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

The incidence of dystocia from ewes in nine lambing periods (1992-2000) was recorded at an obstetrical clinic. First we analysed parturition difficulties in normal pregnant sheep (group 1, n = 229). In the second group parturitions of ewes with vaginal prolapse ante partum were investigated (n = 129). In group 1 maternal causes of dystocia occurred more often than fetal ones (50% maternal, 45% fetal). In maternal parturition difficulties ringwomb was the dominating reason (64%), while abnormal presentations, position and/or posture of the lambs occurred most frequently in fetal dystocia (67%). But there was no statistical influence of age and number of parturitions in both groups. The average of the first notice of prolapsed vaginal tissue was 11 days before lambing. There was a predominance in the affection of sheep at first and second pregnancy (52%). Only 26% of the group 2 sheep had a spontaneous delivery. In 58% of the cases a dystocia was diagnosed. A preterm caesarean section had carried out in 12%, five ewes died before parturition because of septicemia (4%). Sheep suffering from vaginal prolapse ante partum showed maternal caused dystocia significant more frequently than members of group 1 (p < 0.001), with ringwomb as dominating reason (70%). The number of born lambs was significant higher in group 2 than in group 1 (p = 0.019).
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PMID:[Investigations about kind and frequency of mechanical dystocia in ewes with special regard to the vaginal prolapse ante partum]. 1217 20

Premature rupture of membranes is defined as expulsion of the amniotic liquid occurring at least 1 hour before initiation of uterine contractions and without apparent cervical changes. According to the literature, premature rupture of membranes occurs in 2-15% of all pregnancies, with an average of 10%. The etiology is considered multifactorial, and treatment remains controversial. A retrospective review was conducted to determine the occurrence of maternal or perinatal morbidity and mortality in 230 cases of premature rupture of membranes in a social security hospital in Santo Domingo, Dominican Republic, observed between 1983-88. Premature rupture occurred in 3.5% of cases according to the records. 37.4% of affected mothers were 21-25 years old and 69.6% were 21.30. 62.9% of the women were nulliparas. 2.2% had had no prenatal care, 59.1% had insufficient prenatal care, defined as 1-5 visits and only 36.1% had 6 or more visits. 81.3% of ruptures occurred at 37-42 weeks of gestation. In 64.8% of cases the pregnancy was terminated within 1-24 hours and 35.2% were considered prolonged. Prematurity and low birth weight was the most common perinatal disorders, affecting 10.9%. Respiratory difficulty syndrome affected 4.3%. 60% of infants with respiratory problems were born at less than 37 weeks gestation. Neonatal sepsis occurred in 3% of cases and prolapse of the umbilical cord in 1.3%. Perinatal mortality averaged 2.6%. Prematurity was a factor in all cases. Respiratory distress syndrome and neonatal sepsis were each present in 50% of cases and hyperbilirubinemia in 33%. 8.7% of the mothers developed chorioamnionitis. Only 23.9% terminated their pregnancies spontaneously. Oxytocin was used to induce labor in 30.4% and cesareans were performed in 44.8%.
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PMID:[Premature rupture of membranes: maternal - perinatal morbidity and mortality in the Dominican Republic]. 1231 12

A critical evaluation of the maternal deaths that occurred in the performance of 745 caesarean sections performed in the rural environment of India over the 1965-1973 period was conducted. During this period there were 20 maternal deaths, giving an incidence of 2.7%. In the series there were 11 moribund cases of placenta previa with history of internal examination done outside in 9 cases. Out of 5 deaths in obstructed labor, 4 were in group 2 (obstructed labor with pronounced effect on mother but with a living fetus) and 1 in group 3 (obstructed labor with dead fetus). Out of 4 deaths in secondary cervical dystocia, 3 were associated with prolapse and 1 with carcinoma cervix. The clinical condition at the time of section was severe anemia with shock and bleeding in 8 cases, features of exhaustion with or without evidence of sepsis in 10 cases and apparently normal in 2 cases. While there was no death in elective section, in emergency cases the mortality was 4.1%. With increasing duration of labor the risk was found increased from nil to as high as 6.8% where caesarean section was performed beyond 48 hours of labor. Shock, sepsis and embolism accounted for 75% of deaths. 7 of 20 deaths were within 6 hours of operation and as many as 9 deaths occurred after 72 hours. There were 13 stillbirths and 2 neonatal deaths out of 20 maternal deaths.
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PMID:A critical evaluation of maternal deaths in caesarean section met in rural obstetric practice. 1232 30

Garcin syndrome is characterized by an unilateral cranial nerves involvement without sensory or motor long-tract disturbances. It is usually caused by tumor infiltrating in the skull base with osteolytic changes on radiological study. We report a case of 64-year-old man with history of alcohol overintake, who admitted local hospital, because of right periorbital edema and facial swelling. He noted right ptosis 2 weeks prior to admission. Neurological examination revealed right multiple cranial nerves involvement including II, III, IV, V, and VI cranial nerves. MR imaging of the brain showed marked paranasal sinusitis and abnormal infiltration of right orbital fat. Orbital apex syndrome related to paranasal sinusitis was diagnosed, and antibiotics was administered. But a few days after admission, he developed a right VII, IX, X cranial nerve palsy. He was transferred to our hospital because of acute development of left hemiparesis and deteriorated consciousness. MR imaging of the brain showed right internal carotid artery (ICA) occlusion, and infarction in right middle cerebral artery (MCA)'s territory. The diagnostic biopsy of the paranasal sinus showed mucorales hyphae, indicating that the pathological diagnosis was mucormycosis. Despite of antibiotic therapy included of amphotericin-B administration and strict control of diabetic mellitus, his sinusitis was gradually spread. His condition progressively deteriorated, and finally died of sepsis. Post-mortem examination revealed a widespread mucor infiltration in the dura mater without skull bone invasion. This case presented with unilateral multiple cranial nerve involvements (Garcin syndrome) followed by left hemiparesis associated with rhinocerebral mucormycosis. It is suggested that mucormycosis should be considered in case of Garcin syndrome without osteolysis in the skull base.
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PMID:[Garcin syndrome in a patient with rhinocerebral mucormycosis]. 1511 47

The clinical hallmark of myasthenia gravis (MG) is fluctuating, painless weakness of muscles that most often affect extraocular, lower bulbar, or limb musculature. Predicting the probability of successful treatment for the patient assumes that the physician has made an accurate diagnosis. In this review, the practical differential diagnosis of MG is reviewed from the perspective of conditions (at presentation of symptoms and signs) that may mimic the disorder. The differential diagnosis includes disorders that limit eye movements (with or without associated diplopia), cause false-positive laboratory studies, and mimic MG but have normal eye movements. The differential diagnosis includes disorders that affect the upper brainstem, cranial nerves, neuromuscular junction, muscles, or local orbit anatomy. Nonneurological systemic diseases (i.e., encephalopathy, sepsis) can produce fluctuating ptosis or eye movements that can occasionally be confused with MG. Although MG is considered often in the differential diagnosis of weakness or fatigue symptoms that lack a correlate on neurological examination (subjective fatigue, breakaway weakness, chronic fatigue syndrome), MG is almost never found.
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PMID:Myasthenia gravis: diagnostic mimics. 1525 10

This study reviews all cases of hysterectomy performed at the University of Ilorin Teaching Hospital, Ilorin over a 4-year period between 1 April 1984 and 31 March 1988. There were 155 elective hysterectomies out of 1828 elective major gynaecological procedures with a prevalence rate of 8.5%. An analysis of 128 case notes available for review revealed that 100 (78%) of the patients had total abdominal hysterectomy (TAH) while the remaining 28 (22%) had vaginal hysterectomy (VH). Uterine fibroids were the leading indication for TAH while all the VH were for utero-vaginal prolapse. In spite of routine use of prophylactic antibiotics, febrile morbidity and wound sepsis were among the leading complications. Unnecessary blood transfusions were frequent. Mortality rate in elective hysterectomy was 0.78%.
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PMID:Elective hysterectomy at Ilorin, Nigeria-4 year review. 1551 9

BACKGROUND: This report describes a patient counseling approach and non-surgical management of a dichorionic-diamniotic twin pregnancy where delivery of the second twin followed the delivery of the first by 110 days. CASE PRESENTATION: An early transvaginal sonogram at 19 1/2 weeks suggested cervical dilation with protruding amniotic membranes. Tocolytic and antibiotic therapy was initiated; no cerclage was placed. Spontaneous rupture of membranes and cord prolapse occurred 48 h later, resulting in delivery of a stillborn female infant. Conservative management was offered after counseling for possible risks associated with maternal sepsis, need for extended hospitalization, potential for hysterectomy and death. The cervix appeared closed after delivery and the umbilical cord was ligated, with subsequent spontaneous cord retraction in utero. Reassuring fetal status was observed for twin B without evidence of contractions or chorioamnionitis. A viable male infant (2894 g) was delivered vaginally at 35 1/2 weeks. CONCLUSIONS: This report outlines a counseling approach useful for patients with premature delivery of one twin, and presents application of conservative obstetrical management principles for the aftercoming twin even when delivery interval is extreme.
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PMID:Successful obstetrical management of 110-day intertwin delivery interval without cerclage: counseling and conservative management approach to extreme asynchronous twin birth. 1558 27

Three infants with infant botulism are presented to illustrate how atypical, early, and severe features may obscure or delay diagnosis. Two boys aged 6 weeks and 20 days, respectively, presented with rapid deterioration after brief periods of poor feeding, one with an apparent life-threatening event at home and the other with a full cardiopulmonary arrest. Initial abnormal laboratory findings of coagulopathy suggested sepsis in the first infant. In the second infant, severe acidosis and hypoglycemia suggested an underlying metabolic disorder. A third infant, aged 1 month, was hospitalized originally with an admitting diagnosis of "pharyngitis" resulting from his inability to take adequate feedings. He received intravenous fluids and antibiotics. One week later he suffered a respiratory arrest. Laboratory findings of severe hyponatremia and acidosis at the time of his arrest suggested a metabolic etiology. Even retrospectively, none of these infants had the typical initial complaint of constipation, and none were noted to have ptosis or facial weakness before catastrophic collapse. However, in each case, the parent had initially brought the child to the physician for "poor feeding" or "poor suck," which was not recognized by medical personnel as a result of bulbar weakness. Ultimately, all 3 infants were found to have infant botulism. All 3 had received antibiotics before catastrophic collapse, possibly contributing to the rapidity of the deterioration. Each recovered, although the delay in diagnosis made them ineligible for treatment with botulism immunoglobulin.
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PMID:Catastrophic presentation of infant botulism may obscure or delay diagnosis. 1614 Jun 90

Stapled hemorrhoidopexy is an alternative method to conventional surgical procedures for third-degree hemorrhoids. It has many advantages such as less pain, faster recovery and earlier return to work. Nevertheless, many reports mentioned the persistence of postoperative pain, hemorrhage, recurrence, sphincter injury, and pelvic sepsis. The complications mostly arose during the purse-string phase of the procedure. The internal hemorrhoids and loose rectal mucosa can fill the inside of the anoscope, obstruct the operation field and restrict the maneuverability of the needle holder. To overcome this difficulty, a specially designed anoscope may be used. The purse-string anoscope of the PPH 01 kit (Ethicon Endo-Surgery, Cincinnati, USA) was modified to overcome the obstruction of the staple line by internal hemorrhoids and rectal mucosal prolapse. Stapled mucosectomy with this modified anoscope was performed in 9 patients. The surgical procedure lasted approximately 25 min and the patients healed uneventfully, even though 4 of them had been operated on by surgeons in their first attempts with stapled hemorrhoidopexy. By using a modified anoscope, ideal purse-string suturing may become easier, intraoperative time may be shortened, and the learning curve may be reduced.
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PMID:A modified anoscope to facilitate the purse-string suture for stapled hemorrhoidopexy. 1632 20

Preterm premature rupture of membranes is the rupture of membranes during pregnancy before 37 weeks' gestation. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death. Appropriate evaluation and management are important for improving neonatal outcomes. Speculum examination to determine cervical dilation is preferred because digital examination is associated with a decreased latent period and with the potential for adverse sequelae. Treatment varies depending on gestational age and includes consideration of delivery when rupture of membranes occurs at or after 34 weeks' gestation. Corticosteroids can reduce many neonatal complications, particularly intraventricular hemorrhage and respiratory distress syndrome, and antibiotics are effective for increasing the latency period.
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PMID:Preterm premature rupture of membranes: diagnosis and management. 1650 9


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