Browsing by Author "Ganewatte, E."

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A case of pulmonary endometriosis treated by bronchial angiographic embolization
(Sri Lanka College of Obstetricians & Gynaecologists, 2018) Casather, D.M.; Herath, R.P.; Sanjeewa, J.M.P.; Sandaruwan, N.K.T.S.; Ganewatte, E.
INTRODUCTION: Although usually confined to the pelvis, endometriosis can be found in extra-pelvic organs and tissues as well. One of the rare forms of extra-pelvic endometriosis is thoracic endometriosis (TE). It is characterized by presence of functional endometrial tissues within the pleura, in the lung parenchyma or the airway. We present a case of TE managed with bronchial angiographic embolization (BAE). CASE REPORT: A 32-year-old woman with two children presented with repetitive catamenial haemoptysis for 8 months’ duration Haemoptysis usually started on the first day or the second day of each menstruation and it continued for 5 to 6 days and it was identical with the menstrual interval. She had one vaginal delivery and one caesarean section 10 years ago and 6 years ago respectively. Two years ago, she had diagnostic laparoscopy for chronic pelvic pain and which revealed pelvic endometriosis. Her medical history was otherwise unremarkable. Physical examination of the respiratory system was normal. Chest X-ray had symmetrical thorax and plain lung markings without abnormal findings. A chest computed tomography taken during the menstruation revealed a focal consolidation with adjacent ground glass opacification in the basal segment of the right lower lobe. Since, haemoptysis spontaneously resolved with the menstruation we assumed this catamenial haemoptysis due to pulmonary endometriosis and planed for BAE. During the procedure ultrasound guided diagnostic descending aortogram was performed using a catheter placing in the proximal descending thoracic aorta. Angiogram revealed a hyperaemic area in the lower lobe of the right lung, supplied by the hypertrophied lower lobe branch of right intercosto-bronchial artery. Super selective cauterization and embolization of the feeding right bronchial artery was done with PVA particles. Post embolization angiogram revealed satisfactory occlusion of the arterial supply to the hyperaemic area. Post procedure course was uneventful and there were no recurrences of catamenial haemoptysis following the procedure. CONCLUSION: There is no guidance for the treatment of TE. Hormonal therapy can be considered to suppress the endometrial tissues. Considering the surgical options to treat TE, video assisted thoracic surgery was reported and which was found to be safer and less invasive than lobectomy. In general BAE is an alternative to surgery in the management haemoptysis caused by Tuberculosis and chest trauma. Even though, BAE has not been frequently used to treat TE we reported case of TE successfully treated with BAE. This suggests that BAE is an alternative treatment option for symptomatic TE.
Challenges faced in establishing a pediatric liver transplant program in a lower‐middle‐income country with free healthcare service
(Wiley, 2024) Fernando, M.; Tillakaratne, S.; Gunetilleke, B.; Liyanage, C.; Appuhamy, C.; Weerasuriya, A.; Uragoda, B.; Welikala, N.; Ranaweera, L.; Ganewatte, E.; Dissanayake, J.; Mudalige, A.; Siriwardana, R.
ABSTRACT: BACKGROUND: Liver transplant is the cure for children with liver failure. Sri Lanka is a lower-middle-income country with a predominant free, state health system. Pediatric liver transplant program in Sri Lanka is still in the budding state where the initial experience of the program is yet to be documented. METHODS: A retrospective review was performed including the clinical characteristics of all pediatric liver transplant recipients of Colombo North Centre for Liver Diseases since the inception of the program from June 2020 to May 2023. RESULTS: There were 14 PLT performed in 3 years. The median recipient age and weight were 8 years (6 months–15 years) and 23.3 kg (6.4–49.2), respectively. The majority were boys (64%). All were from low-income backgrounds. Indications for LT were acute liver failure (5/14), decompensated chronic liver disease (5/14), and acute on chronic liver failure (4/14). Underlying liver diseases were Wilson disease (6/14), autoimmune liver disease (3/14), biliary atresia (2/14) and progressive familial intrahepatic cholestasis type 3 (1/14), and unknown etiology (2/14). The majority were living donor liver transplants (86%). Of the living donors, 42% (5/12) were Buddhist priests. There were three immediate deaths and two late deaths. The 3-month survival was 78%, and overall survival was 64%. Living donor transplants carried a higher success rate (92%) compared to diseased donor transplants (0%; 2/2). CONCLUSIONS: Initial experience of pediatric liver transplant program of Sri Lanka is promising despite being established in a free healthcare system amidst the crisis circumstances.
Focal seizures as first presentation of Pepper syndrome in a six-week-old girl
(Sri Lanka College of Paediatricians, 2022) Sandakelum, U.; Balasubramaniam, R.; Fernando, M.; Gunasekera, S.; Ganewatte, E.; Fernando, S.; Dissanayake, D.
No abstract available
Image guided naso-jejunal tube placement in paediatric liver transplant patients in low resource settings: Feasibility, technique, and outcome
(Sri Lanka College of Paediatricians, 2024) Appuhamy, W.N.D.P.C.; Fernando, M.; Tillakaratne, S.B.; Gunathilake, M.B.; Ganewatte, E.; Gishanthan, S.; Jayakody, R.D.C.G.; Siriwardana, R.C.
No abstract available
Imaging in pediatric disorders of the gut-brain interactions: current best practice and future directions
(Taylor and Francis Group, 2023) Rajindrajith, S.; Hathagoda, W.; Ganewatte, E.; Devanarayana, N.M.; Thapar, N.; Benninga, M.
INTRODUCTION: Disorders of Gut-Brain Interactions (DGBI) are a common clinical problem in children and pose significant challenges to the attending pediatrician. Radiological investigations are commonly ordered to evaluate these children. AREA COVERED: This review focuses on the current best practice of using radiological investigations in DGBIs and how novel radiological investigations could revolutionize the assessment and therapeutic approach of DGBI in children. EXPERT OPINION: We believe imaging in DGBI is still in its early stages, but it has the potential to revolutionize how we diagnose and treat children with DGBI. As the understanding of the gut-brain axis continues to grow, we can expect to see the disappearance of conventional imaging techniques and the emergence of more sophisticated imaging techniques with less radiation exposure in the future which provide more clinically meaningful information regarding the gut-brain axis and its influence on intestinal function. Some of the novel imaging modalities will be able to broaden our horizon of understanding DGBI in children providing more useful therapeutic options to minimize their suffering.
Immediate outcome of microwave ablation for liver tumours in a single cohort of patients in Sri Lanka.
(The College of Surgeons of Sri Lanka, 2022) Appuhamy, C.; Ganewatte, E.; Ranaweera, L.; Dassanayake, A.S.; Gunetilleke, M.B.; Tillakaratne, S.; Gunawardena,H.P.; Niriella,M.A.; Siriwardana,R.C.
Introduction and Objectives Microwave ablation (MWA) is an emerging treatment modality for hepatocellular carcinoma (HCC) and other liver tumours. We aimed to assess the immediate success and complications of MWA in a cohort of patients. Method Patients were assessed retrospectively, using an intervieweradministered questionnaire and a follow-up CECT/MRI at, 6-week.Result 55 patients underwent MWA from October 2021-May 2022, at Colombo-North Teaching Hospital, Ragama, Sri Lanka, and selected private hospitals( Durdans Hospital, Colombo, Nawaloka Hospital, Colombo, Lanka Hospital, Colombo).The median age was 64 (40-82) years, with a male preponderance (n=45, 81.1%). The indication was HCC in 54 (98.1%) and metastatic tumour in one (1.8%). The median tumour size was 28 (10-80) mm. Segment VII was the commonest site to be involved (n=18, 34.6%). The majority (n=40, 72.7%) was a single lesion. No participant underwent the procedure twice. The mean post-procedural hospital stay was 12 hours (95%CI=11.4-12.5, SD=2.0).In the 6-week follow-up, 2 recurrences (3.6%) and single death (1.8%) with no relation to the procedure, were reported. Another 2 (3.6%) denied the follow-up. Complete ablation was reported in 46 patients (83.7%), comparable to the rates in literature (95-97%), with only 7 patients (12.7%) having residual tumours. No major complications were reported. 9 patients (16.4%) developed 'Post ablation syndrome', not as common as in literature (34%). They presented with abdominal pain (7.3%), vomiting (7.3%), and fever (3.6%).Conclusion MWA is a successful and safe treatment option for primary liver tumours in Sri Lanka, with ablation rates comparable to the western world.