Browsing by Author "Pandit, U"
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Publication Adenomyosis at Hysterectomy: Prevalence, Patient Characteristics, Clinical Profile and Histopatholgical Findings(Kathmandu University, 2012) Shrestha, A; Shrestha, R; Sedhai, LB; Pandit, UABSTRACT Background Underlying adenomyosis is often the cause of treatment failure for patients undergoing medical therapy for abnormal uterine bleeding and or chronic pelvic pain. Given the limitation of ultrasonography in diagnosing adenomyosis and MRI being unaffordable to most of the patients belonging to developing countries like us, it often remains undiagnosed before a hysterectomy. Objective To find out the clinical profile associated with adenomyosis and to determine the prevalence of adenomyosis in hysterectomy specimens; frequency distribution, as well as to correlate clinical examination with histopathological examination. Methods A total of 60 women who had undergone hysterectomy with histopathologically proven adenomyosis between April 2009 and March 2010 were included . Data were collected on indication for the intervention, age, symptoms, clinical findings, hemoglobin, menopausal status, gross and histopathological findings. Results A total of 256 women were scheduled for hysterectomy. Adenomyosis was diagnosed in 60 of 256 cases (23.4%). Menorrhagia (91.2%), dysmenorrhoea (84.2%), lower abdominal pain (84.2%) beginning later in reproductive life (mean age- 45yrs) is the classic presentation. Adenomyosis was present in 10 of 61 patients (16.3%) with fibroids; 27 of 60 (45%) with abnormal uterine bleeding; 11 of 55 (20%) with prolapse; four of 35 (11.4%) with ovarian mass; five of 25 (20%) with chronic pelvic pain; three of four (75%) with endometriosis. Conclusion Women undergoing hysterectomy with diagnosis of adenomyosis have a distinct symptomatology. The choice of therapy in adenomyosis is hysterectomy for those women who have completed family and had failed medical therapy . KEY WORDS adenomyosis, hysterectomy, prevalencePublication Postoperative pain management with combined local infiltration and oral analgesia in herniotmy wound in children(Institute of Medicine, 2011) Sharma, NR; Pandit, U; Sapkota, PRAbstract Introduction: Post operative pain management in children is one of the most challenging job to anaesthetic as well as to surgeon. Adequate analgesia in children is necessary to reduce parent’s distress after any surgery. This study was carried out to assess the subjective adequacy of combined approach local anaesthesia and oral analgesia after inguinal herniotomy surgery in children. Methods: It was a prospective study done in a very remote district of Ruccum in Nepal. Adequacy of postoperative pain management was observed after wound infiltration at the local site in inguinal herniotomy cases.subsequently after surgery in 80 children. Wound infiltration at the local site was made with 0.5% bupivacaine. subsequently a combination of syrup of oral analgesic ibuprofen and paracetamol was given 4 hours after surgery when child became fully awake. Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) was used to access the adequacy of pain management. Results: out of 80 children, pain score< 6 was observed in 95.5% children . Among behavioralscore the commonest neutral bevavior in torso was found in 75 chidren. Likewise, no cry in 73, smiling in 70%, positive in 70%, not touching in 74%, neutral behavior in 74% were observed in cry, facial, child verbal, torso, touch and legs respectively. Conclusion: Local wound infiltration with 0.5% Bupivacaine is a simple and effective method in pain management in herniotomy cases which givessatisfaction to the children as well astheir parents. Keywords: local infiltration, postoperative pain management