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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Epidemiology of goiters in Sri Lanka with Geographic Information System Mapping: population-based cross-sectional study [Author Reply](Jaypee Brothers Medical Publishers, 2016) Fernando, R.Author Reply to comments by Mayilvaganan, S. Chekavar, A. Agarwal, A. on “Epidemiology of Goiters in Sri Lanka with Geographic Information System Mapping: Population-based Cross-sectional Study, Fernando, R. et. al.” appeared in World Journal of Endocrine Surgery.2015;7(3):55-59Item Recurrent goiters(Jaypee Brothers Medical Publishers (P) Ltd, 2019) Fernando, R.ABSTRACT: A recurrent goiter is the regrowth of thyroid tissue after thyroidectomy. The causes of recurrence following surgery for the benign disease can be broadly attributed to inadequate surgery, embryological remnants left behind inadvertently, and the development of a malignancy in the remnant. Recurrence after surgery for the benign disease should be preventable. Subtotal thyroidectomy (STT) was the main operation for goiters until the 1980s. The main issue with a subtotal surgery is a recurrence. One of the primary reasons why STT fails can be attributed to the fact that STT does not treat the underlying generalized disease adequately. The consensus is emerging that the best surgical option for multinodular goiter is total thyroidectomy. Even after “total” thyroidectomy, there is recurrence, what is left behind is related to the three embryological remnants of thyroid, namely pyramidal lobe recurrences, recurrence of the tubercle of Zuckerkandl, and thyrothymic recurrences. The surgical technique at the initial total thyroidectomy must be meticulous, ensuring that all embryological remnants are excised properly. Goiter recurrence is a failure of surgical treatment of goiter. Inadequate surgery and failure to excise all thyroid tissues are two preventable causes for recurrence. The technique of reoperative thyroidectomy must include capsular dissection, removal of all embryological remnants, and parathyroid autotransplantation. Surgery for recurrent goiter is challenging. It is thought to entail a higher complication rate and complication rates may be high in inexperienced hands; low complication rates have been achieved in specialized centers. The fear of complications should not deter experienced surgeons from performing reoperative thyroid surgery. In terms of technique, the lateral approach to thyroid offers a good alternative for recurrent goiters. A meticulous technique and parathyroid autotransplantation will help minimize the complication rate. © The Author(s). 2019.Item Epidemiology of goitres in Sri Lanka with Geographic Information System Mapping: a population based cross sectional study(Jaypee Publishers, 2015) Fernando, R.; Chandrasinghe, P.C.; Nandasena, S.; Pathmeswaran, A.BACKGROUND: Sri Lanka is considered an endemic region for goiter. Early researchers have suggested the existence of a goiter belt based on rainfall pattern. Subsequent studies done in school children have challenged this theory. Current study is a community-based cross-sectional study done to assess the epidemiology of goiters. Geographic information system (GIS) mapping of the goiter prevalence is developed for the first time in Sri Lanka. METHODS: Study subjects were selected using a multi-staged cluster sampling with probability proportionate to size (PPS) method. Examination for the presence of goiters was done by two trained investigators and graded. ArcGIS 10 software was used for geostatistical analysis and developing a map by interpolating the data collected for the first time in Sri Lanka. RESULTS: A total of 5200 individuals (female-66%, median age-38 years; range 10-92 years) were assessed and 426 goiters were detected. The adjusted prevalence rate of goiters was 6.8%. Kriging interpolation method was used to develop the most appropriate epidemiological map clustering of high prevalence areas with scattered pockets of high prevalence was observed. Current map does not show a prevalence pattern in relation to the rainfall or elevation above sea level as proposed in the past. CONCLUSION: Goiter prevalence in Sri Lanka appears to be different from earlier proposed patterns. Use of GIS has contributed to develop a comprehensive epidemiological map of goiters demonstrating the absence of an endemic goiter belt in the wet zone as proposed earlier.