Browsing by Author "Silva, M.A."

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Coloreetal cancer in young patients, a five year experience
(Sri Lanka Medical Association, 2001) Silva, M.A.; Deen, K.I.
BACKGROUND: Hereditary Non-Polyposis Colorectal Cancer (HNPCC) and Familial Adenomatous Polyposis (FAP) usually manifest in patients under 45 years of age. 70% of these tumours are found proximal to the splenic flexure and are associated with a high incidence of synchronous and metachronous lesions. OBJECTIVES: To ascertain if data available from western studies on young colorectal cancer patients corresponded with that of Sri Lankan patients and how many fulfilled the Amsterdam criteria for diagnosis of HNPCC. DESIGN AND SETTING: Retrospective study. Including all young colorectal cancer patients treated at the University Surgical Unit of the Teaching Hospital of North Colombo. RESULTS: The study included 28 patients (12 male and 16 females). The median age was 35 years (range 14-43). Five (18%) patients fulfilled 2 out of three of the Amsterdam criteria, while 20 (71%) fulfilled only one and 3 (11 %) fulfilled none. Significantly, 21 patients (75%) had lesions distal to the splenic flexure while only 7 (25%) had proximal disease. All underwent operative resection. Eight patients (29%) were alive at one year post operation, while 9 patients (32%) died within a year. Eleven patients (39%) were lost to follow up. CONCLUSION: Colorectal cancers in young Sri Lankan patients is predominantly a distal disease and does not fulfill the restrictive Amsterdam criteria for HNPCC.
The Internal jugular vein valve may have a significant role in the prevention of venous reflux: evidence from live and cadaveric human subjects
(Blackwell Scientific Publications, 2002) Silva, M.A.; Deen, K.I.; Fernando, D.J.S.; Sheriffdeen, A.H.
INTRODUCTION: The internal jugular vein valve (IJVV), which is situated just above the termination of the internal jugular vein, is the only valve between the heart and the brain. This means that it plays a role in the prevention of cephalad flow of venous blood. If the IJVV is damaged or becomes incompetent, increase in intrapleural pressure could result in raised intracranial pressure. Additionally, the jugular venous pulse (JVP) is used clinically to estimate right atrial pressure, a functional IJVV may prevent accurate estimation of the JVP. OBJECTIVES: To describe the presence and the competence of the IJVV in post-mortem and live human subjects. DESIGN - setting and methods: The anatomical appearance of the IJVV from 30 cadavers was studied. Competence was checked by measuring maximum hydrostatic pressure before reflux occurred through the valve. The function of the valve was evaluated in 25 live subjects using colour duplex scanning. RESULTS: The IJVV was present in all cadavers just before its termination (60 IJVVs from 30 subjects). The valve was bicuspid in most cases (93%). The competence of 41 IJVVs was checked of which only three (7%) were found to be incompetent. All IJVVs in live subjects were found to be competent. CONCLUSION: This study confirms that a functional IJVV is present just above the termination of the internal jugular vein. The IJVV may therefore prevent reflux of venous blood from the right atrium into the internal jugular vein.
Laparoscopic excision of a mesenteric cyst case report and review of literature
(College of Surgeons of Sri Lanka, 2002) Silva, M.A.; Rajapakse, T.; Deen, K.I.
Magnetic resonance cholangio-pancreatography(MRCP)
(Elsevier-Medicine Publishing, 2002) Silva, M.A.; Munasinghe, S.H.; Munasinghe, D.; Deen, K.I.
The use of MRCP was first reported in 1991. MRCP is now a well established technique that enables precise evaluation of the biliary tract, gall bladder and pancreatic duct. MRCP is popular because it is rapid and can be performed as an out-patient procedure, usually in less than 10 minutes. It also requires no contrast material, is non-invasive and has a safety level comparable to ultrasonography because no radiation is used.
Quality of life of stoma patients: temporary ileostomy versus colostomy
(Springer-Verlag, 2003) Silva, M.A.; Rathnayake, G.; Deen, K.I.
Ileostomy for proximal diversion as a preferred option over colostomy has been a recent topic of interest. Our study evaluated the quality of life (QOL) of patients with a temporary ileostomy and compared it with that of patients with a temporary colostomy. The QOL of 25 patients with an ileostomy(median age 42 years, range 22-76 years) was compared with that for 25 patients with a colostomy (median age 44 years, range 18-70 years). Indications for a stoma were rectal carcinoma, trauma, inflammatory bowel disease, anastomotic leak, or incontinence following an operative procedure for rectal prolapse. The study was conducted at a median of 8 weeks (range 6-16 weeks) for ileostomy patients and of 9 weeks (range 5-17 weeks) for colostomy patients following stoma creation. A self-administered structured questionnaire was used, with responses obtained for 10 QOL questions on a visual analog rating scale (0-100 mm); they were graded good (71-100), satisfactory (31-70), or poor (0-30). Altogether, 22 (88%)patients with an ileostomy, compared with 16 (64%) patients with a colostomy, were able to purchase their stomal appliances ( p = 0.09, chi(2): NS). Effluent was tolerable in 18 (72%) patients with an ileostomy compared with 7 (28%) patients with a colostomy ( p = 0.002, chi(2)). Appetite was not affected in any of the patients with an ileostomy (100%), compared with 64% of patients with a colostomy ( p = 0.002, chi(2)), travel by public transport 32% compared to 28% with colostomy (NS), dress in 20% compared to 24% with colostomy (NS), and daily activities 28% compared to 24% with colostomy (NS). Moreover, 68% with an ileostomy did not have a problem with hygiene compared with 40% with a colostomy (NS); 95% with an ileostomy abstained from sexual activity compared with 81% with a colostomy ( p = 0.21, chi(2): NS). Both ileostomy and colostomy resulted in significant QOL impairment. However, with ileostomy, the effluent was more tolerable, had less of an impact on personal hygiene, and preserved the appetite compared with colostomy. There were no differences in travel, dress, daily chores, or sexual activity between the two groups.