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 Prolapsed haemorrhoids and anorectal manometry - do haemorrhoids prolapse due to reduction in the anorectal pressures ?(Sri Lanka Medical Association, 1998) Samarasekera, D.N.; Suraweera, P.H.R.Abstract AvailableItem Anatomy of the gall bladder in Sri Lankan population : a warning to the laparoscopic surgeon.(Sri Lanka Medical Association, 1998) Samarasekera, D.N.; Welgama, U.INTRODUCTION : Minimally invasive surgery has advanced rapidly to involve resection of almost all abdominal organs. Out of all these procedures, laparoscopic cholccystectomy has become the operation of choice for the removel of gall bladder and has stood the test of time. AIM : Since we started laparoscopic cholecystectomy procedure in our unit, this study was designed to document the possible variations that we may encounter in the Sri Lankan population. MATERIAL AND METHODS : Seventy five fresh non selected adult cadavers (within 24 hours of death) were dissected, Exclusion criteria were those with crush injuries to the liver and previous hcpato-biliary surgery. Findings were documented according to a standard proforma. FINDINGS : Normal anatomy was seen in 22 ( 29.3%) bodies. Documented abnormalities given in the text books were seen in 45 (60% ). Eight (10.6%) new abnormalities were detected in our study GB - 0, cystic duct - 5, cystic artery - 7). CONCLUSIONS : Altogether nearly seventy percent of the cadavers showed developmental anomalies. Therefore a thorough knowledge of all these anomalies is essential for the surgeon performing laparoscopic cholecystectomy to avoid iatrogenic injury.Item Electrogastrography (EGG) and gastric motility: an investigation to evaluate gastric emptying in those who undergo oesophago -gastric anastomosis without a pyloroplasty(Sri Lanka Medical Association, 1998) Samarasekera, D.N.; Suraweera, P.H.R.; de Silva, H.J.; Dissanayake, A.S.INTRODUCTION: EGG is a non-invasive technique of recording gastric myoelectrical activity by placing electrodes on the abdomen. Objectives : The aim of this study was to assess the myoclcctrical activity of the stomach following ocsophago-gastric anastomosis without a pyloroplasty and also to correlate the values with those who develop symptoms of gastric stasis. DESIGN,SETTING AND METHODS : We present the initial results of an ongoing study. EGG results of six patients (M:F=5: 1) with carcinoma of the oesophagus who underwent transhiatal oesophagectomy were analysed. Mean age was 56y (range 45-76). EGG was performed preoperatively and three months after surgery using computerised digitrapher EGG (Syncctics, UK). One patient complained of symptoms of gastric stasis and reflux and did not respond to therapy with prokinetic agents. She underwent subsequent pyloroplasty and is asymptomatic at present. RESULTS : All patients showed normal preoperative myoelectrical activity (mean - + 131.17 mv) and motility. Postopcratively all patients showed bradygastria and low myoelectrical activity. Postoperative myoelectrical activity in the asymptomatic group showed a value which was positive (mean - +94.12mv) compared to the symptomatic patient who had a persistent mean negative value (- 89.34 mv). CONCLUSIONS : Persistent negative amplitude in the EGG postoperatively may indicate severe gastric stasis. This may be due to poor contractiliy of the denervatcd stomach in some patients. Therefore pyloroplasty should be considered before these patients develop complications of stasis and reflux.Item Hepatic venous drainage : are we Sri Lankans different from rest of the world ?(Sri Lanka Medical Association, 1998) Samarasekera, D.N.; Welgama, U.; Kumara, G.M.C.J.OBJECTIVES : As there is no documented study for the Sri Lankan population, our study was mainly aimed at re-evaluating the hepatic venous drainage. DESIGN,SETTING AND METHODS : Seventy five non selected fresh adult cadavers (within 24 hours of death) were dissected. Those with crush injuries to the liver, abdominal scars or previous hepatobiliary surgery were excluded. Findings were documented according to a standard proforma. All abnormalities were photographed, RESULTS : Male to female ratio was 65 : 10. All three communities were represented in the study (Sinhalese:Tamil,Muslim - 63:3:2). Mean age was 49 years (range 18-81). Normal pattern of hepatic venous drainage as given in the text books was not seen in any of the cadavers. Altogether 70 (93.3%) cadavers revealed major abnormalities. Most striking abnormality was a separate vein draining the caudate lobe directly into the JVC in 47 (62.8%) cadavers. CONCLUSION : Our study indicates that the surgeon should not expect the "normal anatomy" when dealing with hepatic veins. Since the majority of our patients had a separate vein draining the caudate lobe directly into the IVC, this may be considered the norm rather than a variation. Whether it is found only in our population can only be confirmed by conducting multi ethnic and multi national studies.vOBJECTIVES : As there is no documented study for the Sri Lankan population, our study was mainly aimed at re-evaluating the hepatic venous drainage. DESIGN,SETTING AND METHODS : Seventy five non selected fresh adult cadavers (within 24 hours of death) were dissected. Those with crush injuries to the liver, abdominal scars or previous hepatobiliary surgery were excluded. Findings were documented according to a standard proforma. All abnormalities were photographed, RESULTS : Male to female ratio was 65 : 10. All three communities were represented in the study (Sinhalese:Tamil,Muslim - 63:3:2). Mean age was 49 years (range 18-81). Normal pattern of hepatic venous drainage as given in the text books was not seen in any of the cadavers. Altogether 70 (93.3%) cadavers revealed major abnormalities. Most striking abnormality was a separate vein draining the caudate lobe directly into the JVC in 47 (62.8%) cadavers. CONCLUSION : Our study indicates that the surgeon should not expect the "normal anatomy" when dealing with hepatic veins. Since the majority of our patients had a separate vein draining the caudate lobe directly into the IVC, this may be considered the norm rather than a variation. Whether it is found only in our population can only be confirmed by conducting multi ethnic and multi national studies.Item Role of oesophageal manometry and pH studies in the diagnosis of endoscopy negative upper gastrointestinal disorders(Sri Lanka Medical Association, 1999) Samarasekera, D.N.; Gunawardena, P.A.H.A.; de Silva, H.J.Dysphagia and symptoms of gastro-oesophageal reflux disease (GOPD) are common upper gastrointestinal (Gl) symptoms. However a significant proportion of these patients do not have any endoscopic or radiological abnormalities. Therefore, they are most often labeled as having a "motility disorder" or sometimes as "functional", without any objective assessment OBJECTIVES: To assess the oesophageal motility and the pH in symptomatic patients with normal upper Gl endoscopy results. METHODS: Twelve patients with dysphagia and four patients with symptoms of GORD were assessed (n=16) over a period of 20 months {1.1.97 to 30.8.98). Measurements were recorded using a computerized oesophageal pressure/pH transducer (Synectics, UK). RESULTS: Male:Femaie = 7:9. Median age was 52 (range 42-75) years. MotiNty studies indicated oesophageal hypomotility in 3 (19%), early achalasia 2 (13%), and normal motility in 7 (43%) patients. Twenty four hour pH monitoring revealed marked GO reflux in 2 (13%) patients and normal values in 2 (13%) patients.CONCLUSIONS: Since a significant proportion (44%) of our patients showed a positive result, we conclude that manometry and pH studies of the oesophagus are mandatory in the diagnosis of patients with persistent dysphagia and reflux symptoms as most motility disorders cannot be diagnosed only on endoscopy or radiology alone.