Browsing by Author "Fernando, F.R."

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Clnical presentation, characteristics and surgical outcome of retrosternally extending goitres versus goitres confined to neck: results from a case control study
(Sri Lanka Medical Association, 2016) Munasinghe, B.N.L.; Dissanayake, D.M.C.D.; Rathnayake, R.M.G.K.; Pinto, M.D.P.; Kumarasinghe, K.A.P.R.; Fernando, F.R.
INTRODUCTION: Goitres that extend beyond the thoracic inlet are defined as retro-sternally extending (RSE) goitres. These RSE goitres are a surgical challenge and their characteristics could be different to the goitres confined to the neck. METHOD: A retrospective case-control study. Patients were selected from the thyroid database maintained in our unit (from November 2002 to February 2016). Patients with RSE goitres (confirmed by imaging) were selected as study group (SG). Control group (CG) patients (with goitres confined to the neck) were systematically selected in a 1:2 ratio. The end points were: (i) incidence of RSE goitres, (ii) clinical presentation, (iii) degree of RSE (iv) thyroid status, (v) post operative complications and (vi) histological pattern. RESULTS: 527 consecutive patients (465 female: 62 male; median age 45 years, range 17 years to 71 years) were studied. For the case control study, there were 51 patients in the study group and 102 patients in the control group. Compression symptoms were not significantly high in the SG (27% vs 17%, p value <0.17). Majority had RSE of both lobes (78%). The median depth of extension into the mediastinum was 41.6mm (range 12mm - 95mm). A majority were euthyroid (SG 78% vs CG 82%). Post operative stridor was significantly high in the SG (7% vs 2%; P value = 0.015). Although a majority was colloid goitres, papillary carcinoma was significantly high in the CG (P value < 0.05). CONCLUSIONS: A majority of RSE goitres did not present with compression symptoms, but had significantly high post-operative stridor (p value <0.05). Incidence of cancer is not high in SG.
Colorectal cancer burden and trends in a South Asian cohort: experience from a regional tertiary care center in Sri Lanka
(Biomed Central, 2017) Chandrasinghe, P.C.; Ediriweera, D.S.; Hewavisenthi, J.; Kumarage, S.K.; Fernando, F.R.; Deen, K.I.
OBJECTIVE: Colorectal cancer (CRC) burden is increasing in the south Asian region due to the changing socio-economic landscape and population demographics. There is a lack of robust high quality data from this region in order to evaluate the disease pattern and comparison. Using generalized linear models assuming Poisson distribution and model fitting, authors describe the variation in the landscape of CRC burden along time since 1997 at a regional tertiary care center in Sri Lanka. RESULTS: Analyzing 679 patients, it is observed that both colon and rectal cancers have significantly increased over time (pre 2000-61, 2000 to 2004-178, 2005 to 2009-190, 2010 to 2014-250; P < 0.05). Majority of the cancers were left sided (82%) while 77% were rectosigmoid. Over 25% of all CRC were diagnosed in patients less than 50 years and the median age at diagnosis is < 62 years. Increasing trend is seen in the stage at presentation while 33% of the rectal cancers received neoadjuvant chemoradiation. Left sided preponderance, younger age at presentation and advanced stage at presentation was observed. CRC disease pattern in the South Asian population may vary from that observed in the western population which has implications on disease surveillance and treatment.
Detection of incidental thyroid carcinoma is significantly higher in goiters with background thyroiditis
(College of Surgeons of Sri Lanka, 2015) Pradeep, I.H.D.S.; Chandrasinghe, P.C.; Wijewardana, B.D.A.N.; Dissanayaka, D.M.C.D.; Fernando, F.R.; Buddika, U.A.; Kannangara., K.R.
INTRODUCTION: Incidence of 'incidental thyroid carcinoma' (ITC) is reported to be 3 % to 16% in operatively treated benign thyroid diseases. This study analyses the results of a single surgeon performing total thyroidectomy for benign diseases and is the continuation of the study preliminary published in 2009. MATERIAL AND METHODS: All patients, who underwent total thyroidectomy for benign diseases at the unit from January 2003 to October 2014 were included. All patients had preoperative ultrasonography and fine needle aspiration cytology (FNAC). Diagnosis of ITC was based on post op histopathological reporting. Test of proportions with a P value of 0.05 was considered significant. RESULTS: Total thyroidectomy specimens of 449 (Median age- 37 years; range: 25 - 65 years, female – 74.07 %) patients were analyzed. ITC was detected in 6.01% (n=27) of patients. Papillary carcinoma was the commonest (62.96%) subtype. There were 8 (29.62%) follicular and 2 (7.4 %) medullary cancers. Males had a significantly higher proportion of ITC (Male: ITC/benign = 15% Vs Female: ITC/ benign = 5%; P= 0.02). Specimens with ITC reported a significantly higher rate of background thyroiditis (ITC = 33% Vs benign = 15 %; P= 0.02). ITC was not significantly associated with a family history (P= 0.7887). Postoperative transient hoarseness was observed in 3.56%and hypocalcaemia in 10.69%. CONCLUSIONS: A significant proportion of 'benign' goiters may harbor ITC, especially with background thyroiditis. With emerging evidence to support total thyroidectomy with low morbidity it may be prudent to offer total thyroidectomy for benign goiters with background thyroiditis.
Familial adenomatous polyposis (FAP) and papillary thyroid cancer: A rare form of familial cancer syndrome
(College of Surgeons of Sri Lanka, 2012) Nusliha, A.; Fernando, F.R.; Deen, K.I.; Dalpatadu, K.U.A.; Prasanna, W.L.A.D.A.
No Abstract Available
A Novel structure for online surgical undergraduate teaching during the COVID-19 pandemic
(BioMed Central., 2020) Chandrasinghe, P.C.; Siriwardana, R.C.; Kumarage, S.K.; Munasinghe, B.N.L.; Weerasuriya, A.; Tillakaratne, S.; Pinto, D.; Gunetilleke, B.; Fernando, F.R.
BACKGROUND: The Covid-19 pandemic necessitated the delivery of online higher education. Online learning is a novel experience for medical education in Sri Lanka. A novel approach to undergraduate surgical learning was taken up in an attempt to improve the interest amongst the students in clinical practice while maximizing the limited contact time. METHOD: Online learning activity was designed involving medical students from all stages and multi consultant panel discussions. The discussions were designed to cover each topic from basic sciences to high-level clinical management in an attempt to stimulate the student interest in clinical medicine. Online meeting platform with free to use basic plan and a social media platform were used in combination to communicate with the students. The student feedback was periodically assessed for individual topics as well as for general outcome. Lickert scales and numeric scales were used to acquire student agreement on the desired learning outcomes. RESULTS: A total of 1047 student responses for 7 questionnaires were analysed. During a 6-week period, 24 surgical topics were discussed with 51 contact hours. Eighty-seven per cent definitely agreed (highest agreement) with the statement 'students benefitted from the discussions'. Over 95% have either participated for all or most sessions. A majority of the respondents (83.4%) 'definitely agreed' that the discussions helped to improve their clinical sense. Of the total respondents, 79.3% definitely agreed that the discussions helped to build an interest in clinical medicine. Around 90% agreed that both exam-oriented and clinical practice-oriented topics were highly important and relevant. Most widely raised concerns were the poor Internet connectivity and limitation of access to the meeting platform. CONCLUSION: Online teaching with a novel structure is feasible and effective in a resource-limited setting. Students agree that it could improve clinical interest while meeting the expected learning outcomes.