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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Colonoscopic ultrasound is associated with a learning phenomenon despite previous rigid probe experience(Springer India, 2009) Siriwardana, P.N.; Hewavisenthi, S.J.de S.; Pathmeswaran, A.; Deen, K.I.Colonoscopic ultrasound (CUS) enables total colonoscopic examination combined with staging of tumor. Rigid probe transrectal ultrasound (TRUS) is reliable in assessing rectal cancer. Both the modalities are associated with an initial learning curve. We evaluated the predictability CUS in preoperative staging of rectal cancer during the learning curve, despite experience with TRUS. Forty-four patients with non-obstructing rectal cancer were assessed by colonoscopy and colonic ultrasound using a 7.5 MHz rotating transducer. Accuracy of ultrasound staging was compared with pathological staging. Tumor staging and nodal staging at pathology and ultrasound were named pT, pN and uT, uN, respectively. The pathological staging was pT1 in two (4.5%), pT2 in 16 (36%), pT3 in 21 (48%) and pT4 in five (11.5%) rectal cancer specimens. CUS understaged the tumor in 11 cases and overstaged it in 10 cases. Overall, the positive predictive value was 61%, negative predictive value 73%, sensitivity 61%, and specificity 73%. Lymph nodes were not visualized in 14. The overall un-weighted kappa of CUS staging of RC was 0.18 (poor). The predictive value in tumor staging of CUS is suboptimal in the learning phase, despite previous experience with TRUS.Item A Randomized control study of audio versus visual distraction to reduce patient discomfort during colonoscopy(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2015) de Silva, A.P.; Nandamuni, Y.; Nanayakkara, S.; Perera, K.R.; Kodisinghe, S.K.; Subasinghe, S.K.C.; Niriella, M.A.; Dassanayake, A.S.; Pathmeswaran, A.; de Silva, H.J.INTRODUCTION : Colonoscopy can cause anxiety and discomfort in patients who undergo this procedure. Heavy sedation and analgesia as premedication can lead to complications in the elderly and those with co-morbidities. This has led to an interest in use of audio-visual distraction during the colonoscopy as an adjunct. Our aim was to compare effects of audio (AD) versus visual distraction (VD) in reducing discomfort and need for sedation during colonoscopy. METHODS : Consecutive consenting patients who were undergoing colonoscopy were randomized into three groups: one group was allowed to listen to the music of their choice (AD), the second group was allowed to watch a film of their choice (VD) (using SONY head mounted display:HMZ-T3W-H) and the third group with neither during colonoscopy acted as a control (C). Patient controlled sedation (PCS) was administered to all three groups. We used 25 mg pethidine in 5 mg aliquots and 2.5 mg midazolam in 0.5 mg aliquots. All patients were assessed for pain, number of ‘top-ups’ of sedation, total dose of pethidine and midazolam, patient cooperation and willingness to repeat the procedure. RESULTS :There were 77 patients [AD, n=25 (16 males, median age 57 years); VD, n=26, (18 males, median age 58 years); C, n=26 (10 males, median age 59 years)]. The AD group had significantly less pain (p=0.048), number of ‘top-ups’ of sedation (p=0.03), total doses of pethidine (p=0.03) and midazolam (p=0.032), and better patient cooperation (p=0.001) compared with controls. There was no difference between the AD (72%) and VD (73%) groups in willingness to undergo a repeat procedure. Conclusions AD reduces pain and discomfort and the requirement for sedation and seems a useful and simple adjunct to low dose sedation use during colonoscopy.Item Relief of large bowel obstruction with a self-expanding metal stent(College of Surgeons of Sri Lanka, 2000) Malalasekera, A.P.; Deen, K.I.A 58 year old woman presented with progressive abdominal distension of 6 months duration associated with constipation is reported here.