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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Young patients with colorectal cancer have poor survival in the first twenty months after operation and predictable survival in the medium and long-term: analysis of survival and prognostic markers(BioMed Central, 2010) Chan, K.K.; Dassanayake, B.; Deen, R.; Wickramarachchi, R.E.; Kumarage, S.K.; Samita, S.; Deen, K.I.OBJECTIVES: This study compares clinico-pathological features in young (<40 years) and older patients (>50 years) with colorectal cancer, survival in the young and the influence of pre-operative clinical and histological factors on survival. MATERIALS AND METHODS: A twelve-year prospective database of colorectal cancer was analysed. Fifty-three young patients were compared with forty-seven consecutive older patients over fifty years old. An analysis of survival was undertaken in young patients using Kaplan Meier graphs, non-parametric methods, Cox's Proportional Hazard Ratios and Weibull Hazard models. RESULTS: Young patients comprised 13.4 percent of 397 with colorectal cancer. Duration of symptoms and presentation in the young was similar to older patients (median, range; young patients; 6 months, 2 weeks to 2 years, older patients; 4 months, 4 weeks to 3 years, p > 0.05). In both groups, the majority presented without bowel obstruction (young--81%, older--94%). Cancer proximal to the splenic flexure was present more in young than in older patients. Synchronous cancers were found exclusively in the young. Mucinous tumours were seen in 16% of young and 4% of older patients (p < 0.05). Ninety-four percent of young cancer deaths were within 20 months of operation. At median follow up of 50 months in the young, overall survival was 70% and disease free survival 66%. American Joint Committee on Cancer (AJCC) stage 4 and use of pre-operative chemoradiation in rectal cancer was associated with poor survival in the young. CONCLUSION: If patients, who are less than 40 years old with colorectal cancer, survive twenty months after operation, the prognosis improves and their survival becomes predictable.Item Position and morphology of the appendix vermiformis in Sri Lankans(College of Surgeons of Sri Lanka, 2007) Salgado, L.S.S.; Abeysuriya, V.; Kumarage, S.K.; Rupasinghe, D.K.INTRODUCTION: The vermiform appendix varies in length and opens into the posteromedial wall of the caecum, 2cm below the ileo caecal valve. While the position of its base is constant in relation to the caecum, the appendix itself may lie in a variety of positions. OBJECTIVE: To describe the morphological characteristics of the appendix among Sri Lankans. METHOD: A prospective study was carried out among 30 patients who underwent laparoscopic appendicectomy in Colombo North Teaching Hospital and 60 dissected cadavers in the departments of Anatomy at Ragama and Sri Jayewardenepura. While the intra-abdominal position of the appendix was assessed in both laparoscopic appendicectomy patients and the dissected cadavers, the other morphological characteristics were assessed only in the cadavers. RESULTS: The mean length of the appendix was 65mm, (range 35 to 110mm). The base of the appendix opened into the posteromedial wall of the caecum in 96.6% (58/60) and into the apex of the caecum in 3.4% (2/60). The mean outer diameter of the appendix was 5.2mm (range3 to 10mm). The position of the appendix was found to be retrocaecal in 24.4% (27/90), pelvic in 6.6% (6/90), and ileal in 51.6% (46/90) comprising 30% (27/90) post-ileal and21.6%(19/90)pre-ileal. The blood supply of the appendix was the inferior division of the ileo caecal artery in 96.6% (58/60) and the posterior caecal artery in 1.6% (1/60). The mean distance between the base of the appendix and the ileocaecal valve was 21.2 mm, varying from 13 mm to 24mm. CONCLUSION: The frequency of the various positions of the appendix in our study population was different to the reported data. The ileal position of the appendix was the most common and the pelvic position the least common.