Browsing by Author "Pinto, M.D.P."

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Clinically benign breast lumps - how often are they malignant?
(12th Annual Research Symposium, University of Kelaniya, 2011) Jayatunge, D.N.U.; Pinto, M.D.P.; Ariyaratne, M.H.J.
Breast cancer in women is a major public health problem throughout the world. One in ten of all new cancers diagnosed worldwide each year is a cancer of the female breast. Diagnosis of breast cancer is done by triple assessment considering clinical/cytological and radiological behaviour of a breast lump. First encounter of patients with a breast lump is commonly with a primary care physician in our clinical practice. The objective of this study is to assess the case load of carcinoma of the breast presenting as clinically benign breast disease. Retrospective analysis of data from the breast cancer registry (1999-2011) of the Professorial Surgical Unit, NCTH was done. Examination findings of all the patients in the registry were analyzed. Patients who presented a single, well defined, firm, freely mobile breast lump with no nipple discharge or palpable axillary lymph nodes were considered to be clinically benign. Study population consisted of 145 patients (n=145) with a mean age of 53.23 years and a range between 30-84 years. 12 (8.27%) patients with a mean age of 48.33 years presented with above mentioned criteria. With completion of triple assessment, all of them were diagnosed to have carcinoma of the breast. In our setting about 1 in 10 patients with a carcinoma of the breast may present as having a benign breast lump clinically. Thus it is important to conduct cytological and radiological assessment in all patients presenting with a breast lump especially after the age of 40.
Clnical presentation, characteristics and surgical outcome of retrosternally extending goitres versus goitres confined to neck: results from a case control study
(Sri Lanka Medical Association, 2016) Munasinghe, B.N.L.; Dissanayake, D.M.C.D.; Rathnayake, R.M.G.K.; Pinto, M.D.P.; Kumarasinghe, K.A.P.R.; Fernando, F.R.
INTRODUCTION: Goitres that extend beyond the thoracic inlet are defined as retro-sternally extending (RSE) goitres. These RSE goitres are a surgical challenge and their characteristics could be different to the goitres confined to the neck. METHOD: A retrospective case-control study. Patients were selected from the thyroid database maintained in our unit (from November 2002 to February 2016). Patients with RSE goitres (confirmed by imaging) were selected as study group (SG). Control group (CG) patients (with goitres confined to the neck) were systematically selected in a 1:2 ratio. The end points were: (i) incidence of RSE goitres, (ii) clinical presentation, (iii) degree of RSE (iv) thyroid status, (v) post operative complications and (vi) histological pattern. RESULTS: 527 consecutive patients (465 female: 62 male; median age 45 years, range 17 years to 71 years) were studied. For the case control study, there were 51 patients in the study group and 102 patients in the control group. Compression symptoms were not significantly high in the SG (27% vs 17%, p value <0.17). Majority had RSE of both lobes (78%). The median depth of extension into the mediastinum was 41.6mm (range 12mm - 95mm). A majority were euthyroid (SG 78% vs CG 82%). Post operative stridor was significantly high in the SG (7% vs 2%; P value = 0.015). Although a majority was colloid goitres, papillary carcinoma was significantly high in the CG (P value < 0.05). CONCLUSIONS: A majority of RSE goitres did not present with compression symptoms, but had significantly high post-operative stridor (p value <0.05). Incidence of cancer is not high in SG.
Does the retrosternal extension of a goitre and its relationghip to the aortic arch determines the surgical approach
(Sri Lanka Medical Association, 2016) Kumarasinghe, K.A.P.R.; Pinto, M.D.P.; Munasinghe, B.N.L.; Dissanayake, D.M.C.D.; Abeyrathne, I.G.K.P.; Amaraweera, P.C.; Fernando, R.
INTRODUCTION: Retrosternal extension (RSE) is defined as the enlargement of the thyroid below the thoracic inlet. The greatest challenge in embarking on surgery in RSE is to decide whether to involve an intra-thoracic approach (sternotomy or thoracotomy) or not, as this approach accounts for added morbidity & mortality. OBJECTIVES: The aim of this study is to analyse whether the relationship of the retrosternal component of a goitre to the aortic arch decides the surgical approach of total thyroidectomy. METHOD: A total of 527 thyroidectomies were performed at Colombo North Teaching Hospital professorial unit during the period from November, 2002 to February, 2016. There were 51 patients with radiological evidence of retrosternal goitre (6.27%). These patients were categorized into 2 groups according to the degree of RSE. Groups were defined as extension of goitre above the arch of aorta (AA) and below AA. RESULTS: 50 (98%) patients had RSE above the AA and 1 patient had RSE below the AA. RSE was seen on the right side of the mediastinum in 3 (5.88%) patients, on the left in 8 (15.68%) patients and bilaterally in 40 (78.43%). Total thyroidectomy was undertaken in all 50 patients with RSE above the AA, through cervical approach without an added morbidity. The patient with RSE beyond the AA underwent total thyroidectomy with axillary thoracotomy. CONCLUSIONS: Majority of the RSE is above the AA, which can be dealt with a cervical approach and extension below the AA may need an intra-thoracic approach.
Incidence of carcinoma among THY3 lesions of the thyroid
(Sri Lanka Medical Association, 2016) Kumarasinghe, K.A.P.R.; Pinto, M.D.P.; Munasinghe, B.N.L.; Dissanayake, D.M.C.D.; Abeyrathne, I.G.K.P.; Amaraweera, P.C.; Fernando, R.
INTRODUCTION AND OBJECTIVES: Ultra Sound Scan (USS) and Fine Needle Aspiration Cytology (FNAC) of thyroid nodules are carried out in patients with goitre. THY3 lesions cause diagnostic difficulty and risk of malignancy in such lesions is 20%. The objective of this study was to determine the incidence of carcinoma among THY3 lesions and to relate the findings to the size of the nodule. METHOD: All the patients who underwent thyroidectomy at the University Surgical Unit, Colombo North Teaching Hospital from November 2002 to December 2015 were analysed retrospectively. Histological and ultrasonic data in patients with THY3 lesions were analysed. RESULTS: There were 29 (5.68%) THY3 patients among 510 patients who had thyroidectomy. Only 6 (20.7%) patients were histologically proven to be malignant (follicular carcinoma – 3, papillary carcinoma - follicular variant- 2, mixed medullary papillary carcinoma - 1). All patients were females (age range 17y -52y). Pre-operative USS nodule size in the malignant group ranged from 2.6 cm to 6.8 cm (average - 4.25cm). 20 patients (68.9%) had benign histology (MNG - 18, thyroiditis-2). USS nodule size in the benign group ranged from 2.3 cm to 2.5 cm. Three patients (8.7%) were lost to follow up. CONCLUSIONS: About 20.7% of THY3 lesions had thyroid carcinoma. Lesions larger than 4.25 cm were more likely to harbour a malignancy.
Intraoperative visualization of biliary anatomy using Indocyanine green (ICG) fluorescence in a Sri Lankan patient cohort
(The College of Surgeons of Sri Lanka, 2024) Kumarage, S.K.; Lakshani, D.H.J.P.U.; Pinto, M.D.P.; Chandrasinghe, P.C.
INTRODUCTION: Bile duct injury (BDI) is a complication with high morbidity, associated with laparoscopic cholecystectomy (LC). The risk of BDI can be reduced by accurate visualization of the biliary tree with the use of indocyanine green fluorescence (ICG). This study describes the use of this non-invasive technique in a cohort of Sri Lankan patients to visualize the biliary anatomy intraoperatively. METHOD: A total of 121 consecutive patients undergoing LC were included. All received 5 mg of ICG intravenously, 30 minutes prior to induction of anesthesia. The Stryker 1588 laparoscope was used to visualize the anatomical landmarks, both pre and post-dissection of the Calot's triangle, using visible light and near-infrared imaging (NIR). RESULT: In 121 patients (female - 64.5%, median age - 42 years; range of 18-82) included in the study, biliary colic was the commonest indication (70%) for LC. ICG fluorescence resulted in significantly better visualization of the extrahepatic biliary tract (p=<0.001), both pre-dissection (95%CI = 91.7% [85.3%-96.0%]) and post-dissection (95% CI=71.1% [62.1%-79.0%]) of the Calot's triangle. Furthermore, the hepatic ducts were only visualized with ICG. Visualization of the Cystic duct common bile duct junction (CDCBDJ) improved from 6% to 88% (P<0.001) predissection with ICG. Fluorescence enabled the visualization of CDCBDJ post-dissection in all cases compared to 54% without it (P<0.001). ICG enhanced visualization of the Common bile duct (CBD) from 34% to 88% (P<0.001) predissection and 100% visibility post-dissection compared to 62% under visible light (P<0.001). No adverse effects of ICG or bile duct injuries were reported during the study. CONCLUSION: The use of ICG during LC significantly enhanced the identification of biliary landmarks in this cohort. Identification of anatomy can help reduce inadvertent BDI. This safe and effective modality may be considered a routine step in LC.
Lateral approach to thyroid
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Dissanayake, D.M.C.D.; Kumarasinghe, K.A.P.R.; Pinto, M.D.P.; Amaraweera, P.C.; Munasinghe, B.N.L.; Chandrasinghe, P.C.; Fernando, R.
BACKGROUND: Thyroidectomy is the commonest endocrine surgical procedure, undertaken throughout the world. Re-do thyroidectomies are challenging procedures with a higher morbidity rate. Lateral approach to thyroid (LATT) is a good alternative to the standard midline exploration. The key to the technique is the development of the natural tissue plane between the strap muscle and the ipsilateral sternocledomastoid muscle to explore the thyroid bed. OBJECTIVE: This study was done to assess the efficacy, safety and complications of LATT. METHODS: Data on patients undergoing LATT in Professorial Surgical Unit, Colombo North Teaching Hospital, Ragama from 2008 to 2015 was collected prospectively and analyzed. All procedures were done by a single surgeon. RESULTS: A total 36 LATTs were done. Data from 32 people were collected as 4 patients were lost to follow up. 29 (90.6%) were females and 3 (9.4%) were males. Age ranged between 28 and 61 (Median 43.37) years. Three (9.4%) LATTs were for parathyroid explorations and out of which one (3.1%) was for redo parathyroid explorations. Nine (28.1%) were redo thyroidectomies and 18 (56.2%) were mini incision thyroidectomies with lateral approach. Hemi thyroidectomies were performed for 28 (87.5%). Bilateral explorations done for 3(9.4%) patients and 4(12.5%) lateral approaches done for completion thyroidectomies were for follicular malignant lesions. Transient clinical hypocalcaemia was noticed in 4 (12.5%) patients and 1 (3.1%) developed hoarseness of voice which was temporary. None of them had complications such as haematoma or post-surgery stridor. CONCLUSIONS: LATT is a safe alternative to the standard approach, for re-explorative thyroid surgery.
Micronodularity is an important physical sign in chronic autoimmune thyroiditis
(Sri Lanka Medical Association, 2011) Jayatunse, D.N.U.; Pinto, M.D.P.; Fernando, R.
INTRODUCTION AND OBJECTIVES: Chronic autoimmune thyroiditis is the commonest inflammatory disorder of the thyroid. There is evidence that the prevalence of autoimmune thyroiditis is increasing in Sri Lanka. The clinical features of autoimmune thyroiditis have been described in text but micronodularity which is found frequently has not been well documented as a physical sign. Aim of this study was to assess whether micronodularity is an important physical sign in clinical diagnosis of chronic autoimmune thyroiditis. METHODS: Analysis of physical characteristics of goitres in 426 patients who were part of an island wide study on epidemiology of goitre. All physical characteristics were taken note of and micronodularity was taken as a screening test compared with biochemical and cytological evidence of chronic autoimmune thyroiditis.RESULT: From 5200 participants (mean age = 36.3 years) goitres' were detected in 426 participants (143 males, 283 females). Modularity was detected in 271. Micronodularity was present in 190 (70.1 %) whereas macronodularity was detected in 81 (29.9 %). Thyroid antibody status was available in 153 participants where 74 had micronodularity. 27 with micronodularity were test positive (sensitivity - 49.09% / specificity = 52.04% 7PPV = 36.48%/NPV = 64.55%). Cytology was available in 328 subjects where 146 had micronodularity. 54 with micronodularity were cytologically positive (sensitivity = 47.79% and specificity = 57.21% / PPV = 36.98% / NPV = 67.58%). CONCLUSIONS: Diagnosis of chronic autoimmune thyroiditis is based on clinical, biochemical and cytological evidence. Micronodularity is a useful physical sign in diagnosing chronic autoimmune thyroiditis
Mini incision thyroidectomy: alternative approach to cosmetic thyroidectomy
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Munasinghe, B.N.L.; Fernando, R.; Kumarasinghe, K.A.P.R.; Sandaruwan, C.; Pinto, M.D.P.; Amaraweera, P.C.; Dissanayake, D.M.C.D.
BACKGROUND: Technique of thyroidectomy has evolved from conventional open technique to minimally access techniques over the past few years. Regardless of the technique, outcome depends on meticulous surgical technique used. Mini incision is defined as surgical incision less than 3 cm or less in length. Once the small incision is made, retraction is used and thyroidectomy done in the conventional manner. Main advantage is the superior cosmetic outcome compared to conventional method. Size of the gland is a main factor before deciding on a mini incision thyroidectomy (MIT) and careful patient selection must be done as large glands cannot be retrieved with the mini incision. METHODS: A longitudinal descriptive study was carried out on all patients undergoing MIT between 2008 to 2015 in Professorial Surgical Unit, University of Kelaniya, Sri Lanka. Patients with small sized glands and nodules less than 2cm were included. Skin incision was marked by measuring 3 cm with a sterile measuring tape and Methyline blue dye. The thyroid gland was delivered in to the incision and both pedicles were ligated. Capsular dissection with nerve encountering technique was adhered to. Recurrent laryngeal nerves, external branch of the superior laryngeal nerves and parathyroid glands were demonstrated and preserved. Drains were not used and routine closure was done after absolute haemostasis. RESULTS: Twenty nine MITs were performed (Male -3 , Female – 26, median age 34.26 years, range 22 – 42 years, total thyroidectomy -18, hemi-thyroidectomy -11). The commonest indication for total thyroidectomy was small MNG. None had recurrent laryngeal nerve injuries or significant haematoma formation. Transient hypocalcaemia was seen in 3%. The cosmetic outcome was satisfactory. The longest follow up is 7 years. CONCLUSIONS: MIT is a safe alternative to conventional approach in carefully selected patients and also it gives a superior cosmetic outcome.