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At least 613 records · Page 34Linked to original sources
PubMed2002

Do pessaries prevent the progression of pelvic organ prolapse?

Pessaries are used for the management of pelvic organ prolapse, but it is unknown whether a pessary will prevent progression of this condition. The purpose of this study was to describe the course of pelvic organ prolapse among women using a pessary for at least 1 year. Among 56 consecutive women fitted with a pessary, 19 (33.9%) continued its use under our care for at least 1 year. We compared baseline and follow-up examinations, using the Pelvic Organ Prolapse Quantitation examination system. At baseline, 16 (84.2%) had stage 3 or 4 prolapse. After 1 year we observed a significant improvement in the stage of disease ( P = 0.045, Wilcoxon signed rank test). Four women (21.1%, 95% confidence interval -0.2, 43.7%) had an improvement in stage. No women had worsening in stage of prolapse. These data suggest that there may be a therapeutic effect associated with the use of a supportive pessary.

Aged↗
PubMed2005

Digital assessment of lower rectum fixity in rectal prolapse (DALR): a simple clinical anatomical test to determine the most suitable approach (abdominal versus perineal) for repair.

Selection of an appropriate approach to treat full thickness rectal prolapse remains problematic and controversial. We propose that rectal prolapse may be classified as 'low type' (true rectal prolapse) or 'high type' (intussusception of the sigmoid with a fixed lower rectum). This assessment can be made via a simple clinical test of digital rectal assessment of lower rectal fixity ('the hook test') based on anatomic changes in rectal prolapse to guide the selection process. In cases with the low-type prolapse, a perineal approach is appropriate (either Delorme's procedure, or rectosigmoidectomy with or without pelvic floor repair). For the high type, an abdominal rectopexy with or without high anterior resection is needed. Retrospective analysis of our cases treated over the last 6 years showed a recurrence rate of 6% in perineal procedures and 0% in abdominal rectopexy combined with resection to date. We believe that employing our simple test and classification can contribute to better patient selection for either approach, minimize anaesthetic and surgical risks and also result in lower recurrence rates.

Abdomen↗
PubMed2006

Multiple bladder calculi: a rare cause of irreducible uterine prolapse.

BACKGROUND: A vesical calculus in a prolapsed cystocele is rare. OBJECTIVE: To highlight bladder calculi as a cause of irreducible uterine prolapse. CASE REPORT: A case of irreducible total uterine prolapse caused by multiple vesical calculi is presented. Bladder stones were removed through vaginal cystolithotomy followed by vaginal hysterectomy. CONCLUSION: In cases of acute irreducible pelvic organ prolapse, the possibility of bladder stones should be kept in mind and X-ray pelvis including the prolapsed mass should be done to confirm the diagnosis.

Female↗
PubMed2006

Vaginal carcinoma in a completely prolapsed uterus. A case report.

BACKGROUND: The development of genuine vaginal carcinoma onto a completely prolapsed uterus is a very rare condition to deal with. CASE: We report here the clinical characteristics of a patient with vaginal carcinoma associated with a third-degree prolapsed uterus. The 80-year-old patient was admitted with a completely prolapsed uterus. The cervix was clinically normal but on the nearby prolapsed vaginal wall a large exophytical hard lesion had been developed. Biopsy of the lesion revealed squamous carcinoma. TREATMENT: The treatment performed was radical vaginal hysterectomy and excision of the upper two-thirds of the vagina without pelvic lymphadenectomy, followed by external beam irradiation. The patient is alive, with no signs of the disease 3.5 years after surgery. CONCLUSION: Surgical and radiotherapeutic treatments can be effectively combined in patients with vaginal carcinoma and complete genital prolapse, in order to improve survival benefits and reduce morbidity.

Aged, 80 and over↗
PubMed2001

The value of posterior levator repair in the treatment of anorectal incontinence due to rectal prolapse--a clinical and manometric study.

BACKGROUND: When treating a complete rectal prolapse, the most important objective is elimination of the prolapse. In addition, restoration of sufficient anorectal continence is extremely important for the patients. We examined the value of posterior levator repair with respect to stabilization of the pelvic floor and to improvement in anorectal incontinence. METHODS: In patients with disabling anorectal incontinence, a posterior levatorplasty can be concomitantly performed during operative removal of the prolapse. To facilitate evaluation of the operative results, we implemented a scoring system to judge the patients' subjective symptoms of incontinence; in addition, we performed manometric measurements of resting and squeezing pressures of the anal sphincter to objectify the anorectal incontinence. RESULTS: From 1991 to 1997, 84 patients (mean age 65+/-10 years, 38-91 years; 79 women, 5 men) with complete rectal prolapse and severe incontinence were operatively treated; corresponding follow-ups were done. The following procedures were performed: Frykmann-Goldberg, 28 patients; Wells, 18 patients; Ripstein, 22 patients; and perineal proctectomy, 16 patients. Incontinence for liquid and solid stools was present in all of these patients. Posterior levatorplasty was implemented in 38 patients, and in this group we found significantly better postoperative results, both clinically and in the manometric measurements. Continence was improved by 84% in the group with levatorplasty, but improvement was only 67% in the other group (P<0.05). The incontinence score decreased significantly in the group with levatorplasty (preoperative 16.4+/-3.1, postoperative 9.3+/-4.5, P<0.05, vs the other group with preoperative 15.6+/-4.2, postoperative 11.5+/-5.1). Manometric observations in the group with levatorplasty demonstrated 55% improvement in resting pressure (preoperative 29+/-17 cm H2O, postoperative 45+/-21 cm H2O, P<0.05) and 40% improvement in squeezing pressure (preoperative 61+/-25 cm H2O, postoperative 85+/-31 cm H2O, P<0.05). In the group without levatorplasty, resting and squeezing pressure improved only by 20% (resting pressure: preoperative 32+/-16 cm H2O, postoperative 38+/-18 cm H2O; squeezing pressure: preoperative 64+/-29 cm H2O, postoperative 75+/-26 cm H2O). CONCLUSIONS: Posterior levatorplasty is an easy and efficient operative procedure which facilitates an improvement in anorectal continence. There are no apparent disadvantages. For this reason, levatorplasty can be part of operative procedures implemented in the treatment of a complete rectal prolapse accompanied by disabling anorectal incontinence.

Aged↗
PubMed2006

Sequence variant in the laminin gamma1 (LAMC1) gene associated with familial pelvic organ prolapse.

Pelvic organ prolapse is a common condition, affecting up to a third of women throughout their lifetime. Genetic factors are believed to account for about 30% of the incidence, and are the least understood component of the disorder. Familial cases, particularly those in which prolapse manifests in young women, are especially valuable in the effort to find the genes involved. We recently reported autosomal dominant transmission as the most likely mode of inheritance, based on a collection of families with high incidence of prolapse. Of greatest interest was a family in which three generations of female relatives suffered from prolapse at a very young age. A genome-wide linkage scan performed using the Affymetrix GeneChip Human mapping 10K array identified ten regions with a LOD score of 1.5, the maximum possible for this family. Candidate genes within those regions were analyzed for expression in vaginal tissue by RT-PCR. Of the genes confirmed to be expressed, LAMC1 was further evaluated by sequencing and select single nucleotide polymorphism (SNP) genotyping for causative sequence variants in affected family members. We identified one such SNP, rs10911193. The rare T variant segregating with the condition is present at a frequency of 4.9% in the general population and 22% among probands from our cohort of families. It affects the binding site for NFIL3, a transcription factor that we verified to be co-expressed in vaginal tissue. Altogether these data suggest that a polymorphism in the promoter of LAMC1 may increase the susceptibility to early-onset pelvic organ prolapse.

Base Sequence↗
PubMed2000

Laparoscopic repair of rectal prolapse: a prospective study evaluating surgical outcome and changes in symptoms and bowel function.

BACKGROUND: There have been few large series that have focused on the feasibility of the laparoscopic approach for rectal prolapse. This single-institution study prospectively examines the surgical outcome and changes in symptoms and bowel function following the laparoscopic repair of rectal prolapse. METHODS: In a selected group of 34 patients (total prolapse, 28; intussusception, six), 17 patients underwent laparoscopic-assisted resection rectopexy and 17 patients received a laparoscopic sutured rectopexy. Preoperative and postoperative evaluation at 3, 6, and 12 months included assessment of the severity of anal incontinence, constipation, changes in constipation-related symptoms, and colonic transit time. RESULTS: Median operation time was 255 min (range, 180-360) in the resection rectopexy group and 150 min (range, 90-295) in the rectopexy alone group. Median postoperative hospital stay was 5 days (range, 3-15) and median time off work was 14 days (range, 12-21) in both groups. There were no deaths. Postoperative morbidity was 24%. Incontinence improved significantly regardless of which method was used. The main determinant of constipation was excessive straining at defecation. Constipation was cured in 70% of the patients in the rectopexy group and 64% in the resection rectopexy group. Symptoms of difficult evacuation improved, but the changes were significant only after resection rectopexy. Two patients (7%) developed recurrent total prolapse during a median follow-up of 2 years (range 12-60 months). CONCLUSIONS: Laparoscopic-sutured rectopexy and laparoscopic-assisted resection rectopexy are feasible and carry an acceptable morbidity rate. They eliminate prolapse and cure incontinence in the great majority of patients. Constipation and symptoms of difficult evacuation are alleviated.

Adult↗
PubMed2005

Sacral nerve stimulation for fecal incontinence following surgery for rectal prolapse repair: a multicenter study.

PURPOSE: A proportion of patients have fecal incontinence secondary to a full-thickness rectal prolapse that fails to resolve following prolapse repair. This multicenter, prospective study assessed the use of sacral nerve stimulation for this indication. METHODS: Patients had to have more than or equal to four days with fecal incontinence per 21-day period more than one year after surgery. They had to have failed conservative treatment and have an intact external anal sphincter. RESULTS: Four female patients aged 42, 54, 68, and 65 years met the inclusion criteria. Three of the four patients had had more than one operation for recurrent full-thickness rectal prolapse before sacral nerve stimulation, one of whom had undergone a further operation for recurrence following stimulation. One patient had undergone one operation for prolapse repair. The preoperative duration of symptoms was ten, eight, three, and nine years, respectively. Although patients had an intact external anal sphincter, one patient had a fragmented internal anal sphincter. The frequency of fecal incontinent episodes changed from 11, 24.7, 5, and 8 per week at baseline to 0, 1.5, 5.5, and 1 per week at latest follow-up. Ability to defer defecation was also improved in two of three patients who had this documented. Fecal incontinence-specific quality of life assessment showed an improvement in all four domains. CONCLUSION: Sacral nerve stimulation should be considered for patients with ongoing fecal incontinence following full-thickness rectal prolapse repair if they prove resistant to conservative treatment.

Adult↗
PubMed2003

Open vs. laparoscopic surgery for rectal prolapse: a case-controlled study assessing short-term outcome.

PURPOSE: This study was undertaken to evaluate the efficacy and safety of laparoscopic repair for rectal prolapse. METHODS: A case-control study was undertaken. The case group consisted of a consecutive series of patients who underwent laparoscopic repair for rectal prolapse between February 1993 and June 2000. The control group underwent open prolapse repair between October 1987 and January 2000. RESULTS: There were 53 patients in each group. The groups were matched according to operation type, gender, and age. Median operative time was longer in the case group than in the control group (resection rectopexy 210 vs. 117 minutes, rectopexy 127.5 vs. 72 minutes, respectively). Median postoperative hospital stay was shorter in the case group than in the control group (resection rectopexy 5 vs. 7 days, rectopexy 4.5 vs. 7 days, respectively). Median intraoperative bleeding was minor in the case group (resection rectopexy 35 vs. 300 ml, rectopexy 15 vs. 100 ml, respectively). Mortality (0 vs. 4 percent), complications (23 vs. 30 percent), late complications (4 vs. 13 percent), and the rate of recurrent prolapse (6 vs. 13 percent) did not differ significantly between the groups. CONCLUSIONS: Laparoscopic repair for rectal prolapse is technically feasible and can be performed with mortality and morbidity rates comparable to those of the conventional technique. The main advantages of the laparoscopic approach appear to be a shorter hospital stay and lessened intraoperative blood loss. Recurrence rate is not increased in the short term.

Adult↗
PubMed2006

Multimedia article. External pelvic rectal suspension (the express procedure) for internal rectal prolapse, with or without concomitant rectocele repair: a video demonstration.

PURPOSE: Internal rectal prolapse has been proposed as a cause of symptomatic rectal evacuatory dysfunction. Abdominal rectopexy, the standard surgical approach, has significant attendant risk and does not address any concomitant rectocele. This video was designed to demonstrate a novel surgical method that uses porcine collagen implants (Permacol), designed to correct internal rectal prolapse, with or without rectocele. METHODS INCLUSION CRITERIA: severe rectal evacuatory dysfunction refractory to maximal conservative therapy and full-thickness internal rectal prolapse impeding rectal emptying on defecography with or without associated functional rectocoele; normal colonic transit. Patients undergo comprehensive preoperative and postoperative symptomatic assessment and anorectal physiologic testing, including defecography. A crescenteric perineal skin incision allows development of the rectovaginal/rectoprostatic plane to Denonvilliers fascia, with rectal mobilization. A curved tunneller inserted via the perineal wound is guided retropubically to emerge through suprapubic wounds created on each side. Permacol T-strips are sutured to the anterolateral rectal wall bilaterally, upward traction exerted, and the stem of each T-strip is sutured to the suprapubic periosteum, suspending the rectum. Concomitant rectocele is repaired using a Permacol patch in the rectovaginal plane. RESULTS: Short-term results for the "Express" are encouraging with improvement in evacuatory and prolapse symptoms and concomitant anatomic improvement at defecography. CONCLUSIONS: This procedure promises to be an effective technique for managing patients with refractory evacuatory dysfunction secondary to internal rectal prolapse, with or without rectocele.

Collagen↗
PubMed1985

Evaluation of the association of mitral valve prolapse in patients with Wolff-Parkinson-White type ECG and its relationship to the ventricular activation pattern.

The association of mitral valve prolapse (MVP) and Wolff-Parkinson-White (WPW) syndrome was examined using simultaneous two-dimensional and M-mode echocardiography. Twelve-lead electrocardiograms (ECGs) and two-dimensional echocardiograms (2DEs) were recorded in 24 patients with WPW. The location of the accessory pathway was predicted from the ECG as being in one of 10 possible sites correlating the delta wave polarity with epicardial mapping. Nineteen of the 24 patients had conduction via the accessory pathway and five were conducting normally during the recording of the echocardiogram. Mitral valve prolapse was found in 13 of 19 patients conducting via the accessory pathway. The only WPW patient with mitral valve prolapse during normal conduction had a chest deformity which has an independent association with mitral prolapse. No association was found between the prediction of the accessory pathway and the presence of mitral prolapse. We concluded that consideration should be given to the possibility that some patients demonstrating MVP do so as the result of the altered sequence of ventricular activation, rather than as the result of a structural abnormality.

Adult↗
PubMed1986

Observer variation in the echocardiographic diagnosis of mitral valve prolapse.

To assess inter- and intraobserver variation in the echocardiographic diagnosis of mitral valve prolapse, three independent observers analyzed M-mode echocardiograms (n = 80) and two-dimensional echocardiograms (n = 65) of patients with a mobile midsystolic click with or without a late or holosystolic murmur. In addition, a control group of 100 normal echocardiograms were interspersed among the echocardiograms of patients with mitral valve prolapse and were then interpreted. Each of the three observers analyzed all M-mode and two-dimensional echocardiograms initially and then 2 weeks later for the presence or absence of mitral valve prolapse. M-mode echocardiographic criteria for mitral valve prolapse consisted of late systolic posterior motion (greater than or equal to 3 mm) of one or both mitral leaflets or holosystolic hammocking (greater than or equal to 3 mm) of one or both mitral leaflets. Two-dimensional echocardiographic criteria for mitral valve prolapse consisted of: posterior systolic arching of one or both mitral leaflets in the parasternal long-axis view, and/or posterior systolic bowing of one or both mitral leaflets in the apical four-chamber view posterior to the plane of the mitral anulus, and/or excessive posterior coaptation of the mitral leaflets in either view flush with or posterior to the plane of the mitral anulus. There was insignificant observer variation both in the M-mode and two-dimensional echo groups, as determined using Cochran's Q test.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Three-dimensional transesophageal echocardiography in the diagnosis of mitral valve prolapse.

Because the anulus of the mitral valve is nonplanar in systole, false-positive diagnosis of mitral valve prolapse may result from two-dimensional transthoracic echocardiography. Because of the superior image quality of TEE, we used the three-dimensional TEE technique to evaluate the mitral valve in both normal subjects and patients with mitral valve prolapse and with ruptured chordae tendineae. After a conventional TEE examination, sequential images of longitudinal views were obtained by probe rotation. The images at 5-degree intervals were stored in machine cine memory loop; the special temporal images were selected with ECG gating and videorecorded. During the examination, 6 to 8 images of the left heart were recorded for later off-line, three-dimensional reconstruction. A total of 42 subjects were studied: 32 normal, 9 with mitral valve prolapse, and 1 with ruptured chordae tendineae. In normal subjects, three-dimensional TEE showed nonplanarity of the entire mitral valve, which assumes a saddle shape. In mitral valve prolapse, either the anterior or posterior leaflet protruded into the left atrium like a spoon; when both leaflets are involved, they prolapse like two spoons. The anterior and posterior leaflets coapted poorly, and there was a seam between them. In ruptured chordae tendineae the tip of the mitral leaflet protruded during systole into the left atrium far from the coaptation point and was perpendicular to the body of the mitral valve and parallel to the anterior and posterior walls of the left atrium.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Complex ventricular arrhythmias associated with the mitral valve prolapse syndrome. Effectiveness of moricizine (Ethmozine) in patients resistant to conventional antiarrhythmics.

On the basis of epidemiologic studies, more than 10 million Americans have echocardiographic evidence of mitral valve prolapse. Although ventricular arrhythmias occur frequently (over 50 percent of patients with mitral valve prolapse), they rarely result in sustained ventricular tachycardia or sudden cardiac death. However, a common problem in clinical practice is a patient with mitral valve prolapse and symptomatic complex ventricular arrhythmias refractory or intolerant to both beta blockers and conventional type I antiarrhythmics. These drugs are known to have frequent side effects, toxicity, and proarrhythmic effects. In 17 patients with mitral valve prolapse who presented with symptomatic complex ventricular arrhythmias and who were unresponsive to an average of the three conventional agents, moricizine (Ethmozine) was effective in suppressing 90 percent of ventricular premature depolarizations, 99 percent of nonsustained runs of ventricular tachycardia, as well as all sustained runs of ventricular tachycardia, resulting in abolition of palpitations, dizziness, and syncopal episodes. Its efficacy as well as its low frequency of minor side effects makes it ideal for future consideration in the population with mitral valve prolapse, who are frequently young and may therefore require therapy for many years.

Adult↗
PubMed1991

Funic reduction for the management of umbilical cord prolapse.

The current management of umbilical cord prolapse centers on attempts to alleviate the pressure of the presenting part on the cord while preparation for cesarean section is being made. A 10-year experience in which there were vigorous attempts to accomplish safe vaginal delivery after the diagnosis of umbilical cord prolapse is presented. Eight cases of umbilical cord prolapse occurred, a frequency of 1 in 277 deliveries (0.37%), all of which had a normal immediate neonatal outcome. Vaginal delivery was accomplished in seven patients (87.5%); diagnosis was made in two of them when delivery was imminent. Five patients were more remote from delivery and had successful funic reduction (manual replacement of the prolapsed cord). Funic reduction is proposed as a potentially beneficial initial step in the management of umbilical cord prolapse.

Adolescent↗
PubMed1986

Mitral valve prolapse in craniofacial skeletal deformities.

Mitral valve prolapse is a manifestation of a diffuse connective tissue disorder resulting from mesenchymal dysplasia, and it may have an increased association with orthognathic craniofacial deformities. Since craniofacial deformities also result from mesenchymal dysplasias, there may be a causal relationship between them and mitral valve prolapse. Mitral valve prolapse is reviewed briefly in relation to the embryologic development of the facial skeleton. A slightly increased incidence of mitral valve prolapse has been noted but not statistically studied by the authors in their orthognathic patient population. It is hypothesized that patients with mitral valve prolapse have a typical facies that can be cephalometrically measured and identified.

Electrocardiography↗
PubMed1990

Mitral valve prolapse: cardiac arrest with long-term survival.

Cardiac arrest has been reported in patients with mitral valve prolapse; however, clinical characteristics and survival information are limited since most of the cases reported include autopsy data. Nine patients (2 male, 7 female) with mitral valve prolapse were identified who had cardiac arrest; ventricular fibrillation was documented in 8 patients; resuscitation was unsuccessful in 2. Eight had a history of palpitations (months to 15 years duration) and ventricular arrhythmias, 3 had a history (5-15 years) of recurrent syncope, and 1 was totally asymptomatic. Cardiac catheterization-angiographic studies in 8 patients demonstrated normal coronary artery anatomy and mitral valve prolapse. All 9 patients had auscultatory and echocardiographic evidence of mitral valve prolapse. Seven survivors (6 still alive) were followed from 3 to 14 years after cardiac arrest. A subset of patients with mitral valve prolapse and cardiac arrest is described in whom past medical history is compatible with cardiac arrhythmias or syncope, and whose long-term prognosis appears better than patients with other causes of cardiac arrest.

Adult↗
PubMed1989

Temporal resolution of mitral regurgitation in patients with mitral valve prolapse: a phonocardiographic and Doppler echocardiographic study.

To assess the timing and duration of mitral regurgitation in mitral valve prolapse, 20 patients with a mid-systolic click or late systolic murmur, or both (Group 1) and 16 patients with a pansystolic murmur with late systolic accentuation (Group 2) were studied with phonocardiography and echocardiography including various Doppler techniques. The subjects' ages ranged from 15 to 73 years. Mitral valve prolapse with mitral regurgitation was observed in 15 of 20 patients in Group 1 and in all 16 patients in Group 2. M-mode Doppler color echocardiography demonstrated a mitral regurgitant signal throughout systole and isovolumic relaxation in all but 1 of these 31 patients regardless of the pattern of the systolic murmur. The regurgitant signal was recorded after the click in only one patient with mitral valve prolapse in Group 1. Two of the five patients in Group 1 without two-dimensional echocardiographic findings of mitral valve prolapse had the early systolic signal of mitral regurgitation. The timing and duration of the mitral regurgitant signal detected in patients in Group 1 with pulsed or continuous wave Doppler ultrasound varied with the site of the sample volume or beam direction. In the patients in Group 2, however, the signal was demonstrated throughout systole and isovolumic relaxation by both Doppler methods. Compared with M-mode Doppler color echocardiography, therefore, pulsed and continuous wave Doppler methods were less sensitive and thus inadequate to investigate the timing and duration of mitral regurgitation in mitral valve prolapse, especially in patients with a mid-systolic click or a late systolic murmur, or both, who had mild or eccentric mitral regurgitant jets.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗