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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Hepatocellular carcinoma in Sri Lanka: Where do we stand?(Sri Lanka Medical Association, 2013) Siriwardana, R.C.; Liyanage, C.A.H.L.; Jayatunge, D.S.P.; Dassanayaka, A.; Gunetileke, M.G.; Niriella, M.A.; Sirigampola, C.; Upasena, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES:Hepato-cellular carcinoma (HCC) is the sixth commonest cancer worldwide. We studied 105 consecutive patients with HCC in a single tertiary care centre. METHODS: North Colombo Liver Unit maintains a prospective database of HCC since September 2011. There were 105 entries by February 2013. Decision on the best form of treatment was taken at a multidisciplinary meeting. RESULTS: The median age at presentation was 63 years (range 12-79). Patients were predominantly male 93 (87%). Alcohol consumption above the safe limit was reported in 47 (45%). Hepatitis B surface antigen or C antibody was not detected in any of the patients. Background liver cirrhosis was evident in 59 (79%). Forty two (46%) patients had single nodular tumours while in 20 (21%) it was diffusely infiltrating. Portal vein invasion was seen in 22 (20 %). Median alpha-feto protein (AFP) level was 57.25 mg/ml (1.16- 94120 ng/ml; n=72). Twenty four (33%) patients had AFP level > 400u/l. Surgery was performed in 20 (19%), liver transplant in 2 (1.9%), radio frequency ablation or alcohol ablation in 8 (7.6%), trans arterial chemo embolization (TACE) in 44 (41.9%) and sorafmib was prescribed in four patients. Overall mean survival was 15 months. In the ‘no treatment’ group, mean survival was 4 months. Surgery group had a mean survival of 20 months. CONCLUSION: Hepatitis B is not a risk factor for HCC in Sri Lankans. Median survival without treatment is 4 months.Item Hepatocellular carcinoma in Sri Lanka: Where do we stand?(Sri Lanka Medical Association, 2013) Siriwardana, R.C.; Liyanage, C.A.H.L.; Jayatunge, D.S.P.; Dassanayake, A.; Gunetileke, M.G.; Niriella, M.A.; Sirigampola, C.; Upasena, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES:Hepato-cellular carcinoma (HCC) is the sixth commonest cancer worldwide. We studied 105 consecutive patients with HCC in a single tertiary care centre. METHODS: North Colombo Liver Unit maintains a prospective database of HCC since September 2011. There were 105 entries by February 2013. Decision on the best form of treatment was taken at a multidisciplinary meeting. RESULTS: The median age at presentation was 63 years (range 12-79). Patients were predominantly male 93 (87%). Alcohol consumption above the safe limit was reported in 47 (45%). Hepatitis B surface antigen or C antibody was not detected in any of the patients. Background liver cirrhosis was evident in 59 (79%). Forty two (46%) patients had single nodular tumours while in 20 (21%) it was diffusely infiltrating. Portal vein invasion was seen in 22 (20 %). Median alpha-feto protein (AFP) level was 57.25 mg/ml (1.16- 94120 ng/ml; n=72). Twenty four (33%) patients had AFP level > 400u/l. Surgery was performed in 20 (19%), liver transplant in 2 (1.9%), radiofrequency ablation or alcohol ablation in 8 (7.6%), trans arterial chemo embolization (TACE) in 44 (41.9%) and sorafinib was prescribed .in four patients. Overall mean survival was 15 months. In the 'no treatment' group, mean survival was 4 months. Surgery group had a mean survival of 20 months. CONCLUSION: Hepatitis B is not a risk factor for HCC in Sri Lankans. Median survival without treatment is 4 months.Item Risk factors for post operative complications, prolong ICU and hospital stay in patients with colorectal surgery(Sri lanka Medical Association, 2015) Gunetilleke, M.B.; Jayatunge, D.S.P.; Munasinghe, A.H.E.; Jayarathne, K.D.V.S.; Liyanage, C.A.H.; Siriwardana, H.D.R.C.; Kumarage, S.K.; Deen, K.I.INTRODUCTION AND OBJECTIVES: Identifying predictors for development of post-operative complications and prolong hospital stay will improve outcome of colorectal surgery. METHOD: Colorectal surgeries from May 2012 -February 2015 at NCTH were assessed for post¬operative complications, prolong ICU and hospital stay RESULTS: Out of 101 patients [43.6 % males, median age 52, 54.3% ASA class ll/lll ] 19 patients suffered complications (11 Sepsis, 10 respiratory complications and 4 ACS). Prolong hospital in 33 and prolong ICU stay in 14 were noted. On univariate analysis higher intra-operative fluid usage (IOFU), usage of blood products (UBP), increase blood loss and reduce usage of epidurals (RUE) predicted respiratory complications. Females, higher IOFU for sepsis and higher IOFU, UBP for ACS were predictors. Higher IOFU , higher ASA class, females, longer duration of anaesthesia ( LDOA ) for prolong ICU stay and UBP , LDOA , higher IOFU for prolong hospital stay were predictors. In multivariate model a higher IOFU, RUE for cardiorespiratory complications and low albumin & haemoglobin, female gender for sepsis were independent predictors. For prolonged ICU/ hospital stay higher IOFU (> 20 ml/kg), LDOA (> 240 min), higher ASA class were independent predictors. Patient without intra-operative vasopressors had a higher IOFU and no significance in development of complications. CONCLUSION: Patients without intra-operative vasopressor had higher IOFU. IOFU >20ml/kg is a major contributor for post-operative cardio¬respiratory complications, prolong ICU and hospital stay.