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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Anatomic description of the distal great saphenous vein to facilitate peripheral venous access during resuscitation: a cadaveric study(BioMed Central,London, 2023) Senevirathne, S.A.M.D.R.U.; Nimana, H.K.V.; Pirannavan, R.; Fernando, P.; Salvin, K.A.; Liyanage, U.A.; Malalasekera, A.P.; Mathangasinghe, Y.; Anthony, D.J.The distal great saphenous vein is a popular site for venous access by means of percutaneous cannulation or venous cutdown in a hemodynamically unstable patient. The aim of this study was to precisely define the surface anatomy and dimensions of the distal part of the great saphenous vein to facilitate the aforementioned procedures. Cross-sectional anatomy of the distal saphenous vein was studied in 24 cadaveric ankles sectioned at a horizontal plane across the most prominent points of the medial and lateral malleoli. The curvilinear distance from the most prominent point of the medial malleolus to the center of the saphenous vein, its widest collapsed diameter and skin depth were obtained. The great saphenous vein was located at a mean distance of 24.4 ± 7.9 mm anterior to the medial malleolus. The mean widest collapsed diameter was 3.8 ± 1.5 mm. The mean distance from the skin surface to the vein was 4.1 ± 1.2 mm. These measurements could be used to locate the saphenous vein accurately, particularly in hemodynamically unstable patients with visually indiscernible veins.Item Microcytic anemia in children: Parallel screening for iron deficiency and Thalassemia provides a useful opportunity for Thalassemia prevention in low- and middle-income countries(Hemisphere Pub. Corp., 2020) Mettananda, S.; Paranamana, S.; Fernando, R.; Suranjan, M.; Rodrigo, R.; Perera, L.; Vipulaguna, T.; Fernando, P.; Fernando, M.; Dayanath, B.K.T.P.; Costa, Y.; Premawardhena, A.ABSTRACT:Microcytic anemia in children is commonly attributed to iron deficiency without attempting to find the cause. Inadequate investigations to exclude hemoglobinopathies lead to missed opportunities for identification of thalassemia carriers. Here we aim to describe the relative contribution of iron deficiency and thalassemia to microcytic anemia in children. This hospital-based prospective study was conducted at the Colombo North Teaching Hospital, Ragama, Sri Lanka. All newly diagnosed patients with microcytic anemia were recruited and data were collected using an interviewer-administered questionnaire. Full blood count, blood film, serum ferritin, c-reactive protein, quantification of hemoglobin sub-types and α-globin genotype were performed using 4 ml of venous blood. A total of 104 children (Male- 60.5%) were recruited. Iron deficiency was the cause for anemia in 49% whilst 16% and 10% had α- and β-thalassemia trait respectively. Seven (6.7%) children had co-existing iron deficiency and thalassemia trait while two coinherited α- and β-thalassemia trait. Children with β-thalassemia trait had significantly higher red cell count and lower mean corpuscular volume compared to children with iron deficiency. However, none of the red cell parameters were significantly different between children with α-thalassemia trait and iron deficiency. Iron deficiency contributes only to half of children with microcytic anemia; one-fourth had thalassemia trait. Co-existence of iron deficiency and thalassemia trait or co-inheritance of α- and β-thalassemia trait were found in 9%. Parallel investigation of children with microcytic anemia to diagnose iron deficiency and thalassemia provides an opportunity to identify thalassemia carriers which is beneficial for thalassemia prevention.Item A Descriptive study of deep vein thrombosis (DVT) in a tertiary care hospital(Sri Lanka Medical Association, 2008) Botheju, W.I.K.; Navaratne, A.C.R.; Somarathne, C.K.; Balasooriya, B.L.P.P.; Wijebandara, R.J.K.S.; Mandawala, M.B.S.N.; Ruwanpathirana, T.; Kasturiratne, K.T.A.A.; Hewawitharana, C.P.; Rathnasena, B.G.N.; Fernando, P.; Wijesinghe, P.S.; Premawardhena, A.OBJECTIVE: The incidence and risk factors for DVT are not well established for the Sri Lankan population. Though believed to be an effective screening tool for DVT, the Well's Clinical score is not widely used in Sri Lankan hospitals. DESIGN, SETTING AND METHODS: Over a period of 8 months, a total of 23274 patients who presented to four units (including one general medical, one general surgical, one Gynaecology & Obstetrics, and the Orthopedic ward) of the North Colombo (Teaching) Hospital were screened for asymmetrical limb swelling more than 2 cm. The latter group were subjected to risk assessment for DVT, Well's scoring and CDU (Colour Duplex Ultrasound). RESULTS: Of the 23274 patients, 93 (0.4%) had unilateral limb swelling of which 12 (12.9%) were CDU confirmed to have DVT (0.5 per 1000). Limb swelling for more man two weeks was significantly commoner among DVT patients when compared to those without DVT (75% Vs 25.9%: p=0.001). None of the patients had been evaluated with the Well's score as a guide to refer for CDU by the relevant clinical teams. In 55 (59.1%) subjects, Well's score was 0 or less (minimum probability of DVT) and there were no subjects with DVT in this group. All 12 patients with DVT had a moderate or high probability Wells score. CONCLUSIONS: Overall incidence of DVT in the study population was lower than in other comparable published studies from Asia. Well's score which was underused by the clinicians is a highly sensitive screening tool for DVT.Item Histology of the tendon sheath in tigger finger(Sri Lanka Medical Association, 2000) Fernando, P.; Hewavisenthi, S.J.de S.OBJECTIVE: Describe the histology of the proximal end of the tendon sheath in trigger fingers, and to ascertain whether there is a rational basis for the use of local steroids in this condition. METHOD: Excised portions of tendon sheaths in 16 consecutive patients were submitted for routine histology. None of the patients had previous steroid injection or any intercurrent systemic disease. The specimens were assessed for evidence of acute and chronic inflammation. RESULTS: The age range of the patients was 29-68 (Median: 54) with 5 males and 11 females, and the duration of illness ranged from 3 weeks to 9 months. A total of 15 specimens were studied (one lost in processing). All the specimens were of fibrous tissue. None of the specimens showed infiltration with cells of acute inflammation, but 10 specimens showed mild chronic inflammation (less than 25 mononuclear cells per high power field). The other five showed moderate chronic inflammation (25-100 per high power field). CONCLUSIONS: The histology of the tendon sheath in trigger finger has not been previously studied. This study suggests that inflammation is not a dominant feature.Item Use and interpretation of phrases in histopathology reports(Sri Lanka Medical Association, 2005) Hewavisenthi, S.J.de S.; Fernando, P.No abstract available.