Browsing by Author "Hewavisenthi, J."

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Advancd hepatic fibrosis and cirrhosis due to nonalcoholic fatty liver disease in Sri lankan children: a preliminary report
(Springer International, 2008) Rajindrajith, S.; Dassanayake, A.S.; Hewavisenthi, J.; de Silva, H.J.
Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases and may progress to advanced hepatic fibrosis and cirrhosis in some patients. Cirrhosis due to NAFLD is considered extremely rare in children in the Asia-Pacific region. We report the characteristics of 5 children with advanced hepatic fibrosis and cirrhosis due to NAFLD. Four of them were obese, and all of them had high alanine transaminase levels and ultrasonographic evidence of fatty liver. None had diabetes mellitus or hyperlipidemia. The calculated HOMA-IR was more than two in all five cases. Liver biopsy showed stage III fibrosis in 2 patients and stage IV fibrosis (cirrhosis) in 3.
Clinical features and treatment outcomes in patients with symptoms of irritable bowel syndrome (IBS) with and without non-specific colitis (NSC) on histology
(Sri Lanka Medical Association, 2003) de Silva, H.J.; Navaratne, N.M.D.; Hewavisenthi, J.
BACKGROUND: Routine rectal biopsies in patients with IBS symptoms often show histological changes of NSC. The aetiology and pathogenesis of NSC are unclear, and there are no guidelines for treatment. OBJECTIVE: To determine clinical features and treatment outcomes in patients with IBS symptoms with and without NSC on rectal or colonic biopsies. METHODS: Consecutive patients attending an out-patient clinic diagnosed as having IBS using ROME II criteria were further studied. They all had a clinical assessment, and routine stools examination and culture, flexible sigmoidoscopy and barium enema or colonoscopy with biopsy. Patients who had normal rectal/ colonic histology (NHIBS) or NSC were given treatment for IBS symptoms with dietary modification, anti-spasmodics, anti-diarrhoeals, and anti-depressants, alone or in combination. Response to treatment was assessed after three months. RESULTS: 75 patients (M;- F=50:25; mean age 35.9 years) who had IBS symptoms and normal stool examination and large bowel endoscopy/ radiology were followed up. Six (one with ulcerative colitis, 5 with lymphocytic colitis) were excluded after rectal histology. Patients with NHIBS (n=29) and NSC (n=40) were well matched for age, gender and duration of symptoms. After 3 months of treatment for IBS symptoms, the response to treatment was similar in the two groups (NIBS Vs. 20, worsening 7 Vs 8). CONCLUSIONS; NSC is frequently seen in patients presenting with IBS symptoms. The clinical significance of this finding is unclear, as clinical features and short-term response to symptomatic treatment is similar to patients with BHIBS.
Clinical outcome of patients having neo-adjuvant therapy(NAT) for rectal cancer: a case control study
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Wijesuriya, S.R.E.; Deen, K.I.; Hewavisenthi, J.; Ratnayake, G.
INTRODUCTION: From July i 999 we have employed NAT on a selective basis in the management of rectal cancer. OBJECTIVE: To explore the value of NAT in patients with rectal cancer in the short term. To study the effect of Neo Adjuvant Therapy for rectal carcinoma in the short term. METHODS: Two abdomino perineal resections and 24 anterior resections were done in the NAT group and 5 and 2 l in the no NAT group. There were 2 perioperative deaths in NAT group and one in the no NAT group (P 0.75). There were 7 Cancer related deaths in the NAT group and 6 in the no NAT group (P = l). The survival was 15 month (5 -45) for the NAT group and 16 (3 -54) for the non NAT group (P = I). There were no difference in the recurrences (2 vs 4 P ""0.67) metastasis (4 vs 4 P = 1) or complication (8 vs 2 p =0.08) abdomino perineal resections were performed in 2 patients in the NAT group and 5 in the no NAT group. Anterior resections were performed in 24 patients and 24 patients in NAT and no NAT groups. CONCLUSION: Overall there was no significant difference in the clinical out come between those given NAT and those not given.
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.
Comparison of one and two weeks of triple therapy for eradication of H. pylori: a randomized, controlled study in a tropical country
(Wiley Blackwell Scientific Publications, 2004) de Silva, H.A.; Hewavisenthi, J.; Pathmeswaran, A.; Navarathne, N.M.M; Peiris, R.; Dassanayake, A.S.; de Silva, H.J.
INTRODUCTION: Resistance of H. pylori to antibiotics may be particularly high in parts of the tropics. Infection may prove difficult to eradicate in such situations, and there is some evidence of benefit in increasing duration of treatment (triple therapy) from one week to two or three weeks. AIM : To assess the efficacy and tolerability of one-week versus two weeks triple therapy for eradication of H. pylori in a Sri Lankan population. METHODS: 82 consecutive patients aged 18–70 years with peptic ulcer disease testing positive for H. pylori infection (histology and rapid urease test on gastric antral biopsies) were randomly allocated to two treatment groups. The baseline characteristics of the two groups were similar. Both groups received omeprazole 20mg, clarithromycin 250mg, and tinidazole 500mg. Group A (n = 42) received the trial medication twice daily for one week and the Group B (n = 40) twice daily for two weeks. H. pylori eradication was defined as a negative 14C labeled urea breath test at two weeks after completion of therapy. The assessors were blind to randomization and other patient information. RESULTS; All patients presented for follow up after completion of therapy. H. pylori infection was eradicated in 36 (85.7%) patients in group A and 36 (90%) patients in group B (p = 0.9; 95% CI: -19.1 to 10.8). 23 (55%) patients in group A and 17 (43%) in group B reported adverse effects attributable to trial medication (p = 0.387); none were serious. 3 (7.5%) patients in group B discontinued treatment due to adverse events that developed on days 7, 9 and 10. CONCLUSION: Twice daily treatment with clarithromycin, tinidazole, and omeprazole for one-week is well tolerated and provides as good a rate of H. pylori eradication as two weeks therapy in Sri Lankan patients.
Comparison of one week and two weeks of triple therapy for the eradication of Helicobacter pylori in a Sri Lankan population: a randomised, controlled study
(Sri Lanka Medical Association, 2004) de Silva, H.A.; Hewavisenthi, J.; Pathmeswaran, A.; Dassanayake, A.S.; Navarathne, N.M.M.; Peiris, R.; de Silva, H.J.
INTRODUCTION: Resistance of Helicobacter pylori to antibiotics may be particularly high in parts of the tropics. Infection may prove difficult to eradicate in such situations, and there is some evidence of benefit in increasing the duration of treatment (triple therapy) from 1 week to 2 or 3 weeks. AIM: To assess the efficacy and tolerability of 1 week versus 2 weeks of triple therapy for eradication of H. pylori in a Sri Lankan population. METHODS: Eighty two patients aged 18-70 years with gastritis or peptic ulcer and testing positive for H. pylori infection were randomly allocated totwo treatment groups. Both groups received omeprazole 20 mg, clarithromycin 250 mg, and tinidazole 500 mg. Group A (n = 42) received the trial medication twice daily for 1 week and the Group B (n = 40) twice daily for 2 weeks. H. pylori eradication was defined as a negative 14C labelled urea breath test at 2 weeks after completion of the therapy. RESULTS: H. pylori infection was eradicated in 36 (85.7%) patients in Group A and 36 (90%) patients in Group B (p = 0.9). Twenty three (55%) patients in Group A and 17 (43%) in Group B reported adverse effects attributable to trial medication (p = 0.387); none were serious. Three (7.5%) patients in Group B discontinued treatment due to adverse events that developed on days 7, 9 and 10. CONCLUSION: Twice daily treatment with clarithromycin, tinidazole, and omeprazole for 1 week is well tolerated and provides as good a rate of H.pylori eradication as 2-week therapy in Sri Lankan patients.
Detection of micrometastases in lymph nodes using reverse transcription polymerase chain reaction (RT-PCR) for cytokeratin 20 (CK-20)--a pilot study
(Sri Lanka Medical Association, 2010) Wijesuriya, S.R.E.; Kuruppuarachchi, K.G.; Weerasinghe, A.; Hewavisenthi, J.; Deen, K.I.
OBJECTIVES: The aim of the study was to detect micrometastases in lymph nodes in patients with rectal cancer following neoadjuvant therapy, staged node negative by routine histology. PATIENTS AND SETTING: Mesenteric lymph nodes from patients who have undergone neoadjuvant therapy for rectal cancer were harvested during surgery. Nodes were bisected and one half was sent for haematoxylin and eosin (H&E) staining and evaluated by a single pathologist. The other half was examined for CK20 by RT-PCR. The technique was validated by testing mesenteric lymph nodes with known metastases and nodes from patients without cancer. Twenty one lymph nodes from 6 patients (median age 46 years, range 25- 55) which were negative for tumour deposits by H&E stain were assessed for micro-metastases. RESULTS: All 21 nodes which were histologically negative for metastases were positive for micrometastases. Two nodes with known metastases were positive for CK20 and 3 nodes from non cancer patients were negative for CK20.CONCLUSIONS: Detection of CK20 is accurate in identification of rectal cancer micro-metastasing to lymph nodes. Assessment of nodes by H & E histology risks under staging
Detection of micrometastasis in LYMPH nodes using reverse transcription polymerase chain reaction (RT-PCR) for Cytokeratin 20 (CK-20): are we under staging rectal cancer
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Wijesuriya, S.R.E.; Kuruppuarachchi, K.O.R.; Deen, K.I.; Weerasinghe, A.; Ramesh, R.; Hewavisenthi, J.
INTRODUCTION: Postoperative adjuvant chemotherapy in rectal cancer is determined by the presence of metastases in lymph nodes. Detection of LYMPH node metastases is routinely performed by light microscopy. Conventional histology may not detect all metastases especially following neoadjuvant therapy (NAT). CK-20 is a cytokeratin known to be specific to colonic epithelium which may help detection of rectal cancer metastases in lymph nodes. OBJECTIVE: To detect micro metastases in lymph nodes in patients with rectal cancer. staged node negative by routine histology. METHODS: Mesenteric lymph nodes from patients who have undergone NAT for rectal cancer were harvested during surgery. Nodes were bisected and one half sent for Haernatoxylin and eosin (H&E) staining and evaluated by a single pathologist, while the other half was examined for CK 20 by RT-PCR. The technique was validated by testing lymph nodes with known metastases and nodes from patients without cancer. 21 lymph nodes from 6 patients (median age 46 years, range 25-55) which were negative for tumour deposits by H&E stain were assessed for micro metastases. RESULTS: All 2 l nodes which were histologically negative for metastases were positive for micro metastases (positive predictive value l 00%) whilst 2 nodes with known metastases were positive for CK-20, 3 nodes from non-cancer patients were negative for CK-20. CONCLUSION: Detection of CK-20 is accurate in identification of micro metastases of rectal cancer to lymph nodes. Assessment of nodes by H&E histology risks under staging lymph node micro metastases in rectal cancer.
The detection of the expression of Keratin 19 and Keratin 20 genes in the diagnosis of micrometastases of colonic cancers
(Sri Lanka Medical Association, 2003) Weerasinghe, A.; Kuruppuarachchi, G.; Wijesuriya, R.; Hewavisenthi, J.; Deen, K.I.
OBJECTIVE: Keratin 19(K-19) and Keratin 20(K-20) genes are expressed in the epithelial tissues while they are absent in lymphoid-tissues. Therefore the expression of these foreign genes in lymph nodes is used in the diagnosis of micrometastases. We investigated the expression of K19 and K2C in the diagnosis of micrometastases of colonic cancer. DESIGN, SETTING AND METHODS: Regional lymph nodes of patients with colonic cancer (n = 5) were obtained from University Surgical Unit of Ragama. Two corresponding lymph nodes from non-cancer patients and colonic tumor tissue were used as negative and positive control respectively. De-ionized water was used as blank control. Lymph nodes were collected directly to the RNA extracting media (Isogen) during the surgery. Specimens were transported to Medical Research Institute within one hour at 4 C. cDNA was synthesized using reverse transcriptase and K19 and K20 primers were used to detect the expression of these genes. PCR products were identified using agarose gel electrophoresis after amplification using the thermal cycler (Perkin Elmer). (3-actin primer was used for internal quality control. RT/PCR findings were compared with the routine histological findings of the patients. RESULTS: Lymph nodes of all five patients with colonic cancers and the colonic cancer tissues were positive for the expression of K19 and K 20. Both control lymph nodes were negative for the expression of K-19 and K-20. All the patients with colonic cancers were negative on histology of the lymph node biopsies. CONCLUSION: These findings suggest that the detection of the expression of K19 and K20 help to identify the metastases, which are negative on histology.
Distribution of human papillomavirus genotypes in archival cervical tissue from women with cervical cancer in urban Sri Lanka
(Elsevier, 2011) Samarawickrema, N.A.; Tabrizi, S.N.; Hewavisenthi, J.; Leong, T.; Garland, S.M.
OBJECTIVE: To identify the contributions of various human papillomavirus (HPV) genotypes in tissue samples from women diagnosed with cervicalcancer in Sri Lanka. METHODS: In a retrospective study, archival cervical tissues samples (n=108) obtained from Sri Lankan women diagnosed with histologically proven invasive squamous cell carcinoma between 2006 and 2007 were tested for HPV. Genotyping of HPV DNA was performed using an INNO-LiPA assay. RESULTS: Overall, 93% of tumor samples tested positive for HPV DNA. HPV types 16 and 18 accounted collectively for 83.4% of the positive samples. CONCLUSION: The findings suggest that the HPV genotypes responsible for causing cervical cancer in Sri Lanka are similar to those reported elsewhere worldwide. Consequently, women in Sri Lanka could benefit from currently available prophylactic HPV vaccines should they be implemented.
FNAC in the 'field'- a new experience
(Sri Lanka Medical Association, 2008) Fernando, R.; Hewavisenthi, J.; Pathmeswaran, A.; Edirisinghe, D.; Abeysinghe, S.; Atulugama, N.; Bandara, D.; Premathileke, M.
BACKGROUND: Fine needle aspiration cytology (FNAC) is an important diagnostic test in thyroid diseases. It usually is undertaken at a hospital or laboratory setup. As part of an islandwide field based study, FNAC was undertaken in the field. Literature review revealed that FNAC accuracy rate was around 65-70% in most Centres with full-fledged facilities. OBJECTIVES: To determine the effectiveness of FNAC done in the field DESIGN, SETTING AND METHODS: Informed written consent was obtained and the goitre was delineated with a marker pen. FNAC was carried out by a trained team member in the standard manner. Four slides were prepared from each patient. All slides were processed and examined by a cytologist RESULTS: 308 FNAC were done. 226 FNAC were diagnostic (73.36%) and 82(26.64%) were non diagnostic. 62(23.8%) showed benign cells only. The pathological entities detected were: 112 (49.5%) auto immune thyroiditis, 32 (14.1%) colloid storing nodules, 14(6.1%) colloid storing nodules with autoimmune thyroiditis, 5 (2.2%) follicular lesions and one toxic lesion. There were no significant complications noted in any of the patients. CONCLUSIONS: Field FNAC has a high diagnostic accuracy if done by a trained person. It is a safe procedure in the field.
General pathology made easy
(Faculty of Medicine, University of Kelaniya, 2017) Hewavisenthi, J.
No abstract available
Goitre prevalence in diabetes - results of an islandwide study
(Sri Lanka Medical Association, 2008) Fernando, R.; Hewavisenthi, J.; Atulugama, N.S.; Edirisinghe, E.M.D.A.R.; Abeysinghe, A.P.S.D.; Fernando, W.M.T.P.S.; Premathilaka, H.M.M.S.; Bandara, S.D.
Abstracts Available
Histological analysis of chronic inflammatory patterns in the gall bladder
(International Organization of Scientific Research (IOSR), 2016) Hasan, R.; Abeysuriya, V.; Hewavisenthi, J.; Wijesinghe, J.A.A.S.
INTRODUCTION: Cholecystectomy is a common surgical procedure. Inflammatory disease is the most common pathology of the gallbladder. OBJECTIVE: To assess the different morphological changes of chronic cholecystitis in cholecystectomy specimens. METHODS: Thirty histological specimens from cholecystectomies from patients clear clinical history of biliary lithiasis were histologically evaluated with Haematoxylin-Eosinstaining. Three samples were obtained from fundus, middle third and the neck respectively from each gallbladder. RESULTS: 76% of the specimens had metaplastic epithelial changes. Hyperplasia showed a positive correlation (1.0000) with chronic inflammation. Regenerative morphology of epithelial cells was found in 73% of the cases. Regenerative epithelium showed a positive correlation (1.0000) with presence of neutrophils and was significantly associated with mucosal erosions (P=0.005). Fibrosis was observed in all cases (26% mild, 62% moderate, 12% severe). Moderate degree showed a positive correlation (0.999) with severe chronic inflammation. Activity was present in 29% of the cases. Muscular thickness was considered mild in 55% of cases, moderate in 37%, and severe in 8%. Adipose tissue deposits were mild in 47% of cases, moderate in 38%, and severe in 15%. Evolution of the chronic inflammatory cholecystitis was observed in four stages. Initial stage is characterized by mild fibrosis, often with cellular foci, admixed with granulation type tissue in superficial portions of the wall, mild to moderate mononuclear infiltrate and absence of Rockitansky Aschoff sinus(RAS). The second stage consisted of moderate fibrosis and inflammatory infiltrate, often with mild amounts of adipose tissue with RAS extending in to one-third of the length of the specimen. The third stage showed severe fibrosis and chronic inflammation, with moderate to severe adipose tissue deposits with RAS extending in to two-third of the length. The final stage was that of severe fibrosis, often laminated, with reduction of adipose tissue, a moderate to severe inflammatory infiltrate with RAS extending almost entire length of the specimen. CONCLUSION: Staging of chronic inflammatory changes in the gallbladder might help in evaluation of the cholecystectomy specimen, to give a rational, systematic, and reproducible diagnosis of different patterns of the inflammatory process.
Histopathology reporting in colorectal cancer: a proforma improves quality
(Wiely-Blackwell, 2009) Siriwardana, P.N.; Pathmeswaran, A.; Hewavisenthi, J.; Deen, K.I.
AIM: The histopathology report is vital to determine the need for adjuvant therapy and prognosis in colorectal cancer (CRC). Completeness of those in text format is inadequate. This study evaluated the improvement of quality of histopathology reports following the introduction of a template proforma, based on standards set by the Royal College of Pathologists (RCP), UK. METHOD: Sixty-eight consecutive histopathology reports based on 19 items for rectal cancer (RC) and 15 items for colon cancer (CC) using the proforma were prospectively analysed and compared with results of a previous audit of 82 consecutive histopathology reports in text format. The percentage of reports containing a statement for each data item for both series was compared using the Normal test for difference between two proportions. Completeness of each report was assessed and a percentage score (percentage completeness) was given. Mean percentage completeness was calculated for each format and compared using the two sample t-test. RESULTS: Except for comments on the presence of 'histologically confirmed liver metastases' in CC and RC, 'distance from dentate line' and 'distance to circumferential margin' in RC, all other items were commented in more than 90% of reports, where 71% of the items based on the minimum data set were present in all reports. Compared to prose format, the mean percentage completeness (SD) improved from 74% (8) to 91% (4) (P < 0.0001) and from 81% (5) to 99% (1) (P < 0.0001) for RC and CC respectively in template proforma format. CONCLUSION: A template proforma and surgeon's contribution in relation to operative findings improves the quality of the histopathology report in CRC.
Intestinal tuberculosis masquerading as difficult to treat Crohn disease: a case report
(Biomed Central, 2016) Niriella, M.A.; Kodisinghe, S.K.; de Silva, A.P.; Hewavisenthi, J.; de Silva, H.J.
BACKGROUND: Crohn disease has low prevalence in Sri Lanka while compared to the West, while intestinal tuberculosis is common in the region. Since clinical, endoscopic and investigation features of Crohn disease overlap with intestinal tuberculosis, differentiating these two conditions becomes a dilemma for the clinician in the intestinal tuberculosis endemic setting. An 18-year old Sri Lankan Muslim female presented with chronic abdominal pain and weight loss. Colonoscopy revealed an ulcerated ileocaecal valve and a terminal ileal stricture. Biopsy confirmed Crohn disease with no supportive features to suggest intestinal tuberculosis. Despite treatment with adequate immunosuppression she failed to improve and underwent a limited right hemicolectomy and terminal ileal resection. Histology confirmed intestinal tuberculosis and she made full recover with 6 months of anti-tuberculosis treatment. CONCLUSION: This case illustrates the importance of reviewing the diagnosis to include intestinal tuberculosis in an endemic setting, when already diagnosed Crohn disease is treatment refractory.
Local recurrence of rectal cancer in patients not receiving neoadjuvant therapy - the importance of resection margins
(Sri Lanka Medical Association, 2011) Dassanayake, B.K.; Samita, S.; Deen, R.Y.I.; Wickramasinghe, N.S.A.; Hewavisenthi, J.; Deen, K.I.
OBJECTIVES : Local recurrence of rectal cancer reduces quality of life and survival. A multi-factorial linear logistic model was used to analyse risk factors for local recurrence in rectal cancer in patients not receiving preoperative chemo-radiation. METHODS : A case-control study of patients with rectal cancer having surgery with curative intent, between 1996 and 2008. Eighteen putative risk factors for local recurrence were subjected to uni-variate analysis. Significant factors were selected for multi-factorial analysis. RESULTS : Twenty-one patients with local recurrence (cases) and 78 controls were selected. Uni-variate analysis showed significant associations with recurrence for nodal stage (N) (p=0.027), metastasis (M) (p=0.009), adjuvant chemotherapy (p=0.039), positive resection margin (R) (p=0.018) and American Joint Committee for Cancer (AJCC) tumours above stage II (p=0.043). Significant uni-variate odds ratios (OR) were obtained for the same factors. Two linear logistic models were fitted as (1) N, M, R1 status and adjuvant chemotherapy and (2) AJCC stage, R1 status and adjuvant chemotherapy. From both models, the only factor significantly associated (p≤0.01) with local recurrence was found to be a positive resection margin (OR 4.81 and 5.51 respectively). CONCLUSIONS: A positive resection margin is the single factor affecting local recurrence of rectal cancer in patients not receiving neo-adjuvant therapy.
Manual of basic cervical cytology
(National Cancer Control Programme,Colombo, 2001) Kumarasinghe, P.; Hewavisenthi, J.
No abstract available
Mènétrier's disease treated with gastrectomy
(Sri Lanka Medical Association, 2008) de Silva, A.P.; Aryasingha, S.; Dassanayake, A.S.; Hewavisenthi, J.; Rathnasena, B.G.N.; de Silva, H.J.
No Abstract Available
Methyldopa use should be restricted
(Sri Lanka Medical Association, 1999) de Silva, H.A.; Hewavisenthi, J.; Wijesiriwardena, B.; Fonseka, M.M.D.
No Abstract Available