Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item 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.Item 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.