ABSTRACT
Uterine balloon therapy is a minimally invasive technique for dysfunctional uterine bleeding done on day care basis. It can be offered as a treatment of option to women who have completed their family and have a diagnosis of dysfunctional uterine bleeding. The study was undertaken to analyse the success rate, complications of UBT and incidence of patients requiring alternative methods of treatment for DUB. Twenty four patients were treated with UBT (Thermachoice) for DUB. Efficacy of the procedure was analyzed at follow up periods of one, 3, 6 and 12 months. After undergoing UBT, at twelve months follow up, amenorrhea was achieved in 29.17% of patients, 33.33% were having oligomennorhea, 33.33% were eumenorrehic and no response was seen in 4.17% of patients. Our overall treatment success and patient satisfaction rate was 95.83%.Uterine balloon therapy is a safe, minimally invasive day care procedure requiring no extra expertise for the treatment of DUB in patients who want to save uterus with instant results. Post procedure there is improved patient well being and high treatment satisfaction.
ABSTRACT
Complete obstruction of the abdominal aorta at the renal artery level is a difficult surgical problem. Aortic clamping and declamping can lead to profound haemodynamic changes, myocardial infarction, ventricular failure or even death may result. These complications are important challenges in anesthetic management of these patients. Between August, 2010 and April, 2012, descending thoracic aorta to femoral artery bypass grafting was used to revascularize lower limbs in 11 patients in our institute. The anesthetic management of these patients is described here. Epidural catheter placement was done in T 5-6 or T 6-7 space for post operative pain relief. Induction was done by, Inj. Glycopyrolate 0.2 mg, Inj. Fentanyl 5 micro g/kg., Inj. Pentothal sodium 5 mg/kg, Inj. Rocuronium 0.9 mg/kg, IPPV done. Left sided double lumen tube was inserted, Maintenance of Anesthesia was done by O[2] + N[2] O [30:70]. Increments of Vecuronium and Fentanyl were given Monitoring of Heart rate, arterial pressure, central venous pressure were continuously displayed. The available pharmacological agents were used when there is deviation of more than 15% from base line. In our study, inspite of measures taken to control rise in blood pressure during aortic cross clamping, a rise of 90 mm of Hg in one patient and 60-80 mm of Hg in four patients was observed, which was managed by sodium nitropruside infusion. At the end of surgery seven patients were extubated on the operation table. In remaining four patients DLT was replaced by single lumen endotracheal tube and were shifted to ICU on IPPV. They weaned off gradually in 3-5 hours. In our series blood loss was 400 ml to 1000 ml. There was no mortality in the first 24 hours. Postoperative bleeding was reported in one case which was re-explored and stood well. The anesthetic technique during aortic surgery is directed at minimizing the hemodynamic effects of cross clamping in order to maintain the myocardial oxygen supply demand ratio