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PubMed1983

[Phase analysis of mitral regurgitation in mitral valve prolapse: comparison of pulsed Doppler echocardiography with phonocardiography].

The clinical implication of the timing of mitral regurgitation (MR) in mitral valve prolapse (MVP) was investigated by comparison of the phonocardiographic patterns of the regurgitant murmur with either prolapsing phase of the mitral valve determined by two-dimensional echocardiography (TDE) or regurgitant flow patterns by pulsed Doppler echocardiography (PDE). A total of 23 patients (pts) with MVP was classified into five subsets on the basis of the phonocardiographic findings: six pts with a pansystolic murmur, seven with a late systolic murmur, two with an early systolic murmur, three with only a click(s) and five with a angiotensin II-induced regurgitant murmur (provocative MR). A comparative study between the regurgitant murmur and regurgitant flow patterns was also made in 10 pts with MR due to other etiology (four pts of rheumatic MR, three of ruptured chordae tendineae and three of papillary muscle dysfunction). MR was detected at or just above the mitral orifice using a combined system of the PDE and TDE from a transcutaneous approach. The results obtained were as follows: Phase of MR detected by PDE coincided well in timing with a regurgitant murmur recorded on the phonocardiogram (PCG) except one patient. In four of five pts with provocative MR, abnormal Doppler signals indicating MR were detected even at rest and these coincided temporally with a newly developed regurgitant murmur by provocation. Phase of MR detected by PDE was not synchronous with prolapse of the mitral leaflets examined by TDE in five out of 23 pts, suggesting that MR does not necessarily occur in accordance with mitral prolapse. Regurgitant flow patterns examined by PDE in 30 pts including 10 pts of MR due to other etiology were either a widely dispersed dot pattern or a narrow banded reverse flow pattern. Pts with a loud systolic regurgitant murmur (Levine 3/6 or greater) tended to show a widely dispersed dot pattern, and pts with a soft systolic regurgitant murmur (less than Levine 2/6) showed a narrow banded reverse flow pattern. In conclusion, PDE seems to be more sensitive than PCG for the detection of MR in MVP, and PDE may serve to the qualitative as well as quantitative evaluation of MR in MVP.

Adolescent↗

PubMed1984

Transsacral approach to repair of rectal prolapse in children.

Rectal prolapse is not uncommon in the pediatric age group. Occurring more frequently in boys than girls and most often during the period of toilet training, the condition is usually self-limited. Treatment typically consists of nonoperative measures. There are patients, however, in whom operative intervention becomes necessary. Operative procedures described are based largely on adult experience and the most common repairs involve the use of a foreign body (Ripstein procedure) or colonic resection. These procedures are of considerable magnitude and may be attended by significant morbidity. As a result, there is reluctance to apply these techniques in children. There exists, then, a place for an efficacious method of repair for large prolapses that incurs minimal morbidity. This report recounts our experience with the treatment of four children with rectal prolapse using a transsacral rectopexy. The results indicate minimal perioperative morbidity, discharge within a few days, with the mechanisms of fecal continence being preserved. The longest follow-up is 17 years with a mean follow-up of 9 years. The overall treatment of rectal prolapse in children is reviewed with specific emphasis upon the indications for and technique of the transsacral approach.

Child↗

PubMed1982

[Two dimensional echocardiographic diagnosis of mitral valve prolapse syndrome in presumably healthy young students].

We studied the prevalence of mitral valve prolapse (MVP) in presumably healthy young students using two-dimensional echocardiography and compared their clinical pictures with those of hospital patients with MVP. In 265 students undergoing routine physical examination (228 males and 37 females, aged from 18 to 25 years), 29 (11%) were diagnosed as having MVP. There was no sex difference (11% for males and 8% for females). Anterior leaflet prolapse was seen in 26 cases, and anterior and posterior leaflets prolapse was in 3 cases. Twenty-four of the 29 MVP students revealed neither midsystolic click, late systolic murmur nor holosystolic murmur on phonocardiograms (PCG). These 24 students had no cardiac symptoms and the incidence of electrocardiographic (ECG) abnormalities, such as arrhythmias and ST-T changes, was similar to that of students without MVP (4/24 vs 50/236). In contrast, of 54 patients (32 males and 22 females, aged from 15 to 25 years) who were diagnosed as having MVP in the hospital, 28 patients (52%) had no PCG abnormalities. The anterior leaflet was predominantly involved in 42 patients and both anterior and posterior leaflets in 12 patients. These 28 patients visited the hospital because of cardiac symptoms; dyspnea on exertion (3 patients), palpitation (2 patients) or atypical chest pain (7 patients), or abnormal physical examination (11 patients). ECG abnormalities were noticed in 15 of 28 patients (54%). The prevalence of cardiac symptoms and ECG abnormalities were similar to those in 26 patients with PCG evidence of MVP. It was concluded that the prevalence of MVP in young healthy students is 11% and the anterior leaflet is predominantly involved. Most cases were asymptomatic and had no PCG or ECG abnormalities. In contrast, age-matched MVP patients, diagnosed in the hospital with the same two-dimensional echocardiographic criteria, demonstrated similar predominancy of the anterior leaflet prolapse, but had more cardiac symptoms and ECG abnormalities, irrespective of the presence or absence of PCG findings.

Adolescent↗

PubMed1982

[Diagnosis of idiopathic mitral valve prolapse by two-dimensional echocardiography: evaluation of its clinical significance in the prospective follow-up study].

One hundred and five cases with idiopathic mitral valve prolapse (MVP) diagnosed by two-dimensional (2-D) echocardiography were classified into 5 groups according to the grade of prolapse (Fig. 1), 47 cases of which were followed prospectively for average 2.9 years. 1) Most of the cases with MVP of grade 3 or less showed normal left ventricular diastolic dimension (LVDd) and left atrial dimension (LAD) throughout the follow-up period, while the majority of the cases with MVP of grade 4 revealed increased LVDd and LAD. Thus the mitral regurgitation due to MVP seemed to be insignificant in cases of grade 3 or less, while it is significant in cases of grade 4. 2) During the follow-up period cases of grade 1, 2 and 3 showed the transition of the grade of prolapse each other. On the other hand, most of the cases of grade 4 at the initial examination did not show the change in its grade of prolapse. 3) Fifty-eight cases (55.2%) had symptoms such as chest pain, palpitation and dizziness, and various electrocardiographic abnormalities such as ST and T wave changes, prolongation of QT interval and arrhythmias were also frequently observed. However, the incidence of these symptoms and signs was independent from the grade of MVP. It was concluded that MVP with grade 4 or more is hemodynamically significant, while it was insignificant in cases of grade 3 or less. Therefore, those with symptoms and/or electrocardiographic abnormalities in cases with MVP of grade 3 or less will not require any treatment but only a follow-up observation.

Adult↗

PubMed1981

Mitral valve prolapse: clinical features, laboratory abnormalities, complications, and prognosis.

Mitral valve prolapse is being diagnosed with increasing frequency now that its characteristic clinical features, including auscultatory abnormalities, and echocardiographic manifestations have been identified. This article describes the valvular pathology, physical findings, and electrocardiographic, echocardiographic, and angiographic features which may be observed in patients with mitral valve prolapse. Potential complications attributable to mitral valve prolapse are discussed and its prognosis is addressed. While mitral valve prolapse may be complicated by serious ventricular arrhythmias, sudden death, endocarditis, or sudden or progressive mitral regurgitation requiring valve replacement, it is frequently asymptomatic and is usually associated with a relatively benign prognosis.

Angiography↗

PubMed1995

Transvaginal sacrospinous ligament fixation for treatment of vaginal prolapse.

PURPOSE: We performed sacrospinous ligament fixation for the treatment of vaginal apical prolapse in a urological practice. MATERIALS AND METHODS: A total of 24 patients underwent sacrospinous ligament fixation for the treatment of vaginal prolapse. In 13 patients another procedure was done concomitantly through the same exposure for treatment of stress urinary incontinence and/or pelvic relaxation. RESULTS: At a mean followup of 13.8 months (range 4 to 26) 18 of 24 patients had complete resolution of vaginal prolapse, while 5 had a clinically significant recurrence. Two patients underwent repeat sacrospinous ligament fixation with a good result, colpocleisis was performed in 1 and 2 are being managed conservatively. One patient had a cystocele postoperatively. All recurrences were within 6 months. Complications were uncommon. One patient suffered a small rectal laceration that was repaired primarily and she had no further clinical sequelae. If the 2 patients who underwent repeat sacrospinous ligament fixation are considered, the overall success rate was 87.5% (21 of 24). CONCLUSIONS: Sacrospinous ligament vaginal fixation can be used safely and effectively to treat vaginal prolapse in urological practice, either alone or combined with another transvaginal procedure for the treatment of stress urinary incontinence.

Aged↗

PubMed1995

Recurrent pelvic support defects after sacrospinous ligament fixation for vaginal vault prolapse.

BACKGROUND: Multiple studies have shown sacrospinous ligament fixation to be highly effective therapy for vaginal vault prolapse. Several authors have suggested that the marked vaginal retroversion subsequent to sacrospinous ligament fixation may predispose to recurrent pelvic support defects in the anterior fascial segment, resulting in cystocele or urethrocele, or both. STUDY DESIGN: Thirty-six patients, 46 to 86 years of age, were examined at six weeks postoperatively and at long-term follow-up evaluation 15 to 79 months (median of 42 months) after sacrospinous ligament fixation and repair of associated pelvic support defects. The examinations, by an unbiased examiner, were done to identify and grade recurrent pelvic support defects. RESULTS: At the six week postoperative visit, one patient had a small enterocele, and none of the patients demonstrated vaginal vault prolapse. At the long-term follow-up visit, 33 (92 percent) of the patients had cystoceles, six (17 percent) had rectoceles, two (6 percent) had enteroceles, and three (8 percent) demonstrated recurrent vaginal vault prolapse. Most cystoceles were small and asymptomatic. CONCLUSIONS: A high rate of success in the treatment of prolapse of the upper vagina by sacrospinous ligament fixation was observed. Pelvic support defects at long-term follow-up evaluation occurred more commonly in the anterior fascial segment. Retroversion and fixation of the upper vagina predisposes the anterior fascial segment to excess pressure and a higher incidence of cystocele than could be attributed to the effects of aging and menopause.

Aged↗

PubMed1994

[The surgical treatment of intestinal prolapse (prolapsus recti) in fattening swine under practice conditions].

The amputation of the prolapsed rectum of 102 pigs of a fattening unit was carried out by means of a 5-10 cm piece of a plastic hose inside and a ligation around the prolapse. The pressure necrosis due to the ligation leads to the amputation of the prolapse. The positive effect of this method on the performance of the pigs was demonstrated by comparing the 102 treated pigs with a group of pigs that were not treated and with the non-diseased control group. Additionally the influence of diarrhoea and coughing on the frequency of rectal prolapses was investigated.

Amputation, Surgical↗

PubMed1995

[Hiatal hernia associated with mitral prolapse in childhood].

Authors examined 17 cases of hiatal hernia, out of which 13 proved to have mitral valve prolapse. The diagnosis was based on auscultation, ECG and echocardiographic examination. The incidence of mitral valve prolapse (76.5%) found in this study in considerably high. Up to now no such relationship has been reported in the literature. At the moment it could not be stated that similar aetiological factors may play any role in the developmental of both hiatal hernia and mitral valve prolapse. At the same time it can not be excluded either, that the hiatal hernia and mitral valve prolapse are not a part of a connective tissue disorder. Authors plan to follow up the patients.

Adolescent↗

PubMed1995

[Surgical therapy of rectal prolapse using rectopexy and resection. Effect of resection treatment on postoperative constipation and sphincter muscle function--a follow-up study of 112 patients].

Between 1985 and 1991, 112 patients underwent posterior abdominal rectopexy (n = 59 Ivalon sponge, n = 53 Vicryl-rectopexy) for complete rectal prolapse. The follow-up period was 3 months to 9 1/2 years. 25 patients with severe constipation and rectal prolapse were treated by rectopexy combined with colectomy (left colectomy n = 18, sigmoidectomy n = 3, ileo-sigmoidostomy n = 4). Left colectomy combined with Ivalon or Vicryl-rectopexy does not seem to increase operative and postoperative morbidity but tends to diminish constipation in 84% of patients. There were no complications attributable to bowel resection or anastomosis. Following abdominal rectopexy without resection constipation was reduced 7.5% only, the bowel function was unchanged in 69% and obstipation was improved after the operation in 23%. In the group of patients without evident constipation (n = 74) treated with synchrone resection has no benefit with regard to the new occurred constipation, recurrence prolapse and continence ability. Infection around the prosthesis developed in 1.5% in the resection group, and in 2.1% in the rectopexy alone group. The prolapse recurrence rate was 2.6%. Conclusion. Resection in conjunction with abdominal rectopexy tends to diminish postoperative constipation does not seem to increase operative morbidity, and is indicated in patients with constipation only.

Adult↗

PubMed1994

Surgical management of genital prolapse in an industrial hospital.

Surgical management of 200 cases of genital prolapse was reviewed and analysed. Forty per cent cases had 3rd degree uterine prolapse, 42 per cent had 2nd degree uterine prolapse and 18 per cent had 1st degree uterine prolapse. Fothergill operation was performed in 91 cases (45.5%). Vaginal hysterectomy with pelvic floor repair was performed in 70 cases (35%) and was the choice of treatment in pre-and postmenopausal patients.

Adult↗

PubMed1994

[Etiology and therapy of rectal prolapse. Experiences with 308 cases 1956-1991].

The cause of a prolapse of the rectum is intrinsic to the organ itself. Neither paralysis of the pelvic floor sphincter complex nor a loosening of the suspending ligaments--which have never been demonstrated in situ--are causative. Determining for the development of a prolapse of the rectum is the break in calibre between the very tight pelvic colon and the wide rectal reservoir. Radiologically we can prove that it is here, where the genesis of prolapse development starts. In comparative anatomy the rectal ampulla is equivalent to the cloaca. Its stable transverse folds (rugae) are reminiscent to the transverse folds of a cloaca anlage, e.g. in the crocodile. A rectal prolapse only includes this cloaca equivalent. For this reason it is never larger than about the size of a fist. Rectosigmoid resection, by removing the calibre break, removes the cause. The involved sigmoid resection also improves the symptoms of constipation. 107 cases operated by peripheral procedures had a recurrence rate of 23.3%, whereas 202 operations removing the calibre break had recurrences in only 3.8% of the cases. Here the calibre break resection has had the best permanent results with a follow-up period up to 30 years.

Adult↗

PubMed1993

Clinical and functional results of abdominal rectopexy with absorbable mesh-graft for treatment of complete rectal prolapse.

OBJECTIVE: To report the long term results of abdominal rectopexy in patients with complete rectal prolapse. DESIGN: Ongoing prospective randomised study. SETTING: Department of Surgery, Westfälische Wilhelms-University, Münster. SUBJECTS: 47 patients with complete rectal prolapse operated on between 1982 and 1989. INTERVENTIONS: Abdominal rectopexy with absorbable mesh made of either polyglycolic acid (n = 17) or polyglactine 910 (n = 30). MAIN OUTCOME MEASURES: Postoperative complications and late results at a mean of 50.5 (range 2-102) months after operation. RESULTS: Thirteen patients (28%) developed postoperative complications, most of them minor; there was one enterocutaneous fistula. Thirty five patients (74%) were available for late follow up. There were no case of recurrent prolapse and 5 (14%) had developed mucosal prolapse. Of the 22 patients who had been incontinent before operation, 8 had become totally continent and 6 partially continent Overall continence improved in 18 (51%) of the 35 patients. Three patients who were continent before operation had become incontinent. CONCLUSION: Absorbable mesh is a suitable material for abdominal rectopexy.

Absorption↗

PubMed1993

[Relationship between volume reduction of the left ventricle and the increase of mitral valve prolapse. An experimental study in dogs].

PURPOSE: To verify whether accentuated reductions of left ventricular volume lead to mitral valve prolapse. METHODS: Seven mongrel dogs were bled through the internal jugular vein, the systolic systemic pressure being kept between 100 and 140 mmHg by means of continuous infusion of dopamine; the inferior vena cava vein, in tree other dogs, was partially obstructed for 4 to 6 seconds; epicardial echocardiography was carried out in all cases. RESULTS: Reductions of volemia were about 50% of the estimated total blood volume. Systolic internal diameter of left ventricle decreased about 25% and systolic ostial diameter, about 12.5%. Three out of seven died suddenly from arrhythmia before one has reached a significant decrease in total blood volume; one showed momentary mitral valve prolapse, during a period of hypotension; however, this prolapse disappeared completely when systemic blood pressure was restored by increasing the dopamine dosage; one dog had slight systolic displacement of the anterior cusp toward left atrium (0.5mm) and the last two showed no change; one out of 3 dogs submitted to partial constriction of inferior vena cava had systolic displacement of anterior cusp of 1mm; in one case there was an equivalent degree of displacement of the anterior cusp toward the left ventricle and in the last one no change was detected. In all dogs there was a change in the dynamics of mitral valve closure: with accentuated reduction of left ventricular volume the posterior cusp became less mobile, the anterior cusp being the principal responsible for the systolic ostial occlusion. CONCLUSION: Accentuated reduction of dog's left ventricular volume does not, necessarily, cause mitral valve prolapse but only slight displacement of the anterior cusp toward the left atrium in some animals or no displacement at all.

Animals↗

PubMed1993

[A case of traumatic hernia of diaphragm showing prolapse of liver with abnormal lobulation into pleural cavity].

A 48-year-old male was admitted to our hospital in 1988 with injury by a traffic accident, resulting in fracture of the right rib, right clavicle, and pelvic. The patient came to us again with a chief complaint of abdominal pain in May, 1991 when digestive tract gas was observed in the right pleural cavity casting a doubt of diaphragmatic hernia. Chest CT scan and liver scintigraphy disclosed prolapse of the colon into the pleural cavity together with a picture on the diaphragm being supposed as parenchyma of the liver. Operation findings showed prolapses of the colon and the omentum through the opening of diaphragm into the pleural cavity and also exhibited prolapse of hepatic parenchyma, supposedly S4, together with gallbladder into the pleural cavity. The case, which had showed no abnormality in the Chest X-ray film before the injury, was conceivably an extremely rate case of traumatic hernia with the right diaphragm showing; abnormality of hepatic lobulation accompanied by diaphragmatic rupture, and prolapse of the liver with abnormal lobulation.

Colonic Diseases↗

PubMed1993

[Rectal prolapse. Experiences with rectopexy and Delorme's operation].

During the period 1982-91, 52 patients were treated for rectal prolapse. We present the results for 25 treated with Delorme's operation and 14 with rectopexy, all of whom were observed for more than 12 months after operation. Four patients who had internal prolapse were treated with rectopexy. Eight (15%) of 52 patients had postoperative complications, including six in the Delorme group and two in the rectopexy group. A 75 year-old woman operated with rectopexy died from peritonitis. Eight patients (32%) developed recurrent prolapse after Delorme's operation. Five of these were successfully reoperated. No patients in the rectopexy group had a recurrent prolapse. Incontinence and bleeding were reduced in both groups. Despite a relatively high rate of recurrence, we consider Delorme's operation to be a good alternative, also for old debilitated patients, and to involve a minimal risk of serious complications. If recurrence occurs, reoperation can be carried out with good results.

Adult↗

PubMed1977

Transabdominal proctopexy (Ripstein procedure) for massive rectal prolapse.

Transabdominal proctopexy (Ripstein procedure) for correction of massive rectal prolapse has greatly simplified the complicated problem of managing procidentia. The operation secures the rectum into the hollow of the sacrum by a Teflon sling. This restores and maintains the normal posterior curve of the rectum and prevents intussusception with subsequent prolapse. There has been no recurrence of rectal prolapse and no mortality in 36 patients, half of whom have been followed from five to ten years. Posterior proctopexy is a simple, safe and effective operation to repair massive rectal prolapse.

Adult↗

PubMed1993

Racial comparisons and contrasts in urinary incontinence and pelvic organ prolapse.

OBJECTIVE: To compare black and white women with regard to urinary incontinence and prolapse. METHODS: Two hundred consecutive women referred for evaluation of urinary incontinence or severe prolapse, 54 of whom were black, were evaluated. Each had a comprehensive standardized evaluation. Qualitative and quantitative data were analyzed for significant differences between the groups. RESULTS: The symptoms of pure stress, pure urge, and mixed incontinence were described by 7, 56, and 37% of black subjects, respectively, compared to 31, 28, and 41% of white subjects (P = .001). The conditions of pure genuine stress incontinence (GSI), pure motor incontinence, and mixed incontinence were diagnosed in 27, 56, and 17% of black subjects, respectively, compared to 61, 28, and 11% of whites (P = .0008). Black women with mixed symptoms were significantly less likely than white women to have pure GSI (47 versus 74%; P = .05). Blacks with GSI were significantly heavier, had higher parity, more often took a diuretic, were more often diabetic, and had better passive urethral closure pressure but greater urethral axis mobility than whites. Blacks with motor incontinence were significantly younger, heavier, less likely to have had prior continence surgery or hysterectomy, and had better passive urethral closure pressure but smaller bladder capacities than whites. The prevalence of severe prolapse in this referral population was the same for blacks and whites (24 and 23%), although blacks had significantly more vaginal deliveries. No other significant racial differences were noted in the prolapse group. CONCLUSIONS: Black women with urinary incontinence have a different distribution of symptoms, different conditions causing their incontinence, and different risk profiles for these conditions than do whites. The significantly lower prevalence of pure GSI in black women compared to white women makes the clinical evaluation for GSI appreciably less accurate in the individual black patient. Until further epidemiologic information regarding incontinence in black women is available, such women should be considered candidates for more accurate, sophisticated urodynamic testing before continence surgery.

Black People↗