Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Closure of the peritoneum during vaginal hysterectomy and repair (VH & R)(Sri Lanka Medical Association, 1998) Wijesinghe, P.S.; Gunasekera, P.C.INTRODUCTION : Standard VH & R involves closure of the peritoneum with a purse string suture. Potential benefits are prevention of Fallopian tube prolapse, prolapse of intestines, vault prolapse and recurrence of the cntcrocoele. However, damage to the ureters, blood vessels and intestines is possible with this method. OBJECTIVES : To assess the usefulness of a technique which does not involve closure of the peritoneum with a purse string suture. DESIGN :Case control study. Setting : The Professorial Gynaecology Unit of the North Colombo General Hospital, Ragama. MAIN OUTCOME MEASURES :Post operative febrile morbidity, vault haematoma and abscess formation, and prolapse of viscera. Follow up for recurrence of components of prolapse. RESULTS : Over a period of 15 months from June 1995, 115 women awaiting VH & R were randomly allocated to two groups viz. A and B. conventional VH & R was carried out in group A. In group B the peritoneum was not closed separately but the pedicles except the vascular one were tied together in the midline. In spite of prophylactic antibiotics 3 out of 56 in group A and 4 out of 59 in group B developed post operative fever which lasted more than 48 hours. The incidence of postoperative haematoma and abscess formation was not different between the two groups and there were no cases of fallopian tube prolapse or intestinal prolapse. Apart from two cases each of recurrent cystocoele in the two groups, there were no other relevant morbidity during the follow up of upto two years. CONCLUSION : In this series closure of the peritoneum during VH & R with a purse string suture does not appear to be of any extra benefit. This step can be safely omitted during this procedure without adding to morbidity.Item New contraceptive options(Sri Lanka College of Obstetricians and Gynaecologists, 2004) Gunasekera, P.C.; Wijesinghe, P.S.No Abstract AvailableItem Better reproductive health: a strategy for poverty reduction(Sri Lanka College of Obstetricians and Gynaecologists, 2003) Gunasekera, P.C.; Wijesinghe, P.S.Item Emergency Obstetric care: the key to further reducing maternal mortality in Sri Lanka(World Health Organization Regional Office for South-East Asia, 2002) Gunasekera, P.C.; Wijesinghe, P.S.This paper, in the South East Asia Regional Health Forum, discusses ways of reducing maternal mortality in Sri Lanka. Whilst the maternal mortality rate in Sri Lanka compares favourably with that of other countries in the region, much more can be done to bring down this rate further. The paper recommends that emphasis should be directed towards providing emergency obstetric care where all basic facilities for childbirth, including instrumental deliveries are provided. In addition, comprehensive emergency obstetric care must be made available in selected centres where mothers needing Caesarean section and blood transfusion are cared for. The paper concludes that the majority of maternal deaths occur due to delays in providing emergency obstetric care. This area has to be add-ressed urgently in order to maintain and improve the rate of reduction of maternal deaths. The political will to make drastic changes is a prerequisite if maternal deaths are to be reduced significantly. The authors argue that preventing maternal death and disability is not only a health issue – it is also a moral issue underpinned by the guiding principles of human rights, social responsibility, participation, and equity [adapted from author].Item Reducing abortions is a public health issue(Sri Lanka Medical Association, 2001) Gunasekera, P.C.; Wijesinghe, P.S.No Abstract Available, Comment in: Jayasuriya, L.(Ceylon Med J. 2001; 46(4):163); Gunasekera, P.C.(Ceylon Med J. 2002; 47(2):74).Item The Caesarean section rate is rising(Sri Lanka Medical Association, 2001) Gunasekera, P.C.; Wijesinghe, P.S.; Goonewardene, I.M.R.No Abstract Available.Item Early pregnancy loss:are we doing enough?(Sri Lanka College of Obstetricians and Gynaecologists, 2001) Wijesinghe, P.S.; Gunasekera, P.C.; Goonewardene, I.M.R.No abstract availableItem Altered pelvic floor physiology in uterovaginal prolapse: evidence for a pan-pelvic floor disorder(1998) Deen, K.I.; Gunasekera, P.C.Item Spontaneous hepatic rupture in pregnancy(Sri Lanka Medical Association, 1998) Wijesinghe, P.S.; Gunasekera, P.C.; Sirisena, J.Spontaneous hepatic rupture in pregnancy is rare and associated with significant maternal morbidity and mortality. It has been reported in association with severe pregnancy-induced hypertension and HELP (haemolysis elevated liver enzymes low platelets) syndrome. New imaging techniques enable early diagnosis, and in those with subcapsular haematomas, conservative management. Surgical intervention is necessary in capsular rupture with haemodynamic instability. We here report three fatal cases and discuss the diagnosis and managementItem Female victims of sexual assault(Sri Lanka Medical Association, 1997) Gunasekera, P.C.; Wijesinghe, P.S.Drawbacks in this area are highlighted: admission may be hours or years after the offence, dearth of Forensic experts, lack of proper analysis of specimens, competence required of the clinicians to fulfil medical as well as legal responsibilities, lack of psychiatric assistance. (letter to editor)