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

The fourth lumbar vertebrae and L4-5 discs from six cadaveric lumbar spines were subjected to detailed strain gauge analysis under conditions of controlled loading. With central compression loads, maximal compressive strain was found to occur near the bases of the pedicles and on both superficial and deep surfaces of the pars interarticularis, which emphasises the importance of the posterior elements of lumbar vertebrae in transmitting load. Radial bulge and tangential strain of the disc wall were maximal at the posterolateral surface, in agreement with the fact that disc degeneration and prolapse commonly occur there. Under posterior offset loads simulating extension, both compressive and tensile strains were found to be increased on both surfaces of the pars interarticularis, which suggests that hyperextension may lead to stress fractures and spondylolisthesis. Posterior offset loads also increased the radial bulge of the posterior disc wall and tangential strain at the anterior surface of the disc. Anterior offset loads simulating flexion increased the radial bulge of the anterior disc wall and tangential strain at the posterior surface of the disc. These findings are compatible with movement of the nucleus pulposus within the disc during flexion and extension. This hypothesis was supported by post-mortem discography.
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PMID:The distribution of surface strain in the cadaveric lumbar spine. 65 74

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.
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PMID:Transabdominal proctopexy (Ripstein procedure) for massive rectal prolapse. 83 6

In a review of the effect of gynecological operations on sexual function, difficulties resulting from operative technique and from psychological side effects were discussed. In repair of prolapse of the vagina, operative technique has been considered of crucial importance in influencing the sexual life of the patient. Preoperative clinical assessment rarely gives an accurate picture but can prepare the operator for some unforeseen difficulties. Patients with recurrent prolapse may have to sacrifice a functional vagina in the interest of surgical cure. However, the patient's views on coitus must be sought before surgery. Vaginal hysterectomy as an alternative to abdominal surgery can result in a rapid return to normal sexual function. Anterior colporrhaphy, the most commonly performed prolapse repair, may narrow the vagina from a too wide excision of vaginal epithelium. Some degree of shortening was thought to be almost invariable. Posterior colpoperineorrhaphy has been the major cause of vaginal stenosis after prolapse repair. The operation should be avoided but a technique by Simmons avoids the useless skin bridge, the main cause of postoperative dyspareunia. In anticipation of continuing postmenopausal atrophy, undue tightening of the vagina should be avoided. Sexual difficulties resulting from episiotomy frequently result from inaccuracy of siting and repair in favor of speed and dispatch. However, some postpartum difficulties in return to sexual function can result from emotional factors. Relief from postoperative contracture after vaginal operations may be obtained by several means including William's operation for vaginal atresia. Other gynecological procedures were considered outside the scope of this article. Therapeutic abortion and sterilization represent a different kind of operation because of emotional impact. However, it is suggested that many sexual problems are the result of poor preoperative explanation and postoperative instructions.
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PMID:Sexual life after gynaecological operations--II. 113 77

Two first cousins, the offspring of consanguineous marriages, had features suggestive of Marden-Walker syndrome. Phenotypic similarities and differences for Schwartz-Jampel syndrome have been discussed. Main features of the Marden-Walker syndrome are failure to thrive, marked motor and mental retardation, and multiple malformations in the form of peculiar facies associated wilth poor muscle mass, mild congenital joint contractures, pigeon breast, kyphoscoliosis and arachnodactyly. Peculiar facies is due to blepharophimosis, congenital ptosis, hypoplastic mandible and low-set and malformed ears. Posterior median cleft of the palate as well as cardiac and renal anomalies were noted in the case reported by Marden and Walker. Our Case 2 had dextrocardia. The present report suggests autosomal recessive inheritance of this syndrome.
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PMID:Probable Marden-Walker syndrome: evidence for autosomal recessive inheritance. 122 20

To determine diagnostic value of lens opacities in myotonic dystrophy (DM), we examined 98 at-risk members of 9 DM kindreds. Haplotype analysis of restriction fragment length polymorphisms (RFLPs) using ApoC2, CKMM, and pEFD4.2 supported the diagnosis of DM in 33 and excluded the diagnosis in 51 members. The sensitivities of bilateral iridescent lens opacities, posterior cortical lens opacities, orbicularis oculi weakness, low intraocular pressure, ptosis, and ocular myotonia were 46.7, 50.0, 60.6, 59.3, 51.5, and 3.0%, while their specificities were 100.0, 100.0, 98.0, 94.1, 96.1, and 100.0%, respectively. A peripheral pigmentary degeneration and central macular lesions of retina were not found on indirect fundoscopy. In 86.2% of DM patients, bilateral iridescent lens opacities, posterior cortical lens opacities, or both were present. Unilateral iridescent lens opacities occurred in only 3 of our DM patients, and 2 of non-DM relatives showed a few unilateral iridescent particles. Posterior cortical lens opacities in DM patients always affected both eyes in this series. We conclude that 1) bilateral iridescent lens opacities and posterior cortical lens opacities are highly specific for DM and useful for establishing clinical diagnosis of DM, 2) unilateral iridescent lens opacities are infrequent in DM and are seen in some non-DM members, and 3) ocular myotonia and clinical retinopathies are rare in DM.
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PMID:Diagnostic value of ophthalmologic findings in myotonic dystrophy: comparison with risks calculated by haplotype analysis of closely linked restriction fragment length polymorphisms. 136 51

Rectopexy associated with anterior prolepsectomy was performed for 22 patients (19 females, 3 males), with solitary rectal ulcer syndrome (SRUS) surrounding internal rectal prolapse. The different lesions of SRUS were distributed among 3 main groups (G) according to the macroscopic appearance: G1: solitary ulcer (n = 7); G2: ulcerated proctitis (n = 7); G3: muco-hemorroidal prolapse (n = 3). A significant difference (P less than 0.05) was observed between each group, concerning mean age (G1: 34 years, G2 = 49, G3: 65) and the degree of perineal descent, which was more important in G3 and G2. Posterior intersphincteric rectopexy was performed for 6 patients in G3, with descending perineum and faecal incontinence, treated in the same time by perineoplasty (Parks). Abdominal rectopexy, mainly by the antero-posterior technique (Nicholls), was performed for the other patients (n = 6). Large anterior prolapsectomy reaching the top of the mucosal prolapse (4-7 cm), allowing ulcer resection in 3 cases, was combined with rectopexy. Associated operations were: sphincterotomy (n = 8) for narrow fibrous anal canal, sigmoidectomy (n = 4) for dolichocolon. Mean healing time for the solitary ulcer group (G1) was 2 months, 1 month for lesion of G2 and G3. Failures concerned 1 solitary ulcer after abdominal rectopexy and 1 ulcerative proctitis after rectopexy without prolapsectomy. Anorectal pain (81%), rectal bleeding (76%), faecal incontinence (27%), straining (81%), were cured or improved in 80% of cases. These results tend to confirm the efficacy of rectopexy, specially using the antero-posterior technique, for the treatment of SUSR with internal rectal prolapse. Nevertheless, rectopexy seems to be insufficient to correct the mucosal component of internal rectal prolapse, bearing the ulcerated lesion which needs to be treated by associated anterior prolapsectomy. Similarly all functional or organic disorders involving the perineum, anal canal or colon leading to anorectal dysfunction must also be considered to ensure complete treatment.
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PMID:[Solitary rectal ulcer syndrome: clinical features, clinical course and treatment. Apropos of 22 cases]. 210 Jan 20

To estimate frequency of the posterior mitral valve leaflet prolapse in routinely performed left ventriculography, 1000 consecutive ventriculograms of the right anterior oblique projection were analyzed. A group of patients consisted of 511 women and 489 men at mean age 46,5 years. Clinical diagnosis of heart lesions, myocardial disease, pulmonary hypertension or arrhythmias were indications for hemodynamic studies. In the investigated group of patients, there were no patients with clinical diagnosis of the coronary artery disease. Prolapse of the posterior mitral valve leaflet was diagnosed in 59 patients. Idiopathic mitral valve prolapse was diagnosed in 10 patients. Prolapse of the posterior mitral valve leaflet was most frequent in atrial septal defect (16.6%), myocardial lesion (12.5%), and after mitral commissurotomy (8.9%). Posterior mitral valve leaflet prolapse is not a frequent anomaly in routinely performed left ventriculography. Relatively often occurrence of the mitral valve prolapse in atrial septal defect and only occasional in the aortic lesions and dilated cardiomyopathy seems to point out at a role of the left ventricle size in pathogenesis of this syndrome.
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PMID:[Mitral valve prolapse detected during hemodynamic studies]. 210 30

Anal prolapse in adults is cured by the Milligan-Morgan procedure. Operation for the rectal prolapse has to repair procidentia, incontinence and obstipation. Procidentia and incontinence in low-risk patients are best repaired by abdominal rectopexy with or without plastic materials (Ripstein's procedure is preferred). Obstipation remains a long-term problem. Rectopexy in combination with sigmoid resection (Goldberg) improves obstipation, but there is leakage in 4% of the patients. The perineal approach offers no technical advantage. Perineal rectopexy, prolapse resection and Thiersch ring with modifications are preferred in high-risk cases. Posterior levator plastic improves remaining incontinence.
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PMID:[Surgical methods in anal and rectal prolapse]. 257 35

Colour flow mapping was used to examine the pattern of regurgitant flow in 46 patients with mitral regurgitation due to mitral valve prolapse. Valve morphology was assessed from the real-time two-dimensional image and the presence of mitral regurgitation was determined from real time Doppler. On morphological criteria 11 (24%) patients had isolated or predominant anterior leaflet prolapse, 22 (48%) patients posterior and 13 (28%) patients bi-leaflet prolapse. A single regurgitant jet was detected in 43 patients (93%) and multiple jets in three (7%). The direction of the regurgitant jet was assessed in multiple views in two orthogonal planes (antero-posterior and medial-lateral) defined in relation to the mitral valve leaflets. The regurgitant jet was eccentric in the antero-posterior plane of the mitral leaflets in 40 of 45 (89%) cases and in the medial-lateral plane in 36 of 40 (90%) cases. Posterior leaflet prolapse was usually associated with antero-medially directed jets, anterior leaflet prolapse with postero-central or postero-lateral jets and bi-leaflet prolapse with predominantly postero-medial jets. In a subgroup of patients with significant mitral regurgitation and an eccentric regurgitant jet, a 'swirling' effect was produced with late systolic flow in the body of the left atrium toward the mitral valve. Colour flow mapping in patients with mitral regurgitation due to mitral valve prolapse demonstrated eccentric jets in most patients. The direction of regurgitant flow appeared to depend greatly on the dynamic anatomy of the mitral valve leaflets during systole. Although a single jet was detected in most patients, multiple jets did occur in a minority.
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PMID:Colour Doppler echocardiographic assessment of regurgitant flow in mitral valve prolapse. 259 43

Posterior abdominal rectopexy was performed in 12 patients with a full-thickness rectal prolapse: 9 had faecal incontinence. The prolapse was successfully controlled in all cases and six of nine patients were rendered continent. Physiological studies in patients were compared with age- and sex-matched controls. Preoperative anal pressures were significantly lower than in controls at rest (R), during maximum pelvic floor contraction (Sq) and attempted defaecation (St) (R, P less than 0.005; Sq, P less than 0.005; St, P less than 0.005). Anorectal angles were significantly more obtuse in patients than in controls (R, P less than 0.05; St, P less than 0.025). None of these parameters changed significantly after abdominal rectopexy. Median rectal emptying significantly decreased after operation (preoperative 83 per cent/min; postoperative, 58 per cent/min, P less than 0.05). Median perineal descent during attempted defaecation also significantly decreased after operation (preoperative, 8.5 cm; postoperative, 7.1 cm; P less than 0.025). Parameters which predicted return of continence included: delayed leakage during the saline infusion test (P less than 0.025), a narrow anorectal angle during pelvic floor contraction (P less than 0.025), minimal pelvic floor descent during contraction (P less than 0.05), and a long anal canal at rest (P less than 0.05) and during pelvic floor contraction (P less than 0.025).
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PMID:Anorectal function after abdominal rectopexy: parameters of predictive value in identifying return of continence. 263 77


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