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 Hepatitis B virus markers in primary hepatocellular carcinoma(Faculty of Medicine, University of Peradeniya, Sri lanka, 1994) de Silva, H.J.; Ratnatunga, N.; Ramadasa, S.Based on serological studies, Sri Lanka has a relatively low Hepatitis B virus (HB V) [hepatitis B surface antigen (HBsAg)] carrier rate of 0.9% and a low prevalence of HBV (5-10%) among patients with primary hepatocellular carcinoma (PHC). To investigate this further we looked for HBV markers in PHC using more sensitive immunoliistochemical methods. Formalin fixed paraffin embedded tissue obtained from 18 PHCs were studied. Only 7 of the specimens contained non-tumour liver tis¬sue around the PHC, and evidence of cirrhosis was seen in 5 of them. Four micron thick sections of tissue were stained, with polyclonai antibod¬ies directed against HBsAg and hepatitis B core antigen (HBcAg) using a three stage immunoperoxidase technique (peroxidase-anti peroxidase). Positive control liver tissue was used in all experiments. HBsAg was detected in6(33.3%)of the 18 specimens (in the tumour tissue only in 3 speci¬mens, tumour tissue and surrounding cirrhotic liver tissue in 1. and surrounding cirrhotic liver tissue only and not in tumour tissue in 2 speci¬mens). The staining was cytoplasrnic. HBcAg was not detected in any of the tissue specimens tested. Nodatareg;irding serum alphafetoprotein levels were available from the patients medical records. From the preliminary results of this on going study, HBsAg markers appear to be more frequently associated with PHC than serological studies from Sri Lanka have indicated. HBV may, therefore, have arnore important aetiologi-cal role in PHC in this country than was previ¬ously believed.Item Effect of music on blood pressure in healthy young men(Faculty of Medicine, University of Peradeniya, Sri lanka, 1994) de Silva, A.P.; de Silva, H.J.; Fonseka, C.It is widely believed that listening (.0 music quietly is relaxing and therefore tends to reduce blood pressure (BP). To test this hypothesis we performed a cress-over study in 30 healthy Sinhalese male volunteers (non-smokers) aged between 23 and 25 years. None ol" them, were on any medication and all were requested not to consume coffee or a similar beverage for at least two hours prior to the test. Each individual rested silting for five minutes before the ex¬periment, and then listened to light classical music of his choice while sitting quietly for 30 minutes. BP was measured before and after listening to music. He was then allowed to engage in normal activities for one hour and the experiment was repeated, this time without music, where the person just sat quietly for 30 minutes in the same room. The systolic and diastolic BP differences were recorded for each person. Subjects were not allowed to fall asleep during the experiment and all experiments were performed between 1 and 4 pm to reduce the possible effect, if any, of diurnal variation in BP. There was no difference in diastolic BP either with or without music. Systolic BP dropped by a mean of 8 rnm (range 4-10) when listening to music and by a mean of 7 mm (range4-10) when sitting quietly without music (P>0.5, Mann-Witney U test). We conclude that listening to light music by itself does not reduce BP signifi¬cantly in normal individuals. Any reduction that occurs is probably a result of the subject sitting quietly while listening to the music.Item The Recto-Anal Inhibitory Reflex (RAIR): abnormal response in diabetics suggests an intrinsic neuro-enteropathy(BMJ Publishing, 1997) Deen, K.I.; Premaratna, R.; Fonseka, M.M.D.; de Silva, H.J.INTRODUCTION: The recto-anal inhibitory reflex (RAIR) is characterized by reflex relaxation of the anal canal in response to electrical stimulation of the rectal mucosa, and is mediated by nitrergic neural plexuses within the gut wall. Impairment of this reflex may lead to incontinence. AIM: To measure anal canal pressures, anal mucosal electrosensation and RAIR in diabetic patients and correlate these measurements with incontinence for gas or faeces. METHODS: Anal canal pressure, RAIR and continence was evaluated in 30 diabetic patients [Male:Female=13:17, median age 57 years (range 37- 70)], and these data were compared with similar data obatained from 22 age and sex matched 'healthy' controls [Male:Female= 9:13, median age 51 years (range 19 - 65 )]. Median duration of diabetes was 8 years (range 3 -30 ). 12 (40%) of the 30 diabetics had impaired continence for gas (n=12) and liquid faeces (n=3). None ofthe controls had incontinence. RESULTS: Maximum resting anal canal pressure (MRP) was [median (range)]: Patients 30mmHg (20-75) vs. Controls 40mmHg (20-105), P=0.61. Maximum squeeze pressure (MSP) [median (range)]: Patients 65mmHg (30- 150) vs. Controls 84mmHg (35-230), P=0.59. Threshold rectal mucosal eletrosensation (RMES-T) [median (range)]: Patients 27 mA (5-40) vs. Controls l3mA (5-28), P=0.03. Maximum tolerable rectal mucosal electrosensation [median (range)]: Patients 40 mA (20-60) vs. Controls 20 mA (10-30), P=0.042 (all comparisons using Wilcoxon rank test). RAIR was present in 8, abnormal in 5 (1 with incontinence), and absent in 17 (II with incontinence) diabetics while it was present in 18 and abnormal in 4 controls (test of proportion, P=0.03 I). CONCLUSIONS: RAIR was impaired in significantly more patients with diabetes than controls implying impairment of intrinsic neuronal function. All diabetic patients with incontinence had impaired or absent RAIR. Impairment of this reflex may be a useful predictor of incontinence in diabetics.Item The recto-anal inhibitory reflex (rair): abnormal response in diabetics suggests an intrinsic neuro-enteropathy(Sri Lanka Medical Association, 1997) Deen, K.I.; Premaratna, R.; Fonseka, M.M.D.; de Silva, H.J.INTRODUCTION: The recto-anal inhihilory reflex (RAIR) is characterized by reflex relaxation of die anal canal in response to electrical stimulation of the rectaJ mucosa, and is mediated by nitrergic neural plexuses within the wall. Im-painnent of this reflex may lead lo incontinence. AIM: To measure anal canal pressures, anal mueosal electrosensation and RAIR in diabetic patients and corre¬late these measurements with incontinence for gas or faeces. METHODS: Anal canal pressure, RAIR and continence was evaluated in 30 diabetic patients [Male : Female = 13:17, median age 57 years (range 37 - 70) ], and these data were compared with similar data obtained from 22 age and sex matched 'healthy' controls [Male:Female = 9:13,age51 years (range 19-65)]. Median duration of diabetes was 8 years(rangc 3-30). 12 (40%) of Uic 30 diabetes had impaired continence for gas (n = 12) and liquid faeces (n =3). None oi'the controls had incontinence. RESULTS : Maximum resting anal canal pressure (MRP) was [median (range)]: Patients 30 mml Ig (20 -75) vs. Controls 40mmHg (20-105). P=0.61. Maximum squeeze pressure (MSP) [median (range)] : Patients 65 mmllg (30-150) vs. Controls 84mmHg (35 -230), P = 0.59. Threshold rectal mueosal elec(rosensation (RMES-T) [median(range)]: Patients 27 mA (5-40) vs. Controls 13mA (5-28), P = 0.03. Maximum tolerable rectal mueosal electrosensation [median(rangc)]: Patients 40mA (20-60) vs. Controls 20mA (10-30), P=0.042 (all comparisons using Wiicoxon rank test). RAIR was present in 8, abnormal in 5 (1 with inconti¬nence), and absent in 17 (11 with incontinence) diabetics while it was present in 18 and abnormal in 4 controls (testof proportion, P = 0.031). CONCLUSIONS: RAIR was impaired in significantly more patients with diabetes than controls implying impairment of intrinsic neuronal function. All diabetic patients with incontinence had impaired or absent RAIR. Impairment of this reflex may be a useful predictor of incontinence in diabetics.Item Psychometric analysis and emotional state in the irritable bowel syndrome (ibs)(Sri Lanka Medical Association, 1997) Kuruppuarachchi, K.A.L.A.; Deen, K.I.INTRODUCTION: Data are lacking on psychometric scores and the emotional state in Sri Lankan patients with the irritable bowel syndrome. AIM: To evaluate patients with IBS using a Hospital Anxiety Depression (I IAD) scale and to assess the accuracy of clinical prediction of the emotional state by a non psychia¬trist clinician. METHODS: Data from 30 patients (20 male, median age - 27 years, range 20 - 50) with IBS titling me manning criteria were compared with 44 age and sex matched controls without IBS. Anxiety rating (median, range) was : Patients 11 (5-17) versus Controls 6 (1-17); P<0.05. Depression rating was : Palients 7 (2 -14 ) versus Controls 5 (0-16) P>0.05, Wilcoxon lest. Prediction of emotional state in patients with IBS correlated well with HAD scores in 17 (56%), was inaccurate in 6 (20%) and equivocal in 7 (24%). All patients in whom clinical prediction of emotional state was inaccurate had combined high anxiety and depression scores. CONCLUSION: Sri Lankan patients with IBS have greater prevalence of anxiety state disorders compared with controls. Clinical prediction of the emotional state by an untrained physician was inaccurate. The HAD scale may be of value in clinical decision making for patients with the irritable bowel syndrome associated with emotional state disorders.Item New bone formation in fractured head of the femur. A study using the scanning electron microscope(Sri Lanka Medical Association, 1997) Jayasinghe, J.A.P.INTRODUCTION: In senile osteoporosis, thinning and loss of irabeculae in tlie proximal end of ilie lemur leads to hip fractures. New bone formation in ihe form of thickening of remaining irabeculae and microcallus formation around stressed and cracked trabeculae has been demonstrated to occur both before and after fractures. I lowever, formation of an effective trabecular architecture to compensate for lost bone lias not been demonstrated to date. OBJECTIVE: To assess new bone formation in head of Jhe femur associated with hip fracture. METHOD: Femoral heads removed from 22 patients (15 fe¬males 8 males aged from 58 to 82 years) were fro/en and cut into 4 mm thick sections. Macerated specimens were made superficially anorganic by treating them with 1 lydro-gen Peroxide; coated with Platinum and examined under a Scanning Electron M icroscope. RESULTS: Microcallus formation on irabeculae showing different morphological appearance was evident in most specimens. Evidence of bone remodelling was observed on surfaces of these calluses. Irregular deposition of mineral nodules was seen on the fracture face of five specimens indicating that they may have been deposited after the fracture has occurred. The presence of growing trabecular patterns made up of woven bone from ihe remaining irabeculae was observed in six specimens; a phenomenon hitherto not described. Their morphology suggested dial they have been growing before the fracture has occurred. CONCLUSION: The findings suggest a reparalory mechanism resulting in growth of new interconnected trabcculae occurring prior to tlie fracture in a femoral head consequent to bone thinning in senile osteoporosisItem Utrastructural changes of foetal surface of the placenta in hypertensive disorders of pregnancy(Sri Lanka Medical Association, 1997) Salgado, S.; Angunawala, P.; de Tissera, A.OBJECTIVES : The pathogenesis of pregnancy induced hypertension and its relationship to pathological and ullrastructural changes of the placenta has not been adequately understood We studied placenta! (issue from foetal side to show whether there are any significant ullrastructural changes. This area of the placenta has not been studied previously. METHODS: Placenial tissue from 15 pregnant mothers with a persistent blixxi pressure of 140/90 or more, and 10 normal mothers who had normal full term deliveries were studied. Fresh placentae were examined macroscopically. 2mm sized section were taken from (lie central, foetal surface and fixed in 2% gluteraldehyde lor electron microscopic studies. RESULTS: 9 months had pregnancy induced hypertension without proteinuria, 3 had hypertension and proteinuria and oilier 3 had essential hypertension. All hypertensive placenta showed increased number of cytotrophoblast cells. Syncytiotrophoblast cells of the hypertensive placenta showed Jess number of lipoid droplets, compared to the controls. Syncliotrophoblast cells of the test group also showed short, blunt and swollen microvilli. All hypertensive placentae except one, showed thickened, laminated and irregular subirophoblasu'c basement membranes and increased amount of interestitial collagen in the villous stroma CONCLUSIONS: In electron microscopic study of normal and hypertensive placentae revealed that the placentas of hypertensive disoalers pregnancy is associated with increased number of cytotrophoblast cells, thickening of subtrophoblastic basement membrane, abnormal microvilli, and increased amunt on interestitial collagenItem Altered pelvic floor physiology in women with uterovaginal prolapse (UVP)(Sri Lanka Medical Association, 1997) Deen, K.I.; Gunasekara, P.C.INTRODUCTION: Although an association between Uterovaginal prolapse (UVP) and urinary incontinence is known, the prevalence of anoreetal dysfunction in UVP remains largely unexplored. AIM: To evaluate the prevalence of u re ih roves Seal and anorectal dysfunction in UVP. METHODS: 27 women (median age - 52 years, range 31 - 68 years) with UVP were evaluated by functional and anoreetal physiologic assessment. Data were compared with 20 age matched controls without UVP. Urethrovesical fimcfion was assessed by a 5 point functional score (micturitition frequency, nociuria, urgency, stress incontinence and residual sensation of urine), where 0- no dysfunction, 1,2-minimal, 3,4 - moderate and 5 implied severe dysfunction. Anoredal function was evaluated by clinical assessment and anoreetal physiology. Anal canal pressures were measured by microballoon manomelry. RESULTS : Moderate to severe urethrovesical dysfunction was seen in 33% of patients compared with none of (lie control group (P = 0.052, test of proportions). Anorectal mucosal prolapse was seen in 63% of patients compared with 13% of controls (p = 0.045, test of proportions). Maximum resting (MRP) and squeeze anal pressures (MSP) did not differ significantly between patients and controls. MRP [median, (range)] - Patients; 51 mm Hg (20 - 87) vs. Controls; 60mm 1 Ig (25 - 80), P>0.05; MSP [median, (range)] - Patients; 82 mm Hg (39 - 165) vs. Controls; 100mm Ilg (60 - 185, p>0.05, Wiieoxon test. However, the length of Hie high pressure zone (I IPZ) was significantly less in patients compared with controls (111*2 I cm - Patients = 56% vs. IIPZ 1cm - Controls = 10%, P=0.038, test of proportions). Abnormal anal electroscnsilivity (> 14 inAmps) was seen in 52% of patients compared with none in the control group (P=0.024) and abnormal vaginal electrosensation (> 12mAmps) in 55% of patients vs. 10% Of controls (P = 0.031), test of proportions. CONCLUSION: A greater proportion of women with UVP exhibited either urethrovcssical or anoreetal dysfunction or both compared with controls indicating a pan-pelvic floor weakness. Theses abnormalities should be considered in overall management of women with UVPItem Stroke subtypes in Sri Lanka(Sri Lanka Medical Association, 1997) Gunatilake, S.B.; Premawardhena, A.AIM: Data on stroke subtypes in Sri Lanka are limited. This is due to the unavailability of brain imaging facilities in most government hospitals in the country. In two leading private hospitals in Colombo, a high proportion of stroke patients are subjected to computerised tomography (CT) scanning. Therefore it was decide to study the stroke patients admitted to these two hospitals to determine the stroke subtypes METHODS: A prospective study of 103 consecutive first -ever stroke patients who were under the eare of the first author during the period 15lhMay 1995 lo30th August 1996 were studied. Diagnosis of stroke was made according to the WI10 definition. Transient ischaemic attacks (TIA) were not included in the study. The pathological subtype was confirmed by CT scan in 99 patients RESULTS: The age of the patients ranged from 37 to 94 years (mean 65y). 87 patients were over the age of 50 years. The proportion of pathological subtypes confirmed by CT scanning was cerebral infarction (CI) 74%, intracerebral haemorrhage (ICH) 19% and subarachnoid haemorrhage (SAII) 6%. Of the 74 infarcts 31 (23%) were cortical, 30 (22%) were lacunar, 12(9%) were cerebellar and brains tern and 1 (0.7%) was a border zone infarct, In-hospilal mortality was 19% for all strokes: 14% for infarcts and 35% for haemorrhages. Mortality was lowest in (he lacunar stroke group (3%). In the cortical infarct group the mortality was 16%, in the ICH group 22% and in the SAM group 50%. CONCLUSION: Direct comparisons with stroke subtypes seen in other countries are not possible due to differences in methodology. In developed countries in the West cerebral infarcs account for about 80% of alI first-ever strokes and of these 13 to 21% are lacunar strokes. Countries in the East like Japan and Hongkong have reported higher proportion of haemorrhages; 27% of first-ever strokes in Hong Kong. In Sri Lanka The proportion of stroke subtypes seem to be intermediate between these countries from die west and east. Lacunar .stroke .seem to be commoner in Sri Lanka than in other countries. These differences may be because of differences in risk factors prevalent in our country.Item Interaction between pericytes and endothelial cell of foetal capillaries in hypertensive placentae(Sri Lanka Medical Association, 1998) Salgado, S.; Angunawela, P.; Sirisena, J.; de Tissera, A.INTRODUCTION : Pericytes and endothelial cells are known to possess direct contacts in many parts of the vascular tree. Pericytes are known to have modulating effects on endothelial cell growth and differentiation. It is possible that some pericytes are a source of new endothelial cell. OBJECTIVES : Information regarding the ultrastructural changes of foetal capillaries of hypertensive placentae is lacking. Therefore we studied the foetal capillaries of hypertensive placentae to ascertain any significant ultrastructural interaction between pericytes. endothelial cells and basement membrane. METHOD : Placental tissue from 15 pregnant mothers with a blood pressure of 140/90 or more and 10 normal mothers who had normal full term deliveries were studied. Fresh placentae were examined and 2mm sized pieces were taken from central foetal and fixed in 2% gluteraldehyde for eletron microscopic studies. RESULTS : All hypertensive placentae showed a number of pericytic processes, which was significantly higher than in normal placentae. (P<0.001). Both frequency and complexity of direct connections between endothelial cells and pericytes appear to be increased in foetal capi 1 laries of hypertensive placentae . Basement membranes of foetal capillaries in 9 hypertensive placentae showed marked thickening. CONCLUSIONS : There was complexed interaction between endothelial cells and pericytes of foetal capillaries of hypertensive placentae.