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Biomedical subjects

A P Aluwihare

Publications and source records attributed to A P Aluwihare.

At least 19 recordsLinked to original sources
PubMed1990

Primary perineal rectovaginoanoplasty for supralevator imperforate anus in female neonates.

Sixteen girls (including 12 neonates), all of whom had supralevator anorectal anomalies usually with a high rectovaginal fistula, were treated by a primary rectovaginoanoplasty. None of these patients had any opening onto the perineum or into the vestibule. Through the perineum, with a dissection behind the vagina, the rectum was freed of any fistulous attachment and brought through the puborectalis sling to the perineum. Of the 12 patients now aged 2-years and over, 11 can control solid stools, and three soil with diarrhea only. The operation is easier than other available procedures, and the complications were minimal.

Anal Canal↗
PubMed1989

Imperforate anus in male children: a new operation of primary perineal rectourethroanoplasty.

From experience in managing 348 patients with imperforate anus and after considering the existing literature, there appeared to be the possibility of performing a safe primary correction of supralevator anorectal anomalies via a perineal approach in the neonatal period in males. A total of 39 patients have been treated by the new operation, and in 31 of these patients the operation was carried out at birth. With a stiff catheter in the urethra, via a horizontal 'H'-shaped perineal incision and through the puborectalis sling, the rectum was mobilised and the fistula transfixed. The rectum was brought through the sling and sutured to the perineum so that perineal skin entered the new anal canal. In a few patients an abdominal approach was required at the same time. There were few postoperative complications. Subsequent X-rays showed good urethral and pelvic floor anatomy and function. Twenty-five of the babies are now over 2 years old. Of these, 84% are continent for solid faeces and 68% for liquid faeces. The perineal approach permits satisfactory identification of the puborectalis, rectum and fistula in most babies. Cutting the pelvic floor is not satisfactory. Introducing perineal skin into the anal canal is important. Early operation enables the child to learn to use its perineum. It is difficult to know whether the results in this series are attributable to the type of operation or its timing.

Anus, Imperforate↗
PubMed1987

Evaluation of acute anal sepsis, and anterior horseshoe fistula.

A technique is described for examining patients with perianal sepsis in the acute stage in which with an anal retractor in place the abscess is pressed to watch for pus coming out of the anal canal. The fistulous tract if present can be diagnosed and satisfactorily treated. As a result of these and other studies a number of anterior horseshoe fistulae have been found both in acute and non acute patients. Anterior horseshoe fistulae should be suspected to exist if a patient with an opening of the fistula anterior to the line drawn coronally through anal canal has such an opening more than 2.5 cm away from the anal verge or if there are multiple openings. In recurrent apparently straight forward anterior fistulae, anterior horseshoe fistula should be suspected to exist.

Abscess↗
PubMed1987

Challenges in imperforate anus: I--Primary perineal rectourethroanoplasty for anatomical and functional correction in males with supralevator anomalies.

Out of a total of 372 patients with imperforate anus, 99 males with high imperforate anus have been treated. Of these patients 34 have had a new operation through the perineum; 26 of these operations were done as a one stage procedure in the neonatal period. During the operation, through the perineum the puborectalis sling is identified, the recto urethral fistula divided, and the rectum mobilised and brought through the pelvic floor to be sutured to H flaps at the site of the original perineal incision in such a way that these flaps are drawn up to form part of the new anal canal. Post operative clinical and radiological evaluation show good urethral and rectal contours with good functional results. The good functional results are probably partly due to the timing of surgery and partly due to the type of operation.

Anal Canal↗
PubMed1987

Challenges in imperforate anus: II--Large rectovaginal defects: colonic vaginoanoplasty.

There are several infants and young children with a large recto vaginal fistula or common recto vaginal opening. This could arise either as a result of previous surgery, or entirely congenitally. Surgical correction in these difficult patients has been satisfactorily achieved in 11 patients using a modification of the Soave technique in which the upper rectum and colon are brought through a rectal sleeve and sutured to the perineum. The pliability of the vagina, and control of bowel movements and the cosmetic appearance following this procedure are good. The procedure is not very demanding technically.

Adolescent↗
PubMed1987

Rectal prolapse in young adults.

Electromyographic studies in young adults with rectal prolapse have shown that there are a group of persons who cannot pull their prolapses in who have got very abnormal electromyograms. If this group are treated with major pelvic floor surgery the electromyogram appears to return to almost normal in two years. There are other young adults with rectal prolapse who can pull the prolapse in by contracting their own pelvic floors whose electromyograms approximate more closely to the normal. This latter group were treated with the insertion of circumanal nylon. It seems possible to differentiate the two groups without using electromyography on the basis of whether or not they can pull in the prolapse by contracting the pelvic floor and therefore the selection between patients for major surgery and minor surgery can be a clinical one. Further it would seem that as an initial operation, even the patients who are in the bad group can be treated by good bowel training and in a lesser operation, that if the bowel is kept in, the electromyograph returns to normal and hopefully in some of the patients major surgery is avoided.

Adult↗
PubMed1986

Attitudes of the 1984 medical graduates of Sri Lanka to anaesthesia.

A total of 196 intern medical officers who had graduated from the four medical schools in Sri Lanka in 1984 indicated their attitudes towards anaesthesia as a medical specialty in response to a postal questionnaire. Eighty per cent of the graduates considered anaesthesia to be an established specialty in Sri Lanka, while 17% felt that the specialty had limited clinical application. A total of 62% of the graduates were not aware, prior to their entry to medical school, that anaesthesia was related to medical practice. All the graduates indicated that the intra-operative role of the anaesthetist was on a par with that of the surgeon, but 40% felt that the pre- and post-operative roles were of a secondary nature. Overall, 42% considered that an anaesthetist acts as an assistant to the surgeon. The graduates were of the opinion that only 35% of the patients undergoing surgery were appreciative of the services rendered by an anaesthetist. Fifty per cent of the graduates considered exposure to the specialty in the undergraduate curriculum as inadequate. Anaesthesia was chosen as the first career preference by 1.5%. The dominant reasons for not selecting anaesthesia as a career specialty were: minimal patient contact and patient recognition (62%), and lack of recognition of the specialty by society (54%). Anaesthetists in Sri Lanka are challenged to alter the perceptions associated with the specialty, which are probably a result of chronic staff shortages restricting practice to the confines of operating theatres.

Anesthesiology↗
PubMed1986

Career preferences of the 1984 medical graduates of Sri Lanka.

A total of 196 graduates from the four medical schools in Sri Lanka responded to a postal questionnaire on their career preferences and factors influencing the choice of specialty. Medicine (38%), surgery (21%), paediatrics (15%) and obstetrics (12%) were the most popular choices. 'Service' specialties such as anaesthesia (1.5%), pathology (1.5%) and radiology (1%) were strikingly less attractive. Community medicine (2%) and general practice (2%) were similarly unattractive; medical administration (0.5%) was the least popular choice. In the choice of a career, opportunity for direct contact with patients (59%) was the most important determinant when compared to financial reward (12%), social prestige (10%) and fixed hours of work (12%). Research prospects (6%) and teaching opportunity (5%) were relatively unimportant considerations. The graduates preferred employment in the state health service (65%) to teaching in the clinical departments of medical schools (26%) and full-time private practice (7%). Pre- and paraclinical departments of medical schools attracted only 2% of the graduates. A total of 80% of the graduates wished to practise in the capital city or a major provincial city, while 10% chose to seek employment overseas. These results will be useful in planning undergraduate and postgraduate education, and in designing policies to attract manpower to the scarcity and high priority disciplines, so that the imbalances encountered would be minimal in the future.

Adult↗
PubMed1983

Anterior horseshoe fistulae.

A series of anal fistulae is presented in which a high proportion were anterior horseshoe fistulae. The incidence of this type of fistula in this series is higher than that previously reported. It can be recognised by a study of the position of the track by palpation, and the distance from the anal verge of the external opening. A meticulous dissection at operation is required. In order to get good results it is important that this clinical entity be recognised and managed with the same care and attention that is required for a posterior horseshoe fistula.

Acute Disease↗
PubMed1982

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Accident Prevention↗