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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 A Possible progression of an atypical leiomyoma to a leiomyosarcoma(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Ekanayake, C.D.; Liyanage, A K.; Herath, R.P.; Fernando, W.S.; Mahendra, B.A.G.G.BACKGROUND: The spectrum of uterine smooth muscle cell tumours can range from leiomyoma to leiomyosarcoma. Atypical leiomyomasare a group of tumours with cellular atypia and a mitotic indexof up to 5/HPF that are classified between the innocuous leiomyoma and leiomyosarcomas. The absence of coagulative necrosis helps to differentiate it from leiomyosarcomas.Traditionally atypical leiomyomas are thought to have a low recurrence rate. CASE DETAILS: A 41-year-old woman underwent a myomectomy for ananteriorcervical fibroid.Histology revealed a smooth muscle tumour (SMT) withdiffusely scattered hyperchromatic large cells. The maximum mitotic count was 5/10 HPF.There was no coagulative necrosis or atypical mitotic figures. It was classified as an atypical leiomyomas and had close follow up. However, 30 months later she developed heavy menstrual bleeding. The ultrasound scan revealed an anterior fibroid. She underwent a total abdominal hysterectomy with ovarian conservation. The specimen showed a well-defined myometrial nodule of 7cm with haemorrhagic areas,compressing the cervix. It was a SMT with high a mitotic activity (11-12/HPF), atypical cells with bizarre nuclei and focal coagulative necrosis confirming a leiomyosarcoma (FIGO 1B). CONCLUSION: As atypical leiomyomashave a low risk profile and are mostly found in younger women,it invariably leads to treatment that offers fertility preservation. This case challenges the generalisability of this currently held viewpoint and recommends more extensive surgery or further heightened surveillanceItem A possible progression of an atypical leiomyoma to a leiomyosarcoma(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Ekanayake, C.D.; Liyanage, A.K.; Herath, R.P.; Fernando, W.S.; Mahendra, B.A.G.G.BACKGROUND: The spectrum of uterine smooth muscle cell tumours can range from leiomyoma to leiomyosarcoma. Atypical leiomyomasare a group of tumours with cellular atypia and a mitotic indexof up to 5/HPF that are classified between the innocuous leiomyoma and leiomyosarcomas. The absence of coagulative necrosis helps to differentiate it from leiomyosarcomas.Traditionally atypical leiomyomas are thought to have a low recurrence rate. CASE DETAILS: A 41-year-old woman underwent a myomectomy for ananteriorcervical fibroid.Histology revealed a smooth muscle tumour (SMT) withdiffusely scattered hyperchromatic large cells. The maximum mitotic count was 5/10 HPF.There was no coagulative necrosis or atypical mitotic figures. It was classified as an atypical leiomyomas and had close follow up. However, 30 months later she developed heavy menstrual bleeding. The ultrasound scan revealed an anterior fibroid. She underwent a total abdominal hysterectomy with ovarian conservation. The specimen showed a well-defined myometrial nodule of 7cm with haemorrhagic areas,compressing the cervix. It was a SMT with high a mitotic activity (11-12/HPF), atypical cells with bizarre nuclei and focal coagulative necrosis confirming a leiomyosarcoma (FIGO 1B). CONCLUSION: As atypical leiomyomashave a low risk profile and are mostly found in younger women,it invariably leads to treatment that offers fertility preservation. This case challenges the generalisability of this currently held viewpoint and recommends more extensive surgery or further heightened surveillance.Item Sexual practices, knowledge and usage of contraceptives among adolescents and young adults(Sri Lanka College of Obstetricians and Gynaecologists, 2008) Herath, H.M.R.P.; Dissanayake, D.M.A.B.; Hilmi, M.A.M.; Pathmeswaran, S.; Fernando, W.S.; Wijesinghe, P.S.INTRODUCTION: Adolescence is a critical period of development, as important behaviour patterns are learnt during this period. The sexual debut in Sri Lankan schooling adolescents has been reported as 15.3 years for males and 14.4 for females. Furthermore a significant difference in the prevalence of heterosexual experience among the two sexes have been reported(14% among boys Vs 2% among girls). In 2001, of the pregnant women who received antenatal care from public health midwives, 7.8% were teenagers. Interestingly 22.2% of maternal deaths due to illegal abortions were in this age group during 1996. Thus the situation demands research into sexual practices and strategies to increase the contraceptive uptake by teenagers. OBJECTIVES: To describe and compare the sexual practices. knowledge and usage of contraceptives by the adolescents and young adults with different educational backgrounds. METHOD: Study was a cross sectional descriptive study done involving subjects of three different educational levels i.e. students of universities and technical colleges and employees of garment factories. Data were collected with a pretested self administered questionnaire. RESULTS: Data of 1258 subjects were analyzed. Of them 23% were garment factory workers, 38.2% were technical college students and 38.8% were university students. Females consisted 58.9% of the population. The mean age for males and females were 20.5 years and 20.7 years respectively. The mean age of first sexual relationship of males and females were at 17.65 and 19.44 years respectively (p<.001). Out of the total population 17% of females and 33.5% of males were sexually active. Sexual relationships were reported by 51.7% of garment factory employees, 19.4% technical college students and 12.3% of university students. Majority of male garment factory workers ("90 %) were sexually active. Of the 166 sexually active males 19.3% had sexual relationship with commercial sex workers. Out of the 172 people who have not used modern contraceptives during heterosexual relationships, 32% has used natural family planning. Significantly larger proportion (21.7%) of garment factory workers compared to other settings believed that IUCD would protect them from HIV infection. Of the study population 24.9% of females and 71.2% of males knew barrier methods would minimize the risk of development of HIV. With regard to primary source of information regarding contraceptive methods, 24.2 % and 23.4% of subjects reported school and news papers, while 28.4% felt that information from parents as the least important source. Of the people who selected school as their main source of information, only 41.4% knew barrier methods could protect them from HIV. Majority preferred instructions from school and special health clinics on contraceptive usage. CONCLUSIONS: Teenage and young adult males have their first sexual relationship at an earlier age than female counterparts. A larger proportion of garment factory employees are sexually active compared to students of technical colleges and universities. Significant proportion of males of the age group had their first relationship with commercial sex workers. The knowledge about different contraceptive methods among this population is inadequate. More emphasis should be given to the preferred media by the adolescents and young adults in educating them on contraceptive methods.Item Perifartum hysterectomy from 2000 to 2004: Any new lessons?(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Pathiraja, R.P.; Wijesinghe, P.S.; Fernando, W.S.; Fernandopulle, R.C.OBJECTIVE: We aimed to identify the risk factors and subsequent maternal and perinatal outcome associated with the procedure of peripartum hysterectomy. MATERIALS AND METHODS: This was a retrospective case review carried out at the Professorial unit, North Colombo Teaching Hospital, Ragama, of all patients who underwent a peripartum hysterectomy from January 2000 to December 2004. RESULTS: Eighteen cases were performed during the study period from a total of 28,038 deliveries (0.064%) mean maternal age was 33 years (24-43), There were five nulliparous patients. Seven patients had previous vaginal deliveries. Six had a history of previous caesarean section, four of whom had more than one caesarean sections. The indications for the hysterectomy were placenta praevia (2), abruptio placenta (1), atonic postpartum haemorrhage (7), placenta accreta (3), traumatic postpartum haemorrhage (5). All Abstracts - Free Papers patients received blood transfusions, 27% receiving more than 10 units. There were five maternal deaths (Maternal mortality rate 17.8 /100,000). There were two stillbirths and one neonatal death secondary to antepartum haemorrhage. CONCLUSION: Even though the maternal mortality was not very high, the associated maternal morbidity and perinatal mortality were high. One third of the cases were associated with previous caesarean section. The caesarean section rate is increasing worldwide for many reasons, including recent emphasis on maternal request. We recommend that caesarean section be performed only for valid clinical indications which should help reduce the problems associated with peripartum hysterectomy.Item Uterine artery embolisation (uae) for symptomatic uterine fibroids(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Rannulu, P.; de Silva, P.; Fernando, W.S.INTRODUCTION: Uterine Artery Embolisation is a modern treatment modality used in the treatment of symptomatic uterine fibroids. Though common in the developed world it is still not routinely done in Sri Lanka. We report four patients with symptomatic uterine fibroids who were treated with bilateral UAE. SETTING: North Colombo Teaching Hospital, Ragama. METHOD: Four patients with symptomatic leiomyomas were selected from Gynaecology out patient clinics. Sizes of the fibroids were assessed by ultrasound imaging. Bilateral UAE was performed via retrograde femoral artery catheterization of the uterine arteries under local anaesthesia using absorbable soft Gelatine (USP). Imaging of the myomas were performed three months after the procedure. Results: Size of the fibroids were reduced in three patients when compared with the pre- procedure imaging. No major complications were noted. The severity of menorrhagia was reduced in three Patients. One patient failed to respond to the therapy with regard to the reduction of size of the fibroid and improvement of symptom severity. CONCLUSIONS: UAE is a non-surgical alternative in the management of symptomatic fibroids, which could be carried out in the local setting.Item Semen ph in infertile males and its association with semen parameters(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Dissanayake, D.M.A.B.; Palihawadana, T.S.; Amarasena, J.M.T.; Fernando, W.S.INTRODUCTION: Assessment of pH of the ejaculate is part of the basic seminal fluid analysis. The WHO defines the reference range for seminal fluid pH to be 7.2 or more. In practise we have observed that the pH is commonly in the alkaline range in patients with normal as well as abnormal seminal parameters. Furthermore, there are many others who question the reference range defined by the WHO, and claim it to be too low. Objective: To define the range of pH in seminal fluid in a infertile male population and to assess the association it shows to seminal fluid parameters. METHOD: Seminal fluid analysis including pH assessment was done on 168 males who sought infertility treatment at the university infertility clinic, at teaching hospital, Ragama. The pH was assessed within 30 minutes from collecting the sample using a pH meter. The seminal fluid analysis was done according to the WHO criteria. Log inversion of pH was done prior to calculation ofmeans. Results: The mean (±SD) pH of the sample population was 7.70 (±0.25) with a minimum of 6.78 and a maximum of 8.52. Only five patients (3%) had a pH less than 7.2. The distribution of the pH showed a 5" percentile value of 7.37 and a 95 'percentile of8.21.Thirty four percent (n=57) of subjects had a normal Seminal fluid analysis with regard to volume, concentration, motility and viability. Mean pH value showed a significant difference between the groups with a normal vs. abnormal volume of ejaculate, 7.75 vs. 7.59, P<0.05. Similar differences were not seen with any other semen parameter. Conclusion: The pH of ejaculate in this study sample is towards an alkaline range. Associations between semen pH and seminal parameters needs further study.Item Vulvitis granulomatosa, Melkersson-Rosenthal syndrome, and Crohn's disease: dramatic response to infliximab therapy(Wiley-Blackwell, 2012) Wickramasinghe, N.; Gunasekara, C.N.; Fernando, W.S.; Hewavisenthi, J.; de Silva, H.J.No Abstract AvailableItem Positive peritoneal fluid cytology in ovarian malignancies with metastasis:a descriptive study(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Hewavisenthi, S.J.de S.; Palihawadana, T.S.; Fernando, W.S.; Wijesinghe, P.S.Detection of malignant cells in peritoneal fluid and peritoneal washings obtained at laparotomy is useful in predicting the presence of peritoneal metastasis in ovarian cancer. It will help in tumour staging, planning of further management as well as predicting the prognosis. The accuracy of such predictions will depend on the diagnostic accuracy of cytology in detecting metastasis, which is expressed by sensitivity, specificity and positive and negative predictive values. We tried to determine the said parameters in a series of patients with ovarian cancer who underwent laparotomy at a tertiary care teaching hospital. Forty two consecutive patients with malignant ovarian tumours were studied with respect to differentiation, grade and size of tumour. The peritoneal fluid obtained was assessed for the presence of malignant cells and the nature (serous or blood stained) of the fluid. The accompanying omentectomy specimens were examined for histological evidence of metastasis. Nineteen out of 42 patients had histologically proven omental tumour deposits. Of these only 11 yielded positive cytology. One specimen was cytology positive in the absence of histological evidence of peritoneal deposits. The sensitivity of peritoneal fluid cytology was 57.9%, specificity was 95.7%, positive predictive value was 91.7% and negative predictive value was 76.7% in our series. Any of the characteristics in the tumour or the peritoneal fluid failed to demonstrate a significant association with positive cytology. The sensitivity of peritoneal fluid cytology in detection of peritoneal spread was low (measured against histologically proven omental deposits), which highlights the need of other adjunct methods such as biochemical markers and fluorescence in situ hybridisation to improve the diagnostic accuracy.Item Dengue fever in pregnancy- a mamagement dilemma(College of Anaesthesiologists of Sri Lanka, 2003) de Silva, B.A.; Wijesekera, C.; Fernandopulle, R.C.; Fernando, W.S.; Palihawadana, T.S.