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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Risk factors for locally advanced cancer associated with ulcerative colitis: Results of a retrospective multicentric study in the era of biologics(Elsevier, 2020) Rottoli, M.; Tanzanu, M.; Di Candido, F.; Colombo, F.; Frontali, A.; Chandrasinghe, P.C.; Pellino, G.; Frasson, M.; Warusavitarne, J.; Panis, Y.; Sampietro, G.M.; Spinelli, A.; Poggioli, G.BACKGROUND: Patients affected by ulcerative colitis (UC) are more likely to develop colorectal cancer, and are often diagnosed with lymph node involvement (N+) at surgery. AIM: To identify the risk factors for N+ cancer in UC patients. METHODS: Patients undergoing surgery from 2001 to 2018 in six European tertiary centres were included. N+ patients were compared to the control group (N-) for clinical variables. The evaluation of risk factors for N+ was assessed using univariate and multivariable logistic regression analyses. RESULTS: A total of 130 patients were included. Median duration of disease was 21 years (1-52). Forty patients (30.8%) were N+ at surgery. Eighteen (13.8%) developed cancer within 10 years from the onset of UC. Younger age at surgery (Odds ratio -OR- 0.96, p = 0.042), left colon location (OR 2.44, p = 0.045) and the presence of stricture (OR 5.07, p = 0.002) were associated with N+. CONCLUSION: Location in the left colon, presence of strictures and younger age strongly correlated with a higher risk of N+ cancer, which could develop before the starting point of surveillance. Duration, extension and severity of disease were not associated with N+. These results should be considered in the evaluation of risk of advanced cancer in UC patients. KEYWORDS: Cancer; Lymph nodes; Ulcerative colitis.Item The long term outcome of a cohort of Sri Lankan patients with ulcerative colitis at two tertiary care hospitals: preliminary results(Sri Lanka Medical Association, 2011) Senanayaka, S.M.; Fernandopulle, A.N.R.; Wijesinghe, N.T.; Ranaweera, A.G.R.M.A.; Kasturiratne, A.; Pathmeswaran, A.; Nawaratne, N.M.M.; de Silva, A.P.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Inflammatory bowel disease, especially ulcerative colitis (UC), is increasing in many 'non-western' populations. Although clinical impressions are that UC has a mild clinical course in these populations, long term outcomes have been poorly studied. Methods: In this ongoing retrospective cohort study conducted at the Gastroenterology clinics of the Colombo North Teaching hospital and the National Hospital of Sri Lanka, patients diagnosed with ulcerative colitis (UC) were assessed for 3 outcomes: colectomy, development of colorectal carcinoma and death. Registered patients not attending the clinic during the past 4 weeks or their families were contacted by telephone to obtain clinical details and survival status. The cause of death was confirmed from clinical records and death certificates. RESULTS: Of 414 registered patients with UC, to date, details of 274 (66%) (mean age 44.9 (SD 13.6) years, M:F =1:1.13) were available for analysis. The mean duration of follow up was 6.8 (SD 6.5) years. Cumulative rates for colectomy, colorectal carcinoma and death were 3.3%, 1.1% and 1.1% respectively. At 1, 5, 10 and 15 years, cumulative cancer free survival proportions were 0.99, 0.99, 0.99 and 0.98, cumulative colectomy free survival proportions were 0.99 0.96, 0.96 and 0.96, and cumulative survival proportions were 0.99, 0.99, 0.98 and 0.98 respectively. The proportions of patients who had none of these three outcomes were 0.98, 0.95, 0.93 and 0.92. CONCLUSIONS: In this cohort of Sri Lankan patients with UC, rates of colectomy, colorectal carcinoma and death were rare, indicating a benign disease course.Item The agreement among different scoring systems used in the assessment of histologicai activity in ulcerative colitis(Sri Lanka Medical Association, 2007) Mahendra, B.A.G.G.; Hewavisenthi, S.J.de S.INTRODUCTION: Histology is one of the most important criteria in determining the disease activity in ulcerative colitis which in turn is important in the choice of drug treatment, monitoring of therapy and in clinical trials. Many different histologicai scoring systems are used to determine the disease activity in ulcerative colitis. OBJECTIVE: To compare three different histologicai scoring systems used in assessing the activity in ulcerative colitis. DESIGN, SETTING AND METHODS: 41 mucosal biopsies of ulcerative colitis patients were reviewed. The histologica! disease activity in each of these was scored by the two authors at a conference microscope using three different histologicai scoring systems. They were A - Bristol activity index, B – scoring index by Saverymutty et al, and C - scoring index by Geboes et al. The correlation among the three histologicai scoring systems was calculated using Spearman rank correlation coefficient. RESULTS: The Spearman rank correlation coefficient between system A vs system B was 0.883 (0.000), system A vs. system C was 0.883 (0.000) and system B vs system C was 0.952 (0.000). The correlation among the three histologicai scoring systems was statistically significant (p<0.01). CONCLUSION: Therefore any one of these three systems can be recommended in scoring the histologicai activity in ulcerative colitis and the choice will depend on the ease of use and personal preference.