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 Anatomical variations of the common peroneal nerve (cpn) and the deep pereoneal nerve (dpn) in the lateral compartment of the leg: A cadaveric study(College of Surgeons of Sri Lanka, 2015) Salgado, L.S.S.; Karunanayake, A.L.; Hasan, R.; Salvin, K.A.; Fernando, E.D.P.S.; Ranaweera, M.S.L.; Padeniya, A.G.P.M.; Senevirathne, S.P.; Ranaweera, K.R.K.L.K.INTRODUCTION: The aim of this study is to demonstrate anatomy of CPN and DPN in the lateral compartment and identify high risk area/s which is important in high tibial osteotomy, in total knee arthroplasty, in external fixation of leg and CPN decompression surgery. MATERIAL AND METHODS: Thirty cadaveric legs (female-14, male-16) were dissected to demonstrate the bifurcation of the CPN and the exit point of the DPN from the lateral compartment. The ethical clearance was obtained. RESULTS: None of the specimens showed bifurcation of the CPN proximal to the apex of the fibular head. Musculoaponeurotic fibular arch at the entrance to the fibular tunnel was confirmed in all specimens. The mean distance from the apex of the fibular head to the opening of the fibular tunnel was 28.4mm (SEM±1.4mm). Of 30 specimens respectively 21(70%), 7(23.33%) and 2(6.66%) had bifurcation vertically distal to, on and proximal to the entry point with the average of 8.0mm and 12.0mm from the entry point. Eleven legs had muscular branches of the DPN in the lateral compartment of the leg. The mean exit point of the DPN/its longest muscular branch was observed 66.5mm (SEM±2.6mm) distal to the apex of the fibular head. CONCLUSIONS: Variations of the CPN bifurcation in relation to the fibular tunnel and muscular branches of the DPN in the lateral compartment were observed. From the apex of the fibular head, distance of 25.6mm-71.6mm was identified as the high risk area for surgeries involving in the upper part of the lateral compartment.Item Anatomical variations of the musculocutaneous nerve - A cadaveric study(College of Surgeons of Sri Lanka, 2015) Padeniya, A.G.P.M.; Salgado, L.S.S.; Hasan, R.; Fernando, E.D.P.S.; Ranaweera, R.M.S.L.; Abeysuriya, V.; Karunanayake, A.L.; Salvin, K.A.; Siriwardana, S.A.S.R.; Balasooriya, B.M.C.M.; Alahakoon, A.M.D.K.INTRODUCTION: The musculocutaneous (MC) nerve commences from the lateral cord of the brachial plexus, passes inferolaterally and pierces the coracobrachialis while innervating it. It then descends between biceps and brachialis muscles, innervating both and continues as the lateral cutaneous nerve of the forearm. Few studies have been done with regard to variations in origin, course, branching pattern, termination and communications of the MC nerve. These variations are important for anatomists, clinicians, anesthetists and surgeons to avoid unexpected complication as these variations have clinical significance during the surgical procedures and in diagnostic clinical neurophysiology. Therefore the aim of this paper was to study the anatomical variations of the MC nerve. MATERIAL AND METHODS: This descriptive cross sectional study was carried out in the Department of Anatomy, Faculty of Medicine, University of Kelaniya. Dissections were carried out on 50 upper limbs of 25 cadavers to record anatomical variations of the MC nerve. RESULTS: MC nerve was present only in 46(92%) upper limbs. Of the 46 upper limbs where the MC was present, one (2%) did not pierce the coracobrachialis. Communications were seen between MC and median nerve in 06(13%) samples of which 1(17%) was proximal and 5(83%) were distal to the point of entry of the MC into the coracobrachialis and in 4(9%) upper limbs MC nerve rejoins with the median nerve. CONCLUSIONS: It is evident that significant anatomical variations of the MC nerve exist in our study. These variations emphasize the complexities and irregularities of this anatomical structure with regard to surgical approaches.Item Variants of acan gene associate with severity of lumbar disc degeneration(Sri Lanka Medical Association, 2016) Perera, G.L.R.S.; Wijayaratne, L.S.; Senarath, U.; Dissanayake, P.H.; Karunanayake, A.L.; Dissanayake, V.H.W.INTRODUCTION AND OBJECTIVES: Structural integrity of aggrecan (coded by ACAN gene) plays a major role in lumbar disc degeneration (LDD). Single nucleotide polymorphisms (SNPs) of ACAN gene have been implicated in LDD. The study aimed to determine the associations between SNPs of ACAN gene and the severity of disc space narrowing (DSN) and osteophytes (OS) of lumbar spine in patients with chronic mechanical low back pain (CMLBP). METHOD: A descriptive cross-sectional study was carried out on 120 patients with CMLBP. Lateral lumbar X-rays were assessed for severity of DSN and OS using a semiquantitative scores (grade 0-3). Twenty-seven exonic SNPs of the ACAN gene were genotyped on a Sequenom mass array iPLEX platform. Multiple linear regression analysis was carried out adjusting for age and body mass index. RESULTS: Mean age was 51.46 ± 10.43 years. 82 (68.3%) were females. 30 (25%) were obese. 31 (25.8%) and 47 (39.2%) had grade 1 DSN and AOS respectively, while 42 (35%) and 13 (10.8%) had grade ≥ 2 DSN and AOS, respectively. “A” allele of rs2882676 (regression coefficient (β) = -0.25, p<0.03), “A” allele of rs1042630 (β = -0.28, p<0.01) and “T” allele of rs1042631 (β = -0.28, p<0.02) were negatively associated with the severity of DSN. “T” allele of rs16942341 (β = 0.4, p<0.02) and “G” allele of rs28407189 (β = 0.4, p<0.02) were positively associated with the severity of AOS. CONCLUSION: SNPs of ACAN gene are associated with severity of degenerative changes of the lumbar spine.Item Gross anatomical variations of lumbar vasculature among Sri Lankan adults: a cadaveric study(Sri Lanka Medical Association, 2003) Karunanayake, A.L.; Jayasinghe, J.A.P.; Wijayaratne, L.S.; Pathmeswaran, A.BACKGROUND: Lumbar arteries supply intervertebral discs, vertebrae, muscles and ligaments in the lumbar region. Lumbar arteries can get damaged during urological and vascular surgery. According to textbooks of anatomy there are four pairs of lumbar arteries arising as individual stems from abdominal aorta and they travel posterior to crura of the diaphragm. There are no published studies in Sri Lanka either confirming this or describing the variations of lumbar arteries. OBJECTIVE: To describe the anatomy of lumbar arteries with regard to their numbers, origin and pathway. MATERIALS AND METHODS: This descriptive study was done on cadavers in anatomy departments of Kelaniya, Colombo and Sri Jayawardenepura Universities. Lumbar arteries were cleared from the origin of the abdominal aorta up to the point of passing deep to the Psoas major muscle. Their origin, number and pathway were noted. RESULTS: Dissected 109 cadavers. Ages ranged 43 -90 years. Mean age 70 years (SD 13.6). Males constituted 57% of the sample. The number of lumbar arteries varied from 3-5 pairs. In 12% of cadavers lumbar arteries originated as a common stem from the aorta and divided into two. These arteries traveled anterior to crura of the diaphragm in 17% of cadavers. CONCLUSIONS: There were variations with regard to the number, origin from abdominal aorta and pathway of lumbar arteries from what is described in textbooks. These findings will be useful for surgeons performing retroperitoneal surgery.Item Radiological features of chronic low back pain (LBP) in adult Sri Lankans; A case control study(Sri Lanka Medical Association, 2003) Karunanayake, A.L.; Fonseka, M.M.D.; Pathmeswaran, A.; Wijayaratne, L.S.BACKGROUND: Chronic LBP affects 30% of adult Sri Lankans. The presence of vertebral osteophytes, spondylolisthesis and disc space narrowing are thought to be important contributing factors of LBP. No studies have been done in Sri Lanka, investigating the importance of these in LBP. Objective: To determine the association between chronic LBP and vertebral osteophytes, spondylolisthesis and disc space narrowing. MATERIALS AND METHODS: A case control study was done in two hospitals in Ragama. Cases and controls were selected from medical, surgical and orthopaedic wards and clinics. They were matched for age and sex. Subjects who were 18 years and above with chronic LBP (more than three months) were selected as cases. Patients who were 18 years and above without LBP were selected as controls. They had symptoms such as abdominal pain and dysuria requiring radiography. In both groups postero-anterior and lateral radiographic appearances of the lumbar spine were studied. RESULTS: There were 130 cases and 130 controls. Age range was 18 -82 years. Mean age of patients was 49.3 years (SD 15). Mean age of controls was 51.4 years (SD 17). Females constituted 62% of cases and controls. Vertebral osteophytes were present in 72% of cases and 64% of controls (P = 0.184). Spondylolisthesis was present in 8% of cases and 7% of controls (P = 0.959). Disc space narrowing was present in 15% of cases and 2% of controls (OR = 7.8, P =0.0004). CONCLUSIONS: Disc space narrowing was significantly higher in patients with LBP.Item Effect of atherosclerosis on lumbar intervertebral disc cells in a sample of Sri Lankan population: a postmortem study(Sri Lanka Medical Association, 2004) Karunanayake, A.L.; Pathmeswaran, A.; Wijayaratne, L.S.; Fonseka, M.M.D.BACKGROUND: Disc degeneration is an important cause of low backache. The cartilage cells of the disc are important to maintain the structure and function of intervertebral discs. Lumbar arteries provide blood supply to lumbar discs. OBJECTIVE: To describe the association between cell density of fourth lumbar intervertebral disc and atherosclerotic changes of fourth lumbar artery openings. METHODS: Descriptive study was done on 4th lumbar intervertebral disc and 4lh lumbar arteries of postmortem specimens. H&E sections were prepared on the annulus fibrosus of lumbar discs. Atherosclerotic changes of lumbar artery openings were studied. By using a graticule number of cells per 4mm" were counted in each disc specimen in ten low power fields and mean cell density was calculated. Cell density of less than three was categorized as low cell density. Atherosclerotic changes of lumbar arteries were graded into three groups according to severity. Grade 1 was the least severe and grade 3 was the most severe. The chi-square for trend was used to find the association between the atherosclerotic changes of lumbar arteries and the cell density. RESULTS: 31 postmortem specimens. Age range 21 - 96 years. Median age 43 years. There was a significant association (P = 0.005) between atherosclerotic changes of lumbar arteries and low cell density. OR for gradcl, grade 2 and grade 3 was I, 4.5 and 18 respectively. CONCLUSIONS: Atherosclerotic changes of lumbar arteries had a significant negative association with the cell density.Item Association between pain and disability in patients with chronic mechanical low back pain(Sri Lanka Medical Association, 2015) Perera, G.L.R.S.; Wijayaratne, L.S.; Senarath, U.; Dissanayake, P.H.; Karunanayake, A.L.; Dissanayake, V.H.W.INTRODUCTION AND OBJECTIVES: Low back pain is the leading cause of years lived with disability in developed countries as well as in South Asian countries. The aim of this study is to evaluate the association between the intensity of pain and disability in patients with chronic mechanical low back pain (CMLBP) who attended the rheumatology clinic, National Hospital of Sri Lanka (NHSL). METHOD: This is a descriptive study on 675 patients with CMLBP who attended the rheumatology clinic, NHSL, from May 2012 to May 2014, recruited according to inclusion and exclusion criteria. Intensity of pain was measured using the 101-point numerical pain rating scale (NRS) and the disability was measured using the modified Oswestry Disability Index (MODI). A multiple linear regression model adjusted for age, gender, level of education, duration and frequency of pain and duration of treatment was used to assess the association between the intensity of pain and disability. RESULTS: Majority (482, 71.4%) were females. Mean age was 49.19 ± 11.75 years. Mean score for NRS was 46.79 ± 20.38 and for MODI was 31.77 ± 14.16, while 84.3% had daily pain. Intensity of pain was positively associated with the disability (p<0.01) and the standardized regression coefficient was +0.627 after adjusting for confounders. Frequency of pain, female gender and aging were positively associated with disability (p<0.05) while level of education, and durations of pain and treatment did not reach significant level. Conclusion: Intensity of pain explains 63% of the disability associated with CMLBP. Frequency of pain, female gender and age were also associated with disability.Item Prevalence of osteoporosis in a sample of Sri Lankan urban population(Sri Lanka Medical Association, 2008) Karunanayake, A.L.; Salgado, L.S.S.; Abeysuriya, V.; Fernando, S.; Herath, H.M.R.P.; Kumarendran, B.; Premaratna, B.A.H.R.; Mahawithanage, S.T.C.BACKGROUND: Osteoporosis is characterized by low bone mineral density and deterioration in the micro architecture of bone. It predisposes individuals to increased risk of fractures of the hip, spine and other skeletal sites. Peripheral DEXA (P-DEXA) scans are ideal for mass screening of bone mineral density (BMD). OBJECTIVE: To determine the prevalence of osteoporosis and osteopenia in a sample of urban Sri Lankans. DESIGN, SETTING AND METHODS: A descriptive cross sectional study was conducted at the Faculty of Medicine, University ofKelaniya from July 2007 to October 2007. The study subjects were selected from 22 Gramasevaka Niladhari Divisions of the Ragama MOH area. From each division, people aged 35 to 65 years were randomly selected from the voters list and invited to participate in the study. A P-DEXA scan was used to measure the BMD of the left middle finger. A T score of <-2.5 was considered as osteoporosis, -1 to -2.5 as osteopenia. These two categories together were considered low BMD. A T score of > -1 was considered normal. RESULTS: There were 731 subjects with a mean age (SD) of 52.5 (7.5) comprising 60% females. The prevalences of osteoporosis and osteopenia were 14% and 29% respectively. 20% of females and 6% of males were affected with osteoporosis. The prevalence of osteoporosis was 7% among those <50 years and 20% among those >50 years. CONCLUSION: There was a high prevalence of low BMD in this urban population. Prevalence of low BMD was higher among females and those over fifty years.Item Is osteoporosis more common among adult Sri Lankans with inflammatory bowel disease (IBD)?(Sri Lanka Medical Association, 2008) de Silva, A.P.; Karunanayake, A.L.; Dissanayaka, T.G.I.; Dassanayake, A.S.; Duminda, H.K.K.T.; Pathmeswaran, A.; de Silva, H.J.BACKGROUND: IBD is a recognized risk factor for osteoporosis among Caucasians. Although the incidence of IBD seems to be increasing in Asians, there are no data on osteoporosis in Asian patients. Objective: To determine whether osteoporosis is more common among adult Sri Lankans with IBD. DESIGN, SETTING AND METHODS: Consecutive patients with previously diagnosed IBD who were older than 30 years and age and sex matched controls from the general population (3 controls for I patient) were screened for osteoporosis using a previously validated peripheral DEXA scan. Patients who were pregnant, had other significant co-morbidities, were on caicium supplements or on treatment for osteoporosis within the past 6 months were excluded. RESULTS: There were 86 IBD patients (55 females, mean age 46.4 years) and 258 controls (165 females, mean age 47.3 years). Osteoporosis was significantly more common among IBD patients (14.7%) than controls (6.5%) (P=0.048). Increasing age (P=0.019), female gender (P=O.OOS), menopause (P=0.022) and use of systemic steroids (P= 0.008) were found to be significantly associated with osteoporosis among JBD patients, while severity of disease (PKK470), number of relapses (P=0.391), duration of illness (P=0.540) and treatments other than systemic steroids (P=0.434) were not. Osteoporosis did not differ significantly between patients with ulcerative colitis (14.28%) and Crohn's disease (15.79%) (P=0.891). CONCLUSION: Osteoporosis is more common among adult Sri Lankans with IBD than community controls. The use of systemic steroids is a disease related independent risk factor for development of osteoporosis in these patients.Item Association between the intima media thickness of lumbar arteries and the cell density of lumbar intervertebral discs: a postmortem study among Sri Lankan adults(Sri Lanka Medical Association, 2005) Karunanayake, A.L.; Pathmeswaran, A.; Fonseka, M.M.D.; Wijayaratne, L.S.BACKGROUND: Disc degeneration is an important cause of low backache. Cartilage cells help to maintain the structure of the disc. The lumbar arteries provide blood supply to the lumbar discs. The tunica media affects the mechanical properties of the vessel wall and thereby control the blood supply to the tissues. OBJECTIVES: To describe the association between the intima media thickness (expressed as a percentage of total thickness) of 4th lumbar artery and the mean cell density of the 4th lumbar disc. METHODS: Descriptive cross sectional study was done on 4th lumbar discs and 4th lumbar arteries of postmortem specimens. H&E sections were prepared on the annulus fibrosus of lumbar discs and lumbar arteries. By using a graticule number of cells per 4mm2 were counted in each disc specimen in ten low power fields and the mean cell density was calculated. With a graticule measurement of intima media thickness (IMT) and total thickness of lumbar arteries were taken on each artery specimen in ten low power fields. Mean of IMT expressed as a percentage of TT was calculated. Correlation coefficient was calculated to find out the association between the IMT and the mean cell density. RESULTS: Postmortem specimens of 31 subjects aged between 21-96 years (mean age 46 years. SD 19 years) were examined. 24 were males. There was a significant association between the IMT and the cell density (r = 0-37, P< 0.05). CONCLUSIONS: IMT of lumbar arteries had a significant positive association with the cell density.