Conference Papers
Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/6561
This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
Browse
14 results
Search Results
Item Histological types of Gynaecological tumours in the teaching hospital, Ragama over a 9 year period(Sri Lanka College of Obstetricians and Gynaecologists, 2008) Nishad, A.A.N.; Herath, H.M.R.P.; Padumadasa, S.G.J.; Wijesinghe, P.S.; Feranando, W.S.; Rathayake, R.M.U.S.; Hewavisenthi, S.J.de S.INTRODUCTION: Gynaecological malignancies contribute significantly to the mortality of women. The pathological spectrum of ovarian and uterine malignancies is wide and diverse. Differences in incidence of histological types and stages at presentation have been reported. OBJECTIVE: To describe the histological types of ovarian, uterine and fallopian tube malignancies diagnosed at Professorial unit Ragama during the period of 1st January 1999 to 1st May 2008. METHODOLOGY: A descriptive, retrospective study was done using the histopathological reports during the study period. RESULTS: There were 96 ovarian, 44 uterine and 1 fallopian tube malignancies detected during the study period. Out of the 96 ovarian malignancies, 94 (97.9%) were primary ovarian tumours while 2 (2.1%) were secondary tumours. Epithelial tumours were the commonest accounting for 80.9% of primary ovarian malignancies while stromal and germ cell tumours contributed to 9.6% and 5.3% respectively. There were 39 (51.3%) serous tumours, 18 (23.7%) endometrioid tumours and 9(11.9%) mucinous tumours among the epithelial tumours. Immature teratomas were the commonest (60%) germ cell tumour. At presentation 22 (23.4%) were bilateral tumours. Majority 29 (31%) of ovarian malignancies were FIGO stage T11C at diagnosis. Among the uterine malignancies there were 33(75%) endometrial carcinoma, 3(7%) Endometrial stromal sarcoma, 2 (4.5%) leiomyosarcomas, ,and 6 (13.5%) other sarcomas. Most (67%) of the patients who had endometrial carcinomas were FIGO stage 1 at the time of diagnosis. DISCUSSION: Though the proportion of the epithelial tumours were similar to the standard figures, germ cell tumours seems to be less in number. Secondary ovarian tumours seem to be less in our study population. The fact that the ovarian malignancies are diagnosed late is evident by the study.Item An Unusual case of polycystic ovary syndrome(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Padumadasa, G.S.; Wijesinghe, P.S.; Hewavisenthi, S.J.de S.A 19 year old girl with primary smenorrhoea presented with lower abdominal pain, deepening of voice, hirsutism and hyperpigmentation of skin for five years. She had undergone left sided oophorectomy and wedge biopsy of the right sided ovary five years back and histology had revealed multiple ovarian cysts of follicular origin. On examination she was found to have a normal body habitus, temporal recession of hairline, hirsutism and clitoromegaly. Breasts were of Tanner stage 4-An ultrasound scan of abdomen revealed a right adnexal cyst of approximately 7x7 cm size. Serum testoeterone was mildly elevated. Serum dehydroepiandrosterone sulphate and 17 hydroxy progesterone levels were normal. A laparotomy carried out on 10 May 2005 revealed a right ovarian cyst of 7x7 cm. Cut surface of the cyst showed a large unilocular cyst and peripherally displaced multiple cysts of 0.5x0.5 cm size in thinned out stroma. Right sided oophorectomy was performed. Histology revealed multiple follicular cysts which was suggestive of polycystic ovaries. One month after surgery there is already an improvement in the pigmentation of skin and hirsutism. She was started on oral contraceptive pills. She is awaiting results of androstenedione, follicle stimulating hormone, luteinizing hormone and karyotype. This is a rare presentation of polycystic ovary syndrome.Item Response to neoadjuvant therapy in breast cancer: tumour regression and lymph node status(Sri Lanka Medical Association, 2002) Ratnayake, S.A.G.R.; Hewavisenthi, S.J.de S.BACKGROUND: Neoadjuvant therapy (NAT) prior to mastectomy is used to treat locally advanced breast carcinoma. This study assessed the response of breast cancer patients to NAT. METHODS: In a prospective study on 17 patients with carcinoma of the breast (16 females; age range 34—71 years) subjected to NAT prior to mastectomy, reduction in tumour size and the residual microscopic tumour percentage graded as, 0% - complete regression, 1-19% - marked regression, 20-79% - moderate regression, 80-99% - minimal regression, 100% - no regression, was assessed. Number of lymph nodes harvested and the number containing metastases (positivity) was compared with a control group of breast cancer patients (age and stage matched) undergoing mastectomy without NAT from a unit with a different treatment policy. RESULTS: Tumour size before NAT (mean 4.1cms) compared with that after NAT (mean l.Scms) was statistically significant (p<0.05). Microscopic assessment of residual tumour percentage showed 4 (23.5%) with complete regression, 2 (11.9%) with marked regression, 4 (23.5%) with moderate regression, 6 (35%) with minimum regression and 1 (5.8) with no regression. Neither the mean lymph node harvest of 11 (range 6-20) nor the mean lymph node positivity of 1.7 (range 0-8) in the NAT group were significantly different from values obtained for the control group [mean lymph node harvest 9.7 (range 4-18); mean lymph node positivity 2 (range 0-8)] (p>0.05). CONCLUSIONS: NAT causes macroscopic and microscopic reduction in tumour size in breast cancer. However, there is no significant difference on the therapeutic effect on axillary lymph nodes between patients receiving NAT and those undergoing mastectomy alone.Item Gastric disease in patients presenting with dyspeptic symptoms(Sri Lanka Medical Association, 2002) Hewavisenthi, S.J.de S.; Suranimala, H.D.C.; Alwis, W.H.D.INTRODUCTION: Upper gastrointestinal endoscopy and biopsy is a relatively common procedure that is now frequently used in the investigation of patients with 'dyspeptic symptoms'. OBJECTIVES: To correlate the endoscopic findings with histological features. To ascertain patterns of gastric disease occurring in patients undergoing upper gastrointestinal endoscopy and biopsy for dyspeptic symptoms. METHODS: 419 endoscopic biopsies performed on patients with dyspeptic symptoms during the period April 2000 to October 2001 were reviewed. In all patients biopsies were performed on an area of the gastric mucosa showing an endoscopic abnormality. The patients included 258 males and 161 females with ages ranging from 11-86 years (median 45.5). Most biopsies were obtained from the antral region (322/419). RESULTS: 110/419 (26%) biopsies were histologically normal despite an 'endoscopic abnormality' being reported. 15 biopsies (3.5%) were non-diagnostic due to biopsy artefacts, poor preservation and other factors. 13/419 (3%) biopsies revealed neoplastic lesions (11- malignant, 2-fundic gland cysts). Of the non neoplastic gastric disorders 33 (7.9%) were peptic ulcers, 202 (48%) chronic gastritis, 40 (9.5%) reactive gastritis, 6 (1%) portal gastropathy, 1 hyperplastic gastropathy. Helicobactorpylori was identified in 112/202 (55%) of the biopsies with chronic gastritis. CONCLUSIONS: Endoscopic and histologic correlation was satisfactory in a majority, 74% of the biopsies showing histological evidence of disease. Helicobactor pylori induced gastritis was the commonest (27%) pathology encountered in patients investigated for dyspeptic symptoms.Item The role of perineural invasion in long-term survival following curative resection of pancreatic carcinoma(Sri Lanka Medical Association, 2004) Janes, S.; Hewavisenthi, S.J.de S.; Zaitouun, A.M.; Cation, J.; Lobo, D.N.; Rowlands, B.J.BACKGROUND & AIMS: Most pancreatic carcinomas demonstrate perineural invasion, however its prognostic significance is unclear. The aim of this study is to grade the severity of perineural invasion and correlate this with survival. METHODS: A retrospective analysis of all resected pancreatic carcinomas (n=44) in a UK teaching hospital from 1997-2002. Perineural invasion was graded 0 (absent) to 3 (severe). Factors predictive of hospital mortality and 5-year survical were determined. RESULTS: Hospital mortality (18%), was significantly higher for patients with albumin <35g/L, operating time> 5.25 hours, blood loss > 5 litres, lowest quartile Townsend score and reoperation. Multivariate analysis identified albumin < 35 g/ dL, (odds ratio (OR) 22.5, p=0.043), reoperation (OR 30.3, p=0.029) and lowest quartile Townsend score (OR 39.8, p=0.0l8) as independent predictors of hospital mortality. Actuarial survival at 1,3 and 5-years was 56%, 29% and 24%. Perineural invasion grade 0-1 than grade 2-3: median survival 37 versus 17 months respectively, p=0.007. Five-year survival was significantly less with vascular invasion and tumours > 2cm.Cox proportional hazard analysis identified grade 2-3 perineural as the only significant independent indicator of poor prognosis, hazard ratio 2.S (95% Cl 1.1-7.2) p=0.031, CONCLUSIONS: Grade 2-3 perineural invasion is a strong prognostic indicator. Grading should become standard practice in reporting of pancreatic cancer. Previous studies may have concluded perineural invasion was not a prognostic indicator because invasion was graded present/ absent.Item The value of brunt scoring in predicting the short term outcome of non-alcohlic steatohepatitis(Wiley Blackwell Scientific Publications, 2004) Hewavisenthi, S.J.de S.; Pathmeswaran, A.; de Silva, H.J.BACKGROUND: Brunt scoring is currently used in the grading and staging of liver biopsies in non-alcoholic steatohepatitis (NASH). Its value in predicting the outcome of patients following modifications in lifestyle, the cornerstone of management in NASH, needs evaluation. OBJECTIVES: To determine whether Brunt grades correlate with Aspartate transaminase (AST) and Alanine transaminase (ALT) levels, and outcome following lifestyle modifications in NASH. METHOD: In a prospective study from May 1999 to May 2003 the biopsies of 79 patients diagnosed as having NASH were assigned 3 necroinflammatory grades based on the Brunt system. The mean serum transaminase values at presentation for each necroinflammatory grade were compared using ANOVA. 77/79 patients were given advice on lifestyle modifications and then followed up for a median 2.5 years. The time taken for serum transaminases to return to normal was correlated with the necroinflammatory grades, AST and ALT values at presentation using Kendall tau b. RESULTS : The mean AST and ALT values (IU/L) in the three necroinflammatory grades were - grade 1:62.4 and 102:1, grade 2: 87.6 and 139.4 and grade 3: 90.9 and 164.5. There was a significant difference in the AST and ALT values between grades 1 and 2, and grades 1 and 3, but not between grades 2 and 3. In 51/77 patients serum transaminases returned to normal levels after a median 6 months (range 3– 14 months). There was no significant correlation between the time taken for serum transaminases to return to normal and the transaminase values or necroinflammatory grades at presentation. CONCLUSION: Brunt grading correlates with both AST and ALT levels. However, neither necroinflammatory grades nor serum transaminase values at first presentation are predictors of the duration to normalization of liver enzymes in NASH patients managed with life style modificationsItem Prevalence of eosinophilic oesophagitis among adult Sri Lankan patients with refractory upper gastrointestinal symptoms: a prospective study(Wiley Blackwell Scientific Publications, 2012) Ranawaka, C.K.; de Silva, A.P.; de Alwis, R.; Waraketiya, P.R.; Jayathilake, T.M.A.H.; Niriella, M.A.; Dassanayake, A.S.; Hewavisenthi, S.J.de S.; de Silva, H.J.BACKGROUND AND AIM: Eosinophilic oesophagitis (EoE) is increasing in the West (community prevalence 0.02–1%). It is especially prevalent among patients with refractory upper gastrointestinal (UGI) symptoms (8.8–48%). Diagnosis is important as the treatment is with corticosteroids and other immunomodulators rather than acid suppression and prokinetics. EOE has been poorly studied in Asian populations. Our aim of this study was to evaluate the prevalence of EoE among adult Sri Lankan patients with refractory UGI symptoms. METHODS: The study was carried out in the University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka. Over a period of one year from March 2011, consecutive, consenting patients (aged 18–70) referred for gastroduodenoscopy (OGD); with persistent UGI symptoms despite standard therapy for at least two months were recruited. Patients without significant abnormalities other than features of EoE on OGD underwent two biopsies each from the distal and mid oesophagus. Biopsies were obtained from duodenum and stomach at the same time to rule out possible eosonophilic gastroenteritis. A diagnosis of EoE was made when there were 15 or more intra-epithelial eosinophils per high-power field, according to the international guidelines. RESULTS AND DISCUSSION: Common refractory symptoms were dyspepsia, gastro-oesophageal refl ux and dysphagia in 74, 64, 27 respectively. Only 106 patients (M: F = 42:64 mean age 48 yrs (SD 13.3) who fulfill the criteria underwent oesophageal biopsies. Endoscopy was macroscopically normal in 98 patients and suggestive of EoE in 8; concentric mucosal rings in 2 and white exudates in 6 patients. Only 2 (1.9%) patients had histological evidence of EoE, both had symptoms of refractory dyphagia and one had compatible macroscopic endoscopic features of EoE (concentric mucosal rings). CONCLUSION: The prevalence of EoE in this Sri Lankan cohort of adult patients with refractory UGI symptoms was much lower than reported in Western seriesItem The value of BRUNT scoring in predicting the short term outcome of non-alcoholic(Sri Lanka Medical Association, 2005) Hewavisenthi, S.J.de S.; Pathmeswaran, A.; de Silva, H.J.BACKGROUND: BRUNT scoring is currently used in the grading and staging of liver biopsies in non¬alcoholic steatohepatitis (NASH,). Its value in predicting the outcome of patients following modifications in lifestyle, the cornerstone of management in NASH, needs evaluation. Objectives: To determine whether BRUNT grades correlate with aspartate transammase (AST) and alanine transaminase (ALT) levels, and outcome following lifestyle modifications in NASH. METHOD: In aprospective study from May 1999 to May 2003 the biopsies of 79 patients diagnosed as having NASH were assigned 3 necromfiamrnatory grades based on the BRUNT system. The mean serum transaminase values at presentation for each necroinflammatory grade were compared using ANOVA. 77/79 patients were given advice on lifestyle modifications and followed up for a median 2.5 years. The time taken for serum transaminases to return to normal was correlated with the necroinflammatory grades, AST and ALT values at presentation. RESULTS: The mean AST and ALT values (IU/L) in the three necroinflammatory grades were - grade 1:62.4 and 102:1, grade 2: 87.6 and 139.4 and grade 3: 90.9 and 164.5. There was a significant difference in the AST and ALT values between grades 1 and 2, and grades 1 and 3, but not between grades 2 and 3. In 51/77 patients serum transaminases returned to normal levels after a median 6 months (range 3-14 months). There was no significant correlation between the time taken for serum transaminases to return to normal and the transaminase values or necroinflammatory grades at presentation. CONCLUSION: BRUNT grading correlates with both AST and ALT levels. However, neither necroinflammatory grades nor serum transaminase values at first presentation are predictors of the duration to normalisation of liver enzymes in NASH patients managed with lifestyle modifications,Item Peritoneal fluid cytology in ovarian carcinoma(Sri Lanka Medical Association, 2000) Hewavisenthi, S.J.de S.OBJECTIVES: 1. Determine the sensitivity of cytology in the detection of spread of ovarian carcinoma to the peritoneum. 2. Determine whether tumour size, type and differentiation, and the volume and nature of the peritoneal fluid are related to the presence of metastasis. METHOD: Peritoneal fluid cytology specimens in 28 consecutive malignant tumours were studied with respect to size of tumour, and volume and presence of blood in the peritoneal fluid. The accompanying omentectomy specimens were examined for deposits. RESULTS: 12 out of 28 ovarian carcinomas had histologically proven omental deposits. Of these only 7 were cytologically positive for malignant cells. Only I specimen was cytologically positive in the absence of histological evidence of peritoneal deposits. 10/12 carcinomas with histologically proven deposits were accompanied by > 1000 ml of blood stained peritoneal fluid. We did not find a correlation between tumour size, type and differentiation and the presence of metastatic spread. The sensitivity of cytological assessment of spread of ovarian carcinoma was 66.6%. However cytology was 100% specific. CONCLUSION: The sensitivity of cytological assessment of peritoneal fluid in the detection of peritoneal spread was low (measured against histologically proven omental deposits). The fluid volume and presence of blood appear related to tumour spread, while tumour size, type and differentiation were unrelated.Item Do pathologists and clinicians understand each other?(Sri Lanka Medical Association, 2000) Hewavisenthi, S.J.de S.; Fernando, W.P.A.OBJECTIVE: Pathologists use many phrases in histopathology reports to convey the level of diagnostic certainty. This could be variably interpreted by the clinician. Our study was carried out to determine the level of diagnostic certainty the pathology report conveys to a clinician, their preferences, and the frequency of usage of these phrases. METHOD: A questionnaire constructed using the 13 most frequently encountered phrases in pathology reports was circulated among 15 pathologists and 15 clinicians. Both groups were asked to score the level of diagnostic certainty of each of these phrases. Pathologists were asked to comment on the frequency of usage and clinicians their preference for each of these phrases. RESULTS; 'Consistent with' and 'those/that of were the most commonly used phrases (73%). There was variation in the interpretation of both these phrases amongst the pathologists. A high degree of diagnostic certainty was conveyed to 100% of the clinicians by the former and only 73% by the latter. 'Diagnostic of and 'Characteristic of were the phrases most commonly preferred by the clinicians (86%). There was concordance in interpretation of the former phrase between both groups. But this phrase was used frequently only by 20% of the pathologists and occasionally by 33%. CONCLUSION: A wide individual variation in interpretation of phrases exist among both groups. Therefore a limited number of mutually acceptable phrases or a "single line" conclusion is recommended.