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

Sixteen selected patients with rectal procidentia, anal incontinence, or both were treated by the insertion of a Dacron impregnated Silastic sling at the Lahey Clinic between 1981 and 1984. The indications for operation were incontinence in 14 patients, procidentia with incontinence in one patient, and procidentia alone in one patient. No operative deaths occurred. Immediate complications included urinary retention in the three patients and hematoma in one patient. Late complications included infection, requiring removal of the Silastic sling in four patients; however, two of these patients underwent subsequent successful reinsertion of the sling after control of local sepsis. Among patients for whom follow-up data were available, satisfaction with the results of this procedure were excellent in two patients, good in six, fair in two, and poor in one. Sphincter repair with a Silastic sling is a safe, reliable alternative in the treatment of selected patients with anal incontinence or rectal procidentia.
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PMID:Sphincter repair with a Silastic sling for anal incontinence and rectal procidentia. 405 2

Within 7 years 4 cases of prolapse of the small bowel through the vaginal vault stump were observed. These occurred between 5 and 10 years following two cases of radical abdominal hysterectomy for cancer and two cases of vaginal hysterectomy and colporrhaphy. The small bowel was replaced three to six hours following the prolapse by median laparotomy. One patient died following late sepsis after the laparotomy.
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PMID:[Prolapse of the small bowel through the vaginal vault, following hysterectomy]. 655 21

A new inherited neuromuscular disease was identified in 4 patients (1 male, 3 females), offspring of consanguineous marriages, belonging to the same kindred. The proband was a 24-year-old female with history of ptosis and ophthalmoplegia since childhood and progressive intestinal pseudo-obstruction for the last 4 years of her life. A sural nerve biopsy showed axonal and demyelinating neuropathy. Muscle biopsies of pectoral and gastrocnemius revealed myopathic alterations with marked variation in muscle fiber size, atrophy of both fiber types and normal mitochondria. An upper gastrointestinal study showed barium in the stomach after 8 h and jejunal diverticula. Tests for absorption of fat, protein, carbohydrate, folic acid and vitamin B12 were normal. Serum levels of vitamin A and lipoproteins were also normal. The patient underwent partial gastrectomy and gastrojejunostomy. Postoperatively, she developed severe pancreatitis, sepsis, peritonitis and expired. Tissue samples from the proband and from her brother, revealed normal mucosa, but degeneration of smooth muscle of the stomach and small intestine. The myenteric plexus and vagus nerves were normal. The biochemical studies of contractile proteins (myosin, actin, tropomyosin) in the fresh and cultured smooth muscle cells of the proband obtained at the time of gastrectomy showed a 50-75% decrease in the synthesis of different contractile proteins. Turnover of contractile proteins and synthesis and turnover of collagen showed normal values. The reduction in synthesis of contractile proteins may account for the weak peristalsis and be a factor in the pathogenesis of the intestinal pseudo-obstruction.
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PMID:Inherited ophthalmoplegia with intestinal pseudo-obstruction. 668 98

This paper presents data on perinatal and maternal deaths occurring in the Black Lion Hospital, Addis Ababa, in 1980. The data were collected by a research midwife. A total of 3936 infants were delivered to 3868 women during this period. The stillbirth rate was 52.6/1000; the perinatal mortality rate was 8.6/1000; and the maternal mortality rate was 7.8/1000. Of the 207 stillbirths 92 (44.5%) were unexplained, 66 (31.9%) were due to mechanical causes (e.g., ruptured uterus, cord prolapse, obstructed labor), 34 (26.4%) resulted from pregnancy complications (e.g., hemorrhage,hypertensive disease, congenital abnormalities), and 15 (7.3%) were due to intrapartum death. There was no obvious pathology in 38 of the 84 neonatal deaths. The remaining cases were due to conditions such as intrapartum asphyxia, antepartum hemorrhage, septicemia, and congenital abnormalities. 10 of these death involved preventable factors. Of the 30 maternal deaths, 13 were due to sepsis, 9 to hemorrhage, 4 to surgical conditions, 3 to medical conditions, and 1 to eclampsia. Inadequate monitoring of shocked patients and the nonavailability of blood tranfusions contributed to some of these deaths. Although socioeconomic and cultural factors play a role in perinatal and maternal mortality, coordinated maternity services could produce short-term improvements. Such maternity services should embrace both primary care, with an emphasis on the training of traditional birth attendants and health assistants, and high-risk hospital care. Good prenatal care and monitoring can identify women at high risk and ensure that they receive adequate medical supervision.
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PMID:Maternal and perinatal deaths in an Addis Ababa Hospital, 1980. 674 50

A double-blind placebo controlled trial was embarked upon to study the prophylactic effect of intravenous metronidazole in the prevention of septic complications following gynaecological surgery. Comparison was made between the effect of a single dose only, given during the operation and that of a single dose given during the operation with an additional dose given 12 h later. 270 patients took part in the trial. These patients were admitted for elective hysterectomy, abdominal or vaginal, or for repair of uterovaginal prolapse. They were randomly allocated to one of three treatment groups. In group I, each patient received 500 mg/100 ml of metronidazole i.v. given over a 20 min period at the beginning of the operation followed by a second dose of 500 mg/100 ml of metronidazole i.v. 12 h later. In group II, the procedures were the same but the second dose was 100 ml of normal saline (placebo). In group III, both doses were 100 ml of normal saline. Out of 90 patients in group I, 2 patients (2.2%) developed postoperative sepsis. 8 patients (9.0%) out of 89 in group II developed sepsis. In the placebo group (group III) 19 patients (20.9%) developed sepsis. The results clearly indicate that a two-dose i.v. metronidazole regimen is highly effective in the prevention of post-operative sepsis in gynaecological surgery.
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PMID:A comparative study of the prophylactic effect of one dose and two dose intravenous metronidazole therapy in gynaecological surgery. 694 47

Twenty-two female patients (mean age 75 years) with complete rectal prolapse have been treated by operative fixation of the rectum to the sacrum using a perineal approach. There has been no operative mortality, sepsis or serious morbidity. Recurrence of complete prolapse has been seen once only within a month of operation and was due to inadequate operative fixation. The other 21 patients have been followed for up to 4 years. This type of operation may be the treatment of choice in the elderly patient considered unfit for major abdominal surgery but further experience is required before it can be advocated in other groups of patients.
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PMID:Perineal rectopexy for rectal prolapse. 702 58

There have been many techniques applied to the repair of mitral valve prolapse, and the method used in a particular case is usually selected according to the position and extent of the lesion. To simplify and standardize the technique of mitral valve repair, we have adopted the resection, sliding plasty and ring annuloplasty methods since December 1992. Of 10 consecutive surgical cases, 2 involved prolapse of the anterior leaflet, 1 the posteromedial commissural, and 7 the posterior leaflet. One patient with posterior leaflet prolapse required valve replacement due to dehiscence of the plastied site on the 3rd postoperative day, and one died because of sepsis. However, the remaining patients were doing well without mitral regurgitation at a mean of 20 months (range: 8-32) after the operation. The advantages of these techniques include easy adjustment of the height of the leaflet and a good chance of long-term durability, since the affected lesion is resected.
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PMID:[Repair of mitral valve prolapse by resection and sliding plasty]. 764 1

According to a 3-year collaborative study estimating maternal mortality rates from 41 hospitals affiliated with teaching centers in India, maternal mortality was 721 per 100,000 live births. Community studies in rural areas of Sirur, Pachod, and Ambula reported maternal mortality as 210-253 per 100,000. Cohort studies conducted by the Indian Council of Medical Research reported maternal mortality as 530 per 100,000 based on data from rural areas of Varanasi, 460 per 100,000 in urban Delhi, and 450 per 100,000 in urban Madras. The Ministry of Health gave the rate as 460 per 100,000 in 1984, while UNICEF gave a figure of 400 per 100,000 for 1980-91. India has 1 out of 4 of the world's maternal deaths, or 1 every 6 minutes. The risk of maternal death has been calculated to be one in 64. Risk is unevenly distributed geographically. Risk is low in Kerala compared to Uttar Pradesh or Madya Pradesh. In 1992 maternal mortality was calculated to be 1320 per 100,000 births based on 5 district hospitals. The cause of maternal deaths was anemia in 25% of cases. 75% of cases were accounted for by eclampsia, sepsis, hemorrhage, and abortion. Anemia (pre-existing the pregnancy) is acerbated by the demands of pregnancy and causes congestive heart failure and death. Blood losses of greater than 150 ml (due to hemorrhages of pregnancy and labor) can be fatal. During 1982-89 anemia was responsible for 17-24% of all maternal deaths in rural areas. Morbidity from pregnancy-related causes included obstetric fistulae, pelvic inflammatory disease, anemia, genital prolapse, and urinary incontinence. Quality of maternal care is an important factor in reducing maternal mortality and morbidity. Societal factors such as illiteracy and malnutrition, early marriage, poorly supervised pregnancies, and lack of transportation during emergencies are other determinants of mortality and morbidity. About 10% of maternal deaths are attributed to unsafe abortion. The government aim for the year 2000 of 100% prenatal care and care during delivery will require professional commitment and thousands more midwives in rural areas.
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PMID:How safe motherhood in India is. 765 33

A 5-year audit of the formation, management and closure of small-bowel stomas and colostomies at Red Cross War Memorial Children's Hospital, Cape Town, is described. Of the 203 patients, 128 (63%) required the stroma in the neonatal period. Anorectal malformations (80), Hirschsprung's disease (65), necrotising enterocolitis (33), trauma (11) and neoplasm (5) comprised most of the indications. One hundred and thirty large-bowel stomas were sited in the proximal sigmoid and 37 in the transverse colon, all but 11 being divided with each end brought out through a short muscle cutting incision or through the laparotomy wound. Thirty-six ileostomies were performed and in 30 of these the stoma was sited in the wound. Complications, which included necrosis, bleeding, prolapse and wound sepsis, occurred in 31%. The colostomies sited in the transverse colon had the highest incidence of prolapse (38%). Neonatal stomas brought out in the wound had an acceptably low incidence of complications. Most stomas were temporary in nature. One hundred and eighty-eight were closed, all with excision and end-to-end intraperitoneal anastomosis. There was a 4% incidence of complications (5 would sepsis, 2 leaks, 1 stenosis). The formation, management and closure of bowel stomas represents a considerable section of the work of the paediatric surgeon. Correct meticulous technique is essential in keeping complications to a minimum.
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PMID:Bowel stomas in infants and children. A 5-year audit of 203 patients. 812 23

The existence of combined rectal and vaginal prolapse is more common than the literature would suggest. This paper outlines a further development in the operative management which has been applied to 24 patients with this problem. All had had a hysterectomy and most had had in addition one or more vaginal repairs. The common mode of presentation was one of pelvic pain (19 patients), sometimes severe, crippling and intractable and some form of protrusion (14 patients), difficult or unsatisfied defaecation and rectal incontinence (9 patients). The vaginal prolapse which always involved the vault and usually involved the lower vagina was usually found to be incomplete and the rectal prolapse complete (but occult). The operative procedure essentially consists of a Wells type rectopexy which has a new modification in which the sling is extended to anchor the vaginal vault after correction of the enterocele by the abdominal approach. A vaginal repair is subsequently performed at the same operation where anterior or posterior vaginal prolapse persists. Important points in the procedure are the avoidance of sepsis (the vaginal vault is not opened during the procedure) and protection of the ureters by careful assessment of the lateral margins of the vaginal vault which is illuminated by transvaginal vault endoscopy. At this early stage operative morbidity has been minimal, relief of the pelvic symptoms has been most encouraging, but the length of follow-up is short (range 6-30 months, average 15.6) and long-term evaluation will be necessary as with all surgery for prolapse.
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PMID:Posthysterectomy rectal and vaginal prolapse, a commonly overlooked problem. 830 99


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