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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 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.