Introduction:The vermiform appendix is a vestigial structure showing extreme variability in its position. Varying symptoms of acute appendicitis reflect this variability making the clinical presentation of appendicitis highly inconsistent. Objective: To observe the anatomical variations of the position of the tip of the appendix and its base, length, details of meso-appendix and appendicular artery in adult medico-legal autopsies. Methods: A sample of medico legal autopsies carried out on those over 18 years by forensic pathologists at the Teaching Hospital Peradeniya was included in this study. Results: Of the 60 autopsies, 39 were male, with an age range of 19-88 years. Fifty eight appendixes were healthy, 1 appendicular mass and 1 absent appendix. Positions of the appendices were: 29 (50%) post-ileal, 20 (34.48%) retro-caecal, 7 (12.07%) pelvic and 2 (3.45%) para-caecal. The base was at the postero-medial wall in 36 (62.07%), lower pole in 18 (31.03%) and postero-lateral wall of the ceacum in 4 (6.0%) subjects. The length was 3cm -14 cm (mean 8.2 cm). The distance between ileo-caecal valve and base of the appendix was 1 cm -6 cm (mean 2.8 cm). The distance between the edge of the meso-appendix and the tip was 0 cm -7 cm (mean 1.23 cm). In 51.7 % of cases meso-appendix continued to the tip. The appendicular artery continued to the tip in 37 (63.8%) cases. Conclusions: Post ileal position is the commonest position of the appendix, with the base situated commonly on the postero-medial wall of the caecum. In the majority of cases mesoappendix and the appendicular artery continued to the tip.

Objectives: Knee is the largest weight bearing joint in the body and thereby is affected by diseases such as osteoarthritis more frequently. The aim of this study was to evaluate the effect of a 4 week physiotherapy exercise program, designed to improve quadriceps muscle strength and girth, and to observe its effect on knee pain and activities of daily life through a pre and post exercise analysis in patients with knee joint osteoarthritis (OA). Methods: Thirty patients diagnosed with knee joint osteoarthritis irrespective of gender, over the age of 45 and less than 75 years were recruited for the study. Initially knee joint pain severity was assessed using the VAS (visual analogue scales) and WOMAC questionnaire was used to assess the activities of daily living. The thigh circumference was measured in centimeters. Data was analyzed by SPSS 20. Results: Mean age of osteoarthritis patients was 54 years. There was a statistically significant, reduction in knee pain (p=0.001), improvement of quadriceps muscles girth (p=0.012) and an improvement of daily living activities (p=0.001) after engaging in the physiotherapy exercise program. Conclusion: A four week guided quadriceps muscle strengthening exercise program can significantly increase the quadriceps muscles girth and knee joint stability and reduce pain and improve the activities of daily living in patients with knee OA.

Female knees are more varus inclined than that of males in the Sri Lankan participants and this inclination increases with age. Reasons for this could be genetic and lifestyle differences and may partly explain the reason for the predominance of varus osteoarthritis in Sri Lankan females.

Introduction Osteoarthritis of the knee is common among the elderly. The alignment of the knee plays an important part in disease progression. Objectives The aim was to determine the relationship between goniometric measurement of malalignment and gross and histological damage to articular cartilages of osteoarthritic knees. Methods Anterior plane knee alignment was measured using a handheld metal goniometer in 84 patients awaiting knee replacement. Articular cartilages removed at surgery were stained and examined for macroscopic and microscopic damage which were quantified with macroscopic visual assessment score and Mankins histochemical score, respectively. The relationship between the type of knee angulation and macroscopic and microscopic damage to medial and lateral compartments was analyzed using analysis of variance (ANOVA), and the relationship between the degree of angulation and the degree of damage was determined using multiple linear regression models. Results Varus knees had markedly higher macroscopic damage scores in the medial than the lateral compartment (p<0.0001), while valgus knees showed the opposite (p<0.0001). The knee angulation, together with age and BMI, predicted 54% of the macroscopic (p<0.0001) and 60% of the microscopic damage (p<0.0001) in varus knees. Conclusion Anterior plane goniometric knee alignment is a significant predictor of the articular cartilage damage present in an osteoarthritic knee. Goniometric measurement is a valuable tool in assessing the disease severity as it is a simple, safe and cost-effective method.

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