Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
19 results
Search Results
Item Idiopathic pancreatitis: Is it a consequence of an altering spectrum of bile nucleation time?.(BMJ Publishing Group, 2009) Abeysuriya, V.; Deen, K.I.; Navaratne, N.M.M.; Kumarage, S.K.INTRODUCTION: The pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of the microcrystallisation of hepatic bile. AIMS AND METHODS: A prospective case-control study compared 55 patients (symptomatic cholelithiasis, 30: 14 men, 16 women, median age 36 years, body mass index (BMI) 25.1 +/- 0.33 kg/m2; gallstone pancreatitis, nine: six women, three men, median age 35 years, BMI 24.86 +/- 0.23 kg/m2; and idiopathic pancreatitis, 16: seven women, nine men, median age 34 years, BMI 23.34 +/- 0.2 kg/m2) with 30 controls (15 men, 15 women, median age 38 years, BMI 24.5 +/- 0.23 kg/m2, undergoing laparotomy and who had normal gallbladder and no demonstrable stones on ultrasonography). Ultrafiltered bile from the common hepatic duct in patients and controls was anaerobically incubated and examined by polarised light microscopy, for nucleation time (NT). Ethical approval was obtained. RESULT(S): Patients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (established gallstones cumulative mean NT, 1.73 +/- 0.2 vs controls, 12.74 +/- 0.4 days vs, p = 0.001, t test and IP patients mean NT, 3.1 +/- 0.24 days vs controls, 12.74 +/- 0.4 days, p = 0.001, t test). However, NT in those with IP was significantly longer compared with those with established gallstones (mean NT in IP, 3.1 +/- 0.24 SEM days, vs cumulative mean in patients with established symptomatic gallstones, 1.73 +/- 0.2 days, p = 0.002, t test). CONCLUSION(S): NT in bile in patients with IP is abnormal and is intermediate in NT of lithogenic and non-lithogenic bile.Item Hardware interface for haptic feedback in laparoscopic surgery simulators(Institute of Electronics and Electrical Engineers(IEEE), 2014) Kannangara, S.M.; Ranasinghe, S.C.; Kumarage, S.K.; Nanayakkara, N.D.Minimally Invasive Surgeries (MIS) such as laparoscopic procedures are increasingly preferred over conventional surgeries due to many different advantages. Laparoscopic surgical procedures are very complex compared to open surgeries and require high level of experience and expertise. Hybrid surgery simulators available for training using physical phantoms are expensive and not readily available in majority of health care facilities around the world. Therefore, computer simulation or Virtual Reality (VR) is a better way to obtain skills for MIS. A VR simulator incorporated with haptic feedback provides a comprehensive training closer to real world experience. In this paper, we present a novel approach to incorporate force feedback to VR laparoscopic surgery training. The proposed interface incorporates force feedback in all three axes to provide three levels of force feedback. Computational models of abdomen organs were generated using the cryosection data of Visible Human Project of the National Library of Medicine, USA. The organ models were developed with three basic force categories: soft, mild and hard. A hardware interface is developed to provide the force feedback for the interaction of virtual tools with the said organ models while generating the tool navigation information for the VR simulator. © 2014 IEEE.Item Pre-operative hypoalbunaemia is associated with poor overall survival in rectal cancer.(The College of Surgeons of Sri Lanka, 2012) Chandrasinghe, P.C.; Ediriweera, E.P.D.S.; Kumarage, S.K.; Deen, K.I.INTRODUCTION: Serum albumin is a marker of nutrition and inflammation. It has recently emerged as a predictor of outcome after surgery for rectal cancer. Our aim was to evaluate if pre-operative serum albumin would predict survival after resection for rectal cancer. METHOD: 226 Patients with rectal cancer of all stages undergoing resection with curative intent were studied. Kaplan-Meier curves analysed survival based on a pre-operative albumin level of <35g/L vs. >35g/L. We sought for significant associations of survival with age, sex, stage, tumour site, use of neoadjuvant chemoradiation, microscopic positive resection margins (R1 ), differentiation, angio, peri-neural, and lymphovascular invasion using individual variable analysis. Multifactorial analysis was performed using type III analysis with Weibull hazard model and Cox-proportional hazard model. Significance was assigned to a P value <0.05. RESULTS: Of 226 patients (median age- 59 years; range 19 - 88, Male - 54%), forty five (20%) had an albumin level < 35g/L and was associated with a poor overall survival (P=0.01). Mean survival in months for <35g/ s. >35g/L was 64.7 (SE - 9.3) vs. 95.8 (SE - 7.0). Individual variable anaysis revealed age, circumferential margin, stage,, perineural, lymphovascular and angio invasion to be also significant. With multifactorial analysis hypo-albunaemia (HR= 0.58, P=0.03), advanced stage (HR= 2.0, P < 0.01 ) and R1 circumferential margin (HR= 2.2, P < 0.01) remained significant. CONCLUSION: Preoperative hypoalbunaemia is an independent risk factor for poor overall survival in rectal cancer. Advanced tumour stage and R1 circumferential margin were the other associations with poor survival.Item Local infiltration versus laparoscopic-guided transverse abdominis plane block in laparoscopic cholecystectomy: double-blinded randomized control trial(Springer, 2019) Siriwardana, R.C.; Kumarage, S.K.; Gunetilleke, M.B.; Thilakarathne, S.B.; Wijesinghe, J.S.BACKGROUND: Transverse abdominal plane block (TAP) is a new technique of regional block described to reduce postoperative pain in laparoscopic cholecystectomy (LC). Recent reports describe an easy technique to deliver local anesthetic agent under laparoscopic guidance. METHODS: This randomized control trial was designed to compare the effectiveness of additional laparoscopic-guided TAP block against the standard full thickness port site infiltration. 45 patients were randomized in to each arm after excluding emergency LC, conversions, ones with coagulopathy, pregnancy and allergy to local anesthetics. All cases were four ports LC. Interventions-Both groups received standard port site infiltration with 3-5 ml of 0.25% bupivacaine. The test group received additional laparoscopic-guided TAP block with 20 ml of 0.25% bupivacaine subcostally, between the anterior axillary and mid clavicular lines. As outcome measures the pain score, opioid requirement, episodes of nausea and vomiting and time to mobilize was measured at 6 hourly intervals. RESULTS: The two groups were comparable in the age, gender, body mass index, indication for cholecystectomy difficulty index and surgery duration. The pain score at 6 h (P = 0.043) and opioid requirement at 6 h (P = 0.026) was higher in the TAP group. These were similar in subsequent assessments. Other secondary outcomes were similar in the two groups. CONCLUSION: Laparoscopic-guided transverses abdominis plane block using plain bupivacaine does not give an additional pain relief or other favorable outcomes. It can worsen the pain scores.Item Idiopathic pancreatitis: is it a consequence of an altering spectrum of bile nucleation time?(BMJ Publishing, 2009) Abeysuriya, V.; Deen, K.I.; Navarathne, N.M.M; Kumarage, S.K.INTRODUCTION: The pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of the microcrystallisation of hepatic bile. AIMS AND METHODS: A prospective case–control study compared 55 patients (symptomatic cholelithiasis, 30: 14 men, 16 women, median age 36 years, body mass index (BMI) 25.1 ¡ 0.33 kg/m2 ; gallstone pancreatitis, nine: six women, three men, median age 35 years, BMI 24.86 ¡ 0.23 kg/m2 ; and idiopathic pancreatitis, 16: seven women, nine men, median age 34 years, BMI 23.34 ¡ 0.2 kg/m2 ) with 30 controls (15 men, 15 women, median age 38 years, BMI 24.5 ¡ 0.23 kg/m2 , undergoing laparotomy and who had normal gallbladder and no demonstrable stones on ultrasonography). Ultrafiltered bile from the common hepatic duct in patients and controls was anaerobically incubated and examined by polarised light microscopy, for nucleation time (NT). Ethical approval was obtained. RESULTS: Patients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (established gallstones cumulative mean NT, 1.73 ¡ 0.2 vs controls, 12.74 ¡ 0.4 days vs, p = 0.001, t test and IP patients mean NT, 3.1 ¡ 0.24 days vs controls, 12.74 ¡ 0.4 days, p = 0.001, t test). However, NT in those with IP was significantly longer compared with those with established gallstones (mean NT in IP, 3.1 ¡ 0.24 SEM days, vs cumulative mean in patients with established symptomatic gallstones, 1.73 ¡ 0.2 days, p = 0.002, t test). CONCLUSION: NT in bile in patients with IP is abnormal and is intermediate in NT of lithogenic and non-lithogenic bile.Item Risk factors for post operative complications, prolong ICU and hospital stay in patients with colorectal surgery(Sri lanka Medical Association, 2015) Gunetilleke, M.B.; Jayatunge, D.S.P.; Munasinghe, A.H.E.; Jayarathne, K.D.V.S.; Liyanage, C.A.H.; Siriwardana, H.D.R.C.; Kumarage, S.K.; Deen, K.I.INTRODUCTION AND OBJECTIVES: Identifying predictors for development of post-operative complications and prolong hospital stay will improve outcome of colorectal surgery. METHOD: Colorectal surgeries from May 2012 -February 2015 at NCTH were assessed for post¬operative complications, prolong ICU and hospital stay RESULTS: Out of 101 patients [43.6 % males, median age 52, 54.3% ASA class ll/lll ] 19 patients suffered complications (11 Sepsis, 10 respiratory complications and 4 ACS). Prolong hospital in 33 and prolong ICU stay in 14 were noted. On univariate analysis higher intra-operative fluid usage (IOFU), usage of blood products (UBP), increase blood loss and reduce usage of epidurals (RUE) predicted respiratory complications. Females, higher IOFU for sepsis and higher IOFU, UBP for ACS were predictors. Higher IOFU , higher ASA class, females, longer duration of anaesthesia ( LDOA ) for prolong ICU stay and UBP , LDOA , higher IOFU for prolong hospital stay were predictors. In multivariate model a higher IOFU, RUE for cardiorespiratory complications and low albumin & haemoglobin, female gender for sepsis were independent predictors. For prolonged ICU/ hospital stay higher IOFU (> 20 ml/kg), LDOA (> 240 min), higher ASA class were independent predictors. Patient without intra-operative vasopressors had a higher IOFU and no significance in development of complications. CONCLUSION: Patients without intra-operative vasopressor had higher IOFU. IOFU >20ml/kg is a major contributor for post-operative cardio¬respiratory complications, prolong ICU and hospital stay.Item Morphological characteristics of appendix vermiformis in human: a pilot study to establish regional norms with special interest on its position(Sri Lanka Medical Association, 2007) Salgado, L.S.S.; Abeysuriya, V.; Kumarage, S.K.; Rupasinghe, D.K.INTRODUCTION: Regional variations of morphology of the appendix vermiformis have been observed, especially with reference to its position, but due to the scarcity of scientific studies on its regional anatomy, achieving norms for its morphology is difficult. OBJECTIVE: To describe morphological characteristics of human cadaveric appendices. Design, setting and methods: A descriptive, prospective, cross sectional study was carried out among 30 patients who underwent laparoscopic appendicectomy in Colombo North Teaching Hospital, and 60 dissected cadavers in Departments of Anatomy in the Medical Faculties of Ragama and Sri Jayewardenepura. Results: The mean length of appendix was 65mm, ranging from 35mm to 110mm. 96.6% (58/60) of appendices were attached to the postero-medial surface and 3.4%(2/60) to the apex of the cecum. In all cadavers, the shape of the cecum was found to be ampullary. The mean outer diameter of appendices were 5.2mm, ranging from 3mm to 10mm. 41.6% (22/90) were retrocecal, 6.6% (6/90) pelvic (subcecal and promonteric 3.3% each), and 51.6% (46/90) were ileal (consisting 30% (27/90) post ileal and 21.6% (19/90) pre-ileal). 96.6% (58/60) of appendices were supplied by the inferior division of ileo-cecal artery, and 1.6% (1/60) by the posterior cecal artery. The mean distance between the opening of the appendix to cecum and to the opening of ileo cecal opening was 2i.2mm (range 13mm to 24mm). The mean length of the appendicular artery was 35mm (range 25mm to 40mm). CONCLUSION: Regional variations of morphological characteristics of appendix are numerous, especially with regard to its position. Therefore to establish norms for a population, further extensive studies are needed.Item Uses of a familial adenomatous polyposis registry(Sri Lanka Medical Association, 2011) Dalpatadu, K.U.A.; Anwar, N.; Wijesuriya, S.R.E.; Kumarage, S.K.; Amarasinghe, B.; Deen, K.I.OBJECTIVES :To improve the prognosis of patients with familial adenomatous polyposis (FAP) by early diagnosis and prophylactic treatment through a coordinated FAP register. DESIGN: The establishment and descriptive analysis of the prospective database of the FAP registry. SETTING: University surgical unit, Colombo North Teaching Hospital Ragama, Sri Lanka. PATIENTS : Probands were identified by tracing all diagnosed FAP patients from 1996 to 2010 and their family members at risk. INTERVENTIONS :The establishment of a polyposis register included the following stages: ascertainment of probands (first contact symptomatic FAP patients), construction of pedigrees, counselling relatives and prophylactic screening of family members at risk, treatment and follow up. RESULTS : Twenty seven enrolled probands (12 male and 15 female, age 11-52 years, median age 34 years) were investigated. Pedigree analyses showed 206 relatives at risk. Twenty four family members at risk were screened of a total of 51 registered individuals. The rate of spontaneous mutations was 41%. Thirty five were diagnosed with FAP. Eight were screen detected (median age – 32 years) and 27 symptomatic (median age – 34 years). Concomitant colorectal cancer was detected in 17 (63%) symptomatic individuals and in 1 (13%) screen detected individual. Colectomy was performed in 27 (77%) patients while 8 (23%) are on chemoprophylaxis. Congenital hypertrophic retinal pigment epithelium was detected in 15. Desmoids tumours (6%) and other extraintestinal manifestations including osteomas, sebacious cysts and dental abnormalities (34%) were also detected. A thyroid gland malignancy was screen detected while retinoblastoma, hepatoblastoma and cerebral tumours were seen in pedigrees. CONCLUSIONS :A polyposis register may improve prognosis of FAP by early detection. It will help coordinate, optimise and streamline clinical management of patients with FAP and their relatives at risk.Item Synchronous liver metastasis in colorectal cancer in Sri Lanka(Springer India, 2010) Siriwardana, R.C.; Wijesuriya, S.R.E.; Kumarage, S.K.; Deen, K.I.OBJECTIVE: To assess the incidence of synchronous colorectal liver metastasis in patients referred to a tertiary referral center in Sri Lanka and to evaluate the differences in the clinicopathological features of patients with and without synchronous metastasis. METHODS: Records of 438 patients were retrospectively analyzed. Patients were classified into metastatic group (n = 34, 8%) and non metastastatic group (n = 404, 92%). In the two groups macroscopic features compared were: tumor size (2 cm, 2-5 cm, and >5 cm), site of primary tumor and side of liver involved. Carcinoembryonic antigen (CEA) levels were recorded. At microscopy, tumor differentiation, invasion and nodal status were evaluated. RESULTS: The rectum was the primary site of the tumor in a majority (60%) of patients. There was no difference in the distribution of the primary site and size of the tumor, pathological stage, lymphatic infiltration and the degree of tumor differentiation in two groups (p > 0.05). Patients with metastasis had higher levels of CEA, higher frequency of vascular infiltration and N3 nodes involved (p < 0.05). CONCLUSION: The incidence of synchronous colorectal liver metastasis seems to be lower in our patients. Association of higher CEA level, advanced nodal stage and presence of vascular invasion needs to be further assessed with risk of developing metachronous liver metastasisItem The Prevalence of colorectal cancer and survival in patients from the Gampaha District, North Colombo region(Sri Lanka Medical Association, 2008) Perera, T.; Wijesuriya, S.R.E.; Suraweera, P.H.R.; Wijewardene, K.; Kumarage, S.K.; Ariyaratne, M.H.J.; Deen, K.I.INTRODUCTION: The prevalence and survival of colorectal cancer in Sri Lankans has not been previously reported. We did a retrospective and a prospective survey, in the region of North Colombo, Sri Lanka between 1992 and 2004. The aim was to study cancer burden, sites of colorectal cancer and survival after surgery. PATIENTS AND METHODS: The records of 175 patients with colorectal cancer between 1992 and 1997 in the selected region of were analysed retrospectively. A prospective study was performed in 220 new patients with colorectal cancer between 1996 and 2004. Data evaluated were demographics, tumour stage and survival. RESULTS: Between 1992 and 1997 the crude annual incidence of colorectal cancer was 1.9 per 100,000, which increased over the years. The current national crude annual incidence is 3.2 per 100,000 in women and 4.9 in men. Median age at presentation was 60 years with similar prevalence of cancer in men and women. In the entire group, 28% of cancers were in those less than 50 years old. Survival at 2 and 5 years was 69% and 52%. The majority of cancer related deaths were within the first 2 years after surgery. CONCLUSION: The burden of colorectal cancer in Sri Lanka is on the rise. Up to a third of cancers occur in those under 50 years, and the majority of cancers are in the rectum or rectosigmoid region. Flexible sigmoidoscopy offers a useful screening tool.