Browsing by Author "Gunawardena, P.A.H.A."

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Closed loop small bowel obstruction caused by a retained faecolith complicating acute appendicular perforation
(College of Surgeons of Sri Lanka, 1999) Gunawardena, P.A.H.A.; Deen, K.I.
Case report of an 11 year old boy presented with a 36 hour history of central abdominal pain which localized in the right iliac fossa, vomiting and fever. A diagnosis of appendicitis was made. He developed abdominal distension and vomitting on the third post-operative day. The primary cause of the complication was the retained faecolith which was not found at the time of apendicectomy, despite extension.
Comparison of hydrogen peroxide instillation with Goodsall's rule for fistula in-ano
(Wiley-Blackwell Pub. Asia, 2001) Deen, K.I.; Gunawardena, P.A.H.A.
BACKGROUND: Identification of the internal opening is an essential step in the management of fistula-in-ano. The predictive accuracy of Goodsall's rule is compared with instillation of hydrogen peroxide for fistulas-in-ano. METHODS: Thirty-five patients (32 male, three female; median age 42 years; range: 6 months-70 years) were studied. Hydrogen peroxide solution was injected into the external opening of the fistula track and effervescence was observed at the internal opening within the anal canal. A fistula track was either excised or incised. Setons were placed within high fistulas. RESULTS: There were 24 simple fistulas, compared to 11 complex fistulas (horseshoe, n = 4; abscess, n = 4). Eighteen external openings were anterior and 17 were posterior. Thirty-four of 35 (97%) internal openings were identified. Only 20 internal openings were in accordance with Goodsall's rule (positive predictive value: 59%). Predictive accuracy was greater for anterior external openings (13 of 18 (72%)) versus posterior external openings (six of 17 (41%); P = 0.016). For recurrent fistulas, seven of 17 fistula tracks had an internal opening in accordance with Goodsall's rule, resulting in a positive predictive value of 41%. (Positive predictive value: anterior 67% vs posterior 12.5%; P = 0.0009.) CONCLUSION: The overall predictive accuracy of Goodsall's rule was poor chiefly because of poor predictive accuracy in posterior and recurrent fistulas. The use of Goodsall's rule alone in decision-making before surgical intervention is not recommended.
Mixed medullary follicular carcinoma--an unusual thyroid neoplasm
(Sri Lanka Medical Association, 2000) Hewavisenthi, S.J.de S.; Ariyaratne, J.; Gunawardena, P.A.H.A.
Case report of a 24 year old woman who had a right sided thyroid enlargement of one years' duration, and hoarseness of voice. explains the investigations carried out. It was diagnosed as a case of mixed medullary follicular thyroid carcinoma, a recently recognized unusual thyroid neoplasm clinically and prognostically different from classical medullary carcinoma. Includes discussion.
Role of oesophageal manometry and pH studies in the diagnosis of endoscopy negative upper gastrointestinal disorders
(Sri Lanka Medical Association, 1999) Samarasekera, D.N.; Gunawardena, P.A.H.A.; de Silva, H.J.
Dysphagia and symptoms of gastro-oesophageal reflux disease (GOPD) are common upper gastrointestinal (Gl) symptoms. However a significant proportion of these patients do not have any endoscopic or radiological abnormalities. Therefore, they are most often labeled as having a "motility disorder" or sometimes as "functional", without any objective assessment OBJECTIVES: To assess the oesophageal motility and the pH in symptomatic patients with normal upper Gl endoscopy results. METHODS: Twelve patients with dysphagia and four patients with symptoms of GORD were assessed (n=16) over a period of 20 months {1.1.97 to 30.8.98). Measurements were recorded using a computerized oesophageal pressure/pH transducer (Synectics, UK). RESULTS: Male:Femaie = 7:9. Median age was 52 (range 42-75) years. MotiNty studies indicated oesophageal hypomotility in 3 (19%), early achalasia 2 (13%), and normal motility in 7 (43%) patients. Twenty four hour pH monitoring revealed marked GO reflux in 2 (13%) patients and normal values in 2 (13%) patients.CONCLUSIONS: Since a significant proportion (44%) of our patients showed a positive result, we conclude that manometry and pH studies of the oesophagus are mandatory in the diagnosis of patients with persistent dysphagia and reflux symptoms as most motility disorders cannot be diagnosed only on endoscopy or radiology alone.