Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item A Synopsis of surgical training in Sri Lanka: the present(The College of Surgeons of Sri Lanka, 2021) Chandrasinghe, P.Second of a three part series based on personal correspondence with Dr. Upali Banagala, Prof. Ranil Fernando and Dr. Ranjan Dias on their experience and memories of surgical training in Sri Lanka.Item A Synopsis of surgical training in Sri Lanka: the past(The College of Surgeons of Sri Lanka, 2021) Chandrasinghe, P.First of a three part series based on personal correspondence with Professors Arjuna Aluwihare, A.H. Sherriffdeen and Channa Rathnathunga on their experience and memories of surgical training in Sri Lanka.Item Fistulizing Crohn's disease(Mosby Inc., 2020) Lightner, A.L.; Ashburn, J.H.; Brar, M.S.; Carvello, M.; Chandrasinghe, P.; Van Overstraeten, A.D.B.; Fleshner, P.R.; Gallo, G.; Kotze, P.G.; Holubar, S.D.; Reza, L.M.; Spinelli, A.; Strong, S.A.; Tozer, P.J.; Truong, A.; Warusavitarne, J.; Yamamoto, T.; Zaghiyan, K.No abstract availableItem Transanal ileal pouch-anal anastomosis for ulcerative colitis has comparable long-term functional outcomes to transabdominal approach: a multicentre comparative study(Elsevier Science., 2020) Chandrasinghe, P.; Carvello, M.; Wasmann, K.; Foppa, C.; Tanis, P.; Perry-Woodford, Z.; Warusavitarne, J.; Spinelli, A.; Bemelman, W.BACKGROUND:The transanal approach to ileal pouch-anal anastomosis (Ta-IPAA) provides better access to the lower pelvis with lower short-term morbidity in ulcerative colitis (UC). The aim of this study was to assess the long-term functional outcomes after Ta-IPAA versus transabdominal IPAA (Abd-IPAA) in UC.STUDY DESIGN:A multicentre cohort analysis was done between March 2002 and September 2017. Patient characteristics, surgical details and postoperative outcomes were compared. CGQL (Cleveland global quality of life) score at 12 months with a functioning pouch was considered the primary endpoint.RESULTS:A total of 374 patients (100 Ta-IPAA vs 274 Abd-IPAA) were included. Ta-IPAA demonstrated a comparable overall quality of life (CGQL score) to Abd-IPAA (0.75 ± 0.11 vs 0.71 ± 0.14; respectively, p=0.1). Quality of life (7.71 ± 1.17 vs 7.30 ± 1.46; p=0.04) and energy level items (7.16 ± 1.52 vs 6.66 ± 1.68; p=0.03) were significantly better after Ta-IPAA, while the quality of health item was comparable (7.68 ± 1.26 vs 7.64 ± 1.44; p=0.96). Analysis excluding anastomotic leaks did not change the overall CGQL scores. Stool frequencies (>10/ 24 hrs:22% vs 21%; p=1.0) and the rate of single episode of major incontinence during the 12-month period (27% vs 26%; p=0.89) were similar. The differences in thirty-day morbidity rates (33% vs 41%; p=0.2) and the anastomotic leak rates were not significant (6% vs 13%; p=0.09). CONCLUSION AND RELEVANCE:This study provides evidence of comparable long-term functional outcome and quality of life after Ta-IPAA and Abd-IPAA for UC.Item Technical variations and feasibility of transanal ileal pouch-anal anastomosis for ulcerative colitis and inflammatory bowel disease unclassified across continents.(Springer-Verlag, 2018) Zaghiyan, K.; Warusavitarne, J.; Spinelli, A.; Chandrasinghe, P.; Di Candido, F.; Fleshner, P.PURPOSE: Initial reports of transanal ileal pouch-anal anastomosis (taIPAA) suggest safety and feasibility compared with transabdominal IPAA. The purpose of this study was to evaluate differences in technique and results of taIPAA in three centers performing taIPAA across two continents. METHODS: Prospective IPAA registries from three institutions in the US and Europe were queried for patients undergoing taIPAA. Demographic, preoperative, intraoperative, and postoperative data were compiled into a single database and evaluated. RESULTS: Sixty-two patients (median age 38 years; range 16-68 years, 43 (69%) male) underwent taIPAA in the three centers (USA 24, UK 23, Italy 15). Most patients had had a subtotal colectomy before taIPAA [n = 55 (89%)]. Median surgical time was 266 min (range 180-576 min) and blood loss 100 ml (range 10-500 ml). Technical variations across the three institutions included proctectomy plane of dissection (intramesorectal or total mesorectal excision plane), specimen extraction site (future ileostomy site vs. anus), ileo-anal anastomosis technique (stapled vs. hand sewn) and use of fluorescence angiography. Despite technical differences, anastomotic leak rates (5/62; 8%) and overall complications (18/62; 29%) were acceptable across the three centers. CONCLUSIONS: This is the first collaborative report showing safety and feasibility of taIPAA. Despite technical variations, outcomes are similar across centers. A large multi-institutional, international IPAA collaborative is needed to compare technical factors and outcomes.Item The MACC1-SPON2 axis: a new biomarker and therapeutic target in colorectal cancer(Nature Publishing Group, 2017) Chandrasinghe, P.; Stebbing, J.; Warusavitarne, J.In this issue of the Journal, Schmid et al identify Spondin 2 (SPON2) as a prominent downstream signaling target of metastasis-associated in colon cancer 1 (MACC1) in colorectal cancer (CRC). It is shown that SPON2 mediates MACC1-induced CRC cell proliferation, invasion and metastasis in vitro and in vivo, while its high expression correlates with adverse disease free survival in clinical samples. Therefore, not only does this study shed further light into the complexity of colorectal carcinogenesis, but it also puts forward a potential novel prognostic biomarker to predict high-risk tumors before they metastasize. The MACC1/SPON2 axis may also have utility beyond an indicator of tumor aggressiveness and lends itself as a promising therapeutic target for colorectal and potentially other solid tumors.Item Development of a model of three-dimensional imaging for the preoperative planning of TaTME(Springer, 2018) Sahnan, K.; Pellino, G.; Adegbola, S.O.; Tozer, P.J.; Chandrasinghe, P.; Miskovic, D.; Hompes, R.; Warusavitarne, J.; Lung, P.F.C.Item Role of SMAD proteins in colitis-associated cancer: from known to the unknown(MacMillan Press, 2018) Chandrasinghe, P.; Cereser, B.; Moorghen, M.; Al Bakir, I.; Tabassum, N.; Hart, A.; Stebbing, J.; Warusavitarne, J.Small mothers against decapentaplegic (SMAD) proteins are a family of signal transduction molecules in transforming growth factor β (TGFβ) ligand pathways that have been found to have a key role in the pathogenesis of inflammatory bowel disease (IBD). Long standing IBD predisposes individuals to colitis-associated colorectal cancer (CAC), an entity that possess unique characteristics compared to hereditary and sporadic cancer. The ligands of the TGFβ super family along with SMADs have also been implicated in several aspects of colorectal cancer formation. SMAD proteins are shown to be involved in a number of potentially carcinogenic mechanisms such as altering gene transcription, controlling stem cell differentiation to causing epigenetic changes. Modulation of these proteins has emerged as a novel therapeutic intervention for IBD although its effect on carcinogenesis remains elusive. This account reviews available evidence linking SMAD proteins to CAC and explores the potential areas for future research in this area.