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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Reducing the public health expenditure through a surgical method that facilitates early mobilization of lower limb burns(Sri Lanka Medical Association, 2017) Perera, C.; Hajith, Z.M.; Mahendra, B.A.G.G.INTRODUCTION & OBJECTIVES: Grafted skin in the conventional way tends to contract towards the midline bridging across the joints. Prolonged immobilization following skin grafting promotes contracture across the joints. In the advanced graft orientation technique (AGOT) devised by the Burns Unit of the National Hospital of Sri Lanka (BU-NHSL), the graft is orientated in a tension free direction. This method does not require prolonged splinting or immobilization. The aim of the study was to assess the impact of graft orientation on early mobilization and prevention of contracture in lower limb (LL) burn patients. METHODS: A total of 61 patients treated with AGOT for LL burns at BU-NHSL (study group-SG) were compared with 21 patients who were primarily treated with conventional skin grafting for LL burns at local hospitals and referred for reconstruction at BU-NHSL (control group-CG). Vancouver Scar Scale (VSS) and range of motions (ROM) of involved joints were measured one year following the date of burn in the SG. These were measured prior to reconstructive surgery in the CG. Comparison was done using independent t-test. RESULTS: Mean value of VSS in the SG and the CG were 2.8889 (SD+1.65878) and 9.4074 (SD+3.21366) respectively. Spared normal joint ROM was seen in 95.6% of the SG. 100% in the CG had reduced joint ROM. CONCLUSION: AGOT has a lesser possibility of contracture across the grafted joints. Lower VSS value in the SG suggests that the quality of grafted skin is closer to normal skin. This technique is beneficial in low and middle income countries where access to specialized burn rehabilitation and health budget is limited.Item Design and development of a web based histopathology reporting system(Sri Lanka Medical Association, 2017) Ediriweera, D.S.; Hettiarachchi, W.G.; Mahendra, B.A.G.G.; Liyanage, S.K.; Ratnayake, R.M.U.S.; Hewavisenthi, S.J.de.S.INTRODUCTION & OBJECTIVES: The current histopathology reporting system in the unit has only basic features including report generation and limited data retrieval. Thus a newer system was required to address the issues faced in histopathology reporting, chiefly a prolonged turnaround time caused by lack of clinical data, inability to track delays in sample processing, delays in data entry and report dispatch. More efficient data retrieval for research purposes and monitoring of postgraduate training were also considered important. The aim of the study was to design and develop a generic histopathology reporting system that facilitates the generation of timely reports and helps in research and postgraduate training. METHODS: A software framework was designed and developed into a functional web based histopathology reporting system (WBHPRS) which can be easily customizable to different settings. This was designed using MySQL and PHP. Data entry was facilitated by using drop down menus and prompts. Standard templates for reports with the option to edit were uploaded enabling quick report generation. RESULTS: A WBHPRS has the ability to capture data throughout the process of generating a report, thus enabling the tracking of the specimen from surgery to dispatch of the report. The system also provides facilities for more efficient data retrieval due to a modified coding system. It facilitates postgraduate supervision enabling the trainer to determine the time taken, quality and quantity of work done by the trainees. CONCLUSION: This system has vastly enhanced features that will improve the timeliness of reporting and provide additional features useful in research and postgraduate training.Item A Retrospective study on perinatal post-mortems(University of Kelaniya, Sri Lanka, 2016) Liyanage, S.K.; Mahendra, B.A.G.G.; Ratnayake, R.M.U.S.; Hewavisenthi, S.J.A post-mortem examination is the key to the recognition of pathologies related to perinatal deaths. A perinatal death could be related to fetal, maternal or placental factors. A complete perinatal post-mortem (PPM) includes examination of the dead body and the placenta. The PPM findings assist the clinical team in confirming their clinical findings and uncover the additional pathologies, and the family for future pregnancy planning. This study was carried out to identify the number of perinatal post mortems (PPMs) reported during the study period, the number of PPMs with multiple congenital anomalies and the number of PPMs accompanied by a placenta and the number of placentae with identifiable pathology. This study was on already reported PPMs in a tertiary care center from January 2011- August 2016. Multiple congenital anomalies were noted in 14% (16/118) of the PPMs. Placentae were submitted for examination in 26% (31/118) with clinically significant placental pathologies in 23% (7/31). In 64% (76/118) of PPMs there were no gross abnormality in the fetus/baby. The placenta was not available for examination in 72% (55/76) and therefore, the possibility of placental pathology, which might have led to the death, could not be excluded.Item Views of students on the use of computer aided pathology practical classes(Sri Lanka Medical Association, 2012) Mahendra, B.A.G.G.; Rathnayake, R.M.U.S.; Hewavisenthi, J.INTRODUCTION: Conducting pathology practical classes in the traditional manner is becoming increasingly difficult With rapidly advancing medical knowledge it is a challenge to impart a large amount of facts within a limited time. A programme of Computer Aided Pathology Practicals (CAPP) was introduced to overcome these challenges. AIMS: To determine whether this programme was successful in the view of the students, what the short comings were, and how the system could be improved. METHODS: A self administered questionnaire was used to assess the views of the students of Batch 20 of the Medical Faculty, Kelaniya. The pathology practicals for these students had been conducted using both the traditional and the CAPP systems. Results: 62.7 % students preferred the CAPP programme. The reasons offered for this preference included greater enhancement of knowledge of the course content [59.6% ), a greater area of knowledge covered within a single session (76.9%], ability to appreciate the architectural (73.4%) and cytological features ( 76.8%) of lesions better, being easier to operate (77%) and the saving of time ( 85.7%). However 67.9% of the students were of the opinion that the traditional pathology practicals were more realistic especially with regard to appreciating the macroscopic features, than the CAPP system. CONCLUSIONS: Overall the CAPP programme was well received by a majority of students. The lack of "hands on experience" is a problem encountered in all forms of virtual teaching. This could be improved by encouraging the students to use the pathology museum more frequently.Item Quality of the specimens received at a histopathology laboratory of a medical faculty in Sri Lanka(Sri Lanka Medical Association, 2015) Weerasinghe, T.M.B.; Weddagala, W.M.S.R.; Weerasekara, W.M.M.O.R.; Wasala, W.M.A.D.; Weerasinghe, M.P.A.M.; Mahendra, B.A.G.G.; Pathmeswaran, A.INTRODUCTION AND OBJECTIVES: The accuracy of the histopathology reporting depends on the completeness of the request forms and the condition of specimens. To assess the completeness of histopathology request forms and the condition of specimens received by a pathology laboratory, Medical Faculty, University of Kelaniya METHOD: This cross sectional study was conducted at the pathology laboratory of a medical faculty in Sri Lanka. We included 342 consecutive specimens received from the professorial units of the teaching hospital during the study period, September to November 2014. Data were collected using a checklist consisting of 10 items for the request form, 6 for the label, 7 for the container and sample. SPSS16.2 was used to analyze the data. RESULTS: Only 56.1% had completed request forms. Patients' sex and a short clinical history with a probable diagnosis were missing in!2.6% and 24.6% respectively. Labelling was incomplete in 14.6% and date of specimen collection was missing in 11.4%. Compatibility of the 6 items on the label with the request form was observed in 71.3%, and the most mismatched item was the date of specimen collection (17%). Appropriate container was used in 89.5%. Inadequate amount of fixative was found in 13.2% of specimens. Only 24% of specimens fulfilled all requirements. CONCLUSION: This study demonstrates that the quality of the specimens is poor mainly due to the incomplete request forms, poor labelling and use of inappropriate containers. Redesigning the request form and introducing printed labels and standard set of containers may improve the quality of specimens.Item The agreement among different scoring systems used in the assessment of histologicai activity in ulcerative colitis(Sri Lanka Medical Association, 2007) Mahendra, B.A.G.G.; Hewavisenthi, S.J.de S.INTRODUCTION: Histology is one of the most important criteria in determining the disease activity in ulcerative colitis which in turn is important in the choice of drug treatment, monitoring of therapy and in clinical trials. Many different histologicai scoring systems are used to determine the disease activity in ulcerative colitis. OBJECTIVE: To compare three different histologicai scoring systems used in assessing the activity in ulcerative colitis. DESIGN, SETTING AND METHODS: 41 mucosal biopsies of ulcerative colitis patients were reviewed. The histologica! disease activity in each of these was scored by the two authors at a conference microscope using three different histologicai scoring systems. They were A - Bristol activity index, B – scoring index by Saverymutty et al, and C - scoring index by Geboes et al. The correlation among the three histologicai scoring systems was calculated using Spearman rank correlation coefficient. RESULTS: The Spearman rank correlation coefficient between system A vs system B was 0.883 (0.000), system A vs. system C was 0.883 (0.000) and system B vs system C was 0.952 (0.000). The correlation among the three histologicai scoring systems was statistically significant (p<0.01). CONCLUSION: Therefore any one of these three systems can be recommended in scoring the histologicai activity in ulcerative colitis and the choice will depend on the ease of use and personal preference.Item Synovial sarcoma [Letter to the Editor](College of Pathologists of Sri Lanka, 2012) Mahendra, B.A.G.G.; Hewavisenthi, S.J.de S.No Abstract Available.Item Is Endoscopic examination alone adequate in determining the extent of disease in ulcerative colitis?(College of Surgeons of Sri Lanka, 2006) Mahendra, B.A.G.G.BACKGROUND : Endoscopic and histological examination of the mucosa are the mainstay in the diagnosis of ulcerative colitis. Assessing the extent of disease is important in the management of these patients. Sometimes an endoscopic examination alone is performed without biopsy and histological examination. OBJECTIVE: To compare the extent of disease in ulcerative colitis as assessed endoscopically versus that determined histologically. METHOD: 41 patients with ulcerative colitis were identified. In each of these patients endoscopy was performed and the appearance was recorded. In each patient 1-6 mucosal biopsies (mean - 3.2) were obtained for histological evaluation. A total of 136 biopsies were examined histologically and compared with the endoscopic appearance of the corresponding area of the bowel. The sensitivity of endoscopy in detecting the presence of true inflammation was also studied for the different regions of the bowel. RESULTS: 125 biopsies showed histological involvement. The endoscopy and histology were both positive in 68. The endoscopy was negative whilst the histology was positive in 57 biopsies. Endoscopy and histology were both negative in 10 biopsies and endoscopy alone was positive in only one biopsy.The kappa value of agreement was 0.136 denoting poor agreement between endoscopy and histology.Endoscopic examination had a high sensitivity in detecting proctitis. When more proximal regions of the bowel were biopsied, the sensitivity of endoscopic examination in detecting histological inflammation gradually declined. CONCLUSION: Since endoscopy and histology show poor agreement it is recommended that both should be performed to assess the true extent of disease in ulcerative colitis.