Browsing by Author "Salvin, K.A."

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Accessory muscle in the flexor compartment of the forearm: A case report
(Book of Abstracts, Annual Research Symposium 2019, 2014) Hasan, R.; Fernando, E.D.P.S.; Salvin, K.A.; Dilshani, W.M.S.; Niwunhella, N.A.D.P.; Perera, A.A.M.M.S.L.; Wijesundara, W.M.R.D.
A wide array of supernumerary and accessory musculature has been described in anatomical, surgical and radiological literature. Awareness of potential muscular variations is essential for anatomists, surgeons and clinicians in numerous areas of medical field.
Anatomic description of the distal great saphenous vein to facilitate peripheral venous access during resuscitation: a cadaveric study
(BioMed Central,London, 2023) Senevirathne, S.A.M.D.R.U.; Nimana, H.K.V.; Pirannavan, R.; Fernando, P.; Salvin, K.A.; Liyanage, U.A.; Malalasekera, A.P.; Mathangasinghe, Y.; Anthony, D.J.
The distal great saphenous vein is a popular site for venous access by means of percutaneous cannulation or venous cutdown in a hemodynamically unstable patient. The aim of this study was to precisely define the surface anatomy and dimensions of the distal part of the great saphenous vein to facilitate the aforementioned procedures. Cross-sectional anatomy of the distal saphenous vein was studied in 24 cadaveric ankles sectioned at a horizontal plane across the most prominent points of the medial and lateral malleoli. The curvilinear distance from the most prominent point of the medial malleolus to the center of the saphenous vein, its widest collapsed diameter and skin depth were obtained. The great saphenous vein was located at a mean distance of 24.4 ± 7.9 mm anterior to the medial malleolus. The mean widest collapsed diameter was 3.8 ± 1.5 mm. The mean distance from the skin surface to the vein was 4.1 ± 1.2 mm. These measurements could be used to locate the saphenous vein accurately, particularly in hemodynamically unstable patients with visually indiscernible veins.
Anatomical landmarks for ankle block
(BioMed Central, 2023) Nimana, K.V.H.; Senevirathne, A.M.D.S.R.U.; Pirannavan, R.; Fernando, M.P.S.; Liyanage, U.A.; Salvin, K.A.; Malalasekera, A.P.; Mathangasinghe, Y.; Anthony, D.J.
We aimed to describe anatomical landmarks to accurately locate the five nerves that are infiltrated to accomplish anaesthesia of the foot in an ankle block. Twenty-four formaldehyde-fixed cadaveric ankles were studied. Photographs of cross sections of the frozen legs, cut at a horizontal plane across the most prominent points of the medial and lateral malleoli, were analysed. The curvilinear distance from the most prominent point of the closest malleolus to each of the five cutaneous nerves and their depth from the skin surface were measured. Sural, tibial, deep peroneal, saphenous and medial dorsal cutaneous nerves were located 5.2 ± 1.3, 9.2 ± 2.4, 7.4 ± 1.9, 2.8 ± 1.1, 2.1 ± 0.6 mm deep to the skin surface. The curvilinear distances from the medial malleolus to the tibial, deep peroneal and saphenous nerves were 32.5 ± 8.9, 62.8 ± 11.1 and 24.4 ± 7.9 mm, respectively. The curvilinear distances from the lateral malleolus to the sural and medial dorsal cutaneous branches of superficial peroneal nerves were 27.9 ± 6.3 and 52.7 ± 7.3 mm, respectively. The deep peroneal nerve was found between the tendons of the extensor hallucis longus and the extensor digitorum longus in the majority of specimens, while the medial dorsal cutaneous nerve was almost exclusively found on the extensor digitorum longus tendon. The sural and tibial nerves were located around halfway between the most prominent point of the relevant malleolus and the posterior border of the Achilles tendon. In conclusion, this study describes easily identifiable, palpable bony and soft tissue landmarks that could be used to locate the nerves around the ankle.
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.
An anatomical study of the tarsal tunnel: A cadaveric study
(University of Kelaniya, 2011) Karunanayake, A.; Hasan, R.; Salgado, S.; Salvin, K.A.; Fernando, P.; Ranaweera, L.; de Alwis, R.P.; Herath, S.; Senadipathy, C.; Mahawaththa, T.; Fernado, E.; Ilayperuma, I.
Tarsal tunnel is a passage formed between the flexor retinaculum and the underlying tarsal bones. Tendons of tibialis posterior, flexor digitorum longus, flexor hallucis longus and the neurovascular bundle of the posterior compartment of the leg pass through this tunnel in separate fascial compartments. To relieve symptoms and signs of Tarsal tunnel syndrome, orthopedic surgeries and anesthetic nerve blocks are used. Therefore, knowing the anatomy of the tarsal tunnel is important to understand and manage conditions related to this region. The aim of this study, is to describe the morphology and its possible variations in a Sri Lankan population compared to what is described in standard anatomy text books. A descriptive study was carried out by dissecting 28 human cadavers available in the Department of Anatomy, University of Kelaniya. Typical anatomy was observed in 26 cadavers (92.85%) where tibialis posterior (TP), flexor digitorum longus (FDL),neurovascular bundle and flexor hallucis longus (FHL) were in separate compartments anterior to posterior respectively. In one cadaver (3.57%) FDL and FHL were in a single compartment. In another cadaver (3.57%) bifurcation of the tendon of flexor digitorum longus was observed passing through a separate compartment posterior to neurovascular bundle. Even though the majority of the results were in agreement with the typical description of the anatomy of the tarsal tunnel, a certain degree of variability was observed in this area. This knowledge will be of use to clinicians involved in procedures related to the tarsal tunnel.
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.
Anomalies of the Lumbrical Muscles of the Hand
(University of Kelaniya, 2012) Ranaweera, L.; Hasan, R.; Salgado, S.; Karunanayake, A.; Salvin, K.A.; Fernando, P.; Fernando, E.; Wijesooriya, P.; Vithanage, S.
Introduction:The human hand occupies a unique position in evolution. The lumbrical muscles, one of the major constituents of intrinsic musculature in hand, play significantly greater role in the precision movements of the fingers. There are four cylindrical lumbrical muscles which rise from the four tendons of flexor digitorumprofundus (FDP) in the hand and pass along the radial side of the corresponding metacarpophalangeal joint to insert into the dorsal digital expansion of the medial four fingers. The first and second lumbricals are unipennate while the third and fourth lumbricals are bipennate. Anomalies of the attachments of the lumbricals are not uncommon and have a significant value in the design of surgical procedures. Objectives: To study the possible variations of lumbrical muscles and also document a relevant Sri Lankan study. Methodology:This research was carried out as a descriptive study in19 preserved human hands in the Departments of Anatomy, University of Kelaniya, Ragama. Results: In 9 (47.4%) hands the lumbricals were normal. Regarding the proximal attachments, the third lumbrial was unipennate in 3 (15.7%) whereas same architecture for the fourth lumbrical encountered was 2 (10.5%). Moreover, it was found that 1 (5.3%) of the second lumbricals was bipennate. Regarding the distal attachments, the split insertion of the third lumbrial and fourth lumbrical were observed as 2 (10.5%) and 1 (5.3%), respectively. Interestingly, 1 (5.3%) of the third lumbricals was inserted on the medial side of the middle finger. Conclusion: In our preliminary studyof lumbrical muscles of the hand, it was apparent that majority of the observations are comparable to previous research, while there were a higher percentage of proximal attachment variations than distal attachment variations in the study group.
Conducting viva voce examinations during preclinical years in the faculty of medicine, University of Kelaniya: Is it of relevance?
(Book of Abstracts, Annual Research Symposium 2018, 2014) Hasan, R.; Perera, A.A.M.M.S.L.; Wijesundara W M R D; Dilshani, W.M.S.; Niwunhella, N.A.D.P.; Salvin, K.A.; Fernando, E.D.P.S.
Viva voce (vivas) or oral examinations are an integral part of medical education. During a viva the examiner is given the opportunity to assess the candidate�s knowledge and ability to respond under pressure. For medical students vivas are an opportunity to develop verbal and presentation skills. Vivas were part of the preclinical examinations held in the Faculty of medicine Ragama prior to the introduction of the new curriculum. This research was carried out in order to identify the opinion of lecturers on reintroduction of vivas for preclinical examinations.
A conjunctival myxoid stromal tumor (COMST) mimicking phlyctenulosis: A case report and brief review of the literature
(Elsevier, 2022) Medagoda, K.; Salvin, K.A.; Mahendra, B.A.G.G.
Purpose: This is a case report of a patient with a conjunctival myxoid stromal tumor (COMST), mimicking a phlyctenulosis. Tumors of the conjunctiva and cornea occupy a large spectrum ranging from benign lesions of myxoma to aggressive, life-threatening malignancies. Phlyctenulosis and phlyctenular keratoconjunctivitis are hypersensitivity reactions to a foreign antigen. Observations: A 64-year-old male presented with six-month history of non-painful lump in the conjunctiva of the left eye. It was a mobile, non-tender, non-ulcerated, non-hemorrhagic, non-pigmented lesion and was non-adherent to the sclera. The differential diagnosis of phlyctenulosis or a soft tissue tumor was considered. The lesion was completely excised. The microscopy showed an ill-defined hypocellular myxoid lesion composed of stellate and spindle-shaped cells with eosinophilic cytoplasm, containing round-ovoid and spindle-shaped nuclei with a vesicular chromatic pattern. The tumor cells were diffusely and strongly positive for vimentin and CD 34 and were negative for S100. The immunomorphological features were compatible with a conjunctival myxoid stromal tumor. Complete systemic evaluation excluded the possible association with systemic myxomas. Conclusions and importance: Myxoid tumors of the conjunctiva are benign tumors, however, they can mimic other benign conditions like phlyctenulosis or more sinister lesions like malignant tumors. Therefore, it is important to do an excisional biopsy to ascertain the definitive pathology of an indeterminate conjunctival lesion. COMST may be the index presentation for the detection of previously undiagnosed myxoma syndromes. One such association is with cardiac myxomas, which can result in vascular embolic events. Therefore, it is important to do cardiac screening in all patients diagnosed with a COMST.
The influence of preoperative counselling on the incidence and the adaptation of postoperative dysphotopsia
(College of Ophthalmologists of Sri Lanka, 2022) Salvin, K.A.
No abstract available
Morphology of the Thyroid Gland and its common variations
(12th Annual Research Symposium, University of Kelaniya, 2011) Hasan; Rizvi; de Alwis, R.P.; Herath, S.; Senadipathy, C.; Mahawaththa, T.; Karunanayake, A.; Salvin, K.A.; Fernando, P.; Ranaweera, L.; Fernado, E.; Ilayperuma, I.; Salgado, S.
The thyroid gland is an endocrine gland located in the anterior triangle of the neck across the midline. Many pathological conditions such as tumours and inflammatory diseases are associated with the thyroid gland. The incidence of thyroid diseases, with or without an indication for surgical intervention is a common occurrence in clinical practice. Hence an in-depth knowledge of the morphology of the thyroid gland and its variation is of paramount importance to clinicians. Literature surveys carried out do not reveal adequate studies relevant to the morphology of the thyroid gland and its variations in a Sri Lankan population. The aim of the study is to identify the morphology of the thyroid gland and its possible variations in the Sri Lankan population. A descriptive study was carried out by dissecting 31 human cadavers (12 female and 19 male) aged between 35-80 years in the Department of Anatomy, University of Kelaniya. Measurements were taken with Vernier Caliper. The results show thirty one thyroid glands (62 sides) were observed and measurements were taken. Average length, width and thickness of the right lateral lobes were 4.11cm, 1.25cm and 1.95 respectively. Average length, width and thickness of the left lateral lobes were 4.02cm, 1.13cm and 2.05cm respectively. Pyramidal lobe was found in 12 thyroid glands (38.7%), of which 4 were in females and 8 in males. Of these 12, in 9 glands pyramidal lobe was arising from the left lobe (75%) and the rest from the isthmus(25%). Only 83.33% of pyramidal lobes were associated with levator glandulae thyroidae and the rest were independent. Levator glandulae thyroidae was observed in 10 glands (32.25%). In three glands (9.67%) isthmus was found to be absent. Significant gender difference was not identified in the dimensions of the gland. No significant difference in dimensions was observed when compared to western figures. Presence of the pyramidal lobe is not an uncommon finding. Therefore, having a sound knowledge in morphology of the thyroid may reduce the unwarranted outcomes in thyroid surgeries in Sri Lanka.
Preoperative 532 double frequency YAG anterior capsulotomy in hypermature cataracts
(College of Ophthalmologists of Sri Lanka, 2020) Salvin, K.A.
Phacoemulsification in hyper-mature cataracts is a challenge due to high intra-lenticular pressure, resulting in the capsulorhexis extending to the periphery. A continuous curvilinear capsulorhexis (CCC) is crucial to uncomplicated, safe and successful phacoemulsification and posterior chamber intraocular lens (IOL) implantation. Achieving a CCC in eyes with white hyper-mature cataract is challenging due to high intra-lenticular pressure and risk of extension of capsulorhexis (Argentinian flag sign). Various techniques such as double capsulorhexis, phacocapsulorhexis, massaging, anterior capsular puncture with a needle or YAG laser and femtosecond laser capsulorhexis have been described to prevent this complication.
A review of oculotoxicity in iodine overdose
(College of Ophthalmologists of Sri Lanka, 2019) Medagoda, K.; Salvin, K.A.
“Silent” white matter changes in brain MRI in patients with haemoglobinopathies and their clinical significance
(Sri Lanka Medical Association, 2016) Premawardhena, A.P.; Ranawaka, U.R.; Hapangama, A.; Pathmeswaran, A.; Hettiarachchi, S.; Salvin, K.A.; Pilapitiya, T.; Sanjaya, G.; Oilvieri, N.F.; Weatherall, D.J.
INTRODUCTION AND OBJECTIVES: Increasing interest has been directed to the study of white matter changes and lacunar infarcts in patients with haemoglobinopathies which are thought to be clinically silent. Previous studies suggest an association with splenectomy and thrombocytosis. The objective was to assess the association of white matter changes in patients with haemoglobinopathies. METHOD: Older patients with haemoglobinopthies attending the Hemals Thalassaemia Unit were assessed by a specialist neurologist and simultaneously had MRI brain. Relevant clinical, biochemical and hematological data were collected. A non-thalassaemic control group (age and sex matched) too were assessed. RESULTS: There were 82 patients (25 Thalassaemia Major,24 Intermedia and 33 Haemoglobin E b thalassaemia) and 19 controls. Mean age of the study group was 32yrs. 21 patients (26%) had MRI changes (20%,29%,27% in the three groups respectively) (p=0.73). 10% of controls had MRI changes. 12 (60%) of the patients with MRI changes were asplenic whilst 53.2% without changes were asplenic (P=0.138). There was no difference in the two groups with platelet counts. (Mean platelet count 581 Vs. 452 (p= 0.709) 58% of patients and 53% of controls had headache as a symptom. Headache was commoner among those with MRI changes (85% vs 51.6%; p=0.008). CONCLUSIONS: The white matter changes in MRI occurred in all three sub groups of thalassaemic patients studied in high frequency. To our knowledge, this is the first report of the association of MRI changes with neurological symptoms in thalassaemic patients. The higher frequency of headache in those with MRI changes suggest that these changes may not be silent as previously believed.
Variations in the Termination of the Human Thoracic Duct
(University of Kelaniya, 2012) Hasan, R.; Salgado, S.; Karunanayake, A.; Salvin, K.A.; Fernando, P.; Ranaweera, L.; Vithanage, S.; Wijesooriya, P.; Ilayperuma, I.; Fernando, E.
Introduction: The mammalian thoracic duct is the main lymphatic channel which drains lymph from the distal extremities of the trunk, lower limbs and the left half of the proximal trunk. In humans, it runs a typical course commencing over the twelfth thoracic vertebra and ascends through the aortic orifice of the diaphragm. It inclines to the left at the level of the Sternal angle and terminates by draining into the left jugulosubclavian junction. Objectives: Variations from this typical course are not uncommon and have been the subject of extensive research. Knowledge of the possible variations in the thoracic duct would enable accurate thoraco- cervical surgery, thus preventing inadvertent damage to the thoracic duct and consequent leakage of chyle.This research is carried out with the aim ofenhancing the existing knowledge of the possible variations of termination of the human thoracic duct while also documenting a relevant Sri Lankan study. Methodology: This research was carried out as a descriptive study in36 preserved human cadavers in the Departments of Anatomy, the University of Kelaniya and the University of Ruhuna. Results: In 22 (61.11%) cadavers the thoracic duct drained into the left jugulosubclavian junction whereas in 11 (30.56%) cadavers it drained into the left subclavian vein. Moreover, in 2(5.56%) cadavers it drained into the left internal jugular vein. Interestingly, in 1 (2.77%) cadaver thoracic duct drained into both left subclavian vein and jugulosubclavian junction through the presence of a bifurcation. Conclusion: It was apparent that majority of the findings are comparable to previous research, while there were variations in the percentage incidence of the findings.
Visual outcomes in the management of dropped nucleus without using the fragmatome
(College of Ophthalmologists of Sri Lanka, 2020) Salvin, K.A.
Background: Phacoemulsification (Phaco) and intraocular lens implantation is the commonest surgical practice for the treatment of cataract. Posterior capsular rupture and dropping the nucleus into the vitreous is one of the less common but sight threating complication of phacoemulsification. Trans pars plana posterior vitrectomy (TPPV), removal of the dropped lens fragments and insertion of an intraocular lens is the preferred treatment option for the above complication. The intraocular lens may be placed in the sulcus where capsular ring is intact or scleral fixation is done in the case of absent capsular ring. Methodology: This study is a retrospective review of patients who had TPPV, removal of the lens fragments through the corneal incision using torsional phaco hand piece and sulcus insertion of multipiece intraocular lens (IOL) as the treatment for dropped lens fragments complicating cataract surgery at Nawaloka Hospitals PLC, Colombo, Sri Lanka. Forty four consecutive patients who underwent TPPV from January 2018 to December 2019 have been studied. The notes on the medical records at the initial presentation, second and eighth week post vitrectomy records were reviewed. Results: Forty four patients were reviewed within the 24-month period. There were 30 (68.2%) males and 14 (31.8%) females. All the patients were operated within a week after phacoemulsification. The best corrected visual acuity was 6/9 or better in 33 (75%) eyes at two weeks and 8 weeks post-surgery. There were no major complications observed in the series. Conclusion: Dropped nucleus following phacoemulsification can be managed by removal of the lens through the corneal incision using phaco handpiece with good visual outcomes.