Browsing by Author "Nawaratne, N.M.M."

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    The long term outcome of a cohort of Sri Lankan patients with ulcerative colitis at two tertiary care hospitals: preliminary results
    (Sri Lanka Medical Association, 2011) Senanayaka, S.M.; Fernandopulle, A.N.R.; Wijesinghe, N.T.; Ranaweera, A.G.R.M.A.; Kasturiratne, A.; Pathmeswaran, A.; Nawaratne, N.M.M.; de Silva, A.P.; de Silva, H.J.
    INTRODUCTION AND OBJECTIVES: Inflammatory bowel disease, especially ulcerative colitis (UC), is increasing in many 'non-western' populations. Although clinical impressions are that UC has a mild clinical course in these populations, long term outcomes have been poorly studied. Methods: In this ongoing retrospective cohort study conducted at the Gastroenterology clinics of the Colombo North Teaching hospital and the National Hospital of Sri Lanka, patients diagnosed with ulcerative colitis (UC) were assessed for 3 outcomes: colectomy, development of colorectal carcinoma and death. Registered patients not attending the clinic during the past 4 weeks or their families were contacted by telephone to obtain clinical details and survival status. The cause of death was confirmed from clinical records and death certificates. RESULTS: Of 414 registered patients with UC, to date, details of 274 (66%) (mean age 44.9 (SD 13.6) years, M:F =1:1.13) were available for analysis. The mean duration of follow up was 6.8 (SD 6.5) years. Cumulative rates for colectomy, colorectal carcinoma and death were 3.3%, 1.1% and 1.1% respectively. At 1, 5, 10 and 15 years, cumulative cancer free survival proportions were 0.99, 0.99, 0.99 and 0.98, cumulative colectomy free survival proportions were 0.99 0.96, 0.96 and 0.96, and cumulative survival proportions were 0.99, 0.99, 0.98 and 0.98 respectively. The proportions of patients who had none of these three outcomes were 0.98, 0.95, 0.93 and 0.92. CONCLUSIONS: In this cohort of Sri Lankan patients with UC, rates of colectomy, colorectal carcinoma and death were rare, indicating a benign disease course.
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    Management of hilar cholangiocarcinoma
    (Sri Lanka Medical Association, 2014) Jayarathne, V.S.; Siriwardana, R.C.; Nawaratne, N.M.M.; Liyanage, C.A.H.
    INTRODUCTION AND OBJECTIVES: Cholangiocarcinoma (CCA) is a malignant disease involving the biliary system with majority occurring in the hilar region. Cholangiocarcinoma demands prompt management because of its aggressive nature. METHODS: Patients who presented to North Colombo Teaching Hospital- Liver Unit (NCTH- LU) and National Hospital of Sri Lanka (NHSL- GHU) from January 2011 to March 2014 were included in this study. Diagnosis was made by CT imaging, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: Total of 108 patients were diagnosed with CCA. The median age of presentation was 62 years (range 31-87). 51.4% were males. Majority (58.3%) of CCA occurred in the hilar region with rest involving the common bile duct. 76.8 % were stented and 8 patients were offered surgical treatment. Out of 62 hilar CCA 46 were classified according to the bismuth classification. 9 were type I, 8 were type II, 13 were type III and 16 were type IV. Six patients underwent hepatic resection, Majority (n=46) were stented, six were treated with radiofrequency ablation. Out of 45 patients with CBD involvement 33 were stented and 2 had Whipple's surgery. Six patients who underwent surgery are currently followed up at NCTH-LU. CONCLUSIONS: Surgery appears to be the effective treatment for cholangiocarcinoma. Aggressive palliation with stenting was beneficial.