Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item The Rambewa bus bomb, a clinico-pathological review(College of Surgeons of Sri Lanka, 2001) Banagala, A.S.K.; Ariyaratne, M.H.J.BACKGROUND : Exposure to an explosion produces a well-defined pattern of injury. A retrospective study of the pattern of injury sustained by the victims of a blast in a vehicle has been undertaken. METHOD: Injuries sustained by the eight (08) patients who died on the spot were obtained,with permission, from the records of the Judicial Medical Officer. Injuries of those who survived initially, including the two (02), who succumbed to their- injuries after admission to the hospital, were gathered from the hospital records. RESULTS: The dead had all suffered multiple system injuries and or traumatic amputation of lower extremity whilst most survivors suffered skeletal injuries alone. Two (02) of the survivors had penetrating abdominal injuries together with skeletal injuries. CONCLUSION: Presence of multiple system injuries and/or traumatic amputation of limbs are a poor prognostic indicator in a blast scenario. Haemorrhage was the most frequent life-threatening problem among the survivors.Item The Value of sentinel node biopsy in breast cancer(College of Surgeons of Sri Lanka, 2012) Ariyaratne, M.H.J.; Jayatunge, D.N.U.No Abstract AvailableItem Exploring infections as an aetiological agent of breast carcinoma(College of Surgeons of Sri Lanka, 2012) Ariyaratne, M.H.J.Breast cancer currently enjoys the position of being the commonest cancer in females worldwide [1] and indeed in Sri Lanka. In 2005 breast cancer contributed to 14.3% of all cancers reported island wide and 25.4% of all female cancers [2]. Many aetiological factors have been discovered with a strong focus on hereditary forms of breast cancer [3]. However, these contribute only to 5-10% of breast cancers overall. Environmental, socio-economic, hormonal and radiation factors have also been shown to contribute to the aetiology. An emerging area of interest is the role of infectious agents in breast cancer aetiology. The global burden of infectious agents causing cancer is 16- 18% [4]. Most of these infection related cancers occur in developing countries and are due to treatable infections caused by Hepatitis B virus (HBV), Hepatitis C virus (HCV), Human Papilloma virus (HPV), Helicobacter pylori,Epstein Barr virus (EBV) and Cytomegalovirus (CMV). The aim of this article is to give an overview of infectious agents linked to carcinomas and their association with breast cancer.Item Current concepts in management of chronic wounds(College of Surgeons of Sri Lanka, 2010) Chandrasinghe, P.C.; Ariyaratne, M.H.J.No Abstract AvailableItem New concepts of breast cancer aetiology(College of Surgeons of Sri Lanka, 2009) Ariyaratne, M.H.J.; Dilesha, W.A.L.No Abstract AvailableItem The Prevalence of colorectal cancer and survival in patients from the Gampaha District, North Colombo region(Sri Lanka Medical Association, 2008) Perera, T.; Wijesuriya, S.R.E.; Suraweera, P.H.R.; Wijewardene, K.; Kumarage, S.K.; Ariyaratne, M.H.J.; Deen, K.I.INTRODUCTION: The prevalence and survival of colorectal cancer in Sri Lankans has not been previously reported. We did a retrospective and a prospective survey, in the region of North Colombo, Sri Lanka between 1992 and 2004. The aim was to study cancer burden, sites of colorectal cancer and survival after surgery. PATIENTS AND METHODS: The records of 175 patients with colorectal cancer between 1992 and 1997 in the selected region of were analysed retrospectively. A prospective study was performed in 220 new patients with colorectal cancer between 1996 and 2004. Data evaluated were demographics, tumour stage and survival. RESULTS: Between 1992 and 1997 the crude annual incidence of colorectal cancer was 1.9 per 100,000, which increased over the years. The current national crude annual incidence is 3.2 per 100,000 in women and 4.9 in men. Median age at presentation was 60 years with similar prevalence of cancer in men and women. In the entire group, 28% of cancers were in those less than 50 years old. Survival at 2 and 5 years was 69% and 52%. The majority of cancer related deaths were within the first 2 years after surgery. CONCLUSION: The burden of colorectal cancer in Sri Lanka is on the rise. Up to a third of cancers occur in those under 50 years, and the majority of cancers are in the rectum or rectosigmoid region. Flexible sigmoidoscopy offers a useful screening tool.Item Sexual and urinary dysfunction following rectal dissection compared with segmental colectomy(Wiley-Blackwell, 2008) Perera, M.T.; Deen, K.I.; Wijesuriya, S.R.E.; Kumarage, S.K.; de Zylva, S.T.U.; Ariyaratne, M.H.J.INTRODUCTION: The aim of this study was to assess the impact of nerve sparing surgery and major abdominal surgery on sexual and urinary function in men and women with colorectal cancer undergoing rectal dissection and segmental colectomy. METHOD: Forty-eight patients (group A: 22 males, 26 females; median age 55 years) undergoing rectal dissection were compared with 24 having segmental colectomy (group B: 12 male, 12 female; median age 55 years). Preoperative data were also compared with age- and gender-matched controls (group C). RESULTS: More patients after rectal dissection vs segmental colectomy had urinary tract infections [15 (31%) vs 3 (17.5%), P = 0.04]. At 37 months, urinary dysfunction after rectal excision was seen in 29 (60%; 20 men) vs nine (37.5%; eight men) after segmental colectomy. Postoperative urinary symptoms were significant in group A, but not in group B (pre: vs post; groups A and B: poor stream--13%vs 38%, P = 0.001 and 21%vs 21%, P = NS; incontinence--4.2%vs 17%, P = 0.008 and 8%vs 8%, P = NS; hesitancy--13%vs 35%, P = 0.034 and 17%vs 21%, P = NS). Sexual health was worse after rectal excision compared with segmental colectomy (men--62.5%, women--25%vs 44% of men) respectively. Erectile dysfunction was the chief cause (rectal excision--50%vs segmental colectomy - 33%). After rectal excision, 6% of women had dyspareunia and 19% reported reduced orgasm but none after segmental colectomy. Conclusion More men than women had urinary and sexual impairment after rectal excision than after segmental colectomy. Its aetiology is multifactorialItem Complications of loop ileostomy and ileostomy closure and their implications for extended enterostomal therapy: A prospective clinical audit(Pergamon Press, 2008) Rathnayake, M.M.; Kumarage, S.K.; Wijesuriya, S.R.E.; Munasinghe, B.N.L.; Ariyaratne, M.H.J.; Deen, K.I.INTRODUCTION: Patients who have a temporary loop ileostomy have impaired quality of life. Complications associated with a loop ileostomy orileostomy closure will impair patients' quality of life further and require extended enterostomal therapy. We performed a prospective audit of loop ileostomy to ascertain the nature of the workload that may be created with ileostomy-related complications. PATIENTS AND METHODS: One hundred and forty patients (67 males, 73 females, median age 50 years, range 5-90 years) who received a temporary loop ileostomy were analysed after completion of proformas on a prospective basis between 1999 and 2006. RESULTS: Operation was performed for rectal cancer 100 (71%), familial adenomatous polyposis 14 (10%), ulcerative colitis 21 (15%) and for trauma or Hirchsprung's disease 5 (3%). Complications of loop ileostomy were: retraction 1 (0.7%), ileostomy flux 11 (8%), stomal prolapse 1 (0.7%), parastomal hernia 1 (0.7%), paraileostomy abscess 4 (3%) and severe skin excoriation 9 (6%). The loop ileostomy was reversed in 117 (83%) at a median (range) of 13 weeks (1-60). Ileostomy closure-related complications were: small bowel fistula 1 (0.9%), small bowel obstruction 5 (4.3%) and a stitch sinus in 1 (0.9%). Five women developed recto-vaginal fistula (n=3; 2.6%), pouch-vaginal fistula (n=1; 0.9%) and pouch-anal fistula (n=1; 0.9%) that required extended enterostomal therapy, after loop ileostomy reversal. CONCLUSION: Nineteen percent of patients following creation of a loop ileostomy and 10.5% of patients after reversal of the ileostomy requiredextended enterostomal care by a specialized enterostomal therapist, which supported resumption of a normal life.Item Biofeedback with and without surgery for fecal incontinence improves maximum squeeze pressure, saline retention capacity and quality of life(Springer India, 2008) Munasinghe, B.N.L.; Rathnayaka, M.M.G.; Parimalendran, R.; Kumarage, S.K.; de Zylva, S.; Ariyaratne, M.H.J.; Deen, K.I.Item Trap guns injuries in rural Sri Lanka(College of Surgeons of Sri Lanka, 2007) Banagala, A.S.K.; Ariyaratne, M.H.J.BACKGROUND: Trap gun injuries are not uncommon in rural Sri Lanka. They cause considerable morbidity and mortality. Peripheral vascular injuries are encountered frequently among the victims. METHOD: A retrospective analysis of the injuries, methods of treatment, and results was performed. Details of fifty eight (58) patients were studied. Operative details were accurately recorded in a separate log book. Perusal of bed head tickets and the records of the judicial medical officer too helped. RESULTS: Two (02) patients died and six (06) others had amputation of lower limb at different levels. One survivor had severe tourniquet shock syndrome. Twenty eight percent (28%) of patients had wound infection. CONCLUSION: Abdominal injuries carry a high risk of mortality. Lower limb injuries are associated with a high incidence of vascular injuries. Lag time is the single most important factor that affects the outcome of the peripheral arterial injuries. Prognosis of popliteal artery injuries is particularly poor.