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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Usefulness of knowledge in anatomy of the internal iliac artery in its ligation during life-threatening pelvic haemorrhages(Sri Lanka College of Obstetricians & Gynaecologists, 2023) Dodampahala, S.H.; Chandrasena, L.; Abeysuriya, V.INTRODUCTION: Post-Partum haemorrhage is a significant cause of maternal mortality. Bilateral internal iliac artery ligation is a life-saving procedure to control massive obstetric and gynaecological haemorrhages. Bilateral internal iliac artery ligation results in toning down the pulsatility making the arterial flow a slow venous flow encouraging the clot formation of the damaged pelvic vessels. This study assesses the retroperitoneal anatomy and regional variations of the internal iliac artery. METHODS: The study was based on examining 45 pelvic halves (23 right sides and 22 left sides), which were dissected during the gross anatomy laboratory at the faculty of medicine, Ragama, University of Kelaniya, from 2020 -2023. There were all adult pelvises. The internal iliac artery and its major branches were carefully dissected and examined. Adachi classification was used to classify the distribution pattern of the internal iliac artery. The study was done on the donated cadavers, and the nature of the study did not warrant any special ethical clearance. No conflict of interest. RESULTS: No anatomical deviation has been noted with regard to the levels of division of aorta, common iliac artery, the division into internal and external iliac arteries and the division of anterior and posterior branches of the internal iliac artery from that of classical anatomical literature. It was also noted that there had been no significant deviation of anatomical relations with regard to the structures as described in the internal lilac artery in our study. In our study, Type Ia was found in 35/45 (78%) of the specimens, Type IIa in 3/45 (6%), Type III in 7 (16%), and no specimens were found with Type IV and. Type V. CONCLUSION: Our study showed no significant anomalies of the pelvic anatomical structural relations to the internal iliac artery. The type Ia branching pattern was found to be the commonest.Item Anatomical landmarks for ankle block(BioMed Central, 2023) Nimana, K.V.H.; Senevirathne, A.M.D.S.R.U.; Pirannavan, R.; Fernando, M.P.S.; Liyanage, U.A.; Salvin, K.A.; Malalasekera, A.P.; Mathangasinghe, Y.; Anthony, D.J.We aimed to describe anatomical landmarks to accurately locate the five nerves that are infiltrated to accomplish anaesthesia of the foot in an ankle block. Twenty-four formaldehyde-fixed cadaveric ankles were studied. Photographs of cross sections of the frozen legs, cut at a horizontal plane across the most prominent points of the medial and lateral malleoli, were analysed. The curvilinear distance from the most prominent point of the closest malleolus to each of the five cutaneous nerves and their depth from the skin surface were measured. Sural, tibial, deep peroneal, saphenous and medial dorsal cutaneous nerves were located 5.2 ± 1.3, 9.2 ± 2.4, 7.4 ± 1.9, 2.8 ± 1.1, 2.1 ± 0.6 mm deep to the skin surface. The curvilinear distances from the medial malleolus to the tibial, deep peroneal and saphenous nerves were 32.5 ± 8.9, 62.8 ± 11.1 and 24.4 ± 7.9 mm, respectively. The curvilinear distances from the lateral malleolus to the sural and medial dorsal cutaneous branches of superficial peroneal nerves were 27.9 ± 6.3 and 52.7 ± 7.3 mm, respectively. The deep peroneal nerve was found between the tendons of the extensor hallucis longus and the extensor digitorum longus in the majority of specimens, while the medial dorsal cutaneous nerve was almost exclusively found on the extensor digitorum longus tendon. The sural and tibial nerves were located around halfway between the most prominent point of the relevant malleolus and the posterior border of the Achilles tendon. In conclusion, this study describes easily identifiable, palpable bony and soft tissue landmarks that could be used to locate the nerves around the ankle.Item Teaching Anatomy in a unique setting: innovative methods to overcome challenges(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Weerasundera, B.BACKGROUND: Teaching of Anatomy at the Northern Territory Medical Programme (NTMP) of Flinders University, Australia is by retaining traditional methods as well as modern techniques using the latest technology to overcome the disadvantages of distant learning. It occurs in the first two years of the medical curriculum. It is provided by lectures via video conferencing from Flinders University in Adelaide and practicals, dissections and other teaching sessions conducted in Darwin. Incorporating such remote as well as on-site teaching presents numerous challenges, requiring constant review and modification to ensure quality of training. In the dissection component, students are expected to dissect a cadaver during their first two years of learning. After evaluating student feedback, changes were introduced to the teaching methods used in this process over three years. OBJECTIVES: This study aims to assess the effectiveness of, changes introduced to the teaching methods in Anatomy in the Northern Territory Medical Programme (NTMP) of Flinders University, Australia METHODS: Changes were made in consultation with the Body Donation Programme of University of Adelaide, Audio Visual Unit of the NTMP and the curriculum committee of the University of Flinders. They included the incorporation of novel teaching methods and introducing changes to the timing of the dissection programme. Performances in Anatomy of the three batches of students at examinations and their feedback were analysed to determine the effect of these changes RESULTS: It revealed improved performances and a higher level of student satisfaction. CONCLUSIONS: Feedback from students and their performance at examinations suggest that the changes had an overall positive impact. Constant monitoring and review of teaching methods is of significant value.Item Anatomy of the gall bladder in Sri Lankan population : a warning to the laparoscopic surgeon.(Sri Lanka Medical Association, 1998) Samarasekera, D.N.; Welgama, U.INTRODUCTION : Minimally invasive surgery has advanced rapidly to involve resection of almost all abdominal organs. Out of all these procedures, laparoscopic cholccystectomy has become the operation of choice for the removel of gall bladder and has stood the test of time. AIM : Since we started laparoscopic cholecystectomy procedure in our unit, this study was designed to document the possible variations that we may encounter in the Sri Lankan population. MATERIAL AND METHODS : Seventy five fresh non selected adult cadavers (within 24 hours of death) were dissected, Exclusion criteria were those with crush injuries to the liver and previous hcpato-biliary surgery. Findings were documented according to a standard proforma. FINDINGS : Normal anatomy was seen in 22 ( 29.3%) bodies. Documented abnormalities given in the text books were seen in 45 (60% ). Eight (10.6%) new abnormalities were detected in our study GB - 0, cystic duct - 5, cystic artery - 7). CONCLUSIONS : Altogether nearly seventy percent of the cadavers showed developmental anomalies. Therefore a thorough knowledge of all these anomalies is essential for the surgeon performing laparoscopic cholecystectomy to avoid iatrogenic injury.