
New concepts of breast cancer aetiology
(College of Surgeons of Sri Lanka, 2009) Ariyaratne, M.H.J.; Dilesha, W.A.L.
No Abstract Available
The Prevalence of colorectal cancer and survival in patients from the Gampaha District, North Colombo region
(Sri Lanka Medical Association, 2008) Perera, T.; Wijesuriya, S.R.E.; Suraweera, P.H.R.; Wijewardene, K.; Kumarage, S.K.; Ariyaratne, M.H.J.; Deen, K.I.
INTRODUCTION: The prevalence and survival of colorectal cancer in Sri Lankans has not been previously reported. We did a retrospective and a prospective survey, in the region of North Colombo, Sri Lanka between 1992 and 2004. The aim was to study cancer burden, sites of colorectal cancer and survival after surgery. PATIENTS AND METHODS: The records of 175 patients with colorectal cancer between 1992 and 1997 in the selected region of were analysed retrospectively. A prospective study was performed in 220 new patients with colorectal cancer between 1996 and 2004. Data evaluated were demographics, tumour stage and survival. RESULTS: Between 1992 and 1997 the crude annual incidence of colorectal cancer was 1.9 per 100,000, which increased over the years. The current national crude annual incidence is 3.2 per 100,000 in women and 4.9 in men. Median age at presentation was 60 years with similar prevalence of cancer in men and women. In the entire group, 28% of cancers were in those less than 50 years old. Survival at 2 and 5 years was 69% and 52%. The majority of cancer related deaths were within the first 2 years after surgery. CONCLUSION: The burden of colorectal cancer in Sri Lanka is on the rise. Up to a third of cancers occur in those under 50 years, and the majority of cancers are in the rectum or rectosigmoid region. Flexible sigmoidoscopy offers a useful screening tool.
Prevention of presacral haemorrhage using thumb tacks
(Sri Lanka Medical Association, 1999) Sundaresan, K.T.; Sugirtha, S.; Devanarayana, N.M.; Ariyaratne, M.H.J.; Deen, K.I.
Prospective clinical and functional audit of emergency and elective haemorrhoidectomy
(College of Surgeons of Sri Lanka, 1999) Deen, K.I.; Paris, M.A.S.; Ariyaratne, M.H.J.; Samarasekera, D.N.
Background Traditionally, prolapsed thrombosed haemorrhoids have been treated conservatively because of the popular belief that the incidence of complications are greater after emergency operation compared with elective operation for haemorrhoids. An audit comparing emergency operation for prolapsed thrombosed haemorrhoids with elective operation for third and fourth degree haemorrhoids is presented. Patients and methods 104 patients (82 male, median age 47 years, range -18 to 80 years) undergoing emer- gency (65) or elective haemorrhoidectomy (39) were evaluated for complications after operation, hospital stay and postoperative bowel function which was assessed at 3 months by mailed questionnaire. Results Trainees performed as many operations as consultants (trainee 48 (46 percent) vs. consultant 56 (54 percent) although consultants performed more emergency operations (trainee-20, consultant-45). Postoperative complications were seen in 13 (12percent) ; emergency-9 versus elective-4 (p=0.69). There was no difference in complications after trainee performed operation (8) compared with operation by consultant (5). Median (range) duration of hospital stay after emergency operation was 2 days (1-17) compared with elective operation -2 days (1-10). A subset of 41 patients responded to a questionnaire on bowel function at 3 months: 5 of twenty five (20 percent) after emergency haemorrhoidectomy and 2 of sixteen (12.5 percent) after elective haemorrhoidectomy reported transient incontinence to gas or stool up to 3 weeks after operations but none were incontinent at 3 months. After emergency haemorrhoidectomy, 9 (36 percent) reported a sense of anal narrowing compared with 2 (12.5 percent) after elective haemorrhoidectomy (p=0.13). None required corrective surgery for anal stenosis. Conclusion There were no significant differences in complications, hospital stay and postoperative bowel function in patients after emergency and elective haemorrhoidectomy. Emergency haemorrhoidectomy is likely to result in low morbidity when undertaken by trained persons.
The Rambewa bus bomb, a clinico-pathological review
(College of Surgeons of Sri Lanka, 2001) Banagala, A.S.K.; Ariyaratne, M.H.J.
BACKGROUND : Exposure to an explosion produces a well-defined pattern of injury. A retrospective study of the pattern of injury sustained by the victims of a blast in a vehicle has been undertaken. METHOD: Injuries sustained by the eight (08) patients who died on the spot were obtained,with permission, from the records of the Judicial Medical Officer. Injuries of those who survived initially, including the two (02), who succumbed to their- injuries after admission to the hospital, were gathered from the hospital records. RESULTS: The dead had all suffered multiple system injuries and or traumatic amputation of lower extremity whilst most survivors suffered skeletal injuries alone. Two (02) of the survivors had penetrating abdominal injuries together with skeletal injuries. CONCLUSION: Presence of multiple system injuries and/or traumatic amputation of limbs are a poor prognostic indicator in a blast scenario. Haemorrhage was the most frequent life-threatening problem among the survivors.
Sexual and urinary dysfunction following rectal dissection compared with segmental colectomy
(Wiley-Blackwell, 2008) Perera, M.T.; Deen, K.I.; Wijesuriya, S.R.E.; Kumarage, S.K.; de Zylva, S.T.U.; Ariyaratne, M.H.J.
INTRODUCTION: The aim of this study was to assess the impact of nerve sparing surgery and major abdominal surgery on sexual and urinary function in men and women with colorectal cancer undergoing rectal dissection and segmental colectomy. METHOD: Forty-eight patients (group A: 22 males, 26 females; median age 55 years) undergoing rectal dissection were compared with 24 having segmental colectomy (group B: 12 male, 12 female; median age 55 years). Preoperative data were also compared with age- and gender-matched controls (group C). RESULTS: More patients after rectal dissection vs segmental colectomy had urinary tract infections [15 (31%) vs 3 (17.5%), P = 0.04]. At 37 months, urinary dysfunction after rectal excision was seen in 29 (60%; 20 men) vs nine (37.5%; eight men) after segmental colectomy. Postoperative urinary symptoms were significant in group A, but not in group B (pre: vs post; groups A and B: poor stream--13%vs 38%, P = 0.001 and 21%vs 21%, P = NS; incontinence--4.2%vs 17%, P = 0.008 and 8%vs 8%, P = NS; hesitancy--13%vs 35%, P = 0.034 and 17%vs 21%, P = NS). Sexual health was worse after rectal excision compared with segmental colectomy (men--62.5%, women--25%vs 44% of men) respectively. Erectile dysfunction was the chief cause (rectal excision--50%vs segmental colectomy - 33%). After rectal excision, 6% of women had dyspareunia and 19% reported reduced orgasm but none after segmental colectomy. Conclusion More men than women had urinary and sexual impairment after rectal excision than after segmental colectomy. Its aetiology is multifactorial
Trap guns injuries in rural Sri Lanka
(College of Surgeons of Sri Lanka, 2007) Banagala, A.S.K.; Ariyaratne, M.H.J.
BACKGROUND: Trap gun injuries are not uncommon in rural Sri Lanka. They cause considerable morbidity and mortality. Peripheral vascular injuries are encountered frequently among the victims. METHOD: A retrospective analysis of the injuries, methods of treatment, and results was performed. Details of fifty eight (58) patients were studied. Operative details were accurately recorded in a separate log book. Perusal of bed head tickets and the records of the judicial medical officer too helped. RESULTS: Two (02) patients died and six (06) others had amputation of lower limb at different levels. One survivor had severe tourniquet shock syndrome. Twenty eight percent (28%) of patients had wound infection. CONCLUSION: Abdominal injuries carry a high risk of mortality. Lower limb injuries are associated with a high incidence of vascular injuries. Lag time is the single most important factor that affects the outcome of the peripheral arterial injuries. Prognosis of popliteal artery injuries is particularly poor.
The Value of sentinel node biopsy in breast cancer
(College of Surgeons of Sri Lanka, 2012) Ariyaratne, M.H.J.; Jayatunge, D.N.U.
No Abstract Available