Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Detection of micrometastasis in LYMPH nodes using reverse transcription polymerase chain reaction (RT-PCR) for Cytokeratin 20 (CK-20): are we under staging rectal cancer(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Wijesuriya, S.R.E.; Kuruppuarachchi, K.O.R.; Deen, K.I.; Weerasinghe, A.; Ramesh, R.; Hewavisenthi, J.INTRODUCTION: Postoperative adjuvant chemotherapy in rectal cancer is determined by the presence of metastases in lymph nodes. Detection of LYMPH node metastases is routinely performed by light microscopy. Conventional histology may not detect all metastases especially following neoadjuvant therapy (NAT). CK-20 is a cytokeratin known to be specific to colonic epithelium which may help detection of rectal cancer metastases in lymph nodes. OBJECTIVE: To detect micro metastases in lymph nodes in patients with rectal cancer. staged node negative by routine histology. METHODS: Mesenteric lymph nodes from patients who have undergone NAT for rectal cancer were harvested during surgery. Nodes were bisected and one half sent for Haernatoxylin and eosin (H&E) staining and evaluated by a single pathologist, while the other half was examined for CK 20 by RT-PCR. The technique was validated by testing lymph nodes with known metastases and nodes from patients without cancer. 21 lymph nodes from 6 patients (median age 46 years, range 25-55) which were negative for tumour deposits by H&E stain were assessed for micro metastases. RESULTS: All 2 l nodes which were histologically negative for metastases were positive for micro metastases (positive predictive value l 00%) whilst 2 nodes with known metastases were positive for CK-20, 3 nodes from non-cancer patients were negative for CK-20. CONCLUSION: Detection of CK-20 is accurate in identification of micro metastases of rectal cancer to lymph nodes. Assessment of nodes by H&E histology risks under staging lymph node micro metastases in rectal cancer.Item Result of trans-anal inter-sphincteric resection(taisr) combined with total mesorectal excision (ime) and colo- anal anastomosis for distal rectal cancer(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Deen, K.I.; Rajendra, S.; Hewavisenthi, J.; Perera, M.T.P.R.; Satheesan, B.INTRODUCTION: The treatment of distal rectal cancer is controversial. Most prefer abdomino-perineal excision because of the potential for wide local clearance. Staplers have limitations in restorative resection for distal rectal cancer. OBJECTIVE: To audit the results ofcombinning TAISR with TME and handsewn colo-anal anastomosis for distal rectal cancer. METHODS: I 08 Patients (45 male, median age 59 years, range -22-87) with rectal cancer underwent abdomino-perineal resection -15 ( 14%), Hartmann's procedure - 7 (6.5%), anterior resection -39 (36%) and anterior resection or total colectomy with TAISR and colo-anal anastomosis -47 (43.5%). TAISR was undertaken for tumours between O and 7 ems from the anal verge for rectal cancer with familial polyposis. Data sought were; overall survival, local clearance (RO- clear margins; R l-at least one involved margin) and local recurrence at 24 month median follow up (range- 5 -89 months). Data in the TAISR group were compared with the rest by the test for proportions. Significance was assigned to p<0.05. RESULTS: For the entire group, operative 30-day mortality was 4.6%. Overall disease related mortality at 24 months was 18%. For the entire group, curative resection (RO) was achieved in 93(86%) { TAISR- 39 of 47 (83%) vs. resection without TAJSR- 54 of61(88.5%)- P>0.05}. Overall, local recurrence was seen in 8 (7.4%) {TAISR - 4 of 47 (8.5%) vs. resection without TAISR- 4 of 61 (6.5%). CONCLUSION: There was no significant difference in achievement of free resection margins and local recurrence, in the-short-term, employin anal inter-sphincteric resection with TME for distal rectal cancer co with resection for proximal rectai cancer. Trans-anal inter-sphincteric r with TME for distal rectal cancer is safe in trained hands and should preferred choice in surgical management of distal rectal cancer.Item Clinical outcome of patients having neo-adjuvant therapy(NAT) for rectal cancer: a case control study(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Wijesuriya, S.R.E.; Deen, K.I.; Hewavisenthi, J.; Ratnayake, G.INTRODUCTION: From July i 999 we have employed NAT on a selective basis in the management of rectal cancer. OBJECTIVE: To explore the value of NAT in patients with rectal cancer in the short term. To study the effect of Neo Adjuvant Therapy for rectal carcinoma in the short term. METHODS: Two abdomino perineal resections and 24 anterior resections were done in the NAT group and 5 and 2 l in the no NAT group. There were 2 perioperative deaths in NAT group and one in the no NAT group (P 0.75). There were 7 Cancer related deaths in the NAT group and 6 in the no NAT group (P = l). The survival was 15 month (5 -45) for the NAT group and 16 (3 -54) for the non NAT group (P = I). There were no difference in the recurrences (2 vs 4 P ""0.67) metastasis (4 vs 4 P = 1) or complication (8 vs 2 p =0.08) abdomino perineal resections were performed in 2 patients in the NAT group and 5 in the no NAT group. Anterior resections were performed in 24 patients and 24 patients in NAT and no NAT groups. CONCLUSION: Overall there was no significant difference in the clinical out come between those given NAT and those not given.Item Clinical features and treatment outcomes in patients with symptoms of irritable bowel syndrome (IBS) with and without non-specific colitis (NSC) on histology(Sri Lanka Medical Association, 2003) de Silva, H.J.; Navaratne, N.M.D.; Hewavisenthi, J.BACKGROUND: Routine rectal biopsies in patients with IBS symptoms often show histological changes of NSC. The aetiology and pathogenesis of NSC are unclear, and there are no guidelines for treatment. OBJECTIVE: To determine clinical features and treatment outcomes in patients with IBS symptoms with and without NSC on rectal or colonic biopsies. METHODS: Consecutive patients attending an out-patient clinic diagnosed as having IBS using ROME II criteria were further studied. They all had a clinical assessment, and routine stools examination and culture, flexible sigmoidoscopy and barium enema or colonoscopy with biopsy. Patients who had normal rectal/ colonic histology (NHIBS) or NSC were given treatment for IBS symptoms with dietary modification, anti-spasmodics, anti-diarrhoeals, and anti-depressants, alone or in combination. Response to treatment was assessed after three months. RESULTS: 75 patients (M;- F=50:25; mean age 35.9 years) who had IBS symptoms and normal stool examination and large bowel endoscopy/ radiology were followed up. Six (one with ulcerative colitis, 5 with lymphocytic colitis) were excluded after rectal histology. Patients with NHIBS (n=29) and NSC (n=40) were well matched for age, gender and duration of symptoms. After 3 months of treatment for IBS symptoms, the response to treatment was similar in the two groups (NIBS Vs. 20, worsening 7 Vs 8). CONCLUSIONS; NSC is frequently seen in patients presenting with IBS symptoms. The clinical significance of this finding is unclear, as clinical features and short-term response to symptomatic treatment is similar to patients with BHIBS.Item The detection of the expression of Keratin 19 and Keratin 20 genes in the diagnosis of micrometastases of colonic cancers(Sri Lanka Medical Association, 2003) Weerasinghe, A.; Kuruppuarachchi, G.; Wijesuriya, R.; Hewavisenthi, J.; Deen, K.I.OBJECTIVE: Keratin 19(K-19) and Keratin 20(K-20) genes are expressed in the epithelial tissues while they are absent in lymphoid-tissues. Therefore the expression of these foreign genes in lymph nodes is used in the diagnosis of micrometastases. We investigated the expression of K19 and K2C in the diagnosis of micrometastases of colonic cancer. DESIGN, SETTING AND METHODS: Regional lymph nodes of patients with colonic cancer (n = 5) were obtained from University Surgical Unit of Ragama. Two corresponding lymph nodes from non-cancer patients and colonic tumor tissue were used as negative and positive control respectively. De-ionized water was used as blank control. Lymph nodes were collected directly to the RNA extracting media (Isogen) during the surgery. Specimens were transported to Medical Research Institute within one hour at 4 C. cDNA was synthesized using reverse transcriptase and K19 and K20 primers were used to detect the expression of these genes. PCR products were identified using agarose gel electrophoresis after amplification using the thermal cycler (Perkin Elmer). (3-actin primer was used for internal quality control. RT/PCR findings were compared with the routine histological findings of the patients. RESULTS: Lymph nodes of all five patients with colonic cancers and the colonic cancer tissues were positive for the expression of K19 and K 20. Both control lymph nodes were negative for the expression of K-19 and K-20. All the patients with colonic cancers were negative on histology of the lymph node biopsies. CONCLUSION: These findings suggest that the detection of the expression of K19 and K20 help to identify the metastases, which are negative on histology.Item Views of students on the use of computer aided pathology practical classes(Sri Lanka Medical Association, 2012) Mahendra, B.A.G.G.; Rathnayake, R.M.U.S.; Hewavisenthi, J.INTRODUCTION: Conducting pathology practical classes in the traditional manner is becoming increasingly difficult With rapidly advancing medical knowledge it is a challenge to impart a large amount of facts within a limited time. A programme of Computer Aided Pathology Practicals (CAPP) was introduced to overcome these challenges. AIMS: To determine whether this programme was successful in the view of the students, what the short comings were, and how the system could be improved. METHODS: A self administered questionnaire was used to assess the views of the students of Batch 20 of the Medical Faculty, Kelaniya. The pathology practicals for these students had been conducted using both the traditional and the CAPP systems. Results: 62.7 % students preferred the CAPP programme. The reasons offered for this preference included greater enhancement of knowledge of the course content [59.6% ), a greater area of knowledge covered within a single session (76.9%], ability to appreciate the architectural (73.4%) and cytological features ( 76.8%) of lesions better, being easier to operate (77%) and the saving of time ( 85.7%). However 67.9% of the students were of the opinion that the traditional pathology practicals were more realistic especially with regard to appreciating the macroscopic features, than the CAPP system. CONCLUSIONS: Overall the CAPP programme was well received by a majority of students. The lack of "hands on experience" is a problem encountered in all forms of virtual teaching. This could be improved by encouraging the students to use the pathology museum more frequently.Item Comparison of one and two weeks of triple therapy for eradication of H. pylori: a randomized, controlled study in a tropical country(Wiley Blackwell Scientific Publications, 2004) de Silva, H.A.; Hewavisenthi, J.; Pathmeswaran, A.; Navarathne, N.M.M; Peiris, R.; Dassanayake, A.S.; de Silva, H.J.INTRODUCTION: Resistance of H. pylori to antibiotics may be particularly high in parts of the tropics. Infection may prove difficult to eradicate in such situations, and there is some evidence of benefit in increasing duration of treatment (triple therapy) from one week to two or three weeks. AIM : To assess the efficacy and tolerability of one-week versus two weeks triple therapy for eradication of H. pylori in a Sri Lankan population. METHODS: 82 consecutive patients aged 18–70 years with peptic ulcer disease testing positive for H. pylori infection (histology and rapid urease test on gastric antral biopsies) were randomly allocated to two treatment groups. The baseline characteristics of the two groups were similar. Both groups received omeprazole 20mg, clarithromycin 250mg, and tinidazole 500mg. Group A (n = 42) received the trial medication twice daily for one week and the Group B (n = 40) twice daily for two weeks. H. pylori eradication was defined as a negative 14C labeled urea breath test at two weeks after completion of therapy. The assessors were blind to randomization and other patient information. RESULTS; All patients presented for follow up after completion of therapy. H. pylori infection was eradicated in 36 (85.7%) patients in group A and 36 (90%) patients in group B (p = 0.9; 95% CI: -19.1 to 10.8). 23 (55%) patients in group A and 17 (43%) in group B reported adverse effects attributable to trial medication (p = 0.387); none were serious. 3 (7.5%) patients in group B discontinued treatment due to adverse events that developed on days 7, 9 and 10. CONCLUSION: Twice daily treatment with clarithromycin, tinidazole, and omeprazole for one-week is well tolerated and provides as good a rate of H. pylori eradication as two weeks therapy in Sri Lankan patients.Item FNAC in the 'field'- a new experience(Sri Lanka Medical Association, 2008) Fernando, R.; Hewavisenthi, J.; Pathmeswaran, A.; Edirisinghe, D.; Abeysinghe, S.; Atulugama, N.; Bandara, D.; Premathileke, M.BACKGROUND: Fine needle aspiration cytology (FNAC) is an important diagnostic test in thyroid diseases. It usually is undertaken at a hospital or laboratory setup. As part of an islandwide field based study, FNAC was undertaken in the field. Literature review revealed that FNAC accuracy rate was around 65-70% in most Centres with full-fledged facilities. OBJECTIVES: To determine the effectiveness of FNAC done in the field DESIGN, SETTING AND METHODS: Informed written consent was obtained and the goitre was delineated with a marker pen. FNAC was carried out by a trained team member in the standard manner. Four slides were prepared from each patient. All slides were processed and examined by a cytologist RESULTS: 308 FNAC were done. 226 FNAC were diagnostic (73.36%) and 82(26.64%) were non diagnostic. 62(23.8%) showed benign cells only. The pathological entities detected were: 112 (49.5%) auto immune thyroiditis, 32 (14.1%) colloid storing nodules, 14(6.1%) colloid storing nodules with autoimmune thyroiditis, 5 (2.2%) follicular lesions and one toxic lesion. There were no significant complications noted in any of the patients. CONCLUSIONS: Field FNAC has a high diagnostic accuracy if done by a trained person. It is a safe procedure in the field.Item Microscopic colitis not otherwise specified (NOS) in patients with diarrhoea predominant IBS in a tropical setting(Sri Lanka Medical Association, 2008) de Silva, A.P.; Dassanayake, A.S.; Hewavisenthi, J.; Liyanage, D.L.M.N.; Dissanayake, T.G.I.; Duminda, H.K.K.T.; de Silva, H.J.BACKGROUND: Coionoscopy is not recommended in IBS unless there are alarm symptoms. However, studies have shown that microscopic colitis and low grade inflammatory bowel disease (IBD) can mimic IBS. Microscopic colitis not otherwise specified (MNOS) is a distinct but poorly studied entity, especially in the tropics. OBJECTIVES: To investigate the presence of colonic and ileal inflammation in patients with diarrhea predominant IBS (IBS-D) in a tropicai setting. DESIGN, SETTING AND METHODS: In a prospective study over one year, we recruited 42 consecutive patients with IBS (diagnosed using Rome II criteria) and no alarm symptoms (mean age 36.1 yrs, M:F=29:13) and 13 controls {mean age 42.3 yrs, M:F=5:8). Serial colonic and ileal biopsies were obtained. RESULTS: Coionoscopy was macroscopically normal in all cases and controls. 23 (54.8%) cases had MNOS, 2(4.76%) ileal inflammation only, and 17(40.48%) had normal histology. Histology was normal in 11(84.62%) controls, and 2(15.38%) had MNOS. MNOS was significantly commoner in cases than controls (P=0.02, chi-square test). MNOS was commonest in the right side of the colon (n=20, 80%). 14(60.8%) patients with MNOS had a history suggestive of post infective IBS, compared to 7(36.8%) patients without MNOS (P>0.05). CONCLUSION: MNOS is common in patients with IBS-D in a tropical setting. Post infectious IBS seems commoner in patients with MNOS than those without MNOS, although this did not reach statistical significance. Coionoscopy with ileoscopy and serial biopsies are useful to detect mucosal inflammation in IBS-D.Item Goitre prevalence in diabetes - results of an islandwide study(Sri Lanka Medical Association, 2008) Fernando, R.; Hewavisenthi, J.; Atulugama, N.S.; Edirisinghe, E.M.D.A.R.; Abeysinghe, A.P.S.D.; Fernando, W.M.T.P.S.; Premathilaka, H.M.M.S.; Bandara, S.D.Abstracts Available