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PubMedDate not supplied

[Surgical treatment of rectal prolapse with transanal resection according to Altemeier. Experience and results].

In recent years the number of patients with partial or total rectal prolapse has increased. Numerous techniques and surgical approaches have been described for its treatment. In this study we examine the main ones and stress the advantages of the transanal-perineal resection technique according to Altemeier and modified by Prasad, which we have used to treat the condition in the last 15 years. From 1988 to 2002, 269 patients with "haemorrhoidal prolapse" were referred to our department; 146 were females (54%), and the mean age was 58 years. Clinical examination and proctosigmoidoscopy revealed the presence of total rectal prolapse in 41 patients (15%, 32 F, 9 M), complicated in 4 cases by moderate incontinence and associated in 3 cases with post-haemorrhoidectomy stenosis. These 41 patients underwent transanal resection according to Altemeier. Thirty-four of them (83%) were operated on under local anaesthesia with sedation, 5 patients (12%) under peridural anaesthesia and 2 patients (5%) under narcosis. The mean hospital stay was 5 days and depended on the time of the first spontaneous evacuation. Check-ups were performed after 7 days, 1 months and every 3 months for 1 year. There was no postoperative mortality, and only 1 case of postoperative haemorrhage, which did not require reoperation, in a patient with a previous myocardial infarct who spontaneously continued to take salicylates up to 24 h before surgery. Thirty-three patients (80%) had their first postoperative evacuation within 48 h of surgery after taking sorbitol orally in the evening, 6 patients (15%) within 72 h, and 2 patients (5%) on postoperative day 4. No evacuative enemas were performed. We observed clinical healing in all patients 1 month after the operation, and regular, spontaneous evacuations without the use of oral laxatives. Stool or gas incontinence were never observed or reported. During the follow-up, only in 2% of cases did we observe partial recurrence of the prolapse. The choice between the numerous surgical techniques for correcting rectal prolapse, depends on the state of the disease, on the patient's general condition and on the surgeon's experience with the various techniques. The perineal approach proposed by Altemeier and modified by Prasad presents a low risk of mortality and immediate complications, as confirmed by our experience, even in high risk patients, and relatively easy execution. It would appear, moreover, to be the only technique capable of correcting the preoperative incontinence sometimes present.

Adult↗
PubMed2004

[Usefulness of transthoracic freehand three-dimensional echocardiography for the evaluation of mitral valve prolapse].

BACKGROUND: Two-dimensional (2D) echocardiography is routinely used in evaluating patients with mitral valve prolapse but requires a systematic examination for accurate assessment of the involved lesion of mitral valve prolapse, because the sonographer is required to mentally reconstruct two-dimensional images into three dimensions. Recently, freehand three-dimensional (3D) echocardiography has been introduced in the clinical setting for three-dimensional visualization of the mitral valve apparatus. OBJECTIVES: To evaluate the accuracy of the freehand 3D echocardiography system in assessing the involved lesion in patients with mitral valve prolapse. METHODS: This study consisted of 25 consecutive patients (15 men, 10 women, mean age 55 +/- 17 years) with mitral valve prolapse who were scheduled for 3D echocardiography. Mitral valve was reconstructed in the view from the left atrium (surgeon's view) by 3D echocardiography. The location of the involved lesion in mitral valve was classified as the medial, middle and lateral portions of the anterior leaflet, and the medial, middle and lateral scallops of the posterior leaflet, respectively. The results by 3D echocardiography were compared with those of 2D echocardiography as the clinical standard. RESULTS: An adequate three-dimensional display of the entire mitral valve for analysis of the involved lesion could be reconstructed in all 25 patients (feasibility 100%). The sensitivity of 3D echocardiography for detecting the lesions at the medial, middle and lateral portions of the anterior leaflet was 80%, 100% and 75%, and the medial, middle and lateral scallops of the posterior leaflet was 100%, 100% and 0%, respectively. The specificities were 100% at all locations in the mitral valve. CONCLUSIONS: These results indicate that freehand 3D echocardiography is useful for assessment of the involved lesion of the mitral valve in patients with mitral valve prolapse.

Aged↗
PubMed2004

Urodynamic comparison of continent and incontinent women with severe uterovaginal prolapse.

OBJECTIVE: To compare the clinical and urodynamic characteristics of continent and incontinent women with severe uterovaginal prolapse. STUDY DESIGN: Fifty-eight consecutive women with stage III or IV pelvic organ prolapse between June 1998 and December 2001 were enrolled. Each woman had a urinalysis, pelvic examination and urodynamic study and answered a urinary questionnaire. They were divided into clinically continent (n = 20) and incontinent (n = 38) groups. The clinical symptoms and urodynamic results in the 2 groups were compared statistically with the chi 2 test, Fisher's exact test and Mann-Whitney U test. RESULTS: Incontinent women with severe genital prolapse were more likely to report urinary frequency, urgency and nocturia than were continent women (P < .05). However, the incidence of voiding hesitancy was significantly higher for members of the continent group as compared to the incontinent group (P = .002). With respect to urodynamic variables, including detrusor pressure at peak flow, maximal urethral closure pressure and pressure transmission ratio, significantly higher values occurred in the continent group as compared with the incontinent group; they were 38 (range, 12-66) vs. 24 cm H2O (range, 10-49) (P < .01), 84 (range, 39-117) vs. 63 cm H2O (range, 45-84) (P = .033) and 102% (range, 66-135) vs. 66% (range, 14-98) (P = .019), respectively. All other parameters and the incidence of bladder outlet obstruction and detrusor instability did not differ significantly between the 2 groups (P > .05). CONCLUSION: The results of this study suggest that severe uterovaginal prolapse could produce obstructive symptoms and prevent or reduce urinary leakage, but whether urethral kinking or external urethral compression causes the obstruction remains unclear. More studies on different types of isolated pelvic organ prolapse are needed to elucidate the mechanism, and specific strategies can be developed to aid urogynecologists in their goal of restoring normal anatomy.

Adult↗
PubMed2003

[Sacropexy with abdominal fascia in treatment of vaginal prolapse vault of menopausal women].

INTRODUCTION: Vaginal vault prolapsed is a rare complication, with a frequency from 0.2 to 1% after hysterectomy, which is presented due to a bad surgical technique in fixation of the vault suspension elements, as well others factors as the multiparity, menopause, chronic lungs disease, obesity, smoking and weak physical activity. There are many techniques reported to correct this pelvic disease, although the conventional sacropexy has been established for abdominal way, where the diversity of materials of fixation is varied, including natural material as the abdominal fascia and aponeurosis of muscle rectos. OBJECTIVE: This descriptive and clinical study was carried out in a group of patient with vaginal vault prolapsed, with the objective to know the results and experience of this correction with the surgical technique of sacropexy utilizing abdominal fascia. MATERIAL AND METHODS: 32 menopausal patient with mean age of 53.9 years, 5 gestations, as well as index of Quetelet of 26.2, were studied, a following of a year was carried out. In these women the main symptom were the sensation of vaginal strange body and subsequently urinary incontinence of effort. Moreover, considering to all group the mean in presentation of the vaginal vault prolapsed after hysterectomy was of 7.7 years, with surgical time of 129 minutes and bled of 172 milliliters. RESULTS. The 97.5% of the patient returned to its sexual life without difficulties and only one referred dyspareunia. Post-surgical complications were not presented and only a patient presented vault prolapsed again (0.31%). CONCLUSIONS: With this results we can consider that the sacropexy with abdominal fascia is a good technique for the correction of the vaginal vault prolapsed in healthy menopausal women with regular sexual activity and then is a natural material who cause not any.

Fascia↗
PubMedDate not supplied

Genital prolapse in Port Harcourt, Nigeria.

BACKGROUND: Damage to the genitourinary supports from repeated pregnancies and labour is the most important predisposing aetiological factor in genital prolapse, a chronic gynaecological disorder that causes distressing morbidity (stress urinary incontinence, micturitional difficulties and problems of defecation). OBJECTIVE: To determine the pattern of presentation and management of genital prolapse at the University of Port Harcourt Teaching Hospital, and compare with experience elsewhere. METHODS: Retrospective review of all cases of genital prolapse admitted and operated upon during the period January 1990 to December 1999. Data collected and analyzed by simple percentages included sociodemographic characteristics, aspects of clinical presentation, management modality and outcome. RESULTS: Genital prolapse (118 cases) accounted for 37.5 per 1,000 gynaecological admissions during the study period. Seventy percent of the study subjects were above age 45 years, while seventy-three percent were grandmultiparous. Thirty percent were of reproductive age. The commonest symptom was "something coming down the vagina" (95% of the study subjects). Only 4% had stress incontinence. Second degree prolapse was the commonest finding on presentation (68.6%) while vaginal hysterectomy with pelvic floor repair was the main operative procedure (undertaken in 73.7% of the subjects). Postoperative deaths occurred in two patients, both diabetics (case fatality ratio 1:59) from septicaemia and intestinal obstruction respectively following vaginal hysterectomy. Postoperative morbidity following vaginal hysterectomy was also higher than that following Manchester Repair. CONCLUSION: This study's results are similar to previous findings in Nigeria and other developing countries. Measures to reduce grandmultiparity, difficult deliveries and postoperative morbidity and mortality are advocated.

Adult↗
PubMed2004

Coexistence of a prolapsed, pedunculated cervical myoma and pregnancy complications: a case report.

BACKGROUND: Different types of fibroids may affect reproductive outcome to a different extent, causing infertility and pregnancy wastage. Rectosigmoid compression, prolapse of a pedunculated submucous tumor through the cervix, venous stasis, polycythemia and ascites are infrequently associated with leiomyomas. Uterine leiomyomas arefound in approximately 2% of pregnant women; 1 in 10 causes complications during pregnancy. CASE: A 37-year-old woman, gravida 3, para 2, abortion 0, at 18 weeks of pregnancy, arrived at our outpatient clinic with a complaint of leaking vaginal fluid. On examination, a prolapsed, pedunculated myoma, measuring 5 x 6 x 7 cm, and pooling of amniotic fluid in the vaginal fornix were detected. Antibiotics were started, but the amniotic fluid leak continued, and the fetal heart beat became undetectable after 12 hours of hospitalization. We tried to excise the myoma from the vagina but because it was very large, we could not reach the proximal point it originatedfrom. We dissected the posterior cervical channel, removed the myoma and performed a total abdominal hysterectomy. CONCLUSION: Vaginal myomectomy is recommended as the initial treatment of choicefor a prolapsed, pedunculated submucous myoma except when other indications necessitate an abdominal approach. Use of Laminaria and hysteroscopic resection has been mentioned as other treatment choices. In our case a prolapsed, pedunculated cervical myoma was detected along with pregnancy complications, preterm premature rupture of membranes and fetal death. The cause-and-effect relationship between the prolapsed myoma and membrane rupture is unknown. We were unable to perform a vaginal or abdominal myomectomy because the myoma originated in the posterior cervical region, so we had to perform an abdominal hysterectomy.

Abortion, Induced↗
PubMed1992

Prevalence of abnormal urodynamic test results in continent women with severe genitourinary prolapse.

Twenty-two clinically continent women with severe genitourinary prolapse were evaluated urodynamically to determine the prevalence of urodynamic abnormalities that could lead to potential urinary incontinence. Urodynamic testing found an occult incontinence disorder in 13 women (59%), of whom four had urine loss during cough pressure profiles after pessary placement, four had uninhibited detrusor contractions during retrograde medium-fill water cystometry, and five had both stress urinary incontinence and an unstable bladder. Therefore, nine of the 22 patients (41%) had uninhibited detrusor contractions during urodynamic testing. However, uroflowmetry did not reveal voiding dysfunction in this group, although peak flow rates appeared to be lower in the subgroup of women manifesting uninhibited detrusor contractions. Associated symptoms of frequency, nocturia, and urgency occurred in 41% of the women in this study; four of nine (44%) who had normal urodynamic test results, five of 13 (38%) who had abnormal test results, and five of nine (56%) who had an unstable bladder. Therefore, associated symptoms could not be used to determine which women would have abnormal urodynamic test results. These preliminary results suggest that women with genitourinary prolapse may be at risk for an occult incontinence disorder that is masked by the prolapse and that could manifest after corrective surgery for prolapse. Urodynamic testing is suggested for women with genitourinary prolapse who present with or without symptoms of incontinence, so that more data can be obtained to determine the importance of abnormal test results.

Female↗
PubMed2005

[Vaginal paravaginal repair in treatment of severe anterior vaginal prolapse and cystocele].

OBJECTIVE: To explore the rationality, efficacy and safety of vaginal paravaginal repair (VPVR) in treating anterior vaginal prolapse and cystocele. METHODS: Twenty-five consecutive women with stage II to IV and grade II-III anterior vaginal prolapse and cystocele evaluated by pelvic organ prolapse quantification (POP-Q) and Baden-Walker half way system were treated by VPVR. One hundred and one concomitant procedures for reconstructive pelvic surgery were also performed. The VPVR consisted of a thorough entry from the vesicovaginal space under the inferior pubic ramus into the retropubic space, exposing the area of the arcus tendineus fascia pelvis (ATFP), placing nonabsorbable sutures around ATFP on either side and fixed to appropriate locations on the bladder fascia and anterior vaginal walls. Tying of these sutures resulted in dramatic elevation of the lateral superior sulci, as well as prolapsed vesica. Patients were followed up after operation. The cure rate was estimated subjectively and objectively, according to POP-Q and Baden-Walker half way system. RESULTS: All patients had their surgery completed by VPVR. The average operative time was 40 min and estimated blood loss was 70 ml. Two minor intraoperative hemorrhage occurred during dissection of retropubic space and there were no other complications. No morbidity after operation was observed either. Postoperatively, two patients developed obstructive voiding and urinary retention. One recovered completely in a few days, the other has improved slowly for 2 months. Patients were followed up for 2 - 14 months. Two patients with asymptomatic stage I or grade I cystocele were found by examination between 2 and 6 months after operation. Our objective cure rate was 92% and subjective cure rate was 100% respectively at a mean of 6 months after operation. CONCLUSIONS: Since VPVR can restore the normal lateral attachment of the pubocervical fascia to pelvic side wall at ATFP, it is a reasonable, safe and effective procedure to correct severe anterior vaginal prolapse and cystocele.

Aged↗
PubMed2005

Expression of lysyl oxidase and transforming growth factor beta2 in women with severe pelvic organ prolapse.

OBJECTIVE: To determine the mRNA expression of lysyl oxidase (LOX) and transforming growth factor beta2 (TGF beta2) in subjects with advanced pelvic organ prolapse as compared to asymptomatic controls. STUDY DESIGN: Seventeen women undergoing vaginal hysterectomy were recruited for the study. Nine women with grade > or = 3 pelvic organ prolapse by the Baden-Walker grading scale were recruited. Eight subjects without pelvic organ prolapse or urinary incontinence undergoing hysterectomy for other indications were recruited as asymptomatic controls. A 1-cm portion of the bilateral distal uterosacral ligaments was excised and immediately frozen at -80 degrees C. Total RNA was extracted, quantified and subjected to reverse transcription for cDNA synthesis. beta-Actin was used as the reference for the semiquantitative analysis. Known volumes of the polymerase chain reaction (PCR) products for each reaction were electrophoresed in agarose gels stained with ethidium bromide and photographed with a digital camera. The optical density for each sample was measured by using computerized image analysis software. The relative abundance of each specific message was calculated as the ratio of PCR product for LOX or TGF beta2 divided by the amount of PCR product for beta-actin from the same sample. RESULTS: The mean age of the study subjects was 55.7 years (38-67) versus 47.1 for the controls (44-54). Mean parity was 4.4 for the study subjects and 2.7 for the controls. Seventy-eight percent of the study subjects were postmenopausal, and 14% of the controls postmenopausal. All postmenopausal subjects had at least 1 month of estrogen therapy prior to surgery. The mean LOX/beta-actin ratio for the study group was 0.35 as compared to 0.72 for the control group. This was statistically significant with a p value of 0.049. The mean TGF beta2/beta-actin ratio for the study group was 0.12 as compared to 0.20 for the control group. This was not statistically significant (p = 0.46). CONCLUSION: Patients with severe pelvic organ prolapse (grade > or = 3) have a significant reduction in the mRNA expression of lysyl oxidase as compared to asymptomatic controls. The mRNA expression of TGF beta2 was not statistically different between the 2 groups. These findings lend further credence to the concept of specific biochemical changes in the pelvic floor in women with pelvic organ prolapse.

Adult↗
PubMed2005

[Transvaginal treatment of anterior vaginal prolapse with collagen implant transobturator fixation].

INTRODUCTION: Prolapse is a common disease with a multifactorial aetiology that may be either isolated or associated with other pelviperineal defects. Surgical reconstruction of the infravesical anterior segment by isolated colpomyorraphy of prolapse is often disappointing with a recurrence rate of 40% according to the literature. Several procedures, consisting of strengthening of the anterior vaginal wall have been proposed. The use of prosthetic material has revolutionized the treatment of cystocele with a reduction of the recurrence rate but at the price of a poorly defined morbidity. Few published studies have assessed the use of xenogeneic tissue in the treatment of anterior vaginal prolapse. The objective of this study was to demonstrate the feasibility, morbidity and short-term results of the use of Pelvicol reticulated collagen mesh in the treatment of cystoceles. OBJECTIVE: To demonstrate the feasibility and short-term results of the transvaginal treatment of cystoceles using collagen implant transobturator (TO) fixation. Many new prosthesis-based techniques are designed to decrease recurrences after repair without prosthesis, but they are often non-standardized, with inadequate evaluation and insufficient follow-up. In contrast with synthetic material, few published studies have investigated the use of xenogeneic tissue. PATIENTS AND METHODS: Twenty-eight patients with a mean age of 70.6 years (range: 53-84) with grade 2 and 3 cystocele and a history of transvaginal prolapse repair in 7 cases, were operated by 2 operators according to an identical technique: the bladder was dissected via a transvaginal approach and a 4 x 7 cm porcine dermis collagen prosthesis was then placed underneath the bladder and fixed, at its anterolateral angles via a TO approach to the midline suburethral part by a resorbable suture. Vaginal hysterectomy was associated in 11 cases. RESULTS: The mean specific prosthesis insertion time was 25 minutes. No intraoperative complication and no serious bleeding were reported. The mean hospital stay was 3.6 days (range: 2-9). The mean follow-up was 8 months (range: 6-16). One case of mesh expulsion was observed on D15, followed by complete healing without recurrence of the cystocele. One case of slight pain of the medial aspect of the thigh was observed with a favourable secondary outcome. The postoperative anatomical results showed complete repair of the prolapse at 1 month and on review. Two cases of de novo SUI were treated by transobturator suburethral tape with a good postoperative result. CONCLUSION: The technique is feasible, simple, safe and ensures very satisfactory short-term results. Follow-up of these patients will be continued.

Aged↗
PubMed2003

Genital prolapse in women of Bhaktapur, Nepal.

Genital prolapse is one of the commonest reproductive morbidity in developing country. Common predisposing factors are multiparity, early postpartum sternous activity, advanced age and menopause. This study conducted in Bhaktapur district in five months included 1337 women aged 20 and above. The prevalence of female genital prolapse found to be 7.55%. Maximum numbers of women were having children eight and more (48.51%). Only 1.9% of women with genital prolapse were nulliparous. Home delivery is still common in Bhaktapur, 79% of women with genital prolapse had all children born at home without help. Regarding post partum activity majority of them (64.3%) told that they took rest at least one month after delivery but 26.73% started working in field in 2-3 weeks after delivery. The use of pessary is 25% among female with genital prolapse but only a few were following medical advice to change the ring. Nine women were having impacted ring in situ for years.

Adult↗
PubMed2006

[Surgical treatment of rectal prolapse].

Rectal prolapse must be distinguished from anal prolapse or mucosal prolapse since the treatment differs. The only effective treatment for rectal prolapse is surgery. The fact that rectal prolapse causes severe disability and that the morbidity of the current surgical treatment is low justifies surgery even at advanced age. Moreover, the success rate is high. Ventral rectopexy seems to be the surgical technique of choice on the grounds of the anatomical advantages (preservation of rectal innervation and lifting of the middle compartment) and the results (low recurrence rates and reduction of constipation). The laparoscopic approach is just as effective as an open procedure and results in less morbidity, quicker recovery and lower medical costs.

Age Factors↗
PubMed2006

[Etiopathogenesis of the prolapsed vaginal vault after hysterectomy].

OBJECTIVE: To determine the main etiopathogenic factors which may participate in the development of vaginal prolapse after hysterectomy. DESIGN: A retrospective study. SETTING: Department of Obstetrics and Gynecology, Medical Faculty of the Palacký University and University Hospital, Olomouc. METHODS: The analysis of relevant factors which can participate in the origin and development of vaginal prolapse was carried out on the group of 51 patients treated for vaginal prolapse after hysterectomy performed in the years 2002 to 2005. The data were retrieved retrospectively from medical documentation and appended by the information obtained from questionnaires send to the patients. RESULTS: Factors participating in the development of vaginal prolapse can be divided into 3 groups: 1. Mistakes in surgical technique and complications in the post-operative period, 2. inherited qualities of patients, and 3. impact of adverse external factors. CONCLUSIONS: Several factors are involved in the etiopathogenesis of vaginal prolapse, the most important of which are the inherited qualities of patients, incorrect surgical technique and adverse outcome in the post-operative period.

Adult↗
PubMedDate not supplied

[Arrhythmia in patients with mitral valve prolapse syndrome and the status of the sympathetic nervous system].

The study aimed at evaluating a possible relationship between the adrenergic system tone determined with the excretion of catecholamines with the urine and an incidence of the ventricular arrhythmias in patients with the mitral valve prolapse. The study included 20 patients (13 women and 7 men aged between 20 and 50 years; mean = 31.6 years) with the mitral valve prolapse syndrome diagnosed with the aid of the patients' history, physical examinations and echocardiography. Echocardiograms have shown anterior mitral leaflet prolapse in 7 patients, posterior mitral leaflet prolapse in 8 patients, and both mitral leaflets prolapse in the remaining 5 patients. Daily excretion of adrenaline and noradrenaline was measured with Van Euler and Lishajko's fluorimetric technique. Cardiac arrhythmias were determined with a 24-hour ECG monitoring and classified according to Lown. Premature ventricular contractions of class I were seen in 1 patient, of class II in 5, class III in 1, class IV in 2, and class V in 3 patients. Holter monitoring technique did not show the arrhythmias in 8 patients. Daily adrenaline and noradrenaline excretion with the urine was within the normal values (3.2-30.8 ug and 0.2-16.2 ug, respectively) in all examined patients. Daily urine noradrenaline was higher in patients with serious ventricular arrhythmias (Lown's class V) than mean values in the whole examined group.

Adrenergic Fibers↗
PubMed2006

Laparoscopic surgery for pelvic organ prolapse.

There is growing interest in laparoscopic procedures for the correction of pelvic organ prolapse. The goals of prolapse surgery are to correct symptomatic pelvic floor defects and reestablish vaginal support resulting in the maintenance or restoration of normal visceral and sexual function. A thorough understanding of pelvic floor support as well as anterior abdominal wall and intra-abdominal, pelvic, and retropubic anatomy must be ascertained before attempting laparoscopic prolapse procedures. As many of these procedures require advanced laparoscopic skills and experienced surgeons, most of the literatures are comprised of case series by expert surgeons, with many of the studies centered on sacral colpopexies. However, the principles of laparoscopic prolapse surgery are based on open procedures and the only difference in the technique should be related to the route of operation; therefore, the efficacy of laparoscopic prolapse procedures should theoretically be comparable to their open abdominal counterparts.

Female↗
PubMed1990

Orthostatic hypotension, catecholamines, and alpha-adrenergic receptors in mitral valve prolapse.

The reported association of mitral valve prolapse with autonomic dysfunction and neuroendocrine abnormalities is derived from studies of patients selected because of symptoms or specifically referred for investigation. To determine whether such associations occur in nonreferred and unselected women with mitral valve prolapse, we measured blood pressure, heart rate, and norepinephrine response to standing in 13 volunteers with mitral valve prolapse and in 11 control subjects. Platelet alpha-adrenergic receptor quantity and affinity on standing also were determined in all persons. No significant differences were found between the groups in any of these measurements. Although small subsets of women with mitral valve prolapse may indeed have associated neuroendocrine epiphenomena and autonomic dysfunction, it is probably incorrect to generalize these findings to the vast spectrum of those with mitral valve prolapse.

Adolescent↗
PubMed1990

Patterns of uterine prolapse in dairy cows and prognosis after treatment.

A 12-month study was undertaken in a 9-veterinarian dairy practice to determine patterns of uterine prolapse and factors associated with posttreatment survival. Of 220,000 cows in herds visited by veterinarians from the practice, 200 (0.09%) developed prolapses mostly (155/169 with data) in the first 24 hours after calving. Most cows (130/200) had prolapses during fall and winter months, and assistance was required in 47 of 200 calvings that resulted in prolapses. Treatment of affected cows (n = 196) consisted of cleansing and replacement of the uterus, insertion of perivulvar retention sutures, local and systemic administration of antibiotics, and parenteral administration of dexamethasone and oxytocin. Calcium was administered to cows with milk fever (n = 117) and to multiparous cows without milk fever attended by veterinarian 9 (n = 8). Crude recovery rate after 2 weeks was 72.4%, but recovery was significantly better if the calf was born alive (P = 0.001), the cow was primiparous (P = 0.03), the cow did not have stage-3 milk fever (P = 0.003), or if the cow was attended by veterinarian 9 (P = 0.01). Time to treatment was not significantly associated with recovery, but affected cows were treated mostly (127/156) within 2 hours of occurrence of the prolapse. By multivariable analysis, presence of a liveborn calf, parity, and lack of stage-3 milk fever, but not attending veterinarian, were significant (P less than 0.05) prognostic indicators of 2-week survival.

Animals↗
PubMed1990

Mitral valve prolapse: associations with symptoms and anxiety.

Mitral valve prolapse has been studied extensively in the adult population, but less is known about it in children. Therefore, 813 children between 9 and 14 years of age were examined by a team of cardiologists and technicians. The children also responded to a questionnaire concerning the presence of symptoms and the What I Think and Feel anxiety instrument. The prevalence of mitral valve prolapse using auscultatory criteria was 4.2% (6.2% for girls, 2.3% for boys). Of those with mitral valve prolapse, 85% had a solitary click, 9% had a click and systolic murmur, and 6% had multiple clicks. Children with auscultatory mitral valve prolapse were less likely to have symptoms than those free of cardiac abnormalities. No difference in average anxiety scores was detected between the two groups. It is concluded that auscultatory mitral valve prolapse is common in children and not accompanied by an increased likelihood of symptoms or anxiety.

Adolescent↗