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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Hilar cholangiocarcinomas - from nihilism to aggressive treatment(The College of Surgeons of Sri Lanka, 2012) Liyanage, C.; Nawaratne, M.; Pathirana, A.; Gunasekara, D.; Pranahewa, L.; Prasad, R.; Wijeratne, T.; Bogammana, M.; Wijesooriya, R.; Siriwardhana, R.INTRODUCTION: Hllar-Cholangio-carcinomas (HCC) are aggressive tumours with a dismal prognosis. The general tendency amongst all specialities is to palliate them. As response to adjuvant therapy is marginal we have embarked on aggressive management of these patients with the available surgical and endoscopic expertise. METHODS: Patients presenting to the North Colombo Teaching hospital· and the Gastrointerology unit of the National hospital in 2011 were included . All had Tri phasic CT , MRCP or ERCP prior to be discussed at MDT with all the above authors regarding further management. Patients with Bismuth 1 v lesions and unfit for surgery underwent Combination ERCP/doublestenting/RFA of lesion/Rendezvous procedure/Percutaneous, stenting or PTC. RESULTS: 32 patients were treated .5/32 had radical surgical resections (2 extended right hepatectomy with bile duct resecton and lymphadenectomy (BDR+LA), 2 extended left hepatectomy +BDR+LA, and 1 extended heft hepatectomy with BDR+LA+Reconstruction of Right hepatic artery and right portal vein. I underwent segment iii bypass. 7 patients underwent ERCP and serial RFA with stenting. 3/5 patients are alive and disease free at 6-12 months. CONCLUSIONS: Where possible HCC patients should be offered a curative resection. RFA gives longer and better palliation compared to standard stenting. These patients should be managed by a specialized team as aggressive management may improve their survival.Item Idiopathic pancreatitis is a consequence of an altering spectrum of bile nucleation time(Biomed Central, 2011) Abeysuriya, V.; Deen, K.I.; Dassanayake, B.; Kumarage, S.; Navarathne, N.; Pathirana, A.BACKGROUND: The pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of micro-crystallization of hepatic bile. METHODS: A prospective case control study compared 55 patients; symptomatic cholelithiasis - 30 (14 male, median age 36 years; mean BMI - 25.1 kg/m2), gallstone pancreatitis - 9 (3 male, median age 35 years; mean BMI - 24.86 kg/m2 ) and IP - 16 (9 male, median age 34 years; mean BMI -23.34 kg/m2) with 30 controls (15 male, median age 38 years; mean BMI = 24.5 kg/m2) undergoing laparotomy for conditions not related to the gall bladder and bile duct. Ultrafiltered bile from the common hepatic duct in patients and controls was incubated in anaerobic conditions and examined by polarized light microscopy to assess bile nucleation time (NT). In the analysis, the mean NT of patients with gallstones and gallstone pancreatitis was taken as a cumulative mean NT for those with established gallstone disease (EGD). RESULTS: Patients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (EGD cumulative mean NT, 1.73 +/- 0.2 days vs. controls, 12.74 +/- 0.4 days, P = 0.001 and IP patients mean NT, 3.1 +/- 0.24 days vs. controls, 12.74 +/- 0.4 days, P = 0.001). However, NT in those with IP was longer compared with those with EGD (mean NT in IP, 3.1 +/- 0.24 days vs. cumulative mean in EGD: 1.73 +/- 0.2 days, P = 0.002). CONCLUSION: Nucleation time of bile in patients with IP is abnormal and is intermediate to nucleation time of lithogenic bile at one end of the spectrum of lithogenicity and non-lithogenic bile, at the other endItem A Case of embryonal sarcoma of the liver(Sri Lanka Medical Association, 2010) Pathirana, A.; Siriwardana, R.C.; Deen, K.I.; Rupasinghe, Y.No Abstract AvailableItem Surgical anatomy of the veins of the lower limb - a cadaveric study(College of Surgeons of Sri Lanka, 2009) Salgado, S.; Abeysuriya, V.; Pathirana, A.INTRODUCTION: With the advent of new surgical techniques, an adequate knowledge of precise anatomy of the venous system of the lower limb is important for safe surgery. The aim of this study is to provide some basic information for those who are interested in phlebology. MATERIALS AND METHODS: The anatomy of the superficial and deep veins of both lower limbs was studied in 20 human cadavers (age 42-72 years) of both sexes (12 males: 08 females). Great saphenous vein (GSV) and small saphenous vein (SSV) were traced from medial and lateral malleoli to the sapheno-femoral junction (SFJ) and saphenopopliteal junction (SPJ) respectively. The number of deep perforators was counted and measurements were taken from a fixed anatomical land mark. RESULTS: In both lower limbs of 17 cadavers (85%), the course of GSV was similar to the course described in the commonly used text books. Large tributary with a diameter similar to GSV at the SFJ was seen in 3 cadavers (15%). The point of entry of SSV into the popliteal vein varied greatly. In majority of cadavers the opening was at the level of the popliteal skin crease and in others it was either above or below this. Large deep perforators were found in the calf and thigh with irregularly distributed small perforators. CONCLUSION: A majority of individuals have the lower limb superficial venous pattern described in standard text books. However, a significant minority had variations, which could have important implications on the presentation and treatment of varicoseItem Anatomy of the pancreatic vasculature:respect of the duodenum preserving resection of head of pancreas(College of Surgeons of Sri Lanka, 2008) Salgado, S. S.; Abeysuriya, V.; Pathirana, A.INTRODUCTION: Duodenum preserving resection of the head of the pancreas is performed mostly in chronic pancreatitis. Knowledge of precise anatomy of the pancreaticoduodenal region especially of the pancreaticoduodenal arteries, which provide blood to the duodenum, is mandatory for safe surgery. MATERIALS AND METHODS: Twenty human cadavers (age 56-87 years) of both sexes (10 males: 10 females) were studied with relevance to the anatomy of the head of the pancreas and duodenum in relation of the regional vascular arcades.RESULTS: The gastroduodenal artery (GDA) originates 3.7cm (3.1cm 5.1cm) from celiac trunk from the common hepatic artery. The Emergence of anterior superior pancreaticoduodenal artery (ASPA) was at 3.4cm (2.9cm - 4.2cm) of the origin of the gastroduodenal artery. After departing from gastroduodenal artery ASPA runs downwards along the medial side of the 2nd part of the duodenum and turned to the posterior aspect of the pancreas to join the anterior inferior pancreaticoduodenal artery (AIPA). Arcade formation between the ASPA and AIPA was found in all cadavers. Posterior superior pancreaticoduodenal artery (PSPA) originates 2.1 cm (1.8cm-2.8cm) from the origin of the gastroduodenal artery. PSPA form an arterial arcade with the branches of the posterior inferior pancreaticoduodenal artery. Posterior vascular arcade always located posterior to the common bile duct. Anterior and posterior vascular arcades were 0.35cm (0.32 cm 0.43cm) and 0.24 cm (0,21 cm 0.34cm) medial to the medial border of the duodenum respectively. CONCLUSION: In duodenal preserving pancreatic surgery, the knowledge of this complex vascularization will help to preserve arterial arcades around head of the pancreas while performing pan create cto my.Item Effectiveness of teaching clinical skills in improving simple wound suturing among medical undergraduates(The Kandy Society of Medicine, 2005) Abeysuriya, V.; de Silva, P.; Pathirana, A.