Browsing by Author "Pathirana, A."

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Anatomy of the pancreatic vasculature:respect of the duodenum preserving resection of head of pancreas
(College of Surgeons of Sri Lanka, 2008) Salgado, S. S.; Abeysuriya, V.; Pathirana, A.
INTRODUCTION: Duodenum preserving resection of the head of the pancreas is performed mostly in chronic pancreatitis. Knowledge of precise anatomy of the pancreaticoduodenal region especially of the pancreaticoduodenal arteries, which provide blood to the duodenum, is mandatory for safe surgery. MATERIALS AND METHODS: Twenty human cadavers (age 56-87 years) of both sexes (10 males: 10 females) were studied with relevance to the anatomy of the head of the pancreas and duodenum in relation of the regional vascular arcades.RESULTS: The gastroduodenal artery (GDA) originates 3.7cm (3.1cm 5.1cm) from celiac trunk from the common hepatic artery. The Emergence of anterior superior pancreaticoduodenal artery (ASPA) was at 3.4cm (2.9cm - 4.2cm) of the origin of the gastroduodenal artery. After departing from gastroduodenal artery ASPA runs downwards along the medial side of the 2nd part of the duodenum and turned to the posterior aspect of the pancreas to join the anterior inferior pancreaticoduodenal artery (AIPA). Arcade formation between the ASPA and AIPA was found in all cadavers. Posterior superior pancreaticoduodenal artery (PSPA) originates 2.1 cm (1.8cm-2.8cm) from the origin of the gastroduodenal artery. PSPA form an arterial arcade with the branches of the posterior inferior pancreaticoduodenal artery. Posterior vascular arcade always located posterior to the common bile duct. Anterior and posterior vascular arcades were 0.35cm (0.32 cm 0.43cm) and 0.24 cm (0,21 cm 0.34cm) medial to the medial border of the duodenum respectively. CONCLUSION: In duodenal preserving pancreatic surgery, the knowledge of this complex vascularization will help to preserve arterial arcades around head of the pancreas while performing pan create cto my.
An Audit on completeness of reporting Whipple's specimens
(College of Surgeons of Sri Lanka, 2020) Pelzom, T.; Tillakaratne, M.S.B.; Jaleel, M.S.A.; Pathirana, A.; Siriwardana, R.C.
INTRODUCTION: This Audit is focused on assessing the completeness of vital information in traditional reports of Whipple's procedure, using the Royal College of Pathologists data sets for pancreatic cancer reporting as the benchmark. We believe a standardized reporting system will take into account significant variables that may impact treatment quality. METHODOLOGY: This is a descriptive cross sectional study. A hundred and forty-three Whipple's histopathological reports were examined and compared to The Royal College of Pathologists data set for reporting of carcinomas of pancreas, ampulla of Vater and common bile duct. RESULTS: The length of the reports varied markedly with the shortest report having 156 words and the longest report having 1095 words. The median word count was 385 words. The frequency of reporting the variables varied too. Type of tumour was documented in 100% of reports whereas variables such as nodal stage and superior mesenteric artery resection margin were reported in only 76.9% and 35% of reports respectively, both having direct implications on prognosis. Further the frequency of reporting of the background pathology was low as 24.5%. CONCLUSIONS: Due to the descriptive nature of the traditional pathological reporting system, some of the significant variables can be missed while converting what is observed in to a report. This may impact adversely in planning adjuvant treatment and evaluation of prognosis after surgery. Adherence to a standardized synoptic reporting system may help to overcome this drawback. KEYWORDS: Whipple's, histopathology, synoptic reporting, pancreatic cancer, survival
A Case of embryonal sarcoma of the liver
(Sri Lanka Medical Association, 2010) Pathirana, A.; Siriwardana, R.C.; Deen, K.I.; Rupasinghe, Y.
No Abstract Available
Clinical and histopathological characteristics of cutaneous leishmaniasis in a group of military personnel in Sri Lanka
(American Society of Tropical Medicine and Hygiene, 2015) Manamperi, N.H.; Fernando, C.S.; Pathirana, A.; Abeyewickreme, W.; de Silva, V.C.; Karunaweera, N.D.
Cutaneous leishmaniasis (CL) is a newly established vector-borne parasitic disease in Sri Lanka. Military personnel have an occupational risk for CL due to being stationed in endemic areas and exposure to vectors outdoors. This study describes the clinical and histopathological features of CL in a group of military personnel. Thirty five patients with smear positive for Leishmania amastigotes were included, their data analyzed for clinical features and skin biopsies processed routinely for histology, examined at a conference microscope and classified into 4 groups using modified Ridley criteria for Leishmaniasis as: I-parasitized macrophages with variable lymphocytes and plasma cells; II-parasitized macrophages with lymphocytes, plasma cells and ill formed histiocytic granulomata; III-a mixture of macrophages (with or without parasites), lymphocytes, plasma cells and epithelioid granulomata; IV-epithelioid granulomatous response with a few lymphocytes and plasma cells but no amastigotes. Lesions were categorized by duration, as acute (< 6 months) or chronic (> 6 months). Study group composed of all males with a mean age of 32.6 years (range 22-47) and lesion duration of 5.6 months (range 1-24). Number of lesions varied from 1 to 6 with majority (71.4%, n= 25) having a single lesion. Nodular (37.1%, n=13) and nodulo-ulcerative (25.7%, n=9) lesions in upper limbs (68.6%, n=24) was the commonest presentation. Twenty nine (82.9%) of the biopsies were positive also by histology. Twenty two (62.9%) were acute and 13 (37.1%) chronic. Group I, II, III and IV patterns were seen in 14 (40%), 12 (34.3%), 5 (14.3%) and 4 (11.4%) respectively and 9 (40.9%), 9 (40.9%), 2 (9.1%) and 2 (9.1%) of acute lesions and 5 (38.5%), 3 (23.1%), 3 (23.1%) and 2 (15.4%) of chronic lesions respectively. Necrosis was not seen in any of the lesions. Majority in this group of military personnel with CL had single lesions affecting the upper limbs and sought treatment within 2 years of appearance of lesions. The histological picture varied from diffuse infiltration of parasitized macrophages admixed with chronic inflammatory cells to ill-formed histiocytic granulomata.
Effectiveness of teaching clinical skills in improving simple wound suturing among medical undergraduates
(The Kandy Society of Medicine, 2005) Abeysuriya, V.; de Silva, P.; Pathirana, A.
Hilar cholangiocarcinomas - from nihilism to aggressive treatment
(The College of Surgeons of Sri Lanka, 2012) Liyanage, C.; Nawaratne, M.; Pathirana, A.; Gunasekara, D.; Pranahewa, L.; Prasad, R.; Wijeratne, T.; Bogammana, M.; Wijesooriya, R.; Siriwardhana, R.
INTRODUCTION: Hllar-Cholangio-carcinomas (HCC) are aggressive tumours with a dismal prognosis. The general tendency amongst all specialities is to palliate them. As response to adjuvant therapy is marginal we have embarked on aggressive management of these patients with the available surgical and endoscopic expertise. METHODS: Patients presenting to the North Colombo Teaching hospital· and the Gastrointerology unit of the National hospital in 2011 were included . All had Tri phasic CT , MRCP or ERCP prior to be discussed at MDT with all the above authors regarding further management. Patients with Bismuth 1 v lesions and unfit for surgery underwent Combination ERCP/doublestenting/RFA of lesion/Rendezvous procedure/Percutaneous, stenting or PTC. RESULTS: 32 patients were treated .5/32 had radical surgical resections (2 extended right hepatectomy with bile duct resecton and lymphadenectomy (BDR+LA), 2 extended left hepatectomy +BDR+LA, and 1 extended heft hepatectomy with BDR+LA+Reconstruction of Right hepatic artery and right portal vein. I underwent segment iii bypass. 7 patients underwent ERCP and serial RFA with stenting. 3/5 patients are alive and disease free at 6-12 months. CONCLUSIONS: Where possible HCC patients should be offered a curative resection. RFA gives longer and better palliation compared to standard stenting. These patients should be managed by a specialized team as aggressive management may improve their survival.
Idiopathic pancreatitis is a consequence of an altering spectrum of bile nucleation time
(Biomed Central, 2011) Abeysuriya, V.; Deen, K.I.; Dassanayake, B.; Kumarage, S.; Navarathne, N.; Pathirana, A.
BACKGROUND: The pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of micro-crystallization of hepatic bile. METHODS: A prospective case control study compared 55 patients; symptomatic cholelithiasis - 30 (14 male, median age 36 years; mean BMI - 25.1 kg/m2), gallstone pancreatitis - 9 (3 male, median age 35 years; mean BMI - 24.86 kg/m2 ) and IP - 16 (9 male, median age 34 years; mean BMI -23.34 kg/m2) with 30 controls (15 male, median age 38 years; mean BMI = 24.5 kg/m2) undergoing laparotomy for conditions not related to the gall bladder and bile duct. Ultrafiltered bile from the common hepatic duct in patients and controls was incubated in anaerobic conditions and examined by polarized light microscopy to assess bile nucleation time (NT). In the analysis, the mean NT of patients with gallstones and gallstone pancreatitis was taken as a cumulative mean NT for those with established gallstone disease (EGD). RESULTS: Patients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (EGD cumulative mean NT, 1.73 +/- 0.2 days vs. controls, 12.74 +/- 0.4 days, P = 0.001 and IP patients mean NT, 3.1 +/- 0.24 days vs. controls, 12.74 +/- 0.4 days, P = 0.001). However, NT in those with IP was longer compared with those with EGD (mean NT in IP, 3.1 +/- 0.24 days vs. cumulative mean in EGD: 1.73 +/- 0.2 days, P = 0.002). CONCLUSION: Nucleation time of bile in patients with IP is abnormal and is intermediate to nucleation time of lithogenic bile at one end of the spectrum of lithogenicity and non-lithogenic bile, at the other end
Long-term survival of stage IV hepatocellular carcinoma treated with multimodal approach:
(College of Surgeons of Sri Lanka, 2015) Siriwardana, R.C.; Pathirana, A.; Liyanage, C.A.H.; Rajapaksa, P.M.; Munasinghe, M.
Prediction of colorectal cancer risk among adults in a lower middle-income country
(AME Publishing Company, 2019) Samarakoon, Y.M.; Gunawardena, N.S.; Pathirana, A.; Perera, M.N.; Hewage, S.A.
BACKGROUND: Globally, colorectal cancer (CRC) is ranked as the third most common cancer in men and the second in women. Use of a simple, validated risk prediction tool will offer a low-cost mechanism to identify the high-risk individuals for CRC. This will increase efficient use of limited resources and early identification of patients. The aim of our study was to develop and validate a risk prediction model for developing CRC for Sri Lankan adults. METHODS: The risk predictors were based on the risk factors identified through a logistic regression model along with expert opinion. A case control design utilizing 65 CRC new cases and 65 hospital controls aged 30 years or more was used to assess the criterion validity and reliability of the model. The information was obtained using an interviewer administered questionnaire based on the risk prediction model. RESULTS: The developed model consisted of eight predictors with an area under the curve (AUC) of 0.849 (95% CI: 0.8 to 0.9, P<0.001). It has a sensitivity of 76.9%, specificity of 83.1%, positive predictive value (PPV) of 82.0%, negative predictive value (NPV) of 79.3%. Positive and negative likelihood ratios are 4.6 and 0.3. Test re-test reliability revealed a Kappa coefficient of 0.88. CONCLUSIONS: The model developed to predict the risk of CRC among adults aged 30 years and above was proven to be valid and reliable and it is an effective tool to be used as the first step to identify the high-risk population who should be referred for colonoscopy examination. © Journal of Gastrointestinal Oncology. All rights reserved.
Recreation Carrying Capacity via Visual Base Analysis Regarding Diyatha Uyana Park
(Faculty of Social Sciences, University of Kelaniya, Sri Lanka, 2015) Pathirana, A.; Ramanayeka, N.
Surgical anatomy of the veins of the lower limb - a cadaveric study
(College of Surgeons of Sri Lanka, 2009) Salgado, S.; Abeysuriya, V.; Pathirana, A.
INTRODUCTION: With the advent of new surgical techniques, an adequate knowledge of precise anatomy of the venous system of the lower limb is important for safe surgery. The aim of this study is to provide some basic information for those who are interested in phlebology. MATERIALS AND METHODS: The anatomy of the superficial and deep veins of both lower limbs was studied in 20 human cadavers (age 42-72 years) of both sexes (12 males: 08 females). Great saphenous vein (GSV) and small saphenous vein (SSV) were traced from medial and lateral malleoli to the sapheno-femoral junction (SFJ) and saphenopopliteal junction (SPJ) respectively. The number of deep perforators was counted and measurements were taken from a fixed anatomical land mark. RESULTS: In both lower limbs of 17 cadavers (85%), the course of GSV was similar to the course described in the commonly used text books. Large tributary with a diameter similar to GSV at the SFJ was seen in 3 cadavers (15%). The point of entry of SSV into the popliteal vein varied greatly. In majority of cadavers the opening was at the level of the popliteal skin crease and in others it was either above or below this. Large deep perforators were found in the calf and thigh with irregularly distributed small perforators. CONCLUSION: A majority of individuals have the lower limb superficial venous pattern described in standard text books. However, a significant minority had variations, which could have important implications on the presentation and treatment of varicose
Worsening cholestasis and possible cefuroxime-induced liver injury following "successful" therapeutic endoscopic retrograde cholangiopancreatography for a distal common bile duct stone: a case report
(BioMed Central, 2016) Niriella, M.A.; Kumarasena, R.S.; Dassanayake, A.S.; Pathirana, A.; de Silva, H.J.
BACKGROUND: Cefuroxime very rarely causes drug-induced liver injury. We present a case of a patient with paradoxical worsening of jaundice caused by cefuroxime-induced cholestasis following therapeutic endoscopic retrograde cholangiopancreatography for a distal common bile duct stone. CASE PRESENTATION: A 51-year-old, previously healthy Sri Lankan man presented to our hospital with obstructive jaundice caused by a distal common bile duct stone. Endoscopic retrograde cholangiopancreatography with stone extraction, common bile duct clearance, and stenting failed to improve the cholestasis, with paradoxical worsening of his jaundice. A liver biopsy revealed features of drug-induced intrahepatic cholestasis. Although his case was complicated by an episode of cholangitis, the patient made a complete recovery in 4 months with supportive treatment and withdrawal of the offending drug. CONCLUSIONS: This case highlights a very rare drug-induced liver injury caused by cefuroxime as well as our approach to treating a patient with paradoxical worsening of jaundice after therapeutic endoscopic retrograde cholangiopancreatography.