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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Author: search.filters.author.Munasinghe, B.N.L.

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    A study of the relationship between the internal jugular vein and carotid artery assessed under direct vision and ultrasonically in surgical patients and in cadavers
    (Sri Lanka Medical Association, 2017) Munasinghe, B.N.L.; de Silva, M.T.D.; Gunetilleke, M.B.
    INTRODUCTION & OBJECTIVES: Use of anatomical landmarks to cannulate the internal jugular veins is fraught with danger due to variations in the relative positions of the common carotid artery (CCA) and the internal jugular vein (IJV). Objective of the study was to identify anatomical variations of the relative positions of the IJV and CCA. METHODS: This was a descriptive cross-sectional study carried out from October 2012 to July 2014 at the NCTH, Ragama. The anatomy was evaluated either ultrasonically or under direct vision. Relationship of the IJV to the CCA was recorded at three levels (sternoclavicular junction-SCJ, cricoid cartilage-CC and upper border of thyroid cartilage lamina-TCL), on the right (R) and left (L) sides. RESULTS: A total of 216 participants (60 male: 156 female; median age 48 years, range 16 to 75) consisting 192 patients (89%) and 24 cadavers (11%) were included. Patients were undergoing either neck USS at the radiology department (144, 67%), central venous catheterisation under USS guidance (22, 10%) or thyroidectomy (30, 14%). At all three levels IJV was lateral to the CCA in a majority (SCJ level: R 66.5%, L 29%; CC level: R 80%, L 85%; TCL level: R 89%, L 76%). IJV was anterior to the CCA at the SCJ level in a proportion of the sample (R 11.5%, L 22%) and antero-lateral in another proportion (R 20%, L 48%). CONCLUSION: Aberrant anatomical relations between the IJV and CCA are not uncommon. Reliance solely on a technique which assumes normal anato y can lead to damage to the CCA.
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    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.
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    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.
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    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.