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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of the present study was to determine the value of circular hemorrhoidectomy (procedure for prolapse and hemorrhoids [PPH]) on the basis of data collected prospectively during the initial experience of a group of Latin American surgeons. Between 2000 and 2001, PPH was performed using a circular stapler in 177 patients who had third- and fourth-degree hemorrhoidal disease. The average age of the patients was 47.7 years (range 26 to 85 years). Anal bleeding was the most common preoperative complaint (93.2%) followed by anal pain (60.2%), anal itching (43%), and constipation (41%). Hemorrhoids were classified as third degree in 132 patients (74%) and fourth degree in 45 patients (25.4%). Skin tags were detected in 86 patients (48.8%) and rectocele in 14 patients (7.9%). Data collected included patient demographics, type of anesthesia, and specific details of the surgery such as duration of the operation, distance from the staple line to the dentate line, need for complementary hemostasis, and any unexpected occurrences. Postoperative data collected included the degree of pain, which was evaluated on the basis of the type and dosage of analgesics required, laxative consumption, and the presence of bleeding, fever, urinary retention, or hematomas. Each patient completed a written questionnaire addressing these events. Patients returned for follow-up visits on days 7, 15, 30, and 90. Responses to pain, bleeding, fever, anal continence, recurrence of hemorrhoids, and level of satisfaction were compiled. The duration of the procedure ranged from 6 minutes to 2 hours (average 23 minutes), and most operations lasted no more than 20 minutes, with the exception of one that lasted 2 hours because of intraoperative bleeding. Intraoperative problems were minor. An additional one or a few sutures were required in 58.7% of patients to achieve perfect hemostasis. In 128 patients (72.3%) the hospital stay was less than 24 hours. Same-day surgery was chosen for 37 patients (20.9%). Pain was controlled with analgesia only using one to six doses of oral dipirona in 126 patients. Five patients were readmitted to the hospital: four for control of bleeding and one for conventional hemorrhoidectomy due to an acute episode of external hemorrhoidal thrombosis. At day 30, patients rated the efficacy of the procedure in alleviating preoperative symptoms as follows: 77.5% excellent; 16% good; 5.3% average, and 1.2% poor. At 3 months postoperatively no patient had had a recurrence of hemorrhoidal prolapse, and there were no instances of stenosis or anal incontinence. Surgeons also rated the efficacy of the procedure as excellent in 75%, good in 19.8%, average in 4.7%, and poor in 0.6%. With proper selection of patients and adequate stapling technique, stapled hemorrhoidectomy may be considered safe; it is easily learned, has a satisfactory degree of pain, and is well accepted by both patients and surgeons.
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PMID:Stapled hemorrhoidectomy: initial experience of a Latin American group. 1312 62

This pilot study is the first to identify female genital schistosomiasis (FGS) in an Egyptian community setting. The year-long interdisciplinary study, in a small hamlet (ezba), combined clinical assessment with an in-depth study of the social context of reproductive health. Schistosoma haematobium ova were found in 16.7% of women in the study (21/126). Half of the women who agreed to a full gynecological examination (43 of 86) had evidence of reproductive morbidity due to schistosomiasis, either schistosome eggs in the cervix or sandy patches, tissue changes in the reproductive tract. Other reproductive tract morbidities included infections (vaginitis 40%, chronic cervicitis 75%, pelvic inflammation 9%) and prolapse (54%). FGS was associated with dysparunia, abnormal vaginal discharge, vaginal or cervical polyps, contact bleeding, vulval itching and chronic cervicitis. Community members recognized S. haematobium as a health problem, but did not believe that it affected reproductive health. Indeed, they had little awareness of reproductive health and the possible impact of reproductive morbity on women's arduous daily tasks. There was no discussion of any reproductive health issues (except infertility) between women or between spouses. The study identified a number of factors that would affect the identification and treatment of FGS, and reproductive health care in general; (1) the neglect of women's health: (2) misconceptions about reproductive health and family planning; and (3) limited access to, and use of formal health care. The paper ends with a brief discussion of the significance of our findings about FGS, strategies to increase awareness of FGS, and the need for future research.
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PMID:The social context of reproductive health in an Egyptian hamlet: a pilot study to identify female genital schistosomiasis. 1465 48

The global prevalence of genital prolapse is estimated to be 2-20% in women under age 45. In Nepal, genital prolapse appears to be widespread, but little published evidence exists to buttress this claim. This paper presents findings of two studies, one ethnographic and one clinic-based, in western Nepal. The ethnographic study involved 16 focus group discussions with 120 community members and key informants, and covered community perceptions and women's experience of prolapse and its perceived causes and consequences. The clinic-based study was conducted among 2,072 women who presented with gynaecological complaints and received a diagnosis. One in four of them had genital prolapse, of whom 95% had self-reported the prolapse. The most commonly perceived causes of prolapse were lifting heavy loads, including in the post-partum period. The adverse effects reported included difficulty urinating, abdominal pain, backache, painful intercourse, burning upon urination, white watery discharge, foul-smelling discharge, itching, and difficulty lifting, sitting, walking and standing. The results confirm prolapse as a significant public health problem in western Nepal. We strongly recommend developing systematic, rotational gynaecological clinics in rural districts, the use of a screening checklist and counselling for prevention and early management of genital prolapse by district health workers for family planning and antenatal patients.
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PMID:Listening to "felt needs": investigating genital prolapse in western Nepal. 1524 25

The objective of this study was to determine prospectively the prevalence of anal complaints amongst Nigerians attending the General Out-patient Department (GOPD) of the hospital and review the records of those admitted to the surgical service with related complications. All the 272 patients attending the GOPD of OOUTH in November, 1999 were interviewed using a structured questionnaire. Information concerning age, sex, educational status, present or past history of at least one of the following symptoms viz recurrent bleeding per rectum, anal prolapse, anal/perianal pain, pruritus ani and anal discharge were obtained. Also obtained were reason(s) for current hospital attendance and any previous medical consultation. Those with at least one of the symptoms were classified as symptomatic. The symptomatic group had rectal examination including proctoscopy. The results showed that 82/272 (30.15% ) were symptomatic. Rectal examination on these 82 patients showed that 10(3.7% of 272) had haemorrhoids, 2(0.7% ) had rectal prolapse, 0.7% had peri-anal warts; 15(5.5% ) anal tags, 10(3.7% ) chronic anal fissure, 2 (0.7% ) perianal fistulae. In 29(10.4% ), the examination was normal and in 12 the rectum was too loaded with feaces to permit proctoscopy. However, only 5/272 (1.84% ) attended the clinic for the anal complaint, while 12(4.4% ) had previously consulted a physician for same. Fear of impotence following surgery in 24 males and belief in herbal remedies in 32 patients were the main reasons for not consulting a physician. During the year 1999, out of a total of 558 admissions into our surgical service, only 4(0.6% ) were for complications related to anal complaints. This study indicated the prevalence of anal complaints in the study population of Nigerians as 30.15% , haemorrhoids constitute 3.7% and anal fissure 3.7% , contrary to low rates reported for developing countries. While this result cannot be extended to represent prevalence amongst Nigerians, it may be a pointer to what is to be expected.
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PMID:Anal complaints in Nigerians attending Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu. 1550 55

The purpose of this study was to investigate the efficacy of surgical deactivation of migraine headache trigger sites. Of 125 patients diagnosed with migraine headaches, 100 were randomly assigned to the treatment group and 25 served as controls, with 4:1 allocation. Patients in the treatment group were injected with botulinum toxin A for identification of trigger sites. Eighty-nine patients who noted improvement in their migraine headaches for 4 weeks underwent surgery. Eighty-two of the 89 patients (92 percent) in the treatment group who completed the study demonstrated at least 50 percent reduction in migraine headache frequency, duration, or intensity compared with the baseline data; 31 (35 percent) reported elimination and 51 (57 percent) experienced improvement over a mean follow-up period of 396 days. In comparison, three of 19 control patients (15.8 percent) recorded reduction in migraine headaches during the 1-year follow-up (p < 0.001), and no patients observed elimination. All variables for the treatment group improved significantly when compared with the baseline data and the control group, including the Migraine-Specific Questionnaire, the Migraine Disability Assessment score, and the Short Form-36 Health Survey. The mean annualized cost of migraine care for the treatment group (925 dollars) was reduced significantly compared with the baseline expense (7612 dollars) and the control group (5530 dollars) (p < 0.001). The mean monthly number of days lost from work for the treatment group (1.2) was reduced significantly compared with the baseline data (4.41) and the control group (4.4) (p = 0.003). The common adverse effects related to injection of botulinum toxin A included discomfort at the injection site in 27 patients after 227 injections (12 percent), temple hollowing in 19 of 82 patients (23 percent), neck weakness in 15 of 55 patients (27 percent), and eyelid ptosis in nine patients (10 percent). The common complications of surgical treatment were temporary dryness of the nose in 12 of 62 patients who underwent septum and turbinate surgery (19.4 percent), rhinorrhea in 11 (17.7 percent), intense scalp itching in seven of 80 patients who underwent forehead surgery (8.8 percent), and minor hair loss in five (6.3 percent). Surgical deactivation of migraine trigger sites can eliminate or significantly reduce migraine symptoms. Additional studies are necessary to clarify the mechanism of action and to determine the long-term results.
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PMID:Comprehensive surgical treatment of migraine headaches. 1562 23

Although stapled anopexy for second and third degree hemorrhoids has been widely used since 1998, there are limited long-term data available. We performed an analysis of a prospectively accrued data set of all patients undergoing stapled anopexy in our practice from 1998 through August 2003. Patients were specifically assessed for early and late complications and long-term reoperation rates for anorectal pathology. We performed stapled anopexy in 654 patients (296 females) during the study period. Mean operation time was 21 min (5-70 min), and the postoperative stay was 3.6 days (1-13 days). Early postoperative complications: urinary retention, 42 patients (6.4%); fecal impaction, 18 (2.8%); postoperative hemorrhage, 26 (4.0%); thrombosed external hemorrhoid, four (0.6%); and fistula/abscess, nine (1.4%). Late postoperative complications: anastomotic dehiscence, 21 patients (3.2%); persistence of prolapse in three (0.5%); submucosal anastomotic cysts in four (0.6%); thrombosed external hemorrhoid in two (0.3%); skin tags in ten (1.5%); fissure in six (0.9%); proctitis in two (0.3%); and fecal incontinence in ten (1.5%). Reoperation was required in 50 patients (7.6%). Reoperation for complications within 30 days occurred in 42 patients (6.4%) for the following reasons: bleeding (23), dehiscence (five), thrombosed external hemorrhoid (three), fecal retention (two), fistula (three), fissure (five), and anal papilla (one). Reoperation for anorectal pathology after 30 days was required in 54 patients (8.3%) and was performed for the following: dehiscence/reprolapse (17), stenosis (two), submucous cyst (two), fistula (four), fissure (six), anal papilla (four), skin tags (five), persistent anal itching (five), and miscellaneous (seven). These data represent the largest series of patients with long-term follow-up following stapled anopexy and confirm that the operation is safe in experienced hands using appropriate patient selection. The early complication rate is low and similar to rates reported for excisional hemorrhoidectomy. Importantly, the procedure is associated with a low 3.4% rate of reoperation for persistence or recurrence of hemorrhoidal prolapse with good patient selection.
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PMID:Complications and reoperations in stapled anopexy: learning by doing. 1682 69

Emergency consultations happen frequently in gynaecology and may be due to abdominal pain, itching, utero-vaginal bleeding, rape, emergency contraception, insertion of foreign bodies, prolapse and urinary tract infection. Considering pregnancy in patients with child bearing potential is essential. Vaginal bleeding may be due to atrophy, infection, carcinoma or pregnancy. In the latter it is crucial to differentiate between ectopic, pathologic or physiologic pregnancy. In postmenopausal women further investigations by the gynaecologist are mandatory to exclude malignancy. Patients who have been raped need psychological, forensic and gynaecological support. Sexually transmitted disease including HIV must be considered and prophylactic drugs should be administered. If unprotected intercourse has occurred the "morning after pill" can be considered within 72 hours after intercourse or an IUD up to five days. Prolapse occurs rarely as an acute problem but may induce urinary retention. Urinary tract infection is a common complaint and should be treated with antibiotics.
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PMID:[Emergencies in gynecology--what must I not forget?]. 1599 32

Hemorrhoid is a common anal problem in our country that is currently treated by many different methods. Three modalities were assessed in a randomized prospective trial in which 848 patients with a second-degree hemorrhoid were treated by rubber band ligation (470 patients), injection sclerotherapy (280 patients), or cryosurgery (98 patients). The effectiveness of each method was assessed clinically at 3, 6, 9, and 12 months after initial treatment, and determined by improvement in presenting symptoms. All patients complained of rectal bleeding and prolapse of the hemorrhoid on defecation, but only 69% had anal pain and 14% suffered from pruritus ani. Rubber band ligation was found to be superior to the other methods, and displayed statistical significance when compared to injection sclerotherapy and cryosurgery.
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PMID:A comparative study of different treatments of hemorrhoids. 1758 60

In 1995, Morinaga reported on a new technique in the treatment of haemorrhoids. It relies on the reduction of haemorrhoidal vascular flow by suturing haemorrhoidal arteries. The artery is located by Doppler ultrasound transducer, haemorrhoidal artery ligation (HAL). This pilot study shows initial experience with HAL in patients with internal haemorrhoidal disease. A prospective study was performed in 35 patients treated by (HAL). After a mean of 18 (range 12-24) months patients were administered a standardized questionnaire by telephone. The treatment's success was observed in 11 of 12 patients (91.5%) with pain, 28 of 33 (85%) with bleeding, 14 of 15 (93%) with Pruritus, 12 of 13 (92%) with discharge, and 17 of 21 (81%) with prolapse. Open haemorrhoidectomy was mandatory in 3 patients (8.5%) due to bleeding and prolapse. HAL is simple, painless, safe, and effective method.
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PMID:Doppler-guided haemorrhoidal arteries ligation: preliminary clinical experience. 1788 28

This light microscopic retrospective study of 798 cervical smear were done to see the pattern of cervical lesions and main presenting complaints of the women who attended the Gynae & Obstetrics department of BIRDEM hospital for medical and surgical advice. Out of these 798 smears examined light microscopically 274(34.34%) was normal, 453(54.26%) were inflammatory smear, 49(6.14%) showed Gardrenella, 9(1.13%) revealed the presence of Candida, 3(0.38%) showed Trichomonial infection, 6(0.76%) showed the presence of atypical cells (5ASCUS, 1 CIN) and 2(0.26%) were positive for malignancy, (1 adenocarcinoma, 1 squamous cell carcinoma). The mean age+/-SE of the women were 43.12+/-9.18 years, mean+/-SE age of the last child was 14.19+/-7.99 years; mean+/-SE of para was 3.5+/-7.34 pregnancies. The common presenting complains of these women Menorrhagia (17.92%), Menopausal Symptoms (17.42%), Lower Abdominal pain (15.78%), White PV discharge (15.78%), Dysmenorrhoea (7.52%), Pruritus/Itching vulva (7.14%), Prolapse (4.39%), Fibroid (2.01%), Infertility (1.13%), Post coital bleeding (0.75%) respectively. Pap's smear is reconfirmed as an established major screening tool for diagnosis of different cervical lesions.
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PMID:Light microscopic study of cervical smear in a tertiary hospital at Dhaka. 2039 13


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