SUNAMO atrial retractor—a custom-made retractor for small left atrium

Many types of atrial retractors are available in practice. Though they have been used routinely for all types of procedures requiring exposure of mitral valve, we felt that these being rigid and having a fixed design and size, not suitable in certain conditions of redo mitral valve procedures where the left atrium is too small to accommodate the retractor. Moreover atrial wall in such situation is more fragile that little more pull on the retractor would cause tear in the wall of the atrial tissue. We have made a novel flexible type of retractor which can be assembled on the table with materials that are readily available in a cardiothoracic operating room.     

Menstrual Problems and Health Seeking in Sri Lanka

Menstruation is associated with some morbidity, although it is a normal physiological event. In this article, we draw on qualitative research conducted in Sri Lanka in 2006–2007, which included eight key informant interviews with healthcare providers, six focus group discussions with eight women in each, and five case studies. We describe and analyze women's perceptions of menstruation and menstrual problems, their help-seeking behaviors to reduce these health problems, and the consequences of them on their lives. The majority of women perceived menstruation as a physiological process and related problems to changes in hormone levels, pathological conditions of the uterus, and the side effects of contraceptive methods. Menstrual problems significantly affected their daily activities, mental well-being, social life, and sexual life, but few sought medical advice to resolve these problems. Implications of the findings included the need for health care providers and educators to provide accurate information on menstruation to girls and women to enable them to identify normal variation of menstruation and to take appropriate action regarding health care.