Browsing by Author "Fernando, E.D.P.S."

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Accessory muscle in the flexor compartment of the forearm: A case report
(Book of Abstracts, Annual Research Symposium 2019, 2014) Hasan, R.; Fernando, E.D.P.S.; Salvin, K.A.; Dilshani, W.M.S.; Niwunhella, N.A.D.P.; Perera, A.A.M.M.S.L.; Wijesundara, W.M.R.D.
A wide array of supernumerary and accessory musculature has been described in anatomical, surgical and radiological literature. Awareness of potential muscular variations is essential for anatomists, surgeons and clinicians in numerous areas of medical field.
Alcohol consumption and tobacco smoking in an urban adult Sri Lankan population
(Sri Lanka Medical Association, 2008) Kasturiratne, A.; Pinidiyapathirage, M.J.; Perera, H.K.K.; Fernando, E.D.P.S.; Ranasinha, C.D.; Edirisinghe, P.A.S.; Makaya, M.; Kato, N.
BACKGROUND: Data on the prevalence and patterns of alcohol consumption and smoking in the general population in Sri Lanka are scarce. Objective: To describe patterns of alcohol use and smoking in an urban adult population in Sri Lanka. DESIGN, SETTING AND METHODS: A random sample of the general population aged between 35-65 years, resident in the Ragama Medical Officer of Health area was interviewed to obtain drinking and smoking habits. RESULTS: Among 2985 subjects [males 45.5%; mean age 52.7 years (SD7.8)], 1156(39.7%) reported ever use of alcohol, and 892(29.7%) reported current use. 58.8% of males and 5.7% of females were current drinkers. 190(14%) males and 12(0.7%) females consumed alcohol above the weekly safe limit (>14 units for males, >7 units for females). The median duration of alcohol use among ever users was 18 years (interquartile range 10-25), and current users was 20 years (interquartile range 1,0-25). The commonest type of alcohol consumed was arrack (n=492), followed by beer (n=217). 60.2% of males and 2.1% of females reported ever smoking, 483(16.2%) were current smokers. 35.1% of males and 0.5% of females were current smokers. The median duration of smoking was 20 years among both ever smokers (interquartile range 10-27.3), and current smokers (interquartile range 15-30). Most (55.3%) smoked cigarettes, only 36(4.2%) smoked beedi. The median pack years of current smokers was 4,5 (interquartile range 2-10). CONCLUSION: Lifetime and current use of alcohol and smoking are high among males. Focused interventions are required to reduce current rates among males and to maintain low rates reported by females.
Anatomical variations of the common peroneal nerve (cpn) and the deep pereoneal nerve (dpn) in the lateral compartment of the leg: A cadaveric study
(College of Surgeons of Sri Lanka, 2015) Salgado, L.S.S.; Karunanayake, A.L.; Hasan, R.; Salvin, K.A.; Fernando, E.D.P.S.; Ranaweera, M.S.L.; Padeniya, A.G.P.M.; Senevirathne, S.P.; Ranaweera, K.R.K.L.K.
INTRODUCTION: The aim of this study is to demonstrate anatomy of CPN and DPN in the lateral compartment and identify high risk area/s which is important in high tibial osteotomy, in total knee arthroplasty, in external fixation of leg and CPN decompression surgery. MATERIAL AND METHODS: Thirty cadaveric legs (female-14, male-16) were dissected to demonstrate the bifurcation of the CPN and the exit point of the DPN from the lateral compartment. The ethical clearance was obtained. RESULTS: None of the specimens showed bifurcation of the CPN proximal to the apex of the fibular head. Musculoaponeurotic fibular arch at the entrance to the fibular tunnel was confirmed in all specimens. The mean distance from the apex of the fibular head to the opening of the fibular tunnel was 28.4mm (SEM±1.4mm). Of 30 specimens respectively 21(70%), 7(23.33%) and 2(6.66%) had bifurcation vertically distal to, on and proximal to the entry point with the average of 8.0mm and 12.0mm from the entry point. Eleven legs had muscular branches of the DPN in the lateral compartment of the leg. The mean exit point of the DPN/its longest muscular branch was observed 66.5mm (SEM±2.6mm) distal to the apex of the fibular head. CONCLUSIONS: Variations of the CPN bifurcation in relation to the fibular tunnel and muscular branches of the DPN in the lateral compartment were observed. From the apex of the fibular head, distance of 25.6mm-71.6mm was identified as the high risk area for surgeries involving in the upper part of the lateral compartment.
Anatomical variations of the musculocutaneous nerve - A cadaveric study
(College of Surgeons of Sri Lanka, 2015) Padeniya, A.G.P.M.; Salgado, L.S.S.; Hasan, R.; Fernando, E.D.P.S.; Ranaweera, R.M.S.L.; Abeysuriya, V.; Karunanayake, A.L.; Salvin, K.A.; Siriwardana, S.A.S.R.; Balasooriya, B.M.C.M.; Alahakoon, A.M.D.K.
INTRODUCTION: The musculocutaneous (MC) nerve commences from the lateral cord of the brachial plexus, passes inferolaterally and pierces the coracobrachialis while innervating it. It then descends between biceps and brachialis muscles, innervating both and continues as the lateral cutaneous nerve of the forearm. Few studies have been done with regard to variations in origin, course, branching pattern, termination and communications of the MC nerve. These variations are important for anatomists, clinicians, anesthetists and surgeons to avoid unexpected complication as these variations have clinical significance during the surgical procedures and in diagnostic clinical neurophysiology. Therefore the aim of this paper was to study the anatomical variations of the MC nerve. MATERIAL AND METHODS: This descriptive cross sectional study was carried out in the Department of Anatomy, Faculty of Medicine, University of Kelaniya. Dissections were carried out on 50 upper limbs of 25 cadavers to record anatomical variations of the MC nerve. RESULTS: MC nerve was present only in 46(92%) upper limbs. Of the 46 upper limbs where the MC was present, one (2%) did not pierce the coracobrachialis. Communications were seen between MC and median nerve in 06(13%) samples of which 1(17%) was proximal and 5(83%) were distal to the point of entry of the MC into the coracobrachialis and in 4(9%) upper limbs MC nerve rejoins with the median nerve. CONCLUSIONS: It is evident that significant anatomical variations of the MC nerve exist in our study. These variations emphasize the complexities and irregularities of this anatomical structure with regard to surgical approaches.
Anatomical variations of the superficial palmar arch in Sri Lankans – A cadaveric study
(Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Salgado, S.; Fernando, E.D.P.S.; Anuradha, W.K.; Nishantha, M.P.
Vasculature of the hand is one of the complex areas having a high degree of anatomical variations. It is very important to have an adequate knowledge of the arterial supply to the hand in this era of modern medical technology, as a significant number of surgical procedures such as radial arterial cannulation, radial forearm flap, and radial artery conduits in coronary artery grafting are carried out. Improvement of microsurgical techniques in reconstructive hand surgery also have made a necessity for better understanding of the vasculature of the hand. The superficial palmar arch provides the major blood supply to the hand along with the deep palmar arch and represents an important anastomosis between the ulnar and radial arteries. Objective: To study the variations of the superficial palmar arch in Sri Lankans compared to the classical description given in standard text books. Methodology: Eighteen hands from formalin preserved cadavers, both males and females of the ages between 30 to 80 years were dissected. Special attention was paid to trace the blood vessels supplying the thumb. Results: The superficial palmar arch is mainly formed by ulnar artery and some contribution from the radial artery. Two types of superficial palmar arches were described, as complete and incomplete. The classic superficial palmar arch was described as the direct continuity between the ulnar artery and the superficial palmar branch of radial artery which is considered as the sub group of complete type. In the incomplete type superficial palmar arch is formed only by the ulnar artery with some communications from the deeper palmar arch . According to the previous literature, complete type ranges from 80% to 90%. In our study 16 hands (89%) were with complete type and 02 (12%) were with incomplete type. However the anastomosis between radial and ulnar arteries were seen in all the specimens of our study. Classical palmar arch having a direct continuity between the ulnar artery and the superficial palmar branch of radial artery was found in 10 (55%) hands, in contrast to the 10% in the literature. Palmar type of median artery was noticed in 2 (12%) hands contributing to form the superficial palmar arch, in contrast to the 20% in literature. Although the sole blood supply to the thumb is by the princeps pollicis according to the standard text books, in our study it was found only in 6 (33%) specimens. The classical picture of the superficial palmar arch, with the princeps pollicis supplying the thumb was not seen in any of the specimens. Conclusion: Variations in the terminations of the radial and ulnar arteries are common. Since there are anastomoses between radial and ulnar arteries it may be safe to sacrifice any of the main arteries when performing surgical and medical interventions of the hand in the absence of vascular diseases.
Conducting viva voce examinations during preclinical years in the faculty of medicine, University of Kelaniya: Is it of relevance?
(Book of Abstracts, Annual Research Symposium 2018, 2014) Hasan, R.; Perera, A.A.M.M.S.L.; Wijesundara W M R D; Dilshani, W.M.S.; Niwunhella, N.A.D.P.; Salvin, K.A.; Fernando, E.D.P.S.
Viva voce (vivas) or oral examinations are an integral part of medical education. During a viva the examiner is given the opportunity to assess the candidate�s knowledge and ability to respond under pressure. For medical students vivas are an opportunity to develop verbal and presentation skills. Vivas were part of the preclinical examinations held in the Faculty of medicine Ragama prior to the introduction of the new curriculum. This research was carried out in order to identify the opinion of lecturers on reintroduction of vivas for preclinical examinations.
Consideration of the Blood Supply of the II eo-caecal Segment in Valve Preserving Right Hemicolectomy
(University of Kelaniya, 2007) Fernando, E.D.P.S.; Deen, K.I.
Introduction: The ilea-caecal valve (ICV) is known to control the flow of chyme and to prevent bacterial colonization of the small intestine. Preservation of this segment during right hemicolectomy is likely 'to prevent loss of its function. Methods: Fifty four fresh human cadavers (37 male, 17 female; median age- 54 years, range 18 to 90 years) were studied after obtaining written, informed consent from a relative. At postmortem, 20cm of terminal ileum with the ilea-caecal segment and up to 20cm of ascending colon were removed en-block with its mesentery and blood supply. The ileo-colic artery was cannulated and injected with 1 Oml of water soluble red dye under pressure. The arterial supply was dissected to demonstrate a pattern. Results: In all, the ICV was supplied by the ileo-colic artery, a branch of the superior mesenteric, which divided into an anterior and a posterior caecal branch. A marginal branch of the right colic was noted to contribute to ICV blood supply in only 2( 4%). Furthermore, study of the anastomosis at the ICV showed that the anterior caecal artery was present in all ( 1 00% ), posterior caecal in 48(89%) and recurrent ileal artery was present in 53(98%). A rich anastomosis between vessels at the ICV; small 'windows', short tributaries, was seen in 38(70%) whilst a poor anastomotic network at the ICV; large 'windows', long tributaries, between these vessels was seen in 12(22%). In 4(8%), we were unable to determine between rich and poor anastomotic networks clearly. Other variants included, was absent posterior caecal artery in 6(11 %) and absent recurrent ileal artery in 1(2%). 144
Consideration of the blood supply of the ileocecal segment in valve preserving right hemicolectomy
(Alan R. Liss, Inc, 2009) Fernando, E.D.P.S.; Deen, K.I.
The ileocecal valve (ICV) is known to control the flow of chyme and to prevent bacterial colonization of the small intestine. Preservation of this segment during right hemicolectomy is likely to prevent loss of its function. This study aimed at evaluating the arterial supply of the ICV to help preserve the valve during right hemicolectomy. Fifty-four fresh human cadavers (37 male, 17 female; median age: 54 years, range: 18-90 years) were studied after relatives gave written, informed consent. At postmortem, 20 cm of terminal ileum with the ileocecal segment and up to 20 cm of ascending colon were removed en bloc with its mesentery and blood supply. The ileocolic artery was cannulated and injected with 10 ml of water-soluble red dye under pressure. The arterial supply was dissected to demonstrate a pattern. In all, the ICV was supplied by the ileocolic artery, a branch of the superior mesenteric, which divided into an anterior and a posterior cecal artery. A marginal branch of the right colic was noted to contribute to ICV blood supply in only two (4%). Furthermore, study of the anastomosis at the ICV showed that the anterior cecal artery was present in all (100%), posterior cecal in 48 (89%), and recurrent ileal artery in 53 (98%). A rich anastomosis between vessels at the ICV; small "windows," short tributaries, were seen in 38 (70%), whereas a poor anastomotic network at the ICV; large "windows," long tributaries, between these vessels were seen in 12 (22%). In four (8%), we were unable to clearly determine between rich and poor anastomotic networks. Other variants included, absent posterior cecal artery in six (11%) and absent recurrent ileal artery in one (2%). The ICV has a predictable blood supply in the majority of patients. Preservation of the anterior cecal artery would ensure a vascularized ICV in right hemicolectomy.
A Descriptive study of knowledge, beliefs and practices regarding osteoporosis among female medical school entrants in Sri Lanka
(BioMed Central Ltd., 2014) de Silva, R.E.E.; Haniffa, M.R.; Gunathillaka, K.D.K.; Atukorala, I.; Fernando, E.D.P.S.; Perera, W.L.S.P.
BACKGROUND: Osteoporosis is a significant problem in rapidly ageing populations in Asian regions. It causes significant personal and societal impact and increases the burden on health care services. OBJECTIVES: Aim of this study is to determine the knowledge, beliefs and practices regarding osteoporosis amon young females entering medical schools in Sri Lanka. METHODS: This is a descriptive cross sectional study conducted amongst 186 female medical school entrants of th Faculties of Medicine, Universities of Colombo and Kelaniya from September to December 2010. A self administere questionnaire was used to assess knowledge, beliefs and practices on osteoporosis, including a food frequenc chart to assess the calcium intake. RESULTS: The mean age was 20.7 +/? 2.1 years. Majority of the participants (51.6%, n = 96) had an average scor (40? 60) on the knowledge test, while 40.8% (n = 76) had a poor score (<40). However, in depth knowledge o risk factors, and protective factors was lacking. Perceived susceptibility for osteoporosis was low with only 13.9 (n = 26) of women agreeing that their chances of getting osteoporosis are high. The mean calcium intake wa 528 mg/day and only 18.8% (n = 35) of the participants achieved the Recommended Daily Allowances (RDA) fo Calcium. Exercise was grossly inadequate in the majority and only 13.6%( n = 23) engaged in the recommende exercises. Only 3.8% (n =7) of the participants currently engaged in specific behaviours to improve bone healt while 10.8% (n = 20) had thought of routinely engaging in such behaviours. CONCLUSIONS: Although majority of participants had a modest level of knowledge on osteoporosis, there wer gaps in their knowledge in relation to risk factors, protective factors and on the insidious nature of osteoporosis Perceived susceptibility for osteoporosis was low. Practices towards preventing Osteoporosis were inadequate. © 2014 Ediriweera de Silva et al.
The ileocaecal valve-functional morphology blood supply and pressure characteristics in humans
(2010) Fernando, E.D.P.S.
The ileocaecal valve-functional morphology, blood supply and pressure charasteristics in humans
(University of Kelaniya, 2009) Fernando, E.D.P.S.
INTRODUCTION: The function of the ileocaecal valve still remains controversial, especially the importance of preservation of the valve during right hemicolectomy. This research was carried-out with an objective to study manometric characteristics combined with videography and the neuronal density to assess the capability of this structure to function as a sphincter. A detailed study of the arterial supply of the ileocaecal region was also done with a view of exploring the possibility of a modified right-hemicolectomy with a preserved ileocaecal valve with adequate arterial blood supply to the anastomosis. PATIENTS AND METHOD - The ganglion density of the ileocaecal region was studied in 73 cadavers within 12 hours of death using haematoxylin and eosin staining. The manometry of the ileocaecal region was studied using a water-filled balloon catheter in twenty-one individuals who underwent colonoscopy. Mean intra-luminal pressure (area under the curve/ duration) was also measured during this procedure. Further more, valve videography was performed in thirteen individuals. Fifty-four fresh human cadavers were studied with informed written consent from relatives. In this study, 20cm of terminal ileum with the ileocaecal segment and approximately 20cm of ascending colon were removed en-block with its mesentery and blood supply. The ileocolic artery was cannulated and injected with 10ml of water-soluble red-dye under pressure. The arterial supply was dissected to demonstrate a pattern. RESULTS: Study on density of the ganglia of myenteric plexus in the ileocaecal region Of 73 specimens studied, the ileocaecal valve had the highest number of ganglions found in one mm of area (mean 0.491 ganglions/mm ; SD 0.283). The terminal ileum had a mean of 0.322 ganglions/mm2; SD 0.209. The least number of ganglia was found in the caecal sections (mean 0.241 ganglions/mm ; SD 0.166). These findings showed a statistically significant (P<0.0001) higher number of ganglions per mm2 in the ileocaecal valve (ICV) than in the terminal ileum or caecum. Study of the pressure gradient across the ileocaecal valve in normal adults: In twenty individuals (95%), the intra-ileal pressure exceeded the intra-caecal pressure {ileal pressure [mean 4018.77, S.D. 4386.51] Pa vs. caecal pressure [mean 1742.64, S.D 4537.54] Pa}, P<0.001. Ante-grade pressure gradients were observed from terminal ileum to caecum in fifteen participants (71%). In five (24%), a high-pressure zone was observed within the ileocaecal valve. A reverse gradient was seen in one (5%). Study of the ileocaecal valve cusp movements in live normal adults using video ecordings during colonoscopy: Videography of the ileocaecal valve was analyzed in thirteen subjects for a total of 121 minutes (mean 9.3 minutes per subject). The valve orifice was observed to be at rest during alternating periods of contraction. Contractions of the valve cusps seemed to change the shape of its orifice. In 11 subjects, during the resting period of the valve, the orifice was semilunar and either closed or partially closed. These subjects had a longer and more curved superior cusp. The valve cusps were thickened in six subjects, while seven had narrow valve cusps. In all, 60 (mean — 5 per subject) active movements were observed in the ileocaecal valve cusps with 14 active caecal contractions. The frequency of active movements of the valve was 0.5 movements per minute. The ejection of effluent was observed on 49 occasions (mean - 4 ejections per XV subject). Chyme was ejected in 15 instances and air in 34 instances. The ejection of effluent was always associated with active movements of the valve cusps. By contrast, some cusp movements were observed to be independent of the onward flow of effluent. Caecal wall contractions were found to be less frequent and were observed on 14 occasions. Study of the arterial supply of the ileocaecal region: In fifty-six cadaveric specimens, the ICV was supplied by the ileocolic artery, a branch of the superior mesenteric, which divided into an anterior and a posterior caecal artery. A marginal branch of the right colic was noted to contribute to the ICV blood supply in only two (4%). Furthermore, study of the anastomosis at the ICV showed that the anterior caecal artery was present in all (100%), posterior caecal in 48(89%) and recurrent ileal artery present in fifty-three (98%). A rich anastomosis between vessels at the ICV: small 'windows', short tributaries, was seen in thirty-eight (70%) whilst a poor anastomotic network at the ICV: large 'windows', long tributaries, between these vessels was seen in twelve (22%). In four (8%), we were unable to determine clearly between rich and poor anastomotic networks. Other variants included an absent posterior caecal artery in six (11%) and absent recurrent ileal artery in one (2%). CONCLUSIONS: Manometry of the ileocaecal valve revealed a flap valve with an ante-grade pressure gradient in the majority. A reverse pressure gradient may explain valve incompetence. The ileocaecal valve had a predictable blood supply in the majority of patients. Preservation of the anterior caecal artery would ensure a vascularized ileocaecal valve in right hemicolectomy.
A rare variation of hepatic artery arising from the left gastric artery in a Sri Lankan cadaver
(Research Symposium 2010 - Faculty of Graduate Studies, University of Kelaniya, 2010) Mallawaarachchi, Ranjan; Wimalarathne, Saranga; Fernando, E.D.P.S.; Salgado, L.S.S.
Introduction Anatomical variations of the arterial supply of the liver are frequently found. The normal hepatic arterial anatomy as described in classic text books is only found in 52-80% of cases. Knowledge of the hepatic arterial anatomical variations are important for those surgeons who perform liver transplant and hepatobilliary operations, to prevent vascular damage while performing surgery. Objective To describe a rare variation of hepatic artery arising from the left gastric artery in a Sri Lankan cadaver. Methodology This variation was found when a dissection was performed on a 65 year old male cadaver with a weight of 73kg, for demonstration of the celiac trunk and its branches, at the anatomy dissection hall, Faculty of Medicine, Ragama. Results The hepatic artery was found to arise from the abnormally large left gastric artery of the celiac trunk and it was the only arterial supply of the liver. The splenic, left gastric and the gastro duodenal arteries were found to arise from the celiac trunk. Conclusion Knowledge of rare hepatic arterial variations is very important for hepatobiliary surgeons who perform frequent biliary tract operations and liver transplantations.