Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
3 results
Search Results
Item Unequal distribution of liver fat warrants careful selection of biopsy site during donor assessment(Sri Lanka Medical Association, 2017) Siriwardana, R.C.; Sivasundarama, T.; Tillakaratne, M.S.B.; Paranahewa, L.INTRODUCTION & OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is a major health concern. Liver fat deposition seems to have a segmental variation. This can affect invasive, and non-invasive detection of NAFLD. The present study evaluates the pattern of fat distribution of the liver using liver computed tomogram (CT) attenuation index. METHODS: Two radiologists evaluated 517 non-contrast CT abdomen and pelvis images. Two 40mm2 regions of interest (ROIs) were selected from each segment. The hepatic segmental densities were obtained by calculating the mean densities of areas of corresponding liver segments. The mean hepatic attenuation (MHA) was quantified by obtaining the mean segmental densities. Densities were compared among segments and with the MHA. RESULTS: The median age was 58 years (min-max: 9-88; IQR: 45-67) and 276 (53.4 %) were males. The overall median hepatic density (i.e. grand median) was 53.05 (95% CI 52.95-53.15) Hounsfield units (HU). Lowest median density was observed in segment IVb, significantly lower compared with other segments (p<0.05). Highest median segmental density was observed in segment V compared to other segments (p<0.05). Segments V, VI and VIII had higher median densities compared with grand median hepatic density (i.e. 53.05; whereas median densities of segments II, III and VII were not significantly different from the grand median. CONCLUSION: Liver biopsy taken from segments II, III and VII are likely to be the most representative of overall fat deposition.Item Standard local infiltration vs. additional laparoscopic-guided transverse abdominis plane block in laparoscopic cholecystectomy: interim analysis of double blinded randomized control study(Sri Lanka Medical Association, 2017) Tillakaratne, M.S.B.; Gunetilleke, B.; Kumarage, S.; Siriwardana, R.C.INTRODUCTION & OBJECTIVES: Transverse abdominal plane block (TAP) is a new technique used in perioperative analgesia. It has shown a clear benefit in long laparoscopic procedures. Current trial evaluates its efficacy in uncomplicated laparoscopic cholecystectomy. METHODS: A single centre double blinded randomized control trial was designed with 45 patients to each group based on 80% power at a p<0.01. Patients who underwent elective uncomplicated laparoscopic cholecystectomy were randomized in to local port site infiltration of bupivacaine and additional TAP block groups. Primary efficacy variables were postoperative pain score and requirement for opioids measured every six hourly. Duration of immobilization and hospital stay were some of the secondary variables. An interim analysis was done at 8 months. RESULTS: Thirty eight patients were randomized to two groups. Twenty-two (58%) were given TAP blocks. The male:female ratio (p=0.24), age (p=0.4), indication for surgery (p=0.34), ASA (p=0.45) and BMI (p=0.58) were similar in the two groups. There was no difference in operating time (p=0.28), intraoperative findings (p=0.4) and the difficulty index (p=0.26). Six hourly pain scores till the time of discharge, total and six hourly opioid dose, number of vomiting episodes, total hospital stay (p=0.98) and time to mobilize out of the bed (p=0.63) were similar in the two groups. CONCLUSION: TAP block does not have an added advantage over standard port site infiltration in uncomplicated laparoscopic cholecystectomy.Item Use of a rectus abdominis muscle cube to seal presacral venous haemorrhage(College of Surgeons of Sri Lanka, 2014) Tillakaratne, M.S.B.; Ekanayake, C.S.; Wijenayake, W.; Deen, K.I.