Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Anatomy of Inferior Mesenteric artery: A cadaveric study(Anatomical Society of Sri Lanka, 2024) Abeysuriya, V.; Hewawardhane, S.Introduction: A comprehensive knowledge of the varied anatomy of the inferior mesenteric artery (IMA) can be important in surgeries in the region of the colon and rectum. Methods: We analyzed 50 fresh cadavers in the department of Anatomy, Faculty of Medicine Ragama from 2022 to 2024. Latarjet’s classification was used for the IMA branching pattern. The anatomical relationships of the IMA left colic artery (LCA), sigmoidal artery (SA), and superior rectal artery (SRA) were observed, and the length from the origin of the IMA to the point of branching into the LCA or common trunk of LCA and SA was measured. The relationship between LCA and inferior mesenteric vein (IMV) was also observed. The data was presented as the value / percentage. Results: Majority showed Type A branching pattern 35/50 (70%). The respective lengths from the origin of the IMA to the beginning of LCA were measured and expressed as (mm) (mean ± SD) for each type; Type A 33.4 ± 4.7, Type B 36.5 ± 5.4, Type C 39.2 ± 8.6. The number of LCA under IMV in type A (51%); type B (54%); type C (62%) respectively. There was no statistically significant difference among the three types. Conclusion: Our study showed that type A branching pattern of LCA was the commonest. It is also observed that almost similar incidence of LCA traversing above and beneath the IMV.Item A cadaveric study on superior hypogastric plexuses(The College of Surgeons of Sri Lanka, 2024) Abeysuriya, V.; Akalanka, H.G.L.; Kumarage, S.INTRODUCTION The superior hypogastric plexus (SHP) is found around the level of aortic bifurcation. It is important in surgical procedures in the pelvis. Methods Ten (5; M & 5; F) fresh intact adult human cadavers were dissected. Following the initial dissection, all of them were further sectioned sagittal in the midline and separated in to half pelvises, and assessed. The study was carried out in the Department of Anatomy, Faculty of medicine Ragama, Sri Lanka from 2022 to 2024. The ethical clearance was obtained. RESULTS In all specimens, left connecting fibers from the inferior mesenteric plexuses (IMA) crossed the left common iliac artery and joining to the superior hypogastric plexuses. In 80%, right connecting nerve fibers from the inferior mesenteric plexuses crossed the right common iliac artery and joined the superior hypogastric plexus (SHP). Eighty percent of the specimens had, well-defined nerve strands, whereas 20% contained a delicate and irregular meshwork. In all of the specimens, the median root, or a nerve root from abdominal aortic plexus from the IMA were present. In 80% specimens, the SHP was located between the aortic bifurcation and the sacral promontory. In 20%, it extended across the pelvic brim and ended on the body of the S1 vertebra. CONCLUSION The majority of the SHP were located below the aortic bifurcation and had well-defined nerve strands, rest traversed the pelvic brim and terminated on the body of the S1 vertebra. Further larger sample studies are recommended.Item Radiological investigations in nephrolithiasis and: a narrative review(The College of Surgeons of Sri Lanka, 2023) Siriwardana, S.; Abeysuriya, V.Nephrolithiasis and ureterolithiasis are increasing in incidence and prevalence worldwide, which are significant clinical challenges in management. Radiological assessments are vital in early diagnosis and effective management to decrease morbidity and healthcare costs. This narrative review explores the role of various radiological investigations in nephrolithiasis and ureterolithiasis, focusing on their clinical implications and limitations. Plain X-ray of the kidney, ureter, and bladder (X-ray KUB) is a widely available, relatively inexpensive modality with limited sensitivity, mainly for smaller stones. However, it is most beneficial when assessing follow-up patients diagnosed with renal or ureteric calculi, but it is less effective in acute ureteric colic. Intravenous Urogram/Intravenous Pyelography (IVU/IVP) is an obsolete investigation and has largely been replaced by newer modalities due to numerous drawbacks. Ultrasonography (USG) is a widely available, relatively lowcost, non-invasive radiological modality without ionising radiation, considered first-line for children and pregnant patients. However, its sensitivity and specificity are traditionally lower than computed tomography and largely depend on the operator and patient factors. Computed tomography kidney, ureter, and bladder (CT-KUB) is the gold standard for diagnosing urolithiasis. It offers high sensitivity, specificity, and the ability to calculate the exact size and stone composition, but it comes with substantial radiation exposure. However, low-dose and ultralow-dose CT (LDCTKUB) protocols reduce radiation to the patient significantly, compromising image clarity. Magnetic Resonance Urography (MRU) is a second-line investigation in obstructive uropathy, particularly in pregnancy and children. It provides vital anatomical and functional information without ionising radiation. Urology and radiology professionals should collaborate to identify individualised and optimal radiological investigations, considering the risks and benefits associated with each modality.Item Anatomical relations of the recurrent laryngeal nerve in thyroid dissection(The College of Surgeons of Sri Lanka, 2023) Abeysuriya, V.; Anjula, S.A.P.D.INTRODUCTION: Recurrent laryngeal nerve (RLN) palsy is one of the major complications thyroidectomy. Visualization of the anatomical relations of the RLN with branches of the inferior thyroid artery (ITA) remains essential for preservation of RLNs. Suspensory ligament of Berry, inferior horn of the thyroid cartilage is considered as other important landmarks for safe thyroidectomy. The objective of this study was to describe the various anatomical relations of the RLN during thyroid dissection. METHODS: An observation cadaveric study was conducted by simple random sampling of 35 cadavers with a total of 70 RLNs over a one-year period, from June 2022 to June 2023. The cadavers that had thyroidotomies and goitres were excluded from the study. RESULTS: The majority of RLNs in this series had a retrovascular course (with respect to the ITA or its branches): 57% on the right and 68.6% on the left. The course of 64/70 of the dissected nerves was posteromedial to the suspensory ligament of Berry, while the other 6 nerves passed between the fibres of this ligament. All RLNs penetrated the larynx by passing posteriorly to the inferior horn of the thyroid cartilage on both sides. No case of non-recurrent laryngeal nerve was observed. CONCLUSION: This preliminary study illustrates the numerous anatomical variants of the RLN with respect to the ITA and its branches. The RLN mainly has a retrovascular course on both the right and the left sides.Item Usefulness of simultaneous use of anatomical landmarks in identification of facial nerve in parotid gland dissection(The College of Surgeons of Sri Lanka, 2023) Abeysuriya, V.; Modaragama, H.INTRODUCTION: Identification of Facial nerve trunk is important in parotid surgery to avoid an iatrogenic injury. The objective of our study was to assess consistent and reliable landmarks for identification of the main trunk of facial nerve during parotid surgery. METHODS: This prospective study was carried out in the department of Anatomy, faculty of Medicine, Ragama from 2022 to 2023. Our study included 35 fresh cadavers (70 parotid regions). The anatomical landmarks of tragal pointer (TP), tympanomastoid suture (TMS), and superior border of posterior belly of digastric (PBD) muscle to the facial nerve trunk was measured. The shortest distances were taken from the facial trunk by using a slide calliper. RESULTS: The age of subjects of the cadavers ranged from 42 to 64 years with a mean of 54.4 years. The mean distance between the TP and the facial nerve trunk was 9.15 mm (8.1–11.7 mm). The mean distance between PBD and the facial nerve trunk was 8.6 mm (7.2–9.8 mm). The mean distance between the TMS and the facial nerve trunk was 6.5 mm (5.2–7.5 mm). CONCLUSION: Our study showed that the tympanomastoid suture line is the closest to the facial nerve trunk, followed by the posterior belly of digastric muscle and the tragal pointer respectively. Further clinical studies are needed to assess these landmarks through various parameters to determine their usefulness in surgical practice.Item Surgically important neurovascular structures related to the submandibular gland.(The College of Surgeons of Sri Lanka, 2023) Abeysuriya, V.; Gunathilaka, C.INTRODUCTION: The pathologies and procedures of the submandibular gland are numerous. Comprehensive knowledge of the anatomy and its relations of the SMG will avoid iatrogenic injuries within the submandibular triangle. This study assesses the presence and frequency of neurovasculature related to the SMG with special interest on the facial artery and the marginal mandibular nerve of cranial nerve (CN) VII. METHODS: In twenty- five fresh cadavers, right and left side SMG (n=50) were dissected and observed in the department of Anatomy, faculty of Medicine, Ragama. Data were recorded on frequency of facial artery and postsynaptic sympathetic periarterial plexus and the marginal mandibular nerve of CN VII with relations to the SMG. RESULTS: The majority 40/50 had the facial artery placed on the posterior surface of the SMG outside the capsule of the gland. Two of those specimens (2/10) had the e facial attires piercing through the parenchyma of the SMG. All facial artery anomalies were found to be present unilaterally, mostly on the right side and mainly among the females. 3/50 female cadaveric specimens had the marginal mandibular nerve of CN VII nerve traversing through the superficial part of the SMG. All of them were in the right side. CONCLUSIONS: The data indicate a higher rate of aberrant submandibular neurovasculature were on the right side with a female preponderance.Item Outcomes of breast abscesses during lactation: a retrospective study(Sri Lanka college of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, S.H.; Chandrasena, L.INTRODUCTION: During breastfeeding one of the most common problems which can encounter is breast abscess. Our retrospective study aimed to assess the outcomes of breast abscesses among a cohort of lactating mothers. METHODS: A single-centre retrospective study was carried out. Randomly selected 2000 medical records of mothers, referred as outpatients and hospitalized from 2002 to 2022 were retrieved. There were 32 breastfeeding mothers with breast abscesses. The diagnosis of lactational breast abscess was made by documented signs of a localized inflammatory, palpable breast lump confirmed with an ultrasound findings. From the retrieved database, data on maternal, perinatal, and breastfeeding features, ultrasound scan reports, methods of interventions and outcomes and microbiological testing reports were evaluated. Ethics Committee Approval was received from Nawaloka Research and Education Unit. No conflict of interest. RESULTS: The mean age of the 32 patients was 28.7 ± 5.7 years. There were 85% primiparous and 15% multiparous. Exclusive breastfeeding at diagnosis was present in 20/32 (63%). Most of the women developed breast abscesses during the initial 40 days (36.3 ± 1.4 days) after delivery. The majority of 26/32 (81.3%) of the breast abscesses were <5cm in diameter in the ultrasound examination. The majority of the patients 28/32 (87%) underwent ultrasound-guided aspiration while on antibiotic coverage according to the standard clinical guidelines. Four patients had repeated ultrasound-guided aspiration. Four patients who had abscesses >5cm, with overlying skin necrosis underwent incising and drainage. None of the patients developed mammary fistulae or sinuses. All of the incision and drainage abscesses were healed within 3 to 5 weeks with repeated wound dressings. Ninety-one percent of the cultures revealed S. aureus positive. None of the patients stops breastfeeding during the acute phase.CONCLUSION: Our retrospective study showed that needle aspiration may be performed, regardless of the size of the breast abscesses in most instances.Item Upper gastro intestinal endoscopy in pregnancy: A single centre experience(Sri Lanka college of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, H.S.; Chandrasena, L.INTRODCTION: Upper gastro intestinal (GI) endoscopy is advisable to perform when strongly indicated during pregnancy. This study was to evaluate the outcomes of upper GI endoscopy during pregnancy. METHODS: A single centre retrospective study was carried out. Randomly selected 500 medical records of the pregnant mothers who were referred as out patients and hospitalized from 2012 to 2022 were retrieved. Inclusion criteria for retrieving data of the patients who underwent upper GI endoscopy were; Major or continued bleeding, severe or refractory nausea and vomiting or abdominal pain, dysphagia or odynophagia. Endoscopic findings were recorded in a computer based database. Ethical approval was obtained from the Ethical Review Committee of Nawaloka Hospitals of Sri Lanka. No conflict of interest. RESULTS: A total of 16 records of patients underwent upper GI endoscopy were retrieved during 2012 to 2022. The mean age of the patients was 25.48 ± 6.5 years. Ten patients (62.5%:10/16) were primigravida. During the first, second and third trimester of pregnancy, number of patients who underwent upper GI endoscopy were 8 (50%), 4 (25%), and 4 (25%) respectively. The major indication was persistence epigastric pain (75%: 12/16) followed by dysphagia (18.7%:3/16) and hematemesis in one patient. All patients had undergone conservative treatment without any therapeutic upper GI endoscopy. There were no records that were found to have ERCP, capsular endoscopy or enteroscopy during pregnancy among our patients. No records were found of having endoscopy related adverse effects on mothers or foetuses. CONCLUSION: The upper GI endoscopy especially oesophago-gastro-dudenoscopy (OGD) may be performed without a major risk to the mother and the baby. However, further prospective multicentre research studies are strongly recommended.Item The usefulness of flexible sigmoidoscopy in bleeding per rectum during pregnancy: an observational study(Sri Lanka College of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, S.H.; Chandrasena, L.INTRODUCTION: Bleeding per rectum is not an infrequent complaint during pregnancy, which may require endoscopic evaluation and treatment. Flexible sigmoidoscopy is a relatively simple, quick procedure. The current study was aimed to assess the usefulness of flexible sigmoidoscopy in bleeding per rectum during pregnancy from a single tertiary care centre. METHODS: A single centre retrospective study was carried out. Randomly selected 1000 medical records of the pregnant mothers who were referred as out patients and hospitalized from 2012 to 2022 were retrieved. All patients had the passage of fresh blood as their chief complaint. All of them had not undergone any prior diagnostic workup for their presentation. All had undergone flexible sigmoidoscopies and patients with significant additional bowel symptoms underwent colonoscopy following sigmoidoscopy. Endoscopic findings were recorded in a computer based database. Ethical approval was obtained from the Ethical Review Committee of Nawaloka Hospitals of Sri Lanka. No conflict of interest. RESULTS: A total of 48 pregnant women had undergone lower GI endoscopies. The mean age of the patients was 25.3 ± 6.5 years. Twenty-four patients (50%) were primigravida. Majority was in the second trimester of pregnancy 89.5% (43/48). The mean (±SD) gestational age at the time of procedure was 18(±2) weeks. All had undergone sigmoidoscopy, and an additional colonoscopy were done in 2 patients. Bleeding per rectum was the main indication. All flexible sigmoidoscopies were done without sedation. Wiliest, the colonoscopies were performed under conscious sedation. Majority of the pregnant mothers found to have haemorrhoids followed by anal fissures (46/48; 95.8%). Ulcerative colitis and a sigmoidal cancer were found in two patients (4.2%). None had an immediate post procedure-related complication. CONCLUSION: Flexible sigmoidoscopy is useful and safe to be performed in pregnancy with clinically significant bleeding per rectum. It has a good diagnostic yield. Further prospective multicentre research studies are strongly recommended.Item Acute appendicitis in pregnancy(Sri Lanka College of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, H.S.; Chandrasena, L.INTRODUCTION: The early diagnosis and management of appendicitis in pregnancy are essential in maternal and fetal morbidity and mortality. In this 20-year retrospective study, we aimed to assess the outcomes of pregnant patients diagnosed with acute appendicitis. METHODS: A single-center retrospective study was carried out. Randomly selected 2000 medical records of pregnant mothers referred as outpatients and hospitalized from 2002 to 2022 were retrieved. Six pregnant patients who were diagnosed and treated in Nawaloka Hospital with the diagnosis of acute appendicitis during 2002-2022 were examined retrospectively. Ethics Committee approval was received. No conflicting interest. RESULTS: The age range of our patients was 22 to 31 years, mean of 26± 3.4. The mean gestational week was 20±5.3 weeks, and most were in the second trimester 4 (68%). All patients were admitted with the complaint of abdominal pain, the majority of them had the right iliac fossa pain (RIF). All had elevated inflammatory markers. No computed tomography (CT) was performed. One patient was diagnosed clinically of having acute appendicitis without any imaging. Acute appendicitis was diagnosed in 3/5 patients who underwent ultrasound scan examination. The other two patients (one from 2nd trimester and one in the third trimester) were diagnosed with acute appendicitis on MRI examination. All patients underwent open appendectomy under general anaesthesia. No maternal or foetal morbidity or mortality was noted during pre or post-surgical and anaesthesia procedures. The mean hospital stay was 3.9±0.9 days. All appendixes were pathologically proven to have acute appendicitis. Except for minor superficial surgical site infection rest of the mothers and foetus had no morbidity or mortality recorded in the follow-up. CONCLUSION: Although appendicitis is not frequent during pregnancy, it is a disease that requires urgent surgical and obstetrics care for timely diagnosis and treatment.