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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Anatomical variations of the common peroneal nerve (cpn) and the deep pereoneal nerve (dpn) in the lateral compartment of the leg: A cadaveric study(College of Surgeons of Sri Lanka, 2015) Salgado, L.S.S.; Karunanayake, A.L.; Hasan, R.; Salvin, K.A.; Fernando, E.D.P.S.; Ranaweera, M.S.L.; Padeniya, A.G.P.M.; Senevirathne, S.P.; Ranaweera, K.R.K.L.K.INTRODUCTION: The aim of this study is to demonstrate anatomy of CPN and DPN in the lateral compartment and identify high risk area/s which is important in high tibial osteotomy, in total knee arthroplasty, in external fixation of leg and CPN decompression surgery. MATERIAL AND METHODS: Thirty cadaveric legs (female-14, male-16) were dissected to demonstrate the bifurcation of the CPN and the exit point of the DPN from the lateral compartment. The ethical clearance was obtained. RESULTS: None of the specimens showed bifurcation of the CPN proximal to the apex of the fibular head. Musculoaponeurotic fibular arch at the entrance to the fibular tunnel was confirmed in all specimens. The mean distance from the apex of the fibular head to the opening of the fibular tunnel was 28.4mm (SEM±1.4mm). Of 30 specimens respectively 21(70%), 7(23.33%) and 2(6.66%) had bifurcation vertically distal to, on and proximal to the entry point with the average of 8.0mm and 12.0mm from the entry point. Eleven legs had muscular branches of the DPN in the lateral compartment of the leg. The mean exit point of the DPN/its longest muscular branch was observed 66.5mm (SEM±2.6mm) distal to the apex of the fibular head. CONCLUSIONS: Variations of the CPN bifurcation in relation to the fibular tunnel and muscular branches of the DPN in the lateral compartment were observed. From the apex of the fibular head, distance of 25.6mm-71.6mm was identified as the high risk area for surgeries involving in the upper part of the lateral compartment.Item Anatomical variations of the musculocutaneous nerve - A cadaveric study(College of Surgeons of Sri Lanka, 2015) Padeniya, A.G.P.M.; Salgado, L.S.S.; Hasan, R.; Fernando, E.D.P.S.; Ranaweera, R.M.S.L.; Abeysuriya, V.; Karunanayake, A.L.; Salvin, K.A.; Siriwardana, S.A.S.R.; Balasooriya, B.M.C.M.; Alahakoon, A.M.D.K.INTRODUCTION: The musculocutaneous (MC) nerve commences from the lateral cord of the brachial plexus, passes inferolaterally and pierces the coracobrachialis while innervating it. It then descends between biceps and brachialis muscles, innervating both and continues as the lateral cutaneous nerve of the forearm. Few studies have been done with regard to variations in origin, course, branching pattern, termination and communications of the MC nerve. These variations are important for anatomists, clinicians, anesthetists and surgeons to avoid unexpected complication as these variations have clinical significance during the surgical procedures and in diagnostic clinical neurophysiology. Therefore the aim of this paper was to study the anatomical variations of the MC nerve. MATERIAL AND METHODS: This descriptive cross sectional study was carried out in the Department of Anatomy, Faculty of Medicine, University of Kelaniya. Dissections were carried out on 50 upper limbs of 25 cadavers to record anatomical variations of the MC nerve. RESULTS: MC nerve was present only in 46(92%) upper limbs. Of the 46 upper limbs where the MC was present, one (2%) did not pierce the coracobrachialis. Communications were seen between MC and median nerve in 06(13%) samples of which 1(17%) was proximal and 5(83%) were distal to the point of entry of the MC into the coracobrachialis and in 4(9%) upper limbs MC nerve rejoins with the median nerve. CONCLUSIONS: It is evident that significant anatomical variations of the MC nerve exist in our study. These variations emphasize the complexities and irregularities of this anatomical structure with regard to surgical approaches.Item The distribution of the anal glands and the variable regional occurrence of fistula-in-ano: is there a relationship?(Springer Nature, 2010) Abeysuriya, V.; Salgado, L.S.S.; Samarasekera, D.N.BACKGROUND: Fistula in ano is a rather common condition, but the disease process is not yet fully understood. The aim of our study was to determine how the distribution of anal glands contributes to the variable occurrence of fistula-in-ano in the perineum. METHODS: we conducted a blinded two-phase prospective study. In the first phase, the perineum of the patients with primary fistulae was anatomically divided into right upper and lower and left upper and lower quadrants in the lithotomy position. The fistulae were classified according to what quadrant the external and internal openings and the tract pathway were in. In the second phase, using 10 human cadaver specimens, full thickness tissue samples were taken from each quadrant of the anus. Samples were histologically evaluated for the volume fractions of the anal glands in each quadrant. RESULTS: The new classification system we propose revealed that the largest number of fistulae 43% (17/39) were in the right lower quadrant, and 22% (9/39), 12% (5/39) and 8% (3/39) were in the left lower, right upper and left upper quadrants, respectively. It was also observed that 14% (5/39) of fistulae were in more than one quadrant. The volume fractions of each quadrant showed that the largest volume fraction of the anal glands was in the right lower quadrant (right lower quadrant: 0.64, left lower quadrant: 0.35, right upper quadrant: 0.26 and left upper quadrant: 0.22, P = 0.001). CONCLUSIONS: To the best of our knowledge, this is the first study that has objectively shown that the distribution of the anal glands is variable, and the highest density of anal glands is in the right lower quadrant of the anus. This variable distribution may be associated with the variable occurrence in fistula in ano.Item Can we improve the criteria for selection of medical students in Sri Lanka?(Sri Lanka Medical Association, 2010) de Silva, N.R.; Salgado, L.S.S.; Fernando, G.M.O.; Liyanage, P.L.C.K.; Hewage, S.N.; Pathmeswaran, A.OBJECTIVE: To examine the validity of selected entry level characteristics in relation to the GCE Advanced Levei (AL) examination as predictors of performance of medical students. METHODS: Data on two consecutive batches of students at the Medical Faculty, Kelaniya University, were analysed. These included students' sex. AL attempt, AL z-score, English placement test marks on registration at the faculty, and aggregate marks at summadve examinations held in the 2nd (Phase I), 3rd and 4l (Phase II) years. The effect of predictor variables on medical school marks was assessed by multivariate analysis with causal path diagrams. RESULTS: The sample consisted of 294 students; 58.8% were females. Most had entered after the 2nd attempt (32% from 1s1, 48.3% from 2nd, 19.7% from 3rd attempt). The mean z-score was 2.017 (SD0.142). Mean English placement test mark was 59.1 (SD14.2). Mean marks in Phase I and II examinations were 54.3 (SD7.3) and 56.5 .(SD7.6) respectively. Significantly more males had entered after the 3rd attempt than females (27.2% of males, vs 14.5% of females, Pearson x2=0.027). Females did significantly better in English and in Phase I and II examinations. Path analysis showed that z-score, attempt and English placement test marks were all significant predictors of outcome at the First Examination. There was high correlation between performance at First and Second Examinations. CONCLUSION: Requiring prospective medical students to pass General English and restricting the number of attempts at the AL to two instead of three, will result in selection of medical students that perform better.Item Histological and ultra-structural changes in enpothelial cells of the placenta in hypertensive disorders of pregnancy(Sri Lanka Medical Association, 2000) Salgado, L.S.S.; Angunawela, P.; Tissera, A.; Sirisena, J.INTRODUCTION: The maternal syndrome of pre-eclampsia is thought to result from a generalized vascular endothelial cell disturbance caused by a circulating factor probably derived from the placenta. Objective: Study the histological and ultra-structural changes of endothelial cells, so that the contribution of these changes to the pathogenesis of hypertensive disorders of pregnancy can be understood. METHOD: Placentae of 150 normal pregnancies and 200 hypertensive disorders of pregnancy were selected for this study. Tissue from the fetal surface was obtained for microscopic examination. Electron microscopic examination was done on 20 normal placentae and 30 placentae from hypertensive disorders of pregnancy. RESULTS: Histologically there were no significant changes in the normal group and in the group with hypertensive disorders of pregnancy. Ultra-structurally significant changes were observed in golgi bodies, mitochondria, pinocytotic vesicles, rough endoplasmic reticulum, glycogen and interaction with pericytic processes in the endothelial cells of the placentae with hypertensive disorders of pregnancy when compared to normal placentae. CONCLUSIONS: Significant changes were observed in endothelial cells at the ultrastructural level in the placentae of women with hypertensive disorders of pregnancy.Item Morphological characteristics of appendix vermiformis in human: a pilot study to establish regional norms with special interest on its position(Sri Lanka Medical Association, 2007) Salgado, L.S.S.; Abeysuriya, V.; Kumarage, S.K.; Rupasinghe, D.K.INTRODUCTION: Regional variations of morphology of the appendix vermiformis have been observed, especially with reference to its position, but due to the scarcity of scientific studies on its regional anatomy, achieving norms for its morphology is difficult. OBJECTIVE: To describe morphological characteristics of human cadaveric appendices. Design, setting and methods: A descriptive, prospective, cross sectional study was carried out among 30 patients who underwent laparoscopic appendicectomy in Colombo North Teaching Hospital, and 60 dissected cadavers in Departments of Anatomy in the Medical Faculties of Ragama and Sri Jayewardenepura. Results: The mean length of appendix was 65mm, ranging from 35mm to 110mm. 96.6% (58/60) of appendices were attached to the postero-medial surface and 3.4%(2/60) to the apex of the cecum. In all cadavers, the shape of the cecum was found to be ampullary. The mean outer diameter of appendices were 5.2mm, ranging from 3mm to 10mm. 41.6% (22/90) were retrocecal, 6.6% (6/90) pelvic (subcecal and promonteric 3.3% each), and 51.6% (46/90) were ileal (consisting 30% (27/90) post ileal and 21.6% (19/90) pre-ileal). 96.6% (58/60) of appendices were supplied by the inferior division of ileo-cecal artery, and 1.6% (1/60) by the posterior cecal artery. The mean distance between the opening of the appendix to cecum and to the opening of ileo cecal opening was 2i.2mm (range 13mm to 24mm). The mean length of the appendicular artery was 35mm (range 25mm to 40mm). CONCLUSION: Regional variations of morphological characteristics of appendix are numerous, especially with regard to its position. Therefore to establish norms for a population, further extensive studies are needed.Item Selection of medical students in Sri Lanka: time to re-think criteria?(Sri Lanka Medical Association, 2011) Hewage, S.N.; Salgado, L.S.S.; Fernando, G.M.O.; Liyanage, P.L.C.K.; Pathmeswaran, A.; de Silva, N.R.OBJECTIVE: To examine the validity of selected entry level characteristics in relation to the GCE A/L examination as independent predictors of performance of students in medical school. METHODS : A retrospective, analytical study was done at the Faculty of Medicine, University of Kelaniya. Student characteristics at entry were described by sex, the average z-score, General English grade and attempt at GCE A/L examination, and average mark obtained at the English placement test on registration to medical school. Average marks at three summative examinations were used as indicators of performance in medical school. Multivariate analysis using multiple linear regression was carried out using these three outcome measures in relation to four entry point variables as predictors of performance in medical school. Causal path diagrams were constructed using standardised regression coefficients for the whole group and for male and female students separately. RESULTS: The A/L z-score, A/L attempt and English placement test marks were all significant predictors of outcome at the First Examination. Of the variables relating to the A/L examination, the attempt had a much higher path coefficient with performance at the First Examination than the A/L z-score, as did the English marks. Separate path analyses for male and female students showed that while the significance of the relationships remained the same, the magnitude of the correlation was different. CONCLUSIONS: Students who gain admission on their 3rd attempt at the AL examination fare much worse than those admitted to medical school on their 1st attempt. Differences between sexes in examination performance are probably linked to both A/L attempt and English language proficiency.Item The Distribution of the anal glands and the variable regional occurrence of fistula-in-ano: is there a relationship?(Springer-Verlag, 2010) Abeysuriya, V.; Salgado, L.S.S.; Samarasekera, D.N.BACKGROUND: Fistula in ano is a rather common condition, but the disease process is not yet fully understood. The aim of our study was to determine how the distribution of anal glands contributes to the variable occurrence of fistula-in-ano in the perineum. METHODS: we conducted a blinded two-phase prospective study. In the first phase, the perineum of the patients with primary fistulae was anatomically divided into right upper and lower and left upper and lower quadrants in the lithotomy position. The fistulae were classified according to what quadrant the external and internal openings and the tract pathway were in. In the second phase, using 10 human cadaver specimens, full thickness tissue samples were taken from each quadrant of the anus. Samples were histologically evaluated for the volume fractions of the anal glands in each quadrant. RESULTS: The new classification system we propose revealed that the largest number of fistulae 43% (17/39) were in the right lower quadrant, and 22% (9/39), 12% (5/39) and 8% (3/39) were in the left lower, right upper and left upper quadrants, respectively. It was also observed that 14% (5/39) of fistulae were in more than one quadrant. The volume fractions of each quadrant showed that the largest volume fraction of the anal glands was in the right lower quadrant (right lower quadrant: 0.64, left lower quadrant: 0.35, right upper quadrant: 0.26 and left upper quadrant: 0.22, P = 0.001). CONCLUSIONS: To the best of our knowledge, this is the first study that has objectively shown that the distribution of the anal glands is variable, and the highest density of anal glands is in the right lower quadrant of the anus. This variable distribution may be associated with the variable occurrence in fistula in ano.Item Anatomical variations of the vasculature in suprarenal glands in Sri Lankans(College of Surgeons of Sri Lanka, 2007) Salgado, L.S.S.; Abeysuriya, V.; Kumarage, S.K.INTRODUCTION: Anatomical variations of vascular patterns in the suprarenal glands have not been very well studied..METHOD: A descriptive study was performed in 40 human cadavers to identify the anatomical variations in the vasculature of the suprarenal gland. RESULTS: Superior, middle and inferior groups of arteries supplied the suprarenal glands, superior and inferior groups were present in all while the middle group was found in only 94.5%. The superior group had 3 arteries in males and 4 in females on each side. The middle had 01 artery on each side in both sexes. The inferior group had 2 arteries in males and 1 in females on each side. The superior group originated from the posterior branch of the ipsilateral inferior phrenic artery in 85.5% +/- 6.3 on the right and 82% +/- 7.5 on the left. With regard to the middle group, the aortic origin was the most frequent; 55.4%+/- 8.1 on the right and 44.6%+/- 8.1 on the left. The origin of the middle group from the trunk of the inferior Phrenic artery on both sides were, 25.6%+/-8.4 on the right and 38.57% +/- 8.6 on the left. The arteries of the inferior group arose from the ipsilateral renal artery in 75% +/- 8.5 on the right and 53% +/- 8.7 on the left. CONCLUSION: The most number of variations were found in relation to the middle group of suprarenal arteries, whilst superior and inferior groups were constant.Item Position and morphology of the appendix vermiformis in Sri Lankans(College of Surgeons of Sri Lanka, 2007) Salgado, L.S.S.; Abeysuriya, V.; Kumarage, S.K.; Rupasinghe, D.K.INTRODUCTION: The vermiform appendix varies in length and opens into the posteromedial wall of the caecum, 2cm below the ileo caecal valve. While the position of its base is constant in relation to the caecum, the appendix itself may lie in a variety of positions. OBJECTIVE: To describe the morphological characteristics of the appendix among Sri Lankans. METHOD: A prospective study was carried out among 30 patients who underwent laparoscopic appendicectomy in Colombo North Teaching Hospital and 60 dissected cadavers in the departments of Anatomy at Ragama and Sri Jayewardenepura. While the intra-abdominal position of the appendix was assessed in both laparoscopic appendicectomy patients and the dissected cadavers, the other morphological characteristics were assessed only in the cadavers. RESULTS: The mean length of the appendix was 65mm, (range 35 to 110mm). The base of the appendix opened into the posteromedial wall of the caecum in 96.6% (58/60) and into the apex of the caecum in 3.4% (2/60). The mean outer diameter of the appendix was 5.2mm (range3 to 10mm). The position of the appendix was found to be retrocaecal in 24.4% (27/90), pelvic in 6.6% (6/90), and ileal in 51.6% (46/90) comprising 30% (27/90) post-ileal and21.6%(19/90)pre-ileal. The blood supply of the appendix was the inferior division of the ileo caecal artery in 96.6% (58/60) and the posterior caecal artery in 1.6% (1/60). The mean distance between the base of the appendix and the ileocaecal valve was 21.2 mm, varying from 13 mm to 24mm. CONCLUSION: The frequency of the various positions of the appendix in our study population was different to the reported data. The ileal position of the appendix was the most common and the pelvic position the least common.