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 Paraspinal extramcduallry erythropoiesis- a rare cause of spinal cord compression: two case reports(Sri Lanka Medical Association, 2004) Arambepola, M.; Premawardhena, A.P.; de Silva, S.; Olivieri, N.; Weatherall, D.J.INTRODUCTION: Extrameduallry erythropoiesis (EME) is characterized by the appearance of haemopoietic tissue outside the bone marrow. When EME occurs, albeit rarely, outside the liver and spleen problems may occur. We describe two patients with haemoglobin E- [β thalassaemia who had spinal cord compression, due to EME masses which was reversed with treatment with hydroxyurea and hypertransfusion. PATIENT A: Was a 27year old with HbE -(β thalassaemia. His mean pre transfusion haemoglobin level was 5.5 g/dl. He presented with a six-month history of progressive numbness of his legs. On examination he was found to be paraparetic. The magnetic resonance scan (MRI) showed external compression of the spinal cord between the 4th and 8th thoracic vertebrae. Patient was put on a hypertransfusion regimen and hydroxyurea and made a complete recovery within 4 weeks. Patient B: Was a 9 year old boy with a diagnosis of Haemoglobin E [β thalassaemia who presented with paraplegia which had developed over 3 months. His spinal MRI showed two masses one in the upper thoracic vertebrae and the other at the 1st lumbar level. He was commenced on hydroxyurea and hypertransfusiion to maintain pre-transfusion haemoglobin at >9.5g/dl) and his neurological recover was remarkable. Six months later he had no neurological deficit. DISCUSSION: The above cases highlight the potentially dangerous complications of EME when it involves the spinal cord. They also highlight that even lesions which are sufficiently large to cause complete paraplegia are potentially reversible. Hypertransfusion, hydroxyurea, surgery and previously been used with varying success. The problem remains in deciding the optimal method of management.Item Sensitization patterns of allergens among asthmatics in Sri Lanka(Lippincott Williams & Wilkins, 2007) Weerasinghe, A.; Weerasinghe, S.; Amarasena, M.; Medagoda, K.; Katelaris, C.H.Introduction: The sensitization pattern among asthmatics in Sri Lanka is unknown. Objectives: To determine the sensitization pattern among asthmatics in Sri Lanka. Methodology: The study was carried out in forty physician-diagnosed asthmatic patients. Twenty two non-asthmatics were recruited as controls. Sensitization to 12 allergens was assessed by skin prick test using standardized allergen extracts. A skin wheal diameter, 3mm greater than the negative control was considered a positive reaction. Results: The mean age of asthmatics was 32.4 years (range 9Y59) and 57.5% were males. The mean age of controls was 32.2 years (range 14Y58) and 59.1% were males. The analysis of the data showed that 97.5% asthmatics had positive skin reaction to at least one allergen compared to 72.7% prevalence in the control group. The common allergens among asthmatics were Dermatophagoides pteronyssinus (77.5%), blomia (65.5%), cockroach (55%), storage mite (35%), latex (20%)), cat fur (17.5%), aspergillus (12.5%), grass pollen (12.5%), cow’s milk (12.5%) egg white (10%) cereals (7.5%) and dog hair (5.%). The pattern of sensitization among non-asthmatics was Dermatophagoides pteronyssinus (54.5%), cockroach (50%), blomia (36.4%), aspergillus (36.4%), grass pollen (27.3%), storage mite (22.7%), cow`s milk (18.2%), latex (13.6%), egg white (13.6%), cereals (13.6%), dog hair (9.1%) and cat fur (9.1%). Sixty two percent (n = 25) of the asthmatics had at least one other allergic manifestation while non-asthmatics with other allergic manifestation were 36.4% (n = 8). Other allergic manifestations in the asthmatic group were rhinitis alone 22 (55%), eczema alone 1(2.5%) and both rhinitis & eczema 2(5%) whereas in the non-asthmatic group it was rhinitis alone 7 (31%), eczema alone 0% and both rhinitis and eczema 1(4.5%). The pattern of sensitization for mites alone, cockroaches alone and mites and cockroaches in the asthmatic group with rhinitis (n = 24) was 23 (57%), 11(27%) and 11(27%) and in the non-asthmatic group with rhinitis (n = 7) was 3 (13%), 4 (18%) and 3 (13%) respectively. Conclusion: The results show that mites, and cockroaches are the most common sensitizing allergens in asthmatics and the commonest association of asthma was rhinitis in Sri Lanka.Item Idiopathic pancreatitis: Is it a consequence of an altering spectrum of bile nucleation time?.(BMJ Publishing Group, 2009) Abeysuriya, V.; Deen, K.I.; Navaratne, N.M.M.; Kumarage, S.K.INTRODUCTION: The pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of the microcrystallisation of hepatic bile. AIMS AND METHODS: A prospective case-control study compared 55 patients (symptomatic cholelithiasis, 30: 14 men, 16 women, median age 36 years, body mass index (BMI) 25.1 +/- 0.33 kg/m2; gallstone pancreatitis, nine: six women, three men, median age 35 years, BMI 24.86 +/- 0.23 kg/m2; and idiopathic pancreatitis, 16: seven women, nine men, median age 34 years, BMI 23.34 +/- 0.2 kg/m2) with 30 controls (15 men, 15 women, median age 38 years, BMI 24.5 +/- 0.23 kg/m2, undergoing laparotomy and who had normal gallbladder and no demonstrable stones on ultrasonography). Ultrafiltered bile from the common hepatic duct in patients and controls was anaerobically incubated and examined by polarised light microscopy, for nucleation time (NT). Ethical approval was obtained. RESULT(S): Patients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (established gallstones cumulative mean NT, 1.73 +/- 0.2 vs controls, 12.74 +/- 0.4 days vs, p = 0.001, t test and IP patients mean NT, 3.1 +/- 0.24 days vs controls, 12.74 +/- 0.4 days, p = 0.001, t test). However, NT in those with IP was significantly longer compared with those with established gallstones (mean NT in IP, 3.1 +/- 0.24 SEM days, vs cumulative mean in patients with established symptomatic gallstones, 1.73 +/- 0.2 days, p = 0.002, t test). CONCLUSION(S): NT in bile in patients with IP is abnormal and is intermediate in NT of lithogenic and non-lithogenic bile.Item A new on-table colonic irrigation device- results of a pilot study(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Sabaratnam, V.Y.; Deen, K.I.; Kim, J.H.INTRODUCTION: Management of left colon obstruction either by primary anastomosis or by diversion almost always requires decompression and lavage of the colon. This will facilitate colonic mobilization primary anastomosis, delivery of stoma without contamination and tension free abdominal wound closure. Objective: To examine the results of a new devise that enables on-table he ability to perform concomitant colonoscopy. METHODS: 8 patients (5 males, median age 44 years; range 23 to 78 years) underwent resection of left colon cancer (I), recto-sigmoid cancer (3), and rectal cancer (4). Four were obstructing tumours, while in the remaining 4, full bowel preparation with polyethylene glycol was deemed risky hence requiring intraoperative preparation. The device consisted of a screw-on plastic tube (diameter- 35mm), with an inlet valve and a single outlet for faecal effluent. Following complete irrigation. on table colonoscopy was possible through the inlet. Features assessed were extra intestinal faecal leakage, bowel perforation, irrigation time, volume infused and total time taken. RESULTS: There was no technical problem with introduction and securing the device to the bowel wall. Leakage of faeces was not encountered in a single case. Total time taken for irrigation was (median. range) 20 minutes (8-20), colonoscopy time was 8 and 10 minutes respectively in 2 patients who underwent colonoscopy. 5 underwent primary anastomosis whilst 2 underwent Hartmann operation and I had a Paul-Mickulicz procedure. No anastomotic leakages were detected clinically. No faecal contamination was encountered. All were commenced on oral fluids on day 1 after operation, median time to pass flatus was 2 days (1-3) and discharge from the hospital was (median. range) 8 days (6-12). CONCLUSION: This disposable irrigation device guarantees a complete bowel seal during on-table lavage and ensures complete decompression with bowel cleansing, enabling safe anastomosisItem Accuracy of histopathology reporting in colorectalcancer (crc): we need a proforma(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Siriwardana, P.N.; Rathnayaka, G.; Deen, K.I.INTRODUCTION: The quality of a histopathology report in CRC will determine prognosis and the need for adjuvant therapy. OBJECTIVE: To evaluate the completeness of pathology reports in colorectal cancer.METHODS: In 82 consecutive patients (rectal cancer 47, colon cancer 35) based on the minimum data set by the Royal College of Pathologists, UK. Pathology reports were reviewed by a single person who looked for 17 pathology data sets for colon cancer and 15 for rectal cancer. Completeness of reporting(%) was classified as 40 - 50%, 60 - 70% or 80 - I 00%. RESULTS: 47 of rectal cancer group, 5 (11%) reports were 40-59% complete and 23 (49%) and 19 (40%) were 60-79% and 80-100% complete respectively. In the colon cancer group 04 ( 11.5%), 13.(37%) and 18 (51.5%) were in the categories of 40-59%, 60-79% and 80-100% respectively. The presence or absence of tumour at the resection margin was reported in 91.5%. Information on the distance of tumour to distal resection margin was present in 68% of reports. Apical node involvement was commented in 33%. CONCLUSION: There is a wide variation in the quality of pathology reports in colorectal cancer. We have found a lack of vital data in up to two thirds of the reports.Item Cell kinetics in colorectal carcinoma progression: proliferation or apoptosis?(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Hewavisenthi, S. J.; Obrien, J.; Powe, D.; Zaitoun, A. M.INTRODUTION: The growth and development of tumours depend on the balance between cell proliferation and cell death apoptosis. Since the adenoma - carcinoma sequence is well established in colorectal carcinogenesis it provides an ideal model for the study of this concept. OBJECTIVE: To evaluate the proliferation, apoptosis and the expression of the apoptotic gene P53 in normal (N), adenoma (A). early carcinoma (C) and late carcinoma (LC) and to determine any differences in the above groups.METHODS: 49 ECC arising in adenomas, belonging to Dukes A (pT1) were retrieved from the histopathology files of the Queens Medical Centre. Nottingham. Blocks containing discrete areas of N, A and EC were identified for immunohistochemical staining with MIB I, M30 and P53 to assess proliferation, apoptosis and P53 gene expression. The Proliferation index (Pl), apoptotic index (AI) and P53 labelling index (P53 LI) were derived by counting 500 cells from each of the above tissue regions and giving the number of cells expressing each antigen as a percentage. J 9 LC belonging to Dukes C (pT3 and pT4) were also assessed similarly. The one way analysis of variance (ANOVA) was used to compare the means of Pl, Al and P53Ll among N, A and EC groups and an unpaired T test to compare the EC and LC group . RESULTS: The PIs were (mean+ SD) 17.0 (6.6), 51.6 (12.7), 57.8 (13.2) and 63.5 (8.8) for the groups SN, A, EC and LC respectively (Annova, fvalue=l 87.72 sig P= 0.00 unpaid t test f value 6.078, P=O 16), The Als (mean and range) were 0. 7 (0.09), 1.9( 1.5), 3.1 (2.1) and 3.5 ( 1.9) were for the groups N, A, EC and LC respectively (Annova, fvalue 11.01 sig P 0.00, t test 0.004, P= 0.952). For the four groups ofN, A, EC and LC the P 53 Lis were (mean and SD) 0,6 ( 6.8), 48.9 (21.7), 47.6 (30.7 ), 59.8 (25,3) respectively (Annova. f value=52.55, sig= P0.00 and t test, fvalue 1.002, p== 0,321 ). CONCLUSIONS: The increase in Pl in the N, A, EC and LC group reached a level of statistical significance. The Al and P53LI though different among most groups was not of statistical significance in the A, EC and LC groups signifying that even following malignant transformation cell proliferation keeps increasing whilst a marked change in apoptosis per se is not seen in colorectal carcinoma progression.Item Outpatient flexible Cystoscopy: prospective single centre experience(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Sabaratnam, V. Y.; Ariyaratne, M. H. J.INTRODUCTION: Flexible cystoscopy is performed as an out patient procedure. OBJECTIVE: To audit the our experience of out patient flexible cystoscopy. Methods: Patients presenting with lower urinary symptoms (haematuria, irritability, dysuria, obstructive symptoms, pain, and recurrent urinary tract infection) were prospectively recruited into this study over a two-year period. Flexible cystoscopy was performed under surface anaesthesia using lignocaine 2% gel and single dose intravenous antibiotic prophylaxis (80 mg of Gentamycin if not contraindicated). RESULTS: This study included 552 (400 males) patients.None had complications. In 30 (5.4 %) patients instrument could not be introduced. These patients underwent meatal and urethral dilatation followed by rigid cystoscopy. Prostomegaly was present in 196 patients (49% of Males). Urethral stricture was present in 38 patients (6.8 %). Bladder stone was present in 24 (6.3%) patients. Bladder mucosal abnormality was detected in 59 (11 %). All patients who had mucosal abnormality were subjected to rigid cystoscopy. CONCLUSION: Flexible cystoscopy is a useful minimally invasive investigation with no complication in experienced hands. Commonest abnormalities found were prostomegaly followed by mucosal abnormality in the bladder.Item A comparative study of patients with pancreatic calcification in Sri Lanka(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) de Silva, M.; Selliah, S.; Thabrew, I.INTRODUCTION: Although alcohol abuse is a common cause of pancreatic calcification in the west, a non-alcoholic form called Tropical caicific Pancreatitis (TCP) is recognized in Asian countries.OBJECTIVE: To compare the clinical, biochemical, radiological and endoscopic profiles and success of endotherapy of TCP with Alcoholic Calcific Pancreatitis (ACP). METHODS:Biochemical assay. and ERCPs were performed on 50 patients with pancreatic calcification.There were 28 TCP and 22 ACP in the sample. Mean age of ACP (43.7y SD 8.9) was higher than TCP (37.7 SD 10 p<0/05). ACP was exclusively seen among males.Mean age of onset of pain was lower in the TCP. Nearly 80% of TCP had pain scores more or equal to 7 compared to 54.5% in ACP. Onset of diabetes mellitus in TCP occurred earlier than ACP (34y Vs 40y). Mean serum insulin and duodenal trypsin levels were higher in the TCP patients. On x-ray 85% of TCP had coarse calcium plaques and 71.4% of ACP had speckled plaques. ERCP was successful in nearly 70% of the total sample and 50% underwent stenting. Adequate pain relief was observed in 50% in TCP and 54% in ACP. CONCLUSION:Onset of pain and diabetes mellitus occurred at a younger age in TCP. Although more intraductal plaques were seen in TCP, no difference was observed in the response to endotherapy.Item Is cassava consumption related to tropical calcific pancreatitis in Sri Lanka(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Siva, S.; de Silva, M.; Thabrew, I.INTRODUCTION: Presence of calcification in the pancreas confirms the diagnosis of Chronic Pancreatitis. In the developing countries, a non alcoholic form referred to as Tropical Calcific Pancreatitis (TCP) is been increasingly recognized. An association has been suggested to malnutrition and cassava consumption. OBJECTIVES: To assess the aetiological factors and BMI of TCP patients. METHODS: On 28 TCP patients a detailed questionnaire was administered to collect the aetiological factors. Height and weight measurements were taken. The results were compared with 50 healthy controls and 22 Alcoholic Calcific Pancreatitis (ACP). RESULTS: The mean age of TCP patients and ACP was 34. 7 (SD 10) yrs and 43.7 (SD 8.9) yrs respectively. The percentage with monthly income less than Rs: 5000.00 was high in ACP (70%) compared to TCP (60%) which was similar to control group (58%). TI1e proportion of severe malnutrition {BM! <20) was comparable in TCP and ACP (72%) and was significantly higher (p<0.05) than control group (35%). Regularity of consumption of cassava for last 5 years was significantly (p<0.05) higher in ACP (35%) compared to 19% in TCP, and 4% in the control group. There was no difference in the consumption of red, green chilli, pepper, tea and coffee in the 3 groups. CONCLUSION: The above data indicate higher consumption of manioc by ACP than TCP. A long term study will assist in establishing the association of cassava consumption and malnutrition in Chronic Calcific Pancreatitis.Item Abdominal suture rectopexy without large bowel resection for rectal prolapse does not result in constipation: data from prospective bowel function evaluation, anorectal physiology and transit studies(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Sabaratnam, V. Y.; Rathnayake, G.; Deen, K.I.INTRODUCTION: Traditionally, suture rectopexy has been combined with sigmoid resection for rectal prolapse to prevent postoperative constipation. Furthermore, preservation of lateral ligaments will not result in constipation. Suture rectopexy alone without resection, is being popularised. OBJECTIVE: To study the influence of suture rectopexy without resection on colonic transit and postoperative constipation. PATIENTS AND METHODS: Forty-six patients (median (range) age 32(19-82) years) with rectal prolapse underwent suture rectopexy alone without division of lateral ligaments from March 1999. Prospectively, bowel function and anorectal physiology (ARP) were evaluated before and after surgery in a subset of 15 patients. Follow up (median, range) has been 12 (1-42) months. RESULTS: Follow up was complete in 36 patients. Recurrent prolapse was seen in 5 (full thickness 3 (8.3%); mucosa! prolapse 2 (5.5%)). Physiological data in a subset of 15 patients revealed no significant difference in anorectal physiology before and 3 months after the operation (table). Similarly there was no significant difference in the rate of evacuation of transit markers on day 3 and 5. Maximum resting pressure (median and range) was 25(7-50) mmHg and 33.2(7- 80, P value 0.026) before and after surgery. The median (range) maximum squeeze pressure were 67.5(19-i30) and 90(28 - 157, P 0.!64) before and after surgery. The maximum tolerable volume (ml) was 230 ( ! 80 -340) before surgery and 200 (50-290) after surgery (P. 0.139). Transit (as an excretion percentage) was 100% before and after surgery (P = 0. 197). CONCLUSION: Abdominal suture rectopexy without resection for rectal prolapse improves constipation and does not result in significant change in colonic transit. We recommend this procedure either by open operation or by laparoscopy.