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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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Author: search.filters.author.Wijesuriya, S.R.E.

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Now showing 1 - 10 of 23
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    Long distance travel prior to major surgical procedure: Does it have an impact on post operative pulmonary embolism
    (Springer Nature, 2009) Wijesuriya, S.R.E.; Delriviere, L.D.; Mitchell, A.W.
    BACKGROUND: Long distance travel is a known risk factor for venous thrombo-embolism. In our hospital approximately 15% of surgical procedures are performed on patients from the country, needing prolong travel. The purpose of this study is to evaluate whether prolong travel prior to a surgical procedure increases the risk for post operative pulmonary embolism (PE). METHODS AND MATERIALS: Thirty patients with post operative pulmonary embolism confirmed by Computed Tomography Pulmonary Angiogram (CTPA), perfusion scan or by post-mortem, diagnosed during the same hospital admission were evaluated. Patients were categorised in to two groups, who travelled from the country or from metropolitan area in view of hospital admission. RESULTS: Operations in 25 metropolitan patients (12 males, 13 females, median age:71years, range:25-97, median distance:26km, range:5-55), and in five country patients (four males, one female, median age:65, range:33-73, median distance:183km, range:133-425) were complicated by post operative PE. Whilst 17 of 25 metropolitan patients (68%) received peri-operative prophylaxis against DVT/PE (pre-operatively or within 24hours of procedure), four of five patients (80%) from the country received prophylaxis. CONCLUSIONS: Long-distance travel prior to hospital admission seems to have no impact on the incidence of postoperative PE, as the proportion of country patients with postoperative PE (15%) is comparable to the proportion of country patients operated in a metropolitan hospital. Therefore the current policy of perioperative prophylaxis is adequate. Extended prophylaxis prior to initiation of travel seems unnecessary. © 2009 Indian Association of Cardiovascular-Thoracic Surgeons. AUTHOR KEYWORDS: Computed tomography; Pulmonary embolism; Surgery
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    Detection of micrometastasis in LYMPH nodes using reverse transcription polymerase chain reaction (RT-PCR) for Cytokeratin 20 (CK-20): are we under staging rectal cancer
    (The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Wijesuriya, S.R.E.; Kuruppuarachchi, K.O.R.; Deen, K.I.; Weerasinghe, A.; Ramesh, R.; Hewavisenthi, J.
    INTRODUCTION: Postoperative adjuvant chemotherapy in rectal cancer is determined by the presence of metastases in lymph nodes. Detection of LYMPH node metastases is routinely performed by light microscopy. Conventional histology may not detect all metastases especially following neoadjuvant therapy (NAT). CK-20 is a cytokeratin known to be specific to colonic epithelium which may help detection of rectal cancer metastases in lymph nodes. OBJECTIVE: To detect micro metastases in lymph nodes in patients with rectal cancer. staged node negative by routine histology. METHODS: Mesenteric lymph nodes from patients who have undergone NAT for rectal cancer were harvested during surgery. Nodes were bisected and one half sent for Haernatoxylin and eosin (H&E) staining and evaluated by a single pathologist, while the other half was examined for CK 20 by RT-PCR. The technique was validated by testing lymph nodes with known metastases and nodes from patients without cancer. 21 lymph nodes from 6 patients (median age 46 years, range 25-55) which were negative for tumour deposits by H&E stain were assessed for micro metastases. RESULTS: All 2 l nodes which were histologically negative for metastases were positive for micro metastases (positive predictive value l 00%) whilst 2 nodes with known metastases were positive for CK-20, 3 nodes from non-cancer patients were negative for CK-20. CONCLUSION: Detection of CK-20 is accurate in identification of micro metastases of rectal cancer to lymph nodes. Assessment of nodes by H&E histology risks under staging lymph node micro metastases in rectal cancer.
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    Clinical outcome of patients having neo-adjuvant therapy(NAT) for rectal cancer: a case control study
    (The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Wijesuriya, S.R.E.; Deen, K.I.; Hewavisenthi, J.; Ratnayake, G.
    INTRODUCTION: From July i 999 we have employed NAT on a selective basis in the management of rectal cancer. OBJECTIVE: To explore the value of NAT in patients with rectal cancer in the short term. To study the effect of Neo Adjuvant Therapy for rectal carcinoma in the short term. METHODS: Two abdomino perineal resections and 24 anterior resections were done in the NAT group and 5 and 2 l in the no NAT group. There were 2 perioperative deaths in NAT group and one in the no NAT group (P 0.75). There were 7 Cancer related deaths in the NAT group and 6 in the no NAT group (P = l). The survival was 15 month (5 -45) for the NAT group and 16 (3 -54) for the non NAT group (P = I). There were no difference in the recurrences (2 vs 4 P ""0.67) metastasis (4 vs 4 P = 1) or complication (8 vs 2 p =0.08) abdomino perineal resections were performed in 2 patients in the NAT group and 5 in the no NAT group. Anterior resections were performed in 24 patients and 24 patients in NAT and no NAT groups. CONCLUSION: Overall there was no significant difference in the clinical out come between those given NAT and those not given.
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    Complete pancreatic transection in a child treated by drainage and sphincterotomy
    (Lippincott Williams & Wilkins, 2010) Siriwardana, R.C.; Wijesuriya, S.R.E.; Marasinghe, A.; de Silva, M.; Deen, K.I.
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    Liver transplantation - initial experience at Colombo North Liver Transplantation Service
    (Sri Lanka Medical Assosiation, 2012) Bogamuwa, M.M.M.P.; Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Wijesuriya, S.R.E.; Liyanage, C.A.H.; Gunetilleke, M.B.; de Silva, H.J.
    INTRODUCTION: Liver transplantation (LT) is the treatment of choice for end stage liver diseases. LT is still in its infancy in Sri Lanka. AIMS: To describe the initial experience of the Colombo North Liver Transplantation Service (CNLTS) METHODS: The study population included all patients referred for LT to CNLTS. All cases were evaluated for the indication and medical, social and psychological suitability for LT. Decision to list patients for LT was reached by a multidisciplinary team consisting of surgeons, physicians and anaesthetists. All data were collected prospectively. RESULTS: 52 patients were referred for LT over a period of 7 months. 48/52[92.3%) were males. The median age at referral was 52(range 13-66) years. The median Child-Turcotte-Pugh(CTP) score at referral was 9/15(range 5-13/15). Median Model for End Stage Liver Disease (MELD) score at referral was 17(range 9-26). 3/52(5.8%) had hepatocellular carcinoma and 9/52(17.3%) had a low MELD score (<14) but with life threatening complications of cirrhosis as indication. 4/9(44.4%) of those being upper gastrointestinal bleeds from varices. 28/52(53.8%) of the referrals had cryptogenic cirrhosis (CC), 18/52(34.6%) had alcoholic cirrhosis, 2/52(3.8%) each had metabolic, congenital and other causes for cirrhosis. 7/52(13.5%) transplants were performed [3 Live Donor LTs(LDLT) and 4 Deceased Donor LTs(DDLT)]. 5/7(71.4%)[2 - LDLT, 3 -DDLT] had a successful LT outcome. 11/45(24.4%) patients died while on the LT waiting list. CONCLUSIONS: High MELD CC was the commonest reason for referral for LT in our group. There was a high waiting list mortality highlighting the need for an efficient DDLT service.
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    Cryptogenic cirrhosis is the leading cause for listing for liver transplantation in Sri Lanka
    (Springer India, 2013) Siriwardana, R.C.; Niriella, M.A.; Liyanage, C.A.H.; Wijesuriya, S.R.E.; Gunetilleke, B.; Dassanayake, A.S.; de Silva, H.J.
    Hepatitis B and C are rare in Sri Lanka. Nonalcoholic fatty liver disease is increasing in the country. Eighty-one patients referred for liver transplantation (LT) over a period of 18 months were prospectively evaluated. Ninety-two percent (n = 74) were males. Cryptogenic cirrhosis was the leading indication for LT (58%, n = 47) followed by alcohol in 27% (n = 33). Hepatitis B and C were not seen in our cases. The liver biochemistry and clinical status of cirrhosis were similar in cryptogenic and alcoholic cirrhotics. Fourteen patients died while waiting for transplant, and nine transplants were performed. Cryptogenic cirrhosis is the leading cause for LT in Sri Lanka.
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    Obstructive jaundice caused by a biliary mucinous cystadenoma in a woman: a case report
    (BioMed Central, 2013) Chandrasinghe, P.C.; Liyanage, C.; Deen, K.I.; Wijesuriya, S.R.E.
    INTRODUCTION: Mucinous cystadenoma of the liver is a rare (less than 5%) neoplasm. This condition is more common in young women and accounts for non-specific symptoms. Cyst adenomas commonly affect the intrahepatic system (90%) and are rarely found in the extrahepaticbiliary system or affecting both the systems. CASE PRESENTATION: A 39-year-old Sinhalese woman presented with features of obstructive jaundice and was found to have a biliaryneoplasm on imaging. In the absence of a definitive diagnosis despite extensive imaging she underwent preoperative endoscopic biliarydrainage followed by a left hemihepatectomy with Roux-en-Y hepaticojejunostomy. A pathological examination of the specimen revealed an obstruction of the bile duct caused by a biliary mucinous cystadenoma affecting both the intrahepatic and extrahepatic systems. CONCLUSIONS: Biliary mucinous cystadenoma rarely present with obstructive jaundice affecting both intrahepatic and extrahepatic ducts. Exhaustive investigation might not help in the diagnosis and may need to be treated based on clinical judgment. The definitive treatment modality is surgery due to its malignant potential. The operative procedure is technically demanding and is best performed at specialist centers to minimize complications. © 2013 Chandrasinghe et al.; licensee BioMed Central Ltd.
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    Aortic patch reconstruction of superior mesenteric and celiac axis in a deceased donor liver transplantation
    (Sri Lanka Medical Association, 2012) Marasinghe, N.C.; Siriwardana, R.C.; Wijesuriya, S.R.E.; Liyanage, C.A.H.; de Silva, H.J.
    No Abstract available
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    Eversion thrombectomy for partial portal vein thrombosis during living donor liver transplantation
    (College of Surgeons of Sri Lanka, 2012) Siriwardana, R.C.; Wijesuriya, S.R.E.; Liyanage, C.A.H.
    No Abstract Available
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    Urinary catheter bulb mimicking obstructed femoral hernia
    (Wiley-Blackwell Pub. Asia, 2011) Wijesuriya, S.R.E.; Deen, K.I.
    No Abstract Available
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