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Thomian cricketer Sarath Seneviratne’s surgical feat in the Caymans

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A team of doctors led by Dr. Sarath de Alwis Seneviratne, Associate Professor/Senior Consultant, at CTMH, The Doctors Hospital in the Cayman Islands, recently removed a giant tumour from the uterus of a patient – the largest seen on the Cayman Islands and perhaps the world. Seneviratne was assisted by surgeons Dr Steve Tomlinson, F.R.C.S., L.R.C.P and Dr Chris Bromley, F.R.C.S. (Eng.), F.R.C.S. (Edin.). 

 

Lankan surgeon removes giant tumour in the Cayman Islands

 

A team of doctors led by Dr. Sarath Seneviratne (STC CRICKET & SPORTS FAME), Associate Professor/Senior Consultant, at CTMH The Doctors Hospital in the Cayman Islands, recently removed a giant tumour from the uterus of a patient, which was easily one of the largest tumours the doctors had ever removed, weighing in at 21 pounds 2 ounces. This was very likely the largest tumour ever seen by surgeons in the Cayman Islands and one of the largest ever seen in the world with a successful outcome. The team of medical professionals who successfully removed the tumour was led by Dr. Sarath, assisted by surgeons Dr Steve Tomlinson, FRCS, LRCP and Dr Chris Bromley, FRCS. (Eng.) and (Edin).

“The patient was presented with an abdominal mass extending to the chest and extending under the liver. She was in considerable pain and discomfort, particularly in the back, having undergone surgery previously in London “. Dr Sarath Seneviratne said. “She needed the mass to come out.”

It was anticipated that the surgery would take three hours and present challenges, given the size of the mass. Therefore Seneviratne enlisted the assistance of Drs. Tomlinson and Bromley, along with a team of experienced nurses experienced in working together as a surgical team. The approach was to ensure every measure was taken to keep the patient safe, the doctor advised.

“We anticipated difficult surgery and considerable bleeding,” Seneviratne said. “The anesthetist, Dr Stephen Gay, put in an arterial line rather than the usual venous line to help control the bleeding, as many patients have died under similar circumstances through uncontrollable blood loss, renal failure and sometimes other complications such as a coagulopathy or multiple organ failure.”

The mass was under the diaphragm and pressing against the liver, aorta and kidneys and it had gone into the pelvis; so much so that the pelvic structures could not be seen from below. The abdominal wall was enlarged vertically as well as transversely, that it looked like triplets. The lady had hypertension and weighed over 300 pounds, which added to the risks for anesthesia and surgery.

The size of the mass and intra-abdominal adhesions was the biggest difficulty, because the tumour had attached itself to various parts of the patient’s internal organs, including the small bowel, rectum, bladder and pelvic wall, hence increasing the risk of bleeding.

During the surgery, she was bleeding profusely from all sides of the tumour, especially from behind the mass. Hemostatic clamps and large warm packs were used to control the hemorrhage, while meticulously ligating the vessels.

“We had to stick to basic principles of surgery, we couldn’t do any fancy stuff,” Seneviratne said. “The basic principles are: a) you have to stop the bleeding and b) approach the tumour in such a way that she won’t bleed. Those are the two cardinal things.”

The doctors then had to move quickly to remove the mass, trying to remove it in one piece so it could be examined histologically as a whole, to look for malignancies. They kept the tumour in a large bucket before it was flown to the US to be examined. They managed to save one ovary and the patient went home three days later in good health.

“It was considered one of the biggest tumours in the world, most likely the largest ever in the Cayman Islands,” Seneviratne said.

Assisting surgeon Dr Christopher Bromley said that he had looked at the size of the patient’s stomach with some concern before they began to operate. “I could see it was going to be a substantial operation,” he confirmed.

Bromley said that the operation began smoothly and continued so with Seneviratne performing the surgery “extremely expertly”. However, when they uncovered the tumour he said he was “truly over- awed” at its size.

“It went way beyond my experience, probably the largest I had ever seen,” he said.

“It was the largest uterine fibroid that I had ever seen,” assisting surgeon Dr. Steve Tomlinson confirmed. “The surgery went like clockwork and did not take that long considering the amount of work that had to be done, especially when you consider that a normal hysterectomy takes about an hour. We had a great team – it’s really nice when a team is used to working together and can anticipate whatever the surgeon needs. Everything went very well.”

Seneviratne confirmed this: “You need a very experienced team who are on the ball because we needed 27 needles and sutures, which needed to be constantly given to the surgeon. It’s a synchronised exercise where everybody knows what they are doing. It was a great experience for the team.”

Tomlinson said the patient had told him subsequently that she had lost 32 lbs overall and was doing well now. She has already seen Seneviratne for a check-up and he confirmed she was doing well and had a very positive and cheerful outlook on her situation.

Senior Consultant Obstetrician and Gynaecologist/ Associate Professor Dr Sarath de Alwis-Seneviratne has been practicing medicine in the Caymans for 26 years, having previously practiced in the UK for 14 years. He has delivered thousands of babies and treated thousands of patients in the Cayman Islands over the years, with an unblemished record.

Also of interest is that this ground-breaking doctor has placed the Cayman Islands on the medical map by operating on a patient who was thought to be inoperable by leading cancer specialists in Florida.

Seneviratne explained: “The patient went to her general practitioner with pelvic pain. The GP did an ultrasound scan and found a six cm tumour which the doctor considered to be a possible carcinoma. The GP sent the patient to a consultant OB/GYN Board certified in the USA, who did a CT scan which confirmed the mass. The specialist doctor suspected a malignancy and sent the patient to Baptist Hospital in Florida to one of the best doctors in the world.”

In the USA, the doctors did an MRI and booked the patient in for surgery, but during the surgery, they had a lot of trouble and could not find the tumour because it was not easily accessible. Having spent thousands of dollars up until this point, the patient finally came back to the Caymans with the tumour still inside her.

” We did a scan in my surgery and I identified the tumour to be about six or seven centimeters,” Seneviratne said. “I took her to the operating room and put her under the laparoscope. I do this special technique where I insert a rigid catheter into the bladder and shake the catheter. When the catheter was shaken only the top of the bladder was shaking not the entire bladder, which meant that the tumour was under the bladder. This is an extremely rare presentation and cannot be seen if you just look through a telescope and have a look. I then went under the bladder and removed the tumour, from between the ureters.”

He said that the tumour was bigger than the uterus and the tubes and ovaries put together.

“After two days in the hospital she went home and the biopsy was benign and now she is happy and well,” he confirmed.

Seneviratne is involved in innumerable charities in the Cayman Islands, Sri Lanka and in the Philippines, albeit anonymously. Recently he provided dry rations for the villages around his ancestral home to 750 families.

Dr. Seneviratne’s ualifications include FRCS(Edin), FRCOG(GB), MRCP(Ire), FFSRH(GB), FACOG(USA), MS.(SL), MRCS/LRCP(GB), LRCP/LRCP&S(Edin) and a whole host of other diplomas and memberships. He has a laparoscopic entry method named after him, a suture technique for suturing the vagina and an efficient posture for examination of a prolapsed uterus.

As a fine sportsman here, he captained Sri Lanka cricket President’s Eleven against Malaysia; he headed the national batting, averages in 1976, captained Sri Lanka against Agra at hockey after the New Delhi tournament in India and was awarded the Sports Star trophy at the university. He captained the Colombo and Combined University cricket teams. He captained STC and Combined Schools cricket in 1965. He also represented the Nation in hockey at the Asian Games in Thailand.

Interestingly, he top-scored each time he played against foreign teams. This included the match against State Bank of India, captained by Ajith Wadekar, where the National team was captained by the famous Stanley Jayasinghe. He scored half a century facing up to Venkatarhagavan and V.V.Kumar who were considered to be the best spinners in the world at that time.

He top-scored with half a century, in the Gopalan Trophy match playing for the team captained by Anura Tennakoon; he top-scored against the Australian team captained by Bill Lawry on a wet wicket, in a low scoring match in Kandy. 

 

ESTO PERPETUA

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SLAF on hazardous wall, Sri Lanka Air Force has sent us the following statement……

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Sri Lanka Air Force has sent us the following statement in response to an article (That hazardous Ratmalana Wall) published on 21 Jan.

It is with regret that I would like to inform you that the newspaper article titled “That Hazardous Ratmalana Wall” published in The “Island” newspaper of 21 January 2021 contains false information which has not been clarified from the Air Force Director Media nor any other official channel of the Sri Lanka Air Force (SLAF).

It should also be highlighted that the Sri Lanka Air Force does not wish to challenge the freedom of reporting information by journalists. However, news articles of this nature published with the use of unsubstantiated information tarnishes the image of Sri Lanka Air Force.

The newspaper article in concern has caught the attention of the Commander of the Sri Lanka Air Force. As alleged in the article, the Commander has not declared on behalf of the SLAF that there is no objection for the removal of the wall and replacing it with a fence. On the contrary he had in fact stated that a collapsible wall could be put in place of the permanent wall which should have a solid finish obstructing the view from outside due to security reasons.

In addition, to date there has been no incident/accident reported at the Ratmalana Airfield related to the wall along the Galle Road. Further, vehicles such as passenger coach/container etc; travelling on the main road would be taller than the wall in concern and according to the article, the main road would also have to be closed each and every time when an aircraft approaching of taking off from that end of the runway. International runway due to limitations which is also can be considered as hazardous to flight safety, SLAF consider Flight Safety is a paramount important factor as an organization which operates different types of aircraft over the years from this airfield.

It is pertinent to mention the wall in concern was erected by the SLAF before year 2009 with the consent of the Airport and Aviation Sri Lanka (AASL) to address the security concerns at that time and maintained to date. The outer perimeter security of the Colombo International Airport at Ratmalana is being provided by the SLAF free of charge over years. As a measure of gratitude, with the consent of AASL and the approval of the Ministry of Defence (MOD), SLAF authorized to erect hoardings along this wall and to utilize the funds generated for welfare measures of airmen.

Further, publishing of an article which has an author with a fictional name will have serious and adverse effects on the newspaper as well as the goodwill which prevails between SLAF and AASL. The goodwill which prevails between the SLAF and your esteemed Organization will also be adversely effected by articles of this nature. SLAF Directorate of Media always provide accurate and precise information to media institutions which has an impact on general public as well as to other organizations. Undersigned is contactable any time of the day through mobile (0772229270) to clarify ambiguities of SLAF related information.

In conclusion, I would like to express our displeasure regarding the newspaper article in concern and the damage which has been done to the good name of the Sri Lanka Air Force and in particular to the Commander of Air Force.

 

WADC WIJESINGHE

Group Captain

DIRECTOR MEDIA

for COMMANDER OF THE AIR FORCEs

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Dog-eat-dog culture

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By Rajitha Ratwatte

There is an old joke that goes around regularly about Sri Lankans’ in hell. How absolutely no guards are needed to keep Lankans in hell because they do a very good job of pulling each other down into hell when anyone even looks like they will escape. When you extrapolate that into real life in the Pearl, the examples are plenty. All of us have personal experiences of neighbours, peers, relations and even our bosses “cutting us” as the popular phrase goes. It is mostly those who either realise and watch out for these pitfalls or those who clearly identify a powerful figure to “bum suck” for want of a better word that display pure unadulterated sycophancy to, that “progress” to propagate these trends in the future. This I believe is something that is triggered by the basest of all human emotions, jealousy, and probably egged on by a sense of insecurity as well.

One would expect that in a nation of devout Buddhists such reprehensible behaviour would be addressed and controlled. Alas it is not to be and looks like it never will be.

It is rather disconcerting to observe that this behaviour is ‘going strong’ among the Lankan community in this the land of the “long White Cloud” as well. The more I live here and mix with the community, the more I hear about people who try to start new projects or give fruition to new and possibly brilliant schemes who have been stymied by fellow citizens born in the Pearl. They indulge in the anonymous letter method (that dates back from time immemorial) made even easier by using false identities, and “one-off” e mail addresses on the web. They inform all government authorities of what they believe are attempts to break the law of their adopted country. If there are bilateral trade agreements, they diligently contact the other parties and try to cast aspersions on the people concerned. They even inform the management of any company that these people with the new ideas may be working at, that their employee may be breaking a sub clause in his contract and thinking of doing some other business while working for them. All triggered by a wonderful sense of self-righteousness from people who don’t think twice about breaking the law when it concerns their own affairs!

As a result, those who have had a measure of success, guard their positions very carefully and a few who have tried to include other Lankans in their operations have learned hard lessons from those who stole their trade secrets and started rival businesses on their own. I daresay this happens in other communities too, but among the Chinese and Indian communities that form similar minorities in Aotearoa, there are official networks formed to help new immigrants. There are schemes and methods in place to help their people do business, especially in the field of imports, to try and reach some sort of equilibrium with regard to the balance of trade between Aotearoa and their home countries. Sri Lanka imports so much milk from New Zealand but almost nothing of our spices, gems and jewellery, tourism products or even our tea that used to have a much larger share of the market, are imported.

In these desperate economic times, shouldn’t the government be looking at ways to improve our export trade? There are so many pockets and communities of Lankans in so many different countries who are doing well enough to be able to afford some luxuries from their home countries but have to pay exorbitant prices or do without. A recent import of ‘sweet meats’ for Sinhala New Year saw such a massive offtake that great plans for expansion were disrupted by Covid-19, before the Lankan rivals could put paid to it. Although such plans were in place!

Something that is rather obvious to those observing the antics in the Pearl from outside is that there seems to be no plan. Innovative thinking, especially in the field of ‘non-traditional’ exports does not exist. We have all seen how fickle tourism is. Using our fertile soil and the artistic skills of our people to build a reputation for quality exports has been totally neglected in recent times. I daresay the relevant ministries and export bodies exist, but it is a well-known fact that they simply serve as JOBS for political catchers, who do nothing except enjoy a foreign junket or two every year on account of the taxpayer.

That brilliant marketing idea of the Ceylon Tea Centers was so far ahead of its time that no one really understood it. We had the best retail locations in some of the greatest cities in Europe and the UK and were building up a great reputation for serving quality tea and promoting our cuisine. It should have been expanded to handle handicraft products on the lines of Laksala and even spices. Of course, promoting our culture, hospitality and tourism would have followed. There are two ways to handle a crisis. We can either put up our shutters and slide deeper and deeper into the mire of debt and economic ruin, or take some bold steps, make innovative investments and take a gamble on products and ideas that are endemic to our country.

 

Even if the latter method fails the end result couldn’t be much worse! Go down fighting I say! Rather than ask expatriates to come back and try to work in a totally corrupt and politician dominated society, approach expatriates with ideas in other countries and back them to promote those ideas if they show real economic benefits to our land. Not everything will work but even a 5% success rate is better than nothing at all.

It is also acknowledged that RANIL has been reappointed as leader of the UNP. Now then, what does this mean? Is it that the Uncle-Nephew party has stuck to tradition or does it mean that at least some people have realized that an experienced politician with world recognition and a certain amount of credibility in the first world, is useful to have around? Search your minds all you critics who blamed absolutely everything on Ranil. Have a dispassionate look at the Muppets in parliament and think for yourself what sort of account they would give of themselves on the world stage. After you do this, place Ranil on the world stage next to those morons and realize for yourself the DIFFERENCE!

 

fromoutsidethepearl@gmail.com

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Lenin comes to town (again)

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By Gwynne Dyer

When Russian opposition leader Alexei Navalny returned to Moscow on Sunday after convalescing in Germany from an attempted poisoning by the FSB domestic spy agency, the regime-friendly media loyally failed to mention his arrival. With one striking exception: Vremya, the flagship news show of Russian state television.

Presumably, somebody there was hoping to win favour with the Kremlin, because they briefly mentioned Navalny three-quarters of the way through Sunday’s two-hour programme. In fact, they compared Navalny’s trip home to Vladimir Lenin’s famous return to Russia in 1917, and suggested that he was as great a danger to Russia as Lenin had been.

As every Russian knows, the Germans plucked Lenin from exile in Switzerland in the middle of the First World War. He was sent across Germany in a ‘sealed train’ (so he wouldn’t spread the infection of Communism there) to St. Petersburg, then in the throes of Russia’s first democratic revolution – and he did just what the Germans had hoped he would.

Lenin overthrew the fumbling democratic ‘Provisional Government’ in a military coup, took Russia out of the First World War – and launched a 73-year totalitarian Communist regime that cost at least 20 million Russian lives in purges, famines and lesser acts of repression. Is Navalny really that great a danger?

The ambitious presenter at Vremya probably won’t get the job he wanted, because President Vladimir Putin really won’t have liked seeing his noisiest critic compared in stature to Lenin, a genuine world-historical figure. Putin himself never mentions Navalny’s name at all.

Russians cannot even put a name to the system they live under, as the poor Vremya presenter’s confusion illustrates. It’s certainly not a democracy, although there are regular elections. It’s definitely not Communist, although most of the regime’s senior figures were Communists before they discovered a better route to power and wealth.

It’s not a monarchy, although Putin has been in power for twenty years and is surrounded by a court of extremely rich allies and cronies. And ‘kleptocracy’ is just a pejorative term used mostly by foreigners, although Navalny does habitually refer to Putin and his cronies as “crooks and thieves”.

In fact, Putin’s regime is not a system at all. Its only ideology is a traditional Russian nationalism that is lightweight compared to blood-and-soil religious and racist movements like Trump’s in the United States and Modi’s in India. It’s a purely personal regime, and it is very unlikely to survive his dethronement or demise.

Putin has been in power for twenty years, and he has just changed the constitution with a referendum that lets him stay in power until 2036. But that seems unlikely, partly because he is already 68 and partly because the younger generation of Russians is getting restless and bored.

Navalny is a brave man who has gone home voluntarily to face a spell in Putin’s jails. (He missed two parole appointments for a suspended sentence on trumped-up embezzlement charges because he was in Germany recovering from the FSB assassination attempt.) But his role in Russian politics so far had been more gadfly than revolutionary.

His supporters do their homework and make clever, witty videos detailing the scandalous financial abuses of the regime (the latest is a virtual tour of Putin’s new $1 billion seaside palace on the Black Sea near Novorossiysk), but he is probably not the man who will finally take Putin down. What he is doing to great effect is mobilising the tech-savvy young.

Since 2018 the average age of protesters at anti-Putin demos, mostly linked to Navalny one way or another, has dropped by a decade, and their boldness has risen in proportion. Moreover, their attitude to the regime now verges on contempt. Rightly so: consider, for example, the last two assassination attempts by regime operatives.

In 2018, the GRU, the Russian military intelligence agency, sent two agents to England to kill defector Sergei Skripov and his daughter Yulia. The agents made two trips to Salisbury because they couldn’t find the right house, they were tracked by CCTV every step of the way, and in the end, they left too little novichok (nerve poison) on the doorknob to kill the targets.

Equally crude and bumbling was the FSB’s attack on Navalny in Tomsk, where the novichok was put on his underpants. Once again, the target survived, and afterwards the investigative site Bellingcat was able to trace FSB agents tracking Navalny on forty flights over several years before the murder was attempted.

Neither agency is fit for 21st-century service, nor is the regime they both serve. Russians have put up with it for a long time because they were exhausted and shamed by the wild political banditry of the 1990s, but Putin’s credit for having put an end to that has been exhausted. He may still be in power for years, but this is a regime on the skids.

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