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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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    2021 Asia-Pacific Graves' Disease consortium survey of clinical practice patterns in the management of graves' disease
    (Humana Press, 2023) Parameswaran, R.; de Jong, M.C.; Kit, J.L.W.; Sek, K.; Nam, T.Q.; Thang, T.V.; Khue, N.T.; Aye, T.T.; Tun, P.M.; Cole, T.; Miller, J.A.; Villa, M.; Khiewvan, B.; Sirinvaravong, S.; Sin, Y.L.; Muhammad, R.; Jap, T.S.; Agrawal, A.; Rajput, R.; Fernando, R.; Sumanatilleke, M.; Suastika, K.; Shong, Y.K.; Lang, B.; Bartalena, L.; Yang, S.P.; Asian Graves Consortium Study.
    Aim: Although Graves' disease (GD) is common in endocrine practices worldwide, global differences in diagnosis and management remain. We sought to assess the current practices for GD in countries across Asia and the Pacific (APAC), and to compare these with previously published surveys from North America and Europe.Methods: A web-based survey on GD management was conducted on practicing clinicians. Responses from 542 clinicians were received and subsequently analysed and compared to outcomes from similar surveys from other regions. Results: A total of 542 respondents participated in the survey, 515 (95%) of whom completed all sections. Of these, 86% were medical specialists, 11% surgeons, and 3% nuclear medicine physicians. In addition to serum thyroid-stimulating hormone (TSH) and free thyroxine assays, most respondents would request TSH-receptor autoantibody (TRAb) measurement (68%) during initial work-up. Thyroid ultrasound is requested by about half of respondents (53%), while the use of nuclear medicine scans is limited. The preferred first-line treatment is anti-thyroid drug (ATD) therapy (79%) with methimazole (MMI) or carbimazole (CBZ), followed by radioiodine (RAI; 19%) and surgery (2%). In case of surgery, one-third of respondents would opt for a subtotal rather than a total thyroidectomy. In case of mild Graves orbitopathy (GO), ATDs (67%) remains the preferred treatment, but a larger proportion of clinicians prefer surgery (20%). For a patient with intention to conceive, the preferred treatment pattern remained unchanged, although propylthiouracil (PTU) became the preferred ATD-agent during the first trimester. In comparison to European and American practices, marked differences were noted in the relatively infrequent usage of nuclear medicine scans and the overall higher use of a ATDs and β-blockers and adjunctive ATD-treatment during RAI in the APAC-group.Conclusion: Although regional differences regarding the diagnosis and management of GD are apparent in this first pan-Asia-Pacific survey, this study reveals the overall approach to the management of this disease in Asia-Pacific generally tends to fall between the trends appreciated in the American and European cohorts.
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    Thyroidectomy: no place for routine drainage- experience of two centres
    (The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Fernando, R.; Esufali, S. T.
    INTRODUCTION: Insertion of drains following thyroidectomy is considered a 'hallowed' practice. This practice has remained unchallenged because of fear and tradition. There is sufficient scientific evidence to show that routine drainage following thyroidectomy is not necessary. METHODS: Twosimultaneousprospective studieswere undertaken at University Surgical uriits of'Kelaniya and Peradeniya 150 patients undergoing elective thyroidectomy from 1999to 2002 were included in thestudy, The researcher in Kelaniya had NOT undertaken routine drainage for several years arid 100 consecutivepatientsundergoingthyroidectomywithout drainage were included in the study In Peradeniya 25 patients underwent thyroidectomy with drains and 25 patients underwent thyroidectomy without drains. All types of thyroidectomies were included in the study. Total- Thyroidectomy - 23 (Kelaniya) ,- 03 (Peradeniya) Subtoal - thyroidectomy - IO (Kelaniya),- 29 (Peradeniya) Thyroid- Lobectomy - 55 (Kelaniya) ,- 18 (Peradeniya) Redo- Thyroidectomies - 12 (Kelaniya) Parameters assessed: 1. Prospective complications - Wound infection, Haematoma, Hypocalcaernia and Recurrent laryngeal nerve injury 2 Re-exploration and indications RESULTS: Wound infection rate:With drains-8% Hypocalcaemia-1%(permanent) Without drains-0% (both groups) Wound Haematoma: With drains-6% Nerve injury-2% (transient) Without drains-2%(Seroma) (both groups) No patient required re-exploration for a life threatening complication in either group. CONCLUSIONS: 1. Thyroidectomy without drainage can be done safely. 2. Routine drainage in thyroidectomy is NOT indicated
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    Incidental occult carcinomas in total thyroidectomy for benign diseases of the thyroid
    (Sri Lanka Medical Association, 2009) Fernando, R.; Mettananda, D.S.G.; Kariyakarawana, L.
    BACKGROUND: Total thyroidectomy is increasingly recognised as the preferred surgical option for benign diseases of the thyroid. One factor contributing towards this change in policy is reports of incidental carcinomas in the resected specimens. METHODS: This was a prospective study of patients, who underwent total thyroidectomy for benign diseases of the thyroid at the University Surgical Unit, Colombo North Teaching Hospital from January 2003 to December 2005. RESULTS: There were 68 patients (67 females) aged 28 to 67 years (mean 44.2 (SD=11.1). In 6 (8.8%) patients, histological examination of the post-operative specimen showed incidental carcinomas: 2 papillary, 2 medullary and 2 follicular carcinomas. There was no significant difference in age, clinical presentation and functional thyroid status of patients with incidental carcinomas and those with histologically confirmed benign diseases. CONCLUSIONS: Occurrence of incidental thyroid cancers was 8.8% in this series, and they were difficult to predict pre-operatively. The policy of performing total thyroidectomy for benign disease of the thyroid obviates the need for further surgery if an incidental carcinoma is found.
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    Inorganic content of water and prevalence of goitre in Sri Lanka
    (College of Surgeons of Sri Lanka, 2009) Fernando, R.; Pathmeswaran, A.; Atulugama, N.S.; Mubarak, M.N.A; Edirisinghe, E.M.D.A.R.; Abeysinghe, A.P.S.D.; Fernanado, W.M.T.P.S.; Premathilaka, H.M.M.S.
    BACKGROUND: Total thyroidectomy is increasingly recognised as the preferred surgical option for benign diseases of the thyroid. One factor contributing towards this change in policy is reports of incidental carcinomas in the resected specimens. METHODS: This was a prospective study of patients, who underwent total thyroidectomy for benign diseases of the thyroid at the University Surgical Unit, Colombo North Teaching Hospital from January 2003 to December 2005. RESULTS: There were 68 patients (67 females) aged 28 to 67 years (mean 44.2 (SD=11.1). In 6 (8.8%) patients, histological examination of the post-operative specimen showed incidental carcinomas: 2 papillary, 2 medullary and 2 follicular carcinomas. There was no significant difference in age, clinical presentation and functional thyroid status of patients with incidental carcinomas and those with histologically confirmed benign diseases. CONCLUSIONS: Occurrence of incidental thyroid cancers was 8.8% in this series, and they were difficult to predict pre-operatively. The policy of performing total thyroidectomy for benign disease of the thyroid obviates the need for further surgery if an incidental carcinoma is found
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