Browsing by Author "Rathnasena, B.G.N."

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Accidental scrotal burns due to paraquat while handling a patient with deliberate self-harm
(Sri Lanka Medical Association, 2007) Premaratna, R.; Rathnasena, B.G.N.; de Silva, H.J.
INTRODUCTION: The main risk of paraquat poisoning is from deliberate ingestion. Serious accidental or occupational poisoning is comparatively rare. We report two patients who had accidental exposure to paraquat resulting in scrotal burns in both, and systemic poisoning in one, while attending to a patient who had ingested paraquat for deliberate self harm. CASE REPORT: Two days after death of a patient who had ingested paraquat for deliberate self harm, his brother and a friend who had accompanied him to hospital presented with painful swelling of the scrotum. The brother had severe burns in the scrotal skin sparing the penile skin, and the friend had milder burns in the scrotum. The patient had vomited several times onto the laps of these two men while being brought to hospital in a vehicle. The brother developed mild derangements in hepatic and renal functions suggesting significant systemic absorption. His biochemical and clinical parameters returned to normal over the next 2 weeks on conservative management. In both these patients, the scrotal skin healed without scarring over the next 4 weeks after treatment with silver sulphadiazine local application and amoxicillin given orally. CONCLUSIONS: Precautions should be taken by persons attending to those who have ingested poison. This is especially applicable to patients who have ingested corrosive substances
Accidental scrotal burns from paraquat while handling a patient
(Sri Lanka Medical Association, 2008) Premaratna, R.; Rathnasena, B.G.N.; de Silva, H.J.
The main risk of paraquat poisoning is from deliberate ingestion. Serious accidental or occupational poisoning is comparatively rare. We report two patients who had accidental exposure to paraquat, resulting in scrotal burns in both and systemic poisoning in one, while attending to a patient who had ingested paraquat for deliberate self harm
Carbimazole induced agranulocytosis treated with GCS Fand surgery
(College of Surgeons of Sri Lanka, 2006) Senevirathne, M.P.; Rathnasena, B.G.N.; Jayathileke, M.M.; Pathmeswaran, A.
No Abstract Available
Cushing syndrome due to an adrenal phaeochromocytoma
(Sri Lanka Medical Association, 2006) Gunasekara, A.D.C.J.; Premawardhena, A.P.; Hettiarachchi, H.A.N.S.; Rathnasena, B.G.N.; de Silva, H.J.
No Abstract Available
Dengue fever mimicking acute appendicitis
(Oxford University Press, 2007) Premaratna, R.; Bailey, M.S.; Rathnasena, B.G.N.; de Silva, H.J.
We report 12 patients [5 males, mean age 28 years (SD 4.6)] presenting with clinical features suggestive of acute appendicitis who were later diagnosed as having dengue fever (DF). Seven were admitted to hospital by surgeons and then referred to physicians due to thrombocytopenia (one of them following appendicectomy). Five were admitted to medical wards and then referred to surgeons due to abdominal pain. The mean time from onset of fever to abdominal pain was 2.2 d (SD 0.9). Clinical features included: right iliac fossa tenderness in 12 patients, rebound tenderness in nine, vomiting in nine, erythematous rash in eight, arthralgia/myalgia in eight, headache in six, diarrhea in three and palatal petechiae in three. All patients had C-reactive protein <12mg/l, and DF was confirmed serologically. Leucocytopenia and thrombocytopenia occurred by the third or fourth day of illness in all patients. Seven had free fluid around the appendix on abdominal ultrasound. The mean duration of abdominal symptoms and signs was 1.8 d (SD 1.3). DF may present with features suggestive of acute appendicitis in dengue-endemic areas. A carefully obtained history, clinical examination and a full blood count done on the third or fourth day of illness may help to differentiate DF from acute bacterial appendicitis
Dengue fever presenting as acute appendicitis
(Sri Lanka Medical Association, 2007) Premaratna, R.; Bailey, M.S.; Fernando, M.J.; Rathnasena, B.G.N.; de Silva, H.J.
INTRODUCTION: Dengue-fever (DF) is known to present with surgical emergencies, including acute pancreatitis and acalculous cholecystitis. CASE RECORDS: During 2006, 12 patients [5 males, mean age 28(SD 4.6) years] presented with features of acute appendicitis and were later diagnosed as having DF. Seven were admitted to surgical casualty and referred for medical opinion due to thrombocytopenia (one following appendicectomy). Five were first seen by physicians and referred for surgical assessment. The mean time from onset of fever to abdominal pain was 2.2 days (SD 0.9). Clinical features at presentation included: right iliac fossa tenderness in 12 (100%), rebound tenderness in 9 (75%), vomiting in 9 (75%), erythematous rash in 8 (67%), arthralgia/myalgia in 8 (67%), headache in 6 (50%), diarrhoea in 3 (25%) and palatal petechiae in 3 (25%). All patients had CRP <12 mg/1 and DF was confirmed on IgM/IgG ELISA (Panbio, Australia). Leucocytopenia and thrombocytopenia occurred in 8 (67%) and 10 (83%) on admission and in 11 (95%) and 12 (100%) during hospital stay. Seven (58%) had free fluid around the appendix on ultrasound scan. Histology in one showed non-specific lymphoid-follicular hyperplasia. Only one patient (who underwent appendicectomy) received IV antibiotics. The mean duration for disappearance of abdominal pain and severe tenderness from the time of first examination was 1.8 days (SD 1.3). Discharge diagnoses were: classical DF in 3(25%), DHF (platelets <100xl09/iitre) in 7(58%) and DSS in 2(17%). Conclusions: DF may present as acute appendicitis. An early blood count and C-reactive protein can help to differentiate dengue fever from acute bacterial appendicitis.
A Descriptive study of deep vein thrombosis (DVT) in a tertiary care hospital
(Sri Lanka Medical Association, 2008) Botheju, W.I.K.; Navaratne, A.C.R.; Somarathne, C.K.; Balasooriya, B.L.P.P.; Wijebandara, R.J.K.S.; Mandawala, M.B.S.N.; Ruwanpathirana, T.; Kasturiratne, K.T.A.A.; Hewawitharana, C.P.; Rathnasena, B.G.N.; Fernando, P.; Wijesinghe, P.S.; Premawardhena, A.
OBJECTIVE: The incidence and risk factors for DVT are not well established for the Sri Lankan population. Though believed to be an effective screening tool for DVT, the Well's Clinical score is not widely used in Sri Lankan hospitals. DESIGN, SETTING AND METHODS: Over a period of 8 months, a total of 23274 patients who presented to four units (including one general medical, one general surgical, one Gynaecology & Obstetrics, and the Orthopedic ward) of the North Colombo (Teaching) Hospital were screened for asymmetrical limb swelling more than 2 cm. The latter group were subjected to risk assessment for DVT, Well's scoring and CDU (Colour Duplex Ultrasound). RESULTS: Of the 23274 patients, 93 (0.4%) had unilateral limb swelling of which 12 (12.9%) were CDU confirmed to have DVT (0.5 per 1000). Limb swelling for more man two weeks was significantly commoner among DVT patients when compared to those without DVT (75% Vs 25.9%: p=0.001). None of the patients had been evaluated with the Well's score as a guide to refer for CDU by the relevant clinical teams. In 55 (59.1%) subjects, Well's score was 0 or less (minimum probability of DVT) and there were no subjects with DVT in this group. All 12 patients with DVT had a moderate or high probability Wells score. CONCLUSIONS: Overall incidence of DVT in the study population was lower than in other comparable published studies from Asia. Well's score which was underused by the clinicians is a highly sensitive screening tool for DVT.
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