Browsing by Author "Padeniya, A.G.P.M."

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The anatomical relationship of the parotid duct to the buccal and zygomatic branches of the facial nerve: a Sri Lankan cadaveric study
(Sri Lanka Medical Association, 2017) Padeniya, A.G.P.M.; Salgado, M.K.R.; Mendis, B.M.I.U.; Salvin, K.A.; Fernando, E.P.D.S.; Salgado, S.S.
INTRODUCTION & OBJECTIVES: The aim of this study was to demonstrate the anatomical relationship of the parotid duct to the buccal and zygomatic branches of the facial nerve and provide information to preserve these structures in parotid surgeries. METHODS: Fifteen cadavers (20 parotid areas) were dissected at the Anatomy Department, Faculty of Medicine, University of Kelaniya to demonstrate the pathway of the parotid duct and course of the buccal and zygomatic branches of the facial nerve. Twelve Anatomical parameters were measured by a flexible tape. RESULTS: Of 20 specimens, two (10%) had two buccal branches, two (10%) had two zygomatic branches, one had an accessory parotid gland, one had an accessory parotid duct. Mean parotid duct length was 34.88mm (SD-6.31, CV-18.09). Mean distance between the beginning of the parotid duct and the point at which the zygomatic nerve crossed the duct was 19.36mm (SD-6.82, CV-35.19%). The average distance between the lateral canthus and intersection point of the zygomatic nerve and duct was 52.45mm (SD-3.15, CV-6.05%). Mean distance between the zygomatic arch and the above intersection point was 20.73mm (SD-2.49, CV-12.01%). CONCLUSION: The reliable measurement in our study with the smallest coefficient variation was the distance between the lateral canthus and intersection point of the zygomatic nerve and parotid duct; 52.45mm. Thus the intersection point of the zygomatic nerve and duct lies between 46.15 - 58.75mm from the lateral canthus. If two circles are drawn with radii of 46.15mm and 58.75mm from the lateral canthus the duct will mark a segment along its pathway, within which 95% confidence the intersection point with the zygomatic branch will lie.
Anatomical variations of the common peroneal nerve (cpn) and the deep pereoneal nerve (dpn) in the lateral compartment of the leg: A cadaveric study
(College of Surgeons of Sri Lanka, 2015) Salgado, L.S.S.; Karunanayake, A.L.; Hasan, R.; Salvin, K.A.; Fernando, E.D.P.S.; Ranaweera, M.S.L.; Padeniya, A.G.P.M.; Senevirathne, S.P.; Ranaweera, K.R.K.L.K.
INTRODUCTION: The aim of this study is to demonstrate anatomy of CPN and DPN in the lateral compartment and identify high risk area/s which is important in high tibial osteotomy, in total knee arthroplasty, in external fixation of leg and CPN decompression surgery. MATERIAL AND METHODS: Thirty cadaveric legs (female-14, male-16) were dissected to demonstrate the bifurcation of the CPN and the exit point of the DPN from the lateral compartment. The ethical clearance was obtained. RESULTS: None of the specimens showed bifurcation of the CPN proximal to the apex of the fibular head. Musculoaponeurotic fibular arch at the entrance to the fibular tunnel was confirmed in all specimens. The mean distance from the apex of the fibular head to the opening of the fibular tunnel was 28.4mm (SEM±1.4mm). Of 30 specimens respectively 21(70%), 7(23.33%) and 2(6.66%) had bifurcation vertically distal to, on and proximal to the entry point with the average of 8.0mm and 12.0mm from the entry point. Eleven legs had muscular branches of the DPN in the lateral compartment of the leg. The mean exit point of the DPN/its longest muscular branch was observed 66.5mm (SEM±2.6mm) distal to the apex of the fibular head. CONCLUSIONS: Variations of the CPN bifurcation in relation to the fibular tunnel and muscular branches of the DPN in the lateral compartment were observed. From the apex of the fibular head, distance of 25.6mm-71.6mm was identified as the high risk area for surgeries involving in the upper part of the lateral compartment.
Anatomical variations of the musculocutaneous nerve - A cadaveric study
(College of Surgeons of Sri Lanka, 2015) Padeniya, A.G.P.M.; Salgado, L.S.S.; Hasan, R.; Fernando, E.D.P.S.; Ranaweera, R.M.S.L.; Abeysuriya, V.; Karunanayake, A.L.; Salvin, K.A.; Siriwardana, S.A.S.R.; Balasooriya, B.M.C.M.; Alahakoon, A.M.D.K.
INTRODUCTION: The musculocutaneous (MC) nerve commences from the lateral cord of the brachial plexus, passes inferolaterally and pierces the coracobrachialis while innervating it. It then descends between biceps and brachialis muscles, innervating both and continues as the lateral cutaneous nerve of the forearm. Few studies have been done with regard to variations in origin, course, branching pattern, termination and communications of the MC nerve. These variations are important for anatomists, clinicians, anesthetists and surgeons to avoid unexpected complication as these variations have clinical significance during the surgical procedures and in diagnostic clinical neurophysiology. Therefore the aim of this paper was to study the anatomical variations of the MC nerve. MATERIAL AND METHODS: This descriptive cross sectional study was carried out in the Department of Anatomy, Faculty of Medicine, University of Kelaniya. Dissections were carried out on 50 upper limbs of 25 cadavers to record anatomical variations of the MC nerve. RESULTS: MC nerve was present only in 46(92%) upper limbs. Of the 46 upper limbs where the MC was present, one (2%) did not pierce the coracobrachialis. Communications were seen between MC and median nerve in 06(13%) samples of which 1(17%) was proximal and 5(83%) were distal to the point of entry of the MC into the coracobrachialis and in 4(9%) upper limbs MC nerve rejoins with the median nerve. CONCLUSIONS: It is evident that significant anatomical variations of the MC nerve exist in our study. These variations emphasize the complexities and irregularities of this anatomical structure with regard to surgical approaches.
Assessing liver fibrosis in patients with transfusion dependent beta thalassaemia - a predictive model
(Sri Lanka Medical Association, 2021) Padeniya, A.G.P.M.; Ediriweera, D.; de Silva, A.; Niriella, M.A.; Premawardhena, A.P.
Introduction and Objectives Liver fibrosis in β-thalassaemia major is mainly due to transfusion-related iron overload. Transient elastography (TE) is an imaging modality which measures liver stiffness/fibrosis non-invasively. TE is simple, safe and efficient. However, inaccessibility and high-cost hinders its routine use. We designed a predictive model to evaluate liver fibrosis using demographic, anthropometric, biochemical and imaging data. Methods Sixteen patients with transfusion dependent beta thalassaemia were recruited to the study. FBC, LFT, serum ferritin and Transient Elastography (TE) and FerriScan measurements were recorded at the baseline and after two years follow up. Multiple regression model was developed to predict liver fibrosis using demographic, anthropometric, biochemical and imaging data. [age, gender, body mass index (BMI), steatosis score, liver iron content, mean pre-Hb over the last year, no of blood transfusions (lifetime), amount of blood ingested over the last year(ml/kg), amount of elemental iron by transfusions over last year(mg/ kg), serum ferritin, SGOT, SGPT and compliance with iron chelation].Results Of 16, 8 (50%) were females, mean (SD) age, BMI and fibrosis scores were 21(4.3) years, 18.8 (2.8) kgm-2 and 9.7(5.7) kPa respectively. Gender, BMI, SGOT, SGPT, compliance, number of transfusions taken lifetime showed significant association with liver fibrosis. The final model showed a coefficient of determination (R2) of 0.859. According to the model, predicted liver fibrosis is given by;-26.18 - 4.38*male+1.01*BMI - 0.11*SGPT+0.32*SGOT+2.78*compliance (rps)+0.04*no. of transfusions. ConclusionThe suggested model is a reliable tool to predict liver fibrosis in transfusion-dependent β-thalassaemia major patients in resource poor settings.
Assessing reversibility of liver fibrosis in patients with transfusion-dependent beta thalassaemia following intensive chelation
(Sri Lanka Medical Association, 2023) Padeniya, A.G.P.M.; Ediriweera, D.; Niriella, M.A.; de Silva, A.; Premawardhena, A.P.
INTRODUCTION: Transfusion-related iron overload is a leading cause of hepatic fibrosis in transfusion-dependent thalassaemia (TDT). OBJECTIVES: This study aimed to evaluate the reversibility of liver fibrosis with intensive chelation therapy in TDT. METHODS: Forty-five patients were included. Serum ferritin, hepatic fibrosis & steatosis (assessed by Transient Elastography), and liver iron concentration/LIC (estimated by FerriScan) were recorded at recruitment and after 2 ½ years of intensive chelation. Compliance for iron chelators was monitored and recorded as good (gc), moderate compliance (mc), and poor (pc) compliance based on the number of days the iron chelators were used. RESULTS: 22/45 (49%) were males [mean age (SD)-19 (4.78) years]. There were 23 (51%), 12 (27%), and 10 (22%) patients with gc, mc, and pc with iron chelators, respectively. The LIC decreased in 36 (80%) patients. The median LIC reduction after 2 ½ years was as follows: gc group-13.5 to 5.1 mg Fe/g dw (P=0.0002); mc group-25.5 to 17.75 mg Fe/g dw (P=0.001). In the pc group, the LIC increased by 10.4 mg Fe/g dw (P =0.058). Liver fibrosis declined in 23 (51%) patients. The liver stiffness at recruitment and after 2 ½ years was 7.6 and 7.1 kPa (P=0.08) in the gc group. In both mc and pc groups, liver fibrosis increased on follow-up [significantly worsened in the pc group (P=0.04)]. CONCLUSION: The reduction of LIC in TDT was related to compliance with chelation therapy; substantial reductions were achieved in those with gc and mc. However, only those with gc managed to arrest the fibrosis progression.
Evaluation of the proportion of Genetic Disorders detected at prenatal testing in a Tertiary fetal medicine referral centre
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Padeniya, A.G.P.M.; Dias, T.D.; Punchihewa, C.
OBJECTIVE: Prenatal suspicion of fetal chromosomal aneuploidies is the most common indication for invasive prenatal testing. Amniocentesis followed by genetic testing for chromosomal aneuploidies is the diagnostic technique for prenatal detection of chromosomal disorders. Prenatal detection of these disorders would enable timely medical or surgical treatment of a condition before or after birth. It further “prepare” the family psychologically, socially, financially, andmedically of a baby with a health problem or disability or for the likelihood of a still birth. The objective of this study was to evaluate the proportion of genetic disorders detected at prenatal testing procedures at a Tertiary Fetal Medicine referral centre. METHODS: A retrospective study was carried out from 2016 October to 2017 April in all invasive procedures done in the Fetal Medicine Unit, Ninewells Care Mother & Baby hospital, Colombo, Sri Lanka. Prenatal samples were analyzed by Fluorescent in situ hybridization for the common chromosomal aneuploidies including chromosome number 13, 18, 21, X andY and by karyotype. Patient information and details of invasive procedures were obtained from the Fetal Medicine Unit database. RESULTS: A total of 57 prenatal examinations was performe during the study period of which 55 were amniocentesis and 02 were cordocentesis procedures. The mean maternal age at which the procedure was performed was 33 years(SD=6.3). The commonest indication for the prenatal testing was increased nuchal translucency (NT) thickness (27) detected at the NT scan. The other common indications for prenatal detection were atrioventricular septal defect (5), omphalocoele (4), nonimmunehydrops (3) and Diaphragmatic hernia (2) detected at the second trimester scan. There were 3 who had elevated double test and1 with increased Non Invasive Prenatal test result which directed them for prenatal testing. Chromosomal abnormalities were detected in 13 fetuses of which majority were Trisomy 18 (5). Trisomy 21 and Trisomy 13 syndromes were detected in 4 and 3 fetuses respectively. Of the 27 fetuses who had elevated NT thickness, 4 fetuses were Trisomy 21. Fetuses who had structural abnormalities 4 had Trisomy 18 syndrome. There was one which had Trisomy 21 mosaic syndrome and one with Turner mosaic syndrome. CONCLUSION: Testing for diseases or conditions in a fetus/embryo by an invasive method before it is born would enable the doctors to improve the outcome of the developing fetus/embryo hence prepare the family for an anticipated problem.
Genetic modifier of Hereditary Hemochromatosis gene (HFE) in transfusion dependent thalassemia: phenotype genotype relationship in a Sri Lankan population
(Staff Development Center, University of Kelaniya, 2015) Padeniya, A.G.P.M.
Background and Purpose: Iron overload is a major complication in patients with transfusion dependant thalassaemia and co- existence of Hereditary Haemochromatosis (HH) aggravates this complication. Two common missence mutations in the HFE gene 845G>A (p.C282Y) and c.187C>G (p.H63D) are associated with HH. The aim of this study was to genotype c.845G>A and c.187C>G mutations in regularly transfused β thalassaemia patients and to correlate the association between these mutations with their serum ferritin levels. Method: 125 patients with β thalassaemia who were on regular blood transfusions referred to ward 2, 3, 4 and 9, Lady Ridgway Hospital, Colombo and who were at Thalassaemia center, Teaching Hospital, Anuradhapura were recruited to the study. HFE gene was tested for c.845G>A and c.187C>G mutations by Amplification Refractory Mutation System Polymerase Chain Reaction. Serum ferritin level was measured using electrochemiluminescense method. The C-reactive protein (CRP), erythrocyte sedimentation level (ESR), and Serum Glutamine Aspartate Transaminase (SGPT) levels were done to exclude coexisting inflammatory states and liver disease. The results were analyzed using Student’s t-test. Results: None had the p.C282Y variant. 23 were heterozygous for the p.H63D variant. Allele frequencies of the two variants; p.C282Y and p.H63D, were 0% and 9.2% respectively. There was no statistically significant difference (p = 0.865) between the mean ferritin level of carriers and wild type of the p.H63D variant; the levels were 4987ng/ml and 4571ng/ml respectively. CRP, ESR and SGPT were elevated in 9 (7.2%; c.187CC 4, c.187CG 5), 65(52%; c.187CC 50, c.187CG 15), 82(65.6%; c.187CC 64, c.187CG 18) respectively. The confounding effect of inflammation and liver disease on the serum ferritin level could not be analyzed due to small sample size. Conclusions: In Sri Lankan patients with transfusion dependant thalassaemia the p.C282Y mutation is rare and cannot be considered as a risk factor for iron over load. The p.H63D mutation may be a potential risk factor for iron overload; this needs to be verified using larger cohort studies.
Invasive prenatal testing at a Tertiary Fetal Medicine referral center in Sri Lanka: A service evaluation audit
(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Padeniya, A.G.P.M.; Dias, T.D.
A multicentre study on pattern of fetal anomalies detected in Sri Lanka
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Padeniya, A.G.P.M.; Dias, T.D.; Ediriweera, D.S.; Mendis, B.M.I.U.
OBJECTIVE: Prenatal diagnosis is a rapidly evolving specialty in modern medicine. The mid-trimester scan has been an important practice in safe antenatal care which predicts birth defects of the developing fetus. This scan performed during 18-23 weeks of pregnancy detects both internal and external abnormalities of the fetus. The objective of this study was to present the pattern of fetal anomalies detected in Sri Lankan pregnant women who were referred for the anomaly scan. METHOD: A multi centre retrospective study was carried out in all the fetal medicine referral centers conducted in the Island including Colombo, Ragama, Galle and Kurunegala between July 2013 and March 2017. Patient information and the ultrasound scan findings were obtained from the purpose built database maintained by the authors. RESULTS: A total of 7370 referrals were reviewed and 6704 singleton pregnancies were selected. The mean maternal age and the mean gestational age at which the anomaly scan was performed were 31 years (SD=4.9) and 23 weeks (SD= 4.5) respectively. Congenital Heart Disease (CHD) was the commonest abnormality detected in the study group 149 (2.2%). Thirty-one (0.5%) fetuses had Atrioventricular Septal Defect which predicts Down syndrome at the mid-trimester scan. Majority (8.3%) of the CHD were referred from the Uva province. Of the 7370 referrals 63 (0.9%) and 27 (0.4%) had Neural Tube Defects (NTDs) and cleft lip/palate respectively. Highest percentage (4.4%) of NTDs were referred from the North Central province and cleft lip/palate referrals were commonest in Sabaragamuwa (0.9%) province. Abdominal wall defects and cystic renal disease were detected in 33 (0.5%) and 38 (0.6%) fetuses correspondingly. Referrals received from the Uva (1.9%) province reached the highest number of abdominal wall defects and cystic renal disease referrals were peaked in the Uva (7.4%) province. Forty-eight (0.7%) referrals had Congenital Talipes Equino Varus deformity and highest number of referrals was from the Eastern (2.4%) province. CONCLUSION: Referrals received from the Uva province had highest number of fetal anomalies (20%) either as a major or minor birth defect. Of the total referrals congenital heart defect was the commonest congenital abnormality detected in the study group.