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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Case report: Giantadenomatoidtumour of uterus mimicking like large leiomyoma(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Gunarathna, S.M.S.G.; Wijesinghe, P.S.; Hewavisenthi, S.J.INTRODUCTION: Adenomatoidtumours of uterus are rare benign neoplastic disorder of the female genital tract. Even though reported incidence is around 1-2% true incidence is probably more than that as they are not usually symptomatic. Most cases are under 3 cm in diameter, but giant variants up to 15 cm in diameter are also described. Here, we describe a case of giant adenomatoid tumor of the uterus that was managed surgically. CASE HISTORY: A 24-year-old nulliparous woman presented with abdominal distension, regurgitation and early satiety of five months duration. She did not have any menstrual disorders. Abdominal examination revealed a large pelvic tumourcorresponding to 20 weeks gravid uterus. Ultrasonography revealed a large uterus with multiple fibroid. She underwent a laparotomy,a subserosal mass arising from the posterior uterine wall near the fundus and extending to the left uterine cornuwas found. It was not a welldefined mass and consistency was firm in nature. Tumour was easily enucleated and sent for histology. Uterus was repaired into two layers.Post-operative recovery was uneventful.The histology report revealed as adenomatoid tumor of the uterus. DISCUSSION: Adenomatoidtumour arises from the germinal epithelium of abdomen and thorax. It is a variant of mesothelioma. They can beassociated with fibroids and tend to mimic them clinically, making pre-operative diagnosis difficult. Macroscopically, most appear as nodular formations with ill- defined margins and can occur in ovary, mesentery, adrenal glands, and omentum. Rarely do they recur even after conservative surgery and so far no malignant transformation has been reported. Therefore, the recommended treatment is simple excision of the tumor, if possibleItem Case report: Giant adenomatoid tumour of uterus mimicking like large leiomyoma(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Gunarathna, S.M.S.G.; Wijesinghe, P.S.; Hewavisenthi, S.J.INTRODUCTION: Adenomatoid tumours of uterus are rare benign neoplastic disorder of the female genital tract. Even though reported incidence is around 1-2% true incidence is probably more than that as they are not usually symptomatic. Most cases are under 3 cm in diameter, but giant variants up to 15 cm in diameter are also described. Here, we describe a case of giant adenomatoid tumor of the uterus that was managed surgically. CASE HISTORY: A 24-year-old nulliparous woman presented with abdominal distension, regurgitation and early satiety of five months duration. She did not have any menstrual disorders. Abdominal examination revealed a large pelvic tumour corresponding to 20 weeks gravid uterus. Ultrasonography revealed a large uterus with multiple fibroid. She underwent a laparotomy, a subserosal mass arising from the posterior uterine wall near the fundus and extending to the left uterine cornu was found. It was not a well-defined mass and consistency was firm in nature. Tumour was easily enucleated and sent for histology. Uterus was repaired into two layers. Post-operative recovery was uneventful. The histology report revealed as adenomatoid tumor of the uterus. DISCUSSION: Adenomatoid tumour arises from the germinal epithelium of abdomen and thorax. It is a variant of mesothelioma. They can be associated with fibroids and tend to mimic them clinically, making pre-operative diagnosis difficult. Macroscopically, most appear as nodular formations with ill- defined margins and can occur in ovary, mesentery, adrenal glands, and omentum. Rarely do they recur even after conservative surgery and so far no malignant transformation has been reported. Therefore, the recommended treatment is simple excision of the tumor, if possible.Item A Retrospective study on perinatal post-mortems(University of Kelaniya, Sri Lanka, 2016) Liyanage, S.K.; Mahendra, B.A.G.G.; Ratnayake, R.M.U.S.; Hewavisenthi, S.J.A post-mortem examination is the key to the recognition of pathologies related to perinatal deaths. A perinatal death could be related to fetal, maternal or placental factors. A complete perinatal post-mortem (PPM) includes examination of the dead body and the placenta. The PPM findings assist the clinical team in confirming their clinical findings and uncover the additional pathologies, and the family for future pregnancy planning. This study was carried out to identify the number of perinatal post mortems (PPMs) reported during the study period, the number of PPMs with multiple congenital anomalies and the number of PPMs accompanied by a placenta and the number of placentae with identifiable pathology. This study was on already reported PPMs in a tertiary care center from January 2011- August 2016. Multiple congenital anomalies were noted in 14% (16/118) of the PPMs. Placentae were submitted for examination in 26% (31/118) with clinically significant placental pathologies in 23% (7/31). In 64% (76/118) of PPMs there were no gross abnormality in the fetus/baby. The placenta was not available for examination in 72% (55/76) and therefore, the possibility of placental pathology, which might have led to the death, could not be excluded.Item Prevalence of eosinophilic oesophagitis among adult Sri Lankan patients with refractory upper gastrointestinal symptoms - a prospective study(Sri Lanka Medical Association, 2012) Ranawaka, C.K.; de Silva, A.P.; Hewavisenthi, S.J.; Jayathilake, T.M.A.H.; de Alwis, W.R.S.INTRODUCTION: Eosinophilic oesophagitis (EoE) is increasing in the West (community prevalence 0.02-1%), and is especially prevalent among patients with refractory upper gastrointestinal (UGI) symptoms (about 6.5-40%). Diagnosis is important as the treatment is with corticosteroids and other immunomodulators rather than acid suppression and prokinetics. EOE has been poorly studied in Asian populations. AIMS: To study the prevalence of EoE among adult Sri Lankan patients with refractory UGI symptoms. Methods: The study was carried out in the University Medical Unit of the Colombo North Teaching Hospital, Ragama. Over a period of one year from March 2011, consecutive, consenting patients (aged 18-70) referred for gastroduodenoscopy (OGD), with persistent UGI symptoms despite standard therapy for at least two months, were included. All patients underwent OGD with two biopsies each from the distal and mid oesophagus. A diagnosis of EoE was made when there were 15 or more intra-epithelial eosinophils per high-power field, according to international guidelines. RESULTS: 106 patients (M: F= 42:64 mean age 48 yrs (SD 13.3) were recruited. Common symptoms were refractory dyspepsia, gastro-oesophageal reflux and dysphagia in74, 64, 27 patients respectively. Endoscopy was macroscopically normal in 97 patients, and suggestive of EoE in 7; concentric mucosal rings in 3 and white exudates in 4 patients. Only 2 (1.9%) patients had histological evidence of EoE, one of whom had compatible macroscopic endoscopic features. CONCLUSIONS: The prevalence of EoE in this Sri Lankan cohort of adult patients with refractory UGI symptoms was much lower than reported in western series.Item Follow up of histopathology and cytopathology reports that are duly signed out - are standard procedures required?(College of Pathologists of Sri Lanka, 2014) Ratnayake, R.M.U.S.; Somarathna, T.; Mahendra, B.A.G.G.; Hewavisenthi, S.J.Item Usefulness of Ileoscopy during Colonoscopy(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2011) Wijewantha, H.; de Silva, A.P.; Wijesinghe, N.T.; Kumarasena, R.S.; Dassanayake, A.S.; Hewavisenthi, S.J.; de Silva, H.J.INTRODUCTION: Ileoscopy during colonoscopy adds only three minutes to total procedure time and has no added complications. However, available evidence for recommending the procedure is contradictory. There are few studies adressing this issue in South Asian populations. Aims: To investigate the usefulness of terminal ileoscopy during colonoscopy in a cohort of Sri Lankan patients attending a tertiary care centre. METHODOLOGY: From January 2007, our unit policy was to perform ileoscopy in all patients undergoing colonoscopy. A retrospective analysis of all patients who underwent colonoscopy in the unit from January 2007 to September 2010 was performed. Data were obtained from endoscopy unit and patient records. We compared usefulness of ileoscopy in patients considered to have specific clinical indications for ileoscopy - right iliac fossa pain, diarrhea, anemia, inflammatory bowel disease and raised inflammatory markers (group A) with those that did not (group B). RESULTS: 789 colonoscopies were performed during the study period, and the terminal ileum was successfully intubated in 638 (80.9%). Reasons for not intubating the ileum were technical difficulty and/or severe patient discomfort. Overall, 108/ 638 (16.9%) patients had macroscopic or microscopic abnormalities of the ileum. 51/638 (8%) of these were considered to be significant ileal pathology: Crohn’s disease (34), tuberculosis (5), ileitis-resolving infection (8) or drug induced (4). The other abnormalities, of doubtful clinical importance and which did not alter management, were backwash ileitis in ulcerative colitis (12), and non-specific ileitis (37). 35 patients with ileal abnormalities (Crohn’s disease 6, non-specific ileitis 29) had no abnormalities in the colon. 66 patients with a macroscopically normal terminal ileum had abnormal microscopy: Crohn’s disease (21), ileitis - resolving infection (3) or drug induced (2), backwash ileitis in ulcerative colitis (4), non-specific ileitis (36). In group A [n=511; mean (SD) age 47.7 (16) years; 53.4% males] 47/511 (9.2%) had significant ileal pathology compared to 4/ 127 (3.15%) in group B [n=127; mean (SD) age 53.2 (16) years; 50.4% males] (x2 4.270, df=1, p=0.038). CONCLUSION: Ileoscopy and biopsy during colonoscopy is a useful investigation which detects significant pathology, in some instances where the rest of the colon is normal and sometimes even when the ileum appears macroscopically normal. The procedure should be recommended, especially for patients with right iliac fossa pain, diarrhea, anemia, inflammatory bowel disease and raised inflammatory markers.