Objectives To ascertain if there has been a change in the pattern of thyroid cancer in Sri Lanka. If so, whether there is a correlation to the implementation of the programme of iodination.Design Retrospective (1974Retrospective ( -1986Retrospective ( ) and prospective (1987Retrospective ( -2001 Setting Kandy Hospital (1974-1982), Peradeniya Hospital (1982-2001 and private hospitals in Kandy (1979Kandy ( -2001.Method Three hundred consecutive patients with cancer of the thyroid seen over 28 years period were reviewed for demography, histopathology and extent of spread at presentation. Seventy one patients of this group had a pre-existing goitre of greater than 10 years' duration and were similarly reviewed.Results A highly significant reduction of anaplastic thyroid cancer and a highly significant reduction in the extent of extra-thyroidal spread at presentation of differentiated thyroid cancer were observed after 1995. In malignancy supervening on pre-existing goitre, a significant reduction in anaplastic carcinoma and a highly significant increase in papillary carcinoma were noted in the post-1996 period. A significant reduction of extra-thyroidal spread was also observed.Conclusion A trend towards more differentiated thyroid cancer with lesser degree of spread was observed in recent years. The iodination programme implemented in 1995 is likely to be responsible for this change.

This is a descriptive study of chronic ischaemia of the lower limb caused by atherosclerotic disease in 588 patients. The study was performed over 34 years in a tertiary clinic in the central province of Sri Lanka. It was found that the pattern of occlusions were similar to that of other reports on western patients. However, critical ischaemia was seen in 57% of Sri Lankan patients, suggesting a more florid disease. Pioneering efforts of reconstructive surgery in 278 patients and in-hospital results are presented.

ObjectiveA descriptive study to evaluate the pattern of presentation of lymphoedema of limbs to a tertiary care clinic in the central province of Sri Lanka. Patients and MethodPatients with lymphoedema seen over 28 years, (1980-2007) in the vascular clinic at the General Hospital Peradeniya were reviewed retrospectively. Results649 cases of lymphoedema of limbs were seen. 47 were in the upper limb, 36 of whom were secondary, mostly following axillary clearance associated with a mastectomy, and 11 cases were idiopathic. 602 patients had their lower limbs involved, with 96 cases amongst them being secondary, mostly to trauma, filariasis and a few with pelvic carcinoma and lymphoma. The rest (n =506) were considered to have lymphoedema of primary aetiology. The involvement of the legs was predominantly below the knees. A late onset group of lymphoedema patients, predominantly males above 60 years posed a problem in diagnosis and is worth future study.Complications among patients with lymphoedema of lower limbs with no overt secondary cause included inter digital cleft sepsis in 54.5 %, cellulitis or a history of the same in 66 %, lymphangitis 16 % lymphadenitis 3.5% and 11 % had septicaemia which aggravated the clinical state. ConclusionPrimary lymphoedema needs recognition as the dominant cause of limb lymphoedema especially in the Central Province. This diagnosis is required to prevent complications which need long term treatment. A filarial aetiology for most cases, as is popularly believed, is not evidence based. Secondary causes for lower limb lymphoedema must be looked for, such as pelvic malignancy and lymphoma. Trauma or surgery over lymphatic pathways should be avoided to prevent limb lympheodema. IntroductionNo significant documentation exists on the pattern of presentation of lymphoedema in Sri Lanka, though there exists records of its presence as a disease entity since the eighteenth century [1]. Lymphoedema is a disorder that has geographical implications such as possible association to Filaria [2], bare foot walking and the soil texture as in podoconioses [3]. It also involves genetic factors [4], with a pathogenesis seen to be of protean origin.The complications associated with lymphoedema, namely interdigital cleft sepsis, lymphangitis, lymphadenitis and cellulitis are quite disabling and aggravate the morbidity of the disease [5]. Surgical procedures that have been attempted to rectify lymphedema have yielded poor long-term results [5].The data regarding prophylactic care given to such limbs is inadequate, and makes it difficult to adopt focused and effective remedial measures. We present a database collected and collated over twenty eight years of attending to such patients in the hope that it will provide a scaffolding for care of this as yet mostly ignored area of clinical care. Patients and MethodOver a period of 28 years , 649 patients with limb lymphoedema were seen in the vascular clinic of the General Hospital Peradeniya. Majority of patients were from Central Province of Sri Lan...

_____________________________________________________________________________ Abstract BackgroundIodine supplementation with salt as a carrier was introduced in Sri Lanka in 1995. Literature from elsewhere suggest that there is an increase in hyperthyroidism after the initiation of such programmes. Objectives To identify weather iodination precipitated an exacerbation of hyperthyroidism in the Central Province of Sri Lanka Methods Four-hundred-and-eight consecutive patients with hyperthyroidism seen over a period of thirty one years in a General Surgical Clinic at Teaching Hospital, Peradeniya were reviewed. ResultsThe prevalence of secondary hyperthyroidism increased after iodination. No change in the demography and presentation of simple diffuse toxic goiter was observed. Conclusions Physicians must be aware of this increased incidence of hyperthyroidism after iodination and need to be vigilant of the need to control it, in view of its complications.

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