Browsing by Author "Casather, D.M."

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A case of labial adhesions following primary genital herpes infection
(Sri Lanka College of Obstetricians & Gynaecologists, 2018) Casather, D.M.; Herath, R.P.; Ranathunga, R.D.J.; Pannala, W.S.
INTRODUCTION: Genital Herpes is one of the common sexually transmitted diseases in Sri Lanka. Although, the labial adhesions usually associated with hypo-oestrogenism, it may occur as a rare complication of Genital Herpes infection. Here we present a case of almost complete thick band labial adhesions following Genital Herpes infection. Case Report: A 23 year old nulliparous woman presented with vulval pain, dysuria and fever for two days. On vulval examination she had extensive, multiple, painful genital ulcers with some blistering lesions over both labia majora and minora. She had been in a monogamous relationship with the partner, with last sexual exposure about 10 days prior to the development of ulcers. Presumptive diagnosis of primary genital herpes was made on clinical manifestations. She was treated with 7 days course of oral Acyclovir. Ten days later she presented with a complaint of narrowing of the vaginal introitus and dysuria. On examination vulval lesions were in the partial remission and there was thick band of adhesion on the upper two third of labia minora with multiple scars of healing ulcers on either side. Manual separation of adhesions was not attempted due to tense nature of the adhesions. Surgical separation of labial adhesions was done under general anesthesia. After two weeks she made complete remission of Genital herpes ulcers and there were no further labial adhesions. A further follow up appointment was arranged in three months. DISCUSSION: Labial adhesions are not common among women in reproductive age who are having well oestrogenised vulva, in comparison to prepubertal and postmenopausal women with less oestrogenised vulva. Labial adhesions are rare, but severe form of local complication of genital herpes infection. The formation of labial adhesions can be prevented by early treatment with adequate dose of oral acyclovir. Gentle application of local anaesthetic over the labia minora alleviates pain and prevents labial adhesions formation in patients with genital herpes. The usual solution for adult labial adhesion following genital herpes infection is surgical adhesiolysis. Manual separation of the labia under application of local anaesthesia can be considered in patients who have less dense adhesions. This is the first published material in Sri Lanka on this matter. The importance of this report is to maintain the vigilance among health care providers about this rare complication as Genital Herpes infection is a very common sexually transmitted infection in Sri Lanka.
A Case of labial adhesions following primary genital herpes infection
(Kandy Society of Medicine, 2018) Casather, D.M.; Herath, R.P.; Ranathunga, R.D.J.; Pannala, W.S.
Labial adhesions are usually associated with hypo-oestrogenism, but it is also a rare complication of genital herpes infection. We present a case report of a 23-year-old woman presenting with primary genital herpes infection, progressing to labial adhesions.
A case of pulmonary endometriosis treated by bronchial angiographic embolization
(Sri Lanka College of Obstetricians & Gynaecologists, 2018) Casather, D.M.; Herath, R.P.; Sanjeewa, J.M.P.; Sandaruwan, N.K.T.S.; Ganewatte, E.
INTRODUCTION: Although usually confined to the pelvis, endometriosis can be found in extra-pelvic organs and tissues as well. One of the rare forms of extra-pelvic endometriosis is thoracic endometriosis (TE). It is characterized by presence of functional endometrial tissues within the pleura, in the lung parenchyma or the airway. We present a case of TE managed with bronchial angiographic embolization (BAE). CASE REPORT: A 32-year-old woman with two children presented with repetitive catamenial haemoptysis for 8 months’ duration Haemoptysis usually started on the first day or the second day of each menstruation and it continued for 5 to 6 days and it was identical with the menstrual interval. She had one vaginal delivery and one caesarean section 10 years ago and 6 years ago respectively. Two years ago, she had diagnostic laparoscopy for chronic pelvic pain and which revealed pelvic endometriosis. Her medical history was otherwise unremarkable. Physical examination of the respiratory system was normal. Chest X-ray had symmetrical thorax and plain lung markings without abnormal findings. A chest computed tomography taken during the menstruation revealed a focal consolidation with adjacent ground glass opacification in the basal segment of the right lower lobe. Since, haemoptysis spontaneously resolved with the menstruation we assumed this catamenial haemoptysis due to pulmonary endometriosis and planed for BAE. During the procedure ultrasound guided diagnostic descending aortogram was performed using a catheter placing in the proximal descending thoracic aorta. Angiogram revealed a hyperaemic area in the lower lobe of the right lung, supplied by the hypertrophied lower lobe branch of right intercosto-bronchial artery. Super selective cauterization and embolization of the feeding right bronchial artery was done with PVA particles. Post embolization angiogram revealed satisfactory occlusion of the arterial supply to the hyperaemic area. Post procedure course was uneventful and there were no recurrences of catamenial haemoptysis following the procedure. CONCLUSION: There is no guidance for the treatment of TE. Hormonal therapy can be considered to suppress the endometrial tissues. Considering the surgical options to treat TE, video assisted thoracic surgery was reported and which was found to be safer and less invasive than lobectomy. In general BAE is an alternative to surgery in the management haemoptysis caused by Tuberculosis and chest trauma. Even though, BAE has not been frequently used to treat TE we reported case of TE successfully treated with BAE. This suggests that BAE is an alternative treatment option for symptomatic TE.
Obliterative endarteritis in placentae and hypertensive disorders of pregnancy: a case control study
(Sri Lanka Medical Association, 2008) Salgado, L.S.S.; Casather, D.M.; Abeysuriya, V.
OBJECTIVE: Obliterative endarteritis in placenta is known to interrupt the fetal circulation in hypertensive disorders related to pregnancy. DESIGN, SETTING AND METHODS: Case control study was performed among 196 pregnant mothers (median age of 29 years, range 15-42 years) with hypertensive disorders complicating pregnancy and 150 normal mothers (median age 28 years; range 15-41 years). Mothers who had blood pressure of 140/90 mmHg or above on admission and remaining above that level after 24 hours of admission, mothers with diastolic blood pressure of 110 mmHg on admission, eclamptic mothers and known hypertensive mothers who are currently on antihypertensive drugs were included. All cases were classified as essential hypertension, pregnancy induced hypertension (PIH), pre-eclamptic toxaemia (PET), severe pre-eclamptic toxaemia and eclampsia. Haematoxyiin and Eosin stained placental tissue sections were visualized under light microcopy. Presence of Obliterative endarteritis was confirmed by the swelling, proliferation of endothelial cells, thickening of the basement membrane and fibromuscular sclerosis of the vessel wall. RESULTS: In controls, 61/150 (40.7 %) and in cases, 150/196 (76.5%) had endarteritis (P=0.001). Among the cases, placentae in mothers with essential hypertension, PIH and PET showed endarteritis in 24/34 (70.6 %), 73/93 (75.3%) and 29/37 (78.4 %) respectively. 24/32 (75%) placentae of mothers with severe pre-eclapmtic toxaemia and eclampsia had endarteritis (severe vs. non-severe hypertensive disorders, P=0.2). CONCLUSION: The incidence of Obliterative endarteritis in placenta is common in hypertensive disorders, but showed no significant difference with the different types of hypertensive disorders.
Spontaneous ovarian hyperstimulation syndrome as a presenting manifestation of acquired hypothyroidism
(Sri Lanka College of Paediatricians, 2024) Kaluarachchi, D.P.; Casather, D.M.; Rathnayaka, R.M.A.N.; Ramachandran, R.; Herath, R.; Mettananda, S.
No abstract available
Variations in the topographical anatomy of the recurrent laryngeal nerve and the inferior thyroid artery
(Sri Lanka Medical Association, 2008) Subasinghe, T.V.; Salgado, L.S.S.; Fernando, R.; Abeysuriya, V.; Casather, D.M.; Willaraarachchi, W.A.M.A.
OBJECTIVE: Thyroidectomy is a commonly performed surgery. Comprehensive knowledge in anatomical variation of the inferior thyroid artery (ITA) in relation to the recurrent laryngeal nerve (RLN) is mandatory for safe thyroid surgery. Data on variations in Sri Lankans is incomplete. DESIGN, SETTING AND METHODS: Thirty cadavers (20 male:10 female; range 56-87 years) were dissected to study the anatomical variations of the ITA in relation to the RLN. RESULTS: In 22 cadavers the right ITA originated from thyrocervical trunk, and in 8 it was a branch of the transverse cervical artery. On left, ITA originated from the thyrocervical trunk in 26 and from the transverse cervical artery in 4 cadavers. Branching of the artery was extra-capsular in 22(72%) on the right and 23(75%) on the left. On the right, the RLN was seen posterior to all the extra-capsular divisions of the ITA in 18(60%) cadavers, while in 7(22%) it was anterior. In 5(18%) cadavers it was between the divisions of ITA. On the left, it was 28(95%) and 2(5%) respectively (Z=2.74, P=0.006). The right RLN was seen in the tracheo-oesophageal groove in 26 cadavers (85%), while in 4(15%) it was on the antero-lateral side of die trachea. On the left, all the recurrent laryngeal nerves was seen in the tracheo-oesophageal groove. CONCLUSION: The anatomical variation is common in relation to the right RLN. These have implications in thyroid surgery and follow up.