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 Characteristics and survival of advanced untreated hepatocellular carcinoma of non-viral etiology(Indian Society of Gastroenterology, 2024) Ekanayaka, S.P.N.; Luke, N.; Thilakarathne, S.B.; Dassanayake, A.; Gunetilleke, M.B.; Niriella, M.A.; Siriwardana, R.C.INTRODUCTION AND OBJECTIVES Hepatocellular carcinoma (HCC) is an aggressive tumor and presents late. The underlying etiology of HCC is changing rapidly. HCC in Sri Lanka is unique due to its predominant non-viral etiology (nvHCC) but lacks survival data.METHOD Data was collected from patients who presented with HCC from 2011 to 2018. There were 560/568 (98.6%) nvHCC. The patients who were not candidates for tumor-specific treatment (149/560 [26.7%]) were selected. Population characteristics, demographic data, tumor characteristics, survival and factors affecting survival were analyzed.RESULTS The median age was 64 years (range 30-88) and 86% (n = 129) were males. As many as 124 (83%) were cirrhotic. The overall performance score was 80%. Nearly 21/124 tumors were detected in cirrhotic screening. Tumors were single nodular in 32 (21%), up to three nodules in 28 (18%), more than three nodules in 33 (22%) and diffusely infiltrating in 56 (37%). The major venous invasions were present in 78 (52.3%). Extra-hepatic tumor spread was seen in 19 (12.7%) (lungs 13 [72.2%], bones 2 [11.1%]). The median survival of patients receiving palliative care was three months (1-43 months). Tumor size and cirrhotic status were significant predictors in univariate analysis.CONCLUSION A quarter of nvHCCs were not amenable to treatment at presentation as they had dismal survival.Item A Case of persistent portal hypertension following ligation of a large porto - systemic shunt during cadaveric donor liver transplantation(Sri Lanka Medical Association., 2020) Siriwardana, R.C.; Shanthanayagam, N.; Gunetilleke, M.B.; Weerasuriya, A.P.; Niriella, M.A.; Dassanayake, A.S.; Dissanayake, R.No abstract availableItem Local infiltration versus laparoscopic-guided transverse abdominis plane block in laparoscopic cholecystectomy: double-blinded randomized control trial(Springer, 2019) Siriwardana, R.C.; Kumarage, S.K.; Gunetilleke, M.B.; Thilakarathne, S.B.; Wijesinghe, J.S.BACKGROUND: Transverse abdominal plane block (TAP) is a new technique of regional block described to reduce postoperative pain in laparoscopic cholecystectomy (LC). Recent reports describe an easy technique to deliver local anesthetic agent under laparoscopic guidance. METHODS: This randomized control trial was designed to compare the effectiveness of additional laparoscopic-guided TAP block against the standard full thickness port site infiltration. 45 patients were randomized in to each arm after excluding emergency LC, conversions, ones with coagulopathy, pregnancy and allergy to local anesthetics. All cases were four ports LC. Interventions-Both groups received standard port site infiltration with 3-5 ml of 0.25% bupivacaine. The test group received additional laparoscopic-guided TAP block with 20 ml of 0.25% bupivacaine subcostally, between the anterior axillary and mid clavicular lines. As outcome measures the pain score, opioid requirement, episodes of nausea and vomiting and time to mobilize was measured at 6 hourly intervals. RESULTS: The two groups were comparable in the age, gender, body mass index, indication for cholecystectomy difficulty index and surgery duration. The pain score at 6 h (P = 0.043) and opioid requirement at 6 h (P = 0.026) was higher in the TAP group. These were similar in subsequent assessments. Other secondary outcomes were similar in the two groups. CONCLUSION: Laparoscopic-guided transverses abdominis plane block using plain bupivacaine does not give an additional pain relief or other favorable outcomes. It can worsen the pain scores.Item Hepatocellular carcinoma in Sri Lanka - where do we stand?(College of Surgeons of Sri Lanka, 2013) Siriwardana, R.C.; Liyanage, C.A.H.; Gunetilleke, M.B.Hepato-cellular carcinoma (HCC) is the sixth commonest cancer and third in cancer-related mortality worldwide. There are no published reports on the pattern of HCC in Sri Lanka. North Colombo Liver Unit maintains a prospective database of 105 HCC patients from September 2011. HCC was diagnosed based on characteristic radiological appearance. Best form of treatment was decided by a multidisciplinary team (MDT). Median age at presentation 63 (12 - 79) years. 87% (n=93) males. 45% (n= 47) had alcohol consumption above safe limits .41% (n=53) had diabetes. Cirrhosis was present in 79% (n=83) .median Model for End Stage Liver Disease (MELD) score 12 (4-22); Childs- Pugh class A 45% (n=37), Childs- Pugh class B or C 55% (n=46)]. A biopsy was necessary in 7 (6.6%) while others were diagnosed on radiology .62.5% had AFP level above the reference range (> 10 ng/ml). 51(49%) had a single modality, 17 (16%) had combined treatment and the rest had no treatment. The overall mean survival was 15 months. Majority of HCCs in Sri Lanka were among males and is likely to be secondary to NASH related cirrhosis. Majority of the tumours were diagnosed at late stage.