Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Vaginal prolapse may occur following hysterectomy or may evolve with the uterus in place. Current treatment options for vaginal prolapse have a limited success rate or are associated with significant morbidity. In this retrospective review, we present our experience with a new procedure for repair of vaginal prolapse. This technique relies on anterior suspension of the vaginal vault to the anterior rectus sheath in a fashion similar to bladder neck suspension. Forty patients have undergone this procedure. All patients had vaginal prolapse, cystocele, and urinary incontinence. In addition, 34 patients had enterocele, six had uterine prolapse, 33 had rectocele, and two had urethral diverticula. All patients had anterior vaginal suspension (AVS), with cystocele repair and bladder neck suspension. Six patients had vaginal hysterectomy, 34 had enterocele repair, 33 had rectocele repair, and two had urethral diverticulectomy. The mean hospital stay was 2.5 days (range, 1-7 days), and their mean follow-up was 30 months (range, 12-54 months). Thirty-six (90%) patients have excellent support of the vagina with no evidence of recurrent cystocele, enterocele, or rectocele. Four (10%) patients have recurrent enterocele. Thirty-three (82.5%) patients are dry or have rare episodes of urinary incontinence (less than one episode/month), whereas four (10%) patients have recurrent stress incontinence and three (7.5%) have urge incontinence. Constipation and fecal incontinence were resolved in all patients. All patients who were sexually active preoperatively remained so postoperatively, and none reported dyspareunea. Vaginogram in 10 patients demonstrated that posterior angulation of the vaginal axis was retained in all patients. AVS is associated with an excellent success rate in terms of resolution of symptoms and correction of prolapse. Morbidity is minimal, and hospital stay is short. The technique is simple and relies on anatomy that is familiar to all urologists. In addition, the vaginal approach allows for simultaneous correction of all components of vaginal prolapse and any associated vaginal pathology.
 ...
PMID:Anterior vaginal suspension for vaginal vault prolapse. 911 84

The Le Fort colpocleisis is an obliterative procedure used in the treatment of pelvic prolapse in elderly women where prolonged reconstructive surgery or general anesthesia may be medically contraindicated. Advantages include the ability to perform this procedure quickly under regional anesthesia with a low postoperative complication rate. The authors describe a previously unreported complication of partial colpocleisis requiring subsequent hysterectomy. A 92-year-old woman presented with a 10-day history of lower extremity edema and pelvic pain. She had recently undergone a second partial colpocleisis for recurrent pelvic prolapse in which the drainage channels were partially obliterated. Radiologic evaluation revealed an enlarged complex pelvic mass. At the time of laparotomy, an enlarged uterus filled with purulent material was noted which necessitated subsequent hysterectomy. It was concluded that, although uncommon, postoperative infection is a recognized complication of Le Fort colpocleisis. To minimize the chance of abscess, adequate lateral channels should be created and maintained during colpocleisis to allow drainage of postoperative secretions, bleeding and inflammatory exudate.
 ...
PMID:Pyometra following Le Fort colpocleisis. 912 84

The perinatal mortality rate (PMR) at the Hopital Evangelique in the Borgon region of Benin was 224/1000 in 1984 compared to 164/1000 in 1994. Despite the decrease, the rate was still high. Perinatal deaths for 1994 were reviewed retrospectively from case notes and data routinely recorded (presentation, distance traveled, and prenatal care). The probable causes of death were determined. A total of 511 babies were delivered by 484 women in 1994 at the hospital. There were 62 stillbirths (26 cases of birth asphyxia, 14 cases of antepartum hemorrhage, 7 cases of ruptured uterus, and 6 cases of intrauterine death before labor) and 22 neonatal deaths (7 cases of birth asphyxia and 11 cases of prematurity). Maternal errors accounted for 14 stillbirths and 4 neonatal deaths; logistical difficulties accounted for 8 stillbirths and 4 neonatal deaths; and the errors of management/referring maternity accounted for 4 stillbirths and 1 neonatal death. Some examples of maternal errors included a patient (gravida 6, para 5) who had not received prenatal care and presented with antepartum hemorrhage after being in labor for 72 hours. She had a ruptured uterus and required hysterectomy. Another patient (gravida 6, para 5) who had not received prenatal care presented to a maternity unit in labor with a shoulder presentation. On arrival, and after referral, intrauterine death was diagnosed and the fetus was delivered. Examples of logistical problems included a primigravida referred from a maternity unit more than 50 km away for delay in the second stage of labor. She delivered normally after arrival; however, the baby was asphyxiated and died. A patient who was gravida 2, para 1 was referred from a maternity unit with a cord prolapse. The fetal heart beat was present on leaving the maternity unit but was absent on arrival at the hospital. Bad management cases related to prolonged labor or attempts at a traumatic vaginal delivery. Maternal errors were the main source of deaths; thus, prenatal and intrapartum care should be more accessible to reduce the PMR.
 ...
PMID:Perinatal mortality in northern Benin. 922 17

Uterine adenosarcoma is an apparently benign mixed tumor with a muller type epithelial component and a sarcomatous stromal component. We present a patient with remodeled genital prolapse who developed a bifocal localization in the endometrium and vagina. These tumors are uncommon, 8% of the sarcomatous tumors of the uterus. Their usual presentation may mimic cervical or endometrial polyps. Pathology is required for positive diagnosis which evidences the two components. The diagnosis may be missed at the first examination (two-thirds of the cases in certain series). Treatment is surgical with hysterectomy in peri- or post-menopaused women and tumoral excision or curettage in younger women. The prognosis is good but can worsen if invasion extends beyond one-third of the myometrial thickness or if pure sarcomatous transformation occurs.
 ...
PMID:[Uterine adenosarcoma. Apropos of a case of uterine and vaginal adenosarcoma with a corrected genital prolapse]. 937 90

Gynecological endoscopy is now a well-established procedure and it has been proved that the laparoscopic surgical technique can be used in the management of most gynecological disorders thus replacing conventional laparotomic procedures. The latest indications apply to such functional pathologic conditions as urinary incontinence and genital prolapse, and oncology (radical hysterectomy, lymphadenectomy). Hysteroscopy has afforded an easier surgical approach to certain pathologies such as septate uterus and endometrial ablation. Indications of conventional surgery are getting fewer. Yet conventional surgery should be part of the training of the gynecologist surgeon as the laparotomic approach is still the only solution in the most difficult cases.
 ...
PMID:Endoscopic surgery. The end of classic surgery? 944 58

The general pharmacological properties of a novel cholecystokinin-A antagonist, loxiglumide ((+/-)-4-(3,4-dichlorobenzamido)-N-(3-methoxypropyl)-N-pentylgl utaramic acid, CR 1505, CAS 107097-80-3) on central nervous system, autonomic nervous system, cardio-respiratory system, gastrointestinal system, hematological and miscellaneous systems were investigated in experimental animals. 1. Central nervous system: At a dose of 30 mg/kg, i.v. loxiglumide showed ptosis in one of 6 mice, but at doses of 3 and 10 mg/kg, i.v. no change on gross behavior in mice. Loxiglumide had no effect on locomotor activity and thiopental-induced hypnosis, anti-convulsive activity, analgesic activity in mice and rectal temperature changes in rats. 2. Autonomic nervous system: In vitro, loxiglumide at concentrations of 10(-4) and 3 x 10(-4) mol/l slightly inhibited agonist-induced contractions in the isolated guinea pig ileum and spontaneous rhythmic contractions in the isolated non-pregnant rat uterus. But loxiglumide had no effect on oxytocin-induced contraction in isolated non-pregnant rat uterus. 3. Cardio-respiratory system: Loxiglumide had no effect on heart rate and electrocardiogram in anesthetized dogs. But it slightly increased blood pressure and decreased the frequency of respirations at a dose of 30 mg/kg, i.v. Furthermore, loxiglumide slightly decreased femoral arterial blood flow at doses of more than 3 mg/kg, i.v. On the other hand, it had no effect on contractile force or contraction rate in the isolated guinea pig atrium and resting tension in the isolated rabbit aorta. 4. Gastrointestinal system: Loxiglumide increased bile secretion at doses of 10 and 30 mg/kg, i.v. in anesthetized rats and at doses of 3, 10 and 30 mg/kg, i.v. in anesthetized dogs. However, total bile acid output was not affected by loxiglumide. On the other hand, loxiglumide had no effect on pancreatic secretion, gastric secretion and gastric emptying in rats and intestinal transport activity in mice. 5. Hematology: In vitro, in the case of samples without bovine serum albumin, at concentrations of more than 1.9 x 10(-3) mol/l loxiglumide showed hemolysis, while in the case of samples with bovine serum albumin, at concentrations of more than 6.9 x 10(-3) mol/l loxiglumide showed hemolysis, and its maximal potency was weak compared to albumin-free conditions. On the other hand, in vivo, loxiglumide had no effect on hemolysis. In addition, it had no effect on platelet aggregation, prothrombin time and activated partial thromboplastin time. 6. Miscellaneous pharmacological actions: Loxiglumide had no effect on local anesthetic activity in guinea pigs and renal function in mice. These results suggest that loxiglumide seems to produce no serious side effects on the central nervous system, autonomic nervous system, cardio-respiratory system, gastrointestinal system, hematological and miscellaneous systems at pharmacologically effective doses.
 ...
PMID:General pharmacological profile of the novel cholecystokinin-A antagonist loxiglumide. 945 Jan 67

An until recently mobile woman of 86 years developed problems with independent living because of a genital total prolapse. After treatment by high perineoplasty she was once more able to resume her social activities. In very old women a genital prolapse can lead to significant morbidity due to hygienic problems and increase of social loneliness due to impairment of mobility. Use of a pessary is rarely an acceptable solution because of ulceration of the vaginal wall. Surgery can be modified because preservation of vaginal function is hardly necessary after the age of eighty. Efficient control of complaints can be achieved by Labhardt high perineoplasty or Le Fort partial colpocleisis. Before such types of operation cytology and ultrasonography of the uterus must be performed to exclude a malignancy with reasonable certainty. Both operations can be done under local anaesthesia with very short hospitalization.
 ...
PMID:[Treatment of genital prolapse in very old women]. 955 91

This study focusses on abdominal sacral colpopexy which appears to provide the most anatomically correct restoration and secure and durable support for advanced vaginal or uterovaginal prolapse. 21 patients underwent colposacropexy or hysterocolposacropexy using Gore-tex mesh. All patients referred symptoms of vaginal heaviness and urinary dysfunctions. Five presented with complete vaginal vault prolapse, 7 with third-degree anterior colpoceles and 9 with uterovaginal prolapse. Hydronephrosis was present in 4. Five patients had previously undergone total hysterectomy, and underwent only sacropexy; 9 underwent standard total abdominal hysterectomy before sacropexy; 7 underwent hysterocolposacropexy, preserving the uterus. In colposacropexy anchorage was designed to provide a large vagina-mesh contact area thus reducing the risk of suspension failure. Hysterocolposacropexy was performed using 3 stitches to anchor the synthetic mesh to the vagina and the uterine isthmus. Postoperative follow-up times range from 12 to 68 months. Overall results for 19/21 patients were satisfactory. In all 21 patients the descensus was markedly reduced. Hydronephrosis was completely resolved. Slight incontinence persisted in 3, but protection was not required. Slight dysuria persisted in 2. First-degree cystoceles recurred only in 3 patients who underwent hysterocolposacropexy. Sacropexy with synthetic mesh seems to be the most valid support of uterovaginal prolapse as the physiological vaginal axis is restored and vaginal function is preserved. Our success rate and the overall satisfaction expressed by 19/21 patients have encouraged us to continue in this surgical approach.
 ...
PMID:Colposacropexy with Gore-tex mesh in marked vaginal and uterovaginal prolapse. 969 45

Hysterectomy is the second most commonly performed major operation in the United States. Approximately one in three women will have this operation, resulting in 590,000 procedures per year. The most common indications for hysterectomy are leiomyomata uteri, abnormal uterine bleeding, endometriosis, pelvic pain, and pelvic organ prolapse. Although hysterectomy is an appropriate therapeutic option for some women with these conditions, in many instances less radical alternatives may be offered. Leiomyomata may be managed expectantly if symptoms are not bothersome; for women with troubling leiomyomata symptoms, alternatives to hysterectomy include: endoscopic removal or destruction of myomas, arterial embolization, or hormonal therapy to inhibit or modify bleeding. Endometriosis and abnormal uterine bleeding of leiomyomata are both amenable to hormonal therapy. Pelvic pain is most effectively approached with a thorough evaluation (particularly for nongynecologic illness), with specific therapy directed at the cause of the pain. Pelvic organ prolapse may respond symptomatically to pelvic floor exercises, or to the use of a pessary. After alternatives to removal of the uterus are discussed, the informed woman may decide that hysterectomy is the option best suited to her. It is unusual for hysterectomy to be her only option.
 ...
PMID:Alternatives to hysterectomy for benign conditions. 972 46

Uterine prolapse is often associated with a concomitant rectocele, cystocele, and/or an enterocele. Moderate degrees of prolapse are often associated with a feeling of pelvic heaviness or fullness or low back pain. The symptoms usually worsen with exertion and ease with bed rest. In severe prolapse, the cervix may descend outside the vaginal introitus, and patients may complain that a "mass" is protruding from the vagina. Bleeding from mucosal ulcerations or from the cervical os may occur due to rubbing of the prolapsed tissue against the patient's clothing. The commonly associated problems of cystoceles and rectoceles may lead the patient to complain of difficulty voiding, recurrent urinary infections, and/or "splinting" to defecate. Mild cases of uterine prolapse do not require therapy unless the patient is symptomatic; in most cases of second- or third-degree prolapse, however, patients may be quite uncomfortable and desire therapy. Nonsurgical options, such as a pessary, are usually tried first if the patient desires conservative therapy. Operative repair for uterine prolapse is usually approached vaginally if the uterus is small. An abdominal approach may be preferred if the uterus is large or if the woman has had multiple previous pelvic procedures or has extensive endometriosis or other processes that may obliterate the cul-de-sac. In either approach, the uterosacral and cardinal ligaments must be carefully ligated and tied together, and the cul-de-sac must be obliterated to reduce the risk of subsequent enterocele and to properly suspend the vaginal vault.
 ...
PMID:Pelvic prolapse: diagnosing and treating uterine and vaginal vault prolapse. 973


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>