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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2004 - 200972010 - 20179

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Author: search.filters.author.Liyanage, C.A.H.Has files: No

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Now showing 1 - 10 of 16
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    Diffuse-Type Hepatoma: A grave prognostic marker
    (Karger Medical and Scientific Publishers, 2017) Siriwardana, R.C.; Liyanage, C.A.H.; Gunetilleke, B.; Niriella, M.A.; de Silva, H.J.; Dassanayake, A.S.; Jayatunga, S.P.
    BACKGROUND: Data on diffuse-type hepatocellular carcinoma (HCC) are rare. HCC in Sri Lanka is rising, and the majority is related to nonalcoholic fatty liver disease. This study was planned to compare nodular- and diffuse-type HCC in this cohort. METHODS: CT scans of 227 patients with HCC negative for infective hepatitis were analyzed and grouped as nodular and diffuse from July 2011 to July 2014. Diffuse-type cancer was defined as a tumor without convex/distinct margin, diffusely infiltrating the hepatic parenchyma. There were 45 (20%) cases. The baseline liver functions, etiology, treatment, and the outcome were compared with nodular-type cancers. Stage III diffuse cancers were matched with 2 stage III nodular cancers looking at the T stage and background liver. RESULTS: There was no difference in the age (63 vs. 62 years, p = 0.937) and gender. Diffuse cancers had a low BMI (24 vs. 22, p = 0.009), a higher alpha fetoprotein (AFP) level (p < 0.001), a higher incidence of major vascular invasion (14 vs. 80%, p < 0.001), and a history of significant alcohol consumption (39 vs. 67%, p = 0.001). The baseline liver functions were similar in diffuse and nodular cancers. A large proportion (27 vs.77%, p < 0.001) of diffuse cancers were not candidates for active treatment. Overall survival was poor in the diffuse type(4.7 vs. 25 months, p < 0.001). Diffuse-type stage III cancers had a poor survival compared to matched nodular cancers (2.5 vs. 15.8 months, p = 0.001). CONCLUSION: HCC without a background of infective hepatitis were common in our cohort. These tumors are associated with high AFP levels, major vascular invasion, and a poor prognosis.
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    Recurrence of graft steatosis after liver transplantation for cryptogenic cirrhosis in recently commenced liver transplant program
    (Springer India, 2016) Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.A.H.; Gunetilleke, B.; de Silva, H.J.
    Non-alcoholic fatty liver disease (NAFLD) seems to recur in at least one third of patients transplanted for non-alcoholic steatohepatitis (NASH)-related cirrhosis. While, NASH recurrence does not seem to affect overall graft and patient survival up to 10 years, cardiovascular and infection-related morbidity and mortality seem to be increased in these patients. This report looks at the graft histology in patients who were transplanted for NASH-related cirrhosis after short-term follow up. We report a high prevalence of recurrent NAFLD in liver grafts post-transplant among five patients. The degree of steatosis noted among the recipients is alarming.
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    Non-alcoholic fatty liver disease among potential live liver donors-a preliminary experience from Sri Lanka
    (Springer India, 2014) Silva, H.; Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.A.H.; Gunetilleke, B.; de Silva, H.J.
    No abstract available
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    Major hepatectomy for hepatoma invading the main portal vein
    (College of Surgeons of Sri Lanka, 2013) Siriwardana, R.C.; Liyanage, C.A.H.; Bulathsinhala, B.K.S.
    No Abstract Available
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    Cryptogenic cirrhosis is the leading cause for listing for liver transplantation in Sri Lanka
    (Springer India, 2013) Siriwardana, R.C.; Niriella, M.A.; Liyanage, C.A.H.; Wijesuriya, S.R.E.; Gunetilleke, B.; Dassanayake, A.S.; de Silva, H.J.
    Hepatitis B and C are rare in Sri Lanka. Nonalcoholic fatty liver disease is increasing in the country. Eighty-one patients referred for liver transplantation (LT) over a period of 18 months were prospectively evaluated. Ninety-two percent (n = 74) were males. Cryptogenic cirrhosis was the leading indication for LT (58%, n = 47) followed by alcohol in 27% (n = 33). Hepatitis B and C were not seen in our cases. The liver biochemistry and clinical status of cirrhosis were similar in cryptogenic and alcoholic cirrhotics. Fourteen patients died while waiting for transplant, and nine transplants were performed. Cryptogenic cirrhosis is the leading cause for LT in Sri Lanka.
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    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.
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    Eversion thrombectomy for partial portal vein thrombosis during living donor liver transplantation
    (College of Surgeons of Sri Lanka, 2012) Siriwardana, R.C.; Wijesuriya, S.R.E.; Liyanage, C.A.H.
    No Abstract Available
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    Clopidogrel and surgical intervention: A point to ponder
    (College of Surgeons of Sri Lanka, 2011) Chandrasinghe, P.C.; Liyanage, C.A.H.
    No Abstract Available
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    Clopidogrel and surgery "be aware"
    (College of Surgeons of Sri Lanka, 2010) Liyanage, C.A.H.; Jayaweera, K.K.D.G.; Deen, K.I.
    INTRODUCTION: Clopidogrel has been used more recently to prevent thrombosis in occlusive arterial disease. It is known that clopidogrel increases bleeding during surgery. We performed a questionnaire survey of surgeons in Sri Lanka regarding their experience with clopidogrel. OBJECTIVES: To share the experience of surgeons from diverse fields regarding surgery on patients on clopidogrel. METHOD: A retrospective descriptive study was performed using a questionnaire. RESULTS: 48 completed questionnaires were received. 21 (44%) Surgeons reported complications relating to clopidogrel. Spontaneous haemorrhage was reported by 8, which manifested as ecchymotic patches in the majority. Most surgeons 36 (75%) preferred aspirin over clopidogrel and 10 (21%) opted for clopidogrel. The majority recommend stopping of clopidogrel at least for 14 days. However, the opinions of the rest varied from 7 to 28 days. CONCLUSIONS: Surgeons felt clopidogrel has the potential to cause complications following surgery. Majority were of the opinion that it is safe practice to stop clopidogrel for at least 14 days which is more than the 5 days recommended by the formularies. A significant majority were comfortable to have the patient on aspirin compared with clopidogrel.
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    A New technique for suture rectopexy without resection for rectal prolapse
    (Springer-Verlag, 2009) Liyanage, C.A.H.; Rathnayake, G.; Deen, K.I.
    BACKGROUND: We surmised that if rectopexy was performed without dissection of the lateral rectal stalks in patients with full-thickness rectal prolapse and normal preoperative transit, sigmoid resection may not be required. This study evaluated a new approach to abdominal suture rectopexy for rectal prolapse. METHODS: A total of 81 patients (57 male, 24 female; median age 37 years, range 5-82 years) with rectal prolapse were assessed by clinical examination, anal manometry (maximum resting pressure, MRP, and squeeze pressure, MSP) and radioopaque marker transit studies. Of the 81 patients, 70 with normal preoperative transit underwent suture fixation alone, without resection, performed under spinal anaesthesia, through a 7-cm transverse left lower quadrant incision gaining access to the presacral space via a left pararectal "window", preserving the lateral stalks. RESULTS: Average surgical time was 50 min, mortality was zero, and morbidity was 9% (three patients with wound infection, four with urinary retention). Anal incontinence improved in 43 of 53 patients (81%, p=0.001). MRP and MSP had improved at 3 months after surgery: MRP from a mean of 27.6+/-1.4 mmHg (range 2-30 mmHg) before surgery to 32.5+/-2.21 mmHg (2-60 mmHg) after surgery (p=0.008); MSP from 69.25+/-6.4 mmHg (8-153 mmHg) before surgery to 79+/-4.77 mmHg (35-157 mmHg) after surgery (p=0.001).. Transit was unchanged in 18 of 20 patients (90%) who were evaluated before and after surgery; none was constipated after surgery. At 56 months, prolapse had recurred in five patients (7%). CONCLUSION: Abdominal suture rectopexy with a left pararectal approach without sigmoid resection in those with normal preoperative transit resulted in an improvement in anal incontinence and satisfactory long-term control of prolapse. The operation did not alter transit and did not result in significant constipation