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1.
Int J Gynaecol Obstet ; 155(2): 268-274, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34543443

RESUMO

BACKGROUND: Pelvic organ prolapse (POP), urinary incontinence, and infertility are all prevalent conditions associated with considerable reduction in quality of life. As a group, Aboriginal and Torres Strait Islander women may be at higher risk of these conditions, but studies are scarce. OBJECTIVE: To review the literature pertaining to the epidemiology, diagnosis, and management of these conditions in Indigenous Australian women. SEARCH STRATEGY: Medline, Embase, and Scopus were searched for articles published between 1980 and 2021 pertaining to these conditions in Indigenous Australian women. SELECTION CRITERIA: Studies that did not directly address the epidemiology, diagnosis, and management of these conditions were excluded. MAIN RESULTS: It was possible to identify only 11 papers dealing with these conditions in Indigenous Australian women. Only one dealt with POP and was a retrospective audit of a health outreach program in the Northern Territory concluding that there was significant underreporting of the condition. Five papers dealt with urinary incontinence and, again, described significant underreporting and poor referral pathways. Five papers reported small studies about infertility, one reporting poor engagement from clinical directors. CONCLUSION: It was concluded that despite the importance of these conditions, there is almost no body of research and this is an urgent national problem.


Assuntos
Infertilidade , Incontinência Urinária , Austrália/epidemiologia , Feminino , Humanos , Grupo com Ancestrais Oceânicos , Prolapso , Qualidade de Vida , Estudos Retrospectivos , Incontinência Urinária/epidemiologia , Incontinência Urinária/terapia
2.
J Card Surg ; 36(12): 4485-4496, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34541716

RESUMO

PURPOSE: Our study aims to examine the midterm outcomes of the loop technique for extended mitral valve (MV) prolapse patients. METHODS: From October 2008 to August 2020, we performed MV repairs in 407 patients with severe mitral regurgitation (MR). Follow-up ranged in duration from 287 to 2899 days (median, 872 days). The prolapse extensiveness (p-score) was determined based on the ratio of prolapsing segment's areas to whole area. We divided the whole MV into 10 segments (A1, A2 medial, A2 lateral, A3, P1, P2 medial, P2 lateral, P3, AC, and PC). Patients were categorized into three groups according to the p-score: simple (0.1-0.2), intermediate (0.3-0.4), and extensive (0.5-0.9). RESULTS: All patients underwent MV repair with the loop technique. The rates of freedom from significant (moderate to severe or severe) MR at 5 and 7 years after surgery were 91% and 91%, respectively. There were 252, 115, and 40 patients in simple group, intermediate group, and extensive group, respectively. The following were significantly increased in extended group: Barlow disease (23/40 patients, p < .001), the number of loops (p for trend < .0001), and the technique score (p for trend < .0001). The rates of freedom from significant MR at 7 years after surgery were 92% in simple group, 87% in intermediate group, and 94% in extended group, respectively (p = .995). Receiver-operating characteristic curves showed a postoperative mild MR with a sensitivity of 86% and a specificity of 68% for predicting significant MR recurrence. CONCLUSIONS: MV repair using the loop technique was useful even in groups with extended prolapse.


Assuntos
Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/cirurgia , Prolapso , Resultado do Tratamento
3.
Gen Thorac Cardiovasc Surg ; 69(12): 1589-1592, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34581947

RESUMO

Blunt tracheal injury is a rare but life-threatening condition. Several indications for treatment have been reported. Conservative treatment (i.e., stenting) can be performed when the patient is clinically stable or has medical contraindications to surgical treatment. Although some studies have reported the use of tracheal stents as treatment for iatrogenic injury and blunt trauma, the efficacy of these stents is unknown. Herein, we report a case of emergency tracheoplasty for the management of tracheal stent prolapse in a patient with blunt tracheobronchial trauma. This report highlights the necessity of being cautious about the migration and prolapse of tracheal stents, which can more frequently occur in blunt trauma than in malignant stenosis or iatrogenic injury. Due to the limitations of non-surgical treatments, early surgical intervention may be lifesaving.


Assuntos
Estenose Traqueal , Ferimentos não Penetrantes , Humanos , Prolapso , Stents , Traqueia/diagnóstico por imagem , Traqueia/lesões , Traqueia/cirurgia , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia
4.
Neurourol Urodyn ; 40(8): 1989-1998, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34487577

RESUMO

AIMS: The aim of this study was to develop and test the feasibility of a magnetic resonance imaging (MRI)-based measurement strategy to evaluate the effectiveness of surgical procedures in restoring normal anatomy in all three systems of pelvic floor support and quantify the structural changes induced by prolapse surgery. METHODS: Patients underwent clinical examination and stress MRI preoperatively and again 3 months postoperatively. Preoperative and postoperative measures of three MRI-based structural support systems were made: (1) vaginal wall, (2) apical and paravaginal support, and (3) hiatal closure system. Preoperative to postoperative structural changes were calculated and compared to normal values, and bivariate associations were determined. RESULTS: The three structural support systems were successfully quantified for both preoperative and postoperative MRIs regardless of operative approaches in all 15 women in the pilot group. Apical support was restored to normal in 11 of 12 patients who underwent an apical suspension procedure and 9 of 14 patients with a posterior repair had normalization of genital hiatus size. Mid-vaginal paravaginal location was elevated an average of 2.5 ± 2.0 cm despite no paravaginal repairs being performed. Paravaginal location improvements were also significantly correlated with apical elevation (r values 0.99-0.87, p < 0.001). CONCLUSIONS: A strategy that quantifies structural-specific preoperative impairments and improvements after prolapse surgery was successfully developed. Early findings reveal that prolapse surgery is more successful in restoring normal anatomy at Level I than Level III. Improvement in paravaginal location is significantly correlated with apical elevation.


Assuntos
Prolapso de Órgão Pélvico , Procedimentos Cirúrgicos Reconstrutivos , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Imageamento por Ressonância Magnética , Diafragma da Pelve/diagnóstico por imagem , Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/diagnóstico por imagem , Prolapso de Órgão Pélvico/cirurgia , Prolapso , Resultado do Tratamento , Vagina/diagnóstico por imagem , Vagina/cirurgia
5.
Nihon Shokakibyo Gakkai Zasshi ; 118(8): 757-767, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34373395

RESUMO

This study included a 45-year-old woman. In 20XX, we performed colonoscopy (CS) on fresh bloody stools, and a diagnosis of rectal mucosal prolapse syndrome (MPS) was made. In 20XX+14 years, CS was reexamined because of fresh bloody stools, and a biopsy of the same site revealed well-differentiated tubular adenocarcinoma. The lesion was resected via endoscopic submucosal dissection (ESD) and histopathologically diagnosed as MPS with high-grade adenoma and well-differentiated tubular adenocarcinoma. The symptoms improved after ESD, and no recurrence was observed during the 18-month follow-up. We experienced a case of a well-differentiated tubular adenocarcinoma in MPS during the long-term follow-up of MPS. In this case, performing ESD was useful not only for cancer treatment but also in terms of therapeutic effects on symptoms. Although MPS is a chronic benign inflammatory disorder, characterized by rectal mucosal prolapse with fibromuscular obliteration, it is necessary to consider the possibility of the appearance of cancer during the follow-up of MPS.


Assuntos
Adenocarcinoma , Adenoma , Ressecção Endoscópica de Mucosa , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Adenoma/complicações , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Colonoscopia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prolapso , Resultado do Tratamento
6.
Sci Rep ; 11(1): 16107, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373536

RESUMO

This study investigates the etiology and clinical features of delayed vitreous prolapse after cataract surgery and evaluates the long-term surgical and visual outcomes. Consecutive patients with vitreous prolapse into the anterior chamber occurring ≥ 3 months after cataract surgery at two hospitals between December 2006 and June 2020 were retrospectively reviewed. The primary outcome was associated ophthalmological events that triggered delayed vitreous prolapse. Secondary outcomes included long-term visual and subjective symptom changes after treatment. Among 20 eyes (20 patients), all had visual symptoms, the most common being blurry vision (12 patients; 60%). Five (25%) were detected after YAG laser capsulotomy, three (15%) had a history of intraocular lens(IOL) implantation in sulcus due to intraoperative posterior capsular tears, three (15%) had prolapsed vitreous alongside dislocated IOLs, and three (15%) were aphakic after previous cataract surgeries. After surgical treatment, the mean corrected distance visual acuity improved from 20/50 to 20/31(P = 0.02) and the mean preoperative intraocular pressure (IOP) that was 26.4 mmHg decreased to 15.6 mmHg, remaining stable until the last follow-up. All reported symptoms were relieved. YAG laser capsulotomy or a history of defective posterior capsule from iatrogenic causes may trigger delayed vitreous prolapse. The long-term outcomes were favorable, particularly after posterior vitrectomy, with improved IOP control and symptom resolution.


Assuntos
Câmara Anterior/fisiopatologia , Catarata/fisiopatologia , Acuidade Visual/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Câmara Anterior/cirurgia , Opacificação da Cápsula/cirurgia , Extração de Catarata/métodos , Feminino , Humanos , Pressão Intraocular/fisiologia , Cápsula do Cristalino/cirurgia , Implante de Lente Intraocular/métodos , Lentes Intraoculares , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Prolapso , Estudos Retrospectivos , Resultado do Tratamento , Transtornos da Visão/fisiopatologia , Transtornos da Visão/cirurgia , Vitrectomia/métodos
9.
BMJ Open ; 11(6): e046616, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135046

RESUMO

OBJECTIVE: This study aimed to evaluate the success rate of vaginal delivery, the reasons for unplanned caesarean delivery, the rate of umbilical cord prolapse and the risk of umbilical cord prolapse in twin deliveries. DESIGN: Retrospective cohort study. SETTING: Single institution. PARTICIPANTS: This study included 455 women pregnant with twins (307 dichorionic and 148 monochorionic) who attempted vaginal delivery from January 2009 to August 2018. The following criteria were considered for vaginal delivery: diamniotic twins, cephalic presentation of the first twin, no history of uterine scar, no other indications for caesarean delivery, no major structural abnormality in either twin and no fetal aneuploidy. RESULTS: The rate of vaginal delivery of both twins was 89.5% (407 of 455), caesarean delivery of both twins was 7.7% (35 of 455) and caesarean delivery of only the second twin was 2.9% (13 of 455). The major reasons for unplanned caesarean delivery were arrest of labour and non-reassuring fetal heart rate pattern. The rate of umbilical cord prolapse in the second twin was 1.8% (8 of 455). Multivariate analysis revealed that abnormal umbilical cord insertion in the second twin (velamentous or marginal) was the only significant factor for umbilical cord prolapse in the second twin (OR, 5.05, 95% CI 1.139 to 22.472, p=0.033). CONCLUSIONS: Abnormal umbilical cord insertion in the second twin (velamentous or marginal) was a significant factor for umbilical cord prolapse during delivery. Antenatal assessment of the second twin's umbilical cord insertion using ultrasonography would be beneficial.


Assuntos
Gêmeos , Cordão Umbilical , Parto Obstétrico , Feminino , Humanos , Gravidez , Prolapso , Estudos Retrospectivos , Cordão Umbilical/diagnóstico por imagem
11.
Am J Obstet Gynecol ; 225(4): 357-366, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34181893

RESUMO

Umbilical cord prolapse is an unpredictable obstetrical emergency with an incidence ranging from 1 to 6 per 1000 pregnancies. It is associated with high perinatal mortality, ranging from 23% to 27% in low-income countries to 6% to 10% in high-income countries. In this review, we specifically addressed 3 issues. First, its definition is not consistent in the current literature, and "occult cord prolapse" is a misnomer because the cord is still above the cervix. We proposed that cord prolapse, cord presentation, and compound cord presentation should be classified according to the positional relationship among the cord, the fetal presenting part, and the cervix. All of them may occur with either ruptured or intact membranes. The fetal risk is highest in cord prolapse, followed by cord presentation, and lastly by compound cord presentation, which replaces the misnomer "occult cord prolapse." Second, the mainstay of treatment of cord prolapse is urgent delivery, which means cesarean delivery in most cases, unless vaginal delivery is imminent. The urgency depends on the fetal heart rate pattern, which can be bradycardia, recurrent decelerations, or normal. It is most urgent in cases with bradycardia, because a recent study showed that cord arterial pH declines significantly with the bradycardia-to-delivery interval at a rate of 0.009 per minute (95% confident interval, 0.0003-0.0180), and this may indicate an irreversible pathology such as vasospasm or persistent cord compression. However, cord arterial pH does not correlate with either deceleration-to-delivery interval or decision-to-delivery interval, indicating that intermittent cord compression causing decelerations is reversible and less risk. Third, while cesarean delivery is being arranged, different maneuvers should be adopted to relieve cord compression by elevating the fetal presenting part and to prevent further cord prolapse beyond the vagina. A recent study showed that the knee-chest position provides the greatest elevation effect, followed by filling of the maternal urinary bladder with 500 mL of fluid, and then the Trendelenburg position (15°) and other maneuvers. However, each maneuver has its own advantages and limitations; thus, they should be applied wisely and with great caution, depending on the actual clinical situation. Therefore, we have proposed an algorithm to guide this acute management.


Assuntos
Cesárea/métodos , Complicações do Trabalho de Parto/terapia , Posicionamento do Paciente/métodos , Prolapso , Tocólise/métodos , Cordão Umbilical/diagnóstico por imagem , Bradicardia , Parto Obstétrico/métodos , Gerenciamento Clínico , Feminino , Sangue Fetal , Decúbito Inclinado com Rebaixamento da Cabeça , Frequência Cardíaca Fetal , Humanos , Concentração de Íons de Hidrogênio , Apresentação no Trabalho de Parto , Complicações do Trabalho de Parto/diagnóstico por imagem , Gravidez , Fatores de Tempo
12.
Sci Rep ; 11(1): 12560, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34131194

RESUMO

The aims of this study were to evaluate pelvic floor dysfunction symptoms one year after delivery and investigate whether adverse functional outcomes after childbirth were related to the degree of perineal injury. A prospective cohort of 776 primiparas were included. Self-reported pelvic floor function data were obtained using a web-based questionnaire. Women with no/first-degree injuries, second-degree injuries, third-/fourth-degree injuries (obstetric anal sphincter injury, OASI) and cesarean section were compared. A total of 511 women (66%) responded. Second-degree tears were a risk factor for stress incontinence (aOR 2.6 (95% CI 1.3-5.1)). Cesarean section was protective against stress incontinence (aOR 0.2 (95% CI 0.1-0.9)). OASI was a risk factor for urge incontinence (aOR 4.8 (95% CI 1.6-15)), prolapse (aOR 7.7 (95% CI 2.1-29)) and pelvic pain (OR 3.3 (95% CI 1.1-10)). Dyspareunia was reported by 38% of women, 63% of women in the OASI group (aOR 3.1 (95% CI 1.1-9.0)). Women with OASI reported that the injury affected daily life (OR 18 (95% CI 5.1-59)). Pelvic floor dysfunction is common after childbirth, even in women with moderate injury. Women with OASI had significantly higher risks of symptoms of prolapse, urge urinary incontinence, pain, dyspareunia and impacts on daily life.


Assuntos
Canal Anal/fisiopatologia , Cesárea/efeitos adversos , Distúrbios do Assoalho Pélvico/epidemiologia , Diafragma da Pelve/fisiopatologia , Adulto , Canal Anal/lesões , Feminino , Humanos , Parto , Diafragma da Pelve/lesões , Distúrbios do Assoalho Pélvico/fisiopatologia , Gravidez , Prolapso , Fatores de Risco , Incontinência Urinária de Urgência/epidemiologia , Incontinência Urinária de Urgência/fisiopatologia
17.
Pediatr Radiol ; 51(10): 1929-1933, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34014354

RESUMO

Bladder prolapse through a patent urachus is rare. We present a newborn with an unusual exophytic, erythematous umbilical mass. Voiding cystography readily demonstrated continuity of the bladder dome with the umbilical mass, confirming bladder prolapse through a patent urachus. The diagnosis of bladder prolapse was rapidly made in a second newborn with similar imaging and clinical findings and confirmed by cystography. We discuss the embryology of this condition including the association with a vesico-allantoic cyst in utero. Pre- and postnatal images are presented. The use of cystography in diagnosis is emphasized.


Assuntos
Cisto do Úraco , Úraco , Cistografia , Feminino , Humanos , Recém-Nascido , Gravidez , Prolapso , Cisto do Úraco/diagnóstico por imagem , Úraco/diagnóstico por imagem , Bexiga Urinária
18.
Low Urin Tract Symptoms ; 13(4): 505-508, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33951749

RESUMO

CASE: Urethral prolapse (UP) is a rare condition with unknown etiology. We reported on an 86-year-old woman with a normal BMI and cystocele, presented with acute urinary retention and perineal pain. A residual urine of 950 mL was measured and released by an indwelling catheter. The physical examination revealed 2 × 3 cm severely sore and purple polyp around the urethral meatus with signs of necrosis. A diagnosis of a strangulated urethral prolapse was stated. OUTCOME: The patient was admitted to the Department of Urology, and treated with surgical excision using the four-quadrant excisional technique. The histopathological examination revealed a non-keratinized, inflammatory squamous epithelium. At a follow-up visit, the patient remained asymptomatic and a complete anatomical resolution was achieved. CONCLUSION: UP is an uncommon, sometimes misdiagnosed condition. The management is controversial and to date no consensus exists. This clinical picture is sufficient for diagnosis and surgical excision of the prolapsed urethral mucosa is reasonable if there are signs of strangulation.


Assuntos
Doenças Uretrais , Retenção Urinária , Idoso de 80 Anos ou mais , Feminino , Humanos , Membrana Mucosa , Pós-Menopausa , Prolapso , Doenças Uretrais/complicações , Doenças Uretrais/diagnóstico , Doenças Uretrais/cirurgia , Retenção Urinária/etiologia
19.
J Forensic Sci ; 66(5): 2002-2005, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33895989

RESUMO

Traumatic dislocation of the eye is usually encountered in high-energy injuries. These include traffic accidents, accidents at work, sporting accidents, falling from a height, impact of the hooves or horns of animals, gunshot injuries, and physical assault. Such incidents are accompanied by facial soft tissue damage and injuries to the facial skeleton, especially the orbit, and can be associated with varying degrees of dislocation of the eye. We describe a rare case of non-fatal traumatic eye dislocation into the maxillary sinus, coupled with an orbital fracture resulting from a physical assault on a 63-year-old woman. The cause of death was asphyxiation due to manual strangulation and mechanical asphyxia. Even though dislocations of the eye are relatively rare, forensic pathologists should be aware of such injuries to correct assessment of injury mechanism. The available literature regarding eye dislocation is summarized, and the forensic issues applicable to the assessment of such cases are reviewed.


Assuntos
Traumatismos Oculares/complicações , Homicídio , Seio Maxilar , Prolapso , Asfixia/etiologia , Feminino , Fratura-Luxação/etiologia , Humanos , Pessoa de Meia-Idade , Lesões do Pescoço/complicações , Fraturas Orbitárias/etiologia
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