Ranil Fernando

A rare variant of the superficial ulnar artery, and its clinical implications: a case report

The superficial ulnar artery is a rare variation of the upper limb arterial system that arises from the brachial or axillary artery and runs superficial to the muscles arising from the medial epicondyle [1–3]. The incidence is about 0.7 to 7% [1, 4, 5]. In our routine dissections we found a superficial ulnar artery, which crossed the cubital fossa superficial to the bicipital aponeurosis making it highly vulnerable to intra-arterial injection. This is a rare variation that every medical and nursing staff member should know about.

The prevalence of autoimmune thyroiditis after universal salt iodisation in Sri Lanka.

INTRODUCTION Sri Lanka is endemic for goiters. Iodine deficiency is thought to be the main cause. The global iodisation programme was implemented in the country in 1995. Several studies done in school children have shown a reduction in the goiter prevalence (3.8%) in the initial post iodisation period. An island wide, community based study was carried out to study the prevalence of goiters. METHODS A multistage cluster sampling method was used. Examination of goiters was done by two trained investigators and graded according to the WHO grading. Fine needle aspiration cytology of the goitres was also undertaken in the field. A sample of urine was collected from all participants. In a random sample of 153 individuals with a goiter, serum was checked for anti thyroid peroxidase antibodies. RESULTS Out of 5200 individuals screened, 426 had a clinically detectable goiter. Adjusted prevalence rate was 6.8%. Both serological and cytological evidence of autoimmune thyroiditis was seen in 19.6% of goiters. Mean urinary iodine concentration was 235 μg/l range 11.1 - 425 μg/l). Association between elevated antithyroperoxidase antibodies and median urinary iodine concentration was significant. CONCLUSION Goiter prevalence in Sri Lanka has increased after an initial drop following the iodisation. A significant proportion of goiters is due to AIT. Urinary excretion of Iodine in the community is high and has a positive correlation with the prevalence of aTPO anti vodies. Increase in AIT due to a high Iodine intake may account for the rise in goiter prevalence.

A comparative international study on the management of acute appendicitis between a developed country and a middle income country

BACKGROUND In the past decade there has been an exponential increase in the use of Computerised Tomography (CT) imaging in the assessment of patients with acute appendicitis. The aim of this study was to compare management approaches and clinical outcomes of acute appendicitis in Sri Lanka and the United Kingdom. METHODS Data was collected prospectively from 400 patients referred to the General Surgical department with a differential diagnosis of acute appendicitis, 200 at University Kelaniya Sri Lanka (SL group), and 200 at University College London Hospital (UK group). RESULTS The groups were similar with respect to gender, but the SL group was younger. Preoperative work-up included ultrasound more commonly in SL patients, and CT more commonly in UK patients. More patients underwent appendicectomy in the SL group, however a laparoscopic approach was utilised more often in the UK group (50.5% vs. 11.9%). Post-operative complications were similarly represented in both groups, but re-admission occurred with greater frequency in the UK group (16.2% vs. 0%). Histologically confirmed appendicitis was seen in a significantly greater proportion of SL patients (93.1% vs. 79.8%). Multivariate analysis confirmed male gender, and diagnosis and treatment in Sri Lanka to be only factors significantly associated with positive appendicitis. DISCUSSION Expensive investigations such as CT do not appear to improve the diagnostic accuracy of appendicitis or prevent complications. This study suggests diagnostic and treatment algorithms in the SL hospital are more accurate and efficient in confirming appendicitis than those seen in the UK hospital under investigation.

Course Pattern of the Muscular Branch of the Median Nerve in Sri Lankans Hand

Las variantes transligamentosas del ramo motor recurrente tienen un mayor riesgo de recibir danos durante la endoscopia y liberacion abierta del tunel carpiano. La incidencia de la variante transligamentosa es de, aproximadamente, 7 a 80% en todo el mundo. Esta amplia variacion de la incidencia podria deberse a la falla en la identificacion del borde distal del retinaculo flexor de la fascia de orientacion oblicua que va desde el borde distal. Hemos utilizado dos criterios para identificar el borde distal, el brusco cambio en el grosor del retinaculo flexor y su cambio de color en la seccion transversal. La incidencia de la variante transligamentosa fue rara y el informe de la alta incidencia podria deberse a un error en la identificacion del borde distal del retinaculo flexor, como lo demuestra Kosin (1998).

Epidemiology of goitre in Sri Lanka in the post-iodization era

INTRODUCTION Previous studies of goitre in Sri Lanka proposed the presence of a goitre belt, which was refuted subsequently. Epidemiology of goitre in the post iodization era needs re-evaluation. Objectives To describe the epidemiology of goitre in Sri Lanka. METHODS A descriptive cross-sectional study was conducted in designated zones except in conflict areas in 2006/2007. An interviewer administered questionnaire was used and patients were evaluated clinically, biochemically and cytologically. RESULTS Among 5200 participans 426 had goitre. Mean age was 36.3 (SD 17.3) years. Goitre was commonest in the age group 40-49 years with a female pre-ponderance. The prevalence was similar in all zones with pockets of high prevalence in each zone. Overall islandwide adjusted prevalence was 6.8% (95% CI = 6.0-7.6). CONCLUSIONS There was no identifiable goitre belt.There were pockets of high prevalence in all zones. Goitre remains a public health issue despite universal iodization.

Inorganic content of water and prevalence of goitre in Sri Lanka

Introduction: Goitre is endemic in Sri Lanka. Iodine deficiency is considered to be the main aetiological factor for goitre in this country. The role of other aetiological factors is well recognized in the literature. The recognized factors apart from iodine include organisms, inorganic content of water and diet. Data on the relationship between goitre and inorganic content of water is not available for Sri Lankan population. Objectives: To determine the relationship between goitre and inorganic matter of water such as fluoride, magnesium, nitrate and hardness of water. Design and setting: Descriptive cross-sectional study carried out in 108 Grama Niladhari (GN) areas, island wide. Method: The country was divided into 6 zones based on the rainfall pattern and 18 GN areas were selected from each zone by randomisation based on PPS (Probability P Score). Two water samples were collected randomly from each GN area one from the people with goitres and other from the non-goitre subjects. The water was analysed at the Industrial Technology Institute (ITI). Results: 108 samples from goitre and non-goitre groups were analyzed respectively. Comparative values for each inorganic content in respect to subjects with and without goitre groups were as follows, Total hardness (CaCO 3 ) mg /L - 55.44, 59.15; Calcium (Ca) mg /L - 15.76, 13.71; Magnesium (Mg) mg /L - 3.14, 4.08; Fluoride (F) mg /L - 0.31, 0.37. There is no discernable statistically significant difference between two groups in relation to inorganic content of water. Conclusion: There was no clear relationship between the inorganic matter of water and prevalence of goitre in this study. DOI: http://dx.doi.org/10.4038/sljs.v27i1.1896 The Sri Lanka Journal of Surgery 2009: 27: 9-12