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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 The treatment of ulcerative colitis: from cure to a new disease(Ceylon Medical Association, 1994) de Silva, H.J.No abstract availableItem Coagulopathy and fibrinolysis following the bite of a hump-nosed viper (Hypnale hypnale)(Oxford University Press, 1996) Premawardena, A.P.; Seneviratne, S.L.; Jayanthi, S.; Gunatilake, S.B.; de Silva, H.J.No abstract availableItem Gastroenterology Update(Gastroenterological and Digestive Endoscopy Society Sri Lanka Colombo, Sri Lanka, 1993) Goonaratna, C.; de Silva, H.J.No abstract availableItem Side effects of drugs annual(Elsevier, 1999) de Silva, H.J.This chapter describes the adverse effects of gastrointestinal drugs. The adverse effects of cisapride include abdominal cramps, diarrhea, headache, dystonic reactions, convulsions, and hypersensitivity. Cisapride cardiotoxicity in association with erythromycin is described in the chapter. Cisapride should be used with caution in patients with severe cardiac disease or other risk factors for developing dysrhythmias, particularly hypokalemia and hypomagnesemia. It should not be given to patients with intestinal obstruction, perforation, or hemorrhage. In adults, metoclopramide has been reported to cause gynecomastia and galactorrhea due to hyperprolactinemia secondary to its dopamine antagonist action. Adverse effects attributable to antiemetic therapy include facial rash, constipation, headache, and weakness. The increased risk of acute liver injury with cimetidine is seen mainly in the first two months of use. In a study discussed in the chapter, gynecomastia and a lobular carcinoma of the breast were reported in a patient with chronic gastric ulcer. The hematological adverse effects of ranitidine include leukopenia, thrombocytopenia, aplastic anemia, hemolytic anemia, and pancytopenia.Item Hepatitis B virus markers in primary hepatocellular carcinoma(Faculty of Medicine, University of Peradeniya, Sri lanka, 1994) de Silva, H.J.; Ratnatunga, N.; Ramadasa, S.Based on serological studies, Sri Lanka has a relatively low Hepatitis B virus (HB V) [hepatitis B surface antigen (HBsAg)] carrier rate of 0.9% and a low prevalence of HBV (5-10%) among patients with primary hepatocellular carcinoma (PHC). To investigate this further we looked for HBV markers in PHC using more sensitive immunoliistochemical methods. Formalin fixed paraffin embedded tissue obtained from 18 PHCs were studied. Only 7 of the specimens contained non-tumour liver tis¬sue around the PHC, and evidence of cirrhosis was seen in 5 of them. Four micron thick sections of tissue were stained, with polyclonai antibod¬ies directed against HBsAg and hepatitis B core antigen (HBcAg) using a three stage immunoperoxidase technique (peroxidase-anti peroxidase). Positive control liver tissue was used in all experiments. HBsAg was detected in6(33.3%)of the 18 specimens (in the tumour tissue only in 3 speci¬mens, tumour tissue and surrounding cirrhotic liver tissue in 1. and surrounding cirrhotic liver tissue only and not in tumour tissue in 2 speci¬mens). The staining was cytoplasrnic. HBcAg was not detected in any of the tissue specimens tested. Nodatareg;irding serum alphafetoprotein levels were available from the patients medical records. From the preliminary results of this on going study, HBsAg markers appear to be more frequently associated with PHC than serological studies from Sri Lanka have indicated. HBV may, therefore, have arnore important aetiologi-cal role in PHC in this country than was previ¬ously believed.Item Effect of music on blood pressure in healthy young men(Faculty of Medicine, University of Peradeniya, Sri lanka, 1994) de Silva, A.P.; de Silva, H.J.; Fonseka, C.It is widely believed that listening (.0 music quietly is relaxing and therefore tends to reduce blood pressure (BP). To test this hypothesis we performed a cress-over study in 30 healthy Sinhalese male volunteers (non-smokers) aged between 23 and 25 years. None ol" them, were on any medication and all were requested not to consume coffee or a similar beverage for at least two hours prior to the test. Each individual rested silting for five minutes before the ex¬periment, and then listened to light classical music of his choice while sitting quietly for 30 minutes. BP was measured before and after listening to music. He was then allowed to engage in normal activities for one hour and the experiment was repeated, this time without music, where the person just sat quietly for 30 minutes in the same room. The systolic and diastolic BP differences were recorded for each person. Subjects were not allowed to fall asleep during the experiment and all experiments were performed between 1 and 4 pm to reduce the possible effect, if any, of diurnal variation in BP. There was no difference in diastolic BP either with or without music. Systolic BP dropped by a mean of 8 rnm (range 4-10) when listening to music and by a mean of 7 mm (range4-10) when sitting quietly without music (P>0.5, Mann-Witney U test). We conclude that listening to light music by itself does not reduce BP signifi¬cantly in normal individuals. Any reduction that occurs is probably a result of the subject sitting quietly while listening to the music.Item The Recto-Anal Inhibitory Reflex (RAIR): abnormal response in diabetics suggests an intrinsic neuro-enteropathy(BMJ Publishing, 1997) Deen, K.I.; Premaratna, R.; Fonseka, M.M.D.; de Silva, H.J.INTRODUCTION: The recto-anal inhibitory reflex (RAIR) is characterized by reflex relaxation of the anal canal in response to electrical stimulation of the rectal mucosa, and is mediated by nitrergic neural plexuses within the gut wall. Impairment of this reflex may lead to incontinence. AIM: To measure anal canal pressures, anal mucosal electrosensation and RAIR in diabetic patients and correlate these measurements with incontinence for gas or faeces. METHODS: Anal canal pressure, RAIR and continence was evaluated in 30 diabetic patients [Male:Female=13:17, median age 57 years (range 37- 70)], and these data were compared with similar data obatained from 22 age and sex matched 'healthy' controls [Male:Female= 9:13, median age 51 years (range 19 - 65 )]. Median duration of diabetes was 8 years (range 3 -30 ). 12 (40%) of the 30 diabetics had impaired continence for gas (n=12) and liquid faeces (n=3). None ofthe controls had incontinence. RESULTS: Maximum resting anal canal pressure (MRP) was [median (range)]: Patients 30mmHg (20-75) vs. Controls 40mmHg (20-105), P=0.61. Maximum squeeze pressure (MSP) [median (range)]: Patients 65mmHg (30- 150) vs. Controls 84mmHg (35-230), P=0.59. Threshold rectal mucosal eletrosensation (RMES-T) [median (range)]: Patients 27 mA (5-40) vs. Controls l3mA (5-28), P=0.03. Maximum tolerable rectal mucosal electrosensation [median (range)]: Patients 40 mA (20-60) vs. Controls 20 mA (10-30), P=0.042 (all comparisons using Wilcoxon rank test). RAIR was present in 8, abnormal in 5 (1 with incontinence), and absent in 17 (II with incontinence) diabetics while it was present in 18 and abnormal in 4 controls (test of proportion, P=0.03 I). CONCLUSIONS: RAIR was impaired in significantly more patients with diabetes than controls implying impairment of intrinsic neuronal function. All diabetic patients with incontinence had impaired or absent RAIR. Impairment of this reflex may be a useful predictor of incontinence in diabetics.Item The recto-anal inhibitory reflex (rair): abnormal response in diabetics suggests an intrinsic neuro-enteropathy(Sri Lanka Medical Association, 1997) Deen, K.I.; Premaratna, R.; Fonseka, M.M.D.; de Silva, H.J.INTRODUCTION: The recto-anal inhihilory reflex (RAIR) is characterized by reflex relaxation of die anal canal in response to electrical stimulation of the rectaJ mucosa, and is mediated by nitrergic neural plexuses within the wall. Im-painnent of this reflex may lead lo incontinence. AIM: To measure anal canal pressures, anal mueosal electrosensation and RAIR in diabetic patients and corre¬late these measurements with incontinence for gas or faeces. METHODS: Anal canal pressure, RAIR and continence was evaluated in 30 diabetic patients [Male : Female = 13:17, median age 57 years (range 37 - 70) ], and these data were compared with similar data obtained from 22 age and sex matched 'healthy' controls [Male:Female = 9:13,age51 years (range 19-65)]. Median duration of diabetes was 8 years(rangc 3-30). 12 (40%) of Uic 30 diabetes had impaired continence for gas (n = 12) and liquid faeces (n =3). None oi'the controls had incontinence. RESULTS : Maximum resting anal canal pressure (MRP) was [median (range)]: Patients 30 mml Ig (20 -75) vs. Controls 40mmHg (20-105). P=0.61. Maximum squeeze pressure (MSP) [median (range)] : Patients 65 mmllg (30-150) vs. Controls 84mmHg (35 -230), P = 0.59. Threshold rectal mueosal elec(rosensation (RMES-T) [median(range)]: Patients 27 mA (5-40) vs. Controls 13mA (5-28), P = 0.03. Maximum tolerable rectal mueosal electrosensation [median(rangc)]: Patients 40mA (20-60) vs. Controls 20mA (10-30), P=0.042 (all comparisons using Wiicoxon rank test). RAIR was present in 8, abnormal in 5 (1 with inconti¬nence), and absent in 17 (11 with incontinence) diabetics while it was present in 18 and abnormal in 4 controls (testof proportion, P = 0.031). CONCLUSIONS: RAIR was impaired in significantly more patients with diabetes than controls implying impairment of intrinsic neuronal function. All diabetic patients with incontinence had impaired or absent RAIR. Impairment of this reflex may be a useful predictor of incontinence in diabetics.Item Electrogastrography (EGG) and gastric motility: an investigation to evaluate gastric emptying in those who undergo oesophago -gastric anastomosis without a pyloroplasty(Sri Lanka Medical Association, 1998) Samarasekera, D.N.; Suraweera, P.H.R.; de Silva, H.J.; Dissanayake, A.S.INTRODUCTION: EGG is a non-invasive technique of recording gastric myoelectrical activity by placing electrodes on the abdomen. Objectives : The aim of this study was to assess the myoclcctrical activity of the stomach following ocsophago-gastric anastomosis without a pyloroplasty and also to correlate the values with those who develop symptoms of gastric stasis. DESIGN,SETTING AND METHODS : We present the initial results of an ongoing study. EGG results of six patients (M:F=5: 1) with carcinoma of the oesophagus who underwent transhiatal oesophagectomy were analysed. Mean age was 56y (range 45-76). EGG was performed preoperatively and three months after surgery using computerised digitrapher EGG (Syncctics, UK). One patient complained of symptoms of gastric stasis and reflux and did not respond to therapy with prokinetic agents. She underwent subsequent pyloroplasty and is asymptomatic at present. RESULTS : All patients showed normal preoperative myoelectrical activity (mean - + 131.17 mv) and motility. Postopcratively all patients showed bradygastria and low myoelectrical activity. Postoperative myoelectrical activity in the asymptomatic group showed a value which was positive (mean - +94.12mv) compared to the symptomatic patient who had a persistent mean negative value (- 89.34 mv). CONCLUSIONS : Persistent negative amplitude in the EGG postoperatively may indicate severe gastric stasis. This may be due to poor contractiliy of the denervatcd stomach in some patients. Therefore pyloroplasty should be considered before these patients develop complications of stasis and reflux.Item Electrogastrographic observations in healthy adults(Sri Lanka Medical Association, 1998) Ferdinandis, T.G.H.C.; Dissanayake, A.S.; de Silva, H.J.INTRODUCTION : Electrogastrography (EGG) is a recently developed non invasive technique of recording gastric myoelectrical activity. Normal values of EGG parameters are yet to be clearly defined. There are suggestions that the values may vary due to factors such as gender and ethnicity. AIM : To determine normal values for several EGG parameters in healthy Sri - Lankan volunteers in the fasting and fed state, and we also hypothesized that, there are significant differences in these between the two sexes. METHOD : EGG was performed in 17 healthy volunteers, 8 males(age 21 -60 yr.) and 9 females(age 24 - 46 yr.) in the follicular phase for one hour each in the fasting and the fed states. Result were analyzed using the statistical package Epilnfo. RESULTS : The mean gastric electrical frequency was 2.65 + 0.67 cpm in the fasting and 2.69 + 0.75 in the fed state. The dominant frequency was in the 2 -4 cpm range in 15 (88.2%) subjects in the fasting and in 14(87.5%) in the fed state respectively. These differences were not statistically significant. Feeding caused an increase in the power of the dominant frequency by 19 - 4600 uV2 in 12(75%) subjects. The above results did not differ significantly between the two sexes. CONCLUSIONS : The dominant gastric electrical frequency in Sri Lankans was consistent with previously reported data from other countries. Increase in EGG power after a solid meal was confirmed by the study. Although a gender difference in EGG parameters has been reported previously, our reports failed to demonstrate such a difference.