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PubMedDate not supplied

An effective technique to correct anterior mitral leaflet prolapse.

Up to one-third of the patients with degenerative mitral valve disease and severe mitral regurgitation have anterior mitral valve prolapse due to chordal rupture or elongation. Surgical treatment of such a condition is often technically demanding and not infrequently associated with suboptimal results. Techniques used to treat anterior leaflet prolapse include chordal transfer, chordal shortening, artificial chordae, and anterior leaflet resection or plication. Each of these strategies has potential shortcomings, and there is considerable controversy concerning the durability of anterior leaflet prolapse repairs using these techniques. The "edge-to-edge" technique, a simple and effective method of correcting anterior mitral leaflet prolapse is described.

Chordae Tendineae↗
PubMed2000

Nonsurgical management of genital prolapse. A review and recommendations for clinical practice.

The prevalence of genital prolapse increases with age. Because more women are living longer, genital prolapse will become even more common in our daily practices. Currently this complication is treated surgically, and there is minimal information about nonsurgical treatments. The National Library of Medicine was electronically searched for current information about the nonsurgical treatment of genital prolapse. This article summarizes the anatomic basis, the standard nomenclature, common symptoms and nonsurgical treatment of prolapse. Pessaries offer an alternative, even temporarily, to surgical therapy. Some women use a pessary on a long-term basis. There is no evidence in the literature that monthly follow-up improves outcome. Once fitted satisfactorily, women who wear pessaries need to be evaluated every three to six months.

Female↗
PubMedDate not supplied

Clinical and echocardiographic assessment of Nigerian patients seen at the Lagos University Teaching Hospital with features of mitral valve prolapse.

In a 3-year prospective echocardiographic study of patients with clinical features of mitral valve prolapse who presented to the cardiology clinic of the medical out patients clinic of the Lagos University Teaching Hospital comprising of sixty-two patients. The most common complaints found were vague chest discomfort (42%) and chest pain. (28%) Their mean body mass index was 20.8 +/- 5.56 Kg/m2. The most common auscultatory sign was apical clicks (8%). Hypertension (12%) was the most common clinical association while the anterior leaflet (87%) was more affected. Mitral regurgitation was present in 35.7% of cases, which were mostly mild in severity (93%). There were statistical differences in the chamber and wall dimension measurements of those with isolated mitral valve prolapse when compared with those associated with other clinical conditions. (p < 0.05). Subjects with isolated mitral valve prolapse were found to have significant differences in the echocardiographic measurements when compared with those with coexisting diseases suggesting that mitral valve prolapse is a relatively benign condition except coexisting with other conditions like hypertension, valvular defects and obesity. These associated conditions tended to increase cardiac risk.

Adolescent↗
PubMed2001

"Natural histories" of mitral valve prolapse. Influence of patient selection on cardiovascular event rates.

BACKGROUND: In previous studies the reported incidence of cardiovascular events among mitral valve prolapse patients has differed more than 10 fold. We endeavored to determine the relation between the clinical features and mode of ascertainment of mitral valve prolapse and the resulting event rate. METHODS: Between January 1979 and August 1996, 275 patients (129-47% men, 146-53% women, mean age 43 +/- 19 years), were followed for a mean of 98 months after evaluation in a referral center for valvular heart disease. Comparative data were obtained from a separate, less selected population consisting of 316 patients. RESULTS: A total of 65 events occurred (2.9/100 patient-years): 46 (2.0/100 patient-years) mitral surgery, 12 cardiac deaths (0.5/100 patient-years), 6 neurologic ischemia (0.26/100 patient-years), and 1 infective endocarditis (0.04/100 patient-years). The overall event rate varied significantly according to demographic, clinical and echocardiographic variables (all p < 0.0001). It was higher among males (odds ratio-OR 2.1), subjects > or = 45 years of age (OR 14.7), those with a holosystolic murmur (OR 25.9), an enlarged left ventricle (OR 13.5) or left atrium (OR 34.9) and those with 3-4+ mitral regurgitation at color Doppler echocardiography (OR 40.0). It was lower in those with an audible mid-systolic click (OR 0.05). These ORs closely resembled those we reported previously in a less selected population. At multivariate analysis, male gender (p = 0.013), severe Doppler mitral regurgitation (p = 0.0048), and left atrial enlargement (p = 0.046) were all independent predictors of events. CONCLUSIONS: In a population of mitral valve prolapse patients, including many with significant mitral regurgitation at baseline, we identified similar predictors of events but an overall event rate nearly 3 times higher than that we previously reported for relatively unselected patients or family members in New York City (1/100 patient-years). Therefore, the impact of patient selection on the prevalence of mitral regurgitation, older age and male gender strongly affects the adversity of the "natural history" of mitral valve prolapse.

Adolescent↗
PubMedDate not supplied

[Use of modified irrigoradioscopy in the diagnosis of external and internal rectal prolapse].

The paper gives colonic X-ray findings in 39 patients with rectal prolapse. Of them, 20 and 19 patients were found to have internal and external rectal prolapse, respectively. Studies were conducted by the modified irrigoscopy developed by the State Coloproctology Research Center, Ministry of Health of the Russian Federation, to explore the anatomic and functional status of the rectum and the fundus of the pelvis in patients with impaired defecation. The X-ray sign of circular invagination that had been detected by the authors allowed them to make the diagnosis of internal rectal prolapse with the greatest assurance. The modified irrigoscopy in combination with oral enterography for external rectal prolapse could show associated changes, including enterocele and sigmocele.

Adult↗
PubMed2001

Posterior vaginal wall prolapse: transvaginal repair of pelvic floor relaxation, rectocele, and perineal laxity.

PURPOSE: Posterior vaginal wall laxity is one manifestation of pelvic organ prolapse in the female. Recognition and repair of the inherent anatomical defects present in this condition are essential in order to ensure a satisfactory surgical result. METHODS AND MATERIALS: A successful operation for posterior vaginal wall prolapse will often involve repair of three discreet abnormalities in support of the posterior vaginal wall, including the pelvic floor, posterior vaginal wall fascia, and perineal musculature. An overaggressive repair is to be assiduously avoided as this can lead to excessive narrowing of the vaginal canal and considerable postoperative symptoms including dyspareunia. RESULTS: Durable restoration of anatomical support can be achieved in >80% of cases. Functional results in symptomatic patients undergoing posterior vaginal wall prolapse repair do not appear to be as successful in some areas. CONCLUSIONS: Successful surgical repair of posterior vaginal wall prolapse requires a thorough understanding of the anatomy and pathophysiology involved in this condition. A careful anatomical dissection and reconstruction will result in successful anatomical repair in the majority of patients with minimal morbidity.

Female↗
PubMed2001

Fetal survival after umbilical cord prolapse for more than three days. A case report.

BACKGROUND: Umbilical cord prolapse is an uncommon obstetric emergency. CASE: A 28-year-old woman, gravida 1, para 0, presented at 23 2/7 weeks' gestation with vaginal leakage of fluid. She was diagnosed with umbilical cord prolapse. Due to the fetus's extreme prematurity, she was managed expectantly. On hospital day 4, we documented severe variable decelerations. After extensive counseling, the patient and her husband decided to deliver by cesarean section. The infant, a 505-g female, spent 54 days in the neonatal intensive care unit. At the eight-month follow-up examination, she was neurologically intact, with no long-term complications secondary to the prolapsed cord. CONCLUSION: To the authors' knowledge, this case entailed the longest reported interval from diagnosis of umbilical cord prolapse to delivery.

Adult↗
PubMed2002

Steroid hormone metabolism in women with pelvic organ prolapse.

OBJECTIVE: To identify whether endogenous steroid hormone metabolism in women with pelvic organ prolapse (POP) is different from that in normal women and the relationship between endogenous steroid hormone metabolites and POP stage. STUDY DESIGN: Twenty postmenopausal women who were clinically diagnosed as having POP and 20 volunteer postmenopausal women without prolapse were included in the study. We compared the urinary profiles of endogenous steroids between the two groups and investigated the relationship between urinary profiles of endogenous steroids and degree of prolapse. Urinary profiles of endogenous steroids were assayed by gas chromatography/mass spectrometry. RESULTS: The ages of the patients and control group were 64.6 +/- 6.5 and 63.5 +/- 3.9 years, and the body mass index was 23.96 +/- 3.14 and 24.11 +/- 2.73 kg/m2 in patients and normal subjects, respectively. The number of patients were 4 at stage I, 4 at stage II, 6 at stage III and 6 at stage IV. 5-Androstene-3 beta,16 beta,17 beta-triol (5-AT), 11 beta-hydroxy an and 17 beta-estradiol were significantly increased in the POP group as compared with the control group (0.76 +/- 0.67 vs. 0.06 +/- 0.03 mumol/g creatinine, P = .002, 1.16 +/- 0.83 vs. 0.65 +/- 0.23 mumol/g creatinine, P = .04; and 15.08 +/- 9.81 vs. 8.53 +/- 6.19 mumol/g creatinine, P = .04). However, tetrahydrocortisone (THE) was significantly increased in the control group as compared with the patient group (9.80 +/- 6.21 vs. 5.22 +/- 4.89 mumol/g creatinine, P = .04). Androgen metabolites 5-AT and THE significantly correlated with the pelvic organ prolapse quantitation (POP-Q) stage (R = .418; P = .027; R = .46, P = .016). Among the estrogen metabolites, 17 beta-estradiol correlated with POP-Q stage, but not significantly so (R = .38, P = .05), and the 17 beta-estradiol/estrone ratio weakly correlated with stage (R = .14, P = .49). CONCLUSION: The metabolites of endogenous steroid hormones could be contributing factors in the pathogenesis of POP.

Aged↗
PubMed2002

Vaginal hysterectomy allied with Kelly-Kennedy surgery and perineal repair for the treatment of patients with a prolapsed uterus and urinary stress incontinence.

PURPOSE: To evaluate patients with uterine prolapse, before and after surgical treatment, using urodynamic and bladder neck ultrasound. MATERIAL AND METHODS: 33 postmenopausal patients with uterine prolapse were submitted to vaginal hysterectomy (Mayo-Ward technique) allied with Kelly-Kennedy surgery and perineal repair. The women were divided into three groups depending on the degree of prolapse. A urodynamic examination was performed before, after 30 days and in the third month after the operation. A bladder neck ultrasound was performed before and in the third month after the operation. RESULTS: In 23 women who lost urine preoperatively, 14 continued to show objective loss 90 days after the surgery. Ultrasound identified a significant elevation in the bladder neck during rest in groups I and II, but not in group III. There was a significant reduction in its mobility in all three groups. CONCLUSION: Kelly-Kennedy surgery does not have any indication, even in patients with urinary stress incontinence and a prolapsed uterus who are submitted to vaginal hysterectomy.

Female↗
PubMed2002

Pupil block glaucoma from traumatic vitreous prolapse in a patient with posterior chamber lens implantation.

BACKGROUND: Angle closure secondary to pupil block is an entity known to occur in aphakic and pseudophakic patients. In aphakic patients, typically the cause of the pupil block is vitreous prolapse (aphakic pupil block). In pseudophakic patients, the typical cause of the pupil block is an anterior chamber lens implant, often in the absence of an iridectomy (pseudophakic pupil block). Rarely, a hybrid of these two conditions can occur, in which vitreous prolapse causes a pupil block in a pseudophakic patient with a posterior chamber lens implant. METHODS: The case presented is that of an elderly pseudophakic man with a posterior chamber lens implant who experienced ocular trauma, and who subsequently also experienced a ruptured posterior capsule with resultant vitreous prolapse and pupil block angle closure. Key diagnostic features are presented, as well as patient-specific management for this uncommon condition. CONCLUSIONS: While diagnosis and management of acute primary angle closure are well-known and reported, acute secondary angle closure is not as well reported. It is imperative to understand the mechanism of angle closure, as this properly delineates the management plan. Use of management plans appropriate to acute primary angle closure with pupil block (the use of miotics) could potentially have disastrous consequences in cases of secondary angle closure from vitreous prolapse.

Aged↗
PubMed2002

[Management of urogenital prolapse in the maternity service of the Tunis military hospital. 82 cases].

This survey has for goal to specify the epidemiological and of the prolapse of our patient, as well as our therapeutic attitude. It is about a retrospective survey that concerned 82 cases of prolapse, structural on a period of 5 years. The average of age of our patient is of 59 years. 73.17% of women are multiparous. 78% of women gave birth less once at home. The main motive of consultation is the vaginal ball sensation, in agreement with the total character of the prolapse that is the third degree in 46.34% of cases. The urinary incontinence is associated to the prolapse in 50% of cases. We achieved a vaginal surgery in 82.93 of cases. The hysterectomy has been achieved at 86.76% of operated then by vaginal surgery whereas for operated them by abdominal surgery, the uterus is preserved in the half of cases.

Adult↗
PubMed2003

Prevalence and risk factors of genital prolapse. A multicenter study.

OBJECTIVE: The objective of this paper is to describe the prevalence of genital prolapse and its risk factors in semi urban and rural communities. We ultimately hope to heighten the attention of providers of care and program managers to the high prevalence of genital prolapse despite the presumed improved access to care, availability of well-trained staff and high rates of hospital deliveries. METHODS: This study was carried out in Giza, Egypt and Ein El-Basha, Jordan in 1997. Presence or absence of genital prolapse was assessed using well-trained physicians who performed full clinical assessment including vaginal examination. RESULTS: The study results showed that the prevalence in Egypt was 56.3% and in Jordan 34.1%; that age and parity remain the most predictive factors for the prevalence of prolapse despite controlling other factors; and that women suffer from accompanying symptoms including feeling of bulge, backaches, vaginal discharge, post coital discomfort and bleeding. CONCLUSION: We believe that women do not have to suffer from these morbid conditions when known preventive interventions exist. Application of standards of care along with designed health education programs are expected to reduce women's suffering. Cost effectiveness studies that show the price tag of surgical intervention in comparison to preventive activities are badly needed.

Adult↗
PubMed2003

[Biomechanics of stress distribution and resistance of biological tissues: why use prostheses for the treatment of genital prolapse?].

BACKGROUND: Solidity and elasticity are the two main biomechanical properties of pelvic tissues involved in surgical cure of genital prolapse-prevertebral, pectinate, and sacrospinal ligaments, tendinous arcs of the pelvic fascia, vaginal tissue. We report data in the literature and personal studies concerning these autologous biological tissues. MATERIAL AND METHODS: The resistance of pelvic tissues was tested on 29 cadavers. Measurements were also made on two 2-cm samples of vaginal tissue obtained during vaginal route surgery for prolapse cure in 20 menopaused women. Stress tests were conducted to determine resistance and level of rupture. RESULTS: There was a wide variability in ligament resistance, ranging from a minimum of 22 Newtons to a maximum to the order of 200 Newtons. Results varied greatly from one woman to another and also between the two sides in the same woman. The prevertebral ligament exhibited the greatest resistance. The pectinate ligament was significantly more resistant than the sacrospinal ligaments and the tendinous arcs of the pelvic fascia. There was a significant relationship between the subjective assessment of ligament quality and objective measurements of resistance. For vaginal tissues, resistance varied greatly from 12 Newtons to a maximum to the order of 76 Newtons. Flexion values ranged from 14 to 130 Newtons. CONCLUSION: Our findings illustrate pelvic tissue failure observed in patients with genital prolapse. Individual maximal resistance of the pelvic ligaments is vary variable, between ligaments and between subjects, and even between sides in a given subject. Pelvic ligaments used for cure of genital prolapse are moderately resistant with wide interindividual variability. The mechanical properties of vaginal tissue are also very variable, illustrating why these tissues may exhibit a certain resistance against dissociation when exposed to loading but much less resistance when exposed to traction by a surgical suture. These findings suggest a revision of classical surgical procedures.

Age Factors↗
PubMedDate not supplied

[Rectal prolapse. Functional results after the Orr-Loygue's rectopexy technique].

The aims of surgery in rectal prolapse are various: reducing the prolapse, preventing relapse, clearing up incontinence and avoiding constipation. Among several technical options available, anterior rectopexy would appear to be the most suitable for achieving these aims. A retrospective clinical study was conducted in 32 patients operated on from January 1996 to June 1999. For patient recruitment, the preoperative examinations were clinical evaluation, barium enema, anorectal manometry, and urodynamic tests. Surgical procedures were Orr-Loygue rectopexy in 29 cases and Ripstein rectopexy in 3 cases. A sigmoidectomy was also performed in 9 cases and a Burch cystopexy in 4 cases. Early results are available for all patients; only 29 have been evaluated after a mean follow-up of 47 months (range: 30-72). Rectal tenesmus, faecal incontinence and urinary incontinence improved in all cases. Constipation cleared up in 9 cases after a complementary sigmoidectomy; in 15 of the remaining 20 patients constipation persisted or developed. Indications for surgery for rectal prolapse must be considered with caution. The good results of anterior rectopexy depend on correct surgical technique and prevention of septic and pelvic complications. Sigmoidectomy does not increase the morbility rate. A planned colic resection in patients with delayed transit would prevent postoperative constipation. The good results are stable even over long-term follow-up periods. This procedure is also effective for the treatment of genital prolapses.

Digestive System Surgical Procedures↗
PubMedDate not supplied

[Coexistence of von Willebrand's disease with mitral valve prolapse].

The authors present the case of mitral valve prolapse. In a young woman with three-year history of systematically treated epilepsia mitral valve prolapse with a spurious string within left ventricle has been diagnosed echocardiographically in coincidence with the symptoms of haemorrhagic diathesis of von Willebrand type in form of haemoptysis and or/massive haemorrhages in mouth occasionally being preceded by heart rhythm disturbances. No local changes have been observed in otorhinolaryngologic examination, bronchoscopy and gastroscopy. Possible mutual dependence of 3 above stated abnormalities is being discussed. It is not excluded, that mitral prolapse may constitute the primary entity and epilepsia is of secondary character as a result of cerebral ischaemic incidents or of cerebral embolism. It is also a matter of discussion to what extent abrupt haemodynamic disturbances connected with critical fall of systemic blood pressure due to mitral prolapse may influence the haemorrhagic episodes.

Adult↗
PubMed1992

Laparoscopically assisted anterior resection for rectal prolapse.

We report for the first time the treatment of rectal prolapse by laparoscopically assisted anterior resection. A 52-year-old woman, institutionalized for the last 10 years after diffuse cerebral injury secondary to toxic shock syndrome, developed rectal prolapse. A long life span is anticipated for this otherwise healthy middle-aged woman. Anterior resection was selected as treatment because of the low, long-term rates of recurrence of rectal prolapse. Approximately 2 1/2 ft of sigmoid colon and proximal rectum were resected. The anastomosis was constructed using a double-stapling technique. After surgery, the patient experienced virtually no pain and received only a single injection of pain medicine in the postoperative period. She was started on clear liquids on the first postoperative day and a regular diet on the second. She passed flatus on postoperative day 2 and stool on day 5. She was discharged 7 days after the operation. We believe that laparoscopically assisted anterior resection offers a promising new option for the treatment of rectal prolapse.

Female↗
PubMedDate not supplied

[Programmed atrial and ventricular stimulation in patients with mitral valve prolapse--a personal experience].

Electrophysiological tests were performed in 60 patients aged between 18 and 63 years (mean age 38 years), and divided into two groups: with mitral valve leaves prolapse syndrome, and without this abnormality, in whom no other heart disease was diagnosed. Refraction of the right atrium, atrio-ventricular node, and right ventricle was evaluated together with cardiac response to different types of electrostimulation. A supraventricular dysrhythmia (most frequently atrial fibrillation) has been produced in 17 patients (42.5%) with mitral valve leaves prolapse syndrome whereas in the control group the same was produced in 2 patients (10%). Programmed stimulation of the ventricles did not produce ventricular tachycardia in none patient of both groups. Multiple ventricular beats have been produced in 3 patients with mitral valve prolapse syndrome and pairs of ventricular beats in other 3 patients of this group. Results suggest that "arrhythmogenic tendency", especially supraventricular dysrhythmia is more frequent in patients with mitral valve prolapse syndrome than in the general population.

Adolescent↗
PubMedDate not supplied

Prevalence of mitral valve prolapse in healthy adult Nigerians as diagnosed by echocardiography.

Fifty (male = 24; female = 26; age 49.33 +/- 12.16) presumably healthy adult Nigerians were prospectively examined for the presence of mitral valve prolapse (MVP). We performed clinical, electrocardiographic (ECG), M-mode echocardiographic (M-mode echo) and two-dimensional echocardiographic (2-D echo) examinations on these subjects. 2-D echos were obtained from parasternal and apical acoustic windows. Parasternal long axis view obtained when the transducer was perpendicular to the chest wall with both mitral valve leaflets and left atrium recorded was considered optimal for studying mitral valve systolic motion. MVP was defined as late or holosystolic bowing of mitral valve leaflet at least 2 mm or 3 mm, respectively, below the C-D line at M-mode echo; or, marked systolic extension of one or both mitral valve leaflets cephalad to the plane of mitral annulus into the left atrium. No subject had classical features of Marfan's Syndrome. Of the four subjects with cardiac symptoms, only one had diagnostic MVP. Three subjects had mid-to late systolic click following valsalva manouver. Seven subjects had apical late systolic murmur none of which was louder than grade II/VI. Four of them had combined anterior and posterior leaflet prolapse and one had posterior leaflet prolapse compatible with diagnostic MVP, thus resulting in 10% prevalence rate of MVP in the study population. Two other subjects with late systolic murmur had no echocardiographic evidence of MVP. Three subjects with non-diagnostic mild-to moderate prolapse of the anterior leaflet alone on 2-D echo had no clinical murmur even though two of them complained of palpitations. Seven otherwise normal subjects had holosystolic bowing of mitral valve leaflets on M-mode echo but not on 2-D echo and were thus classified into non-diagnostic MVP group. No subject with MVP had serious arrhythmias on resting ECG. These results indicate that the prevalence of MVP in presumably healthy adult Nigerians was 10%. The use of M-mode echo resulted in over-diagnosis, whereas 2-D echo was more accurate in identifying true anatomical and structural abnormalities of the mitral valve.

Adult↗