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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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.Item 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.Item Morphological variations of cystic artery in triangle of calot in laparoscopic cholecystectomy: experience in tertiary care surgical unit in South Asian country.(Quest Journals Inc., 2016) Abeysuriya, V.; Kumarage, S.K.; Hasan, R.; Wijesinghe, J.A.A.S.INTRODUCTION: The knowledge and realization of the frequency and multiplicity of abnormalities of the cystic artery is a perquisite for safe laparoscopic cholecystectomy. OBJECTIVE: To describe the morphological characteristics of the cystic artery in the triangle of Calot. METHODS: Descriptive-prospective cross sectional study was performed in 200 patients, who underwent laparoscopic cholecystectomy for symptomatic gallbladder disease, to observe variations cystic artery. RESULTS: Eighty-nine percent (178/200) of the cystic arteries originated as a single artery from the right branch of the hepatic artery. Five percent (10/200) had two cystic arteries originating separately from right hepatic artery while 5 % (10/200) of cystic arteries passed anterior to the common hepatic duct and 1%(2/200) traversed over cystic duct. Majority, 41%(82/200) of the patients right hepatic artery was ling in the triangle of Calot’s. Two percent (4/200) of the patients had right hepatic artery running over the common hepatic duct. CONCLUSION: It has been observed that the variation of the cystic artery in the triangle of Calot is not infrequent and this knowledge will enhance the safe laparoscopic cholecystectomy.Item Experience on endoscopic management of Iatrogenic bile duct injuries following laparoscopic cholecystectomy(Quest Journals Inc., 2016) Hasan, R.; Abeysuriya, V.; Navarathne, N.M.M; Wijesinghe, J.A.A.S.INTRODUCTION: Clinically significant bile leaks due to iatrogenic bile duct injuries following laparoscopic cholecystectomy is not infrequent. Endoscopic procedures have become the treatment of choice for the management of biliary leakage following iatrogenic bile duct injuries. GENERAL OBJECTIVE: To assess the therapeutic outcome of endoscopic therapy of the patients who had iatrogenic biliary injury and biliary leakage following laparoscopic cholecystectomy. METHODS: Prospective descriptive study was performed on32 patients who underwent therapeutic endoscopic procedures for iatrogenic injuries following laparoscopic cholecystectomy for symptomatic gall stone disease in the National Hospital of Sri Lanka. Bile leaks were diagnosed by the presence of persistent abdominal pain, jaundice with cholangitis, abdominal distension and persistent bile flow to the skin surface through and around the existing drains. All the patients underwent abdominal ultra-sonography or CT scan. The presences of bile leaks were confirmed by ERCP. RESULTS: Patients who had bile leaks were diagnosed by, persistent abdominal pain 30 % (9/30), jaundice with cholangitis 6.6% (2/30), abdominal distension 16.6% (5/30), and persistent bile flow to the skin surface through and around the existing drains, 46.6%(14/30). The median duration between initial surgery and detection of bile leak was 3 days (range 0-12 days). Twenty-three patients 76.6% had high-grade bile leaks and 7(23.4%) had low-grade leaks. The iatrogenic bile duct injuries were; cystic duct injuries 10(33.3%) (3 high grade: 7 low grade bile leaks), the common bile duct injuries 16(53.3%) and the right hepatic duct injuries 4(13.3%). All patients were subjected to therapeutic procedures, which consisted of Sphincterotomy with stone extraction followed by biliary stenting (10 patients), Sphincterotomy with biliary stenting (15 patients) and Sphincterotomy alone (5 patients). Bile leaks stopped in all patients at a median of 4 days (range 2-14 days) after endoscopic interventions. Drains were removed at a median duration of time of 6 days (range 5-16 days) after endoscopic procedures. Stents were removed at a 6-8 weeks’ interval. Three (3/6) who had low-grade cystic duct bile leaks, who underwent Sphincterotomy alone, had mean 3.6±0.88SEM days for complete cessation of bile leakage from the drains. Other three patients (3/6) who underwent Sphincterotomy and stent placement had mean of 3.0±0.57SEM days cessation of bile leakage (P=0.52, t-test). All high-grade bile leak (3/10) patients were offered Sphincterotomy and stent placement and had mean 6.8±0.5SEM days for complete cessation of bile leakage from the drains. CONCLUSIONS: Iatrogenic bile duct injuries occur commonly in the common bile duct. Residual stones are found in one-third of cases. No significant difference in healing was seen between the patients who had low-grade bile leaks due to cystic duct injuries and whom were offered either Sphincterotomy alone and Sphincterotomy and stenting.Item Implications of prolactin abnormalities on the male reproductive tract and male factor infertility(Quest Journals Inc., 2016) Hasan, R.; Wijesinghe, J.A.A.S.INTRODUCTION: A significant proportion of male population suffer from Male Factor Infertility (MFI) due to prolactin abnormalities. OBJECTIVE: To establish the role of prolactin on the male reproductive system. METHODOLOGY: A case control study was carried out to determine the effects of prolactin abnormalities in otherwise normal 297 males with infertility after obtaining an informed written consent. Each of the participants was subjected to a Basic Seminal Fluid Analysis(BSA) and an endocrine profile (Follicular Stimulating Hormone, Luteinizing Hormone, Testosterone and Prolactin levels). An age, Sex, height and weight matched voluntary control group was recruited for comparison. None of the cases had any medical or surgical disorder or occupational hazardous exposure which related to infertility. RESULTS: Among the controls mean age 33.2 years+/-5.2, body mass index 21.4+/- 1.39Kgm-2, sperm count 34 x 106, number of children fathered 2+/-1, Serum prolactin level 6.78+/- 2.92mg/ml. Of the case group 28/297 were hyperprolactinemic while 1/297 was hypoprolactinaemia. All the hyperprolactinemic patients had oligospermia, abnormal morphology of sperms, with reduced viability of the sperms. 26/28 Subjects with hyperprolactinaemia had markedly low testosterone levels. The only subject with hypoprolactinaemia had normal testosterone levels. FSH and LH levels were normal in all the participants. 29 subjects with abnormal prolactin levels were followed up for 12 months. 28 patients with hyperprolactinaemia were given oral bromocriptine (2.5mg twice daily). The response with bromocriptine was assessed with repeated Basic Semen Analysis. After 3 months of therapy 19/29 cases showed an improved response to the drug while 4/28 responded after 6 months of treatment. 1/28 took 1 year to show a response. 2 of the cases showed some improvement which fell short of normal BSA parameters. CONCLUSIONS: Prolactin abnormalities affects male reproductive system and semen parameters. Further studies should be carried out to find the exact mechanism of prolactin on the male reproductive system.Item The Effects of abnormal prolactin levels on semen parameters on male white rats.(Quest Journals Inc., 2016) Hasan, R.; Wijesinghe, J.A.A.S.INTRODUCTION:High prolactin levels drastically inhibit sperm production and its quality. The role of high prolactin levels on the male reproductive system has not been completely elucidated and thus its exact role in male factor infertility remains unclear. Hence this study was carried out in order to establish its effects. OBJECTIVE:To determine the effects of prolactin levels on semen parameters of male white rats. METHODOLOGY: A case control study was carried out in the Animal house of the Faculty of Medicine, University of Ruhuna, Sri Lanka. Ethical consent was obtained from the Ethical review committee, Faculty of Medicine, University of Ruhuna. 10+/- 2 week old, 200+/-10 g weighted Wistar strain male white rats weregrouped as G1-G6, with 30 rats per group. They were maintained in separately labeled cages at room temperature of 28+/- degrees Celsius. Hyperprolactinemia was induced in G3, G4 and G5 by using oral largactil a daily dose of 10mg/kg in two divided doseson G3, and subcutaneousinjections of fluphenazine in adose of 0.42mg/kg and 0.84mg/kg on G4and G5 respectively given as single doze in the morning. Hypoprolactinaemia was induced in G2 by using oral bromocriptine in a daily dose of 4.65mg/kg in two divided doses. After 100 days PR Llevels were assayed together with a BSA assessment on each of the groups. Results were compared with corresponding control groups and with each of the groups. RESULTS: The difference between the experimentally obtained values and corrected values for the serum PRL concentrations in the G2 which was administered bromocriptine to induce hypoprolactinaemia was found to be highly significant with compared to the control group by student’s t-test. The difference between the experimentally obtained values and corrected values for the serum PRL concentrations in the G3, G4, G5 which was administered largactil, low dose fluphenazine, high dose fluphenazine respectively to induce hyperprolactinaemia was found to be highly significant with compared to the control group by student’s t-test. Mortality, morphology, cell counts per field and the concentration of sperms seems to affected by serum PRL levels. A correlation between different PRL levels and the semen parameters was evident as those with high PRL levels show more abnormal basic semen analytical parameters while those with a moderate rise of PRL levels and hypoprolactinaemic rats show better basic semen analytical parameters. CONCLUSIONS: The level of serum PRL in white male rats has an effect on semen parameters. The level of effect is proportionate to the level of serum PRL. It is clearly evident that mortality, morphology, cell counts per field and the concentration of sperms are affected by PRL. Thus abnormal PRL levels appear to exert an effect on the spermatogenetic cycle.Item Histological analysis of chronic inflammatory patterns in the gall bladder(International Organization of Scientific Research (IOSR), 2016) Hasan, R.; Abeysuriya, V.; Hewavisenthi, J.; Wijesinghe, J.A.A.S.INTRODUCTION: Cholecystectomy is a common surgical procedure. Inflammatory disease is the most common pathology of the gallbladder. OBJECTIVE: To assess the different morphological changes of chronic cholecystitis in cholecystectomy specimens. METHODS: Thirty histological specimens from cholecystectomies from patients clear clinical history of biliary lithiasis were histologically evaluated with Haematoxylin-Eosinstaining. Three samples were obtained from fundus, middle third and the neck respectively from each gallbladder. RESULTS: 76% of the specimens had metaplastic epithelial changes. Hyperplasia showed a positive correlation (1.0000) with chronic inflammation. Regenerative morphology of epithelial cells was found in 73% of the cases. Regenerative epithelium showed a positive correlation (1.0000) with presence of neutrophils and was significantly associated with mucosal erosions (P=0.005). Fibrosis was observed in all cases (26% mild, 62% moderate, 12% severe). Moderate degree showed a positive correlation (0.999) with severe chronic inflammation. Activity was present in 29% of the cases. Muscular thickness was considered mild in 55% of cases, moderate in 37%, and severe in 8%. Adipose tissue deposits were mild in 47% of cases, moderate in 38%, and severe in 15%. Evolution of the chronic inflammatory cholecystitis was observed in four stages. Initial stage is characterized by mild fibrosis, often with cellular foci, admixed with granulation type tissue in superficial portions of the wall, mild to moderate mononuclear infiltrate and absence of Rockitansky Aschoff sinus(RAS). The second stage consisted of moderate fibrosis and inflammatory infiltrate, often with mild amounts of adipose tissue with RAS extending in to one-third of the length of the specimen. The third stage showed severe fibrosis and chronic inflammation, with moderate to severe adipose tissue deposits with RAS extending in to two-third of the length. The final stage was that of severe fibrosis, often laminated, with reduction of adipose tissue, a moderate to severe inflammatory infiltrate with RAS extending almost entire length of the specimen. CONCLUSION: Staging of chronic inflammatory changes in the gallbladder might help in evaluation of the cholecystectomy specimen, to give a rational, systematic, and reproducible diagnosis of different patterns of the inflammatory process.Item Variations of the Superficial Palmar Arch in a Sri Lankan Perspective: A Cadaveric Study(Global Science and Technology Forum, 2014) Salgado, L.S.S.; Hasan, R.; Perera, A.A.M.M.S.L.; Wijesundara, W.M.R.D.; Anuradha, W.K.INTRODUCTION: The blood supply of the hand is a complex and challenging area of study. The clinical importance of this area lies in the significant number of surgical procedures such as radial artery conduits in coronary artery bypass grafting (CABG), radial arterial cannulation and reconstructive surgery of the hand. Anatomical variations in the typical blood supply of the hand are common and are an area of extensive research. METHODOLOGY: This descriptive study was carried out in the dissecting theatres at the Department of Anatomy, Faculty of Medicine, University of Kelaniya on dissections carried out on 25 cadaveric hands. RESULTS: From the superficial palmar arches studied the following results were obtained. 88% were complete while 22% were incomplete. Specimens with contribution from both the radial and the ulnar arteries for the superficial palmar arches were 80%, while specimens with the contribution solely from the ulnar artery were 12%. 8% hands studied had contributions from the radial, ulnar and the median arteries. Three branches of the radial artery contribute to complete the superficial palmar arch. Of this 60% cadavers had the major contribution from the superficial palmar branch of the radial artery, 24% from the arteria princeps pollicis, and 16% from the first dorsal metacarpal artery. The contribution to the arterial supply of the radial side of the thumb was from the superficial palmar branch of radial artery in 80% of the cadavers while in 20% the contribution was from the arteria princeps pollicis. The contribution to the arterial supply of the ulnar side of the thumb was from the proper palmar digital artery arising from the superficial palmar arch in 44% hands and the contribution in 32% hands was from the arteria princeps pollicis while the contribution in 24% hands was from the first dorsal metacarpal artery. CONCLUSION: It is thus evident that significant anatomical variations of the superficial palmar arch exist in the Sri Lankan population. The arterial supply of the thumb also had significant changes compared to the descriptions given in standard text books.Item Prolactin and male infertility(Sri Lanka Medical Association, 2013) Hasan, R.; Weerasooriya, T.; Illeperuma, I.; Weerasinghe, W.S.; Withana, A.K.G.INTRODUCTION AND OBJECTIVES: Male infertility due to endocrine disturbances is seen among 1% of couples seeking medical help for childlessness. Effects of prolactin on the male reproductive system are not fully understood. Objective was to determine prolactin level in healthy males with infertility. METHODS: A case control study recruited 297 males attending infertility clinics in a government or private institution over a period of 54 months. A detailed clinical assessment of reproductive health was carried out. All underwent a -basic seminal fluid analysis (BSA) and an endocrine profile consisting of FSH, LH, testosterone and prolactin (PRL) hormones carried out using the immulite random access chemiluminescent immunoassay method (normal range 2.5-17ng/ml). Age, weight and height matched volunteers comprised the control group. RESULTS: None of the cases had any anatomical, medical or surgical disorder which could account for the infertility. Among the controls, mean age was 33.2yrs ±5.2, BMI 21.04 kgm-2 ±1.39, BSA 34xl06± 7.87x106, number of children fathered 2 ±1, PRL 6.78ng/ml ±2.92. Twenty nine (9.76%) had abnormal PRL levels irrespective of serum testosterone level with a BSA sperm count < 20x106 and there were structural and functional abnormalities. Hyperprolactinaemic was seen in 28 and 26 had marked hypotestosteronaemia. FSH and LH were normal. CONCLUSIONS: Prolactin abnormalities affect the male reproductive system and semen parameters. Further studies should be carried out on PRL and male infertilityItem Coracobrachialis muscle: morphology, morphometry and gender differences(Springer, 2016) Ilayperuma, I.; Nanayakkara, B.G.; Hasan, R.; Uluwitiya, S.M.; Palahepitiya, K.N.PURPOSE:Coracobrachialis (CBM) is a complex muscle with a wide range of variations in its morphology and innervation. The goal of this study was to elucidate the morphology, morphometry, gender differences of CBM and precise anatomical position of the musculocutaneous nerve (MCN) with reference to surrounding anatomical landmarks in an adult Sri Lankan population. METHOD: Cadaveric upper limbs (n = 312) were examined for the proximal and distal attachments, length, width, thickness of CBM and its relationship with the MCN. RESULTS: The CBM originated from the tip of the coracoid process of the scapula and lateral, posterior and medial aspects of the tendon of short head of biceps brachii. Gender differences were observed in all morphometrical parameters of CBM. In 83.33 %, MCN perforated the CBM. In 50 % the MCN pierced the middle one-third of CBM while none pierced the lower one-third. The distance from the coracoid process to the point of entry of MCN into CBM (distance P) was 50.62 mm. A positive correlation was observed between the arm length and distance P indicating that arm length provides an accurate and reliable means of gauging the distance P of an individual. CONCLUSION: The present study provides new evidence pertaining to the origin of CBM. Further, it was revealed that the predicted distance P of any upper extremity can be calculated by dividing the arm length by 5. Precise anatomical location of MCN in relation to CBM using unequivocal and well-defined anatomical landmarks will be imperative in modern surgical procedures.