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)

We report our experience with 23 girls with urethral prolapse. Vaginal bleeding was the most common complaint, and predisposing factors (cough, trauma, and constipation) were found in 10 children. Although reported almost exclusively in black girls, 14 of the 23 patients were white. Three basic techniques were used for therapy: conservative management, ligation over a Foley catheter, and total excision of the prolapse. Ligation over a Foley catheter had a high incidence of complications (partial recurrence, infection, postoperative pain) and is no longer used. The best results were obtained by complete excision of the urethral prolapse. We propose that treatment should be based on the etiopathogenesis of the prolapse and the clinical condition of the child; patients with a single and acute episode of increased abdominal pressure, such as trauma, and those at high risk for general anesthesia are managed by conservative therapy. All others, and patients who fail medical treatment, undergo surgical excision.
 ...
PMID:Urethral prolapse in children. 844 6

A 54-year-old man with an feverish infection of the lower respiratory tract developed severe pain in the lateral and basal part of the left thorax after a severe coughing bout. A haematoma occurred at the site and it looked as though tissue evaginated at that spot on coughing and pressing. The clinical diagnosis was pneumonia and abnormal mobility of the eighth to tenth rib on the left with crepitations. The chest radiograph demonstrated fractures of these ribs and extrathoracic sickle-shaped collection of air in the left laterobasal area. Computed tomography additionally showed prolapse of pulmonary tissue on pressing. This was thus a case of "cough fracture", complicated by herniation of lung tissue. There was no evidence of incarceration of lung tissue and, as the patient was very obese, surgery was not indicated. Symptoms and signs of infection regressed on symptomatic and antibiotic treatment. The rib fractures healed as pseudoarthroses. Lung tissue prolapse on pressing was still present 3 months later.
 ...
PMID:[Extrathoracic prolapse of the pulmonary parenchyma after a bout of coughing with spontaneous serial rib fractures]. 850 Apr 13

A 52-year-old woman had a 14-year history of stridor attacks. Pulmonary function tests revealed reversible airway obstruction, and bronchial asthma was diagnosed. She also has bilateral ptosis, diplopia, and moderate weakness of all four limbs; a positive edrophonium test confirmed the diagnosis of myasthenia gravis. Although the parasympathetic system plays an important role in the regulation of bronchial tone, in this patient the edrophonium test did not provoke an asthmatic attack or exacerbate pulmonary function, except for increases in sputum production and in frequency of cough. The general weakness was usually worse in the afternoon. The decrease in grip strength and the shortening of arm elevation time also occurred after asthma attacks, which means that general muscle fatigue was caused by the work of breathing. Furthermore, dyspnea increased and pulmonary function worsened when an anti-cholinesterase inhibitor was discontinued, probably because of respiratory muscle weakness. Accordingly, the clinical status of bronchial asthma seemed to change in parallel with that of the myasthenia gravis.
 ...
PMID:[Bronchial asthma complicated by myasthenia gravis]. 869 67

In a prospective and consecutive study, we evaluated the incidence of common symptoms and neurologic disturbances in 200 patients operated on because of lumbar disc herniation by using a computer-coded protocol with pre- and perioperative registration. The preoperative occurrence of pain at rest, at night, and on coughing was registered. Use of analgesics and walking ability were registered as category data. At examination, a straight-leg-raising (SLR) test was graded in four categories, and results from neurologic findings were collected. At surgery, disc herniation was classified as extruded/sequestered herniation, prolapse, or focal protrusion. There were no significant differences concerning pain at rest or at night related to type of herniation. Pain on coughing was more common in extruded/sequestered herniations. Use of analgesics as well as severe reduction of walking capacity were significantly more common in patients with extrusion/sequestration. The highly restricted SLR test, as well as the crossed positive SLR test, were also significantly more common in patients with extruded/sequestered herniation, and this was also true for the incidence of relevant reflex/extensor hallucis longus (EHL) and sensory disturbance. In conclusion, the clinical appearance of lumbar disc herniation was most "aggressive" in extruded and sequestered disc herniation. The symptoms and signs in disc protrusion were less severe, whereas patients with prolapse had an "intermediate" appearance concerning symptoms and signs. The differences in incidence of common signs in noncontained versus contained herniation were statistically significant; these differences may be of clinical interest for patient selection and information as well as in pathophysiologic considerations.
 ...
PMID:Clinical appearance of contained and noncontained lumbar disc herniation. 872 54

Laparoscopic repair of grade 1 to 4 pelvic vault prolapse was performed in 103 patients. All women filled in quality of life questionnaires, and had standing vault examination, transperineal ultrasound examination, and cough stress test. Laparoscopic Burch, paravaginal repair, central pubovesical repair, culdoplasty, sacral colpopexy, and posterior vaginal repair were performed after the type and extent of the prolapse were determined. The majority of the procedures were done as day surgery. Almost all women were able to void spontaneously. At 6 weeks all patients had repeat questionnaires, vault examination, transperineal ultrasound, and cough stress test. No recurrences of vault prolapse or of genuine stress incontinence (GSI) were found at that time. Eighty-nine women were reexamined at 1 one year with the questionnaires, ultrasound vault examination, cough stress, and urodynamics. Of the 89 with GSI, 83 (93%) were objectively dry. Five (6%) of the 89 had recurrent vault prolapse. The laparoscopic cure rate of GSI is comparable with that of open repairs.
 ...
PMID:Laparoscopic Approach for Severe Pelvic Vault Prolapse 907 26

This is a 1-year preliminary report of a 5-year study. Forty-six women with genuine stress incontinence (GSI) were evaluated with multichannel urodynamics before laparoscopic Burch repair and 1 year postoperatively. Reports conclude that as many as 18% of patients develop enteroceles or rectoceles in the first 5 years after Burch repair. To see if prophylactic posterior suspension could prevent this delayed complication, all women had at least a modified culdoplasty. If paravaginal defects, rectoceles, or enteroceles were present, these were also repaired laparoscopically. All patients had a quality of life questionnaire, 24-hour urolog, transperineal ultrasound, cystourethroscopy, cough stress test, and multichannel urodynamics. At 6 weeks they all had a negative ultrasound, cough stress test, and cystometrogram. At 1 year the complete evaluation was repeated. Five women were lost to follow-up. Four of 41 patients had recurrent GSI. One patient had a grade 1 cystocoele with no other signs of pelvic vault prolapse. These are cure rates of 91% and 98% for GSI and pelvic vault prolapse, respectively. The urodynamic studies appear to be comparable with those reported in laparotomy Burch repairs. These findings are encouraging for laparoscopic procedures, but they are short term and it is essential that the patients be followed for 5 years for the data to be clinically relevant.
 ...
PMID:Multichannel Urodynamics for Laparoscopic Burch and Pelvic Vault Repairs 907 27

Prophylactic pelvic support procedures were performed with laparoscopic-assisted vaginal hysterectomies (LAVH) in 91 women to see if the frequency of future pelvic vault prolapse could be reduced. The patients were divided into two groups. In group 1, 43 women were treated with simple LAVH using a suture bipolar technique. In group 2, 48 women had LAVH and prophylactic modified culdoplasties for vault support. Indications for hysterectomy were routine, excluding only patients with significant pelvic relaxation. The work-up included quality of life questionnaire, pelvic ultrasound, standing vault examination, and cough stress test. The study design required follow-up at 6 weeks and 1 year. At 6 weeks all patients were asymptomatic. At 1 year, in group 1, 6 of 40 women had findings of pelvic prolapse and 3 had mild stress incontinence. In group 2, two patients had positive findings and one had stress incontinence. The occurrence rates of 15% and 4% are not statistically significant. It might well represent a trend of increased pelvic prolapse in women who do not have adequate concomitant pelvic support procedures. It will be necessary to follow these patients for 5 years to prove or disprove this concept.
 ...
PMID:Routine Pelvic Support Procedures for Laparoscopic Vaginal Hysterectomies 907 28

Our objective was to determine the effect of cough strength on pressure transmission ratios and establish quantitative and qualitative intra-observer test-retest reproducibility of pressure transmission ratios calculated from dynamic urethral pressure profilometry. The study included 242 consecutive urodynamic evaluations on women without pelvic organ prolapse. Dynamic urethral pressure profiles were performed in duplicate with coughs of different intensities. The analysis included pressure transmission ratios from the proximal 3 urethral quartiles (Q1 through Q3) and the mean pressure transmission ratio calculated from these quartiles. The final diagnoses were stratified into genuine stress incontinence, 135 (56%), and stress continence, 107 (44%). Correlations were strong for pressure transmission ratios from the first versus the second dynamic urethral pressure profile (K = 0.712 for mean). While the variation in cough intensity between hard and soft coughs averaged 30 cm H2O (P < 0.001), correlation's were equally strong between hard and soft cough pressure transmission ratios (K = 0.712 for mean). When mean pressure transmission ratios were stratified into below 90% and at least 90% categories, 83.5% of subjects had test-retest concordance (K = 0.671). Concordance rates were less for stress continent subjects (80.0%; K = 0.527) than for genuine stress incontinence subjects (86.4%; K = 0.679). Pressure transmission ratios appear to have reasonable quantitative and qualitative reproducibility which is unaffected by cough strength. The degree of individual variability limits the utility of pressure transmission ratios to diagnose genuine stress incontinence independent of other, equally variable clinical and urodynamic parameters, but this measure is sufficiently reproducible to be useful in characterizing stress sphincteric function in population studies.
 ...
PMID:Pressure transmission ratio reproducibility in stress continent and stress incontinent women. 913 38

The aim of the study was to introduce an anatomical classification for the management of urinary dysfunction based on the Integral Theory, a new connective tissue theory for female incontinence. Eighty-five unselected patients, aged 27-83 years, 12 with pure stress symptoms and 73 with mixed incontinence symptoms, were classified as having laxity in the anterior, middle or posterior zones of the vagina, using specific symptoms, signs and urodynamic parameters summarized in a pictorial algorithm. Special ambulatory surgical techniques, which included the creation of neoligaments, repaired specific connective tissue defects in the anterior (intravaginal slingplasty (IVS), n = 85), middle (cystocele repair, n = 6), or posterior zones (uterine prolapse repair, n = 31, or infracoccygeal sacropexy, n = 33). Almost all patients were discharged within 24 hours of surgery, without postoperative catheterization, returning to fairly normal activities within 7-14 days. At (mean) 21-month follow-up cure rates were: stress incontinence 88% (n = 85), frequency 85% (n = 42), nocturia 80% (n = 30), urge incontinence 86% (n = 74), emptying symptoms 50% (n = 65). Mean objective urine loss (cough stress test) was reduced from 8.9 g preoperatively to 0.3 g postoperatively, and mean residual urine >50 ml from 110 ml to 63 ml, P = <0.02. Pre- and postoperative urodynamics indicated that detrusor instability was not associated with surgical failure. Two new directions, based on the Integral Theory, are presented for the management of female urinary dysfunction, an anatomical classification which delineates three zones of vaginal damage, and a series of ambulatory surgical operations which repair these defects. The operations are fairly simple, safe, effective and easily learnt by any practising gynecologist.
 ...
PMID:New ambulatory surgical methods using an anatomical classification of urinary dysfunction improve stress, urge and abnormal emptying. 955 90

Urinary incontinence, corresponding to the definition of involuntary urine leaks, due to alteration of the physiological mechanisms of continence, experienced as discomfort in everyday life affects approximately 10% of the female population. The main predisposing factors are age, child-birth (particularly the first), recurrent urinary tract infections, and obesity. Pathophysiologically, urine leak occurs when the forces of expulsion resulting from abdominal straining or detrusor contraction, exceed the physiological (urethral sphincter device) and pathological (obstruction) continence forces. These two mechanisms correspond to two types of incontinence, stress and urge incontinence, which are primarily diagnosed on the basis of the clinical interview, which must also strive to evaluate the volume of urine leaks, the circumstances inducing incontinence, and associated urinary symptoms such as dysuria and frequency. Clinical examination, in women in the gynaecological position, demonstrates incontinence on coughing and control of incontinence by supporting the bladder neck (Bonney's manoeuvre); it also evaluates vulval trophicity and the quality of perineal musculature; it analyses the components of possible vaginal prolapse. The objective of complementary investigations is not to confirm the data of the clinical interview and clinical examination, but to complete them by providing additional elements. Radiological examinations have largely been replaced by urodynamic examinations, able to detect detrusor instability and evaluate the quality of sphincter tone, which largely determines the success of surgery. Surgery remains the reference treatment for stress incontinence with a success rate of almost 90%; the main mechanism consists of supporting the bladder neck, allowing it to close during efforts increasing the abdominal pressure. Perineo-sphincter rehabilitation must be tried first, although its results are less lasting. Currently, the only effective medical treatment is anticholinergic drugs in urge incontinence.
 ...
PMID:[Female urinary incontinence. Which assessments? Which treatment?]. 959 38


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