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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Anterior and posterior intravaginal slingplasty (TVS)(Sri Lanka College of Obstetricians and Gynaecologists, 2003) Sirisena, J.Genuine stress urinary incontinence (SUI) is the involuntary loss of urine associated with activities that increase abdominal pressure such as coughing, laughing, lifting, sneezing, and physical exertion. It is usually associated with an increase in mobility of the neck of the bladder. Increased mobility of the bladderand urethra is called a cystocele and sufferers perceive that their "bladder is falling out". This mobility compromises the function of the bladder to store urine and causes the involuntary loss of urine with maneuvers such as lifting, laughing and staining down. Most procedures to correct SUI are designed to "tack" the bladder and urethra into a more normal anatomic position. The hope is that by correcting the anatomy, normal bladder function will be restored. Keyhole surgery techniques for vaginal prolepse and female incontinence are based on the Integral Theory of Female Incontinence. This theory states that both urinary dysfunction and vaginal prolapse have a common origin, i.e., laxity in the vagina or its supporting ligaments, A classification of laxity in 3 zones of the vagina guides both surgical treatment and new pelvic floor rehabilitation methods. The operations work by strengthening ligaments and connective tissue laxity in the 3 zones. Longer term surgical cure rates for stress incontinence of 85-94% have been reported in multicentre studies. Tension — free Vaginal Tape (TVT) or Anterior Intravaginal Slingplasry (Anterior IVS) device is intended to be used as a pubourethral sling for the treatment of SUI for female urinary incontinence resulting from urethral hypermobiliry and/ or intrinsic sphincter deficiency. This occurs because the pubo-urethral ligament, which attaches the urethra to the pubic bone, becomes stretched and loose due to childbirth and age. It cannot counteract the backward pull of the pelvic muscles, which open or funnel the urethra with coughing or straining, and this leads to stress incontinence. In addition the looseness of "the urethral supports can lead to premature activation of the micturition reflex, causing frequency and urgency of urine. This procedure is minimally invasive. The devise is positioned close to the urethra, with no increased tension on the vaginal wall and no elevation of the urethra. The tape provides a sling under the urethra and does not pull or lift the urethra from its anatomical position. NX/hen at rest, the urethra is in its normal position. When stressed, the devise provides tension - free support of the inner urethra and bladder neck in the correctional position. In essence, a polypropylene tape is inserted under the urethra and bought out through a small 1 cm incision above the pubic bone on each side. There is a fibrous reaction around the tape, which acts as an artificial ligament to strengthen and replace the weakened ligament. The vagina is then attached to the pelvic muscles. Patients have less postoperative pain than with the more invasive procedures and may return home the same day. Complications are rare, but it must be understood and accepted that these can occur. The complications that can occur include infection of the urine or wound, haemorrhage, injury to Bladder. Posterior TVS is performed to correct an enterocoele, which forms after hysterectomy. The ligaments are weakened and a hernia forms at the site where the uterus was removed, pushed down by the bowel above and it protrudes through the vagina. To repair this defect, a tape is passed from near the coccyx bone, up past the rectum to the site of the enterocoele, and then passed down through the other side. This tape is attached to the remains of the weakened pelvic ligaments and vagina. A fibrous reaction occurs around the tape, to strengthen and replace the weakened ligament. The results of any operation cannot be guaranteed, and it is possible for the condition to recur at a later date. However, unlike other vaginal repair operations, there should be a cure of the prolapse without shortening the vagina or making it too tight and thus causing pain with intercourse. Complications are rare but may occur. The complications that can occur are infection of the wound requiring antibiotics, (however a pelvic abscess could develop, requiring drainage), haemorrhage, injury to Rectum, and rejection of the tape.Item Interaction between pericytes and endothelial cell of foetal capillaries in hypertensive placentae(Sri Lanka Medical Association, 1998) Salgado, S.; Angunawela, P.; Sirisena, J.; de Tissera, A.INTRODUCTION : Pericytes and endothelial cells are known to possess direct contacts in many parts of the vascular tree. Pericytes are known to have modulating effects on endothelial cell growth and differentiation. It is possible that some pericytes are a source of new endothelial cell. OBJECTIVES : Information regarding the ultrastructural changes of foetal capillaries of hypertensive placentae is lacking. Therefore we studied the foetal capillaries of hypertensive placentae to ascertain any significant ultrastructural interaction between pericytes. endothelial cells and basement membrane. METHOD : Placental tissue from 15 pregnant mothers with a blood pressure of 140/90 or more and 10 normal mothers who had normal full term deliveries were studied. Fresh placentae were examined and 2mm sized pieces were taken from central foetal and fixed in 2% gluteraldehyde for eletron microscopic studies. RESULTS : All hypertensive placentae showed a number of pericytic processes, which was significantly higher than in normal placentae. (P<0.001). Both frequency and complexity of direct connections between endothelial cells and pericytes appear to be increased in foetal capi 1 laries of hypertensive placentae . Basement membranes of foetal capillaries in 9 hypertensive placentae showed marked thickening. CONCLUSIONS : There was complexed interaction between endothelial cells and pericytes of foetal capillaries of hypertensive placentae.Item Effect of mebendazole threapy in pregnancy on birth outcome(Sri Lanka Medical Association, 1998) de Silva, N.; Sirisena, J.; Gunasekera, D.; de Silva, J.OBJECTIVES : A prospective, unmatched, case-control study was done to assess the safety of mebendazole threapy in pregnancy, a hitherto uninvestigated factor. DESIGN : All women delivering in the University Obstetrics Unit of the Ragama Teaching Hospital between May 1996 and, March 1997 were administered a questionnaire soon after delivery. Details of the birth and the baby were recorded; suspected defects were confirmed by a paediatrician. The incidence of congenital defects in babies of mothers who had taken mebendazole during the pregnancy was compared with the incidence among those who had not taken an anthelmintic (controls). Data analysis was done using Epi Info 6.03. RESULTS : Of 3688 women, 73.5% had taken mebendazole, 24.8% had not taken any any anthelmintic , 1.1% had taken an anthelmintic but could not identify it and 0.6% had taken pyrantel or albedazole. The incidence of birth defects was 2.36% {64/2711) in the mebendazole group compared with 2.3% (21/913) in the controls (odds ratio 1.03, 95% confidence limits 0.61 - 1.75). This difference was not statistically significant even when corrected for other known risk factors by stratified analysis . Data regarding timing of mebendazole threapy was available for 2660 women; 6.9% in the first trimester, 83.8% in the second, and 9.2% in the third. The incidence of birth defects among women who had taken mebendazole in the first trimester was 3.24% (6/185). giving an odds ratio of 1.42 against the controls; this was also not statistically significant.CONCLUSIONS : The use of mebendazole in pregnancy does not lead to a significant increase in the risk of congenital defects.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 Morbidity and mortality of neonates associated with meconium stained liquor in labour(Sri Lanka Medical Association, 2000) Jayawardene, D.R.K.C.; Sirisena, J.INTRODUCTION: Few prospective studies have been performed in Sri Lanka to determine the morbidity and mortality of neonates associated with meconium stained liquor at delivery (MSLD) and rneconium aspiration syndrome (MAS) OBJECTIVES: 1. Determine the incidence, morbidity and mortality of MSLD. 2. Determine the differences in the outcome of babies who had meconiurn above and below the vocal cords. 3. Determine whether foetal heart sound (FHS) and CTG (cardio-tocography) are predictive of MSLD and MAS. METHOD: A prospective study of 77 babies with MSLD at the Professorial Units, Teaching Hospital, Ragama, during a four month period was done. 68 were examined by the PHO with a laryngoscope to detect meconium above or below the vocal cords. All babies were kept under observation for signs of MAS. Respiratory rate, oxygen saturation, CXR changes were recorded, RESULTS: Of 1447 live births 77 (5.3%.) had MSLD, 35 were admitted to a SCBU and 11 (31,41%.) developed MAS. There were 2 deaths (16.7%). 4/58 (6.891%.) with meconium above the vocal cords had MAS compared to 7/10 (70%.) babies who had meconium below the vocal cords (P<0. 001). CTG abnormalities were seen in 13/50 (20%) babies with MSLD, and 3/11 (27,7%) babies with MAS. .FHS abnormalities were seen only in 9/77 (11.87%) babies with MSLD; out of this 2 (22.2%) had MAS. 68/77 (88%) MSLD had regular FHS and 9/1 1 (8 1 %) babies with MAS had regular FHS. CONCLUSIONS: The incidence of MAS following MSLD is low. Meconium below the vocal cords was associated with poor prognosis. FHS and CTG abnormalities were not predictive of MSLD or MAS.Item Ultrastructure of endothelial cells of fetal capillaries of placentae of women with pregnancy induced hypertention(University of Colombo, 2006) Salgado, S. S.; Angunawela, P.; de Tissera, A.; Sirisena, J.The present study aimed to compare the ultra structural features of endothelial cells of fetal terminal capillaries of placentae from hypertensive (n=10) and non-hypertensive (n=10) pregnancies. The ultrastructural features of endothelial cells of terminal capillaries from the fetal surface of each placenta were examined under the electron microscope. Micrographs of 8 different endothelial cells from each placenta were prepared for evaluation by stereological analysis using a coherent double lattice test system. The volume fractions of different organelles and cytosol in endothelial cells of placental fetal capillaries of both hypertensive and non-hypertensive pregnancies were deter¬mined by counting the number of grid intersection points falling on the endothelial cell cytoplasm, mitochondria, rough endoplasmic reticulum and glycogen deposits. Ultrastructural changes were noted in endothelial cells of capillaries of placentae of mothers with pregnancy induced hypertension. Statistical analysis showed that the volume fractions of the organelles and the amount of cytoplasm of endothelial cells of placentae from hypertensive pregnancies were significantly higher than those from non-hypertensive pregnanciesThere was a significant increase in some of the organelles and the capacity of cytoplasm of endothelial cells of placentae from hypertensive pregnancies when compared to normotensive pregnancies. These findings may be attributed to compensatory mechanisms operating as a response to hypoxia caused by reduced maternal blood flow to the placenta.Item Villous syncytial knots in hypertensive placenta(Sri Lanka College of Obstetricians and Gynaecologists, 2004) Salgado, S. S.; Angunawela, P.; de Tissera, A.; Sirisena, J.Syncytial knots are seen on many terminal villi of all mature placentae. Syncytial knots in more than 30 percent of mature terminal villi, is considered as an indication of postmaturity. The aim of this study was to find out whether there is significant increase in syncytial knot formation in pre-eclampsia and to assess the relationship between syncytial knot formation and maternal age, parity, and period of gestation and effects of syncytial knots on the birthweight, and apgar score of the newborn. The study sample consisted of 150 normal and 200 hypertensive mothers. Light microscopic studies were done on sections taken from fetal surface of their placentae. Hundred terminal villi in fetal subdivisions of each placenta were counted and the number of villi with syncytial knots was recorded. Multivariate analysis was done to find out the difference between the number of placentae with high syncytial knot counts in normal and hypertensive groups and the relationship between high syncytial knot counts and the maternal age, parity, period of gestation and birthweight, head circumference and apgar score of the newborn. Statistically significant increase of syncytial knot counts was seen in hypertensive group than the normal group. There was no relationship between syncytial knot formation and maternal age and parity. In normal and hypertensive groups, an increase in the number of placentae with high syncytial counts was observed with increasing maturity. Although the number of placentae with high syncytial knot counts were higher in relation to low apgar score than the normal counts, difference was not statistically significant. A significant difference in the birth weight and the head circumference of newborns in relation to normal and high syncytial knot counts was observed in hypertensive group.Item How accurate is the postnatal estimation of gestational age?(Oxford University Press, 2002) Karunasekera, K.A.W.; Sirisena, J.; Jayasinghe, J.A.C.T.; Perera, G.U.I.The aim of the present study was to determine the accuracy of postnatal gestational age assessment of babies using three different methods. Two hundred women attending the university obstetric unit of North Colombo Teaching Hospital, Ragama, Sri Lanka whose expected date of delivery (EDD) by early ultrasonography fell within a week of EDD by dates were included in the study. Postnatal assessment was performed within 24 h of birth. Two co-researchers performed Dubowitz and Parkin methods separately without prior knowledge of menstrual gestation. Data was analysed using EpiInfo 6 and SPSS packages. The mean difference between menstrual gestation and Dubowitz physical criteria was -0.45 weeks; between menstrual gestation and classical Dubowitz method, +2.18 weeks; and between menstrual gestation and Parkin's method, +0.34 weeks. It was concluded that postnatal assessment of gestational age by the Parkin's method is much closer to menstrual gestation than the classical Dubowitz method and is also easier and quicker to perform.Item Efficiency of Pipelle device in sampling endometrium(Wiley, 2000) Wagaarachchi, P. T.; Sirisena, J.No Abstract AvailableItem A Cautionary tale: intra amniotic injection of methylene blue(Sri Lanka Medical Association, 2000) Sirisena, J.; Lanerolle, S. D.No Abstract Available